Asociación entre rigidez arterial y masa grasa en pacientes con obesidad / Association between arterial stiffness and fat mass in patients with obesity

Objetivo Comprobar si la composición corporal en los pacientes con obesidad de riesgo alto (índice de masa corporal>35 o entre 30 y 34,9kg/m2 con un perímetro abdominal mayor de 102cm en varones o mayor de 88cm en mujeres) se relaciona con la enfermedad vascular. Métodos Estudio transversal de pacientes con obesidad de riesgo alto. Se mide su masa grasa mediante bioimpedancia y la rigidez arterial mediante la velocidad de la onda de pulso (VOP). Se analizan los terciles de pacientes según la distribución de la VOP. Resultados Se ha estudiado a 59 pacientes. Con incrementos de la VOP, aumentan el IMC (p=0,02) y el contenido de masa grasa (p<0,00). Existe, además, un incremento significativo de los indicadores de inflamación. Conclusiones En pacientes con obesidad de riesgo alto existen diferencias relativas a su composición corporal que se asocian a modificaciones de su rigidez arterial y de su carga inflamatoria (AU)

Objective The aim is to observe whether body composition in patients with high-risk obesity (body mass index>35 or between 30 and 34.9kg/m2 with a waist circumference greater than 102cm in men or greater than 88cm in women) is related with vascular disease. Methods This is a cross-sectional study of patients with high-risk obesity. Their fat mass was measured through bioimpedance and arterial stiffness through pulse wave velocity (PWV). Tertiles of patients were analyzed according to PWV distribution. Results A total of 59 patients were analyzed. As PWV increased, BMI (p=0.02) and fat mass content (p<0.00) increased. There was also a significant increase in inflammation indicators. Conclusions In patients with high-risk obesity, there were differences in their body composition which were associated with changes in arterial stiffness and inflammatory burden (AU)

Association between arterial stiffness and fat mass in patients with obesity.

OBJECTIVE: The aim is to observe whether body composition in patients with high-risk obesity (body mass index >35 or between 30 and 34.9kg/m2 with a waist circumference greater than 102cm in men or greater than 88cm in women) is related with vascular disease. METHODS: This is a cross-sectional study of patients with high-risk obesity. Their fat mass was measured through bioimpedance and arterial stiffness through pulse wave velocity (PWV). Tertiles of patients were analyzed according to PWV distribution. RESULTS: A total of 59 patients were analyzed. As PWV increased, BMI (p=0.02) and fat mass content (p<0.00) increased. There was also a significant increase in inflammation indicators. CONCLUSIONS: In patients with high-risk obesity, there were differences in their body composition which were associated with changes in arterial stiffness and inflammatory burden.

Risk for post-thrombotic syndrome after lower-limb deep vein thrombosis: location of the thrombus or residual thrombi? / Risk razvitiia posttromboflebiticheskogo sindroma posle tromboza glubokikh ven nizhnikh konechnostei: lokalizatsiia tromba ili rezidual'nyi tromboz?

BACKGROUND: Many works aimed to determine factors that influence the onset of postthrombotic syndrome after an acute episode of deep venous thrombosis. We aimed to compare the prognostic value of the most proximal extent of thrombus (proximal and distal DVT) versus the residual thrombosis as identified by venous ultrasonography performed during follow-up. METHOD: We conducted a retrospective study of prospectively collected 1183 consecutive cohort patients in the RIETE registry after a first episode of deep venous thrombosis and assessed for postthrombotic syndrome after 12 months. RESULTS: Multivariate analysis revealed that: residual thrombosis (OR 1.40; 95% CI 0,88-2,21), the presence of cancer (OR 1.38; 95% CI: 0,64-2,97), immobility (OR 1.31; 95% CI 0,70-2,43) and estrogen-containing drugs use (OR 2.08, 95% CI 0,63-6,83), all had a predictive value for the occurrence of PTS. CONCLUSION: Our study results revealed that ultrasound finding of residual thrombosis is more predictive than proximal location of thrombus for postthrombotic syndrome after episode of deep venous thrombosis. Real life data from a large group of patients from the RIETE registry substantiates that.

Brachial-ankle pulse wave velocity with a custom device.

BACKGROUND AND OBJECTIVES: The brachial-ankle pulse wave velocity (baPWV) is one of the most widely used arterial stiffness variables for assessing vascular risk. The abiPWV is a device that calculates various PWVs and the blood pressure ankle-brachial index (ABI). The device can also determine baPWV. The aim of this study was to calculate the baPWV with abiPWV, validate it with a reference device (VaSera) and study its clinical usefulness. PATIENTS AND METHODS: We studied 113 patients (mean age, 53 ±â€¯12 years), 59 (52%) of whom were women, and 10 (8.8%) of whom had a previous cardiovascular event. The participants were classified according to cardiovascular risk factors (CRFs) into group I (none), group II (1 or 2 CRFs) and group III (3 or more CRFs). The patients with a previous cardiovascular event were included in group III. All participants had their baPWV measured with abiPWV and VaSera. RESULTS: The baPWV correlation between the 2 devices was r = 0.93 (p < .001), and the percentage error calculated with the Bland-Altman analysis was 4.5%. The baPWV measured with abiPWV (in m/s) was as follows: group I, 10.5 ±â€¯1.6; group II, 13.8 ±â€¯2.9 (p < .001 when compared with group I); and group III, 14.1 ±â€¯2.7 (p < .001 when compared with group I). There were no differences between groups II and III. The results with VaSera were comparable to those of abiPWV. CONCLUSIONS: Measuring baPWV with the abiPWV is safe and has a similar clinical utility to that of VaSera. Incorporating this function into the options of abiPWV makes it a complete device for assessing arterial stiffness.

Velocidad de onda de pulso brazo-tobillo con un dispositivo propio / Brachial-ankle pulse wave velocity with a custom device

Antecedentes y objetivos La velocidad de onda de pulso brazo-tobillo (VOPbt) es una de las variables de rigidez arterial más empleada en la valoración del riesgo vascular. VOPITB es un dispositivo que calcula distintas VOP y el índice tobillo-brazo de presión arterial (ITB). Además, con sus registros se podría determinar la VOPbt. El objetivo de este estudio fue: calcular la VOPbt con VOPITB, validarlo con un equipo de referencia (VaSera) y estudiar su utilidad clínica. Pacientes y métodos Se estudiaron 113 pacientes, con edad media de 53±12años; 59 (52%) eran mujeres y 10 (8,8%) presentaban evento cardiovascular previo. Los participantes se estatificaron según factores de riesgo vascular (FRV) en: grupoI, ninguno; grupoII, uno o 2; y grupoIII, 3 o más FRV. Los pacientes con algún evento vascular previo se incluyeron en el grupoIII. A todos se les midió la VOPbt con VOPITB y VaSera. Resultados La correlación de VOPbt entre ambos equipos fue r=0,93 (p<0,001) y el porcentaje de error calculado con análisis de Bland-Altman: 4,5%. La VOPbt con VOPITB fue (m/s): grupoI, 10,5±1,6 comparado con grupoII, 13,8±2,9 (p<0,001) y grupoIII, 14,1±2,7 (p<0,001). No se observaron diferencias entre gruposII y III. Los resultados obtenidos con VaSera fueron equiparables a los de VOPITB. Conclusiones La medición de la VOPbt con el equipo VOPITB es segura y de utilidad clínica similar a la realizada con VaSera. La incorporación de esta función a las prestaciones de VOPITB lo convertirá en un dispositivo completo para valorar la rigidez arterial (AU)

Background and objectives The brachial-ankle pulse wave velocity (baPWV) is one of the most widely used arterial stiffness variables for assessing vascular risk. The abiPWV is a device that calculates various PWVs and the blood pressure ankle-brachial index (ABI). The device can also determine baPWV. The aim of this study was to calculate the baPWV with abiPWV, validate it with a reference device (VaSera) and study its clinical usefulness. Patients and methods We studied 113 patients (mean age, 53±12years), 59 (52%) of whom were women, and 10 (8.8%) of whom had a previous cardiovascular event. The participants were classified according to cardiovascular risk factors (CRFs) into groupI (none), groupII (1 or 2 CRFs) and groupIII (3 or more CRFs). The patients with a previous cardiovascular event were included in groupIII. All participants had their baPWV measured with abiPWV and VaSera. Results The baPWV correlation between the 2 devices was r=0.93 (P<.001), and the percentage error calculated with the Bland-Altman analysis was 4.5%. The baPWV measured with abiPWV (in m/s) was as follows: groupI, 10.5±1.6; groupII, 13.8±2.9 (P<.001 when compared with groupI); and groupIII, 14.1±2.7 (P<.001 when compared with groupI). There were no differences between groupsII and III. The results with VaSera were comparable to those of abiPWV. Conclusions Measuring baPWV with the abiPWV is safe and has a similar clinical utility to that of VaSera. Incorporating this function into the options of abiPWV makes it a complete device for assessing arterial stiffness (AU)

Brachial-ankle pulse wave velocity with a custom device. / Velocidad de onda de pulso brazo-tobillo con un dispositivo propio.

BACKGROUND AND OBJECTIVES: The brachial-ankle pulse wave velocity (baPWV) is one of the most widely used arterial stiffness variables for assessing vascular risk. The abiPWV is a device that calculates various PWVs and the blood pressure ankle-brachial index (ABI). The device can also determine baPWV. The aim of this study was to calculate the baPWV with abiPWV, validate it with a reference device (VaSera) and study its clinical usefulness. PATIENTS AND METHODS: We studied 113 patients (mean age, 53±12years), 59 (52%) of whom were women, and 10 (8.8%) of whom had a previous cardiovascular event. The participants were classified according to cardiovascular risk factors (CRFs) into groupI (none), groupII (1 or 2 CRFs) and groupIII (3 or more CRFs). The patients with a previous cardiovascular event were included in groupIII. All participants had their baPWV measured with abiPWV and VaSera. RESULTS: The baPWV correlation between the 2 devices was r=0.93 (P<.001), and the percentage error calculated with the Bland-Altman analysis was 4.5%. The baPWV measured with abiPWV (in m/s) was as follows: groupI, 10.5±1.6; groupII, 13.8±2.9 (P<.001 when compared with groupI); and groupIII, 14.1±2.7 (P<.001 when compared with groupI). There were no differences between groupsII and III. The results with VaSera were comparable to those of abiPWV. CONCLUSIONS: Measuring baPWV with the abiPWV is safe and has a similar clinical utility to that of VaSera. Incorporating this function into the options of abiPWV makes it a complete device for assessing arterial stiffness.

[Pulse wave velocity of the leg minus that of the arm measured with a custom device correlates to the coronary calcium quantification]. / La velocidad de onda de pulso de la pierna menos brazo medida con un dispositivo propio se correlaciona con la cuantificación de calcio coronario.

OBJECTIVE: The pulse wave velocity (PWV) in the great arteries is an indicator of vascular risk. Our objective was to identify the PWV index between the arms and legs that best correlates with the coronary calcium quantification (CCQ) and to compare it with other methods. MATERIAL AND METHODS: Eight-one patients without vascular disease underwent the following measurements: CCQ; carotid intima-media thickness (IMT); carotid-femoral PWV (cfPWV), using COMPLIOR; and PWV in the arms and legs, with our own device (abiPWV, ankle brachial index PWV). RESULTS: The difference in PWVs between the leg and arm (l-a PWV) measured with abiPWV was the index that best correlated with CCQ (r=0.401, P<.001). The correlation between IMT and CCQ and between CF-PWV and CCQ were r=0.366, P=.001; and r=0.385, P=.001, respectively. For a CCQ score higher than 100 as a marker of significant coronary arteriosclerosis, the areas under the curve for l-a PWV, IMT and cfPWV were 0.721 (P=.002), 0.758 (P<.001) and 0.636 (P=.058), respectively. CONCLUSIONS: For patients without vascular disease, the l-a PWV measured with abiPWV appears to be the index that best correlates with the CCQ. This association is comparable to that between IMT and CCQ and between cfPWV and CCQ. The abiPWV is an easy-to-use device that can help improve vascular risk stratification.

Historia natural de la enfermedad tromboembólica venosa en el área mediterránea. Una revisión sistemática / Natural history of venous thromboembolism in patients from the Mediterranean region. A systematic review

Antecedentes: El pronóstico de las enfermedades cardiovasculares es mejor en los países mediterráneos que en otras partes del mundo. Se desconoce si estas diferencias también acontecen en la enfermedad tromboembólica venosa (ETV) Métodos: En las bases de datos Medline y EMBASE se revisaron los ensayos clínicos y estudios de cohortes de pacientes con ETV que habían recibido tratamiento anticoagulante durante 3 meses. Dos revisores extrajeron independientemente los datos de forma reglada. Se seleccionaron 24 estudios con un total de 7.225 pacientes incluidos (2.414 del área mediterránea y 4.811 de otras regiones). Resultados: Entre los pacientes del área mediterránea predominaban las mujeres, tenían mayor edad, y la ETV idiopática fue menos frecuente que en otras regiones del mundo. Comparados con otros países, los pacientes del área mediterránea presentaron más recidivas de trombosis venosa profunda (4,35% frente a 2,68%; odds ratio [OR]: 1,65; intervalo de confianza al 95% [IC95%]: 1,27-2,15), recidivas mortales de ETV (0,75% frente a 0,35%; OR: 2,11; IC95%: 1,09-4,12) y sangrado mortal (0,25% frente a 0,06%; OR: 3,99; IC95%: 1-16). En el área mediterránea el porcentaje de recidivas de ETV mortal fue del 12,8%, IC95%: 7,99-19,1 frente al 8,41%, IC95%: 5,15-12,9 en otras zonas del mundo. El porcentaje de hemorragias mortales fue del 11,3%, IC95%: 4,72-22,1 frente al 3,22%, IC95%: 0,83-8,53 en otras zonas geográficas. Conclusiones: Los pacientes con ETV del área mediterránea tienen una mayor mortalidad durante los 3 primeros meses de tratamiento imputable a una mayor incidencia de ETV recidivante y de hemorragias graves (AU)

Background: Patients with cardiovascular diseases living in the Mediterranean area have a better outcome than those in other parts of the world, but it is not known whether these differences also occur with venous thromboembolism (VTE). Methods: We searched the Medline and EMBASE databases to identify clinical trials and cohort studies of patients with VTE who had been treated with anticoagulant therapy for 3 months. Two reviewers independently extracted the data in a standardized manner. A total of 24 studies that included 7,225 patients (2,414 from the Mediterranean region and 4,811 from other regions) were analyzed. Results: The patients from the Mediterranean area were predominately women and older, and the idiopathic VTE was less frequent than in other regions. Compared with patients from other regions, patients from the Mediterranean region had an increased rate of recurrent deep vein thrombosis (4.35% vs. 2.68%; odds ratio [OR], 1.65; 95% confidence interval [95% CI] 1.27-2.15), fatal recurrent VTE (0.75% vs. 0.35%; OR, 2.11; 95% CI 1.09-4.12) and fatal bleeding (0.25% vs. 0.06%; odds ratio: 3.99; 95% CI 1.00-16.0). The case-fatality rate (CFR) for recurrent VTE was 12.8% (95% CI 7.99-19.1) in the Mediterranean region and 8.41% (5.15-12.9) in other areas. The CFR for major bleeding was 11.3% (95% CI 4.72-22.1) and 3.22% (95% CI 0.83-8.53), respectively. Conclusions: Compared to other regions, patients with VTE from the Mediterranean region have greater mortality during the first 3 months of treatment due to a greater incidence of recurrent VTE and severe hemorrhaging (AU)

Natural history of venous thromboembolism in patients from the Mediterranean region. A systematic review.

BACKGROUND: Patients with cardiovascular diseases living in the Mediterranean area have a better outcome than those in other parts of the world, but it is not known whether these differences also occur with venous thromboembolism (VTE). METHODS: We searched the Medline and EMBASE databases to identify clinical trials and cohort studies of patients with VTE who had been treated with anticoagulant therapy for 3 months. Two reviewers independently extracted the data in a standardized manner. A total of 24 studies that included 7,225 patients (2,414 from the Mediterranean region and 4,811 from other regions) were analyzed. RESULTS: The patients from the Mediterranean area were predominately women and older, and the idiopathic VTE was less frequent than in other regions. Compared with patients from other regions, patients from the Mediterranean region had an increased rate of recurrent deep vein thrombosis (4.35% vs. 2.68%; odds ratio [OR], 1.65; 95% confidence interval [95% CI] 1.27-2.15), fatal recurrent VTE (0.75% vs. 0.35%; OR, 2.11; 95% CI 1.09-4.12) and fatal bleeding (0.25% vs. 0.06%; odds ratio: 3.99; 95% CI 1.00-16.0). The case-fatality rate (CFR) for recurrent VTE was 12.8% (95% CI 7.99-19.1) in the Mediterranean region and 8.41% (5.15-12.9) in other areas. The CFR for major bleeding was 11.3% (95% CI 4.72-22.1) and 3.22% (95% CI 0.83-8.53), respectively. CONCLUSIONS: Compared to other regions, patients with VTE from the Mediterranean region have greater mortality during the first 3 months of treatment due to a greater incidence of recurrent VTE and severe hemorrhaging.

Cardiac rehabilitation and outcome in stable outpatients with recent myocardial infarction.

OBJECTIVE: To compare the mortality rate and the rate of subsequent ischemic events (myocardial infarction [MI], ischemic stroke, or limb amputation) in patients with recent MI according to the use of cardiac rehabilitation or no rehabilitation. DESIGN: Longitudinal observational study. SETTING: Ongoing registry of outpatients. PARTICIPANTS: Patients (N=1043) with recent acute MI were recruited; of these, 521 (50%) participated in cardiac rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subsequent ischemic events and mortality rates were registered. RESULTS: Over a mean follow-up of 18 months, 50 patients (4.8%) died and 49 (4.7%) developed 52 subsequent ischemic events (MI: n=43, ischemic stroke: n=6, limb amputation: n=3). Both the mortality rate (.16 vs 5.57 deaths per 100 patient-years; rate ratio=.03; 95% confidence interval [CI], 0.0-0.1]) and the rate of subsequent ischemic events (1.65 vs 4.54 events per 100 patient-years; rate ratio=0.4; 95% CI, 0.2-0.7) were significantly lower in cardiac rehabilitation participants than in nonparticipants. Multivariate analysis confirmed that patients in cardiac rehabilitation had a significantly lower risk of death (hazard ratio=.08; 95% CI, .01-.63; P=.016) and a nonsignificant lower risk of subsequent ischemic events (hazard ratio=.65; 95% CI, .30-1.42). CONCLUSIONS: The use of cardiac rehabilitation in patients with recent MI was independently associated with a significant decrease in the mortality rate and a nonsignificant decrease in the rate of subsequent ischemic events.

Comparison of the clinical history of symptomatic isolated distal deep-vein thrombosis vs. proximal deep vein thrombosis in 11 086 patients.

BACKGROUND: The clinical significance of symptomatic isolated distal deep vein thrombosis (DVT) is uncertain. Consequently, this leads to important disparities in its management. OBJECTIVE: To examine the clinical history of isolated distal DVT and to compare it with that of proximal DVT. METHODS: Using data from the international, prospective, RIETE registry on patients with confirmed symptomatic venous thromboembolism (VTE), we compared the risk factors and 3-month outcome in patients with isolated distal DVT vs. proximal DVT. RESULTS: Eleven thousand and eighty-six patients with symptomatic DVT, but without pulmonary embolism, were included between 2001 and 2008; 1921 (17.3%) exhibited isolated distal DVT. Anticoagulant treatment was received by 89.1% (1680/1885) of isolated distal DVT and 91.8% (7911/8613) of proximal DVT patients for the entire follow-up period. Isolated distal DVTs were more associated with transient risk factors (i.e. recent travel, hospitalization, recent surgery), whereas proximal DVTs were more associated with chronic states (i.e. > or =75 years or with active cancer). At 3 months, major bleeding rate was lower in patients with isolated distal DVT (1.0% vs. 2.2%, P < 0.01), whereas VTE recurrence rate was equivalent (2.0% vs. 2.7%, P = 0.07). The mortality rate was lower in patients with isolated distal DVT (2.7% vs. 7.5%; P < 0.001); this was mainly due to a lower rate of non-VTE-related deaths (2.2% vs. 6.3%; P < 0.001). Active cancer was the main predictive factor of death in patients with isolated distal DVT. CONCLUSIONS: Proximal and isolated distal DVT patients differ in terms of risk factors and clinical outcomes, suggesting different populations. In the short term, the life expectancy of patients with isolated distal DVT depended chiefly on their cancer status.

Control de la presión arterial en Extremadura: resultados del estudio de control de factores de riesgo de Extremadura (estudio COFRE) / Blood pressure control in Extremadura. Results from a study on Risk Control Factors in Extremadura (COFRE Study)

Objetivo: Evaluar la prevalencia y el control de la hipertensión arterial (HTA) en una muestra de la población extremeña con otros factores de riesgo cardiovascular. Diseño y método: Se han recogido los factores de riesgo cardiovascular y su control en una muestra de 1.022 pacientes visitados consecutivamente en consulta que presentaban al menos un factor de riesgo cardiovascular. Se realizó analítica general a todos los pacientes y se registraron sus características antropométricas y el tratamiento que estaban realizando. La presión arterial (PA) se midió dos veces en consulta y se hizo la media de las dos mediciones. Resultados: De los 978 pacientes aceptados para el análisis estadístico, 719 (73,5%) habían sido diagnosticados previamente de HTA (236 varones y 311 mujeres con una media ± desviación estándar de edad de 65,9 ± 10,7 años. En las cifras recogidas en el estudio un 8,3% más presentaban PA sistólica (PAS) > 140 mmHg y un 3,37%, PA diastólica (PAD) > 90 mmHg. El 72,7% de estos pacientes presentaban PAD < 90 mmHg, el 40% tenía una PAS < 140 mmHg y solamente 264 (36,7%) sujetos tenían controlados ambos componentes de la PA. Para el objetivo de PA en diabéticos (n = 215) (< 130/80 mmHg) las cifras eran inferiores (PAD controlada, 33,3%; PAS controlada, 20,9%; control simultáneo de PAS y PAD, 15,9%). El 8,3% de la muestra de hipertensos no recibía tratamiento farmacológico y el 52,9% eran tratados con más de un fármaco antihipertensivo. El tratamiento combinado de la hipertensión arterial (más de un fármaco) era más frecuente en las mujeres (p <0,001). En cuanto al tipo de fármacos utilizado destaca el elevado uso de antagonistas de receptores de la angiotensina, que era mayor en mujeres al igual que los diuréticos. Conclusiones: La HTA es el factor de riesgo cardiovascular más prevalente en la muestra obtenida. El grado de control de la PAS es bajo, pero similar que en la mayor parte de los estudios publicados en España. La gravedad de la hipertensión arterial parece mayor en las mujeres(AU)

Objective: Our study aimed to assess the BP control in a sample of patients with othercardiovascular risk factors attended in primary care in Extremadura.Patients and method: The presence and control of cardiovascular risk factors wascollected in a sample of 1022 patients consecutively seen in the consultation offi ce whohad at least one cardiovascular risk factor. General analysis was done for all the patientsand their anthropometric characteristics and treatment done were recorded. The BP wasmeasured twice in the medical offi ce and the mean of the two measurements wasobtained.Results: A total of 978 patients were accepted for the statistical analysis, 719 (73.5% withprevious diagnosis of BPB (236 men and 311 women with mean age of 65.9 ± 10.7 years).A total of 8.3% more patients had have high blood pressure in offi ce control (SBP > 140mmHg) without known diagnosis of hypertension and 3.37% had DBP > 90 mmHg. Theremaining 72.7% of the patients had DBP<90 mmHg, 40% had SBP < 140 mmHg and only264 subjects were controlled with both components of the blood pressure (36.7%),Regarding the target BP in diabetics (n = 215) (< 130/80 mmHg), the values were lower(controlled DBP, 33.3%, controlled SBP, 20.9%; simultaneous control of SBP and DPB,15.9%). A total of 8.3% of the hypertensive sample were not receiving drug treatment and52.9% were treated with more than one antihypertensive drug. The combined treatmentof high blood pressure (more than one drug) is more frequent among women patients (p< 0.001). Regarding drug type used, the elevated use of angiotensive receptor antagoniststhat was greater in women as were the diuretics stands out.Conclusions: The results of the COFRE study indicate that hypertension was the mostcommon cardiovascular risk in the sample obtained. The optimal BP control grade waslow but similar to the results reported by other Spanish studies. High blood pressureseems to be more severe in women

Homocysteinemia in hypertensive patients with renal target organ damage (mild renal dysfunction).

The prevalence of high plasmatic levels of homocysteine in hypertensive patients with mild renal dysfunction (MRD) defined by 2003 European Hypertension Society Guidelines (men plasmatic creatinine between 1.3 and 1.5; women plasmatic creatinine between 1.2 and 1.4 mg/dl) has not been previously reported. To evaluate this item 18 MRD patients were recruited (54% males, mean age 59.2 +/- 17.3 years, mean plasmatic creatinine 1.30 +/- 0.12 mg/dl). They were compared with a control group of hypertensives with normal renal function (n = 87, 42,9% males, mean age 53.6 +/- 12.3 years, mean plasmatic creatinine 0.83 +/- 0.21 mg/dl) and a group of 29 chronic renal failure patients (51.7% males, mean age 56.9 +/- 15.0 years, mean plasmatic creatinine 2.39 +/- 0.95 mg/dl). Age and sex differences are not significant, plasmatic creatinine levels are different among three groups (p <0.001, t student test). Basal homocysteine levels of CRF (19.3 +/- 7.1 micromol/l) were higher than those of control group (11,0 +/- 4,3 micromol/l) and MRD patients (14.8 +/- 5.5 micromol/l; p = 0.027 vs. CRF and p = 0.007 vs. control, Mann-Whitney test). Mean creatinine clearance was 30.3 +/- 11.5 ml/min for CRF group, significantly lower than MRD patients creatinine clearance (54.5 +/- 9.4 ml/min, p <0.001, t student test) and control ones (88,9 +/- 18,9 ml/min, p <0.001, t student test). Hypertensive patients with mild renal dysfunction showed higher and pathological levels of homocysteinemia as compared with controls, this finding might be related to the higher cardiovascular risk described in this group of patients.

[Control of the systolic blood pressure and related factors in patients with high cardiovascular risk]. / Control de la tensión arterial sistólica y factores relacionados en pacientes de alto riesgo vascular.

OBJECTIVE: To know in a good therapeutic compliance population with high cardiovascular risk (HCR), the systolic blood pressure (SBP) control-rate and the factors that could influence. MATERIAL AND METHOD: A cross-sectional observational study was carried out in a HCR hypertensive population in Cáceres (Spain). A survey of different laboratory tests, SBP in first and last visits. RESULTS: Among 388 HCR hypertensive patients, 199 (51.4%) patients with antihypertensive treatment adherence was selected. The average age was of 63 +/- 11 years, 109 (54.1%) males, 61 (30.7%) diabetes mellitus (DM) ones, the 10 years global cardiovascular risk was 22.25 +/- 8.9%, average follow-up was 16.5 +/- 8 months, means SBP was 158 +/- 22 mm Hg. 59.5% with combined treatment, generally diurets with another antihypertensive one. SBP less 140 mm Hg was observe in 23.9% and, only 13.5% less than 130 mm Hg in DM patients. SBP control was more common in less than five years hypertension diagnosis (with respect to those of more time evolution (33.8% vs 15.7%: p < 0.01). as well as, in those with beat pressure (BP) less of 60 mmHg (73.3% versus 26.7%; p < 0.0005). In multivariable analysis also influences negatively in the SBP control: upper 5 years hypertension diagnosis, OR 1.92 (1.08-3.4; p < 0.05) and, a greater BP of 60 mmHg, OR 30.3 (10.6-87: p < 0.0001). CONCLUSIONS: SBP control is difficult to obtain in a population of HCR and good therapeutic compliance, but more still in DM patients. A time of more 5 years evolution of the hypertension and, BP upper of 60 mm HG, have a negative influences in the SBP control.

Control de la tensión arterial sistólica y factores relacionados en pacientes de alto riesgo vascular / Control of the systolic blood pressure and related factors in patients with high cardiovascular risk

Objetivos: Estudiar el grado de control de la tensión arterial sistólica (TAS) y, los factores que pudieran influir en él, en una población de alto riesgo cardiovascular (RCV) con buen cumplimiento terapéutico. Material y método: Estudio observacional realizado en una población hipertensa con RCV elevado en Cáceres. Se recogieron distintas variables biológicas, así como la medición de TA en su primera y última visita. Resultados: De 388 pacientes hipertensos con RCV global elevado se seleccionaron 199 (51,3%) por su buen cumplimiento del tratamiento antihipertensivo. La edad media fue de 63 ± 11 años, 109 (54,1%) varones, 61 (30,7%) diabéticos, el RCV global a 10 años fue del 22,25 ± 9,8%, seguimiento medio 16,5 ± 8 meses, la TAS media fue,158 ± 22 mmHg. El 59,5% realizó tratamiento combinado, generalmente diuréticos con otro antihipertensivo. El 23,9% de los hipertensos presentó cifras de TAS inferiores a 140 mmHg y, el 13,5% de los diabéticos inferiores a 130 mmHg. El control de la TAS fue más probable en los hipertensos con menos de 5 años de conocimiento de su HTA, respecto a los de más evolución (33,8 vs. 15,7%, p 60 mmHg 30,3 (10,6-87: p < 0,0001), influyeron negativamente en el control de la TA. Conclusiones: El control de la TAS en una población de alto RCV con buen cumplimiento terapéutico es difícil de conseguir, más aún en los pacientes diabéticos. El tiempo de evolución de la hipertensión superior a 5 años y, una PP mayor de 60 mmHg, influyen negativamente en el control de la HTA

Objetive: To know in a good therapeutic compliance population with high cardiovascular risk (HCR), the systolic blood pressure (SBP) control-rate and the factors that could influence. Material and method: A cross-sectional observacional study was carried out in a HCR hypertensive population in Cáceres (Spain). A survey of different laboratory tests, SBP in first and last visits. Results: Among 388 HCR hypertensive patients, 199 (51.4%) patients with antihypertensive treatment adherence was selected. The average age was of 63 ± 11 years, 109 (54.1%) males, 61 (30.7%) diabetes mellitus (DM) ones, the 10 years global cardiovascular risk was 22.25 ± 8.9%, average follow-up was 16.5 ± 8 months, means SBP was 158 ± 22 mm Hg. 59.5% with combined treatment, generally diurets with another antihypertensive one. SBP less 140 mm Hg was observe in 23.9% and, only 13.5% less than 130 mm Hg in DM patients. SBP control was more common in less than five years hypertension diagnosis ( with respect to those of more time evolution (33.8% vs 15.7%: p < 0.01). as well as, in those with beat pressure (BP) less of 60 mmHg (73.3% versus 26.7%; p < 0.0005).In multivariable analysis also influences negatively in the SBP control: upper 5 years hypertension diagnosis, OR 1.92 (1.08-3.4; p < 0.05) and, a greater BP of 60 mmHg, OR 30.3 (10.6-87: p < 0.0001). Conclusions: SBP control is difficult to obtain in a population of HCR and good therapeutic compliance, but more still in DM patients. A time of more 5 years evolution of the hypertension and, BP upper of 60 mm HG, have a negative influences in the SBP control

[Obstructive sleep apneas and arteriosclerosis]. / Apneas obstructivas del sueño y arterioesclerosis.

The clinical importance of the obstructive sleep apnea syndrome underlies in its association with a major morbimortality principally in relation with adverse vascular events. Different physiopathologic mechanisms boosted by the recurrence of obstructive apnea episodes including alterations in several inflammatory mediators, metabolic factors associated with a dysfunction of vascular endothelium and the development of arterial hypertension would lead to an acceleration of the atherosclerotic process responsible in causality degree of the increment of cardiovascular disease in these patients.

Apneas obstructivas del sueño y arterioesclerosis / Obstructive sleep apneas and arteriosclerosis

La importancia clínica del síndrome de apneas obstructivas del sueño subyace en su asociación a una mayor morbimortalidad fundamentalmente en relación con acontecimientos vasculares adversos. Diversos mecanismos fisiopatológicos desencadenados por la recurrencia de los episodios de apneas obstructivas –que incluyen alteraciones en diversos mediadores inflamatorios, factores metabólicos asociados a una disfunción del endotelio vascular y el desarrollo de hipertensión arterial– conducirían a un aceleración del proceso ateroesclerótico responsable en grado de causalidad del incremento de la enfermedad cardiovascular en estos pacientes (AU)

The clinical importance of the obstructive sleep apnea syndrome underlies in its association with a major morbimortality principally in relation with adverse vascular events. Different physiopathologic mechanisms boosted by the recurrence of obstructive apnea episodes including alterations in several inflammatory mediators, metabolic factors associated with a dysfunction of vascular endothelium and the development of arterial hypertension would lead to an acceleration of the atherosclerotic process responsible in causality degree of the increment of cardiovascular disease in these patients (AU)

Utilización y eficacia de la vacunación antigripal en la prevención de ingresos hospitalarios por descompensación cardiorrespiratoria en pacientes de alto riesgo en Cáceres (réplica) / Use and effectivity of influenza vaccination for the prevention of hospital admissions of high risk patients with cardiopulmonary decompensation

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[Herpes simplex encephalitis in Cáceres. An analysis of the last five years]. / Encefalitis herpética en Cáceres. Análisis de los últimos cinco años.

INTRODUCTION: Herpes simplex encephalitis (HSE) is a rare disease, although it is still the most common serious viral infection of the central nervous system. Little is currently known about its epidemiology and clinical features in our area. This paper presents a retrospective description of the clinical, diagnostic and progressive characteristics of patients diagnosed with HSE in Cáceres General Hospital, and confirmed by means of a polymerase chain reaction (PCR) study for the DNA of the herpes simplex virus over the last 5 years. CASE REPORTS: We found four patients who had been diagnosed with HSE in the last 5 years (3.3 cases/million inhabitants/year; CI at 95% of 2.42-4.18), two males and two females, with an age interval between 58 and 75 years. All the patients had high temperatures and three of them also presented neurological focus. A computerised axial tomography scan of the head performed on admission was interpreted as being normal in all cases, while magnetic resonance imaging of the head carried out in two patients showed lesions compatible with HSE in both cases. Electroencephalographic studies were carried out in two patients and revealed focusing in one of them and severe generalised involvement in the other. Analysis of the cerebrospinal fluid (CSF) disclosed lymphocytic meningitis in four cases, although in one of them the study was normal on admission. In two of the patients, viral meningoencephalitis was suspected from the moment the patient was admitted to hospital. For this reason, early treatment with IV acyclovir was established and the clinical progression was good in both patients, although one of them was left with mild neurological sequelae. The other two cases, who died, had a severe underlying pathology and alternative clinical diagnoses that were reasonable on admission (extensive pneumonia and delirium tremens in one of them, and hypercapnic encephalopathy with severe chronic obstructive pulmonary disease in the other), and the clinical suspicion of HSE and the establishment of treatment were late. CONCLUSIONS: The incidence of HSE in our environment is in the upper interval of that reported in the literature. PCR analysis for the herpes simplex virus in CSF seems to have replaced brain biopsy studies as the diagnostic technique. The underlying severe chronic pathology makes it more difficult to diagnose and worsens the prognosis. A multicentre epidemiological study should be conducted to confirm these findings.

Encefalitis herpética en Cáceres. Análisis de los últimos cinco años / Herpes simplex encephalitis in cáceres. an analysis of the last five years

Introducción. La encefalitis herpética (EH) es una enfermedad rara, aunque la más frecuente de las infecciones víricas humanas graves del sistema nervioso central. La epidemiología y las características clínicas en nuestra zona son actualmente poco conocidas. Se describen retrospectivamente las características clínicas, diagnósticas y evolutivas de los enfermos de EH diagnosticados en el Hospital General de Cáceres, confirmados por el estudio de la reacción en cadena de la polimerasa (PCR) para el ADN del virus del herpes simple en los últimos 5 años. Casos clínicos. Encontramos cuatro pacientes diagnosticados de EH en los últimos 5 años (3,3 casos/millón de habitantes/año; IC al 95%: 2,42-4,18), dos varones y dos mujeres, con un intervalo de edad entre 58 y 75 años. Todos los enfermos presentaron fiebre y tres de ellos, focalidad neurológica. El estudio de tomografía axial computarizada craneal en el momento de su ingreso se interpretó como normal en todos, mientras que la resonancia magnética nuclear craneal, que se realizó en dos pacientes, mostró lesiones compatibles con EH en ambos. En dos enfermos se practicó un estudio de electroencefalografía, que demostró focalidad en un paciente y afectación generalizada grave en otro. El análisis del líquido cefalorraquídeo (LCR) puso de manifiesto meningitis linfocitaria en los cuatro casos, aunque en uno de ellos el estudio fue normal cuando ingresó. En dos de los pacientes, la sospecha de meningoencefalitis vírica se produjo desde el momento del ingreso, por lo que se instauró precozmente un tratamiento con aciclovir IV, con evolución clínica favorable en ambos, aunque con ligeras secuelas neurológicas en uno de ellos. Los otros dos casos, que fallecieron, presentaban una patología grave de base y diagnósticos clínicos alternativos razonables en el momento del ingreso (neumonía extensa y delirium tremens uno de ellos y encefalopatía hipercápnica en paciente con enfermedad pulmonar obstructiva crónica grave el otro), y se retrasó la sospecha clínica de EH y el inicio del tratamiento. Conclusiones. La incidencia de EH en nuestro medio se encuentra en el intervalo alto de la descrita en la literatura. El análisis de PCR para el virus herpes simple en el LCR parece haber desplazado como técnica diagnóstica a la biopsia cerebral. La patología crónica grave subyacente dificulta su diagnóstico y ensombrece el pronóstico. Convendría realizar un estudio epidemiológico multicéntrico para confirmar estos hallazgos

Introduction. Herpes simplex encephalitis (HSE) is a rare disease, although it is still the most common serious viral infection of the central nervous system. Little is currently known about its epidemiology and clinical features in our area. This paper presents a retrospective description of the clinical, diagnostic and progressive characteristics of patients diagnosed with HSE in Cáceres General Hospital, and confirmed by means of a polymerase chain reaction (PCR) study for the DNA of the herpes simplex virus over the last 5 years. Case reports. We found four patients who had been diagnosed with HSE in the last 5 years (3.3 cases/million inhabitants/year; CI at 95% of 2.42-4.18), two males and two females, with an age interval between 58 and 75 years. All the patients had high temperatures and three of them also presented neurological focus. A computerised axial tomography scan of the head performed on admission was interpreted as being normal in all cases, while magnetic resonance imaging of the head carried out in two patients showed lesions compatible with HSE in both cases. Electroencephalographic studies were carried out in two patients and revealed focusing in one of them and severe generalised involvement in the other. Analysis of the cerebrospinal fluid (CSF) disclosed lymphocytic meningitis in four cases, although in one of them the study was normal on admission. In two of the patients, viral meningoencephalitis was suspected from the moment the patient was admitted to hospital. For this reason, early treatment with IV acyclovir was established and the clinical progression was good in both patients, although one of them was left with mild neurological sequelae. The other two cases, who died, had a severe underlying pathology and alternative clinical diagnoses that were reasonable on admission (extensive pneumonia and delirium tremens in one of them, and hypercapnic encephalopathy with severe chronic obstructive pulmonary disease in the other), and the clinical suspicion of HSE and the establishment of treatment were late. Conclusions. The incidence of HSE in our environment is in the upper interval of that reported in the literature. PCR analysis for the herpes simplex virus in CSF seems to have replaced brain biopsy studies as the diagnostic technique. The underlying severe chronic pathology makes it more difficult to diagnose and worsens the prognosis. A multicentre epidemiological study should be conducted to confirm these findings