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1.
Curr Hypertens Rev ; 2020 Dec 10.
Artículo en Inglés | MEDLINE | ID: mdl-33305706

RESUMEN

INTRODUCTION: Silent coronary heart disease is frequently undetected in type 2 diabetes mellitus (DM2) and pre diabetes determined by glucose intolerance (GI). Pulse wave velocity (PWV) and albumin-creatinine ratio (ACR) have been considered markers of cardiovascular mortality, coronary heart disease and chronic renal failure. AIMS: To evaluate the incidence of coronary artery disease (CAD) and the relationship between urinary albumin-creatinine ratio, glomerular filtration rate (GFR) and PWV in type 2 DM with silent CAD. METHODS: We analyzed 92 individuals (44 male), 49 (60±7y) type 2 DM non-insulin dependents and 43 prediabetics (43±4y), with Grade I-II hypertension and no symptoms of CAD. All type 2 DM patients were under antidiabetic treatment with an A1C hemoglobin between 5.5 and 6.5%. Every patient underwent a myocardial perfusion SPECT scan. In those subjects with ischemic patterns, a coronary angiography was performed. In addition, a PWV, glomerular filtration rate, and ACR were evaluated. STATISTICS: mean±SEM, and ANOVA among groups. RESULTS: 48.59% of DM2 and 25.58% of GI patients had silent coronary artery disease. DM2 and GI patients with CAD had higher ACR and PWV and reduced GFR. DM2 and GI showed a negative relationship between GFR and ACR. Moreover, this relation was also observed in different levels of GFR (>60 ml/min and <60ml.min (p<0.05) in patients with CAD, suggesting a cardio-renal interaction in DM2. CONCLUSIONS: Higher PWV, lower GFR and ACR predict the incidence of CAD in DM2. Dysglycemic individuals also represent a group of higher risk for coronary artery disease with similar predictors showed in DM2. Diabetic and prediabetics, still develop renal microalbuminuria. Thus, PWV seems to represent a reliable marker of renal impairment and coronary artery disease.

2.
Sci Rep ; 10(1): 14131, 2020 08 24.
Artículo en Inglés | MEDLINE | ID: mdl-32839479

RESUMEN

The mechanisms underlying emotional alterations constitute a key research target in neuroscience. Emerging evidence indicates that these disruptions can be related to abnormal interoception (i.e., the sensing of visceral feelings), as observed in patients with cardiodynamic deficits. To directly assess these links, we performed the first multicenter study on emotion recognition and interoception in patients with hypertensive heart disease (HHD). Participants from two countries completed a facial emotion recognition test, and a subsample additionally underwent an interoception protocol based on a validated heartbeat detection task. HHD patients from both countries presented deficits in the recognition of overall and negative emotions. Moreover, interoceptive performance was impaired in the HHD group. In addition, a significant association between interoceptive performance and emotion recognition was observed in the control group, but this relation was abolished in the HHD group. All results survived after covariance with cognitive status measures, suggesting they were not biased by general cognitive deficits in the patients. Taken together, these findings suggest that emotional recognition alterations could represent a sui generis deficit in HHD, and that it may be partially explained by the disruption of mechanisms subserving the integration of neuro-visceral signals.

3.
High Blood Press Cardiovasc Prev ; 27(2): 165-174, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32215879

RESUMEN

INTRODUCTION: Measurement of central (aortic) systolic blood pressure has been shown to provide reliable information to evaluate target organ damage. However, non-invasive central blood pressure measurement procedures are still under analysis. AIM: To compare human pressure waveforms invasively obtained in the aorta, with the corresponding waveforms non-invasively recorded using an oscillometric device (Mobil-O-Graph). METHODS: In this research were included 20 subjects in which invasive percutaneous coronary interventions were performed. They were 10 males (68 ± 12 y. o. , BMI: 27.4 ± 4.6 kg/m2) and 10 females (77 ± 8 y. o. , BMI: 28.5 ± 5.3 kg/m2). During the invasive aortic pressure recording, a synchronized non-invasive Mobil-O-Graph acquisition beat by beat and reconstructed central pressure wave was performed. Both, invasive and non-invasive pressure waves were digitized and stored for subsequent analysis and calculations. A computerized interpolation procedure was developed in our laboratory to compare these pressure waves. RESULTS: A significant correlation between Mobil-O-Graph central blood pressure measurements and the corresponding invasive values was found in males (r < 0.81; p < 0.01) and females (r < 0.93; p < 0.01). However, in both genders, the slope of the regression lines was lesser than 1 (males: y = 0.7354x + 18.998; females: y = 0.9835x + 2.8432). In the whole population (n = 20), a significant correlation between Mobil-O-Graph central blood pressure measurements and the corresponding invasive values was found (r < 0.89; p < 0.01) and the regression line was lesser than 1 (y = 0.9774x + 1.7603). CONCLUSIONS: In this research, a high correlation between invasive central blood pressure values and those measured with the Mobil-O-Graph device was found in males, females and the whole population. However, a sub estimation of Mobil-O-Graph central blood pressure values was observed.


Asunto(s)
Aorta/fisiopatología , Presión Arterial , Determinación de la Presión Sanguínea , Enfermedad de la Arteria Coronaria/diagnóstico , Hipertensión/diagnóstico , Análisis de la Onda del Pulso , Anciano , Anciano de 80 o más Años , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/terapia , Femenino , Frecuencia Cardíaca , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Oscilometría , Intervención Coronaria Percutánea , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Factores de Tiempo
4.
J Clin Hypertens (Greenwich) ; 22(4): 544-554, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32049425

RESUMEN

Out-of-office blood pressure (BP) monitoring appears to be a very useful approach to hypertension management insofar it allows to obtain multiple measurements in the usual environment of each individual, allows the detection of hypertension phenotypes, such as white-coat and masked hypertension, and appears to have superior prognostic value than the conventional office BP measurements. Out-of-office BP can be obtained through either home or ambulatory monitoring, which provide complementary and not identical information. Home BP monitoring yields BP values self-measured in subjects' usual living environment; it is an essential method for the evaluation of almost all untreated and treated subjects with suspected or diagnosed hypertension, best if combined with telemonitoring facilities, also allowing long-term monitoring. There is also increasing evidence that home BP monitoring improves long-term hypertension control rates by improving patients' adherence to prescribed treatment. In Latin American Countries, it is widely available, being relatively inexpensive, and well accepted by patients. Current US, Canadian, Japanese, and European guidelines recommend out-of-office BP monitoring to confirm and refine the diagnosis of hypertension.

5.
J Clin Hypertens (Greenwich) ; 22(4): 527-543, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32049441

RESUMEN

Accurate office blood pressure measurement remains crucial in the diagnosis and management of hypertension worldwide, including Latin America (LA). Office blood pressure (OBP) measurement is still the leading technique in LA for screening and diagnosis of hypertension, monitoring of treatment, and long-term follow-up. Despite this, due to the increasing awareness of the limitations affecting OBP and to the accumulating evidence on the importance of ambulatory BP monitoring (ABPM), as a complement of OBP in the clinical approach to the hypertensive patient, a progressively greater attention has been paid worldwide to the information on daytime and nighttime BP patterns offered by 24-h ABPM in the diagnostic, prognostic, and therapeutic management of hypertension. In LA countries, most of the Scientific Societies of Hypertension and/or Cardiology have issued guidelines for hypertension care, and most of them include a special section on ABPM. Also, full guidelines on ABPM are available. However, despite the available evidence on the advantages of ABPM for the diagnosis and management of hypertension in LA, availability of ABPM is often restricted to cities with large population, and access to this technology by lower-income patients is sometimes limited by its excessive cost. The authors hope that this document might stimulate health authorities in each LA Country, as well as in other countries in the world, to regulate ABPM access and to widen the range of patients able to access the benefits of this technique.

6.
J Hypertens ; 37(6): 1126-1147, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30882601

RESUMEN

: The prevalence of hypertension, type 2 diabetes mellitus (DM2) and the metabolic syndrome continues to increase in Latin America, while the rates of diagnosis, treatment and control of these disorders remain low. The frequency of the risk factors that constitute the metabolic syndrome and are associated with an increased risk of cardiovascular disease has not diminished since the publication of the previous consensus. This document discusses the socioeconomic, demographic, environmental and cultural characteristics of most associated Latin American countries and partially explains the lack of better results in improving clinical and public health actions that allow high morbidity and mortality rates caused by cardiovascular diseases and DM2 to be reduced through programs aligned with the so-called precision medicine, which should be predictive, preventive, personalized and participatory. The Consensus ratifies the diagnostic criteria expressed in the previous consensus to define hypertension and DM2 but, for the metabolic syndrome, and in the absence of evidence, the recommendation is to implement a cohort study that determines the abdominal perimeter value associated with hard outcomes, such as DM2 and CVD. Meanwhile, we recommend modifying the criterion to more than 94 cm in men and more than 84 cm in women according to WHO recommendations. We also recommend the carrying out of a study that identifies the situation of hypertension and DM2 in people of African ancestry who, in Latin America, exceed 75 million and whose epidemiology does not include solid studies. With respect to the proposed therapeutic targets, we recommended maintaining those defined in the previous consensus, but insisting that early pharmacological management of prediabetes with metformin should be introduced, as should the treatment of diabetic hypertensive patients with a combination therapy of two fixed-dose antihypertensive drugs and management with statins. To increase adherence, the use of different drugs combined in a single pill (polypill) is recommended. The simplification of the therapeutic regimen is accompanied by greater control of cardiovascular risk factors, both in primary and secondary prevention, and has been shown to be cost-effective. The consensus recommends the use of the currently available polypill combining an angiotensin-converting enzyme inhibitor, a statin and aspirin for secondary cardiovascular prevention and in patients with a high cardiovascular risk, such as hypertension patients with DM2.


Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Aspirina/uso terapéutico , Diabetes Mellitus Tipo 2/complicaciones , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipertensión/tratamiento farmacológico , Síndrome Metabólico/complicaciones , Antihipertensivos/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , Estudios de Cohortes , Consenso , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/etnología , Combinación de Medicamentos , Humanos , Hipertensión/complicaciones , Hipertensión/diagnóstico , Hipertensión/etnología , América Latina/epidemiología , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/etnología , Obesidad/complicaciones , Obesidad/diagnóstico , Prevalencia , Factores de Riesgo , Prevención Secundaria
7.
J Hypertens ; 37(3): 636-642, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30113526

RESUMEN

INTRODUCTION: Hypertension control reduces cardiovascular and renal risks in type 2 diabetes. Sodium-glucose cotransporter-2 inhibitors prevent renal glucose reabsorption and decrease glucose plasma levels, blood pressure (BP) and weight reduction. Treatment of hypertension and sodium-glucose cotransporter-2 are able to improve arterial stiffness. AIMS: To evaluate, in patients with type 2 diabetes and hypertension, the effects of 6 months treatment with canagliflozin, or perindopril, an angiotensin converting enzyme inhibitor, on central BP and carotid-femoral pulse wave velocity (cfPWV). METHODS: Thirty type 2 diabetic patients with hypertension taking amlodipine, 10 mg daily, and metformin, 750-2000 mg daily, were randomized and a third medication was added: canagliflozin, 300 mg daily (n = 15, nine women, mean age: 63 ±â€Š8 years), or perindopril, 10 mg daily (n = 15, five women, mean age 59 ±â€Š4 years), for 6 months. Ambulatory BP monitoring was assessed at baseline and after 3 and 6 months of treatment, whereas cfPWV was measured before and after 6 months of treatment. Plasma fasting glucose, glycated hemoglobin, creatinine, plasma and urinary sodium and potassium were also measured. RESULTS: Both treatments significantly reduced BP and cfPWV. Only canagliflozin maintained the PWV action after adjusting for BP values and reduced glycemia, glycated hemoglobin and 24 h urinary sodium. Other security laboratory parameters, including gluthamic oxaloacetic transaminase, gluthamic piruvic transaminase; and bilirubin failed to show any change. CONCLUSION: Canagliflozin reduced BP and improve arterial stiffness, independently of the BP effect. These two conditions could explain the cardiovascular protection observed with canagliflozin compared with perindopril.


Asunto(s)
Presión Sanguínea/efectos de los fármacos , Canagliflozina , Diabetes Mellitus Tipo 2/complicaciones , Hipertensión Esencial/tratamiento farmacológico , Perindopril , Rigidez Vascular/efectos de los fármacos , Anciano , Amlodipino/uso terapéutico , Antihipertensivos/uso terapéutico , Canagliflozina/farmacología , Canagliflozina/uso terapéutico , Hipertensión Esencial/complicaciones , Hipertensión Esencial/epidemiología , Hipertensión Esencial/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Perindopril/farmacología , Perindopril/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/farmacología , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico
8.
BMJ Open ; 8(12): e021038, 2018 12 19.
Artículo en Inglés | MEDLINE | ID: mdl-30573476

RESUMEN

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.


Asunto(s)
Antihipertensivos/uso terapéutico , Monitoreo Ambulatorio de la Presión Arterial , Hipertensión Enmascarada/tratamiento farmacológico , Albuminuria/diagnóstico , Ecocardiografía , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Estudios Multicéntricos como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto
10.
Curr Hypertens Rev ; 14(2): 95-99, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29974832

RESUMEN

Adaptive identification systems focus on dynamical approaches based on the observed data from an experiment and/or clinical data. These systems establish a relationship between an input (arterial or vein instantaneous pressure) and an output (instantaneous arterial or vein diameter). Several dynamics relationships and applications can be established because of this adaptive identification as an arterial dynamic range (frequency response), biomechanical behavior of cryopreserved arteries, regional differences in veins as artery substitution, role of vascular smooth muscle in human hypertension and time invariance in the biomechanics of wall arteries. The aim of this review is to summarize some of those relevant results obtained from adaptive filter identification in cardiovascular dynamics research and clinical evaluation.


Asunto(s)
Arterias/fisiopatología , Hemodinámica , Hipertensión/fisiopatología , Modelos Cardiovasculares , Animales , Antihipertensivos/uso terapéutico , Fenómenos Biomecánicos , Arterias Carótidas/fisiopatología , Criopreservación , Módulo de Elasticidad , Hemodinámica/efectos de los fármacos , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Músculo Liso Vascular/fisiopatología , Factores de Tiempo , Venas/fisiopatología
11.
Curr Hypertens Rev ; 14(2): 154-160, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29651957

RESUMEN

INTRODUCTION: Chronic serum uric acid elevation (SUA) is known to be induced by dyslipidemia, hypertension, inflammation, and insulin resistance. Therefore, it has been associated with higher risk for coronary artery disease and cardiovascular mortality. Also, increased levels of SUA have been associated with regional arterial stiffness, assessed by pulse wave velocity (PWV). AIMS: To evaluate the relationships of PWV, SUA and different metabolic parameters in essential hypertensive patients. MATERIAL AND METHODS: We evaluated 445 essential hypertensive patients, by measuring office blood pressure (BP), weight, height, and waist circumference. In each patient, blood samples were drawn for biochemical evaluations and 24h urine collection. Body Mass Index (BMI) and Glomerular Filtration Rate (GFR) were calculated. Carotid-Femoral PWV and Left Ventricular Mass Index (LVMI) were measured in all patients. RESULTS: All subjects (n=402), 242 males (55±0.9 yrs.; BMI: 28.9±0.3 Kg/m2) and 160 females (58±1 yrs.; BMI: 28.1±0.4 Kg/m2) had normal renal function. PWV values showed a significant association with SUA (p<0.001), Systolic BP (p<0.025) and LVMI (p<0.05). SUA showed a significant association, p<0.025: with BMI, Waist Circumference, and HDL-C; p<0.05: with Glycaemia at 120 min, Insulin at 120 min, TG, and LVMI; and p<0.001: with serum Creatinine. Backward Stepwise Regression showed that PWV could be predicted from SUA (p<0.001) and Systolic BP (p<0.05). BMI, Waist Circumference, DBP and HR did not significantly add to the ability of the equation to predict PWV. CONCLUSIONS: In this population of essential hypertensive patients, SUA was associated to increased arterial stiffness and to components of the Metabolic Syndrome. These results raise the possibility that a new approach to the role of SUA, linked to cardiovascular stratification, and a most appropriate treatment might be considered.


Asunto(s)
Presión Arterial , Hipertensión Esencial/fisiopatología , Hiperuricemia/sangre , Síndrome Metabólico/sangre , Ácido Úrico/sangre , Rigidez Vascular , Biomarcadores/sangre , Glucemia/análisis , Estudios Transversales , Hipertensión Esencial/sangre , Hipertensión Esencial/diagnóstico , Femenino , Humanos , Hiperuricemia/diagnóstico , Hiperuricemia/fisiopatología , Lípidos/sangre , Masculino , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/fisiopatología , Persona de Mediana Edad , Análisis de la Onda del Pulso , Factores de Riesgo , Regulación hacia Arriba
12.
BMC Cancer ; 18(1): 77, 2018 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-29334915

RESUMEN

BACKGROUND: Vaccination of mice with tumors treated with Doxorubicin promotes a T cell immunity that relies on dendritic cell (DC) activation and is responsible for tumor control in vaccinated animals. Despite Doxorubicin in combination with Cyclophosphamide (A/C) is widely used to treat breast cancer patients, the stimulating effect of A/C on T and APC compartments and its correlation with patient's clinical response remains to be proved. METHODS: In this prospective study, we designed an in vitro system to monitor various immunological readouts in PBMCs obtained from a total of 17 breast cancer patients before, and after neoadjuvant anti-tumor therapy with A/C. RESULTS: The results show that before treatment, T cells and DCs, exhibit a marked unresponsiveness to in vitro stimulus: whereas T cells exhibit poor TCR internalization and limited expression of CD154 in response to anti-CD3/CD28/CD2 stimulation, DCs secrete low levels of IL-12p70 and limited CD83 expression in response to pro-inflammatory cytokines. Notably, after treatment the responsiveness of T and APC compartments was recovered, and furthermore, this recovery correlated with patients' residual cancer burden stage. CONCLUSIONS: Our results let us to argue that the model used here to monitor the T and APC compartments is suitable to survey the recovery of immune surveillance and to predict tumor response during A/C chemotherapy.


Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/inmunología , Inmunidad Celular/efectos de los fármacos , Linfocitos T/inmunología , Animales , Células Presentadoras de Antígenos/inmunología , Neoplasias de la Mama/patología , Ciclofosfamida/administración & dosificación , Células Dendríticas/efectos de los fármacos , Células Dendríticas/inmunología , Doxorrubicina/administración & dosificación , Femenino , Humanos , Interleucina-12/genética , Ratones , Terapia Neoadyuvante , Linfocitos T/efectos de los fármacos , Vacunación/métodos
13.
Hum Brain Mapp ; 39(4): 1563-1581, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29271093

RESUMEN

Interoception, the sensing of visceral body signals, involves an interplay between neural and autonomic mechanisms. Clinical studies into this domain have focused on patients with neurological and psychiatric disorders, showing that damage to relevant brain mechanisms can variously alter interoceptive functions. However, the association between peripheral cardiac-system alterations and neurocognitive markers of interoception remains poorly understood. To bridge this gap, we examined multidimensional neural markers of interoception in patients with early stage of hypertensive disease (HTD) and healthy controls. Strategically, we recruited only HTD patients without cognitive impairment (as shown by neuropsychological tests), brain atrophy (as assessed with voxel-based morphometry), or white matter abnormalities (as evidenced by diffusion tensor imaging analysis). Interoceptive domains were assessed through (a) a behavioral heartbeat detection task; (b) measures of the heart-evoked potential (HEP), an electrophysiological cortical signature of attention to cardiac signals; and (c) neuroimaging recordings (MRI and fMRI) to evaluate anatomical and functional connectivity properties of key interoceptive regions (namely, the insula and the anterior cingulate cortex). Relative to controls, patients exhibited poorer interoceptive performance and reduced HEP modulations, alongside an abnormal association between interoceptive performance and both the volume and functional connectivity of the above regions. Such results suggest that peripheral cardiac-system impairments can be associated with abnormal behavioral and neurocognitive signatures of interoception. More generally, our findings indicate that interoceptive processes entail bidirectional influences between the cardiovascular and the central nervous systems.


Asunto(s)
Encéfalo/diagnóstico por imagen , Encéfalo/fisiopatología , Hipertensión/diagnóstico por imagen , Hipertensión/fisiopatología , Interocepción , Anciano , Encéfalo/patología , Imagen de Difusión Tensora , Electroencefalografía , Potenciales Evocados , Femenino , Sustancia Gris/diagnóstico por imagen , Sustancia Gris/patología , Sustancia Gris/fisiopatología , Corazón/fisiopatología , Humanos , Interocepción/fisiología , Imagen por Resonancia Magnética , Masculino , Análisis Multinivel , Vías Nerviosas/diagnóstico por imagen , Vías Nerviosas/patología , Vías Nerviosas/fisiopatología , Tamaño de los Órganos
14.
Artículo en Español | PAHO-IRIS | ID: phr-34513

RESUMEN

[RESUMEN]. La hipertensión arterial es el principal factor de riesgo de la carga global de las enfermedades. Una pregunta en debate es si la hipertensión arterial grado 1 (140–159/90–99 mm Hg) con riesgo cardiovascular (RCV) total bajo (mortalidad cardiovascular < 1% a los 10 años) a moderado (mortalidad cardiovascular > 1% y < 5% a los 10 años) debe ser tratada con agentes antihipertensivos. Un proceso de consulta virtual internacional fue realizado para resumir las opiniones de los expertos seleccionados. Después del análisis holístico de todos los elementos epidemiológicos, clínicos, psicosociales y de salud pública, este proceso de consulta llegó al siguiente consenso para adultos hipertensos < 80 años de edad: 1) La interrogante, de si el tratamiento medicamentoso en la hipertensión grado 1 debe ser precedido por un periodo de algunas semanas o meses, durante el cual solo se recomienden medidas sobre el estilo de vida no está basada en evidencia, pero el consenso de opinión es reservar un periodo para solo cambios en el estilo de vida únicamente en los pacientes con hipertensión grado 1 “aislada” (hipertensión grado 1 no complicada con RCV total absoluto bajo, y sin otros factores de RCV mayores ni modificadores del riesgo). 2) El inicio del tratamiento antihipertensivo medicamentoso en pacientes con hipertensión grado 1 y RCV absoluto moderado no debe demorarse. 3) Los hombres ≥ 55 años y las mujeres ≥ 60 años con hipertensión grado 1 no complicada deben ser automáticamente clasificados dentro de la categoría de RCV total absoluto moderado, incluso en ausencia de otros factores de riesgo mayores y modificadores del riesgo. 4) Las estatinas deben tenerse en cuenta junto con la terapia antihipertensiva, independientemente de los valores de colesterol, en pacientes con hipertensión grado 1 y RCV moderado.


[ABSTRACT]. Hypertension is a leading risk factor for disease burden globally. An unresolved question is whether grade 1 hypertension (140-159/90-99 mmHg) with low (cardiovascular mortality < 1% at 10 years) to moderate (cardiovascular mortality > 1% and < 5% at 10 years) absolute total cardiovascular risk (CVR) should be treated with antihypertensive agents. A virtual international consultation process was undertaken to summarize the opinions of select experts. After holistic analysis of all epidemiological, clinical, psychosocial, and public health elements, this consultation process reached the following consensus in hypertensive adults aged < 80 years: (1) The question of whether drug treatment in grade 1 should be preceded by a period of some weeks or months during which only life style measures are recommended cannot be evidence based, but the consensus opinion is to have a period of lifestyle alone reserved only to patients with grade 1 “isolated” hypertension (grade 1 uncomplicated hypertension with low absolute total CVR, and without other major CVR factors and risk modifiers). (2)The initiation of antihypertensive drug therapy in grade 1 hypertension with moderate absolute total CVR should not be delayed. (3) Men ≥ 55 years and women ≥ 60 years with uncomplicated grade1 hypertension should automatically be classified within the moderate absolute total CVR category, even in the absence of other major CVR factors and risk modifiers. (4) Statins should be considered along with blood-pressure lowering therapy, irrespective of cholesterol levels, in patients with grade 1 hypertensive with moderate CVR.


Asunto(s)
Hipertensión , Enfermedades Cardiovasculares , Factores de Riesgo , Hipertensión , Enfermedades Cardiovasculares , Factores de Riesgo
15.
Curr Probl Cardiol ; 42(7): 198-225, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28552207

RESUMEN

Hypertension is a leading risk factor for disease burden globally. An unresolved question is whether grade 1 hypertension (140-159/90-99mmHg) with low (cardiovascular mortality <1% at 10 years) to moderate (cardiovascular mortality ≥1% and <5% at 10 years) absolute total cardiovascular risk (CVR) should be treated with antihypertensive agents. A virtual international consultation process was undertaken to summarize the opinions of select experts. After holistic analysis of all epidemiological, clinical, psychosocial, and public health elements, this consultation process reached the following consensus in hypertensive adults aged <80 years: (1) The question of whether drug treatment in grade 1 should be preceded by a period of some weeks or months during which only lifestyle measures are recommended cannot be evidence based, but the consensus opinion is to have a period of lifestyle alone reserved only to patients with grade 1 "isolated" hypertension (grade 1 uncomplicated hypertension with low absolute total CVR, and without other major CVR factors and risk modifiers). (2) The initiation of antihypertensive drug therapy in grade 1 hypertension with moderate absolute total CVR should not be delayed. (3) Men ≥55 years and women ≥60 years with uncomplicated grade 1 hypertension should automatically be classified within the moderate absolute total CVR category, even in the absence of other major CVR factors and risk modifiers. (4) Statins should be considered along with blood-pressure lowering therapy, irrespective of cholesterol levels, in patients with grade 1 hypertensive with moderate CVR.


Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Adulto , Femenino , Cardiopatías/etiología , Humanos , Hipertensión/complicaciones , Masculino , Riesgo
16.
BMC Cancer ; 16: 591, 2016 08 03.
Artículo en Inglés | MEDLINE | ID: mdl-27484900

RESUMEN

BACKGROUND: Experimental evidence and clinical studies in breast cancer suggest that some anti-tumor therapy regimens generate stimulation of the immune system that accounts for tumor clinical responses, however, demonstration of the immunostimulatory power of these therapies on cancer patients continues to be a formidable challenge. Here we present experimental evidence from a breast cancer patient with complete clinical response after 7 years, associated with responsiveness of tumor specific T cells. METHODS: T cells were obtained before and after anti-tumor therapy from peripheral blood of a 63-years old woman diagnosed with ductal breast cancer (HER2/neu+++, ER-, PR-, HLA-A*02:01) treated with surgery, followed by paclitaxel, trastuzumab (suspended due to cardiac toxicity), and radiotherapy. We obtained a leukapheresis before surgery and after 8 months of treatment. Using in vitro cell cultures stimulated with autologous monocyte-derived dendritic cells (DCs) that produce high levels of IL-12, we characterize by flow cytometry the phenotype of tumor associated antigens (TAAs) HER2/neu and NY-ESO 1 specific T cells. The ex vivo analysis of the TCR-Vß repertoire of TAA specific T cells in blood and Tumor Infiltrating Lymphocytes (TILs) were performed in order to correlate both repertoires prior and after therapy. RESULTS: We evidence a functional recovery of T cell responsiveness to polyclonal stimuli and expansion of TAAs specific CD8+ T cells using peptide pulsed DCs, with an increase of CTLA-4 and memory effector phenotype after anti-tumor therapy. The ex vivo analysis of the TCR-Vß repertoire of TAA specific T cells in blood and TILs showed that whereas the TCR-Vß04-02 clonotype is highly expressed in TILs the HER2/neu specific T cells are expressed mainly in blood after therapy, suggesting that this particular TCR was selectively enriched in blood after anti-tumor therapy. CONCLUSIONS: Our results show the benefits of anti-tumor therapy in a breast cancer patient with clinical complete response in two ways, by restoring the responsiveness of T cells by increasing the frequency and activation in peripheral blood of tumor specific T cells present in the tumor before therapy.


Asunto(s)
Neoplasias de la Mama/inmunología , Carcinoma Ductal de Mama/inmunología , Linfocitos Infiltrantes de Tumor/inmunología , Linfocitos T/inmunología , Antígenos de Neoplasias/inmunología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/terapia , Carcinoma Ductal de Mama/terapia , Quimioradioterapia , Femenino , Citometría de Flujo , Humanos , Activación de Linfocitos/inmunología , Persona de Mediana Edad , Paclitaxel/uso terapéutico , Trastuzumab/uso terapéutico
18.
Rev. Soc. Argent. Diabetes ; 50(1): 17-34, Abril 2016.
Artículo en Español | LILACS | ID: biblio-880796

RESUMEN

Introducción: la hipertensión arterial (HA) y la diabetes mellitus (DM) son enfermedades de alta prevalencia y frecuentemente asociadas. Objetivo: brindar los conocimientos para la práctica clínica que favorezca la toma de decisiones diagnósticas y terapéuticas adecuadas. Metodología: basándonos en la evidencia disponible, los grandes ensayos clínicos publicados en los últimos cuatro años y la adaptación de los recursos diagnósticos y terapéuticos de nuestro país, se elaboraron estas "Recomendaciones para la Práctica Clínica", enfocando situaciones especiales como embarazo, niñez, adulto mayor y complicaciones crónicas. Conclusiones: la HA aumenta la progresión y el desarrollo de las complicaciones crónicas micro y macrovasculares. El impacto del tratamiento de la HA es significativo en la reducción de la morbimortalidad de las personas con DM y en la aparición y progresión de las complicaciones micro y macrovasculares. En la mayoría de los adultos con HA y DM el objetivo es alcanzar una PA (presión arterial) <140/90 mmHg. Siendo las metas menos estrictas en los adultos mayores frágiles. En personas con trasplante renal, en RAC (relación albúmina/creatinina) >300 mg/g, en jóvenes, los objetivos podrían ser menores (<130-80 mmHg), si se logran sin efectos adversos asociados al tratamiento. Evitar PAD (presión arterial diastólica) <60 mmHg en personas mayores de 60 años. La elección de fármacos dependerá de la edad, el momento biológico, si existe intolerancia o alguna contraindicación y acorde al objetivo terapéutico de cada complicación crónica. El tratamiento debe ser temprano y las metas terapéuticas deberán ser individualizadas según grupo etario, comorbilidades y daño de órgano blanco


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus , Hipertensión , Enfermedades Renales
19.
World J Diabetes ; 6(11): 1186-97, 2015 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-26380062

RESUMEN

Hyperglycemia is associated with an increased risk of cardiovascular disease, and the consequences of intensive therapy may depend on the mechanism of the anti-diabetic agent(s) used to achieve a tight control. In animal models, stable analogues of glucagon-like peptide-1 (GLP-1) were able to reduce body weight and blood pressure and also had favorable effects on ischemia following coronary reperfusion. In a similar way, dipeptidyl peptidase IV (DPP-IV) showed to have favorable effects in animal models of ischemia/reperfusion. This could be due to the fact that DPP-IV inhibitors were able to prevent the breakdown of GLP-1 and glucose-dependent insulinotropic polypeptide, but they also decreased the degradation of several vasoactive peptides. Preclinical data for GLP-1, its derivatives and inhibitors of the DPP-IV enzyme degradation suggests that these agents may be able to, besides controlling glycaemia, induce cardio-protective and vasodilator effects. Notwithstanding the many favorable cardiovascular effects of GLP-1/incretins reported in different studies, many questions remain unanswered due the limited number of studies in human beings that aim to examine the effects of GLP-1 on cardiovascular endpoints. For this reason, long-term trials searching for positive cardiovascular effects are now in process, such as the CAROLINA and CARMELINA trials, which are supported by small pilot studies performed in humans (and many more animal studies) with incretin-based therapies. On the other hand, selective renal sodium-glucose co-transporter 2 inhibitors were also evaluated in the prevention of cardiovascular outcomes in type 2 diabetes. However, it is quite early to draw conclusions, since data on cardiovascular outcomes and cardiovascular death are limited and long-term studies are still ongoing. In this review, we will analyze the mechanisms underlying the cardiovascular effects of incretins and, at the same time, we will present a critical position about the real value of these compounds in the cardiovascular system and its protection.

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