The Role of Obesity in the Development of Preeclampsia.

PURPOSE OF REVIEW: This comprehensive review provides an in-depth exploration of the complex relationship between obesity and preeclampsia (PE) and emphasizes the clinical implications of this association. It highlights the crucial role of screening tools in assessing individual risk and determining the need for additional antenatal care among women with obesity. The review investigates various markers for identifying the risk of developing PE, while emphasizing the significance of interventions such as exercise, weight management, and a balanced diet in reducing the incidence of preeclampsia and improving outcomes for both mother and fetus. RECENT FINDINGS: Actually, there is a global pandemic of obesity, particularly among women of childbearing age and pregnant women. PE, which is characterized by maternal hypertension, proteinuria, and complications, affects 2-4% of pregnancies worldwide, posing significant risks to maternal and perinatal health. Women with obesity face an elevated risk of developing PE due to the systemic inflammation resulting from excess adiposity, which can adversely affect placental development. Adipose tissue, rich in proinflammatory cytokines and complement proteins, contributes to the pathogenesis of PE by promoting the expression of antiangiogenic factors in the mother. This review emphasizes the need for appropriate screening, interventions, and a holistic approach to reduce the incidence of preeclampsia and enhance maternal-fetal well-being, thus providing valuable insights into the multifaceted association between obesity and PE.

Uso de benzodiazepinas en el manejo de la Hipertensión Arterial / Use of Benzodiazepines in Hypertension Treatment

RESUMEN La hipertensión arterial es una enfermedad de alta prevalencia mundial y es uno de los principales factores de riesgo cardiovascular. Hoy en día vivimos como sociedad en una época donde predomina el estrés, la depresión y la ansiedad: trastornos que generan una alta descarga simpática, lo cual resulta perjudicial para la salud cardiovascular. Es habitual que como médicos nos encontremos frente a pacientes que en consultorio y/o en salas de emergencias presentan algún grado de ansiedad asociado a registros elevados de presión arterial, y es frecuente que en estos casos el tratamiento elegido para la disminución de la presión arterial sean los ansiolíticos, y específicamente las benzodiazepinas. Actualmente no existen guías que avalen el uso de drogas ansiolíticas para el manejo de la hipertensión arterial, por lo que decidimos realizar una revisión bibliográfica para evaluar las evidencias sobre su indicación en el manejo de la hipertensión arterial.

ABSTRACT Hypertension is a worldwide prevalent disease and one of the main cardiovascular risk factors. Today we live in a society dominated by stress, depression and anxiety, disorders generating a high sympathetic discharge which is damaging for the cardiovascular health. It is usual that as physician we meet patients who in the office and/or emergency departments present some degree of anxiety associated with elevated blood pressure, and in these cases, the treatment chosen to decrease blood pressure is frequently anxiolytics, specially benzodiazepines. As currently no guidelines support the use of anxiolytics for blood pressure management, we decided to carry out a bibliographic review to assess the evidences of their indication to treat hypertension.

Telmisartan for treatment of Covid-19 patients: An open multicenter randomized clinical trial.

Background: Angiotensin receptor blockers (ARBs), such as telmisartan, have been postulated to treat Covid-19-induced lung inflammation. Methods: This is a parallel-group, randomized, two-arm, open-label, adaptive, multicenter superiority trial with 1:1 allocation ratio. Participants included patients from 18 years of age hospitalized with Covid-19 with 4 or fewer days since symptom onset enrolled at a university and a community hospital in Buenos Aires, Argentina. Exclusion criteria included prior intensive care unit (ICU) admission and use of ARBs/angiotensin converting enzyme inhibitors at randomization. Control arm received standard care alone and treatment arm telmisartan 80 mg twice daily for 14 days. Primary outcomes were C-reactive protein (CRP) plasma levels at day 5 and 8 after randomization. Secondary outcomes included time to discharge within 15 days, admission to ICU and death at 15- and 30-days. NCT04355936 (Completed). Findings: A pragmatic decision to end the study before the third interim analysis was made on Oct. 30th due to sharp reduction in recruitment. A total of 162 patients were randomized. 158 patients enrolled between May 14 and October 30 2020, were included in the analysis, 80 in the standard care and 78 in the telmisartan added to standard care group. Baseline absolute CRP serum levels were 5.53 ± 6.19 mg/dL (95% CI 6.91 to 4.15, n = 80) and 9.04 ± 7.69 (95% CI 9.04 to 10.82, n = 74) in the standard care and telmisartan added to standard care groups, respectively. Day 5 control-group CRP levels were 6.06 ± 6.95 mg/dL (95% CI 7.79-4.35, n = 66) while telmisartan group were 3.83 ± 5.08 mg/dL (95% CI 5.08-2.59, n = 66, p = 0.038). Day 8 CRP levels were 6.30 ± 8.19 mg/dL (95% CI 8.79-3.81, n = 44) and 2.37 ± 3.47 mg/dL (95% CI 3.44-1.30, n = 43, p = 0.0098) in the control and telmisartan groups, respectively (all values expressed as mean ± SD). Kaplan-Meier analysis showed that telmisartan-treated patients had a lower median time-to-discharge (control=15 days; telmisartan=9 days). Death by day 30 was reduced in the telmisartan-treated group (control 22.54%, 16/71; telmisartan 4.29%, 3/70 participants; p = 0.0023). Composite ICU, mechanical ventilation or death was reduced by telmisartan treatment at days 15 and 30. No adverse events were reported. Interpretation: Our study suggests that the ARB telmisartan, a widely used antihypertensive drug, is safe and could reduce morbidity and mortality in hospitalized patients infected with SARS -CoV-2 by anti-inflammatory effects. Further studies employing telmisartan are needed for confirmation of our results and to define its true therapeutic value as a tool against Covid-19.

Los riesgos de ser un paciente con enfermedad cardiovascular en época del COVID-19. Encuesta de la Fundación Cardiológica Argentina / Risks of Cardiovascular Disease Patients in Times of COVID-19. A Survey of the Argentine Foundation of Cardiology

RESUMEN Introducción: La pandemia por Covid-19 llevó a la necesidad de tomar medidas de contención masivas, pero llevó a una disminución de consultas, estudios diagnósticos y tratamientos y en internaciones por eventos cardiovasculares, encefalovasculares y cáncer. Objetivo: Conocer el acceso a la atención médica e información sanitaria en pacientes con enfermedades cardiovasculares durante el aislamiento social obligatorio y preventivo en Argentina. Resultados: Se evaluaron 1487 encuestas. La edad media fue de 56,17 (DE ± 14,0) y el 66,8% de los encuestados eran de sexo femenino. El 38,9% residían en Gran Buenos Aires; el 27,1%, en la Ciudad Autónoma de Buenos Aires. La principal enfermedad cardiovascular reportada como más frecuente fue la hipertensión arterial (52,1%); el 42% dijo haber necesitado atención médica; y el 57,9% no pudo acceder, lo que, en el 68,2%, se debió al sistema de salud. Solo el 16,4% no requirió asistencia por miedo al COVID-19. El 72% necesitó recetas, y el 13% no las consiguió. Accedieron con normalidad a vacunación el 41,4%. El aislamiento social obligatorio fue cumplido por el 92,4%. Finalmente, el 54,6% se sintió desprotegidos por el sistema de salud. Conclusiones: Creemos que es de vital importancia garantizar el acceso de la población con enfermedades cardiovasculares crónicas, al sistema de salud con el fin de adecuar los controles y minimizar las internaciones por descompensación, dado que se trata de una población de riesgo.

ABSTRACT Background: The COVID -19 pandemic led to the implementation of massive lockdown measures producing a reduction in consultations, diagnostic tests, treatments and admissions for cardiovascular and cerebrovascular events and cancer. Objective: The aim of this study was to determine the access to medical care and health care information in patients with cardiovascular diseases during social, preventive, and mandatory confinement in Argentina. Results: A total of 1,487 surveys were analyzed. Mean age was 56.17 ± 14.0 years; 66.8% of survey respondents were women, 38.9% lived in the Greater Buenos Aires area and 27.1 % in the Autonomous City of Buenos Aires. The most commonly reported main cardiovascular disease was hypertension (52.1%); 42% required medical care and 57.9% could not access to consultation due to issues related with the health system in 68.2% of cases. Only 16.4% did not request medical care for fear of becoming infected with COVID-19. Seventy-two percent required prescriptions and 13% did not obtain them. Access to vaccination was normal in 41.4% of respondents. Social mandatory isolation was respected in 92.4% of cases. Finally, 54.6% of the surveyed population felt unprotected by the health system. Conclusions: We believe that access of the population with chronic cardiovascular diseases to the health system should be warranted in order to adapt monitoring and minimize hospitalization due to decompensation in this high-risk population.

[Sudden death due to commotio cordis associated to non compacted myocardium]. / Muerte súbita por conmoción cardiaca (Commotio cordis) asociada a miocardio no compactado.

Non compact of the left ventricular myocardium is a rare congenital cardiomyopathy characterized by the presence of multiple and prominent deep trabeculations in the ventricular wall, that define recesses communicated with the main ventricular chamber. This is a condition with low incidence and prevalence, diagnosed through imaging techniques such as Doppler echocardiogram (DE), multi-slice computed tomography (MSCT) or magnetic resonance imaging (MRI). Clinically, it may be asymptomatic or manifested by cardiac arrhythmias, heart failure or thromboembolism. This is a report on a 33 year old asymptomatic man who suffered a blow on his chest (commotio cordis) during a sports competition that produced a cardiac arrest. The electrocardiogram showed ventricular flutter that required electrical defibrillation. A DE obtained initially, did not show any significant abnormality, but another DE, a MSCT and a RMN obtained after discharge, certified isolated non-compacted myocardium, ruling out coronary artery disease. He received beta blocker and antiplatelet therapy and the placement of an automatic cardioverter defibrillator was considered. The pathophysiology of the association of these two infrequent and potentially lethal conditions is discussed.

Muerte súbita por conmoción cardíaca (Commotio cordis) asociada a miocardio no compactado / Sudden death due to commotio cordis associated to non compacted myocardium

El miocardio no compactado es una rara miocardiopatía congénita caracterizada por la presencia de múltiples y prominentes trabeculaciones profundas en la pared ventricular que definen hendiduras comunicantes con el compartimiento ventricular principal. Es una entidad de baja incidencia y prevalencia que se diagnostica mediante estudios de imágenes como el ecocardiograma Doppler (ED), la tomografía computarizada multicorte (TCM) y la resonancia magnética cardíaca (RMC). Puede ser asintomática o manifestarse mediante arritmias, insuficiencia cardíaca o eventos tromboembólicos. Se presenta el caso de un hombre de 33 años, asintomático, que durante la práctica deportiva sufre una conmoción cardíaca (commotio cordis) que le produce un paro cardiorrespiratorio. El electrocardiograma mostró un ritmo de aleteo ventricular que requirió cardiodesfibrilación eléctrica. En un ED efectuado inicialmente no se observaron anormalidades significativas, pero otro ED, una TCM y una RMN obtenidos luego del alta, certificaron el hallazgo de miocardio no compactado aislado, descartando coronariopatía. Recibió tratamiento beta bloqueante y antiagregante y se discutió la colocación del cardiodesfibrilador implantable. Se plantea la fisiopatología de la asociación de estas dos infrecuentes y potencialmente letales afecciones.

Non compact of the left ventricular myocardium is a rare congenital cardiomyopathy characterized by the presence of multiple and prominent deep trabeculations in the ventricular wall, that define recesses communicated with the main ventricular chamber. This is a condition with low incidence and prevalence, diagnosed through imaging techniques such as Doppler echocardiogram (DE), multi-slice computed tomography (MSCT) or magnetic resonance imaging (MRI). Clinically, it may be asymptomatic or manifested by cardiac arrhythmias, heart failure or thromboembolism. This is a report on a 33 year old asymptomatic man who suffered a blow on his chest (commotio cordis) during a sports competition that produced a cardiac arrest. The electrocardiogram showed ventricular flutter that required electrical defibrillation. A DE obtained initially, did not show any significant abnormality, but another DE, a MSCT and a RMN obtained after discharge, certified isolated non-compacted myocardium, ruling out coronary artery disease. He received beta blocker and antiplatelet therapy and the placement of an automatic cardioverter defibrillator was considered. The pathophysiology of the association of these two infrequent and potentially lethal conditions is discussed.