MASked-unconTrolled hypERtension management based on office BP or on ambulatory blood pressure measurement (MASTER) Study: a randomised controlled trial protocol.

INTRODUCTION: Masked uncontrolled hypertension (MUCH) carries an increased risk of cardiovascular (CV) complications and can be identified through combined use of office (O) and ambulatory (A) blood pressure (BP) monitoring (M) in treated patients. However, it is still debated whether the information carried by ABPM should be considered for MUCH management. Aim of the MASked-unconTrolled hypERtension management based on OBP or on ambulatory blood pressure measurement (MASTER) Study is to assess the impact on outcome of MUCH management based on OBPM or ABPM. METHODS AND ANALYSIS: MASTER is a 4-year prospective, randomised, open-label, blinded-endpoint investigation. A total of 1240 treated hypertensive patients from about 40 secondary care clinical centres worldwide will be included -upon confirming presence of MUCH (repeated on treatment OBP <140/90 mm Hg, and at least one of the following: daytime ABP ≥135/85 mm Hg; night-time ABP ≥120/70 mm Hg; 24 hour ABP ≥130/80 mm Hg), and will be randomised to a management strategy based on OBPM (group 1) or on ABPM (group 2). Patients in group 1 will have OBP measured at 0, 3, 6, 12, 18, 24, 30, 36, 42 and 48 months and taken as a guide for treatment; ABPM will be performed at randomisation and at 12, 24, 36 and 48 months but will not be used to take treatment decisions. Patients randomised to group 2 will have ABPM performed at randomisation and all scheduled visits as a guide to antihypertensive treatment. The effects of MUCH management strategy based on ABPM or on OBPM on CV and renal intermediate outcomes (changing left ventricular mass and microalbuminuria, coprimary outcomes) at 1 year and on CV events at 4 years and on changes in BP-related variables will be assessed. ETHICS AND DISSEMINATION: MASTER study protocol has received approval by the ethical review board of Istituto Auxologico Italiano. The procedures set out in this protocol are in accordance with principles of Declaration of Helsinki and Good Clinical Practice guidelines. Results will be published in accordance with the CONSORT statement in a peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER: NCT02804074; Pre-results.

Rigidez arterial en sujetos normotensos e hipertensos: frecuencia en farmacias comunitarias / Arterial stiffness in normotensive and hypertensive subjects: Frequency in community pharmacies

Antecedentes y objetivo: La rigidez arterial (RA) es una lesión de órgano diana reconocida. El objetivo es determinar: 1) su frecuencia en farmacias comunitarias; 2) si sujetos con RA presentan más factores de riesgo CV, y 3) su dependencia de una definición ajustada por grupos de edad o valores fijos. Pacientes y método: Estudio observacional transversal en 32 farmacias comunitarias de la Comunidad Valenciana entre noviembre de 2015 y abril de 2016. La RA como velocidad de onda de pulso (VOP) se midió mediante un dispositivo validado semiautomático (Mobil-O-Graph(R), IEM), seguido de un cuestionario de 10 preguntas. Resultados: La edad media de los 1.427 participantes consecutivos fue 56,6 años. La proporción de pacientes con RA fue 17,4% (9,4% en normotensos, 28,3% en hipertensos) con ajuste por grupos de edad. La regresión logística multivariante mostró en normotensos una asociación de la RA con el sexo masculino, la obesidad, una mayor presión de pulso y la frecuencia cardiaca, y en hipertensos, con una mayor presión de pulso y una menor edad. Definiendo RA por VOP>10m/s, el 20,5% global (6,2% en normotensos, 40,2% en hipertensos) presentó RA. Se asoció a mayor edad y presión de pulso en normotensos e hipertensos. La concordancia de RA entre ambas definiciones fue del 74,6%. Conclusiones: La RA varió entre el 17,4 y el 20,5%. La RA ajustada por edad se asocia en normotensos a sexo masculino, presión de pulso, obesidad y frecuencia cardiaca, y en hipertensos, a mayor presión de pulso y menor edad. Los determinantes de RA medida como VOP>10m/s son mayor presión de pulso y mayor edad. Ambas definiciones de RA no son superponibles (AU)

Background and objective: Arterial stiffness (AS) is a well-recognized target organ lesion. This study aims to determine: 1) the frequency of AS in community pharmacies; 2) if stiffened subjects identified by brachial oscillometry have more CV risk factors than normal subjects, and 3) the dependence of stiffness on using either age-adjusted values or a fixed threshold. Patients and method: Observational, cross-sectional study in 32 community pharmacies of the Valencia Community, between November/2015 and April/2016. Stiffness was as pulse wave velocity (PWV) measured with a semi-automatic, validated device (Mobil-O-Graph(R), IEM), followed by a 10-item questionnaire. Results: Mean age of the 1,427 consecutive recruited patients was 56.6 years. Overall proportion of patients with AS was 17.4% with age-adjusted PWV (9.4% in normotensives, 28.3% in hypertensives). Multivariate logistic regression showed independent association of stiffness in normotensives with male gender, obesity, higher pulse pressure and heart rate, in hypertensives, with higher pulse pressure and lower age. AS was globally found in 20.5% of subjects, defining stiffness by PWV>10m/s (6.2% in normotensives, 40.2% in hypertensives). It was associated with higher age and pulse pressure in both groups. Concordance in classifying stiffness was 74.6%. Conclusions: Frequency of AS varied between 17.4-20.5%. Age-adjusted stiffness is associated in normotensives with male gender, pulse pressure, obesity and heart rate, in hypertensives with pulse pressure and inversely to age. Stiffness by 10m/s is determined by higher pulse pressure and higher age. Both definitions of PWV are not interchangeable (AU)

Arterial stiffness in normotensive and hypertensive subjects: Frequency in community pharmacies. / Rigidez arterial en sujetos normotensos e hipertensos: frecuencia en farmacias comunitarias.

BACKGROUND AND OBJECTIVE: Arterial stiffness (AS) is a well-recognized target organ lesion. This study aims to determine: 1) the frequency of AS in community pharmacies; 2) if stiffened subjects identified by brachial oscillometry have more CV risk factors than normal subjects, and 3) the dependence of stiffness on using either age-adjusted values or a fixed threshold. PATIENTS AND METHOD: Observational, cross-sectional study in 32 community pharmacies of the Valencia Community, between November/2015 and April/2016. Stiffness was as pulse wave velocity (PWV) measured with a semi-automatic, validated device (Mobil-O-Graph®, IEM), followed by a 10-item questionnaire. RESULTS: Mean age of the 1,427 consecutive recruited patients was 56.6 years. Overall proportion of patients with AS was 17.4% with age-adjusted PWV (9.4% in normotensives, 28.3% in hypertensives). Multivariate logistic regression showed independent association of stiffness in normotensives with male gender, obesity, higher pulse pressure and heart rate, in hypertensives, with higher pulse pressure and lower age. AS was globally found in 20.5% of subjects, defining stiffness by PWV>10m/s (6.2% in normotensives, 40.2% in hypertensives). It was associated with higher age and pulse pressure in both groups. Concordance in classifying stiffness was 74.6%. CONCLUSIONS: Frequency of AS varied between 17.4-20.5%. Age-adjusted stiffness is associated in normotensives with male gender, pulse pressure, obesity and heart rate, in hypertensives with pulse pressure and inversely to age. Stiffness by 10m/s is determined by higher pulse pressure and higher age. Both definitions of PWV are not interchangeable.

Hipertensión arterial y prediabetes / Arterial hypertension and prediabetes

Fundamento y objetivos: Valorar los factores que predisponen a la aparición de diabetes en hipertensos. Pacientes y método: Estudio longitudinal prospectivo en 2.588 hipertensos no diabéticos sin enfermedad cardiovascular previa, con una mediana de seguimiento (mediana-intervalo intercuartílico) de 3,4 (1,4-6,8) años, con seguimiento total de 15.053 pacientes/año. Resultados: Trescientos treinta y tres (13%) pacientes se convirtieron en diabéticos, con una tasa de conversión de 2,21 (intervalo de confianza del 95% [1,98-2,46]) 100/pacientes año. Se realizó un análisis de regresión de Cox con los factores que modificaban la aparición de diabetes. Al inicio del seguimiento los tres componentes del síndrome metabólico (excluyendo los valores de presión arterial y de glucemia) HR 1,69 (intervalo de confianza del 95%, 1,36-2,09), los antecedentes familiares de diabetes HR 1,49 (intervalo de confianza del 95%, 1,20-1,85) y especialmente la glucemia basal 110 mg/dl HR 7,84 (intervalo de confianza del 95%, 5,99-10,29) eran los factores mas importantes para la aparición de la diabetes. Ni las variaciones de peso ni el tratamiento con estatinas, betabloqueantes o diuréticos durante el seguimiento mostraron un incremento del riesgo, solo el buen control de la presión arterial al final del estudio redujo el riesgo de evolución a diabetes HR 0,74 (intervalo de confianza del 95%, 0,61-0,91). Conclusiones: En hipertensos los factores que predisponen a la aparición de diabetes se pueden identificar fácilmente al inicio del seguimiento: ser obeso, tener antecedentes familiares de diabetes y una glucemia ≥ 110 mg/dl multiplican notablemente el riesgo de ser diabético en unos pocos años (AU)

Background and objectives: The aim of this study was to assess the factors related to new diabetes in hypertensive. Patients and methods: This prospective follow-up study involved 2588 non-diabetic, hypertensive patients. The total follow-up was 15053 patient-years with a median of 3.4 years (interquartile interval 1.4-6.8). Results: During the follow-up 333 (13%) patients had new diabetes, with a conversion rate of 2.21 (95% confidence interval [CI], 1.98-2.46) 100/patients/year. In a Cox proportional hazard model including baseline characteristics and modifications during the follow up the three components of metabolic syndrome (excluding blood pressure and glucose values) HR 1.69 (95% CI, 1.36-2.09), family history of diabetes HR 1,49 (95% CI, 1,20-1,85) and baseline blood glucose ≥110 mg/dl HR 7.84 (95% CI, 5.99-10.29) were the most important factors related to new diabetes. Weight variation during the follow up, and statins, beta-bloquers or diuretic treatment did not increase the risk of new diabetes, blood pressure control at the end of study reduce the risk HR 0,74 (95% CI, 0.61-0.91). Conclusions: In hypertensive non-diabetic patients in primary prevention the factors related to new diabetes can easily identified at the beginning of follow up. Being obese, with family history of diabetes, and glucose values ≥110 mg/dl dramatically increase the risk of developing new diabetes (AU)

[Arterial hypertension and prediabetes]. / Hipertensión arterial y prediabetes.

BACKGROUND AND OBJECTIVES: The aim of this study was to assess the factors related to new diabetes in hypertensive. PATIENTS AND METHODS: This prospective follow-up study involved 2588 non-diabetic, hypertensive patients. The total follow-up was 15053 patient-years with a median of 3.4 years (interquartile interval 1.4-6.8). RESULTS: During the follow-up 333 (13%) patients had new diabetes, with a conversion rate of 2.21 (95% confidence interval [CI], 1.98-2.46) 100/patients/year. In a Cox proportional hazard model including baseline characteristics and modifications during the follow up the three components of metabolic syndrome (excluding blood pressure and glucose values) HR 1.69 (95% CI, 1.36-2.09), family history of diabetes HR 1,49 (95% CI, 1,20-1,85) and baseline blood glucose ≥110 mg/dl HR 7.84 (95% CI, 5.99-10.29) were the most important factors related to new diabetes. Weight variation during the follow up, and statins, beta-bloquers or diuretic treatment did not increase the risk of new diabetes, blood pressure control at the end of study reduce the risk HR 0,74 (95% CI, 0.61-0.91). CONCLUSIONS: In hypertensive non-diabetic patients in primary prevention the factors related to new diabetes can easily identified at the beginning of follow up. Being obese, with family history of diabetes, and glucose values ≥110 mg/dl dramatically increase the risk of developing new diabetes.

America's Cup yacht racing: race analysis and physical characteristics of the athletes.

The America's Cup is the oldest competing trophy in sport, yet little is known of the nature and intensity of racing or the physical characteristics of the athletes. In this study, aspects of the physical demands of America's Cup yacht racing were analysed, including the intensity of exercise and activity pattern of "grinding". Anthropometric data were collected from 92 professional male America's Cup sailors, and fitness data from a top-4 and a lower-7 ranking team during the 32nd America's Cup. Over the 135 races, mean race duration was 82 min (s = 9), with 20 tacks (s = 10) and 8 gybes (s = 3) per race. Grinding bouts were 5.5 s (s = 5.4; range: 2.2-66.3) long, with 143 exercise bouts per race and an exercise-to-rest ratio of 1:6. Mean and peak heart rate was 64% and 92% of maximum for all positions, with bowmen highest (71% and 96%). Grinders were taller, heavier, and stronger than all other positions. Body fat was similar between positions (13%, s = 4). The higher-standard team was stronger and had greater strength endurance, which probably contributed to their quicker manoeuvres. Intensity of exercise was dependent on the similarity of competing boats and the role of the athlete. The short duration and intermittent nature of grinding is indicative of predominantly anaerobic energy provision.