Spironolactone in patients with heart failure and preserved ejection fraction. / Espironolactona en pacientes con insuficiencia cardiaca y fracción de eyección preservada.

OBJECTIVES: Aldosterone inhibitors have been shown to be beneficial for patients with systolic heart failure. However, the evidence from patients with heart failure and preserved ejection fraction (HFPEF) is limited. We evaluated the role of spironolactone in the prognosis of a cohort of patients with HFPEF. PATIENTS AND METHODS: We analyzed the outcomes of patients hospitalized for HFPEF in 52 departments of internal medicine of the Spanish RICA registry according to those who did and did not take spironolactone. We recorded the posthospital mortality rate and readmissions at 1 year and performed a multivariate survival analysis. RESULTS: We included 1212 patients with HFPEF, with a mean age of 79 years (standard deviation, 7.9), (64.1% women), the majority of whom had hypertensive heart disease (50.7%). The patients treated with spironolactone, compared with those who were not treated with this diuretic, had a more advanced functional class, a higher number of readmissions (44.3 vs. 29.1%; p<0.001) and a higher rate in the combined variable of readmissions/mortality (39.0 vs. 29.0%; p=0.001). In the multivariate analysis, the administration of spironolactone was associated with an increase in readmissions (RR, 1.4; 95% CI, 1.16-1.78; p=0.001). CONCLUSIONS: For patients with HFPEF, the administration of spironolactone was associated with an increase in all-cause readmission, perhaps due to the higher rate of hyperpotassemia.

[Anemia prevalence in heart failure. GESAIC study results]. / Prevalencia de la anemia en la insuficiencia cardiaca. Resultados del estudio GESAIC.

INTRODUCTION AND OBJECTIVES: There is a great variability in the prevalence of anemia in heart failure (HF) according to cohort based studies where the majority of patients have depressed left ventricular ejection fraction (LVEF). Our study has aimed to evaluate the prevalence of anemia in HF within the usual hospital clinical practice. METHODS: An initial analysis was made of a prospective cohort of inpatients with HF admitted during 3 months in 15 Internal Medicine Services including all health system levels. We used the World Health Organization (WHO) criteria to define anemia (hemoglobin [Hb] < 12 g/l in women and < 13 g/l in men) and a value > or = 45% as preserved LVEF. RESULTS: A total of 391 patients with an average age of 77.9 +/- 9.4; 239 women (61.1%). The 52.7% of the cases had anemia. Regarding multiple associated factors to anemia in the bivariant analysis, the regression model indicated the following variables: preserved LVEF (odds ratio [OR] 3.03), not being HF debut (OR 1.85), glomerular filtration (OR 0.97), functional class III-IV of the New York Heart Association (NYHA) (OR 0.53), arterial vascular disease (OR 0.41), antiaggregant treatment (OR 0.56) and treatment with nitrites (OR 0.48). CONCLUSION: Prevalence of anemia in HF is very high in usual clinical practice, that most frequently occurs in subjects with preserved LVEF.

Blood pressure reactivity to mental stress task as a determinant of sustained hypertension after 5 years of follow-up.

Previous studies have reported an increased risk of developing sustained hypertension (SH) in borderline or mildly hypertensive subjects showing an exaggerated response of blood pressure (BP) to mental stress. The aim of this study was to assess if the response of BP to mental stress tasks is an independent predictor of SH. A total of 89 patients with grade 1 hypertension, aged 18-64 years, 62% males, were included. The mean of follow-up was 5.3 years (s.d. 2.1 years). SH was defined as the development of grades 2-3 hypertension (Systolic BP>or=160 mmHg or diastolic BP>or=100 mmHg) or to be in antihypertensive treatment after follow-up. Two mental stress tasks: mental arithmetic stress task and a stressful interview (SI) were applied at entry. The subjects were classified as hyper-reactors when BP increase was greater than 35 mmHg for systolic BP or greater than 21 mmHg for diastolic BP, according to the results obtained previously in a normotensive control group. In the univariate analysis, the factors associated with the development of SH were age (P=0.0007), office diastolic BP (P=0.014) and hyper-reactivity of BP during a stressful interview (P=0.003). In the Cox regression model, after adjusting for gender, age, and office BP, the hyper-reactivity of BP during SI was an independent predictor of development of SH. In conclusion, the response of BP to mental stress tasks is useful in predicting SH in young and middle-aged subjects with grade 1 hypertension.

Ausencia de relación entre insulinemia y afectación orgánica en hipertensos no tratados grados 1-2 / Absence of relationship between insulinemia and organic involvement in non treated hypertensive patients grades 1-2

Antecedentes. Aunque la hiperinsulinemia se comporta como un factor de riesgo independiente de enfermedad coronaria y cerebrovascular, sólo algunos estudios han investigado la relación entre la resistencia a la insulina y la afectación precoz de órganos diana en los sujetos hipertensos. Objetivo. Valorar si el nivel de insulinemia es un determinante independiente de afectación temprana cardíaca o renal en pacientes no tratados con hipertensión arterial grados 1-2.Pacientes y métodos. De la cohorte de pacientes hipertensos del estudio Hospitalet, 125 sujetos aceptaron participar en el estudio de la insulinemia que se determinó mediante radioinmunoensayo. A estos pacientes, formando parte del protocolo básico de la Unidad de Hipertensión Arterial, se les efectuó una determinación de la excreción urinaria de albúmina (EUA) de 24 horas por nefelometría y una ecocardiografía. Se consideró microalbuminuria una EUA entre 30 y 300 mg/24 horas. Se definió como hipertrofia ventricular izquierda un índice de masa ventricular izquierda superior o igual a 125 g/m2. Resultados. Los pacientes incluidos presentaron una edad media de 41,0 años (desviación estándar [DE]: 11,8). El 40,8 por ciento eran mujeres. La presión arterial diagnóstica media fue de 150,1 (DE: 10,5)/95,1 (DE: 5,0) mmHg. Se detectó hiperinsulinemia basal en un 8,8 por ciento de los pacientes, hipertrofia del ventrículo izquierdo en 26 sujetos (23,2 por ciento; IC 95 por ciento: 15,4 por ciento-31,0 por ciento) y microalbuminuria en 12 casos (13,3 por ciento; IC 95 por ciento: 7,1 por ciento-22,1 por ciento). Las determinaciones ecocardiográficas y la EUA no se correlacionaron de forma estadísticamente significativa con el nivel de insulinemia basal ni tras sobrecarga oral de glucosa. Tampoco se observaron diferencias en dichas variables al comparar únicamente a los pacientes en los terciles superior e inferior de los niveles de insulinemia. Conclusión. No se ha observado asociación entre la insuficiencia basal o tras sobrecarga oral de glucosa y la afectación ecocardiográfica o el nivel de excreción urinaria de albúmina en sujetos con hipertensión grados 1-2 no tratados farmacológicamente (AU)