EPIDEMIOLOGY OF DEPRESSIVE STATES IN ACUTE AND CHRONIC CONDITIONS.

Depression is the only silent cause that mainly affects the adult population and manifests itself in this case in 4% of the world population. However, more than three quarters of those affected belong to land in urbanization without receiving any type of treatment; a situation that represents a gap in access to mental health services. Now, the hallucinatory relationships mean that this condition has a high level of competition with chronic diseases such as HIV, diabetes, lung disease, asthma, arthritis, angina pectoris and cerebral palsy; Assimilation, it has been detected that patient with affective disorders such as coronary syndrome, inflammation, malnutrition, pain, stress and even critical stages of COVID-19 infection act as risk factors for the development of the disease. In this context, as a result of concern for public health, particularly in countries following the crisis, this study presents a proposal to carry out a review regarding the prevalence of depression in the presence of aggravated cases and crises. Strategies are implemented to address this situation. For this, a systematic review of the literature was carried out, complemented with bibliometric data on scientific contributions, with a period of 10 years (2011-2021) registered in the databases: Web of Science, Scopus and PubMed. In this way, the results allowed us to identify that, in recent years, in the fight to combat this problem, various remedies were used for its treatment and prevention; in which the focus is on the modification of health behaviors and collaborative care, which seeks quality of life in cases of patients with chronic diseases. On the other hand, the bibliometric information allows us to determine that the United States, Australia and Canada are the countries with the greatest scientific production on the subject. It is concluded that, although health services have demonstrated and improved their strategies in recent years, and that part of them have been supported by technological innovation, there are bridging markets at the cultural and socioeconomic level that the treatment and primary care of these patients.

Productos de apoyo para paciente con amputación transmetacarpiana / Support products for patient with transmetacarpal amputation

Propósito: Analizar propiedades funcionales y antropométricas de los PA, criterios de selección de diseño, procesos de confección y materiales de fabricación, para analizar las ventajas y/o desventajas que proporcionan y el impacto de esto sobre la CV, ya que los PA disponibles en el mercado no siempre se adaptan a requerimientos del individuo. Se demostrará a través de la presentación de un caso clínico con amputación transmetacarpiana izquierda, de 60 años sufrida el 24/11/2012. Metodología y Materiales: Mediciones antropométricas elementos termoplásticos y de descarte. Resultados: A partir del análisis de propiedades y características de los PA se podría establecer la forma en la cual éstos inciden en la CV de las personas en cuanto a confort, seguridad e independencia funcional, y a partir de ello conocer el grado de satisfacción del usuario respecto a su participación ocupacional en las AVD. Conclusiones: Respecto al desarrollo de PA, se están abriendo nuevas posibilidades para la mejora de la CV de la población en general. Si bien el avance tecnológico está orientado a potenciar la autonomía de los usuarios mediante nuevas y variadas estrategias se ha ido intensificando en campos como la rehabilitación y la antropometría, es necesario en más de una ocasión incorporar acciones que permitan al paciente mejorar su economía, funcionalidad, durabilidad y adecuación estética.

Purpose: Analyze SP functional and anthropometric properties, design selection criteria, preparation processes and manufacturing materials, to analyze the advantages and/or disadvantages that they have and their impact on the LQ, since the SP available in the market do not always adapt to the individual’s requirements. It will be demonstrated through the presentation of a clinical case with left transmetacarpal amputation, 60 years old, suffered on 11/24/2012. Methodology and Materials: anthropometric measures, thermoplastic and disposable items. Results: From the analysis of properties and characteristics of the SP it could be established the way in which they affect people’s LQ in terms of comfort, safety and functional independence, and considering this we can determine the degree of the user’s satisfaction regarding occupational participation in DLA. Conclusions: Regarding the SP development, new possibilities are appearing for the improvement of general population LQ. Even though the technological advance oriented to highlight the user’s autonomy through new and various strategies has been intensifying in some other fields like rehabilitation and anthropometry, it is necessary in more than one occasion to incorporate actions that allow the patient to enhance his functionality with economy criteria, functionality, durability and aesthetics as quality standards in design and construction.

Endemic pemphigus foliaceus in the Peruvian Amazon.

BACKGROUND: Endemic pemphigus foliaceus (EPF) is an organ-specific blistering disease of the epidermis characterized by the presence of IgG autoantibodies, specifically desmoglein (Dsg)1. This condition has been reported particularly in Brazil, Colombia, Tunisia and Peru. AIM: To characterize the humoral response against Dsg1 and Dsg3 autoantibodies of patients with EPF from the Peruvian Amazon region. METHODS: Blood samples were collected from 16 patients with a clinical diagnosis of EPF, and tested using indirect immunofluorescence (IIF), immunoprecipitation and ELISA (for IgG and its subclasses against Dsg1 and IgG against Dsg3). RESULTS: Autoantibodies against the intercellular spaces were detected by IIF in 82.5% and 87.5% of patients, using normal human skin and monkey oesophagus, respectively. Sera from all patients immunoprecipitated recombinant Dsg1, and three serum samples immunoprecipitated recombinant Dsg3 (6.25%). Using ELISA, anti-Dsg1 antibodies were detected in 13 patients (81.25%), and both IgG1 and IgG2 antibodies against Dsg1 in 12 patients (75%). All patients were positive for IgG4 autoantibodies, and only one patient was positive for IgG3 autoantibodies (6.25%). Anti-Dsg3 antibodies were detected in five patients (31.25%). CONCLUSIONS: EPF from Peru shares epidemiological, clinical and immunological characteristics with other forms of EPF that have been described in South America.

Orthostatic hypotension in treated hypertensive patients.

INTRODUCTION: Orthostatic hypotension (OH) is a risk factor for morbidity and mortality and one of the causes of non compliance to treatment among medicated hypertensive subjects. Our objective was to assess the prevalence of OH among treated hypertensive patients and its association with clinical characteristics and antihypertensive drug class. METHODS: This was a cross-sectional study in which we assessed the prevalence of OH, defined according to the American Autonomic Society and American Academy of Neurology guidelines, among adult treated hypertensive patients who performed a home blood pressure monitoring at our institution. We also determined the prevalence of OH according to age group (< 65, 65-79 and > 80), antihypertensive drug class, office and home hypertension control status. RESULTS: We included 302 medicated patients in the study. Mean age was 66.6 (+13.8), 67% were women. We found a 9.7% global prevalence of OH, which was significantly higher among older individuals (3.6% among patients < 65 years-old, 12.2% in the 65-79 year-old group and 16.7% among octogenarians, p = 0.02) and those who consumed alpha-blockers (75 vs. 8.5%, p < 0.01). Uncontrolled hypertensive patients at office and/or at home had also a significantly higher prevalence of OH: uncontrolled vs. controlled office blood pressure (BP), 14.3 vs. 6.5%, p = 0.03 and uncontrolled vs. controlled home BP, 15.1 vs. 6.6%, p = 0.02. Remarkably, 64% of patients with OH had their BP under control when considering office-standing BP. CONCLUSION: OH is a prevalent entity among treated hypertensive patients and systematic measurement of standing BP should be mandatory in the evaluation of these patients.

[Etiology and risk factors for a first episode of cerebral isquemia in young adults]. / Etiología y factores de riesgo para un primer episodio de isquemia cerebral en adultos jóvenes.

INTRODUCTION: To determinate the etiology and risk factors for a first episode of cerebral ischemia in young adults at three hospitals of Lima and Callao-Peru. METHODS: Multicentric study carried out at three national hospitals in Lima. The sample included 30 patients with a first episode of stroke and 60 controls matched by age and sex 2:1 with the patients. Serum biochemistry studies, EKGs and echocardiograms were done. Etiologies were classified based on the classification of Baltimore-Washington Cooperative Young Stroke Study. RESULTS: The most frequent etiologies were cardiac embolism and atherosclerotic valvular heart disease, which were 30% of the cases (9 patients) each one. Hypertriglyceridemia (p=0.014), valvular heart disease (p=0.001) and hormonal contraception/replacement therapy (p=0.002) were independent risk factors for a first episode of cerebral ischemia in peruvian young adults. Motor deficiency was the most frequent presentation (50.0%). Intracraneal hypertension and urinary tract infection were the most frequent complications during acute ischemia and mortality was raised up to 10%. CONCLUSIONS: The hypertriglyceridemia, valvular heart disease and the use of oral contraceptives are independent risk factors for a first episode of ischemia in young adults from three hospitals of Lima and Callao. The most frequent etiologies were cardiac embolism and atheroesclerotic valvular heart disease.

Noninfectious dermatological diseases associated with chronic exposure to mine tailings in a Peruvian district.

BACKGROUND: Mine tailings are metallic wastes which are deposited in the environment due to mining activity. Long-term exposure to these metals is harmful to human health. OBJECTIVE: To determine if chronic exposure to mine tailings constitutes a risk factor for the development of dermatological diseases in the district of San Mateo de Huanchor (Lima, Peru). METHODS: An observational case-control study was carried out in the communities of Mayoc, Daza and Tamboraque (exposed to mine tailings, case group) located in the district of San Mateo de Huanchor, and also in the communities of Choccna and Caruya (not exposed to mine tailings, control group) located in the same district. Out of 230 adults, 121 were exposed and 109 were not exposed to mine tailings and out of 135 children, 71 were exposed and 64 were not exposed to mine tailings. RESULTS: In the adult group, 71% of the exposed cases had some noninfectious dermatological disease while in the nonexposed group the frequency was 34% [P < 0.001; odds ratio (OR) 5.40; 95% confidence interval (CI) 3.02-9.68]. A statistically significant difference between groups was found for arsenical dermatitis, nonpruritic papulovesicular eruption, atopic dermatitis, contact dermatitis, seborrhoeic dermatitis and xerosis. In the paediatric population, 71 exposed and 64 nonexposed children were evaluated. Sixty-nine per cent of the exposed group had some noninfectious dermatological disease vs. 30% in the nonexposed group (P < 0.001; OR 6.00; 95% CI 2.71-13.31). A statistically significant difference between groups was found for xerosis and atopic dermatitis. CONCLUSION: Chronic exposure to mine tailings represents a risk factor for development of noninfectious dermatological diseases in both adults and children.

Antiphospholipid syndrome in Latin American patients: clinical and immunologic characteristics and comparison with European patients.

The objective of this study was to analyse the prevalence and characteristics of the main clinical and immunological manifestations at the onset and during the evolution of the disease in a cohort of patients from Latin America (mainly of mestizo origin) and to compare the Latin American with the European patients. Clinical and serological characteristics of 100 APS patients from Mexico and Ecuador were collected in a protocol form that was identical to that used to study the ;Euro-Phospholipid' cohort. The cohort consisted of 93 female patients (93.0%) and seven (7.0%) male patients. There were 91 mestizos (91.0%), seven whites (7.0%) and two Amerindians (2.0%). The most common manifestations were livedo reticularis (40.0%), migraine (35.0%), inferior extremity deep vein thrombosis (32.0%), thrombocytopenia (28.0%) and hemolytic anemia (20.0%). Several clinical manifestations were more prevalent in Latin American than in European patients and they included mainly neurological (migraine, transient global amnesia, acute ischemic encephalopathy, amaurosis fugax) and cutaneous (livedo reticularis, skin ulcerations, superficial cutaneous necrosis, multiple subungual splinter hemorrhages) manifestations as well as hemolytic anemia. The APS has a wide variety of clinical and immunological manifestations at the onset and during the evolution of the disease and the ethnic origin in addition to environmental and socioeconomic factors can modify the disease expression.

[Prevention of cardiovascular diseases by an antihypertensive program in the elderly, a cohort study]. / Prevención de eventos cardiovasculares en hipertensos mayores de 65 años bajo el cuidado de un programa de control. Estudio de cohorte.

INTRODUCTION: We started on year 2000 a Complex Intervention Program addressed at hypertension control among our patients. AIM: To compare the risk of cardiovascular events and of dying in hypertensive patients under Program care. METHOD: We started follow-up of a cohort of 1922 patients over 65 years in August 2000. Hipertension diagnosis was ascertained if patient reported to be hypertensive, or was under anti hypertensive treatment or if he/she had two blood pressure measurements = 140/90 mm Hg. Cardiovascular events were considered to be admissions due to coronary disease, cardiac insufficiency or stroke. Incidence is reported by 100 person years follow-up. Relative risks between hypertensive and normotensive patients were calculated and Cox regresión was used to adjust for potential confounders. We compared time to first cardiovascular event and to death with Log Rank Test. RESULTS: Fourty eight point three percent of patients were hypertensive and differed from normotensive patients as to age (79 (5) years vs. 77 (5) p < 0.001), proportion of diabetic patients (16.1% vs. 7.6% p < 0.001). Mean follow-up time was 28 months. Mortality RR was 1.04 (95% CI 0.69-1.58). As to incidence of cardiovascular events it was 1.86 in normotensive vs. 3.02 (RR 1.62 95% CI 1.09-2.42). When adjusted by age, sex, smoking, dislipemia and diabetes, OR was 1.3 (95% CI 0.86-1.98). CONCLUSIONS: Hypertension did not increase the risk in cardiovascular events among our hypertensive patients at 2.3 years follow-up.

Hyperhomocysteinemia in stable pediatric, adolescents, and young adult renal transplant recipients.

BACKGROUND: High total plasma homocysteine (tHcy) levels are accompanied by an increased risk for premature development of atherosclerosis and atherothrombosis. Adult renal transplant recipients have elevated tHcy levels. Corresponding data in pediatric, adolescent, and young adult renal transplant recipients are scarce. We investigated whether tHcy levels were elevated in stable renal transplant recipients who received kidney grafts before age 18. METHODS: This cross-sectional study was conducted during routine posttransplantation follow-up. Fasting tHcy levels, serum creatinine, and lipoprotein profile were measured in 38 clinically stable renal transplant recipients with different degrees of renal function. No patient was receiving B vitamin or folic acid supplementation. Estimated glomerular filtration rate (GFR) was assessed according to Schwartz's formula. All patients followed a triple-drug immunosuppressive regimen, with the exception of three patients (deflazacort and azathioprine). Forty-one apparently healthy subjects constituted the control group. tHcy levels were determined by fluorescence polarization immunoassay in an IMx analyzer. RESULTS: Mean tHcy levels in transplant recipients were significantly higher than in controls (16.8+/-8.7 micromol/L and 9.5+/-2.3 micromol/L, respectively; P<0.01). A significant positive correlation between tHcy and serum creatinine levels was observed for both transplant recipients (rS=0.70, P<0.01) and controls (rS=0.54, P<0.01). In transplant recipients, tHcy correlated negatively with estimated GFR (rS=[minus]0.47, P<0.05). Fasting tHcy levels in excess of 14.6 micromol/L (>95th percentile in controls) were present in 19 (50%) patients; 14 of these patients had an estimated GFR<60 ml/min per 1.73 m2. When the renal transplant recipients were analyzed by renal function, mean tHcy was significantly higher in patients with an estimated GFR<60 ml/min per 1.73 m2 compared with patients with an estimated GFR> or =60 ml/min per 1.73 m2 (20.5+/-9.9 vs. 13.2+/-5.8 micromol/L, P<0.01). Both groups were significantly different from controls (P<0.01). No relationship was found between tHcy level and either cumulative cyclosporine or cumulative methylprednisone doses. No differences were observed in tHcy levels or lipoprotein profile between patients who were receiving deflazacort and those on methylprednisone. CONCLUSIONS: Hyperhomocysteinemia in renal transplant recipients is a common condition. Testing for fasting tHcy level might be a useful tool to identify patients at increased risk for development of vascular disease.

Validation of an enzyme immunoassay for the determination of total homocysteine in plasma.

In recent years, the determination of homocysteine (Hcy) has become increasingly important, since high levels of Hcy in plasma or serum represent an independent risk factor for occlusive vascular diseases. Nowadays, clinical laboratories use several analytical techniques to measure Hcy, of which high-performance liquid chromatography (HPLC) is the most popular. Recently, assays for Hcy quantification based on enzyme immunoassays (EIA) have become commercially available. Our group carried out the validation of the Axis method and compared results with those obtained by an established HPLC assay. Intra- and inter-assay coefficients of variation were < or = 8.5%. Compared with HPLC, linear regression analysis showed r=0.984, slope=0.952, intercept = 1.24 /mol/l; Bland-Altman procedure, the mean of the difference EIA-HPLC results = 0.5 micromol/l. Our results suggest that Hcy determinations by both methods are equivalent, and that the Axis assay provides reproducible and reliable data.

Contribution of stroke volume to the change in pulse pressure pattern with age.

This study investigated the effect of age on pulse pressure and its underlying mechanisms in unmedicated hypertensive men with the same level of mean arterial pressure. We included 77 men 17 to 76 years old with daytime mean arterial pressure between 95 and 114 mm Hg. In the supine position, pulse pressure showed a significant widening in young (<30 years) and older (>/=60 years) patients. Pulse pressure decreased in parallel with stroke index from age >30 to 40 to 49 years. Upright posture, however, eliminated this difference through a larger orthostatic fall in stroke index and pulse pressure in the youngest patients. After age 50 years, pulse pressure exhibited a progressive widening despite the further age-related decrease in stroke index. Supine, upright, and 24-hour pulse pressure fitted a curvilinear correlation with age (r=0.55, 0.56, and 0.68, respectively, P<0.001), with a transition at age 50 years. Before age 50 years, 24-hour pulse pressure correlated positively with stroke volume (r=0.5, P<0.001) and negatively with arterial compliance (SV/PP ratio, r=-0.37, P<0.01). In contrast, in men >/=50 years old, 24-hour pulse pressure correlated negatively with the SV/PP ratio (r=-0.5; P<0.01), without significant influence of stroke volume. Thus, in hypertensive men, the age-related change in stroke volume significantly accounted for the change in clinic and ambulatory pulse pressure during young adulthood, but its contribution decreased after the fifth decade.

[PREVALENCE OF HBsAg AND anti-HBs CARRIERS IN PREGNANT WOMEN WHO RESIDE IN DIFFERENT ENDEMIC AREAS LOCATED IN CENTRAL-SOUTHERN DEPARTAMENTS OF PERU] / Prevalencia de Portadoras de HBsAg y anti -HBs en Gestantes Residentes en Areas de Diferente Endemicidad de HVB en Departamentos del Centro - Sur del Perú

The present study was performed to estimate the prevalence of HBV in pregnant women (mean age among groups 25,0 6,9) who live in areas of different endemicity, and located in the Departments of Lima, Junin, Apurimac, and Ayacucho in Peru. All studies were carried out using radioimmunological techniques. In the Instituto Materno Perinatal in Lima, located in a low endemical area, 2086 pregnant women whose ages ranged between 14 and 44 years were evaluated (for laboratory tests) at their first prenatal examination. A prevalence of 9,38% (HbsAG+), 0,38% (Ratio), and 3,18% (HBsAg+, anti-HBsAg+) was found, corresponding to 107 HBsAg+ pregnant women whose treated newborn wouId prevent the HBV chronic infection of approximate 21 newborn each year. 63% HBsAg+ pregnant women were born in Departments other than Lima. In the Hospital de Apoyo La Merced, located in Chanchamayo, Junin, which is a medium endemic area, 217 pregnant women whose ages ranged between 14 and 48 years were evaluated. The prevalence found in this Hospital was of 1,38% (HBsAg+), 1,2% (Ratio), and 17,8% (HBsAg+, anti-HBs+). All positive HBsAg were negative for HBeAg. The projection of results corresponded to a total of 9 HbsAg+ pregnant women and 2 newborn preventive of chronic disease per year. In the Guillermo D az de la Vega Hospital in Abancay, Apurimac, located in a medium to high endemic area, 221 pregnant women whose ages ranged between 15 and 46 years were evaluated. A prevalence of 1,36% (HBsAg+), 1,0% (Ratio), and 36,16% (HBsAg+, anti-HBs+) was found. All positive HBsAg were negative for HBeAg. Projected results corresponded to a total of 37 HBsAg+ pregnant carriers and 7 newborn preventive of chronic disease per year. The Hospital General de Huanta, in Ayacucho, located in a high endemicity area, presented a prevalence of 3,2% (HBsAg+), 1,9% (Ratio), and 76,2% (HBsAg+, anti-HBs+) from 126 pregnant women evaluated with ages between 15 and 48 years old. These results gave a total projection per year of 39 HBsAg+ pregnant women and 8 newborn preventive of chronic hepatic disease. Among a total of 4 positive HBsAg cases, 3 positive pregnant women were studied for HBeAg. All 3 were negative. These results establish the prevalence of HbsAg and antiHBs in pregnant women from different endemical areas with significant prevalence in the Departments of Ayacucho (Huanta), and Apurimac (Abancay). They also contribute towards the costbenefit analysis for the prevention of HBV chronic infection.

Prevalencia de portadoras de HBsAG y anti-HBs en gestantes residentes en áreas de diferente endemicidad de HVB en departamentos del Centro - Sur del Perú / Prevalence of HBsAg and anti-HBs carriers in pregnant women who reside in different endemic areas located in central southern departaments of Peru

Desde febrero de 1996 a febrero de 1997 se evaluaron, mediante estudio prospectivo, diferentes grupos muestrales de gestantes aparentemente sanas (edad promedio entre grupo 25 ñ 6,9 años) atendidas en instituciones hospitalarias ubicadas en los Departamentos de Lima, Junín, Apurímac y Ayacucho en el Perú, con la finalidad de estimar la prevalencia de Hepatitis viral B en la población de gestantes residentes en dichas áreas. Todos los estudios fueron realizados mediante procedimientos radioinmunológicos en fase sólida. En el Instituto Materno Perinatal, ubicado en Lima en un área de baja endemicidad; fueron evaluadas 2086 gestantes, con edades mínimas y máxima entre 14 y 44 años, en su primera atención por consulta externa para las pruebas requeridas de laboratorio. Se encontró una prevalencia del 0.38 por ciento (HBsAG+) y 3.18 por ciento (HBsAg+, anti-HBs+), correspondiendo este hallazgo a un total anual proyectado de 107 gestantes HBsAg positivas cuyos recién nacidos tratados podrían prevenir la infección crónica de HVB de aproximadamente 21 casos cada año. De los casos HBsAg positivos encontrados, el 63 por ciento de gestantes no había nacido en Lima. En el Hospital de Apoyo La Merced en Chanchamayo, área de endemicidad intermedia; fueron evaluadas un total de 217 gestantes, con edades entre 14 y 48 años. La prevalencia encontrada en el Hospital fue de 1,38 por ciento (HBsAg+) y 17,8 por ciento (HBsAg+, anti-HBs+). Las gestantes positivas para HBsAg no fueron positivas para HBeAg. Con estos resultados se estimó un total anual de 9 gestantes HBsAg positivas y 2 RN prevenibles de enfermedad crónica. En el Hospital Guillermo Diaz de la Vega en Abancay, en área de endemicidad intermedia a alta; se evaluaron 221 gestantes, con edades entre 15 y 46 años, encontrándose una prevalencia de 1.36 por ciento (HBsAg+) y 36.16 por ciento (HBsAg+, anti-HBs+). Las gestantes positivas para HBsAg no fueron positivas para HBeAg. Se estimó como proyección un total anual de 37 gestantes HBsAg+ y 7 RN prevenibles de infección crónica. El Hospital General de Huanta, en área de alta endemicidad; presentó una prevalencia de 3.2 por ciento (HBsAg+) y 76.2 por ciento (HBsAg+, anti-HBs+), a partir de 126 gestantes evaluadas con edades entre 15 y 48 años. De las cuatro gestantes positivas para HBsAg, se evaluaron tres que resultaron negativas para HBeAg. Se proyectó un total de 39 gestantes HBsAg+ y 8 RN prevenibles de enfermedad hepática crónica...

Lack of effective blood pressure control among an elder hypertensive population in Buenos Aires.

Our purpose was to determine the level of awareness, treatment, and control of hypertension in a population of subjects aged 65 or more. We studied a random sample from the national health care program in Buenos Aires. Letters were mailed to 1000 selected individuals. Among those eligible, 41.4% (n = 414) were enrolled. The mean age was 73.8 years and 68% were women. Prevalence of hypertension in our sample was 77.5% (n = 321). Awareness of hypertension was 60.7% (n = 195). Fifty-four percent (n = 173) of the hypertensive subjects were receiving pharmacologic treatment and only 18.5% (n = 32) of them were controlled. These results show that there is a low level of awareness, pharmacologic treatment, and control of hypertension in the studied elderly subjects.

Diastolic pressure underestimates age-related hemodynamic impairment.

It has been hypothesized that as large arteries become more rigid with age, the pattern of hypertension changes from diastolic to systolic. Thus, diastolic blood pressure (DBP) may lose its ability to reflect the increase in vascular resistance with age. To assess this, we studied the age-related changes in blood pressure pattern and its steady-state and pulsatile determinants. We performed an epidemiological analysis based on a national survey of 10,462 subjects from Argentina. A hemodynamic analysis (impedance cardiography) was then carried out in 636 consecutive hypertensive patients (age, 25 to 74 years). Whereas the rate of increment in the prevalence of mild to moderate hypertension (MMH) reached a plateau after the sixth decade, isolated and borderline systolic forms of hypertension began a steep and sustained rise. Among patients with MMH, DBP remained stable from the third to the seventh decade, whereas SBP maintained a sustained increase. Despite similar DBP, the systemic vascular resistance index increased 47% (P<.01) and the cardiac index decreased 27% (P<.01), whereas the ratio of stroke volume to pulse pressure, an index of arterial compliance, decreased 45% (P<.01). However, there were no significant differences between older patients with MMH and those with isolated systolic hypertension in the level of SBP, vascular resistance, stroke volume, and cardiac index. Compared with age-matched normotensive control subjects, the ratio of stroke volume to pulse pressure was much more reduced in isolated systolic hypertension (48%) than in MMH (30%). In summary, the present study, carried out in a large sample of hypertensive subjects with a wide age range, showed a simultaneous impairment in vascular resistance and arterial compliance associated with aging in different patterns of hypertension. The magnitude of these changes, with opposite effects on DBP but additive effects on SBP, suggests that a hemodynamic mechanism could determine the transition in the prevalence of diastolic hypertension toward a systolic pattern of hypertension with aging. Also, the results suggest that SBP, but not DBP, is a reliable indicator of the underlying hemodynamic abnormalities (high resistance and low arterial compliance) in the elderly.

Hemodynamic effects of transdermal estradiol alone and combined with norethisterone acetate.

A 24 weeks, randomized, two-period, placebo controlled study was conducted to compare the effects of continuous transdermal 17 beta-estradiol replacement therapy (0.05 mg/day once a week) with placebo on systemic hemodynamics and blood pressure in postmenopausal women. Twenty-nine postmenopausal women (47-62 years) free of hormone replacement therapy were randomized in two groups; group 1 received estradiol patches for the first 12 weeks and placebo patches for the second, and group 2 received the same treatments in the reverse order. The effect of combined estradiol plus oral norethisterone acetate (NETA) 1 mg was also evaluated in the subset of women with intact uteri (n = 24). Crossover analysis showed that stroke volume and cardiac output were significantly higher (P < 0.05) and blood pressure was significantly lower (P < 0.05) with estradiol, irrespective of the order in which the treatments were administered. Although correlations between plasma estradiol levels during active treatment and hemodynamic changes were not significant, hemodynamic changes were significantly greater above 63 pg/ml than below this level (P < 0.05). Oral norethisterone acetate administration either during transdermal placebo or estradiol arms tended to modify systemic hemodynamics in the same direction than estradiol but the changes did not attained statistical significance. In summary compared with placebo, transdermal 17 beta-estradiol, replacement to postmenopausal women, increased cardiac output and decreased blood pressure. Although the average magnitude of changes was small, the results suggest that plasma estradiol levels could be a source of individual variability in the hemodynamic response. Oral NETA administration tended to enhance rather than reverse the estradiol-induced changes.

Influencia de la siesta sobre la presión arterial en pacientes hipertensos esenciales / Afternoon nap influence on blood pressure in essential hypertensives

Hay suficientes evidencias que demuestran que el descenso nocturno de la presión arterial es consecuencia de la inactividad y no depende de una hora determinada, ya que la presión arterial desciende cuando los individuos duermen durante el día. Comparamos la presión arterial sistólica, diastólica y la frecuencia cardíaca durante la siesta, el período nocturno de actividad y el sueño nocturno en 59 pacientes (32 mujeres, 27 hombres) hipertensos sin medicación (edad promedio: 53 ñ 14 años, rango: 26-84 años). La presión arterial y la frecuencia cardíaca fueron registradas utilizando un Pressurometer Del Mar IV 1990. Veintidós pacientes durmieron dos horas por lo menos luego de almorzar, 17 descansaron sin dormir y 20 permanecieron activos en el período posprandial. Evaluamos la media, el área bajo la curva y el desvío estándar de la presión arterial sistólica, diastólica y frecuencia cardíaca durante el período posprandial, el sueño nocturno y el resto del día. Tanto el sueño nocturno como el sueño posprandial disminuyeron la presión arterial sistólica, diastólica y la frecuencia cardíaca. Durante el descanso posprandial la presión arterial diastólica fue similar a la presión arterial diastólica nocturna y durante la siesta disminuyó más que durante el sueño nocturno (AU)

Influencia de la siesta sobre la presión arterial en pacientes hipertensos esenciales / Afternoon nap influence on blood pressure in essential hypertensives

Hay suficientes evidencias que demuestran que el descenso nocturno de la presión arterial es consecuencia de la inactividad y no depende de una hora determinada, ya que la presión arterial desciende cuando los individuos duermen durante el día. Comparamos la presión arterial sistólica, diastólica y la frecuencia cardíaca durante la siesta, el período nocturno de actividad y el sueño nocturno en 59 pacientes (32 mujeres, 27 hombres) hipertensos sin medicación (edad promedio: 53 ñ 14 años, rango: 26-84 años). La presión arterial y la frecuencia cardíaca fueron registradas utilizando un Pressurometer Del Mar IV 1990. Veintidós pacientes durmieron dos horas por lo menos luego de almorzar, 17 descansaron sin dormir y 20 permanecieron activos en el período posprandial. Evaluamos la media, el área bajo la curva y el desvío estándar de la presión arterial sistólica, diastólica y frecuencia cardíaca durante el período posprandial, el sueño nocturno y el resto del día. Tanto el sueño nocturno como el sueño posprandial disminuyeron la presión arterial sistólica, diastólica y la frecuencia cardíaca. Durante el descanso posprandial la presión arterial diastólica fue similar a la presión arterial diastólica nocturna y durante la siesta disminuyó más que durante el sueño nocturno

Relationship between systemic hemodynamics and ambulatory blood pressure level are sex dependent.

Sex-related differences in systemic hemodynamics were analyzed by means of cardiac index and systemic vascular resistance according to the level of daytime ambulatory blood pressure. In addition, we assessed the relations between ambulatory blood pressure measurements and systemic hemodynamics in male and female patients. We prospectively included 52 women and 53 men referred to our unit for evaluation of arterial hypertension. Women and men were grouped according to the level of daytime mean arterial pressure: < 110 or > or = 110 mm Hg. Patients underwent noninvasive evaluation of resting hemodynamics (impedance cardiography) and 24-hour ambulatory blood pressure monitoring. Compared with women men with lower daytime blood pressure had a 12% higher systemic vascular resistance index (P = NS) and a 14% lower cardiac index (P < .02), whereas men with higher daytime blood pressure had a 25% higher vascular resistance (P < .003) and a 21% lower cardiac index (P < .0004). Furthermore, in men systemic vascular resistance correlated positively with both daytime and nighttime systolic and diastolic blood pressures, whereas cardiac index correlated negatively only with daytime diastolic blood pressure. In contrast, women did not exhibit any significant correlation between hemodynamic parameters and ambulatory blood pressure measurements. In conclusion, sex-related differences in systemic hemodynamics were more pronounced in the group with higher daytime hypertension. The relations between systemic hemodynamics and ambulatory blood pressure level depended on the sex of the patient. In men a progressive circulatory impairment underlies the increasing level of ambulatory blood pressure, but this was not observed in women.