Association of Hypertension with All-Cause Mortality among Hospitalized Patients with COVID-19.

It is unclear to which extent the higher mortality associated with hypertension in the coronavirus disease (COVID-19) is due to its increased prevalence among older patients or to specific mechanisms. Cross-sectional, observational, retrospective multicenter study, analyzing 12226 patients who required hospital admission in 150 Spanish centers included in the nationwide SEMI-COVID-19 Network. We compared the clinical characteristics of survivors versus non-survivors. The mean age of the study population was 67.5 ± 16.1 years, 42.6% were women. Overall, 2630 (21.5%) subjects died. The most common comorbidity was hypertension (50.9%) followed by diabetes (19.1%), and atrial fibrillation (11.2%). Multivariate analysis showed that after adjusting for gender (males, OR: 1.5, p = 0.0001), age tertiles (second and third tertiles, OR: 2.0 and 4.7, p = 0.0001), and Charlson Comorbidity Index scores (second and third tertiles, OR: 4.7 and 8.1, p = 0.0001), hypertension was significantly predictive of all-cause mortality when this comorbidity was treated with angiotensin-converting enzyme inhibitors (ACEIs) (OR: 1.6, p = 0.002) or other than renin-angiotensin-aldosterone blockers (OR: 1.3, p = 0.001) or angiotensin II receptor blockers (ARBs) (OR: 1.2, p = 0.035). The preexisting condition of hypertension had an independent prognostic value for all-cause mortality in patients with COVID-19 who required hospitalization. ARBs showed a lower risk of lethality in hypertensive patients than other antihypertensive drugs.

Control integral de los factores de riesgo en pacientes de alto y muy alto riesgo cardiovascular en España. Estudio CIFARC / Integral control of risk factors in patients of high and very high cardiovascular risk in Spain. CIFARC project

FUNDAMENTO Y OBJETIVO: El objetivo del presente estudio es determinar el porcentaje de pacientes con alto riesgo cardiovascular que tienen controlados de forma global todos sus factores de riesgo mayores (hipertensión arterial, hipercolesterolemia, diabetes mellitus, tabaco y obesidad). PACIENTES Y MÉTODO: Estudio transversal sobre pacientes ambulatorios de medicina interna, mayores de 18 años y con riesgo cardiovascular alto o muy alto (según la escala de Framingham, superior al 20% a los 10 años). Se evaluó el grado de control de los factores de riesgo cardiovascular (hipertensión arterial, diabetes mellitus, colesterol unido a lipoproteínas de baja densidad, tabaquismo y obesidad) según las definiciones de control de la Organización Mundial de la Salud/Sociedad Internacional de Hipertensión, Joint National Committee VI, National Cholesterol Education Program-Adult Treatment Panel III y American Diabetes Association. RESULTADOS: Se estudió a 2.264 pacientes (el 53,7% eran varones), con una edad media (desviación estándar) de 66,1 (11,5) años. El 74,6% eran hipertensos; el 61,1%, dislipémicos; el 59,8%, diabéticostipo 2; el 31,1%, fumadores; el 38%, obesos, y el 36,7% se hallaba en prevención secundaria. El control de la hipertensión arterial fue del 34,5%; el de la dislipemia, del 50,3%; y el de la diabetes mellitus, del 35,5%. El control de todos los factores de riesgo de forma global fue del 6,9% (y del 10,2% si se excluye la obesidad). Los factores relacionados de forma independiente con un mal control integral fueron la diabetes mellitus (odds ratio [OR] = 0,33; intervalo de confianza [IC] del 95%,0,23-0,47), la dislipemia (OR = 0,34; IC del 95%, 0,24-0,48) y la existencia de proteinuria (OR =0,36; IC del 95%, 0,18-0,71); se relacionaron con un mejor control integral el sexo varón (OR =1,67; IC del 95%, 1,18-2,38), la hipertrofia ventricular izquierda (OR = 1,62; IC del 95%, 1,15-2,30) y la realización de pruebas complementarias (OR = 1,01; IC del 95%, 1,01-1,08). CONCLUSIONES: Solamente el 6,9% de los pacientes de alto o muy alto riesgo cardiovascular tienen controladoslos 5 principales factores de riesgo mayores. La existencia de diabetes mellitus, dislipemia o proteinuria predisponen a un mal control integral de dichos factores, mientras que el número de exploraciones complementarias realizadas se asocia con un mejor control

BACKGROUND AND OBJECTIVE: The objective of this study was to determine the percentage of patients with high and very high cardiovascular risk, with their risk factors globally well controlled (hypertension,dyslipemia, diabetes mellitus, tobacco and obesity). PATIENTS AND METHOD: Transversal study of ambulatory patients of internal medicine with an estimated cardiovascular risk high or very high (Framingham stratification scale over 20% in ten years). We evaluated the degree of control of their cardiovascular risk factors attending to the recommendations provided by recent international guidelines (WHO/ISH, JNC-VI, NCEP-ATP-III, ADA). RESULTS: We studied 2,264 patients (53.7% males; mean age: 66.1 ± 11.5 years; 74.6% hypertensive, 61.1% dyslipidemic, 59.8% type 2 diabetes, 31.1% smokers, 38.0% obese and 36.7%in secondary prevention). Control of hypertension was achieved in 34.5%, dyslipidemia in 50.3% and diabetes in 35.5%. Global control of every risk factor was achieved in 6.9% (in 10.2% if we exclude obesity since it is not a risk factor used for cardiovascular stratification). Factors independently associated with a bad integral control were: diabetes (OR = 0.33; 95%CI: 0.23-0.47), dyslipidemia(OR = 0.34; 95%CI: 0.24-0.48), proteinuria (OR = 0.36; 95%CI: 0.18-0.71). Factors independently associated with a better cardiovascular control were: male sex (OR = 1.67; 95%CI: 1.18-2.38),ventricular hypertrophy (OR = 1.62; 95%CI: 1.15-2.30) and the number of exploratory tests (OR =1.01; 95%CI: 1.01-1.08).CONCLUSIONS: Only 6.9% of patients with a high or very high cardiovascular risk have all their principal risk factors under control. The presence of diabetes, dyslipidemia or proteinuria predisposed to a worse control and the number of complementary tests performed to the patients was related to a better control

Disminución de hemorragias totales con dosis reducidas de enoxaparina en angina inestable de alto riesgo / Estudio ENHNFAI. (ENoxaparina vs Heparina No Fraccionada en Angina inestable). Informe preliminar. Decrease of total hemorrhage with reduced doses of enoxaparin in high risk unstable angina. ENHNFAI study. (Enoxaparin vs non-fractionated heparin in unstable angina). Preliminary report

In this prospective, randomized and controlled study, we compare complications in 2 groups of patients: group 1, enoxaparin 0.8 mg/kg, subcutaneous every 12 hours during 5 days, and group 2, intravenous unfractionated heparin during 5 days, by infusion treated to activate partial tromboplastin time 1.5-2 the upper limit of normal. Blood samples were obtained at 4, 12, 24 hours and at day 5 of treatment, to measure anti-Xa levels, and also, evaluated end points at 30 days, between groups. Univariate and multivariate logistic regression analyses were performed with clinical and angiographic variables between groups, with p < 0.05. RESULTS: 203 consecutive patients, average age of 60.5 +/- 11.2 years, and 80 men, were included. There were no differences in clinical and angiographic characteristics. All patients with enoxaparin had therapeutic levels of anti-Xa, of 0.5 to 0.67 U/mL. There was increasing risk of total bleeding in group 2 (18.7) than in group 1 (5.6), with RR = 1.72 (95 CI 1.29, 2.29), p = .003. Also, there was 33.3 of MACE in group 2, and only 17.8 in group 1, with RR = 1.88 (CI 95 1.29, 2.29), p = .011. CONCLUSIONS: 1) Low doses of enoxaparine achieve therapeutic levels, since the first 4 hours of treatment. 2) A significant reduction of total bleeding occurred with the low doses of enoxaparin, with the same efficacy to reduce MACE during follow-up.