Hipertensión arterial refractaria verdadera. Estudio de prevalencia en una consulta hospitalaria / True refractory hypertension. Study of prevalence at a tertiary care clinic

Introducción. La hipertensión arterial refractaria (HTA-R) puede definirse como la falta de control de las cifras de presión arterial por debajo de 140/90 mmHg a pesar de tratamiento con una combinación adecuada de tres fármacos, siendo uno de ellos un diurético. La prevalencia de HTA-R entre los hipertensos españoles no es bien conocida. El objetivo sería estimar la prevalencia real de HTA-R en una consulta hospitalaria. Material y métodos. A partir de una población inicial de 281 pacientes remitidos por HTA resistente al tratamiento se seleccionó a aquellos individuos que cumplían criterios de HTA-R tras la primera evaluación. Se realizó un estudio exhaustivo de dichos pacientes para confirmar el diagnóstico de HTA-R, buscando causas de HTA secundaria y otros factores contribuyentes a la falta de respuesta al tratamiento. Resultados. Se seleccionó al subgrupo poblacional que cumplía criterios de HTA-R: 42 pacientes de 60 ± 9 años de edad media (27 mujeres y 15 hombres). Tras un seguimiento medio de 3,3 ± 0,5 años, el 73,8 % de los individuos presentaba HTA secundaria, siendo el síndrome de apnea obstructiva del sueño la causa más frecuente. Se obtuvo un control adecuado de la presión arterial en la mayoría de los casos (61,9 %). Sólo en el 4,8 % del subgrupo de 42 pacientes existía HTA-R verdadera, al presentar HTA esencial y mantener cifras elevadas de presión arterial, a pesar del estricto seguimiento y tratamiento. Discusión. La prevalencia real de HTA-R es muy baja, siendo necesario realizar un estudio exhaustivo de los pacientes. En la gran mayoría de los casos se encuentran causas secundarias de HTA y factores contribuyentes a la aparente refractariedad al tratamiento

Introduction. Refractory hypertension is defined as the failure to reach goal blood pressure (¾ 140/90 mmHg) in patients who are adhering to full doses of an appropriate three-drug regimen that includes a diuretic. Its prevalence among spanish patients is not well documented. The objective was to determine the true prevalence of refractory hypertension in adult patients from a university hospital hypertension clinic. Material and methods. Patients who fulfilled criteria for refractory hypertension were selected from an initial sample of 281 individuals with suspected resistant hypertension. An exhaustive study was performed on these patients in order to confirm refractory hypertension and to search for causes of secondary hypertension and contributing factors to poor response to treatment. Results. Forty two patients were selected (average age: 60 ± 9 years, 27 women, 15 men). After 3.3 ± 0.5 years of monitoring, 73.8 % of the individuals were diagnosed with secondary hypertension (sleep apnoea as the most frequent cause). Recommended treatment goals were achieved in most patients (61.9 %). Only 4.8 % of the selected patients suffered from true refractory hypertension, as they had essential hypertension and maintained high blood pressure in spite of strict treatment and monitoring. Discussion. Real prevalence of refractory hypertension is very low. An exhaustive study is needed in order to diagnose it. Causes of secondary hypertension and other contributing factors to poor response to treatment can be found in most casesIntroduction. Refractory hypertension is defined as the failure to reach goal blood pressure (¾ 140/90 mmHg) in patients who are adhering to full doses of an appropriate three-drug regimen that includes a diuretic. Its prevalence among spanish patients is not well documented. The objective was to determine the true prevalence of refractory hypertension in adult patients from a university hospital hypertension clinic. Material and methods. Patients who fulfilled criteria for refractory hypertension were selected from an initial sample of 281 individuals with suspected resistant hypertension. An exhaustive study was performed on these patients in order to confirm refractory hypertension and to search for causes of secondary hypertension and contributing factors to poor response to treatment. Results. Forty two patients were selected (average age: 60 ± 9 years, 27 women, 15 men). After 3.3 ± 0.5 years of monitoring, 73.8 % of the individuals were diagnosed with secondary hypertension (sleep apnoea as the most frequent cause). Recommended treatment goals were achieved in most patients (61.9 %). Only 4.8 % of the selected patients suffered from true refractory hypertension, as they had essential hypertension and maintained high blood pressure in spite of strict treatment and monitoring. Discussion. Real prevalence of refractory hypertension is very low. An exhaustive study is needed in order to diagnose it. Causes of secondary hypertension and other contributing factors to poor response to treatment can be found in most cases

Concentrado de proteína C en el tratamiento de la sepsis grave en pediatría / Protein C concentrate in the treatment of severe sepsis in the pediatric setting

Los pacientes con sepsis severa desarrollan déficit adquirido de proteína C, existiendo una correlación entre el grado de deficiencia y la evolución clínica negativa. El reemplazamiento de dicha proteína puede contribuir a evitar este proceso. En el mercado existen dos tipos de proteína C, concentrada y activada. Ninguna de ellas están registradas para el tratamiento de sepsis grave en pediatría. La experiencia con proteína C en este grupo de edades es limitada. Se requiere ensayos clínicos adecuados que establezcan su eficacia y seguridad y que clarifiquen el lugar de cada tipo de proteína C en la terapéutica de esta patología en pediatría. En el presente artículo se describe la experiencia del uso de concentrado de proteína C como terapia coadyuvante a la terapia convencional en el tratamiento de tres niños con sepsis grave en la Unidad de Cuidados Intensivos Pediátrica. En los tres casos de nuestro estudio, los niveles altos de proteína C se correlacionan con normalización de los parámetros de coagulación y con disminución de los niveles de dímero D. Dos de los tres pacientes evolucionaron favorablemente en el curso del tratamiento, mientras que la tercera paciente murió al entrar en shock séptico y disfunción multiorgánica (AU)

[Protein C concentrate in the treatment of severe sepsis in the pediatric setting]. / Concentrado de proteína C en el tratamiento de la sepsis grave en pediatría.

Patients with severe sepsis develop acquired protein C deficiency, and the extent of such deficiency and negative clinical outcomes correlate. Replacing this protein may help prevent such a condition. Two protein C types are commercially available - concentrated and activated proteins. None is registered for the treatment of severe sepsis in the pediatric setting. Experience with protein C in this group of conditions is limited. Appropriate clinical trials are required to establish effectiveness and safety, and to elucidate the role of either protein C type in the management of this condition in the pediatric setting. This paper discusses experience with the use of protein C concentrate as an adjuvant treatment in addition to conventional therapy in three children with severe sepsis at a Pediatric Intensive Care Unit. In all 3 cases of our study, high levels of protein C correlated to coagulation parameter normalization and reduced dimer D levels. Two out of three had a favorable outcome following treatment, whereas the third patient died as a result of septic shock and multiple organ dysfunction.