Association between socioeconomic status and hospitalisation requirement in older patients attended at the emergency department: A retrospective cohort study.

INTRODUCTION AND OBJECTIVE: A low socioeconomic status (SES) has been associated with poor health results. The present study aimed to investigate if SES of older patients attending the emergency department is associated with the use of healthcare resources and outcomes. PATIENTS AND METHODS: Observational, retrospective study including consecutive patients 65 years or older admitted to the emergency department. Variables at baseline, index episode, and follow-up were recorded. SES was measured using an indirect theoretical index and patients were categorised into two groups according to whether they lived in a neighbourhood with a low or high SES. Primary outcomes included hospitalisation after the emergency department visit and prolonged hospitalisation (>7 days) at index episode. Secondary outcomes included emergency department re-consultant and hospital admission in the following 3 months after the index episode, and all-cause mortality after long-term follow-up. Logistic regression and cumulative hazards regression models were used to investigate associations between SES and outcomes. RESULTS: The cohort included 553 patients (80 years [73-85], 50.5% female, 55.9% with low SES). After the emergency department visit, 234 patients (42.3%) required hospital admission. A low SES was inversely associated with hospitalisation with an adjusted odds ratio=0.654 (95% CI 0.441-0.970). Among hospitalised patients, a low SES was associated with prolonged hospitalisation (adjusted odds ratio=2.739; 95% CI 1.470-5.104). Follow-up outcomes, including all-cause mortality, were not associated with SES. CONCLUSIONS: Older patients living in more deprived urban areas were hospitalised less often after emergency department care, but hospital stays were longer. Understanding the effect of social determinants in healthcare use is mandatory to tailor resources to patient needs.

[Triage: a key tool in emergency care]. / El triaje: herramienta fundamental en urgencias y emergencias.

"Triage" is a process that enables us to manage clinical risk in order to safely and suitably handle patient flows when demand and clinical needs exceed resources. At present, triage systems that are employed are structured according to five levels of priority. Levels are allocated according to the concept that what is urgent is not always serious and that what is serious is not always urgent. This makes it possible to classify patients according to "degree of urgency", so that the more urgent patients will be attended to first and the rest will be re-evaluated until they are seen by the doctor. The Spanish triage system (SET) and the Manchester triage system (MTS) are the two standardised systems most implemented in our country. We also discuss the system of triage devised in Navarre--integrated in the computerised clinical history--and used in the hospital network of Navarre. All are multidisciplinary systems based on the reasons and urgency of consultation, but not on diagnoses, and are carried out by nursing staff with medical support when required. In addition, they all include monitoring of the quality of the accident and emergency service itself, and can be applied in the outpatient field.

Residentes, guardias y síndrome de burnout / Residents, duties and burnout syndrome

ObjetivosInvestigar el grado de burnout entre los residentes de un hospital universitario y los factores asociados al mismo.Material y métodoSe envió a todos los residentes el Maslach Burnout Inventory que valora cansancio emocional, despersonalización y realización personal. Existe burnout ante un grado de cansancio emocional o de despersonalización altos. Se consignaron variables epidemiológicas (edad, sexo, nacionalidad, año de residencia, especialidad, número de guardias totales y en urgencias, días postguardia, libranza postguardia, posición de guardia). Se investigó la relación de estas con la puntuación en las dimensiones del Maslach Burnout Inventory con el burnout (chi cuadrado) y la asociación con el número de guardias (regresión lineal).ResultadosContestaron 132 de 290 residentes (45,5%): el 40,2% presentaba un alto cansancio emocional y el 64,4% una alta despersonalización. En total, el 69,7% de los residentes presentaba burnout. No existieron asociaciones estadísticamente significativas entre las variables epidemiológicas y las dimensiones del Maslach Burnout Inventory. El número total de guardias se relacionó significativamente con el cansancio emocional (p<0,05), sin relación con las guardias en Urgencias. La realización de 5 o más guardias al mes condicionó burnout con mayor frecuencia (76,6 vs.60,0%, p<0,05). Se observó una tendencia a un mayor burnout entre los residentes de medicina interna y especialidades médicas con respecto al resto (75,6 vs. 60,0%, p=0,05).ConclusionesLa prevalencia de burnout entre los residentes es elevada y se relaciona fundamentalmente con el número de guardias realizadas(AU)

ObjectivesTo investigate the degree of burnout among resident physicians of a university hospital and the factors associated with it.Materials and MethodsMaslach burnout Inventory (MBI) was sent to all residents, which assesses emotional exhaustion, depersonalization and personal accomplishment. Burnout exists when high degree of emotional exhaustion or depersonalization are obtained. Several variables were analyzed (age, sex, nationality, year of residency, speciality, total monthly calls and in emergency departments, days since last call, duty-free day after calls, position at calls). ItŒs relationship with the score on the different dimensions of MBI and burnout was analyzed through the test of the chi-square, whereas the association between scores of MBI and the number of calls were analyzed using linear regression.Results132 of 290 residents answered (45.5%): 40.2% had a high emotional exhaustion and a 64.4% presented depersonalization. In total, 69.7% of the residents had burnout. There was no statistically association between the epidemiological variables and the different dimensions of the MBI. The total number of calls per month were significantly associated with emotional exhaustion (p<0.05). There wasnft any relation to the number of calls in emergency departments. Resident physicians who had 5 or more calls per month showed burnout more often than the rest (76.6% versus 60.0%, p<0.05). A trend towards a higher burnout was present among residents of Internal medicine and medical specialities than the rest (75.6% versus 60.0%, p=0.05).ConclusionsThe prevalence of burnout among the group of residents is high and relates mainly to the monthly number of calls(AU)

[Residents, duties and burnout syndrome]. / Residentes, guardias y síndrome de burnout.

OBJECTIVES: To investigate the degree of burnout among resident physicians of a university hospital and the factors associated with it. MATERIALS AND METHODS: Maslach burnout Inventory (MBI) was sent to all residents, which assesses emotional exhaustion, depersonalization and personal accomplishment. Burnout exists when high degree of emotional exhaustion or depersonalization are obtained. Several variables were analyzed (age, sex, nationality, year of residency, speciality, total monthly calls and in emergency departments, days since last call, duty-free day after calls, position at calls). It's relationship with the score on the different dimensions of MBI and burnout was analyzed through the test of the chi-square, whereas the association between scores of MBI and the number of calls were analyzed using linear regression. RESULTS: 132 of 290 residents answered (45.5%): 40.2% had a high emotional exhaustion and a 64.4% presented depersonalization. In total, 69.7% of the residents had burnout. There was no statistically association between the epidemiological variables and the different dimensions of the MBI. The total number of calls per month were significantly associated with emotional exhaustion (p<0.05). There wasn't any relation to the number of calls in emergency departments. Resident physicians who had 5 or more calls per month showed burnout more often than the rest (76.6% versus 60.0%, p<0.05). A trend towards a higher burnout was present among residents of Internal medicine and medical specialities than the rest (75.6% versus 60.0%, p=0.05). CONCLUSIONS: The prevalence of burnout among the group of residents is high and relates mainly to the monthly number of calls.

Estudio piloto de la utilidad de la tomografía computarizada cardiaca para descartar síndrome coronario agudo en urgencias / Utility of coronary computed tomography to rule out acute coronary syndrome in the emergency department: a pilot study

Objetivo: Analizar, en pacientes con dolor torácico de bajo riesgo, las aportaciones de la coronariografía por tomografía computarizada multidetector (TCMD) en el diagnóstico de síndrome coronario agudo (SCA). Método: Subestudio piloto descriptivo y retrospectivo de un estudio prospectivo que comparaba la rentabilidad diagnóstica de la ecografía de estrés con la angiografía por TCMD. Se realizó en una unidad de dolor torácico (UDT) que atiende a pacientes con dolor torácico no traumático. Se incluyeron, en 2008, pacientes sin coronariopatía conocida y con al menos 2 factores de riesgo coronario y dolor torácico con estudio habitual (historia clínica, electrocardiogramas, troponinas seriadas y ergometría) negativo para SCA. Se registraron datos clínicos, epidemiológicos y se les realizó una coronariografía por TCMD y, si era patológica, un cateterismo. Resultados: De los 502 pacientes con posible SCA atendidos durante la disponibilidad de la prueba, 54 (10,7%) cumplían criterios para la TCMD. La TCMD mostró coronarias normales en 35 (64,8%); en 3 (5,5%), no interpretables por artefactos; y en 16(29,6%) la TCMD fue patológica. En estos últimos, se practicaron 15 cateterismos, de los que 10 fueron patológicos. Así, la TCMD permitió el diagnóstico de SCA en un 2,0% adicional de los pacientes incluidos inicialmente en el grupo de posible SCA y el18,5% de los 54 pacientes finalmente incluidos. Conclusiones: La TCMD cardiaca aumentó el rendimiento diagnóstico de un protocolo estándar (historia clínica, electrocardiogramas y troponinas seriadas y ergometría) en los pacientes con dolor torácico (AU)

Objective: To analyze the diagnostic contribution of coronary multidetector computed tomography (CMCT) in low-riskchest pain patients. Methods: Retrospective, descriptive substudy as part of a prospective study of the diagnostic yield of stress echocardiography in comparison with CMCT angiography. The setting was a non-traumatic chest pain unit. Patients with chest pain but without diagnosed coronary artery disease and fewer than 2 coronary risk factors in 2008 were included if the information usually gathered to diagnose acute coronary syndrome (ACS) (ie, medical history, electrocardiogram, troponin series, and ergometry) was negative. Clinical and patient data were recorded and CMCT was performed; if abnormalities were detected, heart catheterism was undertaken. Results: Of the 502 patients suspected of having ACS while CMCT was available to the department, 54 (10.7%) met the criteria for performing the procedure. CMCT demonstrated normal coronary arteries in 35 (64.8%). In 3 (5.5%) the findings could not be interpreted due to artifacts and in 16 (29.6%), abnormalities were detected. Catheterization was performed in 15 of the 16 patients; the test was positive in 10. CMCT led to a diagnosis of ACS in an additional 2% of the group of patients in whom the diagnosis was initially suspected and in 18.5% of the 54 patients included in the CMCT study (AU)

El triaje: herramienta fundamental en urgencias y emergencias / Triage: a key tool in emergency care

El triaje es un proceso que permite una gestión delriesgo clínico para poder manejar adecuadamente ycon seguridad los flujos de pacientes cuando la demanday las necesidades clínicas superan a los recursos.Actualmente se utilizan sistemas de triaje estructuradocon cinco niveles de prioridad que se asignan asumiendoel concepto de que lo urgente no siempre esgrave y lo grave no es siempre urgente y hacen posibleclasificar a los pacientes a partir del «grado de urgencia», de tal modo que los pacientes más urgentes seránasistidos primero y el resto serán reevaluados hasta servistos por el médico. El sistema español de triaje (SET)y el sistema de triaje Manchester (MTS) son los dos sistemasnormalizados de mayor implantación en nuestropaís, pero analizamos también el sistema de triaje elaboradoen Navarra que se integra en la historia clínicainformatizada (HCI) y que se utiliza en toda la redpública hospitalaria de Navarra. Todos son sistemasmultidisciplinares basados en motivos y en la urgenciade la consulta pero no en diagnósticos y son llevados acabo por enfermería con apoyo médico puntual. Tambiéntodos incorporan elementos de monitorización dela calidad del propio servicio de urgencias y cuentancon proyección para poder ser aplicados en el ámbitoextrahospitalario(AU)

“Triage” is a process that enables us to manage clinicalrisk in order to safely and suitably handle patientflows when demand and clinical needs exceed resources.At present, triage systems that are employed arestructured according to five levels of priority. Levelsare allocated according to the concept that what isurgent is not always serious and that what is seriousis not always urgent. This makes it possible to classifypatients according to “degree of urgency”, so thatthe more urgent patients will be attended to first andthe rest will be re-evaluated until they are seen by thedoctor. The Spanish triage system (SET) and the Manchestertriage system (MTS) are the two standardisedsystems most implemented in our country. We alsodiscuss the system of triage devised in Navarre - integratedin the computerised clinical history- and usedin the hospital network of Navarre. All are multidisciplinarysystems based on the reasons and urgency ofconsultation, but not on diagnoses, and are carried outby nursing staff with medical support when required.In addition, they all include monitoring of the quality ofthe accident and emergency service itself, and can beapplied in the outpatient field(AU)

Rentabilidad del cultivo de esputo en la consulta de urgencias de los pacientes infectados por el VIH y neumonía comunitaria / Cost-effectiveness of sputum culture for patients infected with HIV and community-acquired pneumonia in the emergency department

Objetivo: Determinar la rentabilidad diagnóstica del cultivo de esputo (CU), recogido en el servicio de urgencias (SU) en el diagnóstico microbiológico de la neumonía adquirida en la comunidad (NAC) en el paciente VIH. Pacientes y método: Estudio prospectivo de 2 años y medio de duración realizado enun hospital universitario de tercer nivel. Se incluyeron todos los pacientes VIH diagnosticados de NAC en los que se procedió a la recogida de esputo. Si éste era de buena calidad, según los criterios de Murray, se procedía al cultivo del mismo. Se analizaron las siguientes variables: sexo, número de linfocitos CD4, carga viral, proteína C reactiva(PCR), número de leucocitos, valor de la escala de APACHE II al ingreso y tratamiento antirretroviral de gran actividad (TARGA). Todos los cálculos estadísticos se calcularon con el paquete SPSS versión 14.0.Resultados: Se incluyeron un total de 120 episodios consecutivos de NAC de los cuales se cursó CU en 91 casos. Se obtuvo aislamiento microbiológico en 25 (27%) casos: 20S. pneumoniae, 4 H. influenzae, 1 S. aureus. En cuanto a las variables analizadas no se objetivó ninguna asociación significativa entre su valor y la positividad del CU. Conclusión: El rendimiento en el diagnóstico etiológico de la NAC en el paciente VIH mediante el CU es similar al descrito en la literatura. La positividad del CU es independiente de las variables analizadas. El CU es una prueba útil que, cuando es positivo en los pacientes VIH con NAC, el germen predominante es S. pneumoniae (AU)

Objectives: To assess the diagnostic cost-effectiveness of sputum culture (SC) for microbiological diagnosis of community-acquired pneumonia (CAP) in HIV-infected patients in the Emergency Department. Patients and methods: Two-year and six month prospective study conducted in a third level referral Academic Hospital. All the HIV-diagnosed patients with CAP were included in the study. A sample of sputum was collected from every patient. If the sputum sample was of good quality according to Murray's criteria, the culture was done. The study variables were: gender, number of CD4 limphocytes, viral load, C-reactive protein (RCP), number of leukocytes, APACHE scale values in admission and highly active antiretroviral treatment (HAART). Statistical analysis was performed with the SPSS statistical package (SPSS, version 14.0).Results: A total of 120 consecutive HIV-patients with CAP were enrolled and in 91 of them sputum culture was done. Organisms were present in 25 samples. The species isolated were: S. pneumoniae in 20 cases, H. influenzae in 4, andS. aureus in one case. There was no significant associations between the study variables and SC positivity. Conclusion: The cost-effectiveness of SC for etiological diagnosis of CAP in HIV-patients is similar to the reported inprevious literature. The positivity of SC is independent from the analyzed variables. SC is a useful test in HIV-patients with CAP. Among patients with positive test results the prevalence of S. pneumoniae is higher (AU)

Síndrome coronario agudo por intoxicación con monóxido de carbono / Acute coronary syndrome by carbon monoxide intoxication

La intoxicación por monóxido de carbono (CO) es una patología frecuente en los Servicios de Urgencias que muchas veces no se diagnostica debido a la presentación clínica inespecífica, a la baja disponibilidad de co-oxímetros en los Laboratorios de Urgencias y a las características propias del gas (incoloro, inodoro y noirritante). El CO es un gas producido por la combustión incompleta de la materia orgánica, que se une a la hemoglobina, dificultando el transporte de oxígeno a los tejidos, y a la citocromo-oxidasa, generando una disfunción multiorgánica, en particular sobre el SNC. La afectación cardiovascular es menos frecuente y es un riesgo menos conocido entre los sanitarios, por lo que nos parece de interés presentar un caso de síndrome coronario agudo asociado a una intoxicación grave por CO (AU)

Carbon monoxide (CO) poisoning is a frequent pathology in Emergency Departments (ED) that many times it is not diagnosed due to the lack of a specific clinical presentation, and thelack of co-oximeters in the ED as well as the gas ‘own characteristics(odorless, colorless and non irritating). CO is produced by the in complete combustion of organic materia, it binds to hemoglobin, impairing oxygen transport trough out the tissues and the cytocromeoxidase, thus generating a multiorganic disfunction, particularly over the Central Nervous System. Cardiovascular involvement is less frequent and is a less known risk by sanitary personnel, the reason why it is of special interest to present a case of acute coronary syndrome associated to severe CO intoxication (AU)

Posibilidades de tratamiento fibrinolítico en las primeras tres horas del ictus: ¿existe un techo? / The possibilities of fibrinolytic treatment within the first three hours following a stroke: is there a ceiling?

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Analysis of patient flow in the emergency department and the effect of an extensive reorganisation.

OBJECTIVES: To evaluate the different internal factors influencing patient flow, effectiveness, and overcrowding in the emergency department (ED), as well as the effects of ED reorganisation on these indicators. METHODS: The study compared measurements at regular intervals of three hours of patient arrivals and patient flow between two comparable periods (from 10 February to 2 March) of 1999 and 2000. In between, a structural and staff reorganisation of ED was undertaken. The main reason for each patient remaining in ED was recorded and allocated to one of four groups: (1) factors related to ED itself; (2) factors related to ED-hospital interrelation; (3) factors related to hospital itself; and (4) factors related to neither ED nor hospital. The study measured the number of patients waiting to be seen and the waiting time to be seen as effectiveness markers, as well as the percentage of time that ED was overcrowded, as judged by numerical and functional criteria. RESULTS: Effectiveness of ED was closely related with some ED related and hospital related factors. After the reorganisation, patients who remained in ED because of hospital related or non-ED-non-hospital related factors decreased. ED reorganisation reduced the number of patients waiting to be seen from 5.8 to 2.5 (p<0.001) and waiting time from 87 to 24 minutes (p<0.001). Before the reorganisation, 31% and 48% of the time was considered to be overcrowded in numerical and functional terms respectively. After the reorganisation, these figures were reduced to 8% and 15% respectively (p<0.001 for both). CONCLUSIONS: ED effectiveness and overcrowding are not only determined by external pressure, but also by internal factors. Measurement of patient flow across ED has proved useful in detecting these factors and in being used to plan an ED reorganisation.

Effect of long-term irbesartan treatment on endothelium-dependent vasodilation in essential hypertensive patients.

Endothelial dysfunction plays a pivotal role in the development of essential hypertension and its complications. The purpose of this study is to assess the effect of antihypertensive treatment with the angiotensin receptor blocker irbesartan on endothelial function in a group of essential hypertensive patients. Thirty-two untreated hypertensives are examined at baseline and at the end of a six-month period of irbesartan treatment. Endothelium-dependent and -independent responses are determined by measuring changes in forearm blood flow (FBF) by strain gauge plethysmography in response to intrarterial infusions of acetylcholine (endothelium-dependent vasodilation [EDV]), sodium nitroprusside (endothelium-independent vasodilation [EIV]), with and without the addition of the nitric oxide (NO) synthase inhibitor L-NMMA. Plasma endothelin, plasma and urinary nitrates and nitrites, and cyclic GMP are measured at baseline and at the end of treatment. Irbesartan promoted a significant increase in EDV (from 433+/-147% to 488+/-75%; P=0.027) and EIV (from 442+/-130% to 495+/-104%; P=0.041). L-NMMA-induced vasoconstriction was significantly enhanced after irbesartan treatment (relative decrease of FBF from 33.4+/-9.5% to 39.5+/-5.6%; P=0.001). Plasma concentrations of endothelin fell significantly after irbesartan treatment (from 5.78+/-1.86 to 4.16+/-1.52 pg/mL; P=0.001). We concluded that long-term irbesartan treatment enhances both endothelium-dependent and -independent vascular vasodilation capacity. In addition to this non-specific effect, irbesartan restores the vasoconstriction capacity of NO synthase inhibitors, suggesting a direct effect on tonic NO release, and decreases endothelin production. These actions may play an important role in the vascular protecting effects of irbesartan.

Disfunción endotelial en la insuficiencia renal crónica / Endothelial dysfunction in chronic renal failure

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Validación del aparato oscilométrico Angelini Línea F1 para la medida clínica y la automedida de presión arterial / Validation of the Angelini Line F oscillometric device for clinical and self-measurement of blood pressure

Fundamento. La utilización creciente de aparatos automáticos y semiautomáticos para la medida de la presión arterial (PA) hace necesario que sean sometidos a procesos de validación a partir de unos criterios estandarizados. El objetivo del presente estudio ha sido el de evaluar la fiabilidad del aparato oscilométrico de medida de presión arterial en el brazo Angelini Línea F tomando como base los criterios propuestos por el Grupo de Trabajo sobre Monitorización de la Presión Arterial de la Sociedad Europea de Hipertensión. Métodos. Se han estudiado 33 individuos con rangos de PA inferiores a 130/60 mmHg (11 sujetos) entre 130160/80-100 mmHg (11 sujetos) y superiores a 160/100 mmHg (11 sujetos). En cada individuo se han realizado tres pares de medidas de presión con esfigmomanómetro de mercurio y con el aparato oscilométrico a validar, obteniéndose un total de 99 comparaciones. Resultados. De las 99 comparaciones, 47 para la PA sistólica (PAS) y 70 para la PA diastólica (PAD) presentaron diferencias 5 mmHg, 83 para la PAS y 89 para la PAD diferencias 10 mmHg y 91 para PAS y PAD diferencias 15 mmHg, cumpliendo los requisitos establecidos por la Sociedad Europea de Hipertensión. Las diferencias medias entre ambos procedimientos fueron de 2,8 ñ 8,45 mmHg para la PAS y de 1,2 ñ 6,55 mmHg para la PAD. Los coeficientes de correlación intraclase fueron de 0,969 para la PAS y de 0,925 para la PAD. Conclusiones. El aparato oscilométrico de medida de PA en el brazo Angelini Línea F cumple los requisitos de la Sociedad Europea de Hipertensión y puede considerarse válido para la medida clínica y la automedida de la PA. (AU)

Lack of correlation between two methods for the assessment of salt sensitivity in essential hypertension.

The existence of a heterogeneous blood pressure (BP) response to salt intake, a phenomenon known as salt sensitivity, has increasingly become a subject of clinical hypertension research, and has important clinical and prognostic implications. However, two different methodologies are currently used to diagnose salt sensitivity. The aim of the present study was to compare the BP response to intravenous sodium load and depletion on the one hand, and to changes in dietary salt intake on the other, in order to assess salt sensitivity in a group of essential hypertensive patients. Twenty-nine essential hypertensives underwent two different procedures separated by 1 month: a dietary test consisting of a 2-week period of low (20 mmol/day) and high (260 mmol/day) salt intakes, and an intravenous test consisting of a 2 litre saline load over a 4-h period, followed by 1 day of low (20 mmol) salt intake and furosemide (40 mg/8 h orally) administration. BP was registered at the end of every period using 24-h ambulatory BP monitoring. In the whole group of hypertensive patients studied, both low salt intake and furosemide administration significantly (P < 0.01) decreased mean BP. Correlation coefficients of BP changes obtained using the two methodologies were between 0.3 and 0.4. Moreover, coefficients of agreement between the oral and the intravenous tests, using several cut points for BP changes, were systematically below 0.5, thus indicating a misclassification of salt sensitivity greater than 50%, depending on the method used. None of the cut points for BP changes during furosemide administration showed a good combination of sensitivity and specificity compared with changes in response to low dietary salt. The present results indicate that the diagnosis of salt-sensitive hypertension should be based on the BP response to changes in dietary salt intake, while BP response to saline and furosemide administration leads to a systematic misclassification of more than 50% of patients, even using different cutpoints for changes in BP.

Molecular basis of salt sensitivity in human hypertension. Evaluation of renin-angiotensin-aldosterone system gene polymorphisms.

We analyzed the association between salt sensitivity in essential hypertension and 8 genetic polymorphisms in 6 genes of the renin-angiotensin aldosterone system. Seventy-one patients with essential hypertension were classified as salt sensitive or salt resistant by means of the 24-hour ambulatory blood pressure (BP) change to high salt intake. The polymorphisms evaluated correspond to the following genes: ACE (I/D), angiotensinogen (M235T), angiotensin II type 1 receptor (A1166C), 11beta-Hydroxysteroid dehydrogenase type 2 (11betaHSD2) (G534A), aldosterone synthase (C-344T and Intron 2 conversion), and the mineralocorticoid receptor (G3514C and A4582C); all were determined using standard polymerase chain reaction methods. Thirty-five patients (49%) were classified as salt sensitive. We analyzed the BP response to high salt intake among genotypes and found a significant association for ACE I/D and 11betaHSD2 G534A polymorphisms. Patients homozygous for the insertion allele of the ACE gene (II) had a significantly higher BP increase with high salt intake than did patients homozygous for the deletion allele (DD). Heterozygous patients (ID) exhibited an intermediate response. The prevalence of salt-sensitive hypertension was also significantly higher (P=0.003) in II (68%) and DI patients (59%) compared with DD hypertensives (19%). With respect to 11betaHSD2 G534A, patients with the GG genotype had a significantly higher systolic BP increase with high salt intake than did GA patients. In addition, plasma renin activity suppression in response to high salt was significantly greater in GA patients than in GG patients. The prevalence of salt-sensitive hypertension was 14.3% in GA patients and 50.8% in GG patients (P=0.067). In conclusion, the I allele of ACE I/D polymorphism is significantly associated to salt-sensitive hypertension. The BP response to high salt intake was different among genotypes of ACE I/D and 11betaHSD G534A, suggesting that these polymorphisms may be potentially useful genetic markers of salt sensitivity.