Respuesta hipertensiva al ejercicio: ¿tiene implicaciones pronósticas? / Hypertensive response to exercise: Does it has prognostic implications?

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Cystatin C as a predictor of cardiovascular outcomes in a hypertensive population.

Calculating the estimated glomerular filtration rate (eGFR) using creatinine-based equations may underestimate cardiovascular risk. Cystatin C-based eGFR may be a stronger prognostic biomarker than creatinine-based eGFR when assessing cardiovascular outcomes and mortality. Our aim was to determine whether levels of serum cystatin C, as an estimator of GFR, had a higher predictive value than creatinine-based eGFR for incident cardiovascular disease among hypertensive patients. We retrospectively analyzed the records of 2016 hypertensive patients from the Hypertension Unit at Mostoles University Hospital between 2006 and 2016. We calculated the eGFR using 3 CKD-EPI equations. The outcomes we included in our study were cardiovascular death, non-cardiovascular death, stroke, incident heart failure, and myocardial infarction. We used the Cox regression hazard model to estimate the hazard ratio. Our analysis found that, in terms of cardiovascular morbidity and mortality, both cystatin C-based eGFR (HR 2.88, 95% CI 1.86-4.47, P<0.0001) showed a higher prognostic value than creatinine-based eGFR (HR 2.83, 95% CI 1.73-4.63, P<0.0001). In terms of all-cause mortality, cystatin C-based eGFR (HR 4.24, 95% CI 2.38-7.53, P<0.0001) showed a higher prognostic value than creatinine-based eGFR (HR 2.77, 95% CI 1.43-5.36, P<0.0001). Our findings suggest that both cystatin C-based eGFRs may be stronger predictors of all-cause mortality and cardiovascular events in our hypertensive cohort when compared to creatinine-based eGFR, and may improve the risk assessment in certain populations.

A new algorithm for quadratic sample entropy optimization for very short biomedical signals: application to blood pressure records.

This paper describes a new method to optimize the computation of the quadratic sample entropy (QSE) metric. The objective is to enhance its segmentation capability between pathological and healthy subjects for short and unevenly sampled biomedical records, like those obtained using ambulatory blood pressure monitoring (ABPM). In ABPM, blood pressure is measured every 20-30 min during 24h while patients undergo normal daily activities. ABPM is indicated for a number of applications such as white-coat, suspected, borderline, or masked hypertension. Hypertension is a very important clinical issue that can lead to serious health implications, and therefore its identification and characterization is of paramount importance. Nonlinear processing of signals by means of entropy calculation algorithms has been used in many medical applications to distinguish among signal classes. However, most of these methods do not perform well if the records are not long enough and/or not uniformly sampled. That is the case for ABPM records. These signals are extremely short and scattered with outliers or missing/resampled data. This is why ABPM Blood pressure signal screening using nonlinear methods is a quite unexplored field. We propose an additional stage for the computation of QSE independently of its parameter r and the input signal length. This enabled us to apply a segmentation process to ABPM records successfully. The experimental dataset consisted of 61 blood pressure data records of control and pathological subjects with only 52 samples per time series. The entropy estimation values obtained led to the segmentation of the two groups, while other standard nonlinear methods failed.

Uricemia y síndrome metabólico en pacientes con hipertensión arterial / Uricemia and metabolic syndrome in patients with arterial hypertension

Objetivo. Los niveles de uricemia se han asociado con el síndrome metabólico (SM). Sin embargo, la relación entre estas 2 variables en pacientes con hipertensión arterial (HTA) esencial no ha sido estudiada. Pacientes y métodos. Estudio observacional, transversal, de 592 pacientes con HTA esencial. Para la definición de SM se emplearon >=3 criterios de la ATP-III. Se excluyeron a los pacientes con tratamiento hipouricemiante. Resultados. La prevalencia de SM fue del 52% (IC del 95%: 48-56%) y aumentó gradualmente a medida que se incrementaba la uricemia (uricemia: <=4,7mg/dl, 36%; uricemia >=6,8mg/dl, 70%; p<0,001). Los enfermos hipertensos con SM mostraron una uricemia media más elevada que los que no tenían esta comorbilidad (6,1±1,5mg/dl vs 5,4±1,3mg/dl; p<0,0001). La prevalencia de hiperuricemia (varones: >=7,0mg/dl; mujeres: >=6,0mg/dl) en los pacientes hipertensos que no recibían tratamiento diurético fue del 24,3% (en aquellos con SM, 40,5% frente a un 11,4% en los que no tenían SM; p<0,001). En el análisis multivariante los triglicéridos (OR: 1,008; IC del 95%: 1,004-1,012; p<0,001) y el índice de masa corporal (IMC) (OR: 1,118; IC del 95%: 1,059-1,181; p<0,001) fueron predictores independientes de la uricemia. Conclusiones. En los pacientes con HTA esencial, aproximadamente la mitad padecen SM y uno de cada 4 presenta hiperuricemia. El determinante más relevante del incremento de la concentración sérica de uratos es el aumento del IMC(AU)

Objective. Serum urate levels have been associated with metabolic syndrome (MS). However, the relationship between these two variables in patients with essential arterial hypertension has not been studied. Patients and methods. A Cross-sectional study in 592 patients with essential hypertension. The MS was defined according to the ATP-III criteria. We excluded patients with hypouricemic treatment. Results. The prevalence of MS was 52% (95% CI, 48-56%) and there was a graded increase with increasing serum urate (uricemia <=.7 mg/dl, 36%; uricemia >=6.8 mg/dl, 70%, P < 0.001). Hypertensive patients with MS showed a higher mean uricemia than those without this comorbidity (6.1 ± 1.5 mg/dl versus 5.4 ± 1.3 mg/dl, P <0.0001). The prevalence of hyperuricemia (men, > 7.0 mg/dL; women, >6.0 mg/dL) in hypertensive patients without diuretic treatment, was 24% (in those with MS 40% versus 11% without MS). In multivariate analysis, triglycerides (OR = 1.008, CI 95%: 1.004-1.012, P < 0.001) and body mass index (BMI) (OR = 1.118, CI 95%: 1.059-1.181, P < 0.001), were independent predictors of serum uric acid levels. Conclusions. In patients with essential hypertension, about half have MS and one out of four has hyperuricemia. The most important determinant of hyperuricemia is BMI(AU)

[Uricemia and metabolic syndrome in patients with arterial hypertension]. / Uricemia y síndrome metabólico en pacientes con hipertensión arterial.

OBJECTIVE: Serum urate levels have been associated with metabolic syndrome (MS). However, the relationship between these two variables in patients with essential arterial hypertension has not been studied. PATIENTS AND METHODS: A Cross-sectional study in 592 patients with essential hypertension. The MS was defined according to the ATP-III criteria. We excluded patients with hypouricemic treatment. RESULTS: The prevalence of MS was 52% (95% CI, 48-56%) and there was a graded increase with increasing serum urate (uricemia ≤ 4.7 mg/dl, 36%; uricemia ≥ 6.8 mg/dl, 70%, P < 0.001). Hypertensive patients with MS showed a higher mean uricemia than those without this comorbidity (6.1 ± 1.5 mg/dl versus 5.4 ± 1.3 mg/dl, P < 0.0001). The prevalence of hyperuricemia (men, > 7.0 mg/dL; women, > 6.0 mg/dL) in hypertensive patients without diuretic treatment, was 24% (in those with MS 40% versus 11% without MS). In multivariate analysis, triglycerides (OR = 1.008, CI 95%: 1.004-1.012, P < 0.001) and body mass index (BMI) (OR = 1.118, CI 95%: 1.059-1.181, P < 0.001), were independent predictors of serum uric acid levels. CONCLUSIONS: In patients with essential hypertension, about half have MS and one out of four has hyperuricemia. The most important determinant of hyperuricemia is BMI.

Customization of entropy estimation measures for human arterial hypertension records segmentation.

This paper describes a new application of the recently developed Coefficient of Sample Entropy (CosEn) measure. This entropy estimator is specially suited for cases where the length of the time series is extremely short. CosEn has already been used successfully to characterize and detect atrial fibrillation, using as few as 12 heartbeats. We have customized the methodology employed for heartbeat interval series to blood pressure hypertensive (BPHT) human records. Little can be found about BPHT records and its nonlinear regularity analysis. The method described in this paper provides a good segmentation between control and pathologic groups, based on the corresponding labeled BPHT records. The experimental dataset was drawn from the available records at the Hypertension Unit of the University Hospital of Mostoles, in Spain. The hypertension related variables studied were systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP). The hypothesis test yielded the following results in each case: acceptance probability of 0 for SBP, 0.005 for DBP and 0 for MBP. The confidence intervals for the three variables were nonoverlapping.

Characterization of detrended fluctuation analysis in the context of glycemic time series.

There is a growing interest in the analysis of hyperglycemia and its relationship with other pathologies. The level of glucose in blood is regulated by the flux/reflux and controlled by hyperglycemia hormones and hypoglycemic insulin. Glycemic profiles are characterized by a nonlinear and nonstationary behavior but also influenced by circadian rhythms and patient daily routine which introduce quasi-periodic trends into them. This type of signals are commonly analyzed by Detrended Fluctuation Analysis (DFA) which states that the control system in charge of regulating the glucose level usually holds a long-range negative correlation. But there is an inconsistency about the windowing lengths, as no standard or rules are set. This work studies the influence of the windowing length sequence, and shows that there is a need for selecting the optimal values in order to obtain a good differentiation between different groups, and these values are somehow determined by signal characteristics.

Recomendaciones específicas para el manejo del paciente con síndrome metabólico / Specific recommendations for the management of patients with metabolic syndrome

El término síndrome metabólico hace referencia a un acúmulo de factores de riesgo cardiovascular en cuya fisiopatología subyace la existencia de resistencia insulínica. Este trastorno metabólico se asocia a la presencia de obesidad. Un estado proinflamatorio y protrombótico contribuye al desarrollo de este cuadro. La consecuencia principal del síndrome es una mayor frecuencia en la incidencia de enfermedades cardiovasculares y en el desarrollo de diabetes mellitus tipo 2. El tratamiento consiste en la disminución de peso con medidas dietéticas y en la realización de ejercicio físico. Sin embargo, resulta también apropiado el empleo de fármacos específicos para cada uno de los factores de riesgo definitorios presentes. Rimonabant, un bloqueante selectivo de los receptores tipo 1 de los cannabinoides, que reduce el peso y mejora los factores de riesgo metabólico en pacientes obesos o con sobrepeso, podría convertirse en el primer tratamiento específico para este cuadro

The term metabolic syndrome refers to a group of cardiovascular disease risk factors whose underlying pathophysiology is thought to be related to insulin resistance. This common metabolic disorder is associated to the presence of obesity. A proinflammatory and prothrombotic state probably contributes to the syndrome. The primary consequence of this syndrome is the increased risk for cardiovascular disease and type 2 diabetes. The fundamental approach is weight reduction with dietary measures and increased physical activity. However, drug treatment is also appropriate for specific risk factors. Rimonabant, a selective cannabinoid type 1 receptor blocker, reduces body weight and improves metabolic risk factors in overweight or obese patients and could become the first specific drug treatment for this disorder (AU)

["Nutrition": a program to facilitate the calculations of the composition of menus and diets]. / "Nutrición": un programa para facilitar los cálculos de composición de menús y dietas.

The methodology used to build a software program to compute the nutrient composition of menus and diets is discussed. Topics as the variability of food composition, the scarcity of local food composition data, the bias that may be incurred in nutrient data of food consumption studies are extensively discussed and also the possible solution through the software program. All of these topics must be taken into account in epidemiological studies as well as in computing diet composition.

[Food composition tables: a practical appraisal]. / Tablas de composición de alimentos: una valoración práctica.

We have revised the most common food composition tables published in Spain, France, Germany, England and the United States of America. In this article we have collected information concerning the points that may describe the size, format, numbers of items and numbers of nutrients in each table, so it can help professionals to know which of them may suit his needs properly.

[Lupus vulgaris as initial manifestation of asymptomatic pulmonary tuberculosis]. / Lupus vulgar como manifestación inicial de tuberculosis pulmonar inadvertida.

A clinical case of a male with lupus lesion localized in scalp associated to a bilateral cavitated pulmonary tuberculosis which was non symptomatic. The cutaneous symptoms of tuberculosis is reviewed because the rareness of this presentation.