Factores relacionados con la presencia de lesiones silentes de sustancia blanca cerebral en la hipertensión arterial / Factors related to the presence of silent white matter lesions in essential hypertension

Introducción. El significado clínico y la patogénesis de las lesiones cerebrales de sustancia blanca (LSB) no están aclarados. La mayoría de los estudios sugieren que la edad y la hipertensión arterial son los factores más importantes relacionados con la presencia de LSB. También se ha sugerido la existencia de factores genéticos en la susceptibilidad de desarrollar LSB. El objetivo del presente trabajo ha sido evaluar posibles factores clínicos, biológicos y genéticos relacionados con la presencia de LSB en pacientes de mediana edad afectos de hipertensión arterial esencial. Material y métodos. Se han incluido 71 pacientes hipertensos esenciales de ambos sexos, de edades comprendidas entre 5060 años, nunca tratados, y sin evidencia de enfermedad cardiovascular. Se realizaron las siguientes exploraciones: monitorización ambulatoria de la presión arterial (MAPA) de 24 horas, ecocardiograma y estudio de los polimorfismos genéticos del sistema renina-angiotensina mediante reacción en cadena de la polimerasa. A todos los pacientes se les realizó una resonancia magnética cerebral para valorar la presencia o ausencia de LSB. Resultados. Veintiocho (39,4 por ciento) de los pacientes hipertensos mostraban LSB en la resonancia. Los pacientes con LSB tenían unas cifras de presión arterial (PA) sistólica, diastólica y presión de pulso significativamente mayores que los pacientes hipertensos sin LSB, tanto en la clínica como en la MAPA. No se objetivó una asociación entre el perfil circadiano y las LSB, así como tampoco con la variabilidad de la PA. La presencia de una hipertrofia del ventrículo izquierdo (HVI) concéntrica era significativamente mayor (p = 0,002) en pacientes con LSB (54 por ciento) que en hipertensos sin LSB (11 por ciento). En referencia al estudio genético se objetivó que los pacientes con LSB presentaban una mayor frecuencia del genotipo DD del gen de la enzima de conversión de la angiotensina (ECA) (64 por ciento frente al 28,6 por ciento; p = 0,022) en comparación con los pacientes sin LSB. Discusión. La presencia de LSB en pacientes hipertensos de mediana edad está relacionada con la severidad de la elevación de la PA y con la existencia de una HVI concéntrica. La presencia del genotipo DD del gen de la ECA podría ser un factor predisponente para el desarrollo de LSB en pacientes con hipertensión arterial (AU)

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)

Enfermedad aneurismática difusa e hipertensión arterial: displasia fibromuscular / Diffuse aneurismatic disease and arterial hypertension: fibromuscular dysplasia

Se describe el caso de una displasia fibromuscular que se presentó como enfermedad aneurismática difusa. Se trata de un varón de 42 años que acudió a nuestra Unidad de Hipertensión para estudio de hipertensión arterial, dolor lumbar y hematuria. La práctica de una arteriografía puso de manifiesto la existencia de múltiples aneurismas intrarrenales bilaterales y posteriormente en otros lechos vasculares. Cuando la DFM se presenta como enfermedad aneurismática difusa, el diagnóstico diferencial debe incluir entidades de diversa naturaleza, como vasculitis o enfermedades del colágeno (AU)

Tratamiento de las crisis hipertensivas

A pesar del curso crónico y a menudo silente de la hipertensión arterial, se pueden presentar diversas complicaciones agudas que requieren atención en unidades de urgencias.Existe cierta confusión en la terminología utilizada para definir los problemas relacionados con las elevaciones agudas de la presión arterial. En este artículo se revisan las diversas definiciones de la elevación aguda de la presión arterial y se comenta la actitud diagnóstica y terapéutica frente a ellas (AU)

Tratamiento de la hipertensión arterial: medidas no farmacológicas

En la actualidad, todas las directrices coinciden en recomendar las medidas no farmacológicas como la primera acción a desarrollar por el médico frente a la hipertensión arterial (HTA).Las medidas no farmacológicas más útiles son la restricción de la ingesta de cloruro sódico y de bebidas alcohólicas, y la reducción del sobrepeso. Asimismo, otras modificaciones dietéticas o del estilo de vida pueden tener un efecto beneficioso en algunos subgrupos de hipertensos (AU)

Lack of association between ACE gene polymorphism and left ventricular hypertrophy in essential hypertension.

The possible association between the insertion/deletion (I/D) polymorphism of the angiotensin I converting enzyme (ACE) gene and left ventricular hypertrophy (LVH) was investigated in a group of essential hypertensive patients. Seventy-one essential hypertensive patients (35 men and 36 women), aged 51 +/- 1 years, were genotyped by PCR for the I/D polymorphism of the ACE gene. Cardiac morphology and function were assessed by means of M-mode echocardiography. The relative frequencies of the three genotypes, DD, DI, and II, were respectively: 24%, 55%, and 21%. Mean values of left ventricular mass index were 145, 144, and 150 g/m2 for DD, DI, and II genotypes, without significant differences among them (P = 0.82). Likewise, the prevalence of LVH (76%, 64%, and 87%) was not significantly different among the three genotypes (P = 0.23). We conclude that the ACE gene I/D polymorphism is not associated with LVH in essential hypertension. Journal of Human Hypertension (2000) 14, 47-49.

G-Protein beta(3) subunit gene variant and left ventricular hypertrophy in essential hypertension.

A functional genetic variant consisting of a C825T substitution in the GNB3 gene, encoding for the G-protein beta(3) subunit, has been associated with enhanced G-protein activation and cell growth. The aim of the study was to investigate the association of this polymorphism with left ventricular hypertrophy (LVH) in a sample of patients with essential hypertension. Left ventricular mass was assessed by 2-mode echocardiography in 86 patients with essential hypertension, and GNB3 C825T genotype was determined by polymerase chain reaction and restriction digestion. Thirty-seven (0.43) patients were homozygous for the C allele (CC), 40 (0.47) were heterozygous (CT), and 9 (0.10) were homozygous for the T allele (TT). The genotype distribution among the patients was in Hardy-Weinberg equilibrium. Values of left ventricular end-diastolic diameter (52.0+/-0.7 versus 48.9+/-0.9 mm, P=0.007), posterior wall thickness (11.3+/-0.2 versus 10.6+/-0.2 mm, P=0.042), and left ventricular mass index (152.7+/-4.4 versus 135.2+/-6.4 g/m(2), P=0. 023) were significantly higher in patients with CT and TT genotypes considered together (CT+TT) than in CC patients. The distribution of the genotypes was significantly different when comparing patients with LVH: 20 (0.33) CC and 40 (0.67) CT+TT patients had this complication, and 17 (0.65) CC and 9 (0.35) CT+TT patients did not (P<0.01). The frequency of the T allele was significantly different among patients with (0.40) and without (0.20) LVH (P<0.01). A logistic regression analysis showed that the association between the T allele and LVH was independent of age, mean blood pressure, body mass index, and alcohol consumption. The relative risk of LVH in patients bearing the T allele (CT+TT group) compared with CC hypertensive patients was 3.03 (95% CI 1.14 to 8.05). The findings suggest an association between LVH and the 825T allele in hypertensive patients.

Microalbuminuria in essential hypertension: clinical and biochemical profile.

This study aims to evaluate the clinical and biochemical profile associated with the presence of microalbuminuria in a group of essential hypertensive patients referred to a hypertension clinic. A total of 188 non-diabetic, untreated essential hypertensive patients (100 men, 88 women) aged 55.8 +/- 11.7 years are studied. Urinary albumin excretion was determined in two 24-h urine collections. Clinical and biochemical evaluations and 24-h ambulatory blood pressure (BP) monitoring were performed at baseline. Forty-two patients (22.3%) showed an increased urinary albumin excretion rate (20-200 micrograms/min). These patients showed significantly higher values (P < 0.01) for 24-h, daytime and night-time systolic and diastolic BP, compared with essential hypertensives with normal urinary albumin excretion. However, nocturnal reduction in BP did not differ between the groups. Furthermore, patients with microalbuminuria showed significantly higher (P < 0.01) creatinine, serum uric acid and triglycerides, as well as lower high-density lipoprotein (HDL)-cholesterol. In a multiple logistic regression analysis, a 24-h systolic BP > 140 mmHg (odds ratio: 3.19; 95% confidence interval [CI 95%]: 1.44-7.06) and a serum creatinine > 88 mumol/L (odds ratio: 3.08; CI 95%: 1.39-6.84) were the two factors associated independently with increased urinary albumin excretion. We conclude that, in essential hypertensive patients, the presence of microalbuminuria is associated with elevated BP, but not with its circadian pattern. Likewise, microalbuminuria is associated with the degree of renal impairment, and with increased uric acid and triglycerides and decreased HDL-cholesterol.

[Severe hepatitis from therapeutic doses of paracetamol in an alcoholic patient]. / Hepatitis grave por dosis terapéuticas de paracetamol en un paciente alcohólico.

The case of a 36-year-old chronic alcoholic patient who came to the hospital for presenting general bad shape, arthromyalgia and jaundice and who developed severe hepatitis with an extreme elevation in the transaminase levels following the consumption of therapeutic doses of paracetamol (3 g/day for 4 days). The possibility of other causes of hepatitis were duly discarded. Liver biopsy showed confluent centrolobular necrosis compatible with the diagnosis of toxic hepatitis. The patient was discharged from hospital in stable condition and with a slight alteration in the transaminase levels. Recognizing hepatotoxicity by paracetamol in alcoholics is simple if the clinical history, the marked transaminase elevation and the history of paracetamol intake are adequately evaluated. Lower doses of paracetamol or even avoidance of this drug is recommended in circumstances in which the toxicity of the drug may be potentiated by chronic alcohol consumption or by the lack of appetite associated with deficient alimentation.

[The demand for emergency medical care by the prison population]. / Demanda de asistencia hospitalaria urgente de la población reclusa.

BACKGROUND: Urgent medical claim from recluse population shows some special traits due to firstly, the reclusion situation itself and the high prevalence of certain diseases in this population, as the infections ones, such as HIV infection, hepatitis B and tuberculosis. Moreover, emergency rooms constitute for this patients, a common previous admission place. Thus, a high and a complex medical care claim must be expected from this population in hospital emergency rooms. METHODS: Consultations from ill prisoners examined in emergency room of Hospital Clinic Internal Medicine department during 1993, were checked: Age, sex, date, time of visit, serology and HIV risk factor, stage infection among positive HIV subjects, cause of complaint. age o symptomatology, number and the kind of complementary examinations done, the consulting time, the diagnosis and its link to the HIV infections, the consulting recurrence, and its relation with the initial cause, and the patient final destiny. RESULTS: 394 patients, from 598 who consulted, were visited (1.8% total consultings). The mean age was 32.4 years and 92% were men. A 68% (268 patients) realized that had HIV infection, and among these, a 37% (99 patients) were AIDS. The most frequent cause of complaint were related to respiratory, digestive, neurologic and non foci fever, which caused the higher number of admissions. The tuberculosis diagnosis was done in 39 patients (9.9%). Sixty wine patients discharged from hospital on first examination came again one or more times to the emergency room because of the same complaint. The number of complementary examinations done was 1,370 (a mean of 2.4 per visit), and were significantly higher among the HIV patients than in negative or unknown (p < 0.001). The overall admissions average was 37%, which increased to 71% among patients visited repeatedly. The HIV recluse patients required admission in the 46.3% of visits, and the HIV negative ones, in the 20.6% (p < 0.001). The duration of the visit among the patients that were discharged was 4 hours and 54 minutes. CONCLUSION: Recluse population generates an important urgent medical care claim. The number of admissions among this population is elevated and higher than the respective to the general one, related to the age. This high number of consulting, the increased number of admissions and the complex assistance (high number of complementary examinations that often requires high technology, and the repetitive urgent visits, etc.), are caused, mainly by the high prevalence of HIV infections among this population.

[Tracheobronchomegaly associated with light chain deposition disease]. / Traqueobroncomegalia asociada a enfermedad por depósito de cadenas ligeras.

Tracheobronchomegaly, also known as Mounier-Kühn's Syndrome, is characterized by market dilation of the trachea and main bronchi and has been reported in association with several conditions, particularly connective tissue disease. The pathogenesis and clinical signs of light chain deposition disease are similar to those of light chain amyloidosis, in which these chains are deposited as amorphous material lacking the tinctorial features of the amyloid. We present a case involving both entities, an association that has not been previously reported, and we review the main characteristics of both diseases.