Diagnostic utility of new short versions of AUDIT to detect binge drinking in undergraduate students / La utilidad diagnóstica de las nuevas versiones abreviadas del AUDIT para detectar "Binge drinking" en universitarios

This study examines the usefulness of two AUDIT adaptations with a sample of 907 undergraduate alcohol users. On the one hand, it includes the AR2i that encompasses revised A2r and A3r consumption items, and on the other hand—in addition to the two former items—the inclusion of items 4, 8, and 9, which evaluate consequences. The results indicate that both adaptations identify BD more precisely than the traditional scales (AUDIT and AUDIT-C), but the usefulness of each will depend on the clinical purpose they are given. In environments where time is a key factor in detecting high-risk consumption it will be more appropriate to use AR2i, which evaluates the pattern of consumption, whereas to provide feedback to the young person, to increase their awareness, and to highlight the need for change it would be advisable to use the new combination of five items. (AU)

Este estudio examina la utilidad de dos adaptaciones del AUDIT en una muestra de 907 universitarios consumidores de alcohol. Por un lado se incluye el AR2i, que contiene los ítems de consumo A2r y A3r, y por otro lado la incluida en este trabajo, que suma a los ítems anteriores –A2r y A3r– otros tres sobre consecuencias 4, 8 y 9. Los resultados indican que ambas adaptaciones identifican a los BD de manera más precisa que las escalas tradicionales (AUDIT y AUDIT-C), dependiendo su uso de la finalidad clínica con la que se utilicen. En entornos en los que el tiempo es un factor clave para detectar consumos de riesgo será más adecuado utilizar el AR2i, centrado en el patrón de consumo. Si se quiere proporcionar un feedback al joven que permita poner en evidencia la necesidad de cambio y con ello trabajar su toma de conciencia, sería más adecuado utilizar la nueva combinación de 5 ítems. (AU)

Leishmaniose visceral em cães de assentamentos rurais / Visceral leishmaniasis in dogs from rural settlements

Nos assentamentos rurais há maiores concentrações de reservatórios e vetores da leishmaniose visceral canina (LVC) devido às transformações ambientais resultantes da ação antrópica pela ocupação do território, no entanto, não há estudos no Brasil acerca de informações epidemiológicas da LVC em assentamentos rurais. O objetivo do presente trabalho foi determinar a soroprevalência para Leishmania sp. em cães de assentamentos rurais, bem como identificar os fatores de risco associados a infecção. Foram utilizados 306 cães e o diagnóstico sorológico da LVC foi realizado através do ELISA S7. Dos 306 cães investigados, 118 apresentaram anticorpos anti-Leishmania sp., resultando em frequência de 38,6%. Idade de 12 - 24 meses (OR=2,97), idade de 24--48 meses (OR=4,83), idade de 4-6 anos (OR=4,40), idade >6 anos (OR=3,62), contato com aves (OR=1,67) e sexo (fêmea) (OR=1,97) foram apontados como fatores de risco para LVC. Cães de assentamentos rurais do semiárido paraibano apresentaram frequência elevada de anticorpos anti-Leishmania sp., o que torna a população desses locais susceptíveis à infecção. Isso evidencia a necessidade de alerta aos órgãos de vigilância epidemiológica para estabelecer medidas de prevenção e controle dessa zoonose, incluindo ações educacionais e sanitárias nesses assentamentos, já que os mesmos estão situados em áreas com características propícias à instalação da LVC.(AU)

In rural settlements there are higher concentrations of reservoirs and vectors of canine visceral leishmaniasis (CVL) due to environmental changes resulting from human action by occupation of the territory, however, there are no surveys in Brazil on epidemiological information of CVL in these areas. The aim of this study was to determine the seroprevalence of Leishmania sp. in dogs from rural settlements, as well as to identify the risk factors associated with infection. A total of 306 dogs were tested, and the serological diagnosis of CVL was performed by ELISA S7. Of the 306 dogs, 118 presented anti-Leishmania sp. antibodies., resulting in a frequency of 38.6%. The risk factors identified for CVL seropositivity were: age of 12-24 months (OR=2.97), age of 24-48 months (OR=4.83), age of 4-6 years (OR=4.40), age >6 years (OR=3.62), contact with poultry (OR=1.67) and gender (female) (OR=1.97). Dogs from rural settlements in the semiarid of Paraiba showed high anti-Leishmania sp. antibody frequency, what makes the population of those settlements susceptible to infection. This highlights for the need to alert the epidemiological surveillance agencies to stablish prevention and control methods for that zoonosis, including educational and health activities on these settlements, as they are located in areas with favorable characteristics for CVL installation.(AU)

The utility of the Alcohol Use Disorders Identification Test (AUDIT)for the analysis of binge drinking in university students.

BACKGROUND: The increasingly precise conceptualization of Binge Drinking (BD), along with the rising incidence of this pattern of intake amongst young people, make it necessary to review the usefulness of instruments used to detect it. Little evidence exists regarding effectiveness of the AUDIT, AUDIT-C and AUDIT-3 in the detection of BD. This study evaluates their utility in a sample of university students, revealing the most appropriate cut-off points for each sex. METHODS: All students self-administered the AUDIT and completed a self-report of their alcohol consumption. A Two-step cluster analysis differentiated 5 groups of BD in terms of: the quantity consumed, the frequency of BD over the past six months and gender. A ROC curve adjusted cut-off points for each case. RESULTS: 862 university students (18-19 years-old/59.5% female), 424 (49.2%) from Valencia and 438 (50.8%) from Madrid, had cut-off points of 4 in AUDIT and 3 in AUDIT-C as a better fit. In all cases, the best classifier was AUDIT-C. Neither version properly classifies students with varying degrees of BD. CONCLUSIONS: All versions differentiate BD from non-BD, but none are able to differentiate between types of BD.

Relationship between clinical evaluation and ultrasound assessment of rheumatoid arthritis patients using a 12 joint score.

AIM: To identify if the use of a systematic ultrasound (US) evaluation has relevance in the determination of disease activity in rheumatoid arthritis patients on biological disease-modifying anti-rheumatic drug treatment. METHODS: A 12 joint US assessment was performed on the same day of the routine clinical examination. Both Grey-scale (GS) and Power Doppler (PD) were graded semi-quantitatively (0-3 scale). RESULTS: Forty-one patients were included. GS or PD > 0 were found in 24% and 3% of the ankles, 21% and 17% of the wrists, 19% and 9% of the second metacarpophalangeal joints (MCP), 7% and 2% of the third MCP, 6% and 0% of the knees and 5% and 0% of the elbows, respectively; tenosynovitis of the tibialis posterior was found in 19% of the ankles. Eight of the patients with Disease Activity Score of 28 joints (DAS28) ≤ 2.6 (n = 15) had an US score of 0. Twenty-seven joints (6.7%) had US evidence of synovitis but were not considered to be swollen; 10 (2.5%) were considered to be swollen but had no US evidence of synovitis. CONCLUSIONS: Using a 12 joint US assessment, a high proportion of patients with DAS28 < 2.6 were found to have inflammatory US activity, and a significant proportion of patients had evidence of tenosynovitis of the tibialis posterior, which may be difficult to clinically detect. A regular and standardized US assessment of RA patients is therefore warranted to complement clinical evaluation and better define disease activity.

The construction of arteriovenous fistula for hemodialysis in patients with chronic obstructive arterial disease in the upper limb.

OBJECTIVE: Describe the construction of arteriovenous fistula for hemodialysis in chronic renal patient on hemodialysis who presented chronic arterial obstruction in the upper limb. METHODS: A surgical procedure was performed on a patient with obstruction of the brachial artery in its proximal third. The procedure was carried out by the construction of a bypass with autologous vein between the proximal brachial and distal brachial arteries and the performing of an arteriovenous fistula with superficialized and anteriorized basilic vein, with anastomosis in the bypass at the same surgical procedure. RESULTS: There was good immediate result and arteriovenous fistula presented function for 43 months. CONCLUSIONS: Even when faced with chronic obstructive arterial disease in the arm, there is the possibility of creating a new arteriovenous fistula for hemodialysis.

Influence of chronic kidney disease and haemodialysis treatment on pharmacokinetics of nebivolol enantiomers.

AIM: The present study evaluated the pharmacodynamics and pharmacokinetics of nebivolol enantiomers in patients with chronic kidney disease (CKD) and in patients undergoing haemodialysis. METHODS: Forty-three adult patients were distributed into three groups: healthy volunteers and hypertensive patients with normal kidney function (n = 22); patients with stage 3 and 4 CKD (n = 11); and patients with stage 5 CKD undergoing haemodialysis (n = 10). The subjects received a single oral dose of 10 mg racemic nebivolol. Serial blood samples were collected up to 48 h after administration of the drug and heart rate variation was measured over the same interval during the isometric handgrip test. The nebivolol enantiomers in plasma were analysed by liquid chromatography-tandem mass spectrometry. RESULTS: The pharmacokinetics of nebivolol is enantioselective, with a greater plasma proportion of l-nebivolol. CKD increased the area under the concentration-time curve (AUC) of l-nebivolol (6.83 ng.h ml(-1) vs. 9.94 ng.h ml(-1) ) and d-nebivolol (4.15 ng.h ml(-1) vs. 7.30 ng.h ml(-1) ) when compared with the control group. However, the AUC values of l-nebivolol (6.41 ng.h ml(-1) ) and d-nebivolol (4.95 ng.h ml(-1) ) did not differ between the haemodialysis and control groups. The administration of a single dose of 10 mg nebivolol did not alter the heart rate variation induced by isometric exercise in the investigated patients. CONCLUSIONS: Stage 3 and 4 CKD increases the plasma concentrations of both nebivolol enantiomers, while haemodialysis restores the pharmacokinetic parameters to values similar to those observed in the control group. No significant difference in heart rate variation induced by isometric exercise was observed between the investigated groups after the administration of a single oral dose of 10 mg nebivolol.

Effectiveness and long-term retention of anti-tumour necrosis factor treatment in juvenile and adult patients with juvenile idiopathic arthritis: data from Reuma.pt.

OBJECTIVES: Assess the effectiveness and safety of biologic therapy as well as predictors of response at 1 year of therapy, retention rate in biologic treatment and predictors of drug discontinuation in JIA patients in the Portuguese register of rheumatic diseases. METHODS: We prospectively collected patient and disease characteristics from patients with JIA who started biological therapy. Adverse events were collected during the follow-up period. Predictors of response at 1 year and drug retention rates were assessed at 4 years of treatment for the first biologic agent. RESULTS: A total of 812 JIA patients [65% females, mean age at JIA onset 6.9 years (s.d. 4.7)], 227 received biologic therapy; 205 patients (90.3%) were treated with an anti-TNF as the first biologic. All the parameters used to evaluate disease activity, namely number of active joints, ESR and Childhood HAQ/HAQ, decreased significantly at 6 months and 1 year of treatment. The mean reduction in Juvenile Disease Activity Score 10 (JADAS10) after 1 year of treatment was 10.4 (s.d. 7.4). According to the definition of improvement using the JADAS10 score, 83.3% respond to biologic therapy after 1 year. Fourteen patients discontinued biologic therapies due to adverse events. Retention rates were 92.9% at 1 year, 85.5% at 2 years, 78.4% at 3 years and 68.1% at 4 years of treatment. Among all JIA subtypes, only concomitant therapy with corticosteroids was found to be univariately associated with withdrawal of biologic treatment (P = 0.016). CONCLUSION: Biologic therapies seem effective and safe in patients with JIA. In addition, the retention rates for the first biologic agent are high throughout 4 years.

Using the Juvenile Arthritis Disease Activity Score based on erythrocyte sedimentation rate or C-reactive protein level: results from the Portuguese register.

OBJECTIVE: Our aims were to evaluate the correlation between Juvenile Arthritis Disease Activity Score 27-joint reduced count (JADAS27) with erythrocyte sedimentation rate (ESR) and JADAS27 with C-reactive protein (CRP) scores and to test the agreement of both scores on classifying each disease activity state. We also aimed at verifying the correlation of the 2 scores across juvenile idiopathic arthritis (JIA) categories and to check the correlation between JADAS27-ESR and clinical JADAS27 (JADAS27 without ESR). METHODS: A nationwide cohort of patients with JIA registered in the Portuguese Register, Reuma.pt, was studied. JADAS27-CRP was adapted by replacing ESR with CRP level as the inflammatory marker. JADAS27-CRP was calculated similarly to JADAS27-ESR as the simple linear sum of its 4 components. Pearson's correlations and K statistics were used in the analyses. RESULTS: A total of 358 children had full data to calculate JADAS27; 65.4% were female and the mean ± SD disease duration was 11.8 ± 9.1 years. The correlation coefficient between JADAS27-ESR and JADAS27-CRP was 0.967 (P < 0.0001), although the correlation coefficient between ESR and CRP level was 0.335 (P < 0.0001). The strong correlation between JADAS27-ESR and JADAS27-CRP was maintained when compared within each JIA category. The agreement between JADAS27-ESR and JADAS27-CRP across the 4 activity states was very good, showing 91.1% of the observations in agreement; K = 0.867 (95% confidence interval 0.824-0.91). The correlation between JADAS27 with ESR and JADAS27 without ESR was high (r = 0.97, P < 0.0001). CONCLUSION: JADAS27 based on CRP level correlated closely with JADAS27-ESR across all disease activity states and JIA categories, indicating that both measures can be used in clinical practice. Moreover, the correlation of JADAS27 with and without ESR was also high, suggesting that this tool might be useful even in the absence of laboratorial measures.

Impacto de la obesidad abdominal y la presión arterial ambulatoria en el diagnóstico de hipertrofia ventricular izquierda en hipertensos no tratados / Impact of abdominal obesity and ambulatory blood pressure in the diagnosis of left ventricular hypertrophy in never treated hypertensives

Background and objectives: The principal objective was to assess the prevalence of left ventricular hypertrophy (LVH) in hypertensive, never treated patients, depending on adjustment for body surface or height. Secondary objectives were to determine geometric alterations of the left ventricle and to analyze the interdependence of hypertension and obesity to induce LVH. Patients and methods: Cross-sectional study that included 750 patients (387 men) aged 47 (13, SD) years who underwent ambulatory blood pressure (ABPM) monitoring and echocardiography. Results: The prevalence of LVH was 40.4% (303 patients), adjusted for body surface area (BSA, LVHBSA), and 61.7% (463 patients), adjusted for height2.7 ( ). In a multivariate logistic analysis, systolic BP24h, gender and presence of elevated microalbuminuria were associated with both LVHBSA and . Increased waist circumference was the strongest independent predictor of , but was not associated with LVHBSA. We found a significant interaction between abdominal obesity and systolic BP24h in . Concentric remodelling seems to be the most prevalent alteration of left ventricular geometry in early stages of hypertension (37.5%). Conclusions: The impact of obesity as predictor of LVH in never treated hypertensives is present only when left ventricular mass (LVM) is indexed to height2.7. Obesity interacts with systolic BP24h in an additive but not merely synergistic manner. Systolic BP24h is the strongest determinant of LVH when indexed for BSA (AU)

Fundamento y objetivos: El objetivo principal es determinar la prevalencia de la hipertrofia ventricular izquierda (HVI) en hipertensos no tratados previamente según ajuste por superficie corporal o talla. Los objetivos secundarios son establecer las alteraciones de la geometría ventricular y analizar la interdependencia entre hipertensión y obesidad para inducir HVI. Pacientes y método: Estudio transversal en 750 sujetos (387 varones) con una edad media de 47 años (DE 13) a los que se les practicó monitorización ambulatoria de la presión arterial y ecocardiografía. Resultados: La prevalencia de HVI fue del 40,4% (303 pacientes) ajustando por superficie corporal (HVISC), y del 61,7% (463 pacientes) ajustando por talla 2,7 (HVItalla2,7). En un análisis logístico multivariante, la PA sistólica de 24 h, el sexo y la presencia de microalbuminuria elevada se asociaron tanto con HVISC como con HVItalla2,7. La obesidad abdominal fue el mayor predictor independiente de HVItalla2,7, pero no se asoció a HVISC. Encontramos una interacción significativa entre obesidad abdominal y PA sistólica de 24 h en la HVItalla2,7. El remodelado concéntrico parece ser la alteración más frecuente de la geometría ventricular en estadios precoces de hipertensión (37,5%). Conclusiones: El impacto de la obesidad como predictor de HVI en hipertensos previamente no tratados solo tiene lugar cuando la masa ventricular izquierda se ajusta por talla 2,7. La obesidad interacciona con la PA sistólica de 24 h de manera aditiva, pero no meramente sinergística. La PA sistólica de 24 h es el mayor determinante de la HVI cuando se ajusta por superficie corporal (AU)

Impact of abdominal obesity and ambulatory blood pressure in the diagnosis of left ventricular hypertrophy in never treated hypertensives.

BACKGROUND AND OBJECTIVES: The principal objective was to assess the prevalence of left ventricular hypertrophy (LVH) in hypertensive, never treated patients, depending on adjustment for body surface or height. Secondary objectives were to determine geometric alterations of the left ventricle and to analyze the interdependence of hypertension and obesity to induce LVH. PATIENTS AND METHODS: Cross-sectional study that included 750 patients (387 men) aged 47 (13, SD) years who underwent ambulatory blood pressure (ABPM) monitoring and echocardiography. RESULTS: The prevalence of LVH was 40.4% (303 patients), adjusted for body surface area (BSA, LVHBSA), and 61.7% (463 patients), adjusted for height(2.7) (LVHheight(2.7)). In a multivariate logistic analysis, systolic BP24h, gender and presence of elevated microalbuminuria were associated with both LVHBSA and LVHheight(2.7). Increased waist circumference was the strongest independent predictor of LVHheight(2.7), but was not associated with LVHBSA. We found a significant interaction between abdominal obesity and systolic BP24h in LVHheight(2.7). Concentric remodelling seems to be the most prevalent alteration of left ventricular geometry in early stages of hypertension (37.5%). CONCLUSIONS: The impact of obesity as predictor of LVH in never treated hypertensives is present only when left ventricular mass (LVM) is indexed to height(2.7). Obesity interacts with systolic BP24h in an additive but not merely synergistic manner. Systolic BP24h is the strongest determinant of LVH when indexed for BSA.

Development and validation of an automated step ergometer.

Laboratory ergometers have high costs, becoming inaccessible for most of the population, hence, it is imperative to develop affordable devices making evaluations like cardiorespiratory fitness feasible and easier. The objective of this study was to develop and validate an Automated Step Ergometer (ASE), adjusted according to the height of the subject, for predicting VO2max through a progressive test. The development process was comprised by three steps, the theoretical part, the prototype assembly and further validation. The ASE consists in an elevating platform that makes the step at a higher or lower level as required for testing. The ASE validation was obtained by comparing the values of predicted VO2max (equation) and direct gas analysis on the prototype and on a, treadmill. For the validation process 167 subjects with average age of 31.24 ± 14.38 years, of both genders and different degrees of cardiorespiratory fitness, were randomized and divided by gender and training condition, into untrained (n=106), active (n=24) and trained (n=37) subjects. Each participant performed a progressive test on which the ASE started at the same height (20 cm) for all. Then, according to the subject's height, it varied to a maximum of 45 cm. Time in each stage and rhythm was chosen in accordance with training condition from lowest to highest (60-180 s; 116-160 bpm, respectively). Data was compared with the student's t test and ANOVA; correlations were tested with Pearson's r. The value of α was set at 0.05. No differences were found between the predicted VO2max and the direct gas analysis VO2max, nor between the ASE and treadmill VO2max (p= 0.365) with high correlation between ergometers (r= 0.974). The values for repeatability, reproducibility, and reliability of male and female groups measures were, respectively, 4.08 and 5.02; 0.50 and 1.11; 4.11 and 5.15. The values of internal consistency (Cronbach's alpha) among measures were all >0.90. It was verified that the ASE prototype was appropriate for a step test, provided valid measures of VO2max and could therefore, be used as an ergometer to measure cardiorespiratory fitness.

Phase classification by mean shift clustering of multispectral materials images.

A mean-shift clustering (MSC) algorithm is introduced as a valuable alternative to perform materials phase classification from multispectral images. As opposed to other multivariate statistical techniques, such as factor analysis or principal component analysis (PCA), clustering techniques directly assign a class label to each pixel, so that their outputs are phase segmented images, i.e., there is no need for an additional segmentation algorithm. On the other hand, as compared to other clustering procedures and classification methods, such as segmentation by thresholding of multiple spectral components, MSC has the advantages of not requiring previous knowledge of the number of data clusters and not assuming any shape for these clusters, i.e., neither the number nor the composition of the phases must be previously known. This makes MSC a particularly useful tool for exploratory research, assisting phase identification of unknown samples. Visualization and interpretation of the results are also simplified, since the information content of the output image does not depend on the particular choice of the content of the color channels.We applied MSC to the analysis of two sets of X-ray maps acquired in scanning electron microscopes equipped with energy-dispersive detection systems. Our results indicate that MSC is capable of detecting additional phases, not clearly identified through PCA or multiple thresholding, with a very low empirical reject rate.

Relación entre la presión arterial central y periférica con la masa ventricular izquierda en hipertensos / Relationship of central and peripheral blood pressure to left ventricular mass in hypertensive patients

Introducción y objetivos. Valorar la posible relación de la presión arterial central con la masa ventricular izquierda. Métodos. Estudio observacional transversal en 392 pacientes con hipertensión arterial sin tratamiento farmacológico previo. Se valoraron las presiones clínicas, ambulatorias de 24 h y centrales (medidas por tonometría de aplanamiento) y se calculó el índice de masa del ventrículo izquierdo por ecocardiografía. Resultados. Todos los valores de presión de 24 h tienen mejor relación en el análisis de regresión múltiple con el índice de masa del ventrículo izquierdo que los respectivos de presión clínica y central tras corregir por edad, sexo y síndrome metabólico. La correlación fue siempre mayor con las cifras de presión sistólicas que con las diastólicas en las tres determinaciones. La correlación del índice de masa del ventrículo izquierdo con la presión sistólica de 24 h fue superior a la que presentaba con las presiones sistólicas clínica (p < 0,002) y central (p < 0,002). La variación en las cifras de presión sistólica de 24 h son las que producen un incremento mayor en el índice de masa del ventrículo izquierdo (p < 0,001). Conclusiones. El índice de masa del ventrículo izquierdo se correlaciona más con los valores de presión sistólica ambulatoria de 24 h que con las demás medidas de la presión arterial, incluidas todas las medidas de presión central. La medición de la presión arterial central no permite identificar mejor a los pacientes con hipertrofia del ventrículo izquierdo (AU)

Introduction and objectives. The purpose of the present study was to assess the relationship of central and peripheral blood pressure to left ventricular mass. Methods. Cross-sectional study that included 392 never treated hypertensive individuals. Measurement of office, 24-h ambulatory, and central blood pressure (obtained using applanation tonometry) and determination of left ventricular mass by echocardiography were performed in all patients. Results. In a multiple regression analysis, with adjustment for age, gender and metabolic syndrome, 24-h blood pressure was more closely related to ventricular mass than the respective office and central blood pressures. Systolic blood pressures always exhibited a higher correlation than diastolic blood pressures in all 3 determinations. The correlation between left ventricular mass index and 24-h systolic blood pressure was higher than that of office (P<.002) or central systolic blood pressures (P<.002). Changes in 24-h systolic blood pressure caused the greatest variations in left ventricular mass index (P<.001). Conclusions. In our population of untreated middle-aged hypertensive patients, left ventricular mass index is more closely related to 24-h ambulatory blood pressure than to office or central blood pressure. Central blood pressure does not enable us to better identify patients with left ventricular hypertrophy (AU)

Relationship of central and peripheral blood pressure to left ventricular mass in hypertensive patients.

INTRODUCTION AND OBJECTIVES: The purpose of the present study was to assess the relationship of central and peripheral blood pressure to left ventricular mass. METHODS: Cross-sectional study that included 392 never treated hypertensive individuals. Measurement of office, 24-h ambulatory, and central blood pressure (obtained using applanation tonometry) and determination of left ventricular mass by echocardiography were performed in all patients. RESULTS: In a multiple regression analysis, with adjustment for age, gender and metabolic syndrome, 24-h blood pressure was more closely related to ventricular mass than the respective office and central blood pressures. Systolic blood pressures always exhibited a higher correlation than diastolic blood pressures in all 3 determinations. The correlation between left ventricular mass index and 24-h systolic blood pressure was higher than that of office (P<.002) or central systolic blood pressures (P<.002). Changes in 24-h systolic blood pressure caused the greatest variations in left ventricular mass index (P<.001). CONCLUSIONS: In our population of untreated middle-aged hypertensive patients, left ventricular mass index is more closely related to 24-h ambulatory blood pressure than to office or central blood pressure. Central blood pressure does not enable us to better identify patients with left ventricular hypertrophy.

Respuesta: Hipertensión arterial refractaria. ¿Cuál es la mejor opción? / No disponible

No disponible

Spironolactone and doxazosin treatment in patients with resistant hypertension.

INTRODUCTION AND OBJECTIVES: The aim of this study was to evaluate the use of spironolactone and doxazosin as treatment for patients with resistant hypertension. METHODS: This retrospective study involved 181 outpatients with resistant hypertension (defined as a failure of blood pressure [BP] control despite treatment with three drugs, one of which was a diuretic) who received additional spironolactone (n=88) or doxazosin (n=93). RESULTS: Mean systolic BP in the spironolactone group fell by 28 mmHg (95% confidence interval [CI], 24-32 mmHg; P< .001) and mean diastolic BP fell by 12 mmHg (95% CI, 9-14 mmHg; P< .001). The corresponding falls in the doxazosin group were 16 mmHg (95% CI, 13-20 mmHg; P< .001) and 7 mmHg (95% CI, 5-9 mmHg; P< .001), respectively. The decrease was significantly greater with spironolactone for both systolic (P< .001) and diastolic (P=.003) pressures. At the end of follow-up, 30% of all patients had achieved BP control, with control being more frequent with spironolactone (39%) than doxazosin (23%; P=.02). Multivariate logistic regression analysis showed that the only factors that significantly influenced the achievement of BP control were diabetes (odds ratio=0.17; 95% CI, 0.08-0.39; P< .001) and baseline systolic BP <165 mmHg (odds ratio=2.56; 95% CI, 1.11-5.90; P=.03). CONCLUSIONS: In patients with resistant hypertension, the addition of either spironolactone or doxazosin resulted in a significant decrease in BP, though the decrease appeared to be greater with spironolactone. The presence of diabetes complicated BP control.

Uso de espironolactona o doxazosina en pacientes con hipertensión arterial refractaria / Spironolactone and Doxazosin Treatment in Patients With Resistant Hypertension

Introducción y objetivos. Valorar el uso de espironolactona o doxazosina en el tratamiento de pacientes con hipertensión refractaria (HTAR). Métodos. Estudio retrospectivo comparativo de 181 pacientes con HTAR (pacientes tratados con tres fármacos, uno de ellos diurético, sin alcanzar el control de la presión arterial [PA]) a quienes se añadió espironolactona (88 casos) o doxazosina (93 casos). Resultados. La PA sistólica (PAS) se redujo 28 mmHg (intervalo de confianza [IC] del 95%, 24-32 mmHg; p < 0,001), y la PA diastólica (PAD), 12 mmHg (IC del 95%, 9-14 mmHg; p < 0,001) en los tratados con espironolactona, y 16 mmHg (IC del 95%, 13-20 mmHg; p < 0,001) y 7 mmHg (IC del 95%, 5-9 mmHg; p < 0,001), respectivamente con doxazosina. La espironolactona causó mayor descenso de la PAS (p < 0,001) y la PAD (p = 0,003). Al final del periodo de seguimiento, el 30% de todos los pacientes consiguieron el control de la PA; el control fue mayor con espironolactona (39%) que con doxazosina (23%) (p = 0,02). Al realizar una análisis de regresión logística, sólo la diabetes mellitus (odds ratio multivariable [ORm] = 0,17; IC del 95%, 0,08-0,39; p < 0,001), y la PAS inicial < 165 mmHg (ORm = 2,56; IC del 95%, 1,11-5,90; p = 0,03) tenían influencia significativa en alcanzar el control de la PA. Conclusiones. En los pacientes con hipertensión refractaria, tanto al añadir espironolactona como doxazosina se consigue un significativo descenso de la PA, que parece ser mayor con espironolactona. La diabetes dificulta el control de la PA

Introduction and objectives. The aim of this study was to evaluate the use of spironolactone and doxazosin as treatment for patients with resistant hypertension. Methods. This retrospective study involved 181 outpatients with resistant hypertension (defined as a failure of blood pressure [BP] control despite treatment with three drugs, one of which was a diuretic) who received additional spironolactone (n=88) or doxazosin (n=93). results. Mean systolic BP in the spironolactone group fell by 28 mmHg (95% confidence interval [CI], 24-32 mmHg; P<.001) and mean diastolic BP fell by 12 mmHg (95% CI, 9-14 mmHg; P<.001). The corresponding falls in the doxazosin group were 16 mmHg (95% CI, 13-20 mmHg; P<.001) and 7 mmHg (95% CI, 5-9 mmHg; P<.001), respectively. The decrease was significantly greater with spironolactone for both systolic (P<.001) and diastolic (P=.003) pressures. At the end of follow-up, 30% of all patients had achieved BP control, with control being more frequent with spironolactone (39%) than doxazosin (23%; P=.02). Multivariate logistic regression analysis showed that the only factors that significantly influenced the achievement of BP control were diabetes (odds ratio=0.17; 95% CI, 0.08-0.39; P<.001) and baseline systolic BP <165 mmHg (odds ratio=2.56; 95% CI, 1.11-5.90; P=.03). Conclusions. In patients with resistant hypertension, the addition of either spironolactone or doxazosin resulted in a significant decrease in BP, though the decrease appeared to be greater with spironolactone. The presence of diabetes complicated BP control

Association between serum uric acid, metabolic syndrome and microalbuminuria in previously untreated essential hypertensive patients.

BACKGROUND AND OBJECTIVE: The aim of the study was to assess the association of serum uric acid levels with microalbuminuria -urinary albumin excretion (UAE)> or = 30mg/24h-. PATIENTS AND METHOD: Cross-sectional study in 429 (220 women) hypertensive, non diabetic, never treated patients (mean age: 47 years) with glomerular filtration rate > or =60ml/min/1.73m(2). RESULTS: The prevalence of microalbuminuria was 20.5%; 18% had hyperuricemia and 47% fulfilled the criteria for metabolic syndrome (MS). Baseline UAE correlated in the unvaried analysis to diastolic blood pressure, waist circumference, high-density lipoprotein cholesterol and uric acid. In multiple linear regression models, only MS (beta=0.113; p=0.03), and serum uric acid values (beta=0.04; p=0.05) were independently associated with logUAE, after adjustment for age and sex. Hyperuricemia (serum uric acid level > or =7.0mg/dl for men and > or =6.5mg/dl for women; odds ratio=2.18; 95% confidence interval, 1.21-3.92; p=0.010), and MS (odds ratio=2.16; 95% confidence interval, 1.32-3.53; p=0.002) were independently associated with a higher risk of microalbuminuria in multiple logistic regression analyses. The prevalence of microalbuminuria was 45.8% in patients with coexistent MS and hyperuricemia, as compared to 13.6% in hypertensive patients without it (p<0.001). In patients with concomitant MS and hyperuricemia the probability of being microalbuminuric was 3.7 times higher than in patients without those factors. CONCLUSION: Serum uric acid level is associated with microalbuminuria. Coexistence of MS and hyperuricemia in hypertensive patients increases almost 4 times the odds of being microalbuminuric.

Association between serum uric acid, metabolic syndrome and microalbuminuria in previously untreated essential hypertensive patients

Fundamento y objetivo: valorar la relación de lamicroalbuminuria —excreción urinaria de albumina (EUA) X30 mg/24h— con los valores de ácido úrico y la presencia de síndrome metabólico (SM). Pacientes y método: se ha realizado un estudio transversal de 429 pacientes hipertensos(220mujeres), con una edad media de 47años, sin tratamiento previo ni diabetes, y con filtrado glomerular igual o mayor que 60ml/min/1,73m2. Resultados: la prevalencia de microalbuminuria fue del 20,5%. El 18% presentaba hiperuricemia y el 47% SM. La EUA se correlaciono con la presión arterial diastólica, el perímetro de la cintura, los valores de colesterol unido a lipoproteínas de alta densidad y el ácido úrico. En un modelo de regresión lineal múltiple, sólo el SM(beta ¼ 0,113;p ¼ 0,03) y el ácido úrico (beta ¼ 0,04;p ¼ 0,05)se asociaron de forma independiente al logEUA. La hiperuricemia (ácido úrico Z7,0mg/dl en varones y Z6,5mg/dl en mujeres; odds ratio ¼ 2,18; intervalo de confianza del 95%,1,21–3,92;p ¼ 0,010) y la presencia de SM (odds ratio ¼ 2,16; intervalo de confianza del 95%,1,32–3,53;p ¼ 0,002) se asociaron de forma independiente con la microalbuminuria en un análisis deregresion logıstica. La prevalencia de microalbuminuria fue del 45,8% en pacientes con Smehiperuricemia, comparada con el 13,6% en pacientes sin dichos factores(po0,001). Los pacientes con hiperuricemia y SM tenían 3,7 mas posibilidades de presentar microalbuminuria que los pacientes sin esos factores. Conclusiones: en hipertensos no tratados la coexistencia de Smehiperuricemia aumenta casi 4 veces las posibilidades de presentar microalbuminuria

Background and objectiveThe aim of the study was to assess the association of serum uric acid levels with microalbuminuria —urinary albumin excretion (UAE)≥ 30mg/24h—.Patients and methodCross-sectional study in 429 (220 women) hypertensive, non diabetic, never treated patients (mean age: 47 years) with glomerular filtration rate ≥60ml/min/1.73m2.ResultsThe prevalence of microalbuminuria was 20.5%; 18% had hyperuricemia and 47% fulfilled the criteria for metabolic syndrome (MS). Baseline UAE correlated in the unvaried analysis to diastolic blood pressure, waist circumference, high-density lipoprotein cholesterol and uric acid. In multiple linear regression models, only MS (beta=0.113; p=0.03), and serum uric acid values (beta=0.04; p=0.05) were independently associated with logUAE, after adjustment for age and sex. Hyperuricemia (serum uric acid level ≥7.0mg/dl for men and ≥6.5mg/dl for women; odds ratio=2.18; 95% confidence interval, 1.21–3.92; p=0.010), and MS (odds ratio=2.16; 95% confidence interval, 1.32–3.53; p=0.002) were independently associated with a higher risk of microalbuminuria in multiple logistic regression analyses. The prevalence of microalbuminuria was 45.8% in patients with coexistent MS and hyperuricemia, as compared to 13.6% in hypertensive patients without it (p<0.001). In patients with concomitant MS and hyperuricemia the probability of being microalbuminuric was 3.7 times higher than in patients without those factors.ConclusionSerum uric acid level is associated with microalbuminuria. Coexistence of MS and hyperuricemia in hypertensive patients increases almost 4 times the odds of being microalbuminuric