Relationship of arterial stiffness and baseline vascular burden with new lacunes and microbleeds: A longitudinal cohort study.

INTRODUCTION: Arterial stiffness may have a significant impact on the development of cerebral small vessel disease (cSVD). PATIENTS AND METHODS: We obtained pulse wave velocity (24-h PWV) by means of ambulatory blood pressure monitoring (ABPM) in patients with a recent small subcortical infarct (RSSI). Patients with known cardiac or arterial embolic sources were excluded. Lacunes, microbleeds, white matter hyperintensities and enlarged perivascular spaces at baseline were assessed in a brain MRI and included in a cSVD score. A follow-up MRI was obtained 2 years later and assessed for the appearance of new lacunes or microbleeds. We constructed both unadjusted and adjusted models, and subsequently selected the optimal models based on the area under the curve (AUC) of the predicted probabilities. RESULTS: Ninety-two patients (mean age 67.04 years, 69.6% men) were evaluated and 25 had new lacunes or microbleeds during follow-up. There was a strong correlation between 24-h PWV and age (r = 0.942, p < 0.001). cSVD was associated with new lacunes or microbleeds when adjusted by age, 24-h PWV, NT-proBNP and hypercholesterolemia (OR 2.453, CI95% 1.381-4.358). The models exhibiting the highest discrimination, as indicated by their area under the curve (AUC) values, were as follows: 1 (AUC 0.854) - Age, cSVD score, 24-h PWV, Hypercholesterolemia; 2 (AUC 0.852) - cSVD score, 24-h PWV, Hypercholesterolemia; and 3 (AUC 0.843) - Age, cSVD score, Hypercholesterolemia. CONCLUSIONS: cSVD score is a stronger predictor for cSVD progression than age or hemodynamic parameters in patients with a RSSI.

Medida simultánea de la presión arterial en ambos brazos. ¿ Qué aporta en el manejo y en la evaluación del riesgo vascular en el paciente hipertenso? / Simultaneous measurement of blood pressure in both arms. What does it contribute to the management and assessment of vascular risk in the hypertensive patient?

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Biomarkers levels and brachial and central blood pressure during the subacute phase of lacunar stroke and other ischemic stroke subtypes.

We aimed to evaluate brachial and central blood pressure (BP) estimates and biomarker levels in lacunar ischemic stroke (IS) and other IS subtypes (nonlacunar stroke). We studied 70 functionally independent subjects consecutively admitted to our institution after a first episode of IS. Subjects with previous heart failure were excluded. BP was measured at admission and during the subacute phase of stroke (5-7 days after stroke onset). Aortic pulse wave velocity (aPWV), augmentation index (AIx), and 24 h brachial and central BP (24h-ABPM) were measured by means of a Mobil-O-Graph device during the subacute phase of stroke. Determination of N-terminal prohormone of brain natriuretic peptide (NT-proBNP), urinary albumin excretion, and echocardiography were performed in all subjects. After adjusting for age and clinical severity, lacunar IS had significantly higher levels of BP at admission (systolic BP 173 ± 37 vs 153 ± 28 mmHg, p = 0.006; diastolic BP: 97 ± 21 vs 86 ± 16 mmHg, p = 0.035) and during the subacute phase of stroke (systolic BP 152 ± 23 vs 134 ± 19 mmHg, p = 0.001; diastolic BP: 84 ± 14 and 77 ± 10 mmHg, respectively; p = 0.038) but lower NT-proBNP levels (median: 36,277 vs 274 pg/mL, p = 0.009) than nonlacunar IS. Central BP, aPWV, and AIx were not different between lacunar and nonlacunar IS, neither the rate of target organ damage. In conclusion, patients with a first episode of lacunar IS have higher BP values at admission and during the subacute phase of stroke and lower levels of NT-proBNP, suggesting a closer relationship with hypertension of this IS subtype.

[Clustering of cardiovascular risk factors and prevalence of metabolic syndrome in subjects with resistant hypertension]. / Agregación de factores de riesgo cardiovascular y de prevalencia de síndrome metabólico en personas con hipertensión arterial resistente.

BACKGROUND AND OBJECTIVE: The aim of this study was to analyse the clustering of cardiovascular risk factors and the prevalence of metabolic syndrome (MS) in this sample of subjects with resistant hypertension (RH). PATIENTS AND METHOD: One hundred and fifteen subjects with RH were sequentially included. RH was defined as a level of office blood pressure (BP)>or=140/90 mmHg in subjects treated with at least 3 antihypertensive drugs (one of them a diuretic) during at least 2 months and with good compliance. The usual protocol of the Hypertension Unit and ambulatory BP monitoring during 24 h was applied on all the subjects, and an echocardiogram with Doppler was performed on 68 of them. Subjects with a daytime BP>or=135/85 mmHg were defined as pseudoresistant hypertensive. RESULTS: The mean age (standard deviation) was 61 (10) years, and 50 patients (44%) were males. The mean office BP was 166/95 (16/9) mmHg. The daytime BP was 141/83 (15/12) mmHg. Out of the patients, 88 (76.5%) had a family history of cardiovascular disease; 64 (56%) of obesity; 43 (37%) of hypercholesterolemia; 34 (30%) of low high-density lipoprotein cholesterol; 32 (28%) of diabetes mellitus; and 63 (55%) were sedentary. The prevalence of MS was 54%; target organ damage was found in 70 cases (61%), and 44 (38%) had other associated clinical conditions. Out of the subjects with echocardiography, 49 (72%) presented left ventricular hypertrophy. Pseudoresistant hypertension was found in 31 (27%). There were no significant differences in clinical variables between subjects with RH or psudoresistant hypertension. CONCLUSIONS: Patients with RH had high cardiovascular risk, independent of a good control of ambulatory BP, because of the high prevalence of cardiovascular risk factors and MS. An optimal antihypertensive treatment including specific programs for the control of obesity and a sedentary lifestyle are necessary in the management of these patients.

Agregación de factores de riesgo cardiovascular y de prevalencia de síndrome metabólico en personas con hipertensión arterial resistente / Clustering of cardiovascular risk factors and metabolic syndrome prevalence in subjects with resistant hypertension

Fundamento y objetivo: La hipertensión arterial (HTA) resistente requiere un abordaje global del riesgo cardiovascular. El objetivo del presente estudio ha sido analizar la agregación de factores de riesgo cardiovascular y la prevalencia de síndrome metabólico (SM) en una serie de sujetos con HTA resistente. Pacientes y método: Se incluyó de forma secuencial a 115 personas con HTA resistente, definida como un valor de presión arterial (PA) en consulta de 140/90 mmHg o mayor en tratamiento con 3 fármacos, uno de ellos diurético, durante un mínimo de 2 meses en buenos cumplidores. Se aplicó el protocolo de la Unidad de HTA: seguimiento de la PA de 24 h con un monitor Spacelabs 90202 o 90207, y ecocardiografía Doppler en modo M de buena calidad en 68 sujetos. Se consideró HTA seudorresistente cuando los valores de PA media diurna eran menores de 135/85 mmHg. Resultados: La edad media (desviación estándar) fue de 61 (10) años y 50 pacientes (44%) eran varones. El valor medio de la PA en consulta fue de 166/95 (16/9) mmHg, y el de la PA diurna de 141/83 (15/12) mmHg. Tenían antecedentes familiares de enfermedad cardiovascular 88 sujetos (76,5%), de obesidad 64 (56%), de hipercolesterolemia 43 (37%), de concentración baja de colesterol unido a lipoproteínas de alta densidad 34 (30%), de sedentarismo 63 (55%) y de diabetes mellitus 32 (28%). La prevalencia de SM fue del 54%. Presentaban hipertrofia ventricular izquierda 49 pacientes (72%), lesiones de órgano diana 70 (61%) y un trastorno clínico asociado 44 (38%). En 31 casos (27%) se observó HTA seudorresistente; no se encontraron diferencias significativas en las distintas variables con los resistentes verdaderos. Conclusiones: Los pacientes con HTA resistente en la consulta, independientemente de que tengan la PA ambulatoria controlada, presentan un riesgo muy elevado de experimentar un episodio cardiovascular, dada la importante agregación de factores de riesgo cardiovascular y la alta prevalencia de SM. El manejo de estos hipertensos requiere la optimización del tratamiento antihipertensivo, así como medidas o programas específicos del tratamiento de la obesidad y del sedentarismo

Background and objective: The aim of this study was to analyse the clustering of cardiovascular risk factors and the prevalence of metabolic syndrome (MS) in this sample of subjects with resistant hypertension (RH). Patients and method: One hundred and fifteen subjects with RH were sequentially included. RH was defined as a level of office blood pressure (BP) é 140/90 mmHg in subjects treated with at least 3 antihypertensive drugs (one of them a diuretic) during at least 2 months and with good compliance. The usual protocol of the Hypertension Unit and ambulatory BP monitoring during 24 h was applied on all the subjects, and an echocardiogram with Doppler was performed on 68 of them. Subjects with a daytime BP < 135/85 mmHg were defined as pseudoresistant hypertensive. Results: The mean age (standard deviation) was 61 (10) years, and 50 patients (44%) were males. The mean office BP was 166/95 (16/9) mmHg. The daytime BP was 141/83 (15/12) mmHg. Out of the patients, 88 (76.5%) had a family history of cardiovascular disease; 64 (56%) of obesity; 43 (37%) of hypercholesterolemia; 34 (30%) of low high-density lipoprotein cholesterol; 32 (28%) of diabetes mellitus; and 63 (55%) were sedentary. The prevalence of MS was 54%; target organ damage was found in 70 cases (61%), and 44 (38%) had other associated clinical conditions. Out of the subjects with echocardiography, 49 (72%) presented left ventricular hypertrophy. Pseudoresistant hypertension was found in 31 (27%). There were no significant differences in clinical variables between subjects with RH or psudoresistant hypertension. Conclusions: Patients with RH had high cardiovascular risk, independent of a good control of ambulatory BP, because of the high prevalence of cardiovascular risk factors and MS. An optimal antihypertensive treatment including specific programs for the control of obesity and a sedentary lifestyle are necessary in the management of these patients