Reply to Liccardi et al. Why are allergens not detected in bronchoalveolar lavage fluid?

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Allergens are not detected in the bronchoalveolar lavage fluid of patients undergoing fiberoptic bronchoscopy

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Knowledge, actual and potential use of HIV self-sampling testing kits among MSM recruited in eight European countries.

AIM: To describe the knowledge as well as current and potential use of self-sampling kits among men who have sex with men (MSM) and to analyse their preferred biological sample and result communication method. METHODS: We analyse data of MSM of HIV negative or unknown serostatus from an online survey conducted in eight countries (Belgium, Denmark, Germany, Greece, Portugal, Romania, Slovenia and Spain) between April and December 2016. It was advertised mainly in gay dating websites. We conduct a descriptive analysis of the main characteristics of the participants, and present data on indicators of knowledge, use and potential use of HIV self-sampling as well as their preferences regarding blood or saliva sample and face or non-face-to-face result communication by country of residence. RESULTS: A total of 8.226 participants of HIV negative or unknown serostatus were included in the analysis. Overall, 25.5% of participants knew about self-sampling (range: 18.8-47.2%) and 1.1% had used it in the past (range: 0.3-8.9%). Potential use was high, with 66.6% of all participants reporting that they would have already used it if available in the past (range: 62.1-82.1%). Most (78.6%) reported that they would prefer using a blood-based kit, and receiving the result of the test through a non-face-to-face-method (70.8%), even in the case of receiving a reactive result. CONCLUSION: The high potential use reported by MSM recruited in eight different European countries suggests that self-sampling kits are a highly acceptable testing methodology that could contribute to the promotion of HIV testing in this population.

The COBATEST network: monitoring and evaluation of HIV community-based practices in Europe, 2014-2016.

OBJECTIVE: The objective of this paper is to describe the data collected by the CBVCT services from the Community-based testing (COBATEST) network, from 2014 to 2016, in order to provide an insight into community-based voluntary counselling and testing (CBVCT) services' testing activity in Europe. METHODS: A descriptive analysis of HIV testing activity in CBVCT services that are using the COBATEST tools was performed for the period 2014-2016. RESULTS: During the study period, a total of 30 329 HIV tests were performed on 27 934 individuals, of which 1.8% were reactive. Of these reactive tests, 75.8% had a confirmatory test, 92.2% of those were confirmed as positive, and 90.38% of the confirmed positives were linked to care. The total number of tests performed over the study period increased 19.31%. The proportion of confirmatory tests increased from 63.0% to 90.0% and proportion linked to care increased from 84.1% to 93.8%. Most of the tested individuals were men (70.6%), aged between 21 and 35 years (58.5%) and non-foreign born (68.1%). A high proportion of individuals tested were men who have sex with men (MSM; 42.2%). The percentage of reactive screening tests was particularly high among transgender people (8.37%) and among male sex workers (6.38%). Repeat testers had a higher percentage of reactive tests (2.02%) than those tested for first time (1.1%). CONCLUSIONS: These results prove the feasibility of collecting standardized data from CBVCT services in different countries across Europe and demonstrate the usefulness of such data.

The clinical value of biomarkers in respiratory complications in hematopoietic SCT.

To determine the role of biomarkers in the clinical management of respiratory complications (RC) in hematopoietic stem cell transplantation (HSCT) recipients, we have prospectively evaluated a cohort of 175 patients followed-up for 1 year after HSCT. To avoid misinterpretation, we have excluded both unidentified respiratory infections (RI) and mixed RI. A total of 64 RC were included. Plasma levels of C-reactive protein (CRP), procalcitonin (PCT) and proadrenomedullin (proADM) were measured at diagnosis and on day 3 and 7. Different cytokines were evaluated in serum on the first day. No HSCT recipients without RC were included as a control group. Compared with RI, non-infectious RC showed a significant increase in CRP, proADM and interleukin 6 on day 0 (P=0.005; P=0.03 and P=0.04, respectively). When only RI were considered, we observed that bacterial-fungal PI showed higher levels of CRP (P=0.02), PCT (P=0.04) and proADM (P<0.01). Persistent low levels of proADM biomarkers suggest viral infection (specificity and positive predictive value 100%). Patients dying of RC had PCT and proADM levels higher than survivors (P=0.002 and P=0.03, respectively). In HSCT recipients biomarkers increase in both infectious and non-infectious RC. They may have utility in the assessment of the severity of RC and in suspecting a viral etiology.

Safe Reduction in CD4 Cell Count Monitoring in Stable, Virally Suppressed Patients With HIV Infection or HIV/Hepatitis C Virus Coinfection.

BACKGROUND: It has been suggested that routine CD4 cell count monitoring in human immunodeficiency virus (HIV)-monoinfected patients with suppressed viral loads and CD4 cell counts >300 cell/µL could be reduced to annual. HIV/hepatitis C virus (HCV) coinfection is frequent, but evidence supporting similar reductions in CD4 cell count monitoring is lacking for this population. We determined whether CD4 cell count monitoring could be reduced in monoinfected and coinfected patients by estimating the probability of maintaining CD4 cell counts ≥200 cells/µL during continuous HIV suppression. METHODS: The PISCIS Cohort study included data from 14 539 patients aged ≥16 years from 10 hospitals in Catalonia and 2 in the Balearic Islands (Spain) since January 1998. All patients who had at least one period of 6 months of continuous HIV suppression were included in this analysis. Cumulative probabilities with 95% confidence intervals were calculated using the Kaplan-Meier estimator stratified by the initial CD4 cell count at the period of continuous suppression initiation. RESULTS: A total of 8695 patients were included. CD4 cell counts fell to <200 cells/µL in 7.4% patients, and the proportion was lower in patients with an initial count >350 cells/µL (1.8%) and higher in those with an initial count of 200-249 cells/µL (23.1%). CD4 cell counts fell to <200 cells/µL in 5.7% of monoinfected and 11.1% of coinfected patients. Of monoinfected patients with an initial CD4 cell count of 300-349 cells/µL, 95.6% maintained counts ≥200 cells/µL. In the coinfected group with the same initial count, this rate was lower, but 97.6% of coinfected patients with initial counts >350 cells/µL maintained counts ≥200 cells/µL. CONCLUSIONS: From our data, it can be inferred that CD4 cell count monitoring can be safely performed annually in HIV-monoinfected patients with CD4 cell counts >300 cells/µL and HIV/HCV-coinfected patients with counts >350 cells/µL.

The COBATEST network: a platform to perform monitoring and evaluation of HIV community-based testing practices in Europe and conduct operational research.

The European project "HIV community-based testing practices in Europe" (HIV-COBATEST) has contributed to the establishment of a network of community-based voluntary counselling and testing services (CBVCTs) that monitors and evaluates HIV testing activity in the communities. The objective of this paper is to describe the data that have been collected during 2014 by the COBATEST network in order to provide an insight into testing activity of CBVCTs in Europe. Members of the CBVCT network share common instruments for data collection and data entry. The network has a common database that allows global data analysis and comparison between different centres. In 2014, 40 CBVCTs of 18 European countries were participating in the network, and, from those, 20 CBVCTs were using the common COBATEST data collection tools. In these 20 CBVCTs, a total of 9266 HIV screening tests were performed on 8554 people, of which 1.58% (135/8554) were reactive and 51.1% (69/135) confirmed positive. Five cases were false positives, and 84.1% (58/69) of the confirmed positive cases were linked to care. Most of the tested individuals were men (70.8%), between 21 and 35 years of age (57.6%) and natives (67.1%). A higher proportion of men who had sex with men (MSM) (38.8%; 3267/8554) were tested compared to heterosexual men (27.7%) and women (23.5%). Rapid blood test was used in 78.5% of the cases and mostly performed in CBVCT offices (88.3%). Among sex workers (SWs), the percentage of reactive screening tests was particularly high (4.0%), especially among male SWs (7.7%) as compared to other risk groups, such as MSM (3.1%). The COBATEST network contributes to the availability of standardized information about the activity and impact of CBVCT centres in Europe. This information and standardized tools can help improve these services and inform decision-makers to better contextualize these interventions within their national HIV-prevention programmes.

Pulmonary complications in hematopoietic SCT: a prospective study.

Pulmonary complications are common and often lethal in hematopoietic SCT recipients. The objective of this prospective interventional study was to evaluate the etiology, diagnostic procedures, risk factors and outcome of pulmonary complications in a cohort of hematopoietic SCT recipients followed up for 1 year. For patients suffering from a pulmonary complication, a diagnostic algorithm that included non-invasive and bronchoscopic procedures was performed. We identified 73 pulmonary complications in 169 patients: 50 (68%) were pneumonias; 21 (29%) were non-infectious complications and 2 (3%) were undiagnosed. Viruses (particularly Rhinovirus) and bacteria (particularly P. aeruginosa) (28 and 26%, respectively) were the most common causes of pneumonia. A specific diagnosis was obtained in 83% of the cases. A non-invasive test gave a specific diagnosis in 59% of the episodes. The diagnostic yield of bronchoscopy was 67 and 78% in pulmonary infections. Early bronchoscopy (⩽5 days) had higher diagnostic yield than late bronchoscopy (78 vs 23%; P=0.02) for pulmonary infections. Overall mortality was 22 and 32% of all fatalities were due to pulmonary complications. Pulmonary complications are common and constitute an independent risk factor for mortality, stressing the importance of an appropriate clinical management.

Corticosteroids as adjunctive treatment in community-acquired pneumonia.

Community-acquired Pneumonia (CAP) is the first leading infectious cause of death in developed countries. The mortality rate in severe CAP is very high and has not changed in recent years, despite advances in antimicrobial therapy and supportive measures. Several studies have identified an excessive host inflammatory response as a marker of poor prognosis in CAP. Corticosteroids are anti-inflammatory and immunosupressive agents widely used in modern medicine. Chronic use of corticosteroids has been related to immunosuppression and higher incidence of pneumonia due to opportunistic and high resistant bacteria. However, the use of corticosteroids as adjunctive therapy in CAP may be beneficial due to their anti-inflammatory effect. Experimental pneumonia studies showed that corticosteroid administration was associated with a reduction in circulating and pulmonary cytokine levels, an improvement in histopathological severity scores and a decreased bacterial burden. Several randomized controlled trials (RCT) testing the usefulness of corticosteroids in CAP have been performed in the recent years with conflicting results. However, two recent meta-analyses found improved mortality in the subgroup with severe CAP and/or receiving >5 days of glucocorticoid treatment. Dosage, duration of treatment and side effects are two important aspects not well determined yet. This review discusses the association of corticosteroids as adjunctive therapy and its association with clinical outcomes and side effects in patients with CAP.

Attitudes to rapid HIV testing among Spanish General Practitioners.

OBJECTIVES: The objectives of this study were to investigate the acceptability of rapid HIV testing among general practitioners in Spain and to identify perceived barriers and needs in order to implement rapid testing in primary care settings. METHODS: An anonymous questionnaire was distributed online to all members of the two largest Spanish scientific medical societies for family and community medicine. The study took place between 15th June and 31st October 2010. RESULTS: Completed questionnaires were returned by 1308 participants. The majority (90.8%) of respondents were General Practitioners (GP). Among all respondents, 70.4% were aware of the existence of rapid tests for the diagnosis of HIV but they did not know how to use them. Nearly 80% of participants would be willing to offer rapid HIV testing in their practices and 74.7% would be confident of the results obtained by these tests. The barriers most commonly identified by respondents were a lack of time and a need for training, both in the use of rapid tests (44.3% and 56.4%, respectively) and required pre- and post-test counselling (59.2% and 34.5%, respectively). CONCLUSIONS: This study reveals a high level of acceptance and willingness on the part of GPs to offer rapid HIV testing in their practices. Nevertheless, the implementation of rapid HIV testing in primary care will not be possible without moving from comprehensive pre-test counselling towards brief pre-test information and improving training in the use of rapid tests.

Factores de riesgo de las enfermedades cardiovasculares en el Perú II. Estudio tornasol II comparado con tornasol I después de cinco años / Risk factors of cardiovascular diseases in Peru II. Study II compared litmus litmus after five years I

La Sociedad Peruana de Cardiología realizó el Segundo Estudio de Factores de Riesgo de las Enfermedades Cardiovasculares en el Perú, entre Marzo 2010 y Enero 2011, en todos los Departamento del territorio nacional incluyendo la Provincia Constitucional del Callao y el puerto de Chimbote. Se utilizó la misma metodología de TORNASOL I, cuestionarios, manómetros de mercurio calibrados, en residentes mayores de 18 años de ambos sexos, con un mínimo de 500 sujetos por ciudad, en la vía pública lejos de hospitales o centros de salud. Participaron parejas de encuestadores, uno llenaba el formato de la encuesta y luego el otro medía el pulso, la presión arterial y la circunferencia de cintura.La investigación se realizó en 10 ciudades de la Costa, 12 de la Sierra (06 por encima de los 3,000 msnm) y 04 de la selva.Se obtuvieron 14,675 encuestas, de las cuales 14,508 fueron validadas después de una depuración minuciosa y se digitaron 1´008,017 cifras. El promedio de edad de la población estudiada fue 49.2 años (varones 44.8 y mujeres 42.1 años). La prevalencia de la hipertensión arterial en el Perú ha subido de 23.7% según TORNASOL I (T.I.) a 27.3% en TORNASOL II (T.II.), así como en todos los grupos según la clasificación del VII Reporte del JNC. En las regiones geográficas (costa, sierra y selva) se ha incrementado la hipertensión también en ambos sexos, con excepción en las ciudades ubicadas sobre los 3,000 msnm donde la variación es mínima varones como en mujeres. La costa sigue teniendo más hipertensos y en segundo lugar la región selva. En los varones la prevalencia de la hipertensión es mayor que en las mujeres hasta los 55 años de edad donde se igualan (35.4% de prevalencia) y hacia los 70 años en la mujer sube a 57.1% y en el varón a un menor valor, 50.8% (en T.I. y T.II este fenómeno biológico es similar)...

Acceptability of rapid HIV diagnosis technology among primary healthcare practitioners in Spain.

This study investigated the acceptability of rapid HIV testing among general practitioners (GP) and aimed to identify perceived barriers and needs in order to implement rapid testing in primary care settings. An anonymous questionnaire was distributed online to all members of the two largest Spanish scientific medical societies for family and community medicine. The study took place between 15 June 2012 and 31 October 2010. Completed questionnaires were returned by 1308 participants. The majority (90.8%) of respondents were GP. Among all respondents, 70.4% were aware of the existence of rapid tests for the diagnosis of HIV but they did not know how to use them. Nearly 80% of participants would be willing to offer rapid HIV testing in their practices and 74.7% would be confident of the result obtained by these tests. The barriers most commonly identified by respondents were a lack of time and a need for training, both in the use of rapid tests (44.3% and 56.4%, respectively) and required pre- and post-test counselling (59.2% and 34.5%, respectively). This study reveals a high level of acceptance and willingness on the part of GPs to offer rapid HIV testing in their practices. Nevertheless, the implementation of rapid HIV testing in primary care will not be possible without moving from comprehensive pre-test counselling towards brief pre-test information and improving training in the use of rapid tests.

Fibrobroncoscopia en una unidad de vigilancia intensiva respiratoria / Fiberoptic bronchoscopy in a respiratory intensive care unit

Objetivo: Describir las indicaciones, rentabilidad diagnóstica y complicaciones de la fibrobroncoscopia (FBS) en una unidad de vigilancia intensiva respiratoria (UVIR). Diseño: Estudio prospectivo observacional. Ámbito: UVIR de 6 camas en un hospital universitario de tercer nivel. Pacientes: Pacientes admitidos en una UVIR a los que se les realizó una FBS. Intervenciones: Ninguna. Variables de interés: Indicaciones y complicaciones de la FBS, técnicas endoscópicas realizadas y tiempo empleado en la FBS. Resultados: Se realizaron 107 (23%) FBS a 69 de los 297 pacientes admitidos en la UVIR. El 68% de las FBS se practicaron a pacientes con ventilación mecánica. La FBS se realizó con fines diagnósticos en 88 ocasiones (82%) y terapéuticos en 19 (18%). La indicación más frecuente para la FBS diagnóstica fue el estudio de infiltrados pulmonares (44 casos; 50%), particularmente en pacientes inmunodeprimidos (24 casos; 27%). Para esta indicación, la rentabilidad diagnóstica de la FBS fue significativamente mejor en los pacientes inmunodeprimidos, respecto a los inmunocompetentes (48% vs 30%; p<0,01). La FBS no causó complicaciones mayores; únicamente se observó un descenso significativo en la PaO2/FiO2 (182±74 vs 163±79; p<0,005) cuando se realizó un lavado broncoalveolar. La mortalidad global en la UVIR fue del 14%; del 25% en los pacientes que precisaron FBS y del 45% en aquellos que precisaron FBS adicionales. Conclusiones: La FBS es un procedimiento seguro y rápido que se utiliza con frecuencia en la UVIR y que contribuye significativamente al manejo clínico. Los pacientes de la UVIR que requieren FBS adicionales tienen una elevada mortalidad (AU)

Objective: To describe the indications, diagnostic performance and safety of fiberoptic bronchoscopy (FOB) performed in a respiratory intensive care unit (RICU). Design: A prospective, observational study was carried out. Setting: A 6-bed RICU in a tertiary university hospital. Patients: Patients admitted to RICU who required FOB. Interventions: None. Main measurements: FOB indications and complications, endoscopic procedures, time required to perform FOB. Results: Sixty-nine out (23%) of the 297 patients admitted to the RICU underwent a total of 107 FOB. Sixty-eight percent of FOB were performed in patients on mechanical ventilation. FOB was performed for diagnostic and therapeutic purposes in 88 (82%) and 19 cases (18%), respectively. The study of pulmonary infiltrates was the main indication for diagnostic FOB (44 cases; 50%), particularly in immunocompromised patients (24 cases; 27%). In immunocompromised patients the diagnostic performance of FOB was significantly higher than in immunocompetent subjects (48% vs 30%; p<0.01). No major complications were recorded. Only a significant drop in PaO2/FiO2 ratio was observed (182±74 vs 163±79; p<0.005) in patients undergoing bronchoalveolar lavage. Overall mortality in patients in the RICU was 14%. In patients requiring a single FOB procedure, mortality was 25%, versus 45% among those requiring more than one FOB procedure. Conclusions: These results show that FOB is used commonly in the RICU. It is a safe and fast procedure that contributes significantly to clinical management. Patients requiring additional FOB during admission to the RICU show high mortality (AU)

[Fiberoptic bronchoscopy in a respiratory intensive care unit]. / Fibrobroncoscopia en una unidad de vigilancia intensiva respiratoria.

OBJECTIVE: To describe the indications, diagnostic performance and safety of fiberoptic bronchoscopy (FOB) performed in a respiratory intensive care unit (RICU). DESIGN: A prospective, observational study was carried out. SETTING: A 6-bed RICU in a tertiary university hospital. PATIENTS: Patients admitted to RICU who required FOB. INTERVENTIONS: None. MAIN MEASUREMENTS: FOB indications and complications, endoscopic procedures, time required to perform FOB. RESULTS: Sixty-nine out (23%) of the 297 patients admitted to the RICU underwent a total of 107 FOB. Sixty-eight percent of FOB were performed in patients on mechanical ventilation. FOB was performed for diagnostic and therapeutic purposes in 88 (82%) and 19 cases (18%), respectively. The study of pulmonary infiltrates was the main indication for diagnostic FOB (44 cases; 50%), particularly in immunocompromised patients (24 cases; 27%). In immunocompromised patients the diagnostic performance of FOB was significantly higher than in immunocompetent subjects (48% vs 30%; p<0.01). No major complications were recorded. Only a significant drop in PaO(2)/FiO(2) ratio was observed (182 ± 74 vs 163 ± 79; p<0.005) in patients undergoing bronchoalveolar lavage. Overall mortality in patients in the RICU was 14%. In patients requiring a single FOB procedure, mortality was 25%, versus 45% among those requiring more than one FOB procedure. CONCLUSIONS: These results show that FOB is used commonly in the RICU. It is a safe and fast procedure that contributes significantly to clinical management. Patients requiring additional FOB during admission to the RICU show high mortality.

Evaluación de la efectividad de un programa de lucha contra el tabaquismo en un hospital universitario / Assessment of effectiveness of a plan against tobacco in a universitary hospital

Objetivos. Evaluar la efectividad del proyecto titulado «Hospital libre de humo», en cuanto a disminución del número de trabajadores fumadores y aumento del número de espacios libres de humo de tabaco. Métodos. Estudio de intervención poblacional no controlado. En el año 2004 se realizó un estudio basal de la situación, con el fin de conocer la prevalencia de fumadores y el apoyo de los trabajadores a los planteamientos del proyecto Hospital libre de humo. Para ello se pasó el cuestionario validado por la red europea de hospitales libres de humo (ENSH) a una muestra de 483 trabajadores, seleccionados al azar y estratificados por sexo, edad y estamento. En 2007, se repitió el estudio, con la misma metodología, para conocer la evolución del proyecto, en este caso se recogió una muestra de 425 trabajadores. Resultados. La prevalencia de trabajadores fumadores había pasado del 35,2 al 27,4% (p < 0,05). Esta reducción se había manifestado en prácticamente todos los estamentos, pero era poco acusada en el personal de enfermería. En el año 2007 se había conseguido que prácticamente sólo se fumase en los sitios para fumadores (p < 0,0001). El proyecto era apoyado por fumadores y no fumadores. Conclusiones. El proyecto «Hospital libre de humo» ha conseguido los objetivos propuestos. Las acciones favorecedoras de que se cumpla la ley y se respete que en los espacios de un hospital no se debe fumar, junto con un apoyo decidido a ayudar a los trabajadores que quieren dejar de fumar se manifiestan como efectivas(AU)

Aims. Assessment of effectiveness of a plan entitled «Smoke-free hospitals», specifically the reduction in the number of smoking staff and an increase in smoke-free areas. Method. Interventional, non-controlled, populational study. A baseline study was conducted in 2004 to find out the situation as regards the prevalence of smokers in our hospital and the support of health workers for the smoke-free hospital plan. We used the questionnaire validated for the European smoke free hospital network in a sample of 483 workers randomly selected and stratified by gender, age and establishment. In 2007 we repeated the study with the same methodology to ascertain the progress of the project, in this case a sample of 425 workers was collected. Results. The number of smoking workers had decreased from 35.2% to 27.4 (P<.05). This reduction was seen in virtually all sectors, but was less so in nursing staff. In 2007 we had achieved that people only smoke in smoking areas (P<.0001). The plan was supported by smokers and non-smokers. Conclusions. The «Smoke-free hospital» plan has achieved the objectives proposed. The actions carried out helped to enforce the law and respect that hospital areas should not be for smoking, together with strong support to help workers who want to quit smoking are shown to be effective(AU)

[Assessment of effectiveness of a plan against tobacco in a universitary hospital]. / Evaluación de la efectividad de un programa de lucha contra el tabaquismo en un hospital universitario.

AIMS: Assessment of effectiveness of a plan entitled «Smoke-free hospitals¼, specifically the reduction in the number of smoking staff and an increase in smoke-free areas. METHOD: Interventional, non-controlled, populational study. A baseline study was conducted in 2004 to find out the situation as regards the prevalence of smokers in our hospital and the support of health workers for the smoke-free hospital plan. We used the questionnaire validated for the European smoke free hospital network in a sample of 483 workers randomly selected and stratified by gender, age and establishment. In 2007 we repeated the study with the same methodology to ascertain the progress of the project, in this case a sample of 425 workers was collected. RESULTS: The number of smoking workers had decreased from 35.2% to 27.4 (P<.05). This reduction was seen in virtually all sectors, but was less so in nursing staff. In 2007 we had achieved that people only smoke in smoking areas (P<.0001). The plan was supported by smokers and non-smokers. CONCLUSIONS: The «Smoke-free hospital¼ plan has achieved the objectives proposed. The actions carried out helped to enforce the law and respect that hospital areas should not be for smoking, together with strong support to help workers who want to quit smoking are shown to be effective.

La hipertensión arterial en el Perú según el estudio TORNASOL II / Hypertension in Peru according to the study TORNASOL II

La Sociedad Peruana de Cardiología realizó el Segundo Estudio de Factores de Riesgo de las Enfermedades Cardiovasculares en el Perú, entre Marzo 2010 y Enero 2011, en todos los Departamentos del territorio nacional incluyendo la Provincia Constitucional del Callao y el puerto de Chimbote. Se utilizó la misma metodología de TORNASOL I, cuestionarios, manómetros de mercurio calibrados, en residentes mayores de 18 años de ambos sexos, con un mínimo de 500 sujetos por ciudad, en la vía pública lejos de hospitales o centros de salud. Participaron parejas de encuestadores, uno para llenar el formato de la encuesta y el otro para medir el pulso,la presión arterial y la circunferencia de cintura. La presente publicación se está realizando con las cifras más relevantes de la hipertensión arterial de esta investigación realizada en 10 ciudades de la Costa, 12 de la Sierra (06 por encima de los 3,000 metros de alturasobre el nivel del mar) y 04 de Selva. Se obtuvieron 14,675 encuestas de las cuales 14,508 fueron válidas, después de una depuración minuciosa, se digitaron 1 008,017 cifras. El promedio de edad de la población estudiada fue 49.2 años (varones 44.8 y mujeres 42.1 años). La prevalencia de lahipertensión arterial en el Perú ha subido de 23.7% según TORNASOL I (T.I.) a 27.3% en TORNASOL II(T.II.), así como en todos los grupos de la clasificación del VII Reporte. En las regiones geográficas (costa, sierra y selva) se han incrementado también en ambos sexos, con excepción de las ciudades ubicadas sobre los 3,000 metros de altura donde la variación es mínima tanto en varones como en mujeres. La costa sigue teniendo más hipertensos y en segundo lugar la región selva. En los varones la prevalencia de la hipertensión es mayor que en las mujeres hasta los 55 años de edad donde se igualan (35.4% de prevalencia) y hacia los 70 años en la mujer sube a 57.1% y en el varón es de 50.8% (en T.I. y en T.II. este fenómeno biológico es similar)...