[Sleep-disordered breathing in patients with difficult-to-control hypertension]. / Trastornos respiratorios durante el sueño en pacientes con hipertensión arterial de difícil control.

OBJECTIVE: To analyze the relationship between sleep-disordered breathing and difficult-to-control arterial hyper-tension. PATIENTS AND METHODS: Patients were considered to have difficult-to-control hypertension when mean systolic blood pressure was 125 mm Hg or higher and/or mean diastolic blood pressure was more than or equal to 80 mm Hg (as recorded during 2 24-hour ambulatory monitoring studies) despite the use of 3 or more antihypertensive drugs. Respiratory polygraphy using the AutoSet device (ResMed Corp, Sydney, Australia) was then performed to study sleep-disordered breathing in all patients. RESULTS: Forty-nine patients with a mean (SD) age of 68.1 (9.1) years, mean systolic and diastolic pressures of 152.5 (13)/89.2 (8.5) mm Hg, and an average of 3.5 prescribed drugs were included in the study. The mean apnea-hypopnea index (AHI) was 26.2 (19.5) and events were predominantly obstructive. Patients with severe sleep apnea-hypopnea syndrome (SAHS) (AHI > or = 30; 40.8%) showed more uncontrolled daytime (P = .017) and nighttime (P = .033) systolic pressure than the rest, as well as higher daytime diastolic pressure (P = .035) and a greater consumption of drugs than those without severe SAHS (AHI < 10; 28.6%) (P = .041). The study population as a whole showed a significant correlation between blood pressure and obesity. There was a significant correlation (adjusted for age and sex) with AHI only in patients with SAHS. AHI was found to be the independent predictor with the greatest effect on blood pressure in these patients. CONCLUSIONS: Prevalence of SAHS was very high in patients with difficult-to-control hypertension. In patients with SAHS, AHI was found to be the independent predictor with the greatest affect on arterial blood pressure.

Trastornos respiratorios durante el sueño en pacientes con hipertensión arterial de difícil control / Sleep-disordered breathing in patients with difficult-to-control hypertension

Objetivo: Analizar la relación existente entre los trastornos respiratorios durante el sueño y la hipertensión arterial de difícil control (HTAr). Pacientes y métodos: Se consideró HTAr cuando las cifras medias de la presión arterial sistólica (PAS) eran mayores o iguales a 125 mmHg y/o la diastólica (PAD) era igual o superior a 80 mmHg según el registro de 2 estudios de monitorización ambulatoria durante 24 h a pesar de la utilización de 3 o más fármacos antihipertensivos. Se realizó posteriormente una poligrafía respiratoria (Autoset) para el estudio de los trastornos respiratorios durante el sueño en todos los pacientes. Resultados: Se incluyó en el estudio a 49 pacientes con una media (± desviación estándar) de edad de 68,1 ± 9,1 años, PAS/PAD media de 152,5 ±13/89,2 ±8,5 mmHg y una media de 3,5 fármacos prescritos. El índice de apneas-hipopneas (IAH) fue de 26,2 ± 19,5, de predominio obstructivo. Los pacientes con síndrome de apneas-hipopneas durante el sueño (SAHS) grave (IAH ≥ 30; 40,8%) presentaron mayor descontrol de la PAS tanto diurna (p = 0,017) como nocturna (p = 0,033) que el resto de pacientes, así como mayor PAD diurna (p = 0,035) y toma de un mayor número de fármacos que quienes no lo presentaban (IAH < 10; 28,6%) (p = 0,041). Tomados en su conjunto, los pacientes presentaron una correlación significativa entre las cifras de la presión arterial y la obesidad, además de existir una correlación ajustada significativa con el IAH sólo en los pacientes con SAHS. El IAH se mostró como el predictor independiente que más influyó en las cifras de la presión arterial de estos pacientes. Conclusiones: En pacientes con HTAr la prevalencia de SAHS fue muy elevada. En los pacientes con SAHS, el IAH se mostró como el factor predictivo independiente más importante de las cifras de presión arterial

Objective: To analyze the relationship between sleep-disordered breathing and difficult-to-control arterial hyper-tension. Patients and methods: Patients were considered to have difficult-to-control hypertension when mean systolic blood pressure was 125 mm Hg or higher and/or mean diastolic blood pressure was more than or equal to 80 mm Hg (as recorded during 2 24-hour ambulatory monitoring studies) despite the use of 3 or more antihypertensive drugs. Respiratory polygraphy using the AutoSet device (ResMed Corp, Sydney, Australia) was then performed to study sleep-disordered breathing in all patients. Results: Forty-nine patients with a mean (SD) age of 68.1 (9.1) years, mean systolic and diastolic pressures of 152.5 (13)/89.2 (8.5) mm Hg, and an average of 3.5 prescribed drugs were included in the study. The mean apnea-hypopnea index (AHI) was 26.2 (19.5) and events were predominantly obstructive. Patients with severe sleep apnea-hypopnea syndrome (SAHS) (AHI ≥ 30; 40.8%) showed more uncontrolled daytime (P=.017) and nighttime (P=.033) systolic pressure than the rest, as well as higher daytime diastolic pressure (P=.035) and a greater consumption of drugs than those without severe SAHS (AHI < 10; 28.6%) (P=.041). The study population as a whole showed a significant correlation between blood pressure and obesity. There was a significant correlation (adjusted for age and sex) with AHI only in patients with SAHS. AHI was found to be the independent predictor with the greatest effect on blood pressure in these patients. Conclusions: Prevalence of SAHS was very high in patients with difficult-to-control hypertension. In patients with SAHS, AHI was found to be the independent predictor with the greatest affect on arterial blood pressure

[Transient global amnesia following the use of ergots in the treatment of migraine]. / Amnesia global transitoria tras el uso de ergóticos en la migraña.

INTRODUCTION: Transient global amnesia (TGA) is defined as a selective, or almost selective, deficit of the memory that appears suddenly and lasts less than 24 hours. The aetiopathogenesis of this syndrome remains unknown and different theories have been put forward about its epileptic or ischemic origin, or the relationship that exists with the neuronal depression that is produced in migraine. A number of triggering factors have been described, including the taking of distinct pharmaceutical preparations. CASE REPORT: We report the cases of two patients with a history of migraines who suffered TGA after taking ergotamine and dihydroergotamine, respectively, to treat an attack of migraine. CONCLUSIONS: Given the vasoconstriction effect of these drugs, it was concluded that in both cases the main factor that triggered the TGA was the ingestion of ergots.

Amnesia global transitoria tras el uso de ergóticos en la migraña / Transient global amnesia following the use of ergots in the treatment of migraine

Introducción. La amnesia global transitoria (AGT) se define como un déficit selectivo o casi selectivo de la memoria que aparece bruscamente y dura menos de 24 horas. La etiopatogenia de este síndrome se desconoce y se han postulado distintas teorías sobre su origen epiléptico o isquémico, o la relación existente con la depresión neuronal que se produce en la migraña. Se han descrito numerosos desencadenantes, entre ellos la toma de distintos fármacos. Casos clínicos. Comunicamos dos pacientes con antecedentes de migraña que sufrieron una AGT tras la toma de ergotamina y dihidroergotamina, respectivamente, para el tratamiento de una crisis migrañosa. Conclusión. Dado el efecto vasoconstrictor de estos fármacos, se llegó a la conclusión de que en ambos casos fue la toma de ergóticos el principal factor desencadenante de la AGT. (AU)