The Association Between Depression and Antidepressant Use and Outcomes After Operative Treatment of Distal Radius Fractures at 1 Year.

PURPOSE: Depression has been linked to inferior clinical outcomes among upper extremity patients. It often is challenging to distinguish the symptoms of depression, symptoms of injury, and the interaction between these 2 entities after a patient has been injured. We aimed to study the differences in clinical outcomes after surgical fixation of distal radius fractures between patients with and without a documented history and treatment for depression. METHODS: All subjects with an isolated, acute distal radius fracture undergoing operative fixation in a 10-year period at a level 1 academic trauma center were screened. Baseline demographic data were collected, and psychiatric history and antidepressant use were recorded and verified with a pharmacy database. Quick Disability of the Arm, Shoulder and Hand (QuickDASH), range of motion, and grip strength were assessed at 12 months after surgery. Multivariable linear regression analysis was used to assess the association of depression with QuickDASH scores at 1 year after surgery. RESULTS: A total of 211 patients were available for 1-year follow-up, 50 of whom were being treated actively for depression with medication at the time of injury and 161 were without a known diagnosis of, or treatment for, depression. Demographic and injury characteristics were similar between both groups. In a multivariable linear regression model controlling for age, sex, and a history of osteoporosis, active treatment for depression was associated with a slight mean increase in QuickDASH scores, 6.5 (1.3-11.8), 1 year after surgery. CONCLUSIONS: This study demonstrates a small increase in QuickDASH scores between subjects with a confirmed diagnoses of depression compared with all others after surgical fixation of distal radius fracture at 1-year follow-up. We suggest that a history of depression may portend worse clinical outcomes, although other factors, such as underreporting of depression may influence results. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Understanding and Addressing Psychiatric Comorbidities and Upper-Extremity Trauma: Surgeons in a Multidisciplinary Care Model.

Psychiatric disorders are a common cause of disability and represent an important risk factor for upper-extremity trauma. The review provides an overview of psychiatric illnesses as both contributors and sequelae of 4 major injury patterns: self-inflicted wrist lacerations, self-amputation, upper-extremity fractures, and burns. The authors develop a multidisciplinary model for upper-extremity surgeons to care for patients with psychiatric disorders, with an overview of capacity assessment, optimal psychiatric comanagement, and collaboration with allied health professionals.

Síndrome de Löfgren: presentación de dos casos / Löfgren syndrome: Report of two cases

No disponible

Sarcoidosis presenting with and without Löfgren's syndrome: Clinical, radiological and behavioral differences observed in a group of 691patients.

OBJECTIVES: Just a few series of Löfgren's syndrome have been reported. Our aim was to describe the epidemiology and clinical profile of sarcoidosis patients presenting with Löfgren's syndrome vs. non-Löfgren's syndrome. METHODS: Retrospective cohort study of 691consecutive patients with sarcoidosis diagnosed at the Bellvitge University Hospital in Barcelona, Spain, between 1976 and 2018. RESULTS: Three hundred and nine patients (44.7%) were diagnosed with Löfgren's syndrome and 382with non-Löfgren's syndrome (55.3%). The mean age at diagnosis was 39.8years-old (SD 11.7) vs. 46.6 (SD 14.5) (P<0.001). 249 patients (80.6%) vs. 218 (57.1%) were female (P<0.001), and mostly Caucasians (304, 98.4% vs. 351, 91.9%, P=0.002). Out of the total 309, Löfgren's syndrome patients developed more frequently fever and articular involvement, and 45 (14.6%) presented with isolated periarticular ankle inflammation. When compared, radiological stages at diagnosis were more advanced in non-Löfgren's syndrome patients: stage 0 (2.9% vs. 14.7%), stage I (82.5% vs. 41.4%), stage II (14.6% vs. 29.3%), and stage III/IV (0 vs. 14.7%) (P<0.001). Chronic trend>2years was more prevalent in non-Löfgren's syndrome (66, 22.6% vs. 233, 67.4%; P<0.001), as well as the proportion of patients in whom treatment was needed (58, 18.8% vs. 224, 58.6%; P<0.001). Risk factors related to chronic trend>2 years were older age, stage II at diagnosis and the need of treatment. CONCLUSIONS: Löfgren's syndrome is a well-differentiated form of sarcoidosis with persuasive different epidemiological, clinical, radiological and prognostic features.

Differential characteristics of acute heart failure in very elderly patients: the prospective RICA study.

INTRODUCTION: Acute heart failure (AHF) is a frequent epidemic in geriatrics. The main aim of this study was to evaluate the clinical and prognostic differences of very elderly patients with AHF compared to the rest, and evaluate the factors associated with 90-day mortality. METHODS: We analyzed 3828 patients hospitalized for AHF with an age of ≥ 70 years. The population was divided into three groups: 70-79, 80-89 and ≥ 90 years old (nonagenarians). The baseline characteristics of patients nonagenarians were compared with the rest. In the group of nonagenarians, their clinical characteristics were analyzed according to the left ventricular ejection fraction (LVEF) and the factors associated with mortality at 90 days of follow-up. RESULTS: Nonagenarians showed higher comorbidity and cognitive deterioration, worse basal functional status, and preserved LVEF. Alternatively, they presented a lower rate of diabetes mellitus, lower incidence of de novo AHF, and lower prescription of angiotensin-converting-enzyme inhibitors, aldosterone blockers, anticoagulants, and statins at hospital discharge. Of the total, 334 patients (9.3%) had died by 90 days. The 90-day mortality rate was highest in nonagenarians (7.1% vs 9.8% vs 17%; p = 0.001). Multivariate analysis showed that renal failure, New York Heart Association (NYHA) functional classifications of III-IV, and a more advanced functional deterioration at baseline are predictors of mortality within 90 days. CONCLUSIONS: The AHF in patients nonagenarians has a different clinical profile compared to younger patients and a higher mortality. In this subgroup of patients having a worse baseline functional status, higher NYHA classification (III-IV), and renal failure are predictors of 90-day mortality.

De novo acute heart failure: Clinical features and one-year mortality in the Spanish nationwide Registry of Acute Heart Failure. / Insuficiencia cardiaca aguda de novo: características clínicas y mortalidad al año en el Registro Español de Insuficiencia Cardiaca Aguda.

INTRODUCTION AND OBJECTIVES: Acute heart failure (AHF), can occur as decompensated chronic heart failure (HF) or as a first episode, "new onset". The aim of this study was to analyse the clinical characteristics and prognosis at one-year in a cohort of patients with new onset AHF. METHODS: Prospective observational study of 3,550 patients with AHF. We compared patients with new onset HF with the others. Restricting the analysis to new onset AHF patients, we analysed the clinical characteristics, readmissions, mortality and impact of left ventricular ejection fraction on the prognosis. RESULTS: A total of 1,105 (31%) patients fulfil the criteria for new onset AHF. These patients versus the rest, were younger, had a higher aetiology of hypertension and preserved left ventricular ejection fraction, less global comorbidity and better baseline overall functional status. After one year, mortality in new onset HF was less than chronic decompensated HF (15 vs. 27%; p<.001; respectively). Multivariate analysis showed a correlation between mortality and higher global comorbidity (hazard ratio. -HR- 1.11), renal failure (HR 1.73), higher prescription of antialdosteronics and antiaggregant (HR 2.13; 1.8; respectively). Left ventricular ejection fraction was unrelated to mortality. CONCLUSIONS: New onset AHF shows a clinical profile and prognosis different to that of chronic decompensated HF. Higher comorbidity, renal function and treatment post-discharge predict a higher risk of mortality.

Insuficiencia cardiaca aguda de novo: características clínicas y mortalidad al año en el Registro Español de Insuficiencia Cardiaca Aguda / De novo acute heart failure: Clinical features and one-year mortality in the Spanish nationwide Registry of Acute Heart Failure

Introducción y objetivos: La insuficiencia cardiaca aguda (ICA) puede suceder como una descompensación de una IC crónica o como un primer episodio "de novo". Nuestro objetivo fue analizar las características clínicas y el pronóstico al año, en una cohorte de ICA de novo. Métodos: Estudio observacional y prospectivo de 3550 pacientes con ICA. Se analizan las características clínicas, la fracción de eyección ventricular izquierda, los reingresos y factores asociados a mayor mortalidad al año de los pacientes con ICA de novo y se comparan con el resto. Resultados: Un total de 1105 (31%) pacientes, presentaron ICA de novo. Este grupo fue más joven, con mayor etiología hipertensiva y fracción de eyección ventricular izquierda preservada, mejor estado funcional y menor comorbilidad que el resto de la cohorte. Al año de seguimiento, la mortalidad fue menor en ICA de novo frente a IC crónica descompensada (el 15 vs. el 27%; p<0,001). En el análisis multivariante, los factores asociados a mortalidad en ICA de novo fueron: comorbilidad global (hazard ratio -HR- 1,11), insuficiencia renal (HR 1,73), prescripción de antialdosterónicos y antiagregantes (HR 2,13; 1,8; respectivamente). No se objetivaron diferencias pronósticas en cuanto a la fracción de eyección ventricular izquierda. Conclusiones: Los pacientes con ICA de novo tienen un perfil clínico diferente a la IC crónica descompensada, con un mejor pronóstico. Los principales factores predictores de mortalidad al año en ICA de novo fueron la comorbilidad global, la función renal y el tipo de tratamiento al alta hospitalaria

Introduction and objectives: Acute heart failure (AHF), can occur as decompensated chronic heart failure (HF) or as a first episode, "new onset". The aim of this study was to analyse the clinical characteristics and prognosis at one-year in a cohort of patients with new onset AHF. Methods: Prospective observational study of 3,550 patients with AHF. We compared patients with new onset HF with the others. Restricting the analysis to new onset AHF patients, we analysed the clinical characteristics, readmissions, mortality and impact of left ventricular ejection fraction on the prognosis. Results: A total of 1,105 (31%) patients fulfil the criteria for new onset AHF. These patients versus the rest, were younger, had a higher aetiology of hypertension and preserved left ventricular ejection fraction, less global comorbidity and better baseline overall functional status. After one year, mortality in new onset HF was less than chronic decompensated HF (15 vs. 27%; p<.001; respectively). Multivariate analysis showed a correlation between mortality and higher global comorbidity (hazard ratio.-HR- 1.11), renal failure (HR 1.73), higher prescription of antialdosteronics and antiaggregant (HR 2.13; 1.8; respectively). Left ventricular ejection fraction was unrelated to mortality. Conclusions: New onset AHF shows a clinical profile and prognosis different to that of chronic decompensated HF. Higher comorbidity, renal function and treatment post-discharge predict a higher risk of mortality

Insuficiencia cardiaca aguda de novo en un hospital privado de Barcelona: una epidemia geriátrica / De novo acute heart failure in a private hospital in Barcelona: A geriatric epidemic

No disponible

Sex differences in 1-year mortality risks in older patients experiencing a first acute heart failure hospitalization.

AIM: To assess whether 1-year mortality in older patients experiencing a first admission for acute heart failure was related to sex, and to explore differential characteristics according to sex. METHODS: We reviewed the medical records of 1132 patients aged >70 years of age admitted within a 3-year period because of a first episode of acute heart failure. We analyzed sex differences. Mortality was assessed using multivariate Cox analysis. RESULTS: There were 648 (57.2%) women (mean age 82.1 years) and 484 men (mean age 80.1 years). There were some differences in risk factors: women more often had hypertension, and less frequently had coronary heart disease and comorbidities (women more often had dementia, and men more often had chronic obstructive pulmonary disease, chronic kidney disease and stroke). Women were treated more frequently with spironolactone. The 1-year all-cause mortality rate was 30.2% (30.7% women and 29.5% men). Multivariate Cox analysis identified an association between reduced heart failure (hazard ratio [HR] 0.35, 95% confidence interval [95% CI] 0.21-0.59), hemoglobin <10 g/dL (HR 1.99, 95% CI 1.16-3.40), systolic blood pressure (HR 0.98, 95% CI 0.97-0.99), previous diagnosis of dementia (HR 2.07, 95% CI 1.12-3.85), number of chronic therapies (HR 1.12, 95% CI 1.05-1.19) and 1-year mortality in women. In men, an association with mortality was found for low systolic blood pressure (HR 0.97, 95% CI 0.97-0.98) and higher potassium values (HR 1.42, 95% CI 1.01-2.00). CONCLUSIONS: Among older patients hospitalized for the first acute heart failure episode, there is a slightly higher predominance of women. There are sex differences in risk factors and comorbidities. Although the mortality rate is similar, the factors associated with it according to sex are different. Geriatr Gerontol Int 2019; 19: 184-188.

Human Cartilage-Derived Progenitors Resist Terminal Differentiation and Require CXCR4 Activation to Successfully Bridge Meniscus Tissue Tears.

Meniscus injuries are among the most common orthopedic injuries. Tears in the inner one-third of the meniscus heal poorly and present a significant clinical challenge. In this study, we hypothesized that progenitor cells from healthy human articular cartilage (chondroprogenitor cells [C-PCs]) may be more suitable than bone-marrow mesenchymal stem cells (BM-MSCs) to mediate bridging and reintegration of fibrocartilage tissue tears in meniscus. C-PCs were isolated from healthy human articular cartilage based on their expression of mesenchymal stem/progenitor marker activated leukocyte cell adhesion molecule (ALCAM) (CD166). Our findings revealed that healthy human C-PCs are CD166+, CD90+, CD54+, CD106- cells with multilineage differentiation potential, and elevated basal expression of chondrogenesis marker SOX-9. We show that, similar to BM-MSCs, C-PCs are responsive to the chemokine stromal cell-derived factor-1 (SDF-1) and they can successfully migrate to the area of meniscal tissue damage promoting collagen bridging across inner meniscal tears. In contrast to BM-MSCs, C-PCs maintained reduced expression of cellular hypertrophy marker collagen X in monolayer culture and in an explant organ culture model of meniscus repair. Treatment of C-PCs with SDF-1/CXCR4 pathway inhibitor AMD3100 disrupted cell localization to area of injury and prevented meniscus tissue bridging thereby indicating that the SDF-1/CXCR4 axis is an important mediator of this repair process. This study suggests that C-PCs from healthy human cartilage may potentially be a useful tool for fibrocartilage tissue repair/regeneration because they resist cellular hypertrophy and mobilize in response to chemokine signaling. Stem Cells 2019;37:102-114.

Una causa infrecuente de dolor de cuello. Síndrome de la apófisis odontoides coronada / An infrequent cause of neck pain. Crowned dens síndrome

Resumen En la práctica clínica habitual existe un crecimiento en la demanda asistencial de servicios de urgencias. El dolor cervical es una patología muy frecuente que compete a diversos profesionales sanitarios. El síndrome de apófisis odontoides coronada, es una patología muy poco frecuente, que hace parte del espectro de las enfermedades por microcristales de pirofosfato cálcico, ocasionando una calcificación de ligamentos del proceso de odontoides cervical, llevando a una clínica de cervicalgia, fiebre y rigidez de nuca. Esta patología entra en el diagnóstico diferencial con patologías potencialmente graves. En muchas ocasiones lleva a procedimientos y gastos farmacológicos innecesarios, principalmente por el desconocimiento que la transforma en una patología infradiag-nosticada. (Acta Med Colomb 2018; 43: 230-232).

Abstract In the usual clinical practice there is a growth in the demand for emergency services. Cervical pain is a very common pathology that concerns various health professionals. The crowned den syndrome is a very rare pathology, which is part of the spectrum of microcrystalline diseases of calcium pyrophosphate, causing a calcification of ligaments of the cervical odontoid process, leading to clinical signs of neck pain, fever and neck stiffness. This pathology enters into the differential diagnosis with potentially serious pathologies. In many cases it leads to unnecessary pharmacological procedures and expenses, mainly due to the ignorance that turns it into an infra diagnosed pathology. (Acta Med Colomb 2018; 43: 230-232).

Differential expression of miRNA-146a and miRNA-155 in gastritis induced by Helicobacter pylori infection in paediatric patients, adults, and an animal model.

BACKGROUND: Helicobacter pylori is a major aetiologic agent associated with gastritis. H. pylori infections increase the expression of the Toll-like receptor (TLR), which in turn modulates the expression of microRNA (miRNA)-146a and miRNA-155. The objective of this study was to compare the expression of miRNA-146a and miRNA-155 in gastric lesions of paediatric and adult patients with different pathologies and in Mongolian gerbils (Meriones unguiculatus) infected with H. pylori 26,695. METHODS: Quantification of miRNA expression was performed by quantitative real-time polymerase chain reaction (qRT-PCR) of paraffin-embedded gastric lesions of children with or without an infection (n = 25), adults with follicular gastritis and metaplasia (n = 32) and eight-week-old M. unguiculatus males (Hsd:MON) infected with H. pylori 26,695 for 0, 3, 6, 12 and 18 months (n = 25). The genes RNU48 and RNU6 were used as endogenous controls for data normalization. Statistical analyses were performed using Kruskal-Wallis, Mann-Whitney, ANOVA and Student's t-test. RESULTS: The expression of miRNA-146a and miRNA-155 in infected children increased by 247.6- and 79.4-fold (on average), respectively, compared to that observed in the control group. However, these results were not significant (p = 0.12 and p = 0.07 respectively). In some children a gradual increase in expression was observed, while in others, expression was very high. Additionally, the expression levels of miRNA-146a and miRNA-155 increased by an average of 21.7- and 62-fold, respectively, in adult patients with follicular gastritis when compared to those of the controls. In M. unguiculatus infected with H. pylori 26,695, the expression of both miRNAs increased as the infection progressed. CONCLUSION: This is the first report to show differences in the expression of miRNA-146a and miRNA-155 in paediatric and adult patients with gastritis who were infected with H. pylori. In addition, in M. unguiculatus infected with H. pylori, miRNA expression was associated with the progression of infection and the ability of the bacteria to adapt to the host.

Influencia de la fibrilación auricular en la mortalidad de los pacientes con insuficiencia cardiaca con fracción de eyección preservada / Influence of atrial fibrillation on the mortality of patients with heart failure with preserved ejection fraction

Introducción y objetivos: La información del impacto de la fibrilación auricular (FA) en el pronóstico de los pacientes con insuficiencia cardiaca con fracción de eyección preservada (IC-FEP) es controvertido. Se analizó el pronóstico en cuanto a la mortalidad y los reingresos al año de los pacientes con IC-FEP y FA. Métodos: Estudio observacional y prospectivo en 1.971 pacientes con IC-FEP, que presentan un ingreso por IC aguda. Los pacientes se dividieron en 2 grupos según la presencia o no de FA. Analizamos la mortalidad, los reingresos y el combinado mortalidad/reingresos al año de seguimiento. Resultados: Un total de 1.177 (59%) pacientes presentaban FA, con una edad media de 80,3 (7,8) años, y de ellos, 1.233 (63%) eran mujeres. El paciente con IC-FEP y FA tenía una mayor edad, era del sexo femenino y presentaba más frecuentemente un origen valvular y una menor comorbilidad medida por el índice de Charlson. Al año de seguimiento, 430 (22%) pacientes murieron y 840 (43%) fueron reingresados. Entre los 2 grupos analizados no hubo diferencia en la mortalidad por todas las causas (22 vs. 21%; p=0,739, FA vs. no FA, respectivamente) ni por causas cardiovasculares (9,6 vs. 8,2%; p=0,739, FA vs. no FA, respectivamente). En el análisis multivariable se asociaron con mayor mortalidad: la edad, el sexo masculino, la etiología valvular, la hiperuricemia y la comorbilidad. En el análisis del subgrupo con IC-FEP con FA, la presencia de FA crónica comparada con la FA de novo se asoció con una mayor mortalidad (HR 1,716; IC 95% 1,099-2,681; p=0,018). Conclusiones: En pacientes con IC-FEP es frecuente la presencia de FA. Durante el seguimiento a un año, la presencia de FA no influye en la mortalidad ni en los reingresos hospitalarios en pacientes con IC-FEP

Introduction and objectives: The impact of atrial fibrillation (AF) on the prognosis of heart failure with preserved ejection fraction (HFpEF) is still the subject of debate. We analysed the influence of AF on the prognosis on mortality and readmission in patients with HFpEF. Methods: Prospective observational study in 1,971 patients with HFpEF, who were admitted for acute heart failure. Patients were divided into 2 groups according to the presence or absence of AF. We analysed mortality, readmissions and combined mortality/readmissions at one year follow-up. Results: A total of 1,177 (59%) patients had AF, mean age 80.3 (7.8) years and 1,233 (63%) were women. Patients with HFpEF and AF were older, female, greater valvular aetiology and lower comorbidity measured by the Charlson index. At the one year follow-up, 430 (22%) patients had died and 840 (43%) had been readmitted. In the 2 groups analysed, there was no difference in all-cause mortality (22 vs. 21%; P=.739, AF vs. no-AF, respectively) or cardiovascular causes (9.6 vs. 8.2%; P=.739, AF vs. no-AF, respectively). In the multivariable analysis, factors associated with higher mortality were: age, male, valvular aetiology, uric acid, and comorbidity. In the analysis of the subgroup with HFpEF with AF, the presence of chronic AF compared to de novo AF was associated with higher mortality (HR 1,716; 95% CI 1,099-2,681; P=.018). Conclusions: In patients with HFpEF, the presence of AF is frequent. During the one-year follow-up, the presence of AF does not influence mortality or readmissions in patients with HFpEF

Conclusions: In patients with HFpEF, the presence of AF is frequent. During the one-year follow-up, the presence of AF does not influence mortality or readmissions in patients with HFpEF

Aproximación diagnóstica y terapéutica de las crisis hipertensivas / Diagnostic and therapeutic approach to the hypertensive crisis

La hipertensión arterial es un problema de elevada prevalencia en la población mundial. Las crisis hipertensivas son las formas agudas de presentación y representan un motivo frecuente de consulta en urgencias y atención primaria. Las crisis hipertensivas se dividen en emergencias hipertensivas y urgencias hipertensivas, según exista o no daño agudo en órgano diana, respectivamente. Cada situación tiene un pronóstico y tratamiento diferente, siendo las emergencias hipertensivas potencialmente graves, requiriendo por lo general reducciones rápidas de la presión arterial. Por el contrario, las urgencias hipertensivas podrían ser tratadas ambulatoriamente, reduciendo la presión arterial en horas o días. En un número elevado de pacientes que consultan por una crisis hipertensiva no existen antecedentes de diagnóstico de hipertensión arterial, por lo que es importante incrementar los controles periódicos de la presión arterial en la comunidad

High blood pressure is a problem with elevated prevalence in the world population. The acute forms of presentation are "hypertensive crises", which represent a frequent cause for emergency room and primary care consultations. Hypertensive crises are divided into hypertensive emergencies and hypertensive urgencies, depending on whether or not there is acute damage to the target organ, respectively. Each situation has a different prognosis and treatment. More specifically, hypertensive emergencies are potentially serious and usually require rapid reductions in blood pressure, whereas hypertensive urgencies can be treated as outpatients by reducing blood pressure in hours or days. A significant number of patients who consult medical professionals regarding a hypertensive crisis do not have a prior diagnosis of hypertension; therefore, it is important to periodically monitor blood pressure levels in the community

Insuficiencia cardiaca aguda por amiloidosis senil sistémica: descripción de un caso / Acute heart failure by senil systemic amyloidosis: Case report

No disponible

Association between diabetes and mortality in elderly patients admitted for a first episode of acute heart failure.

AIM: To examine whether the presence of a prior diagnosis of diabetes mellitus (DM) influences mortality risk in elderly patients experiencing a first episode of heart failure (HF) hospitalization. METHODS: A total of 677 consecutive patients aged ≥75 years admitted for a first episode of acute decompensated heart failure were evaluated according to the presence or not of DM, and in-hospital and 1-year mortality rates were evaluated. RESULTS: A total of 240 patients (35.4%) had a diagnosis of DM. Overall, 42 patients (6.2%) died during admission; and 205 patients (30.3%) died after 1 year; however, no differences were observed in mortality rates between both groups. Cox univariate analysis did not identify prior DM diagnosis as a risk factor for 1-year mortality (HR 0.767, P < 0.082). Multivariate analysis identified older age (HR 1.101, P < 0.0001), lower preadmission Barthel Index (HR 0.987, P = 0.002), higher heart rate (HR 1.013, P = 0.02), higher admission serum potassium (HR 1.471, P = 0.016) and non-prescription of angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists (HR 1.597, P = 0.018) as independent risk factors for 1-year mortality. CONCLUSIONS: More than one-third of elderly patients experiencing a first admission because of acute heart failure decompensation had a prior diagnosis of DM. However, DM did not seem to be associated to a significant 1-year mortality risk. Geriatr Gerontol Int 2018; 18: 554-560.

Diagnostic and therapeutic approach to the hypertensive crisis. / Aproximación diagnóstica y terapéutica de las crisis hipertensivas.

High blood pressure is a problem with elevated prevalence in the world population. The acute forms of presentation are "hypertensive crises," which represent a frequent cause for emergency room and primary care consultations. Hypertensive crises are divided into hypertensive emergencies and hypertensive urgencies, depending on whether or not there is acute damage to the target organ, respectively. Each situation has a different prognosis and treatment. More specifically, hypertensive emergencies are potentially serious and usually require rapid reductions in blood pressure, whereas hypertensive urgencies can be treated as outpatients by reducing blood pressure in hours or days. A significant number of patients who consult medical professionals regarding a hypertensive crisis do not have a prior diagnosis of hypertension; therefore, it is important to periodically monitor blood pressure levels in the community.