Prescription of non-steroidal anti-inflammatory and antirheumatic drugs in outpatient hypertensive patients.

BACKGROUND: It has been documented that NSAIDs (nonsteroidal anti-inflammatory and antirheumatic drugs) reduce the effectiveness of some antihypertensive drugs. OBJECTIVE: Analyze the prescription of NSAID and the variables associated in outpatients with hypertension and explore some characteristics of the physicians. MATERIAL AND METHODS: Cross-sectional study, included patients with hypertension from the Family Medicine Unit No. 24 in Mante, Tamaulipas. From the patients, sociodemographic data, clinical history and pharmacological treatments were obtained. From the physicians, sociodemographic and academic information were collected. RESULTS: Mean age of the patients was 63 ± 11 years and 31.7% were prescribed NSAIDs. When compare exposed versus non-exposed to NSAIDs, being in uncontrolled high blood pressure, uncontrolled hypertension, multimorbidity and polypharmacy. The variables associated to the prescription of NSAIDs were: uncontrolled hypertension, multimorbidity and polypharmacy. The 56.7% of the physicians were women, 83.3% with experience >10 years and 33.3% with current certification by the Council in Family Medicine. CONCLUSIONS: The inappropriate prescription of NSAIDs revealed the need to implement actions to mitigate the potential risk for the hypertension patients to present a complication.

ANTECEDENTES: Los antiinflamatorios y los antirreumáticos no esteroideos (AINE) disminuyen la eficacia de algunos antihipertensivos. OBJETIVO: Analizar el patrón de prescripción de AINE y las variables asociadas en pacientes ambulatorios con diagnóstico de hipertensión arterial, así como explorar algunas características de los médicos prescriptores. MATERIAL Y MÉTODOS: Estudio transversal de pacientes con hipertensión de la Unidad de Medicina Familiar 24 en Ciudad Mante, Tamaulipas. De los pacientes se registraron datos sociodemográficos, antecedentes patológicos y tratamientos farmacológicos; y de los médicos, información sociodemográfica y académica. RESULTADOS: La edad promedio de los pacientes fue de 63 ± 11 años, 31.7 % recibía AINE y al contrastarlos con quienes no los recibían, se identificó mayor proporción de obesidad, presión arterial más elevada, más casos en descontrol de la hipertensión arterial, multimorbilidad y polimedicación. Las variables asociadas a la prescripción de AINE fueron estar en descontrol de la hipertensión arterial, multimorbilidad y polimedicación; 56.7 % de los médicos prescriptores fue del sexo femenino, 83.3 % con antigüedad superior a 10 años y 33.3 % con certificación vigente. CONCLUSIONES: La prescripción inapropiada de AINE reveló la necesidad de implementar acciones para mitigar el riesgo potencial de los pacientes hipertensos de presentar una complicación.

[Antihypertensive prescription in type 2 diabetes patients in Andalusia and SEH-LELHA 2022 guidelines: An economic cost evaluation]. / Prescripción de antihipertensivos en personas con diabetes tipo 2 en Andalucía y recomendaciones SEH-LELHA 2022: evaluación del coste y uso.

OBJECTIVE: This study aims to analyze the prescription of antihypertensive drugs in patients with type 2 diabetes (T2D) in Andalusia, comparing it with the SEH-LELHA 2022 guidelines, and to assess the direct cost of these treatments. MATERIALS AND METHODS: A multicentric, cross-sectional, and descriptive study was conducted with 385 T2D patients. Participants were randomly selected from the patient lists of 120 primary care physicians from Andalusia. Inclusion criteria included a diagnosis of T2D and complete clinical records for the year 2022. Demographic data and drug prescription information were collected, with the average cost per patient being calculated. RESULTS: The mean age of the subjects was 70.72 years, with 53.51% being male. A total of 70.9% of the patients were taking antihypertensive drugs, the most common being ACE inhibitors/ARBs (70.9%), diuretics (70.1%), beta-blockers (40.0%), and calcium channel blockers (20.0%). Each patient took an average of 2.46±1.06 antihypertendsive, and fixed association of 2 or more antihypertensive drugs were used by 40.9% of the studied patients. The annual cost per patient was 141.45€/year. CONCLUSIONS: The study reveals strong adherence to the SEH-LELHA 2022 guidelines among physicians in Andalusia regarding the of antihypertensives for T2D patients, with a significant preference for Renin-Angiotensin System blockers, diuretics, and beta-blockers. However, a notable deviation in prescription practices was observed with the frequent choice of doxazosin over spironolactone, despite the latter being the recommended option for resistant hypertension. Although the overall expenditure on antihypertensives is moderate, their cost-effectiveness is enhanced by the efficacy of these treatments in preventing cardiovascular complications.

Six weeks of a concurrent training therapy improves endothelial function and arterial stiffness in hypertensive adults with minimum non-responders.

BACKGROUND: This study aimed to examine the effects of a six-week of concurrent training using high-intensity interval plus resistance training on flow-mediated dilation and pulse wave velocity in hypertensive, elevated blood pressure, or normotensive. A secondary goal was to analyze the inter-individual variability. METHODS: A randomized controlled clinical trial was executed with 60 adult participants distributed across six groups: three control groups of hypertensive, elevated blood pressure, or normotensive and other three experimental hypertensive, elevated blood pressure, and normotensive groups, each comprising n=10 individuals. Participants underwent a six-week intervention of concurrent exercise using high-intensity interval plus resistance training three-weekly. Flow mediated dilation and pulse wave velocity and secondary vascular assessments were conducted before and after the intervention. RESULTS: The hypertensive exercise group exhibited a significant increase in flow mediated dilation (Δ+7.7%; p=0.003) and a reduction in pulse wave velocity (Δ-1.2ms-1; p<0.0001). The normotensive exercise group also showed a significant increase in flow mediated dilation (Δ+8.4%, p=0.002). CONCLUSION: The six-week concurrent exercise using high-intensity interval plus resistance training protocol, characterized by its clinical time-efficiency, was effective in improving endothelial function, as demonstrated by increased flow mediated dilation, and in reducing arterial stiffness, indicated by decreased pulse wave velocity.

[Inter-arm blood pressure difference: Consecutive versus simultaneous measurements in treated and controlled hypertense patients]. / Diferencia de presión arterial entre brazos: mediciones consecutivas versus simultáneas en pacientes hipertensos tratados y controlados.

The inter-arm difference (IAD) of systolic blood pressure (SBP) is associated with higher cardiovascular risk. We compared simultaneous and consecutive recordings in measuring IAD of SBP, and evaluated reproducibility between visits. 143 hypertensive patients (63.8±9.5 years, 51.7% women) treated and controlled with stable antihypertensive medication for a period of ≥3 months were included. Blood pressure (BP) in both arms was measured simultaneously and consecutively with an automatic oscillometric device, in two visits. The IAD of the simultaneous SBP was significantly lower compared to the consecutive one, both in the first (3.51±4.1 vs. 4.40±3.7mmHg; P<.01) and in the second visit (3.62±3.5 vs. 5.69±5.1mmHg; P<.001). When the IAD of SBP was categorized as ≥10 or <10mmHg, the reproducibility between visits was insignificant in both simultaneous measurements and consecutive measurements. The frequency of initial dominance was similar between the left and right arm in simultaneous ones (46.2 vs. 43.3%), and greater in the right arm in consecutive ones (55.2 vs. 38.5). The persistence of dominance between both visits was significantly higher when SBP was measured simultaneously (54.4% vs. 45.5%; P<.01). Our study shows that to define the arm with the highest BP, simultaneous measurements are preferable. In treated and controlled hypertensive patients, the poor persistence of initial dominance between visits requires us to review the recommendation of recording, during follow-up, the BP in the arm where it was highest on the first visit.

Metabolic biomarkers and cardiovascular risk stratification in hypertension.

INTRODUCTION: Cardiovascular risk calculators (CRC) are not locally validated and calibrated. Surrogate biomarkers of insulin resistance had identified subjects at higher risk of type 2 diabetes and cardiovascular disease. AIM: Establish the frequency of surrogate biomarkers of insulin resistance and their correlation with CRC in primary prevention non-diabetic hypertensive subjects. METHODS: This is an observational registry with a prospective consecutive outpatient's sample. The TyG index (TyGi) was calculated as logarithm (Ln) of (fasting triglycerides [mg/dl]×fasting plasma glucose [mg/dl]/2). Patients were stratified according to quartiles of TyGi. Pearson correlation coefficient between TyGi and other relevant variables was evaluated. RESULTS: Four hundred six patients were included with a mean age 55.9±13 years, 231 p (56.9%) males. The mean TyGi was 8.667±0.53. Patients in the highest quartiles of TyGi had significantly higher median difference between expected and actual ASCVD risk (p=0.02), higher frequency of AHA/ACC Pooled Cohort Equation >7.5% (p<0.005), and higher levels of metabolic biomarkers such as median triglyceridemia/HDL cholesterol ratio (TG/HDL) (p<0.0005), glycaemia and A1C (p<0.001 and p=0.02, respectively). The correlation between TyGi and TG/HDL was highly significant (r=0.7076; r2=0.5007; p<0.0001), and intermediate with non-HDL cholesterol (r=0.4553, r2=0.2073; p<0.0001). CONCLUSIONS: Non-diabetic hypertensive patients with high TyGi, a surrogate biomarker of insulin resistance, had a higher 10-year cardiovascular risk by AHA/ACC Pooled Cohort Equation. TyGi is statistically and significantly correlated with other biomarkers of insulin resistance. TyGi could be a reliable biomarker in clinical practice to stratify cardiovascular risk.

Intracranial hypertension secondary to unruptured pial arteriovenous malformation. Suitability of isolated endovascular treatment with ethylene vinyl alcohol/dimethyl sulfoxide (Onyx®). Case report and literature review.

A 36-year-old male presented to the Emergency Department with clinical symptoms of blurred vision of progressive onset of two years of evolution. The ophthalmological examination revealed the existence of bilateral papilledema. Using cranial computed tomography and magnetic resonance imaging, the presence of a right occipital pial arteriovenous malformation was certified. Arteriographically, pial arterial contributions dependent on the right middle cerebral artery and the right posterior cerebral artery were identified. Venous drainage was located at the level of the superior sagittal sinus. An associated right transverse sinus stenosis was also identified. The existence of secondary intracranial hypertension was corroborated by monitoring with an intracranial pressure sensor. An interventional procedure was carried out consisting of embolization of the arterial supplies of the lesion using Onyx®. The clinical-radiological findings after the procedure were favorable: the papilledema disappeared and complete exclusion of the malformation was achieved. A new intracranial pressure measurement showed resolution of intracranial hypertension. Subsequent regulated radiological controls showed complete exclusion of the malformation up to 5 years later.

Treatment patterns and factors associated with adherence in pulmonary arterial hypertension.

OBJECTIVE: Improving understanding of actual pulmonary hypertension (PH) treatment adherence patterns is crucial to properly treating these patients. We aimed to primarily assess adherence to treatments used for pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) specific therapies, identify potential factors related to it and secondly describe its treatment patterns. METHODS: A 6-month observational cross-sectional study in a tertiary care hospital was conducted. Patients with PH-targeted therapy who picked it up in the ambulatory hospital pharmacy and who had been on treatment with the same drug for at least 1 year were included. Adherence was assessed as: 1) Proportion of days covered (PDC); and 2) Simplified Medication Adherence Questionnaire (SMAQ). PDC ≥80% was considered adherent. Statistical analyses were performed to evaluate the study outcomes. Logistic regressions were estimated to identify the association between baseline characteristics and factors associated with adherence. P < 0.05 indicated statistical significance. RESULTS: A total of 63 patients with 127 different treatments were included, 71.4% were females with a mean age (SD) of 59 (15) years. PAH was the most common diagnosis (74.6%). Double therapy was used in 39.7% of patients, being the combination of Macitentan + Tadalafil and Ambrisentan + Tadalafil the most prescribed. Endothelin receptor antagonists were the most used treatment (40.2%). Adherence according to PDC was 93.7%, showing no great differences depending on the targeted drug used, and according to SMAQ 61.9%. The agreement degree of both methods was slight (65.1%; Kappa 0.12). Only female sex (OR: 0.23, 95% CI: 0.06-0.90; p = 0.035) was associated with worse adherence in the SMAQ method but not in the PDC. Adverse events were reported by a 55.6% of participants and the perception of effective treatment was high (95.2%). CONCLUSIONS: Adherence to PH therapy differs depending on the assessment method; PDC showed greater adherence rate than SMAQ. According to SMAQ, female sex may have a negative impact on adherence in this cohort, but PDC revealed no factors influencing it. No notable differences in adherence between treatment types were found and generally patients felt the treatments were effective in controlling their disease.

Prevalence of depression in hypertensive patients and its associated factors in India: A systematic review and meta-analysis.

BACKGROUND: Hypertension is a prevalent health challenge in India, with a bidirectional link to depression. Recognizing the prevalence of depression among hypertensive patients and associated factors are important for better health outcomes. METHODS: A comprehensive search was conducted in PubMed, Embase, Scopus, and Google Scholar databases to identify relevant studies. R software was used for analysis, employing a random effects model with a 95% confidence interval. Subgroup analyses were done to explore sources of heterogeneity within the included studies. RESULTS: The prevalence of depression among hypertensive patients in India was 39.8% (95% CI: 28.6; 52.1). Despite a higher prevalence observed in South region (44.7%) compared to North (26.9%), the difference was not significant (p=0.39). Studies utilizing different assessment scales and varying sample sizes yielded similar prevalence. However, a temporal trend analysis indicated a higher prevalence in studies published between 2020 and 2023 (52.6%) compared to those published between 2016 and 2019 (35.5%) (p=0.03). Major factors associated with depression included lower socioeconomic status, low education level, female gender, uncontrolled hypertension, and COVID-19 related factors. CONCLUSIONS: A significant proportion of hypertensive patients suffer from depression. Therefore, screening for depression in hypertensive patients is essential to improve hypertension management in India.

Fístula carótido-cavernosa con hipertensión ocular secundaria: reporte de caso / Carotid-cavernous fistula with secondary ocular hypertension. A case report

Presentación del caso. Paciente femenina de 62 años con una historia de diez meses de dolor ocular pulsátil, proptosis e inyección conjuntival en el ojo izquierdo; posteriormente presentó un edema palpebral superior izquierdo. Se evaluó con mejor agudeza visual corregida de 20/30 en dicho ojo y presión intraocular de 30 mmHg. Intervención terapéutica.Resonancia magnética nuclear de órbitas evidencia proptosis y dilatación de vena oftálmica superior izquierda, por lo que se diagnosticó como defecto del drenaje venoso e hipertensión ocular del ojo izquierdo. Inició tratamiento hipotensor tópico de ojo izquierdo; estudios de imagen angiotomografía de órbitas y ultrasonido doppler de ojo izquierdo, con énfasis en párpado superior, evidencian fístula carótido-cavernosa izquierda de alto gasto. Se realizó angiografía cerebral diagnóstica y terapéutica con embolización de fístula en arterias meníngea media y faríngea ascendente con ausencia de flujo por dichas ramas después de la intervención. Evolución clínica. Presentó una evaluación clínica favorable, conservando agudeza visual y presión intraocular dentro de valores normales en ojo izquierdo, con evidente disminución de congestión venosa epiescleral, edema de párpado superior y ausencia de proptosis izquierda. Ultrasonido doppler control de párpado superior izquierdo con disminución de flujo venoso a valores normales

Case presentation. 62 years old female with ten months history of ocular pain, proptosis, and conjunctival hyperemia in left eye, developing swollen upper eyelid. Best corrected visual acuity was 20/30 in her left eye, with and intraocular pressure of 30 mmHg. Treatment. Nuclear magnetic resonance of the orbits showed proptosis and dilated superior ophthalmic vein. Initial diagnosis. Abnormal venous drainage and ocular hypertension in the left eye. Topical hypotensive treatment of the left eye was initiated with ocular hypotensive eyedrops. Angiotomography of the orbit and left eye Doppler ultrasound, with upper eyelid emphasis, gave visualization of high flow carotid-cavernous fistula. Cerebral diagnostic and therapeutic angiography with embolization of the fistula in middle meningeal and ascending pharyngeal arteries showed no vascular flow after the procedure. Outcome. Positive clinical outcome, with corrected visual acuity conserved and normal eye pressure. Notable relief of ocular congestion and swollen upper eyelid with no proptosis in the left eye. Doppler ultrasound in the upper eyelid showed normal flow rate measurement.

Non-arteritic anterior ischemic optic neuropathy as the only manifestation of a malignant hypertensive crisis: Report of a case.

Non-arteritic anterior ischemic optic neuropathy (NAION) is after glaucoma the most common optic neuropathy in patients over 50 years. It is known that high blood pressure (HBP) is an important risk factor for the development of NAION. It is also known that malignant arterial hypertension (MAH) could be accompanied by optic disc edema. However, MAH has not classically been considered a cause of NAION. We report the case of a 32-year-old patient who presented irreversible visual loss with a pattern compatible with NAION as the only manifestation of a hypertensive crisis.

Vitamin D3 supplementation in COVID-19 patients with cardiovascular disease and gut dysbiosis.

BACKGROUND: The COVID-19 pandemic has highlighted the vulnerability of particular patient groups to SARS-CoV-2 infection, including those with cardiovascular diseases, hypertension, and intestinal dysbiosis. COVID-19 affects the gut, suggesting diet and vitamin D3 supplementation may affect disease progression. AIMS: To evaluate levels of Ang II and Ang-(1-7), cytokine profile, and gut microbiota status in patients hospitalized for mild COVID-19 with a history of cardiovascular disease and treated with daily doses of vitamin D3. METHODS: We recruited 50 adult patients. We screened 50 adult patients and accessed pathophysiology study 22, randomized to daily oral doses of 10,000IU vitamin D3 (n=11) or placebo (n=11). Plasma levels of Ang II and Ang-(1-7) were determined by radioimmunoassay, TMA and TMAO were measured by liquid chromatography and interleukins (ILs) 6, 8, 10 and TNF-α by ELISA. RESULTS: The Ang-(1-7)/Ang II ratio, as an indirect measure of ACE2 enzymatic activity, increased in the vitamin D3 group (24±5pg/mL vs. 4.66±2pg/mL, p<0.01). Also, in the vitamin D3-treated, there was a significant decline in inflammatory ILs and an increase in protective markers, such as a substantial reduction in TMAO (5±2µmoles/dL vs. 60±10µmoles/dL, p<0.01). In addition, treated patients experienced less severity of infection, required less intensive care, had fewer days of hospitalization, and a reduced mortality rate. Additionally, improvements in markers of cardiovascular function were seen in the vitamin D3 group, including a tendency for reductions in blood pressure in hypertensive patients. CONCLUSIONS: Vitamin D3 supplementation in patients with COVID-19 and specific conditions is associated with a more favourable prognosis, suggesting therapeutic potential in patients with comorbidities such as cardiovascular disease and gut dysbiosis.

New therapeutic targets in hypertension. / Nuevas dianas terapéuticas en hipertensión.

Even though a large number of antihypertensive drugs are suitable for hypertension treatment, some new therapeutic targets are recently under development. Most are focused in the treatment of resistant hypertension, added to the drugs currently available for treating such condition. Others have specific particularities in their duration of action, which allows their use once per month or every six months and could become alternatives to the current antihypertensive treatment. Most interesting therapeutic targets are the renin-angiotensin-aldosterone system, through interference with the RNA of the angiotensinogen, the inhibition of brain aminopeptidase III, the inhibition of aldosterone synthase, and new non-steroidal aldosterone receptor antagonists. In addition, dual endothelin receptor antagonists or agonists of the NPR1 receptor, the main effector of natriuretic peptides are other new interesting therapeutic possibilities. In this paper, we review clinical data on the development of the most interesting molecules acting through these new therapeutic targets.

Pheochromocytoma. Preoperative approach. / Feocromocitoma y su abordaje preoperatorio.

Pheochromocytomas are rare neuroendocrine tumors that derive from the chromaffin cells of the adrenal medulla and secrete catecholamines. The measurement of plasma or fractionated urine metanephrines is the hormonal determination of choice for the biochemical diagnosis. Once the biochemical diagnosis is confirmed, the next step is the localization study. It is recommended to request a genetic study in all patients with pheochromocytomas since 40% of cases are hereditary. Once the diagnostic study is completed, preoperative treatment with alpha blockers should be instituted at least 7-14 days before adrenalectomy. However, in low-risk patients, the omission of presurgical treatment could be considered if the surgery is performed in centers with experience and a strict monitoring of the patient is carried out during the perioperative period. This document offers a practical guide on the diagnosis and perioperative approach in patients with pheochromocytomas.

Cardiopulmonary phenotype in systemic sclerosis associated pulmonary hypertension.

INTRODUCTION: Pulmonary hypertension (PH) associated with systemic sclerosis (SSc) increases morbidity and mortality. Cardiopulmonary comorbidities, as per the 2021 PH consensus, play a role in the choice of therapy between monotherapy and combination therapy. METHODS: A cross-sectional study was conducted in patients with SSc based on the 2013 ACR/EULAR criteria or very early disease (VEDOSS 2011). PH was considered if they met the following criteria: pulmonary artery systolic pressure (PASP)>39mmHg or peak tricuspid regurgitation velocity (PTRV)>3.4m/s, PASP between 33 and 39mmHg or PTRV between 2.9 and 3.4m/s plus two additional findings suggestive of PH. PH was classified as type 2 if LVEF<50% or moderate to severe diastolic dysfunction was present; type 3 if extensive interstitial disease on tomography>20% or forced vital capacity (FVC)<75%; type 4 if abnormalities related to embolism were detected on scintigraphy or tomography. If patients did not meet these criteria, they were classified as type 1 PH. Complete data on cardiopulmonary risk factors and other factors were required. The frequency of these factors in the population and differences between groups based on risk factors were estimated. RESULTS: A total of 228 patients were selected. Three had type 2 PH, 24 had type 3, and 40 had type 1 PH, with the majority (75%) having at least one cardiopulmonary risk factor, and 47.5% having more than one. Mild diastolic dysfunction (25%) and hypertension (35%) were the most prevalent. In the type 1 PH group, those with risk factors experienced an increase in the number of years with Raynaud's phenomenon, anticentromere antibodies, and gastrointestinal symptoms (p<0.05). CONCLUSION: In patients with PH, 75% have one, and 45% have two or more risk factors.

Chronic thromboembolic pulmonary hypertension treatment and sex: Systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of pulmonary embolism and a major cause of chronic pulmonary hypertension leading to right heart failure and death. While pulmonary endarterectomy is the treatment of choice, some patients might benefit from medical therapy or balloon pulmonary angioplasty. Sex differences in outcomes of these therapies are not well characterized. MATERIAL AND METHODS: We conducted a systematic review and meta-analysis to investigate sex differences in outcomes of various therapies for CTEPH. We searched MEDLINE, PubMed, Embase, CINAHL and the Cochrane Library databases between January 1, 2010 and April 30, 2021, published in English. We pooled incidence estimates using random-effects meta-analyses. We evaluated heterogeneity using the I2 statistic. We assessed publication bias using Begg's and Egger's tests. This study is registered in PROSPERO, CRD42021268504. RESULTS: A total of 19 studies met the eligibility criteria, but only 3 trials provided separate outcomes for women and men. Two studies evaluated the efficacy of BPA, and one study evaluated the efficacy of riociguat (129 patients). Overall, 57.3% of patients were women and 62.6% were in functional class III. Mean time of follow-up was 55.5 (SD 26.1) weeks. Women showed a significantly better response in cardiac index (mean difference [MD], 0.10L/min/m2; 95% confidence interval [CI], 0.04-0.16; I2=0%; P=0.001). Alternatively, the reduction of pulmonary vascular resistances was significantly higher for men than for women (MD, 161.17dynscm-5; 95% CI, 67.99-254.35; I2=0%; P=0.0007). CONCLUSIONS: Women and men might show different hemodynamic responses to riociguat or BPA for CTEPH.

Prevalence of secondary arterial hypertension in patients with acute renal failure in a secondary-level pediatric hospital in Northwestern Mexico.

BACKGROUND: The worldwide prevalence of arterial hypertension in pediatric patients is 3.5%, and it has repercussions at renal, cardiovascular, neurological, and lifestyle levels. This study aimed to estimate the prevalence of arterial hypertension, mortality, and follow-up in patients with acute renal failure in the nephrology outpatient clinic at a second-level hospital in Northwestern Mexico. METHODS: We conducted a descriptive, retrospective, and observational study. Men and women aged 1-18 years diagnosed with acute kidney injury were analyzed from January 1, 2012, to December 31, 2021. The medical and electronic records of the candidate patients were analyzed, and nutritional data, laboratory analysis, most frequent etiology, and follow-up in the pediatric nephrology clinic were collected. Those with exacerbated chronic kidney disease and previous diagnosis of high blood pressure were excluded. RESULTS: One hundred and seventy-four patients were evaluated, and only 40 were eligible for the study (22.98%), predominantly males with a mean age of 9.9 years. The degree of arterial hypertension was 50% for grade I and 50% for grade II (p = 0.007); the mortality rate was 32%. One hundred percent of hypertension cases were controlled at 6 months after discharge (p = 0.000080). CONCLUSIONS: Our results were similar to those reported in other studies. Follow-up and early detection of arterial hypertension in children need to be strengthened.

INTRODUCCIÓN: La prevalencia de hipertensión arterial a nivel mundial es 3.5% en los pacientes pediátricos y tiene repercusiones tanto a nivel renal, cardiovascular, neurológico y estilo de vida. El objetivo de este estudio fue estimar la prevalencia de hipertensión arterial en pacientes con insuficiencia renal aguda, estimar la mortalidad y el seguimiento de los pacientes en la consulta externa de nefrología en un hospital de segundo nivel en el Noroeste de México. MÉTODOS: Estudio observacional descriptivo, retrospectivo. Se analizaron hombres y mujeres entre 1 a 18 años de edad con el diagnóstico de lesión renal aguda, entre 1 de enero del 2012 hasta 31 de diciembre del 2021. Se analizaron las historias clínicas y el expediente electrónico de los pacientes candidatos, se recolectaron datos nutricionales, análisis de laboratorio, etiología más frecuente y el seguimiento en la consulta de nefrología pediátrica. Se excluyeron aquellos con enfermedad renal crónica agudizada y diagnóstico previo de hipertensión arterial. RESULTADOS: 174 pacientes fueron evaluados y solamente 40 fueron candidatos al estudio (22.98%), de los cuales predominaron masculinos con una edad media de 9.9 años. El grado de hipertensión arterial fue 50% para grado I y 50% para grado II (p = 0.007); tasa de mortalidad 32%. El 100% del control de la hipertensión se logró en el seguimiento del egreso de los pacientes en 6 meses (p = 0.000080). CONCLUSIONES: Nuestros resultados fueron similares a los reportados en otros estudios. Se debe reforzar el seguimiento y detección oportuna de hipertensión arterial en los niños.

Estudio de prevalencia, conocimiento y control de la hipertensión arterial en barrios vulnerables de Argentina / Prevalence, knowledge and control of arterial hypertension in vulnerable neighborhoods of Argentina: A Cross-sectional Study

Introducción: La hipertensión arterial (HTA) representa el principal factor de riesgo individual, con mayor carga a nivel mundial de enfermedades cardiovasculares (ECV). En nuestro país, algunos trabajos epidemiológicos han mostrado marcadas diferencias en las prevalencias de estos factores de riesgo de acuerdo con la población evaluada. Sin embargo, no hay estudios epidemiológicos de evaluación de factores de riesgo cardiovascular exclusivos referentes a barrios vulnerables con muy bajos recursos económicos, socioculturales y poca accesibilidad a los sistemas de salud. Materiales y métodos: Estudio observacional de corte transversal multicéntrico en habitantes de comunas vulnerables de muy bajos recursos, como asentamientos populares y barrios carenciados con muestreo aleatorizado simple de casas. Se realizaron tomas de presión arterial (PA), medidas antropométricas, así como cuestionarios epidemiológicos, económicos y socioculturales. Se describen los hallazgos: prevalencia, conocimiento y control de la PA en las distintas regiones. Se efectuó una regresión logística para determinar las variables independientes a los resultados principales. Resultados: Se analizaron 989 participantes. La prevalencia de HTA global fue de 48,2%. Un total de 82% tenía un índice de masa corporal (IMC) >25 kg/m2. De estos pacientes, 45,3% tenían menos de seis años de educación. Este último aspecto se asoció a mayor prevalencia de HTA de forma independiente. De los hipertensos, 44% desconocían su padecimiento y solo en 17,2% estaba controlado, asociándose esto a tener obra social (OS) y mayor nivel educativo. Únicamente 24% estaban bajo tratamiento combinado. Conclusión: La prevalencia de HTA en barrios vulnerables es elevada, superando a la de otros estratos sociales con niveles de conocimiento, tratamiento y control de la HTA bajos, similar a otras poblaciones. Se detectó un uso insuficiente de la terapia combinada.

Introduction: Hypertension (HTN) represents the primary individual risk factor, contributing significantly to the global burden of cardiovascular diseases (CVD). In our country, epidemiological research has highlighted substantial variations in the prevalence of these risk factors across different populations. However, there is a lack of epidemiological studies assessing exclusive cardiovascular risk factors within vulnerable neighborhoods characterized by extremely limited economic resources, sociocultural challenges, and inadequate healthcare access. Methods: A multicenter cross-sectional observational study was conducted among individuals residing in economically deprived and marginalized communities, including informal settlements and underprivileged neighborhoods. Simple random sampling of households was employed. Blood pressure measurements, anthropometric assessments, and epidemiological, economic, and sociocultural questionnaires were administered. Results encompass prevalence rates, awareness levels, and blood pressure control across diverse regions. Logistic regression was utilized to identify independent variables influencing primary outcomes. Results: A total of 989 participants were analyzed. The overall prevalence of hypertension was 48.2%. About 82% had a body mass index (BMI) >25. Approximately 45.3% had less than 6 years of formal education. Independent association was established between education levels below 6 years and higher hypertension prevalence Among hypertensive individuals, 44% were unaware of their condition, with only 17.2% achieving control, correlated with having health insurance and a higher educational background. Merely 24% were receiving combined therapy. Conclusion: The prevalence of hypertension within vulnerable neighborhoods is alarmingly high, surpassing rates in other social strata. Knowledge, treatment, and control levels of hypertension are suboptimal, comparable to other populations... (AU)

Renin–angiotensin–aldosterone system blockers effect in chronic kidney disease progression in hypertensive elderly patients without proteinuria: PROERCAN trial / Efecto de los bloqueantes del sistema renina-angiotensina-aldosterona en la progresión de enfermedad renal crónica en pacientes hipertensos añosos sin proteinuria: ensayo clínico Progresión de Enfermedad Renal Crónica en Ancianos

Introduction: Evidence about nefroprotective effect with RAAS blockers in elderly patients with chronic kidney disease (CKD) without proteinuria is lacking. The primary outcome of our study is to evaluate the impact of RAAS blockers in CKD progression in elderly patients without proteinuria. Materials and methods: Multicenter open-label, randomized controlled clinical trial including patients over 65 year-old with hypertension and CKD stages 3–4 without proteinuria. Patients were randomized in a 1:1 ratio to either receive RAAS blockers or other antihypertensive drugs and were followed up for three years. Primary outcome is estimated glomerular filtration rate (eGFR) decline at 3 years. Secondary outcome measures include BP control, renal and cardiovascular events and mortality. Results: 88 patients were included with a mean age of 77.9±6.1 years and a follow up period of 3 years: 40 were randomized to RAAS group and 48 to standard treatment. Ethiology of CKD was: 53 vascular, 16 interstitial and 19 of unknown ethiology. In the RAAS group eGFR slope during follow up was −4.3±1.1ml/min, whereas in the standard treatment group an increase on eGFR was observed after 3 years (+4.6±0.4ml/min), p=0.024. We found no differences in blood pressure control, number of antihypertensive drugs, albuminuria, potassium serum levels, incidence of cardiovascular events nor mortality during the follow up period. Conclusions: In elderly patients without diabetes nor cardiopathy and with non proteinuric CKD the use of RAAS blockers does not show a reduction in CKD progression. The PROERCAN (PROgresión de Enfermedad Renal Crónica en ANcianos) trial (trial registration: NCT03195023). (AU)

Introducción: Actualmente no existe suficiente evidencia sobre el efecto nefroprotector de los bloqueantes del sistema renina-angiotensina-aldosterona (BSRAA) en pacientes añosos con enfermedad renal crónica (ERC) sin proteinuria y sin cardiopatía. El objetivo es evaluar el efecto de los BSRAA en la progresión de la ERC en este grupo poblacional. Métodos: Se trata de un estudio prospectivo, aleatorizado, que compara la eficacia de los BSRAA vs. otros tratamientos antihipertensivos en la progresión renal en personas mayores de 65 años con ERC estadios 3 y 4 e índice albúmina/creatinina<30mg/g. Aleatorización 1:1 BSRAA o tratamiento antihipertensivo estándar. Se recogieron cifras tensionales y parámetros analíticos de un año previo a la aleatorización y durante el seguimiento. Resultados: Se incluyeron 88 pacientes seguidos durante tres años con edad media de 77,9±6,1 años. De estos, se aleatorizaron 40 al grupo BSRAA y 48 al estándar. La etiología de ERC fue: 53 vascular, 16 intersticial y 19 no filiada. En el primer grupo se observó una progresión de la ERC con una caída del filtrado glomerular estimado (FGe) de -4,3±1,1mL/min, mientras que en el grupo estándar un aumento del FGe durante el seguimiento de 4,6±0,4mL/min, p=0,024. No se apreciaron diferencias entre ambos en el control tensional, el número de antihipertensivos, la albuminuria, los niveles de potasio, la incidencia de eventos cardiovasculares ni la mortalidad durante el seguimiento. Conclusiones: En pacientes añosos no diabéticos con ERC no proteinúrica y sin cardiopatía el uso de BSRAA no añade beneficio en la progresión de la ERC. Ensayo clínico Progresión de Enfermedad Renal Crónica en Ancianos (PROERCAN) (NCT03195023). (AU)

Monitorización ambulatoria de la presión arterial en adultos y población pediátrica. Una revisión narrativa / Ambulatory blood pressure monitoring, adult and pediatric population. A narrative review

La hipertensión arterial (HTA) se ha convertido en un factor de riesgo central para el desarrollo de enfermedades cardiovasculares (CV), lo que subraya la importancia de su diagnóstico preciso. Numerosos estudios han establecido una estrecha relación entre los valores elevados de la presión arterial sistólica (PAS) y diastólica (PAD) y un incremento en el riesgo de padecer algún evento cardiovascular (ECV). Tradicionalmente, las mediciones de la presión arterial (PA) realizadas en entornos clínicos han sido el principal método para diagnosticar y evaluar la HTA. No obstante, en los últimos años, se ha reconocido que las mediciones de la PA obtenidas fuera del ambiente clínico, mediante la automedida de la presión arterial (AMPA) y la monitorización ambulatoria de la presión arterial (MAPA), ofrecen una perspectiva más realista de la vida cotidiana de los pacientes y, por lo tanto, brindan resultados más fiables. Dada la evolución de los dispositivos médicos, los criterios diagnósticos y la creciente relevancia de componentes de la MAPA en la predicción de ECV, se requiere una actualización integral que sea práctica para la clínica. Esta revisión tiene como objetivo proporcionar una actualización de la MAPA, enfocándose en su importancia en la evaluación de la HTA. Además, se analizarán los umbrales diagnósticos, los distintos fenotipos según el ciclo circadiano y las recomendaciones en diferentes poblaciones, asimismo, se ofrecerán sugerencias concretas para la implementación efectiva de la MAPA en la práctica clínica, lo que permitirá a los profesionales de la salud tomar decisiones fundamentadas y mejorar la atención de sus pacientes.(AU)

Hypertension has become a central risk factor for the development of cardiovascular disease, underscoring the importance of its accurate diagnosis. Numerous studies have established a close relationship between elevated systolic (SBP) and diastolic (DBP) blood pressure and an increased risk of cardiovascular event (CVE). Traditionally, blood pressure (BP) measurements performed in clinical settings have been the main method for diagnosing and assessing hypertension. However, in recent years, it has been recognized that BP measurements obtained outside the clinical setting, using self-monitoring blood pressure (SMBP) and ambulatory blood pressure monitoring (ABPM), offer a more realistic perspective of patients’ daily lives and therefore provide more reliable results. Given the evolution of medical devices, diagnostic criteria, and the increasing relevance of certain components of ABPM in the prediction of adverse cardiovascular outcomes, a comprehensive update that is practical for daily clinical practice is required. The main objective of this article is to provide an updated review of ABPM, focusing on its importance in the evaluation of hypertension and its impact on public health in Colombia. In addition, it will discuss the implications of changes in diagnostic thresholds and provide concrete recommendations for the effective implementation of ABPM in clinical practice, allowing health professionals to make informed decisions and improve the care of their patients.(AU)