Influencia de los antecedentes familiares sobre la edad de aparición de la hipertensión. Implicación de la impronta genética / The influence of family history on the age of onset of hypertension: possible role of genetic imprinting

Objetivo. El objetivo de este trabajo ha sido estudiarla influencia de la historia familiar de hipertensión enla edad de aparición de la enfermedad en los pacientesestudiados.Pacientes y métodos. Analizamos un grupo de poblaciónhipertensa española de 528 pacientes (302 mujeresy 226 hombres) de edades comprendidas entre16 y 89 años. Se hizo un estudio descriptivo y transversal.Resultados. Nuestros resultados muestran que la edadde aparición de la hipertensión fue más temprana enhombres (43,32±11,74) que en mujeres (47,84±10,92). Encontramos diferencias estadísticamente significativasen la edad de aparición de la hipertensiónentre sujetos con padre hipertenso (independientementede tener madre hipertensa o normotensa) y elgrupo control (ambos padres normotensos), edad quefue más temprana en sujetos con padre hipertenso.Conclusión. Aunque la enfermedad se transmite normalmentepor vía materna, ésta aparece antes cuandoocurre por vía paterna, lo que puede indicar quealgunos de los genes implicados podría estar afectadopor el fenómeno de impronta genética (AU)

Objective. We aimed to study the influence of familyhistory on the age of onset of hypertension.Patients and methods. We analyzed 528 (302 womenand 226 men; age range, 16-89 years) hypertensivepatients in a descriptive cross-sectional study.Results. Onset was earlier in men (43.32±11.74 years)than in women (47.84±10.92). Age of onset was significantlylower in subjects with a hypertense father(regardless of whether the mother was hypertensiveor normotensive) than in the control group (with bothparents normotensive).Conclusion. Although hypertension is usually transmittedmaternally, it appears early when transmittedpaternally; this indicates that one of the genes involvedmight be affected by genetic imprinting (AU)

Estudio de 1.595 casos de brucelosis en la provincia de Almería (1972-1998) según datos epidemiológicos de declaración de la enfermedad / Study of 1,595 brucellosis cases in the Almeria province (1972-1998) based on epidemiological data from disease reporting

Objetivo. Conocer aspectos clínicos, diagnósticos y de tratamiento de la brucelosis en la provincia de Almería. Métodos. Se ha realizado un estudio epidemiológico descriptivo, a partir de las 1.595 fichas de declaración individualizada de enfermedad en la provincia de Almería, en el período 1972-1998. Los apartados de complicaciones y tratamiento aparecen en 890 fichas (57,79 por ciento), los síntomas, signos y hemograma en 565 (35,42 por ciento) y otros datos diagnósticos en la totalidad de las fichas estudiadas. Se realiza la prueba estadística de Chi Cuadrado para comparación de variables cualitativas independientes para un nivel de confianza del 95 por ciento. Resultados. En la fase inicial el síntoma más frecuente fue la astenia (95,2 por ciento); en la fase de estado la sudación (95,8 por ciento). El signo más registrado es la esplenomegalia (37,5 por ciento) y la complicación más descrita la osteoarticular (22,8 por ciento). No se han encontrado modificaciones en la sintomatología a lo largo de los años. El hemograma revela que un 30,3 por ciento de casos presentaban anemia. El hemocultivo ha sido positivo en el 91,2 por ciento. Respecto al diagnóstico serológico, la Rosa de Bengala presenta un 99,2 por ciento de positividad; el hallazgo de las aglutinaciones a Brucella o B. melitensis más frecuente es 1/640 (13,47 por ciento). El tratamiento más utilizado ha sido asociación de tetraciclina y estreptomicina (42,5 por ciento). En un 42,6 por ciento consta que se derivaron los pacientes al hospital, sobre todo a partir del año 1984. Conclusiones. En general, los datos clínicos registrados en las fichas de declaración obligatoria de la brucelosis permiten conocer las características clínicas de esta enfermedad, tras la observación de un largo período de tiempo. La prueba Rosa de Bengala debería ser utilizada como prueba de cribado en el diagnóstico de la enfermedad (AU)

[Study of 1,595 brucellosis cases in the Almeria province (1972-1998) based on epidemiological data from disease reporting]. / Estudio de 1.595 casos de brucelosis en la provincia de Almería (1972-1998) según datos epidemiológicos de declaración de la enfermedad.

OBJECTIVE: To know clinical, diagnostic, and treatment issues of brucellosis in the Almeria province. METHODS: Descriptive, epidemiological study from 1,595 disease report cards in the Almeria province during the 1972-1998 period. Issues concerning complications and treatment were reported in 890 cards (57.8%), symptoms, signs and hemograms in 565 (35.4%), and other diagnostic findings in all cards. The chi2 test was used to compare independent qualitative parameters for a 95% CI. RESULTS: In the early phase the most common symptom was asthenia (95.2%); sweating in the chronic stage (95.8%). The most commonly recorded sign was spleen enlargement (37.5%) and the most commonly reported complication was bone and joint involvement (22.8%). No changes in symptoms occurred over years. The hemogram revealed anemia in 30.3% of cases. Blood culture was positive for 91.2%. Regarding serological diagnosis, rose Bengal was positive for 99.2% of cases; the most common agglutination titer to Brucella or B. mellitensis was 1/640 (13.5%). The most commonly used therapy consisted of the association tetracycline plus streptomycin (42.4%). For 42.6% of cards, patients were transferred to hospital, particularly since 1984. CONCLUSIONS: Generally speaking, clinical data recorded in the reporting card regarding brucellosis disease reveal the clinical features of the disease, after a long surveillance period. Rose Bengal should be used as screening test for the diagnosis of this disease.

Hipertensión y síndrome de apnea del sueño / Hypertension and sleep apnea syndrome

El síndrome de apnea obstructiva del sueño (SAOS) ocurre en más del 10 por ciento de la población mayor de 65 años y representa un factor de riesgo importante asociado a hipertensión, obesidad, ronquido, policitemia e insuficiencia cardíaca (30 por ciento-36 por ciento). Los pacientes presentan somnolencia diurna, pérdida de memoria, irritabilidad, deterioro intelectual e impotencia sexual. El diagnóstico se confirma con la polisomnografía o registro continuo durante el sueño nocturno que permite identificar los estadios sueño-vigilia y los parámetros cardiorrespiratorios. El tratamiento incluye pérdida de peso, abstinencia alcohólica, evitación de barbitúricos y neurolépticos, controlar la hipertensión y el empleo de presión positiva continua aérea (CPAP) en la vía respiratoria superior y apoyo ventilatorio durante el sueño. Este sistema generalmente es bien tolerado y eficaz en más del 80 por ciento de los pacientes. (AU)

Hiperglucemia postprandial como factor de riesgo cardiovascular / Postprandial hyperglycemia as cardiovascular risk factor

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Blood pressure and urinary excretion of electrolytes in Spanish schoolchildren.

Despite the importance of hypertension in adults, its effects on child health are poorly understood. This cross-sectional epidemiological study was designed to look for a relationship between elevated blood pressure (BP) in children and 24-h urinary excretion of sodium (Na) and potassium (K), and between BP and dietary salt intake. The study population was all 59 856 schoolchildren aged 6 to 14 years in the province of Almería in southern Spain, among whom 613 participants were chosen randomly for study. We measured 24-h urinary Na and K concentrations, systolic and diastolic BP, body weight and height. There was a weak correlation between Na excretion and systolic BP (r = 0.18, 95% confidence interval 0.10-0.26), and between K excretion and systolic BP (r = 0.49, 95% CI = 0.04-0.20). Body weight was the variable that best correlated with systolic (r = 0.49, 95% CI = 0.43-0.55) and diastolic BP, and with Na excretion (r = 0.48, 95% CI = 0.42-0.55). Multiple regression analysis also showed that body weight was the variable that best correlated with systolic BP (b = 0.58), although the variables in the equation explained little of the total variability in BP (26%). These correlations were significant at P < 0.05. In conclusion urinary electrolytes correlated poorly with BP in a sample of Spanish schoolchildren. Body weight was the only variable that showed a weak relationship with BP and Na excretion.

¿Hipertensión refractaria de componente psicógeno? / Refractory hypertension due to psychogenic causes

Se presenta un caso clínico correspondiente a una paciente de 48 años, casada, con historia familiar de hipertensión y que presenta una enfermedad hipertensiva de 7 años de evolución con valores correspondientes a una hipertensión grado II-III, rebelde a todo tratamiento farmacológico utilizado. La negatividad de todas las pruebas para confirmar el carácter secundario del proceso unido a la mejoría espectacular tras diversas hospitalizaciones y alejamiento del entorno familiar plantean la posibilidad de tratarse una hipertensión refractaria derivada de un conflicto psíquico profundo, aunque no filiado (AU)

Cinc y enfermedad pulmonar obstructiva crónica / Zinc and chronic pulmonary obstructive disease

Fundamento. Evaluar las concentraciones orgánicas de cinc en la enfermedad pulmonar obstructiva crónica (EPOC) y en controles sanos, así como evidenciar si existen diferencias entre ambos grupos. Determinar si las concentraciones de cinc plasmático se correlacionan con las halladas en hematíes y faneras. Pacientes y métodos. Se estudian 40 pacientes con EPOC, varones, edad media de 62 ñ 7 años e índice de masa corporal (IMC) de 27 ñ 4. El grupo control lo forman 40 individuos; edad media de 57 ñ 9 años e IMC de 24 ñ 5. Se excluyeron los pacientes con patologías concomitantes o en tratamientos que pudieran aumentar la excreción de cinc. A todos los pacientes se les ha realizado historia clínica y exploración física completas, analítica general con hemograma, bioquímica con parámetros hepáticos y lipídicos y determinación del cinc ungueal, plasmático, en cabellos y en hematíes, mediante espectrofotometría de absorción atómica. El método estadístico empleado ha sido el análisis de la varianza de una vía y el coeficiente de correlación lineal de Pearson para estudiar la asociación entre variables. Resultados. El cinc plasmático, intraeritrocitario y ungueal fue similar en los sujetos sanos y en los pacientes; en cambio, la concentración media en cabellos resultó significativamente menor en los pacientes (156 ñ 46) respecto al grupo control (185 ñ 64) con p < 0,05. No se han encontrado diferencias significativas entre fumadores y no fumadores, ni entre bebedores y no bebedores respecto a las concentraciones de cinc orgánico. Conclusión. Los pacientes con EPOC tienen unas concentraciones de cinc en pelo inferiores a la de los sujetos sanos, mientras que el cinc en hematíes, plasma y a nivel ungueal fue similar en ambos grupos. La determinación de cinc en cabellos puede ser un buen método para detectar deficiencias crónicas y asintomáticas de este metal en el organismo. No se ha encontrado correlación entre la determinación de cinc plasmática y las determinaciones en hematíes y faneras. (AU)

Hipertensión arterial y capacidad intelectual

Datos epidemiológicos señalan que la prevalencia de demencia en España en la población mayor de 65 años puede alcanzar la tasa del 10 por ciento. La enfermedad de Alzheimer da cuenta de un mayor número, pero no es despreciable la que se asocia a hipertensión crónica. Las alteraciones cerebrales secundarias a lesiones vasculares generales en los hipertensos, además de condicionar un deterioro intelectual, suponen un hándicap para la calidad de vida de los pacientes. En los últimos años se ha progresado en el control de los pacientes hipertensos y del resto de factores de riesgo y ello ha determinado un descenso en cuanto a las complicaciones cardiovasculares. Se presta más atención a los niveles de presión arterial sistólica y se conoce mejor la fisiopatología del envejecimiento vascular, lo cual contribuye a mejorar aún más el pronóstico cerebral de los hipertensos mayores (AU)

La reestenosis de los stents coronarios / The restenosis of coronary stents

A pesar de los importantes avances técnicos y farmacológicos ocurridos en los últimos años, todavía es elevado el índice de reestenosis tras la implantación de los stents coronarios. En este trabajo se revisan los aspectos más novedosos relacionados con ese problema: Factores predisponentes. Trombosis y antitrombóticos. ¿Es posible predecir la reestenosis del stent examinando los genes? La respuesta tisular a la implantación de stents coronarios. Tejido de granulación por cuerpo extraño en las lesiones de novo en pacientes con stents. Las disecciones en el borde del stent tras su despliegue. Diseño y reestenosis: ¿mejor cuanto más grande? Simetría del stent y reestenosis experimental. Sobreestiramiento focal vascular durante el implante. Remodelado patológico tardío. Luz de láser rojo de baja potencia. Stents recubiertos. Tratamiento con estatinas. Tratamiento de las reestenosis del stent (AU)

[Nocturnal arterial pressure and the cardiovascular risk factors in patients with arterial hypertension]. / Presión arterial nocturna y factores de riesgo cardiovascular en pacientes con hipertensión arterial.

BACKGROUND: Blood pressure (BP) has a circadian rhythm. Most of the people presents a BP fall between 10-20% during nighttime hours (dipper condition). Measurement of these circadian variations is performed by continuous blood pressure ambulatory monitoring. We have studied the possible relation between blood pressure nocturnal fall and cardiovascular risk factors in hypertensive patients. METHODS: We selected 100 hypertensive patients from the Hypertension and Lipids Unit of San Cecilio University Hospital of Granada, Spain. They were divided into two groups: dippers group and non-dippers, depending of whether or not the fall of nocturnal systolic and diastolic BP was > 10%. All patients included in the study underwent complete clinical history, exhaustive physical examination, complementary examinations, urine and hematology tests, and continuous blood pressure ambulatory monitoring by the Space Labs system. RESULTS: The heart rate was found to be significantly higher (p = 0.0253) in the hypertensive dippers group than in the non-dippers. The latter showed higher plasma creatinine values (p = 0.0343) and lower potassemia values (p = 0.0140) than the dippers group. The dippers group presented concentrations of HDL-cholesterol significantly higher (p = 0.008) and diurnal diastolic BP values (p = 0.0211) also higher than the other group. CONCLUSIONS: Non dippers hypertensive patients present a higher number of cardiovascular risk factors as well as a higher tendency to renal lesions, and worse prognosis than the dippers group.

[Zinc and chronic obstructive pulmonary disease]. / Cinc y enfermedad pulmonar obstructiva crónica.

BACKGROUND: To evaluate the zinc organic concentration in the chronic obstructive pulmonary disease (COPD) in relation to a control group. Also, to analyze if the serum zinc levels are related with zinc concentration in erythrocyte, nail and hair. PATIENTS AND METHODS: Forty patients of COPD have been studied, all males, average age 62 +/- 7 years and body mass index (BMI) of 27 +/- 4. Forty patients were included in the control group, with average age 57 +/- 9 years and BMI of 24 +/- 5. The patients with concomitant disease or booth treatment that could increase the zinc excretion were excluded. In all patients clinical history and examination, hematology and biochemistry tests, hepatic and lipid parameters, and nail, plasma, hair and erythrocyte zinc levels by atomic absorption spectrophotometry were done. Variance analysis and Pearson test were done. RESULTS: Blood, intraerythrocyte and nail zinc were similar in healthy subjects and patients; however, the median concentration of zinc in hair was significantly lower in patients (156 +/- 46 micrograms/g versus control group (185 +/- 64 micrograms/g) (p < 0.05). No differences were found between smokers and no smokers, and drinkers and no drinkers in relation with body concentration of zinc. CONCLUSION: The zinc concentration in hair can be a good method to evaluate the chronic deficiency in the human body. The COPD patients could be susceptible to develop zinc deficiency; the situation increases the possibility of infection diseases.

[Risk factors in the elderly. A study of 143 patients]. / Factores de riesgo en ancianos. Estudio de 143 pacientes.

UNLABELLED: Growing old is a process of natural diminish with decrease of biological answer to extrinsic and intrinsic factors and a bigger risk of presenting cardiovascular and metabolic processes. The aim of this study has been to analyse the incidence of cardiovascular factors in an aged population from Almería. PATIENTS AND METHODS: The group is by 172 patients (29 gave up); average global age 72.6 +/- 6.1 (85 women and 58 men). In all cases history and a whole clinic exam have been undertaken; general analytical study (glucose, creatinine, hepatic function cholesterol, HDL-c, LDL-c, trigliceride fibrinogen, microalbuminuria, etc.); blood pressure. STATISTICS: T Students, varianza analysis, Kolmogorov-Smirnov test. RESULTS: With regard to overweight, this was bigger in women (32.1 +/- 4.8 Kg/m2) in relation to men (27.9 +/- 4 Kg/m2). The most frequent risk factor has been hypertension (50.3%) followed by over weight-obesity (46.8%) and hypercholesterolemia (45.4%), only 11.2% did not present any risk factor; shile three factors appeared in 29.5%. Hypertension patients have more risk factors (increase of cholesterol and triglicerids, obesity, diabetes) than normotensive old patients; also diabetic patients have a bigger cardiovascular and lipid risk than non diabetic patients. The ingestion of estatinas or fibrates improves the lipid profile of old patients. In summarizing, conventional therapy can improve the cardiologic and metabolic situation, decreasing so the morbidity and mortality of old patients.

[Lymphoblastic stimulation in cirrhotic and non-cirrhotic chronic alcoholics]. / Estimulación linfoblástica en alcohólicos crónicos con o sin cirrosis hepática.

OBJECTIVE: To study whether there exists a functional change in lymphocytes in chronic alcoholic patients compared with chronic alcoholic cirrhotic patients. An open, prospective study was performed of the in vitro proliferative response (lymphoblastic transformation) of lymphocytes to phytohemagglutinin, mitogen pokeweed, and concanavalin A. PATIENTS: 73 males (51.4 +/- 12 years) divided on the basis of alcoholic intake and/or chronic liver disease in: social drinkers (< 80 g ethanol/day), 23; excessive drinkers (80-160 g ethanol/day), 14; chronic alcoholics (> 160 g ethanol/day), 21; and cirrhotic patients with no current alcohol consume, 15 cases. RESULTS: In social drinkers, excessive drinkers and cirrhotic patients similar proliferative responses to mitogens were observed, with no significant differences between groups. CONCLUSIONS: Our findings support the concept that chronic alcoholism has immunosuppressive effects which precede the emergence of liver cirrhosis.

Variations in magnesium and zinc in hypertensive patients receiving different treatments.

We studied the influence of captopril, atenolol, and verapamil on serum and intraerythrocyte concentrations of magnesium and zinc in 30 normotensive control subjects (12 men and 18 women, aged 30 to 65 years, mean +/- SD 45.76 +/- 12.15 years) and 30 patients with untreated mild or moderate essential hypertension (14 men and 16 women, aged 30 to 65 years, mean +/- SD 49.50 +/- 13.58 years). Ten each of the hypertensive patients were treated with captopril, atenolol, or verapamil. Physical examination and biochemical analyses (serum Mg and Zn) were done in all participants at baseline, and in patients after 3 and 6 months of treatment. The results were compared according to a nested design with Neumann-Keuls test. We found no significant differences between controls and patients in serum and intraerythrocyte concentrations of Zn at the start of the study, although there was a significant decrease in serum Zn in patients after 3 (P < .01) and 6 months (P < .001) of treatment, regardless of the drug used. This decrease was thought to be attributable to the zincuric effect of captopril or to dietary measures, or both. Intraerythrocyte Zn was not significantly affected by antihypertensive treatment. Serum and intraerythrocyte concentrations of Mg were significantly lower (P < .001) in hypertensive than in normotensive subjects, and serum Mg in patients treated with verapamil was significantly lower (P < .05) than after treatment with captopril or atenolol. Serum Mg concentration was related directly with serum concentrations of high density lipoprotein cholesterol (r = 0.4043, P < .05). We conclude that supplementation with Mg may benefit patients with hypertension.

[Does the diuretic effect of calcium inhibitors play an important role in the hypertensive efficacy?]. / L'effet diurétique des inhibiteurs calciques joue-t-il un rôle important dans l'efficacité antihypertensive?

Calcium ions play an important role in the pathophysiology of hypertension. Calcium antagonists, a group of first line drugs in the treatment of hypertension, reduce the intracellular content of calcium in vascular smooth muscle cells, and decrease the peripheral vascular resistance and blood pressure. These drugs differ from other vasodilators in that they also have natriuretic effects; thus they can affect the kidney on three levels: Renal haemodynamics are affected by increased renal blood flow, and increased glomerular filtration rate. Changes in the renin-angiotensin system can decrease aldosterone secretion. Finally, they affect sodium management by acting directly on the renal tubule, increasing sodium excretion and inhibiting tubular reabsorption of this ion. The natriuretic effect of calcium antagonists is independent of the subject's sodium balance. The vasodilating action of these drugs is therefore accompanied by a natriuretic effect that makes satisfactory control of hypertension possible without placing the patient on a low-salt or salt-free diet.

Metabolic and antihypertensive effects of nifedipine in hypertensive patients.

We studied the effects of nifedipine on blood pressure and on clinical and analytical parameters in hypertensive patients. Seven male and eight female subjects (mean age of 46.27 +/- 5.38 years, range of 41-56 years) with essential arterial hypertension were given nifedipine (20 mg b.i.d.) for 3 months. Before and after treatment, history, blood pressure, and biochemical values were recorded [blood: Na, K, Ca, creatinine, uric acid, triglycerides, cholesterol, HDL cholesterol, antidiuretic hormone (ADH), and aldosterone; urine: Na, K, Ca, creatinine, ADH, aldosterone, and percentage fraction of Na, K, and Ca excreted]. After 3 months of treatment, we found (a) significant decreases in systolic (147 +/- 18 vs. 166 +/- 16 mm Hg, p less than 0.001) and diastolic blood pressure (90 +/- 8 vs. 107 +/- 8 mm Hg, p less than 0.0007), triglycerides (107 +/- 47 vs. 120 +/- 49 mg/dl, p less than 0.0007), and cholesterol (236 +/- 4 vs. 257 +/- 44 mg/dl, p less than 0.00075) in blood, and in K excretion (50 +/- 19 vs. 46 +/- 19 mEq/g of creatinine, p less than 0.0007) and excreted fraction of K (49 +/- 6% vs. 8 +/- 5%, p less than 0.0012) in urine; (b) significant increases in HDL cholesterol (65 +/- 13 vs. 58 +/- 13 mg/dl, p less than 0.001) in blood, and in Na (115 +/- 73 vs. 109 +/- 69 mEq/g of creatinine, p less than 0.0007) in urine; and (c) no significant change in the remaining biochemical parameters, or in heart rate. Secondary effects included flushing (34%), headache (20%), ankle swelling (17%), dizziness (13%), palpitations (4%), and pruritus (4%).(ABSTRACT TRUNCATED AT 250 WORDS)

Zinc levels after intravenous administration of zinc sulphate in insulin-dependent diabetes mellitus patients.

Diabetic patients commonly have increased urinary excretion of zinc, although blood concentrations may be normal, lowered, or raised. We analyzed zinc levels in plasma and urine after an intravenous overload of zinc sulphate (8 mg) in 22 patients with insulin-dependent diabetes mellitus (IDDM) and 22 healthy individuals. No significant differences were found in basal levels of serum zinc in either group (111 +/- 29 micrograms/dl in IDDM vs 119 +/- 19 micrograms/dl in controls), although urinary excretion of zinc was significantly raised in diabetics (1396 +/- 622 micrograms/24 h) versus controls (611 +/- 235 micrograms/24 h). After zinc overload, both serum and urinary levels of this element varied between the two groups. Serum zinc in IDDM patients initially increased more markedly, and subsequently showed a more significant decline, than in controls. Urinary zinc levels in IDDM patients, in contrast to control values, showed no increase after overload. These alterations in serum and urinary zinc concentrations suggest that our diabetic patients may be zinc-deficient.