Prevalencia de dislipemia aterogénica, factores relacionados y grado de control lipídico en la población general de Galicia. Estudio GALIPEMIAS / Prevalence of atherogenic dyslipidemia, related factors and level of lipid control in the general population of Galicia. GALIPEMIAS study

Objetivos: GALIPEMIAS es un estudio diseñado para establecer la prevalencia de las dislipemias familiares en la población general de Galicia. El objetivo del presente estudio fue determinar la prevalencia de dislipemia aterogénica (DA), su relación con otros factores de riesgo cardiovascular (RCV) y el grado de control lipídico. Métodos: Estudio transversal realizado en la población general mayor de 18 años de edad residente en Galicia, y con tarjeta sanitaria del Servicio Gallego de Salud (N=1.000). Selección de la muestra mediante muestreo aleatorizado por conglomerados. Se analizó la prevalencia de DA ajustada por edad y sexo, y las variables relacionadas. Resultados: La prevalencia de DA ajustada por edad y sexo fue de un 6,6% (IC 95%: 5,0-8,3). La hipertensión arterial, la glucemia basal alterada, la diabetes mellitus tipo 2 y la enfermedad cardiovascular aterosclerótica fueron más frecuentes en individuos con DA que en el resto de la población. El 47,5% de los sujetos con DA presentaba un RCV alto o muy alto. Recibían fármacos hipolipemiantes el 38,9% (30,5% estatinas) de los participantes con DA (46,1% de los de alto y el 71,4% de los de muy alto RCV). El 25,4% de los sujetos con DA presentaban niveles de cLDL en objetivo, siendo todos ellos de bajo o moderado RCV. Conclusiones: La prevalencia de DA en la población general adulta de Galicia no es despreciable, se relacionó con varios factores de RCV y la enfermedad cardiovascular aterosclerótica. A pesar de ello, estuvo infradiagnosticada e infratratada.(AU)

Objectives: GALIPEMIAS is a study designed to establish the prevalence of familial dyslipidemia in the general population of Galicia. The objective of the present study was to assess the prevalence of atherogenic dyslipidemia (AD), its relationship with other cardiovascular risk (CVR) factors, and the degree of lipid control. Methods: Cross-sectional study carried out in the general population over 18 years of age residing in Galicia and with a health card from the Galician Health Service (N=1,000). Selection of the sample by means of random sampling by conglomerates. The AD prevalence adjusted for age and sex and the related variables were analyzed. Results: The prevalence of AD adjusted for age and sex was 6.6% (95% CI: 5.0-8.3%). Arterial hypertension, altered basal glycemia, type 2 diabetes mellitus and cardiovascular disease were more frequent in subjects with AD than in the rest of the population. 47.5% of the subjects with AD had a high or very high CVR. Lipid-lowering drugs were received by 38.9% (30.5% statins) of the participants with AD (46.1% of those with high and 71.4% of those with very high CVR). 25.4% of the subjects with AD had target LDL-c levels, all of them with low or moderate CVR. Conclusions: The prevalence of AD in the general adult population of Galicia is not negligible, and it was related to several CVR factors and cardiovascular disease. Despite this, this lipid alteration was underdiagnosed and undertreated.(AU)

Prevalence of atherogenic dyslipidemia, related factors and level of lipid control in the general population of Galicia. GALIPEMIAS study. / Prevalencia de dislipemia aterogénica, factores relacionados y grado de control lipídico en la población general de Galicia. Estudio GALIPEMIAS.

OBJECTIVES: GALIPEMIAS is a study designed to establish the prevalence of familial dyslipidemia in the general population of Galicia. The objective of the present study was to assess the prevalence of atherogenic dyslipidemia (AD), its relationship with other cardiovascular risk (CVR) factors, and the degree of lipid control. METHODS: Cross-sectional study carried out in the general population over 18 years of age residing in Galicia and with a health card from the Galician Health Service (N=1,000). Selection of the sample by means of random sampling by conglomerates. The AD prevalence adjusted for age and sex and the related variables were analyzed. RESULTS: The prevalence of AD adjusted for age and sex was 6.6% (95% CI: 5.0-8.3%). Arterial hypertension, altered basal glycemia, type 2 diabetes mellitus and cardiovascular disease were more frequent in subjects with AD than in the rest of the population. 47.5% of the subjects with AD had a high or very high CVR. Lipid-lowering drugs were received by 38.9% (30.5% statins) of the participants with AD (46.1% of those with high and 71.4% of those with very high CVR). 25.4% of the subjects with AD had target LDL-c levels, all of them with low or moderate CVR. CONCLUSIONS: The prevalence of AD in the general adult population of Galicia is not negligible, and it was related to several CVR factors and cardiovascular disease. Despite this, this lipid alteration was underdiagnosed and undertreated.

Prevalencia y relaciones de la hipotensión ortostática en los pacientes de 80 o más años de edad de una unidad de atención primaria / Prevalence and relations of orthostatic hypotension in patients 80 years old and over from a primary care unit

Objetivo: Estimar la prevalencia de la hipotensión ortostática (HO) en pacientes de 80 o más años de edad que demandan consulta en una unidad de atención primaria. Relacionar la HO con las enfermedades más prevalentes y los fármacos más consumidos. Diseño: Transversal observacional. Localización: Unidad de atención primaria, Santiago de Compostela. Participantes: Se reclutaron 81 pacientes de 80 o más años representativos de una unidad de atención primaria. Se excluyeron 10 pacientes. Mediciones principales: Se realizó la medición de la presión arterial en decúbito y posteriormente en bipedestación en el instante siguiente a la incorporación y tras 3 min. Se revisaron en la historia clínica electrónica los diagnósticos y los tratamientos activos mediante una entrevista al paciente y cuidador. Resultados: En un 26,76% de los pacientes se produjo un descenso mayor o igual de 20 mmHg en la presión arterial sistólica y/o 10 mmHg en la presión arterial diastólica, en el instante siguiente al cambio postural. El descenso se mantuvo tras 3min de la incorporación de decúbito a bipedestación en el 16,90% de los pacientes. Ningún paciente estaba diagnosticado de HO. La mayor razón de prevalencia se dio con la diabetes mellitus (1,6; p = 0,412), no habiendo diferencias para la hipertensión arterial (p = 0,881). La HO se relacionó de forma estadísticamente significativa con la toma de bloqueadores de sistema renina-angiotensina-aldosterona (OR: 8,174; IC95%: 1,182-56,536; p = 0,033) y benzodiacepinas (OR: 5,938; IC95%: 1,242-28,397; p = 0,026). Conclusión: La HO tuvo una prevalencia del 16,90% en los pacientes de edad avanzada que acudieron a consulta. Debe tenerse en cuenta su relación con algunos fármacos (bloqueadores de sistema renina-angiotensina-aldosterona y benzodiacepinas)

Objective: To estimate the prevalence of orthostatic hypotension (OH) in patients 80 years old and over attending a primary care unit. To relate OH to the most prevalent pathologies and to the most used drugs. Design: Transversal observational study. Location: Primary care unit, Santiago de Compostela. Participants: Eighty one patients 80 years old or over representative of a primary care unit were recruited. Ten patients were excluded. Main measurements: Blood pressure was measured in decubitus and later in erect position first immediately after standing and then after 3 minutes. Diagnoses and active treatments were reviewed in the electronic clinical history and through an interview with the patient and caregiver. Results: In 26.76% of patients the systolic blood pressure fell by 20 mmHg or more and/or the diastolic blood pressure fell by 10 mmHg in the instant following the postural shift. In 16.90% of patients the drop persisted after 3 minutes of standing from decubitus position. None of the patients was diagnosed with OH. The highest prevalence ratio was observed for diabetes mellitus (1.6; P=.412), not existing differences for arterial hypertension (P=.881). OH related in a statistically meaningful way to the use of renin angiotensin aldosterone system inhibitors (OR: 8.174, CI95%: 1.182-56.536); P=.033] and benzodiazepines (OR: 5.938, CI95%: 1.242-28.397; P=.026)]. Conclusion: OH had a prevalence of 16.90% among the elderly patients who had a consultation. Its connection with some drugs (renin angiotensin aldosterone system inhibitors and benzodiazepines) must be considered

[Prevalence and relations of orthostatic hypotension in patients 80 years old and over from a primary care unit]. / Prevalencia y relaciones de la hipotensión ortostática en los pacientes de 80 o más años de edad de una unidad de atención primaria.

OBJECTIVE: To estimate the prevalence of orthostatic hypotension (OH) in patients 80 years old and over attending a primary care unit. To relate OH to the most prevalent pathologies and to the most used drugs. DESIGN: Transversal observational study. LOCATION: Primary care unit, Santiago de Compostela. PARTICIPANTS: Eighty one patients 80 years old or over representative of a primary care unit were recruited. Ten patients were excluded. MAIN MEASUREMENTS: Blood pressure was measured in decubitus and later in erect position first immediately after standing and then after 3 minutes. Diagnoses and active treatments were reviewed in the electronic clinical history and through an interview with the patient and caregiver. RESULTS: In 26.76% of patients the systolic blood pressure fell by 20mmHg or more and/or the diastolic blood pressure fell by 10mmHg in the instant following the postural shift. In 16.90% of patients the drop persisted after 3 minutes of standing from decubitus position. None of the patients was diagnosed with OH. The highest prevalence ratio was observed for diabetes mellitus (1.6; P=.412), not existing differences for arterial hypertension (P=.881). OH related in a statistically meaningful way to the use of renin angiotensin aldosterone system inhibitors (OR: 8.174, CI95%: 1.182-56.536); P=.033] and benzodiazepines (OR: 5.938, CI95%: 1.242-28.397; P=.026)]. CONCLUSION: OH had a prevalence of 16.90% among the elderly patients who had a consultation. Its connection with some drugs (renin angiotensin aldosterone system inhibitors and benzodiazepines) must be considered.

Rationale, design and preliminary results of the GALIPEMIAS study (prevalence and lipid control of familial dyslipidemia in Galicia, northwest Spain).

AIMS: There is little information on the familial nature of dyslipidemias in the Spanish population. This knowledge could have potential diagnostic and treatment implications. The objective of the GALIPEMIAS study was to determine the prevalence of familial dyslipidemia in Galicia, as well as determine the degree of lipid control in the participants. Prevalence of atherosclerotic cardiovascular disease (ASCVD) was also estimated. This paper presents the design, methodology and selected preliminary results. METHODOLOGY: A cross-sectional study was performed in the population aged ≥18 years using cluster sampling and then random sampling. A sample of 1000 subjects was calculated and divided into three sequential phases with a specific methodology for each one. Phase I: selection of subjects from the general population and collection of informed consent documents; Phase II: collection of data from the digital clinical history to select subjects with dyslipidemia according to study criteria; Phase III: personal interview, blood analysis, family tree, and definitive diagnosis of dyslipidemia. Prevalence of different diseases and active medication was analysed. Corrected prevalence (to the reference population) of different risk factors and ASCVD was estimated. RESULTS: Phase I participation was 89.5%. We extracted complete information from 93% of the participants (Phase II). According to the study's own criteria, 56.5% (n = 527) of the participants had some form of dyslipidemia and almost 33.7% of them had familial dyslipidemia with autosomal dominant inherit pattern. The corrected prevalence of ASCVD was 5.1% (95% CI 3.1-7.2). CONCLUSIONS: Dyslipidemia was the most prevalent cardiovascular risk factor in our population with an autosomal dominant inheritance pattern in one out of every three dyslipidemia cases. Approximately, 5.1% of the sample population aged ≥18 has suffered an episode of ACVD.

CRONIGAL: Prognostic index for chronic patients after hospital admission.

OBJECTIVE: We have followed patients admitted to a Polypathology and Advanced Age Unit for two years in order to identify the variables that best define the mortality prognosis at medium-term (1-2years) for chronic and polypathological patients requiring admission at an Internal Medicine Department. METHODS: This is an observational, prospective study in clinical practice. Polypathological, chronic or multimorbidity patients were included. The classification of the Spanish Ministry for Health was used in order to classify patients as chronic or polypathological. The Charlson Index and Barthel Index were estimated and the Pfeiffer test was administered. The Spanish PROFUND Index was also used. Logistic regression models and Cox proportional hazard model were built in order to study the influence of prognostic factors on survival. RESULTS: A total of 567 patients were included: 333 met polypathological (PPP) criteria and 234 chronic criteria (CC). Mean age was 84.8+7.3years. A total of 469 were followed up, most patients belonged to category E (282), 174 to category A and 118 to category C. The prognosis at one year of our patients can be estimated with 7 variables: age, neoplasia, delirium, Barthel, Pfeiffer, presence of atrial fibrillation, and creatinine. The area under the curve is 0.74. CONCLUSION: The variables dementia, neoplasia, delirium at admission, Barthel Index under 60, or deceased spouse have mortality prognosis value at one or two years. An index with 7 variables applicable to chronic and polypathological patients after admission may serve as tool to better manage complex chronic patients and follow them up.

Blood Pressure Profile and Hypertensive Organ Damage in COPD Patients and Matched Controls. The RETAPOC Study.

BACKGROUND: Several studies suggest that there is a pathogenic link between chronic obstructive pulmonary disease (COPD) and cardiovascular diseases. On the other hand, increased sympathetic tone has been described in several respiratory diseases. Our objective was to determine whether hypertension mediated by sympathetic overactivity is a mechanism that explains the association between COPD and cardiovascular diseases. METHODS: Prospective nested case-control observational study; 67 COPD patients were matched 1:1 by sex and age to controls with smoking history. 24 hour-blood pressure monitoring, urinary catecholamines and their metabolites measurement, echocardiography, carotid ultrasound examination, nocturnal oximetry and retinography were performed. FINDINGS: classic cardiovascular risk factors and comorbidities were similarly distributed between cases and controls. No significant differences for blood pressure variables (difference for mean systolic blood pressure: -0·13 mmHg; 95% CI: -4·48,4·20; p = 0·94; similar results for all blood presssure variables) or catecholamines values were found between both groups. There was a tendency for lower left ventricle ejection fraction in the COPD cases, that approached statistical significance (64·8 ± 7·4 vs 67·1 ± 6·2, p = 0·05). There were no differences in the retinal arteriovenous ratio, the carotid intima-media thickness, or the number of carotid plaques, between cases and controls. Fibrinogen values were higher in the COPD group (378·4 ± 69·6 vs 352·2 ± 45·6 mg/dL, p = 0·01) and mean nocturnal oxygen saturation values were lower for COPD patients (89·0 ± 4·07 vs 92·3 ± 2·2%, p < 0·0001). INTERPRETATION: Hypertension induced by sympathetic overactivity does not seem to be a mechanism that could explain the association between COPD and cardiovascular disease.

Medición de la microcirculación retiniana luego del tratamiento antihipertensivo / Measuring retinal circulation after antihypertensive treatment

Background and objective: With the development of image processing techniques, it has become possible to measure the changes in retinal vessels of hypertensive patients by means of eye fundus photographs. Patients and method: In this paper we aim to classify retinal vessels automatically into arterioles and venules. In order to do so, we have compared three different strategies based on the colour of the pixels in images through an analysis of 78 hypertensive patients' eye fundus images. The first strategy classifies all the vessels by applying a clustering algorithm. The second divides the retinal image into four quadrants and classifies the vessels that belong to the same quadrant independently from the rest of the vessels. The third strategy classifies the vessels by dividing the retinal image into four quadrants that are rotated inside the mentioned image. Results: The third strategy was the one that obtained the best results, since it minimizes the number of unclassified vessels. In the initially analysed set of 20 images, we correctly classified 86.53% of the vessels, and this percentage remains similar in a set of 58 images examined by three medical experts. This confirms the validity of the method that automatically calculates the arteriovenous ratio (AVR).Conclusion: Our results are an improvement on those previously described in the bibliography, reducing the number of non-classified vessels. Furthermore, the method entails low computational costs.

Fundamento y objetivo: El desarrollo de técnicas de procesado de imágenes ha devuelto interés para poder medir de una forma objetiva los cambios en la estructura microvascular del hipertenso a través de las fotografías digitales del fondo de ojo. Pacientes y método: Para clasificar de forma automática los vasos de la retina en arteriolas y vénulas, con una elevada precisión, hemos comparado tres estrategias diferentes basadas en la información del color de los pixeles de la imagen del fondo de ojo, analizando 78 imágenes de fondo de ojo de hipertensos. La primera estrategia clasificaría todos los vasos aplicando un algoritmo de agrupamiento. La segunda divide la retina en cuatro cuadrantes y clasifica los vasos que pertenecen al mismo cuadrante independientemente del resto de los vasos. La tercera estrategia clasifica los vasos dividiendo la retina en cuadrantes que son rotados. Resultados: La mejor estrategia resultó la tercera porque minimiza el error y el número de vasos no clasificados. La característica vectorial más determinante está basada en la media o la mediana del componente gris del espacio de color RGB. Para las 20 imágenes inicialmente analizadas hemos clasificado correctamente el 86.53% de los vasos, y este porcentaje permanece similar en el grupo de 58 imágenes examinadas por tres expertos, lo que confirma la validez del método, para el cálculo del índice arteriovenoso de forma automática. Conclusión: Nuestros resultados son superiores a los descritos previamente, reduciendo además el número de vasos no clasificados. Por otro lado, el costo computacional del método es bajo

Syringomyelia associated with inappropriate antidiuretic hormone secretion.

Hyponatraemia is the most common fluid-electrolyte disorder, and the most frequent related aetiologies are syndrome of inappropriate secretion of antidiuretic hormone (SIADH), which accounts for up to 38%. SIADH has been linked to multiple pathologies that affect the central nervous system; these disorders generally originate in the brain and, more rarely, in the spinal cord. It is often observed in patients undergoing neurosurgery and in patients with head injuries or intracranial tumours, and less common in those with spinal pathologies, especially traumatic. We describe an SIADH case associated with syringomyelia, in a patient admitted for severe, symptomatic hyponatraemia.

Retinal arteriole-to-venule ratio changes and target organ disease evolution in newly diagnosed hypertensive patients at 1-year follow-up.

There is no agreement on the systematic exploration of the fundus oculi (FO) in hypertensive patients, and it is unknown whether the evolution of retinal microcirculatory alterations has prognostic value or not. The aim of this study was to investigate whether the evolution of the arteriole-to-venule ratio (AVR) in newly-diagnosed hypertensive patients is associated with better or worse evolution of target organ damage (TOD) during 1 year. A cohort of 133 patients with newly-diagnosed untreated hypertension was followed for 1 year. At baseline and follow-up, all patients underwent a physical examination, self-blood pressure measurement, ambulatory blood pressure monitoring, blood and urine analysis, electrocardiogram, and retinography. The endpoint was the favourable evolution of TOD and the total amount of TOD, according to the baseline AVR and the baseline and final difference of the AVR. A total of 133 patients were analyzed (mean age, 57 ± 10.7 years; 59% men). No differences were found in the decrease in blood pressure or antihypertensive treatment between quartiles of baseline AVR or baseline-final AVR difference. Patients with a difference between baseline and final AVR in the highest quartile (>0.0817) had a favorable evolution of left ventricular hypertrophy (odds ratio, 14.9; 95% confidence interval, 1.08-206.8) and the amount of TOD (odds ratio, 2.22; 95% confidence interval, 1.03-6.05). No favorable evolution was found of glomerular filtration rate. There is an association between the evolution of the AVR and the favorable evolution of TOD. Patients with greater increase of AVR have significantly better evolution of left ventricular hypertrophy and amount of TOD.

Development of an automated system to classify retinal vessels into arteries and veins.

There are some evidence of the association between the calibre of the retinal blood vessels and hypertension. Computer-assisted procedures have been proposed to measure the calibre of retinal blood vessels from high-resolution photopraphs. Most of them are in fact semi-automatic. Our objective in this paper is twofold, to develop a totally automated system to classify retinal vessels into arteries and veins and to compare the measurements of the arteriolar-to-venular diameter ratio (AVR) computed from the system with those computed from observers. Our classification method consists of four steps. First, we obtain the vascular tree structure using a segmentation algorithm. Then, we extract the profiles. After that, we select the best feature vectors to distinguish between veins and arteries. Finally, we use a clustering algorithm to classify each detected vessel as an artery or a vein. Our results show that compared with an observer-based method, our method achieves high sensitivity and specificity in the automated detection of retinal arteries and veins. In addition the system is robust enough independently of the radii finally chosen, which makes it more trustworthy in its clinical application. We conclude that the system represents an automatic method of detecting arteries and veins to measure the calibre of retinal microcirculation across digital pictures of the eye fundus.

Determinación del calibre vascular retiniano en hipertensos con un método semiautomático basado en el modelo de snakes / Estimation of the retinal microvascular calibre in hypertensive patients with the snakes semiautomatic model

Fundamento y objetivo: Las guías europeas de hipertensión arterial consideran que es necesario un método que cuantifique de forma objetiva los cambios iniciales en la microcirculación retiniana del hipertenso. Previamente hemos descrito y validado un método semiautomático basado en un modelo lineal, con una alta sensibilidad y especificidad, pero con limitaciones. Fundamento y objetivo: Por este motivo, desarrollamos un método basado en el modelo de snakes, para medir el índice arteriovenoso retininano y lo hemos comparado con el método previamente descrito. Pacientes y método: Para validar este método, hemos analizado las fotografías digitales obtenidas de 173 ojos pertenecientes a un total de 96 pacientes hipertensos; la mayoría de éstos estaban recibiendo tratamiento. Las fotos se han realizado en 2 centros: A Coruña (66) y Santiago de Compostela (107), y la misma persona los ha analizado mediante ambos métodos en cada centro (lineal y snake).Resultados: Hemos observado que las medias y las diferencias de las determinaciones del índice arteriovenoso por ambos métodos son mínimas y siguen una distribución normal. El estadístico alfa de Cronbach fue de 0,974, con un coeficiente de correlación intraclase de 0,949 (p<0,001) para el grupo de imágenes de Santiago, mientras que para el grupo de A Coruña el estadístico alfa de Cronbach fue de 0,923, con un coeficiente de correlación intraclase de 0,857 (p<0,001). Conclusión: Se trata de un método para el cálculo del índice arteriovenoso retiniano de una forma semiautomática, con una elevada sensibilidad y mayor especificidad que el previamente descrito y con una excelente correlación con el anterior (AU)

Background and objective: Early alterations in retinal microcirculation are observed in most hypertensive patients seen in daily practice and the European guidelines consider it is necessary an objective method to quantify these alterations. We have previously described a semi-automatic computerized system to evaluate the calibre of retinal blood vessels that has shown high sensitivity and specificity to calculate the arteriovenous ratio (AVR), though with limitations. We describe a method based on the snakes model to calculate the arteriovenous ratio.Patients and method: We haved compared it with the previously reported lineal method, and we have analyed 173 digital photographs from 96 hypertensive patients, most of them reciveing treatment. Photos were made in two hospitals (A Coruña: 66 and Santiago de Compostela: 107), and were analysed by the same people in each Centre, by the lineal and snake method. Results: We have observed that the arithmetic mean and the differences in AVR between both methods were minimal and showed a normal distribution. Cronbach statistics was 0.974 and intraclass correlation coefficient 0.949 (p<0.001), for the images from Santiago and 0.923 with an intraclass correlation coefficient of 0.857 (p<0.001) for the images from A Coruña. Conclusion: This semiautomatic method to calculate the AVR ratio has a high sensitivity and a greater specificity than previous method, and the correlation between the results obtained with both is excellent (AU)

[Estimation of the retinal microvascular calibre in hypertensive patients with the snakes semiautomatic model]. / Determinación del calibre vascular retiniano en hipertensos con un método semiautomático basado en el modelo de snakes.

BACKGROUND AND OBJECTIVE: Early alterations in retinal microcirculation are observed in most hypertensive patients seen in daily practice and the European guidelines consider it is necessary an objective method to quantify these alterations. We have previously described a semi-automatic computerized system to evaluate the calibre of retinal blood vessels that has shown high sensitivity and specificity to calculate the arteriovenous ratio (AVR), though with limitations. We describe a method based on the snakes model to calculate the arteriovenous ratio. PATIENTS AND METHOD: We had compared it with the previously reported lineal method, and we have analyzed 173 digital photographs from 96 hypertensive patients, most of them receiving treatment. Photos were made in two hospitals (A Coruña: 66 and Santiago de Compostela: 107), and were analysed by the same people in each Centre, by the lineal and snake method. RESULTS: We have observed that the arithmetic mean and the differences in AVR between both methods were minimal and showed a normal distribution. Cronbach statistics was 0.974 and intraclass correlation coefficient 0.949 (p<0.001), for the images from Santiago and 0.923 with an intraclass correlation coefficient of 0.857 (p<0.001) for the images from A Coruña. CONCLUSION: This semiautomatic method to calculate the AVR ratio has a high sensitivity and a greater specificity than previous method, and the correlation between the results obtained with both is excellent.

Hipotensión grave y mantenida por inhibidores de la enzima de conversión de angiotensina durante la anestesia intradural. Respuesta de los autores / No disponible

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Hipotensión grave y mantenida por inhibidores de la enzima de conversión de angiotensina durante la anestesia intradural / Severe hypotension during spinal anesthesia induced by angiotensin-converting enzyme inhibitors

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¿Deberían los bloqueadores beta permanecer en la primera línea del tratamiento de la hipertensión arterial esencial? / Should Beta-blockers remain first choice in the treatment of primary hypertension?

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