[Control of arterial pressure: experience at a hospital monographic unit arterial hypertension]. / Control de la presión arterial: experiencia de una Unidad monográfica de Hipertensión Arterial hospitalaria.

OBJECTIVE: To analyse the evolution of blood pressure control in patients referred to our centre for study, proportion of controlled hypertensive patients, changes in the characteristics of hypertensive patients and in therapeutic guidelines in the last twenty years. MATERIAL AND METHODS: A total of 4,103 patients were referred to study of hypertension. The analysed variables year by year included sex, age, weight, systolic blood pressure (SBP) and diastolic blood pressure (DBP). Cross sections at five-year intervals were performed to collect basal SBP and DBP and the evolution of BP in the following five years. RESULTS: From 1977 to 1997 the following changes were observed: basal mean age changed from 67 +/- 9 down to 56 +/- 10 years among males and from 68 +/- 8 down to 52 +/- 9 years among females; basal mean weight changed from 71 +/- 7 up to 81 +/- 8 kg among males and from 69 +/- 12 up to 73 +/- 13 years among females. Males showed a decrease in basal mean values of SBP/DBP from 176 +/- 25/112 +/- 20 mmHg down to 154 +/- 21/94 +/- 12 mmHg. In women, the corresponding values changed from 182 +/- 36/105 +/- 19 mmHg down to and 154 +/- 23/93 +/- 12 mmHg. In the early 1980's, 62% of patients received one or no antihypertensive drug. In the last few years such percentage has been 36% and 64% have been treated with two or more drugs. CONCLUSIONS: A decrease in age and an increase in weight of hypertensive patients referred to study have been observed in the last twenty years. Such patients show a less severe hypertension compared with referred patients in the early years. The use of new hypertensive drugs and their combined use are measures that contribute to improve the percentage of controlled hypertensive patients.

Control de la presión arterial: experiencia de una Unidad monográfica de Hipertensión Arterial Hospitalaria / Blood pressure control: experience in a monographic Hospital Hypertension Unit

Fundamento. Analizar la evolución del control de la hipertensión arterial (HTA) en la población remitida para estudio en nuestro centro, la proporción de hipertensos controlados, los cambios de las características del hipertenso y de las pautas terapéuticas en los últimos 20 años. Pacientes y métodos. Se incluyeron 4.013 pacientes remitidos para estudio de su HTA. Las variables analizadas año por año fueron sexo, edad, peso, presión arterial sistólica (PAS) y diastólica (PAD). Se realizaron cortes transversales cada 5 años para recoger la PAS y PAD basal y la evolución de dichos valores de PA en los 5 años siguientes. Resultados. Entre 1977 y 1997 se observaron los siguientes cambios: la edad basal media pasó de 67 ñ 9 a 56 ñ 10 años en varones y de 68 ñ 8 a 52 ñ 9 años en mujeres; el peso basal medio pasó de 71 ñ 7 a 81 ñ 8 kg en los varones y de 69 ñ 12 a 73 ñ 13 kg en las mujeres. Los varones mostraron una reducción de los valores medios basales de PAS/PAD de 176 ñ 25/112 ñ 20 mmHg a 154 ñ 21/94 ñ 12 mmHg. En las mujeres dichos valores pasaron de 182 ñ 36/105 ñ 19 mmHg a 154 ñ 23/93 ñ 12 mmHg. A principios de los ochenta el 62 por ciento de los pacientes recibían uno o ningún fármaco antihipertensivo. En los últimos años dicho porcentaje es del 36 por ciento y un 64 por ciento son tratados con 2 o más fármacos. Conclusiones. Se observa una disminución de la edad e incremento del peso de los hipertensos remitidos para estudio en los últimos 20 años. Dichos pacientes muestran una HTA menos severa en comparación con los pacientes remitidos en los primeros años. La utilización de nuevos fármacos antihipertensivos y el uso combinado de los mismos son medidas que contribuyen a mejorar el porcentaje de pacientes hipertensos controlados (AU)

Manejo de la hipertensión vasculorrenal / Management of renovascular hypertension

Se revisan los síntomas y signos que orientan a la hipertensión vasculorrenal. Dentro de las exploraciones complementarias, la sensibilidad y especificidad de los métodos no invasivos más utilizados (gammagrafía, Doppler, angiorresonancia y el scanner helicoidal) son muy similares, aunque dependen de los medios y experiencia de cada centro. Hasta estos momentos la gammagrafía renal basal, y tras la administración de un inhibidor de la enzima de conversión de la angiotensina, es la técnica de aproximación más utilizada. Aporta información funcional sobre el grado y repercusión de la estenosis. En relación con exploraciones morfológicas, los resultados publicados sobre la utilización de la angiorresonancia y el scanner helicoidal son muy prometedores. Cuando la sospecha clínica de hipertensión vasculorrenal (HVR) sea muy elevada se puede realizar como primera exploración una arteriografía renal. En los casos de sospecha moderada o baja se realizará como aproximación una prueba no invasiva que depende de la experiencia y resultados de cada centro. Si es positiva, se hará después una arteriografía de confirmación. El objetivo fundamental del tratamiento de la HVR es preservar o mantener la función renal. En la displasia fibromuscular la técnica de elección es la angioplastia transluminal percutánea por sus excelentes resultados, baja morbilidad y nula recidiva. En la enfermedad aterosclerótica la revascularización quirúrgica es la primera indicación, pero en pacientes de alto riesgo o con lesiones severas del sector aórtico se puede realizar angioplastia/endoprótesis. En los casos de enfermedad vasculorrenal bilateral e insuficiencia renal será preciso realizar una valoración individualizada de cada paciente (AU)

Antihypertensive activity of verapamil: impact of dietary sodium. The VERSAL Study Group.

OBJECTIVE: To define the influence of dietary salt intake on the antihypertensive effect of slow-release verapamil 240 mg once a day in a population with mild-to-moderate essential hypertension. DESIGN: Parallel, randomized, multicentre study. METHODS: Patients were advised to follow a moderately low salt diet (Low-salt group). After a 2-week run-in period, those patients with 24-h urinary sodium excretion (UNa) < or = 120 mmol/day and a diastolic blood pressure (DBP) between 90 and 114 mmHg were randomly assigned to verapamil + Low-salt or verapamil + unrestricted-salt diet (High-salt group) for 28 days. Compliance with diets was defined as Low-salt UNa < or = 120 mmol/day and High-salt UNa > 120 mmol/day with UNa increased by > or = 60 mmol/day over the level attained at the end of the run-in period. RESULTS: Significant reductions in mean systolic blood pressure (SBP) and DBP were found in both the Low-salt (n = 235) and High-salt (n = 183) groups. The therapeutic goal (DBP < 90 mmHg) was achieved in 38.3% of patients in the Low-salt and 44.8% of patients in the High-salt group. Office blood pressure results were confirmed by ambulatory 24-h blood pressure monitoring in a subsample of patients. Verapamil reduced mean blood pressure throughout the nycthemeral cycle without any significant difference between the two groups. CONCLUSION: The restriction in sodium intake does not have an additive effect on the antihypertensive effect of the slow-channel calcium antagonist verapamil.

[Treatment of essential arterial hypertension with hypercholesterolemia. Effects of an alpha-adrenergic blocker and an inhibitor of the angiotensin converting enzyme]. / Tratamiento de la hipertensión arterial esencial con hipercolesterolemia. Efectos de un bloqueador alfaadrenérgico y un inhibidor de la enzima conversiva de la angiotensina.

BACKGROUND: Hypertension and hypercholesterolemia are frequently associated with this leading to considerable cardiovascular risk. METHODS: An open parallel randomized study was performed in which the effects of doxazosin, an alpha-adrenergic blocker and enalapril, an inhibitor of the angiotensin converting enzyme were compared in 70 patients with essential high blood pressure and plasma cholesterol levels greater than 240 mg/dl. Following 2-4 weeks of placebo administration the patients were randomly treated with one of the two drugs. When required doses were increased and hydrochlorothiazide added until blood pressure lower than 160/95 mmHg was achieved. After this period the patients were observed for a minimum of 8 weeks. The mean length of the study was of 22 weeks. RESULTS: Both drugs significantly reduced blood pressure without modifying cardiac frequency. Doxazosin tended to favorably modify the lipid profile of the plasma while enalapril significantly reduced the levels of cholesterol, lipids and high density lipoproteins (HDL). Upon termination of the study the total HDL/cholesterol index increased 8.6% in those treated with doxazosin and decreased 5.5% in those receiving enalapril (p < 0.05). CONCLUSIONS: Although doxazosin and enalapril are potent antihypertensive drugs, the effects on plasma lipid obtained with doxazosin indicate that a reduction in cardiovascular risk was achieved with this drug in the patients included in this study.

Negative effect of frusemide pretreatment in glycerol induced acute renal failure.

It is commonly assumed that the decrease in the effective circulatory volume (ECV) is the major event in acute renal failure (ARF) and the preferential ischemia of the cortex another major modification. Frusemide has been given to try to prevent this change in glycerol-induced ARF because of its effect in redistributing renal blood flow from medulla to cortex. Isontonic saline was also tried to avoid the ECV depletion. The pretreatment with frusemide not only fails to protect against the ARF but increases its severity. Isotonic saline adminstration and replacement of urinary losses almost prevent glycerol-induced ARF but when both isotonic saline frusemide are administered together their effect is only a slight increase in the excretion rate of urea and creatinine during the first days of the experiment. The importance of the changes in the ECV or a possible direct action of frusemide on the renin-angiotensin axis are discussed. There is a good correlation between plasma creatinine levels and interstitial oedema. The importance of the oedema in the maintenance of ARF is discussed.