Clustering of target organ damage increases mortality after acute coronary syndromes in patients with arterial hypertension.

The impact of target organ damage (TOD) clustering in hypertensive patients with established cardiovascular disease has not been clearly defined. Multicentre, observational and prospective study of 1054 consecutive patients with acute coronary syndromes (ACSs). The objective was describing the impact of TOD on first-year mortality. Ankle-brachial index (ABI), left ventricular hypertrophy and renal dysfunction were assessed during hospital stay. Hypertensive patients accounted for 80% of the cohort and had slightly higher mean age, higher prevalence of risk factors, previous cardiovascular disease and TOD. During follow-up, mean time 387.9 (7.2) days and median 382 (364.0-430.0) days, mortality rate tended to be higher in hypertensive patients (6.1 versus 3.5%; P=0.16). Cox regression survival analysis identified pathological ABI as the only TOD independently associated with mortality. When assessed globally, the presence of at least one TOD predicted mortality only in patients with hypertension and differences in mortality rate appeared very early in the follow-up. A linear increase in mortality rate was observed with the clustering of TOD: 2.0%, if no TOD was present, 7.6% in one TOD, 11.1% in two TODs and 20.0%, if three TODs were present. An increased risk in the combined end point of ischaemic events was observed in hypertensive patients without TOD (odds ratio (OR): 3.18; 95% confidence interval (CI): 1.31-7.70; P=0.01) and was still higher in patients with hypertension and TOD (OR: 4.61; 95% CI: 1.90-11.80; P<0.01). TOD predicts mortality and ischaemic events of hypertensive patients after ACS.

[Risk factor control in the hypertensive patients with chronic ischemic heart disease attended in cardiologic outpatient clinics. The CINHTIA study]. / Control de los factores de riesgo en los pacientes hipertensos con cardiopatía isquémica crónica atendidos en las consultas de cardiología. Estudio CINHTIA.

OBJECTIVE: The CINHTIA study is a cross-sectional and multicentre survey designed to assess the clinical management of the hypertensive outpatients with chronic ischemic heart disease attended by cardiologists. PATIENTS AND METHODS: Patients > or = 18 years, with a diagnosis of hypertension and chronic ischemic heart disease, were included in the study. Patients with an acute coronary syndrome within the three months prior to the inclusion were excluded. Good blood pressure (BP) control was considered < 140/90 mmHg, < 130/80 mmHg for diabetics (ESH-ESC 2003). LDL cholesterol (LDL-c) < 100 mg/dl (NCEP-ATP III) and fasting glucose between 90 and 130 mg/dl (ADA 2005) were considered as good control rates. RESULTS: A total of 2,024 patients (66.8+/-10.1 years; 31.7% women) were included in the study. Systolic BP was 142.7 +/- 17.9 mmHg and diastolic BP 81.8 +/- 11.3 mmHg. 78.4% of the patients had dyslipidemia and 32.3% diabetes. Almost all the patients (99.7%) were taking at least one antihypertensive drug, beta blockers being the most frequent (67.1%). A total of 74.9% of the patients were taking lipid lowering drugs and 27.9% antidiabetics. BP was controlled in 40.5% of the patients, LDL-c in 30.6% of the dyslipidemic subgroup and fasting glucose in 26.6% of the diabetics. CONCLUSIONS: In this high-risk population, the control rates of risk factors continues to remain low even though the majority of patients were taking several drugs.

Control de los factores de riesgo en los pacientes hipertensos con cardiopatía isquémica crónica atendidos en las consultas de cardiología. Estudio CINHTIA / Risk factor control in the hypertensive patients with chronic ischemic heart disease attended in cardiologic outpatient clinics. The CINHTIA study

Objetivo. CINHTIA es un estudio transversal y multicéntrico diseñado para conocer el manejo clínico de los hipertensos con cardiopatía isquémica crónica atendidos en consultas de cardiología. Pacientes y métodos. Se incluyeron pacientes ≥ 18años, con diagnóstico de hipertensión arterial y cardiopatía isquémica crónica. Se excluyeron aquellos pacientes con un síndrome coronario agudo en los tres meses previos. Se consideró como buen control de presión arterial (PA) <140/90 mmHg,<130/80 en diabéticos (ESH-ESC 2003) y buen control de colesterol LDL (c-LDL) <100 mg/dl(NCEP-ATP III). Se definió como un adecuado control de diabetes una glucemia en ayunas entre90 y 130 mg/dl (ADA 2005).Resultados. Se incluyeron un total de 2.024pacientes (66,8 ± 10,1 años; 31,7% mujeres).La PA sistólica fue 142,7 ± 17,9 mmHg y la diastólica 81,8 ± 11,3 mmHg. El 78,4% de los pacientes tenían dislipemia y el 32,3%, diabetes. El99,7% de los pacientes estaba tomando al menos un antihipertensivo, el más frecuente de los cuales eran los bloqueadores beta (67,1%). El 74,9% tomaba hipolipemiantes y el 27,9%, antidiabéticos. El 40,5%de los pacientes tenían la PA controlada; el 30,6% delos dislipémicos, el c-LDL controlado y el 26,6%de los diabéticos, la glucemia controlada. Conclusiones. En esta población de tan alto riesgo, a pesar de que la mayoría de los pacientes toman varios fármacos, el control de factores de riesgo esa ún insuficiente (AU)

Objective. The CINHTIA study is a cross-sectional and multicentre survey designed to assess the clinical management of the hypertensive outpatients with chronic ischemic heart disease attended by cardiologists. Patients and methods. Patients ≥ 18 years, with a diagnosis of hypertension and chronic ischemic heart disease, were included in the study. Patients with an acute coronary syndrome within the three months prior to the inclusion were excluded. Good blood pressure (BP) control was considered< 140/90 mmHg, < 130/80 mmHg for diabetics(ESH-ESC 2003). LDL cholesterol (LDL-c) < 100mg/dl (NCEP-ATP III) and fasting glucose between90 and 130 mg/dl (ADA 2005) were considered as good control rates. Results. A total of 2,024 patients (66.8±10.1years; 31.7% women) were included in the study. Systolic BP was 142.7 ± 17.9 mmHg and diastolic BP 81.8 ± 11.3 mmHg. 78.4% of the patients had dyslipidemia and 32.3% diabetes. Almost all the patients (99.7%) were taking at least one antihypertensive drug, beta blockers being the most frequent (67.1%). A total of 74.9% of the patients were taking lipid lowering drugs and 27.9%antidiabetics. BP was controlled in 40.5% of the patients, LDL-c in 30.6% of the dyslipidemic subgroup and fasting glucose in 26.6% of the diabetics. Conclusions. In this high-risk population, the control rates of risk factors continues to remain low even though the majority of patients were taking several drugs (AU)

Prevalence and prognostic influence of peripheral arterial disease in patients >or=40 years old admitted into hospital following an acute coronary event.

OBJECTIVE: A significant proportion of patients with ischemic heart disease have associated peripheral arterial disease (PAD), but many are asymptomatic and this condition remains underdiagnosed. We aimed to study the prevalence of PAD in patients with an acute coronary syndrome (ACS) and to evaluate its influence in hospital clinical outcomes. METHODS: The PAMISCA register is a prospective, multicenter study involving patients >or=40 years old with ACS admitted to selected Spanish hospitals. All patients had their ankle-brachial index (ABI) measured between days 3 and 7 after the ischemic event. RESULTS: 1410 ACS patients (71.4% male) were included. PAD determined by ABI was documented in 561 patients (39.8%). Factors independently related to PAD were age (OR: 1.04; 95% CI: 1.03-1.06; p<0.001), smoking (OR: 1.88; 95% CI: 1.41-2.49; p<0.0001), diabetes (OR: 1.30; 95% CI: 1.02-1.65; p<0.05), previous cardiac disease (OR: 1.54; 95% CI: 1.22-1.95; p<0.001) and previous cerebrovascular disease (OR: 1.90; 95% CI: 1.28-2.80; p<0.001). Following the ACS, an ABIor=40 years presenting with ACS is high and it is associated with increased cardiovascular risk.

Automedida de la presión arterial. Documento de Consenso Español 2007 / No disponible

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Documento de Consenso Español 2007 / Self-measurement of blood pressure. Consensus Paper Spain 2007

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Automedida de la presión arterial. Documento de Consenso Español 2007 / Self-measurement of blood pressure. Consensus Paper Spain 2007

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Automedida de la presión arterial. Documento de Consenso Español 2007 / Self-measurement of blood pressure. Consensus Paper Spain 2007

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[Strategies for effective control of arterial hypertension in Spain. Consensus document]. / Estrategias para un control eficaz de la hipertensión arterial en España. Documento de consenso.

Blood pressure (BP) control is inadequate among treated hypertensive patients in Spain. Control rates are lower than 40% of all treated patients and the cause of this problem is multifactorial. Despite the fact that possible solutions to this problem have been repeatedly suggested by expert groups along the last 10 years, BP control rates are still low. This fact have a negative impact on cardiovascular morbidity and mortality of patients with hypertension. The aim of the present document has been to achieve a consensus on effective specific measures in order to improve hypertension control rates in Spain. These measures involve health care professionals (physicians, nurses, pharmaceutics), health care authorities and patients. The document summarizes the consensus conference of several scientific societies involved in cardiovascular medicine in five group of measures: a) improvement of the methodology of office BP measurement; b) improvement of compliance to treatment by patients; c) clarification of pressure targets to be achieved in hypertensive patients; d) optimization of life style modifications and pharmacological treatment of hypertension; and e) continuous medical education. The document emphasize life style changes as a crucial aspect to be implemented in all patients. These changes have a beneficial impact on pressure reduction, contribute to a better control of associated cardiovascular risk factors, and increase the effectiveness of antihypertensive drugs. Health care professionals should base their clinical practice on the recommendations of guidelines in order to modify their therapeutic attitudes in patients whose targets have not been achieved.

Echocardiographic evaluation of the evolutionary changes after heart transplantation.

AIM: To undertake an evolutionary analysis of echocardiographic examinations carried out during follow-up of cardiac transplant patients. MATERIALS AND METHODS: The study included 193 consecutive patients transplanted between August 1998 and December 2004. We excluded pediatric, cardiopulmonary, and repeat transplants. Four echocardiographic examinations were analyzed per patient (first, second, third quarter and the last study carried out; average time from transplant: 1115 +/- 681 days). The total number of examinations was 772. The evaluated variables were thickness of walls and diameters of the cavities, systolic and diastolic functions, pericardial effusion, and number of rejections. RESULTS: The isovolumetric relaxation time showed reduced values during early echocardiography with subsequent increases during evolution (first echocardiogram: 92 +/- 16 vs final echocardiogram 101 +/- 16 ms; P < .0001). Right ventricular function showed initial deterioration with subsequent recovery (first echocardiogram: 16% vs final echocardiogram: 8%; P < .05); moreover, the existence of delayed malfunction of the right ventricle was correlated with a higher incidence of transplant rejection (P < .01). Pericardial effusion was initially present with a tendency to reduce over time (first echocardiogram: 58% vs final echocardiogram: 12%; P < .0001). There was no difference in the other variables. CONCLUSIONS: Cardiac transplant patients undergo evolutionary echocardiogram alterations that were mainly early and normalized as of the first quarter. The most usual changes in this period were restrictive isovolumetric behavior accompanied by some degree of depressed right ventricular function. Right ventricular malfunction during late evolution was correlated with a higher incidence of transplant rejection during follow-up.

Estrategias para un control eficaz de la hipertensión arterial en España. Documento de consenso / Strategies for effective control of arterial hypertension in Spain. Consensus document

El control de las cifras de presión arterial (PA) en los hipertensos tratados en España es insuficiente, no alcanza al 40% de los pacientes tratados y las causas son múltiples. Las posibles soluciones al problema han sido repetidamente sugeridas por grupos de expertos desde hace años, a pesar de lo cual las tasas de control siguen siendo inadecuadas, lo que repercute negativamente en la morbilidad y mortalidad de los pacientes. El objeto del presente documento ha sido analizar medidas concretas efectivas que mejoren el control de la hipertensión en España. Tales medidas afectan a los profesionales de la salud (médicos, profesionales de enfermería y farmacéuticos), a la administración sanitaria y a los propios pacientes. Este documento resume los resultados de esta conferencia de consenso en cinco grandes grupos: a) medidas para mejorar la metodología habitual en la medición de la PA en la consulta; b) medidas para mejorar el cumplimiento terapéutico por el paciente; c) medidas para clarificar el objetivo de PA que el médico debe fijar; d) medidas para optimizar el tratamiento y control de la hipertensión arterial; y e) aspectos de formación continuada. El documento enfatiza la recomendación de los cambios del estilo de vida en todos los pacientes hipertensos, tanto su acción beneficiosa sobre la hipertensión como por lo que implica en la corrección de otros factores de riesgo y en el aumento de la efectividad del tratamiento farmacológico. Los profesionales deben actuar conforme a guías terapéuticas o algoritmos que obliguen a modificar la conducta en los casos en que los objetivos pautados para cada paciente no hayan sido alcanzados

Blood pressure (BP) control is inadequate among treated hypertensive patients in Spain. Control rates are lower than 40% of all treated patients and the cause of this problem is multifactorial. Despite the fact that possible solutions to this problem have been repeatedly suggested by expert groups along the last 10 years, BP control rates are still low. This fact have a negative impact on cardiovascular morbidity and mortality of patients with hypertension. The aim of the present document has been to achieve a consensus on effective specific measures in order to improve hypertension control rates in Spain. These measures involve health care professionals (physicians, nurses, pharmaceutics), health care authorities and patients. The document summarizes the consensus conference of several scientific societies involved in cardiovascular medicine in five group of measures: a) improvement of the methodology of office BP measurement; b) improvement of compliance to treatment by patients; c) clarification of pressure targets to be achieved in hypertensive patients; d) optimization of life style modifications and pharmacological treatment of hypertension; and e) continuous medical education. The document emphasize life style changes as a crucial aspect to be implemented in all patients. These changes have a beneficial impact on pressure reduction, contribute to a better control of associated cardiovascular risk factors, and increase the effectiveness of antihypertensive drugs. Health care professionals should base their clinical practice on the recommendations of guidelines in order to modify their therapeutic attitudes in patients whose targets have not been achieved

[Albuminuria and cardiovascular risk: basal results of the KORAL-CARDIO study]. / Albuminuria y riesgo cardiovascular. Estudio KORAL-CARDIO.

BACKGROUND AND OBJECTIVES: Albuminuria is a marker of higher cardiovascular and renal risk in hypertension; it also indicates the need of a tighter control of blood pressure with drugs blocking the renin-angiotensin system. The objective of the KORAL-CARDIO study was to assess the clinical picture and management of patients with hypertension and cardiac disease and albuminuria not previously treated with angiotensin inhibitors. METHODS: A total of 2711 hypertensive patients (44% female) with ischemic or hypertensive cardiopathy or atrial fibrillation and with a positive screening test for albuminuria was included. Type 2 diabetes was also present in 42%. RESULTS: Macroalbuminuria was present in 7.2% of non diabetic and 12.7% of diabetic patients, respectively. Associated complications were: 25% and 35% body mass index over 30 kg/m2; 22% and 39% ischemic heart disease; 4% and 8% stroke; 19% and 22% atrial fibrillation; 42% and 53% high cholesterol levels; 8% and 8% grade 3 hypertension, for non-diabetics and diabetics respectively. Antihypertensive monotherapy was used in 66% of non-diabetics and in 63% of diabetics; only 7% of patients in both groups were treated with triple antihypertensive therapy. CONCLUSIONS: Cardiovascular complications are very frequently associated to albuminuria in patients with hypertension and heart disease not previously treated with angiotensin inhibitors. Blood pressure control was clearly inadequate in this group.

Estrategias para un control eficaz de la hipertensión arterial en España. Documento de Consenso / Strategies for an effective control of arterial hypertension in Spain. Consensus Document

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Estrategias para un control eficaz de la hipertensión arterial en España. Documento de Consenso / No disponible

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Albuminuria y riesgo cardiovascular. Estudio KORAL-CARDIO / Albuminuria and cardiovascular risk: basal results of the Koral-Cardio study

Introducción y objetivos: La presencia de albuminuria identifica a un grupo dehipertensos con mayor riesgo cardiovascular y renal y obliga a controlar mejor lapresión arterial con fármacos que bloqueen el sistema renina-angiotensina. El objetivodel estudio KORAL-CARDIO fue determinar las características clínicas y demanejo de pacientes con hipertensión, albuminuria y cardiopatía no tratados previamentecon inhibidores angiotensínicos.Pacientes y métodos: Se incluyen prospectivamente 2.711 pacientes (44% mujeres)de 64 años de media con hipertensión arterial, cardiopatía isquémica o hipertensivao fibrilación auricular con positividad en la detección cualitativa de albuminuria.El 42% tenían además diabetes mellitus de tipo 2.Resultados: El 7,2% de los no diabéticos y el 12,7% de los diabéticos teníanmacroalbuminuria; el 25% y el 35% respectivamente tenían índice de masa corporalde más de 30 kg/m2. Las complicaciones asociadas fueron: cardiopatía isquémica(22 y 39%), ictus (4 y 8%), fibrilación auricular (19 y 22%), hipercolesterolemia(42 y 53%), hipertensión de grado 3 (8% en ambos casos). Recibíantratamiento antihipertensivo monofármaco el 66% de los no diabéticos y el 63%de los diabéticos, y sólo el 7% triple terapia; otros tratamientos fueron: hipolipemiantes(41 y 57%) y antiagregantes (37 y 58% respectivamente).Conclusiones: Las complicaciones asociadas a la albuminuria en hipertensos concardiopatías, diabéticos y no diabéticos, no tratados con inhibidores angiotensínicosson muy frecuentes. El grado de control tensional fue escaso en este grupo

Background and objectives: Albuminuria is a marker of higher cardiovascularand renal risk in hypertension; it also indicates the need of a tighter control of blood pressure with drugs blocking the renin-angiotensin system. The objective ofthe KORAL-CARDIO study was to assess the clinical picture and management ofpatients with hypertension and cardiac disease and albuminuria not previously treatedwith angiotensin inhibitors.Methods: A total of 2,711 hypertensive patients (44% female) with ischemic orhypertensive cardiopathy or atrial fibrillation and with a positive screening test foralbuminuria was included. Type 2 diabetes was also present in 42%.Results: Macroalbuminuria was present in 7.2% of non diabetic and 12.7% ofdiabetic patients, respectively. Associated complications were: 25% and 35% bodymass index over 30 kg/m2; 22% and 39% ischemic heart disease; 4% and 8%stroke; 19% and 22% atrial fibrillation; 42% and 53% high cholesterol levels; 8%and 8% grade 3 hypertension, for non-diabetics and diabetics respectively. Antihypertensivemonotherapy was used in 66% of non-diabetics and in 63% of diabetics;only 7% of patients in both groups were treated with triple antihypertensivetherapy.Conclusions: Cardiovascular complications are very frequently associated to albuminuriain patients with hypertension and heart disease not previously treatedwith angiotensin inhibitors. Blood pressure control was clearly inadequate in thisgroup

Risk stratification of patients with acute chest pain and normal troponin concentrations.

OBJECTIVE: To investigate the outcome of patients with acute chest pain and normal troponin concentrations. DESIGN: Prospective cohort design. SETTING: Single centre study in a teaching hospital in Spain. PATIENTS: 609 consecutive patients with chest pain evaluated in the emergency department by clinical history (risk factors and a chest pain score according to pain characteristics), ECG, and early (< 24 hours) exercise testing for low risk patients with physical capacity (n = 283, 46%). All had normal troponin concentrations after serial determination. MAIN OUTCOME MEASURES: Myocardial infarction or cardiac death during six months of follow up. RESULTS: 29 events were detected (4.8%). No patient with a negative early exercise test (n = 161) had events versus the 6.9% event rate in the remaining patients (p = 0.0001). Four independent predictors were found: chest pain score > or = 11 points (odds ratio (OR) 2.4, 95% confidence interval (CI) 1.1 to 5.5, p = 0.04), diabetes mellitus (OR 2.3, 95% CI 1.1 to 4.7, p = 0.03), previous coronary surgery (OR 3.1, 95% CI 1.3 to 7.6, p = 0.01), and ST segment depression (OR 2.8, 95% CI 1.3 to 6.3, p = 0.003). A risk score proved useful for patient stratification according to the presence of 0-1 (2.7% event rate), 2 (10.2%, p = 0.008), and 3-4 predictors (29.2%, p = 0.0001). CONCLUSIONS: A negative troponin result does not assure a good prognosis for patients coming to the emergency room with chest pain. Early exercise testing and clinical data should be carefully evaluated for risk stratification.