Cetoacidosis diabética grave, fracaso renal agudo y deshidratación por canagliflozina en paciente con diabetes mellitus tipo 2: presentación clínica atípica / Severe diabetic ketoacidosis, acute kidney injury and dehydration due to canagliflozin in type 2 diabetes mellitus patient: Atypical clinical presentation

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Nocturnal hypotension in patients after ischemic stroke: does it really matter?

BACKGROUND: We aimed to evaluate the presence of nocturnal hypotension (NHP) in ischemic stroke (IS) survivors using ambulatory blood pressure (BP) monitoring (ABPM). METHODS: We included fifty consecutive patients presenting at our outpatient clinic for review and who had been discharged for IS in the previous six months. 24-h ABPM was performed with Spacelab 90207 monitor. NHP episodes were considered those values on which the mean arterial pressure (MAP)<70mm Hg. Patients were divided into two groups according to the presence or absence of NHP. RESULTS: We studied 31 men and 19 women, mean age 68±11years. Episodes of NHP were observed in 21 patients (42%). There were no significant differences with regard to clinical characteristics between groups. With regard to BP, patients with NHP had significantly lower mean 24-hour BPs, mean daytime BPs and mean nighttime BPs. Dipper pattern occurred more often in patients with NHP, although differences were only statistically significant in the diastolic BP values. Mean office readings were 142±26/77±13mm Hg (149±26 versus 133±20; P=0.06; 82±12 versus 71±12; P=0.008). None of the patients showed office SBP <90mmHg and only four had office DBP <60mmHg. CONCLUSIONS: Episodes of NHP in patients with recent IS are common and difficult to detect with clinical cuff measurements. It is necessary to redefine the target BP levels in secondary stroke prevention, possibly because we are subjecting our patients to increased risk of NHP and cerebral hypoperfusion.

Ambulatory blood pressure monitoring in stroke survivors: do we really control our patients?

BACKGROUND: We aim to evaluate prospectively the long-term changes of blood pressure (BP) in stroke survivors using ambulatory BP monitoring (ABPM) and compare them with the clinic conventional measurements. METHODS: We studied 101 patients who were admitted within 24h after stroke onset. To study the circadian rhythm of BP a continuous BP monitor (Spacelab 90207) was used. After six and twelve months follow-up a new ABPM was undertaken. Data were analyzed using the SSPS 12.0. RESULTS: We studied 62 males and 39 females, mean age: 70.9+/-10.7 years. We included 88 ischemic strokes and 13 hemorrhagic strokes. In the acute phase mean 24 h BPs were 136+/-19/78.6+/-11.4 mm Hg. The normal diurnal variation in BP was abolished in 88 (87.1%) patients. After six months, 74 patients were assessed. Mean office readings were 137.5+/-23.8/76.4+/-11.4 mm Hg, and high systolic BPs and diastolic BPs were found in 37% and 11% of the subjects respectively. ABPM revealed a mean BP of 118.5+/-20.1/70.3+/-8.6 (p<0.0001). In 57 (76.9%), the normal BP pattern remained abolished (p<0.001). After one year, 63 patients were assessed. Mean office readings were 130.8+/-26.3/77.6+/-9.3 mm Hg, and high systolic BPs and diastolic BPs were found in 23.8% and 10% of the subjects respectively. Mean 24 h BPs were 117+/-12.5/69.7+/-7.2 (p<0.001). The normal diurnal variation in BP was now abolished in 47 (74.6%) patients (p<0.001). CONCLUSION: Survivors of stroke, both hypertensive and non-hypertensive patients, present a chronic disruption of circadian rhythm of BP. Conventional clinical recordings are an unreliable method of controlling these patients and ABPM should be routinely performed in this population.

[Screening for high blood pressure among hypertensive and metabolic syndrome patients' children]. / Cribado de hipertensión arterial en hijos de pacientes diagnosticados de hipertensión arterial y síndrome metabólico.

BACKGROUND AND OBJECTIVE: Essential arterial hypertension (HTA) and metabolic syndrome (MS) are highly prevalent disorders, with familiar aggregation and important mortality. Late HTA diagnosis is made in a high percentage of people. The aim of this study was to diagnose HTA among hypertensive and MS patients' children. PATIENTS AND METHOD: Hypertensive and MS patients attended at primary and hypertension clinics were studied. Hypertensive patients collaborated to get their children's blood pressure measured. If high blood pressure was detected, the patients' children were referred to their family doctor in order to confirm the diagnosis of HTA. RESULTS: 118 hypertensive patients were studied. Blood pressure was measured in 117 hypertensive patients' children. Thirty-two of them (27.4%) had blood pressure > or = 130/85 mmHg. Eventually, 20 of them (62.5%) were diagnosed of HTA. 17% of the hypertensive patients' children studied were newly diagnosed of HTA. CONCLUSIONS: Screening for HTA among hypertensive and MS patients' children is useful for early diagnosis or HTA and it is cost-effective.

Cribado de hipertensión arterial en hijos de pacientes diagnosticados de hipertensión arterial y síndrome metabólico / Screening for high blood pressure among hypertensive and metabolic syndrome patients' children

Fundamento y objetivo: La hipertensión arterial (HTA) esencial es una enfermedad prevalente que origina una morbimortalidad elevada y tiene una agregación familiar. Un porcentaje importante de pacientes hipertensos se diagnostican tardíamente. El objetivo del estudio es el diagnóstico temprano de pacientes con HTA. Pacientes y método: Estudio de intervención en hijos de pacientes diagnosticados de HTA y síndrome metabólico (SM) que acuden a consultas. Con la colaboración de los padres, se consigue tomar la presión arterial (PA) de sus hijos. Una consulta posterior a su médico de atención primaria permite confirmar o descartar el diagnóstico de HTA en los hijos que presentaron cifras elevadas de PA. Resultados: Seleccionamos a 118 padres hipertensos con SM. Se ha recibido el cuaderno de recogida de datos de 117 hijos. Treinta y dos de ellos (27,4%) presentaban cifras de PA $ 130/85 mmHg y en este grupo se diagnosticó de HTA a 20 pacientes (62,5%). Se ha detectado un 17% de hipertensos no conocidos. Conclusiones: El cribado de hijos de hipertensos con SM que acuden a las consultas es rentable y permite el diagnóstico temprano de la HTA

Background and objective: Essential arterial hypertension (HTA) and metabolic syndrome (MS) are highly prevalent disorders, with familiar aggregation and important mortality. Late HTA diagnosis is made in a high percentage of people. The aim of this study was to diagnose HTA among hypertensive and MS patients' children. Patients and method: Hypertensive and MS patients attended at primary and hypertension clinics were studied. Hypertensive patients collaborated to get their children's blood pressure measured. If high blood pressure was detected, the patients' children were referred to their family doctor in order to confirm the diagnosis of HTA. Results: 118 hypertensive patients were studied. Blood pressure was measured in 117 hypertensive patients' children. Twirty-two of them (27.4%) had blood pressure $ 130/85 mmHg. Eventually, 20 of them (62.5%) were diagnosed of HTA. A 17% of the hypertensive patients' children studied were newly diagnosed of HTA. Conclusions: Screening for HTA among hypertensive and MS patients' children is useful for early diagnosis or HTA and it is cost-effective

[Ambulatory blood pressure monitoring to study white coat syndrome in patients with hypertension seen in primary care]. / Estudio mediante monitorización ambulatoria de la presión arterial del efecto de bata blanca en hipertensos tratados y controlados en atención primaria.

INTRODUCTION AND OBJECTIVES: The white coat phenomenon is said to occur when the difference between systolic/diastolic blood pressure measured during visits to the doctor's office and in ambulatory recordings is greater than 20/10. These absolute differences, known as the white coat effect, may lead to normotensive patients being classified as having white coat hypertension (WCH). We used ambulatory blood pressure monitoring (ABPM) to monitor the prevalence and response (white coat effect, white coat hypertension or white coat phenomenon) in patients during pharmacological treatment for grade 1 or 2 hypertension, and 4 weeks after treatment was suspended under medical supervision. PATIENTS AND METHOD: Ambulatory blood pressure monitoring was used in 70 patients with hypertension that was well controlled with treatment. Blood pressure was recorded during treatment (phase 1) and 4 weeks after treatment was stopped (phase 2). RESULTS: 18 (26%) of the 70 patients did not participate in phase 2 because when medication was withdrawn, their blood pressure values became unacceptable and it was necessary to restart treatment. The white coat effect was significantly stronger in phase 1, and the prevalence of white coat phenomenon and white coat hypertension did not differ significantly between phases. At the end of phase 2 the prevalence of white coat hypertension was 33%. CONCLUSIONS: Withdrawal of antihypertensive medication in patients with well controlled grade 1 or grade 2 hypertension did not significantly modify the prevalence of white coat phenomenon or white coat hypertension. The white coat effect was greater while patients were on pharmacological treatment. One third of our patients were considered to have been mistakenly diagnosed as having hypertension.

[Influence on white coat effect and heart rate of antihypertensive agents used at a urban health center]. / Influencia sobre el efecto de bata blanca y la frecuencia cardiaca de los fármacos antihipertensivos usados en un centro de salud urbano.

BACKGROUND: We name white coat effect (WCE) to the difference between the systolic arterial pressure (SAP)/diastolic AP (DAP) of consulting room and the ambulatory obtained one with ambulatory blood pressure monitoring (ABPM). In our work we analyzed by means of ABPM, the influence of the antihypertensive medicaments on the WCE and the cardiac frequency of use of the antihypertensive ones. DESIGN: Almost experimental study (with a period before and a period later) and descriptive. SETTING: Primary care. Urban health centre. PARTICIPANTS AND MAIN MEASUREMENTS: Studies of ABPM were realized to 70 hypertense essential patients with good control of the arterial pressure after pharmacological treatment before suspending the antihypertensive medication (phase 1) and to the 4 weeks of leaving the treatment (phase 2). RESULT: Or all 70 hypertense patients. 18 (26%) did not manage to carry out the second ABPM (unbalanced during the wash) that forced to re-introduce the antihypertensive medicaments. The WCE systolic and diastolic is significantly more raised in patient males in treatment with diuretics with regard to which they use other pharmacological groups. The CF is significantly more raised in patient women who do not take blockaders thread (they use another group) with regard to they take it. In the blockaders alpha the CF is significantly more raised in the women who use it with regard to that they use antihypertensive other one. Of all 52 patients who were realized double ABPM, WCE was significantly top in phase 1 that in 2. CONCLUSION: In hypertense controlled patients, the diuretics (in males) are the pharmacological group that of more significant way influences on WCE, them raising with regard to the patients who take antihypertensive other one, being in influence the opposite on CF. The women with blockaders thread present values of CF significantly lower than those who use another antihypertensive medication; happening the inverse thing the blockaders alpha. In our consulting room exists a inadequate use of the antihypertensive ones. The WCE is significantly mayor when is submitted to pharmacological treatment.