Presión arterial central y lesión vascular / Central blood pressure and vascular damage

Fundamento y objetivo: Valorar la posible relación de la presión arterial central con el daño vascular. Material y método: Estudio observacional transversal en 393 pacientes con hipertensión arterial sin tratamiento farmacológico previo (166 mujeres). Se midieron las presiones clínicas (PA), ambulatorias de 24 h (PA24h) y centrales (PAC). Para determinar la presencia de lesión de órgano diana (LOD) se calculó el cociente albúmina/creatinina (CAC), la velocidad de onda de pulso y el índice de masa del ventrículo izquierdo (IMVI) por ecocardiografía. Resultados: Los pacientes con LOD tenían valores más altos de PA, PA24h y PAC. Al comparar las distintas mediciones de PA sistólica, la PA24h sistólica tuvo una mayor correlación con el CAC (test Z Steiger: 2,26; p = 0,02) y con el IMVI (test Z Steiger: 3,23; p = 0,01) que la PAC sistólica. La PA24h sistólica tuvo una mayor relación en el análisis de regresión múltiple con los índices de daño vascular analizados que las respectivas de PA y PAC tras corregir por edad, sexo y síndrome metabólico. Mediante un análisis de regresión logística, presentar cifras de PA24h sistólicas incluidas en el tercil superior fue el mejor predictor de presentar alguna de las LOD (odds ratio multivariante 3,4; IC al 95%: 2,5-5,5, p = 0,001). Conclusiones: La PAC no tiene mayor correlación con las LOD analizadas que otras medidas de PA periférica. La medición de la PA24h identifica mejor a los pacientes con daño vascular (AU)

Background and objective: The aim of this study was to assess the relationship between central blood pressure and vascular damage. Patients and methods: This cross-seccional study involved 393 never treated hypertensive patients (166 women). Clinical blood pressure (BP), 24 h blood pressure (BP24h) and central blood pressure (CBP) were measured. Vascular organ damage (VOD) was assessed by calculating the albumin/creatinine ratio (ACR), wave pulse pressure velocity and echocardiographic left ventricular mass index (LVMI). Results: Patients with VOD had higher values of BP, BP24h, and CBP than patients without ACR. When comparing several systolic BP, systolic BP24h had a higher linear correlation with CBP (Z Steiger test: 2.26; P = .02) and LVMI (Z Steiger test: 3.23; P = .01) than PAC. In a multiple regression analysis corrected by age, sex and metabolic syndrome, all pressures were related with VOD but systolic BP24hshowed the highest correlation. In a logistic regression analysis, having the highest tercile of systolic BP24h was the stronger predictor of VOD (multivariate odds ratio: 3.4; CI 95%: 2.5-5.5, P = .001). Conclusions: CBP does not have more correlation with VOD than other measurements of peripheral BP. Systolic BP24h is the BP measurement that best predicts VOD (AU)

[Central blood pressure and vascular damage]. / Presión arterial central y lesión vascular.

BACKGROUND AND OBJECTIVE: The aim of this study was to assess the relationship between central blood pressure and vascular damage. PATIENTS AND METHODS: This cross-sectional study involved 393 never treated hypertensive patients (166 women). Clinical blood pressure (BP), 24h blood pressure (BP24h) and central blood pressure (CBP) were measured. Vascular organ damage (VOD) was assessed by calculating the albumin/creatinine ratio (ACR), wave pulse pressure velocity and echocardiographic left ventricular mass index (LVMI). RESULTS: Patients with VOD had higher values of BP, BP24h, and CBP than patients without ACR. When comparing several systolic BP, systolic BP24h had a higher linear correlation with CBP (Z Steiger test: 2.26; P=.02) and LVMI (Z Steiger test: 3.23; P=.01) than PAC. In a multiple regression analysis corrected by age, sex and metabolic syndrome, all pressures were related with VOD but systolic BP24h showed the highest correlation. In a logistic regression analysis, having the highest tercile of systolic BP24h was the stronger predictor of VOD (multivariate odds ratio: 3.4; CI 95%: 2.5-5.5, P=.001). CONCLUSIONS: CBP does not have more correlation with VOD than other measurements of peripheral BP. Systolic BP24h is the BP measurement that best predicts VOD.

Relación entre la presión arterial central y periférica con la masa ventricular izquierda en hipertensos / Relationship of central and peripheral blood pressure to left ventricular mass in hypertensive patients

Introducción y objetivos. Valorar la posible relación de la presión arterial central con la masa ventricular izquierda. Métodos. Estudio observacional transversal en 392 pacientes con hipertensión arterial sin tratamiento farmacológico previo. Se valoraron las presiones clínicas, ambulatorias de 24 h y centrales (medidas por tonometría de aplanamiento) y se calculó el índice de masa del ventrículo izquierdo por ecocardiografía. Resultados. Todos los valores de presión de 24 h tienen mejor relación en el análisis de regresión múltiple con el índice de masa del ventrículo izquierdo que los respectivos de presión clínica y central tras corregir por edad, sexo y síndrome metabólico. La correlación fue siempre mayor con las cifras de presión sistólicas que con las diastólicas en las tres determinaciones. La correlación del índice de masa del ventrículo izquierdo con la presión sistólica de 24 h fue superior a la que presentaba con las presiones sistólicas clínica (p < 0,002) y central (p < 0,002). La variación en las cifras de presión sistólica de 24 h son las que producen un incremento mayor en el índice de masa del ventrículo izquierdo (p < 0,001). Conclusiones. El índice de masa del ventrículo izquierdo se correlaciona más con los valores de presión sistólica ambulatoria de 24 h que con las demás medidas de la presión arterial, incluidas todas las medidas de presión central. La medición de la presión arterial central no permite identificar mejor a los pacientes con hipertrofia del ventrículo izquierdo (AU)

Introduction and objectives. The purpose of the present study was to assess the relationship of central and peripheral blood pressure to left ventricular mass. Methods. Cross-sectional study that included 392 never treated hypertensive individuals. Measurement of office, 24-h ambulatory, and central blood pressure (obtained using applanation tonometry) and determination of left ventricular mass by echocardiography were performed in all patients. Results. In a multiple regression analysis, with adjustment for age, gender and metabolic syndrome, 24-h blood pressure was more closely related to ventricular mass than the respective office and central blood pressures. Systolic blood pressures always exhibited a higher correlation than diastolic blood pressures in all 3 determinations. The correlation between left ventricular mass index and 24-h systolic blood pressure was higher than that of office (P<.002) or central systolic blood pressures (P<.002). Changes in 24-h systolic blood pressure caused the greatest variations in left ventricular mass index (P<.001). Conclusions. In our population of untreated middle-aged hypertensive patients, left ventricular mass index is more closely related to 24-h ambulatory blood pressure than to office or central blood pressure. Central blood pressure does not enable us to better identify patients with left ventricular hypertrophy (AU)

Relationship of central and peripheral blood pressure to left ventricular mass in hypertensive patients.

INTRODUCTION AND OBJECTIVES: The purpose of the present study was to assess the relationship of central and peripheral blood pressure to left ventricular mass. METHODS: Cross-sectional study that included 392 never treated hypertensive individuals. Measurement of office, 24-h ambulatory, and central blood pressure (obtained using applanation tonometry) and determination of left ventricular mass by echocardiography were performed in all patients. RESULTS: In a multiple regression analysis, with adjustment for age, gender and metabolic syndrome, 24-h blood pressure was more closely related to ventricular mass than the respective office and central blood pressures. Systolic blood pressures always exhibited a higher correlation than diastolic blood pressures in all 3 determinations. The correlation between left ventricular mass index and 24-h systolic blood pressure was higher than that of office (P<.002) or central systolic blood pressures (P<.002). Changes in 24-h systolic blood pressure caused the greatest variations in left ventricular mass index (P<.001). CONCLUSIONS: In our population of untreated middle-aged hypertensive patients, left ventricular mass index is more closely related to 24-h ambulatory blood pressure than to office or central blood pressure. Central blood pressure does not enable us to better identify patients with left ventricular hypertrophy.

Relationship between increased arterial stiffness and other markers of target organ damage

Background and objectives: The purpose of the present study was to assess the relationship of arterial stiffness with other markers of target organ damage, and the clinical factors related to it. Patients and Methods: Cross-sectional study that included 208 (115 men) never treated hypertensive, non-diabetic patients (mean age, 49¡À12 years). In addition to a full clinical study, 24h ambulatory blood pressure (BP), and determination of left ventricular hypertrophy (LVH) and microalbuminuria were performed. Clinical arterial stiffness was assessed by carotid¨Cfemoral pulse wave velocity (PWV) obtained with applanation tonometry (SphygmoCor-System).Results: PWV was 8.3 (7.3¨C9.9)m/s (median, interquartile range). Stepwise regression analysis revealed that age (¦Â=0.086, p<0.001), 24-h pulse pressure (¦Â=0.058, p<0.001), and low-density lipoprotein (LDL) cholesterol (¦Â=0.009, p<0.013) were independent determinants of PWV. PWV>12m/s (indicating target organ lesion) was present in only 16 (7.7%) patients, less frequent than LVH (28% of the patients) and microalbuminuria (16%). However, of the 16 patients with elevated PWV, 10 (62%) had neither LVH or microalbuminuria. In a logistic multivariate regression analysis the factors related to elevated PWV were age ¡Ý45 in man and ¡Ý55 in women (OR: 23.8, 95% CI: 2.7¨C195.5; p=0.004), LDL cholesterol ¡Ý160mg/dl (OR: 10.6, 95% CI: 2.6¨C42.7; p=0.001) and increased 24-h pulse pressure ¡Ý55mmHg (OR: 3.9, 95% CI: 1.2¨C12.9; p=0.03). Conclusions: In untreated middle age hypertensives arterial stiffness assessed by PWV is less frequent than LVH or microalbuminuria. PWV is mainly related to age, LDL cholesterol, and pulse pressure values (AU)

Fundamento y objetivos: Valorar los factores relacionados con el incremento de la rigidez arterial como indicador de lesión subclínica. Pacientes y Método: Estudio transversal en 208 sujetos (115 varones) hipertensos, no diabóticos, sin tratamiento. Se determinaron la presión arterial (PA) en 24h, la hipertrofia ventricular izquierda (HVI) por ecocardiografía y la microalbuminuria. La rigidez arterial se valoró como velocidad de onda de pulso (VOP) carótida-femoral en m/s, por tonometría de aplanamiento (SphygmoCor-System). Resultados: La VOP fue de 8,3 (7,3¨C9,9)m/s (mediana, rango interquartílico) y se relación en un análisis de regresión múltiple con la edad (Â=0,086, p<0,001), presión de pulso de 24horas (Â=0,058, p<0,001) y colesterol LDL (Â=0,009, p<0,013). Valores de VOP >12m/s se evidenciaron sólo en 16 (7,7%) pacientes, y fue menos frecuente que la HVI (28%) y la microalbuminuria (16%). Sin embargo, de los 16 pacientes con VOP elevada, diez (62%) no tenían otra lesión subclínica asociada Resultados: En un análisis multivariante de regresión logística, los factores relacionados con una VOP elevada fueron: la edad Ý45 en varones y Ý55 en mujeres (OR:23,8, 95% IC, 2,7¨C195,5; p=0,004), colesterol-LDL Ý160mg/dl (OR:10,6, 95% IC, 2,6¨C42,7; p=0,001) y presión de pulso 24horas Ý55mmHg (OR:3,9, 95% IC, 1,2¨C12,9; p=0,03). Conclusiones: En sujetos hipertensos no tratados la rigidez arterial medida como VOP es menos frecuente que la HVI o microalbuminuria y se relaciona con la edad, colesterol-LDL y presión de pulso (AU)

Relationship between increased arterial stiffness and other markers of target organ damage.

BACKGROUND AND OBJECTIVES: The purpose of the present study was to assess the relationship of arterial stiffness with other markers of target organ damage, and the clinical factors related to it. PATIENTS AND METHODS: Cross-sectional study that included 208 (115 men) never treated hypertensive, non-diabetic patients (mean age, 49+/-12 years). In addition to a full clinical study, 24h ambulatory blood pressure (BP), and determination of left ventricular hypertrophy (LVH) and microalbuminuria were performed. Clinical arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWV) obtained with applanation tonometry (SphygmoCor-System). RESULTS: PWV was 8.3 (7.3-9.9)m/s (median, interquartile range). Stepwise regression analysis revealed that age (beta=0.086, p<0.001), 24-h pulse pressure (beta=0.058, p<0.001), and low-density lipoprotein (LDL) cholesterol (beta=0.009, p<0.013) were independent determinants of PWV. PWV>12m/s (indicating target organ lesion) was present in only 16 (7.7%) patients, less frequent than LVH (28% of the patients) and microalbuminuria (16%). However, of the 16 patients with elevated PWV, 10 (62%) had neither LVH or microalbuminuria. In a logistic multivariate regression analysis the factors related to elevated PWV were age > or =45 in man and > or =55 in women (OR: 23.8, 95% CI: 2.7-195.5; p=0.004), LDL cholesterol > or =160mg/dl (OR: 10.6, 95% CI: 2.6-42.7; p=0.001) and increased 24-h pulse pressure > or =55mmHg (OR: 3.9, 95% CI: 1.2-12.9; p=0.03). CONCLUSIONS: In untreated middle age hypertensives arterial stiffness assessed by PWV is less frequent than LVH or microalbuminuria. PWV is mainly related to age, LDL cholesterol, and pulse pressure values.

Body weight variation and control of cardiovascular risk factors in essential hypertension.

OBJECTIVE: The objective was to assess the impact of weight changes on blood pressure (BP), lipids and glucose goals in a cohort of hypertensive subjects. DESIGN: Prospective follow-up. SETTING: Hypertension clinic. PATIENTS: 326 hypertensive non-diabetic subjects, 46% with metabolic syndrome (MS). INTERVENTIONS: Usual care treatment, which included diet, physical exercise and drugs prescribed when indicated. All patients were observed for up to 1 year. MAIN OUTCOME MEASURES: BP and low-density lipoprotein-cholesterol (LDL-C) goal were those in ESH/ESC and ATP III recommendations, respectively. The glucose goal was to delay progression to type 2 diabetes mellitus, or to achieve blood glucose <100 mg/dl for non-diabetics. According to body weight changes, patients were categorized using adjusted ROC curves models. RESULTS: Overall, there was a significant weight increment of 0.5 kg (95% CI 0.1-0.9 kg); 28 patients (8.6%) lost more than 5 kg, and only four (1.2%) lost more than 10 kg. BP, LDL-C and glucose goals were achieved in 56%, 78% and 61% of patients, respectively. To lose or not gain weight was an independent prognostic factor to achieve the BP goal in all the patients and the LDL goal in the presence of MS. For glucose control, being treated with beta-blockers and/or diuretics was a negative factor. CONCLUSIONS: In hypertensive subjects, even small changes in weight may have an important impact on achieving cardiovascular goals, mainly in those with MS.

Respuesta: Hipertensión arterial refractaria. ¿Cuál es la mejor opción? / No disponible

No disponible

Eplerenona en hipertensión arterial resistente con intolerancia previa a espironolactona / Eplerenone in resistant hypertension with previous

No disponible

No disponible

Spironolactone and doxazosin treatment in patients with resistant hypertension.

INTRODUCTION AND OBJECTIVES: The aim of this study was to evaluate the use of spironolactone and doxazosin as treatment for patients with resistant hypertension. METHODS: This retrospective study involved 181 outpatients with resistant hypertension (defined as a failure of blood pressure [BP] control despite treatment with three drugs, one of which was a diuretic) who received additional spironolactone (n=88) or doxazosin (n=93). RESULTS: Mean systolic BP in the spironolactone group fell by 28 mmHg (95% confidence interval [CI], 24-32 mmHg; P< .001) and mean diastolic BP fell by 12 mmHg (95% CI, 9-14 mmHg; P< .001). The corresponding falls in the doxazosin group were 16 mmHg (95% CI, 13-20 mmHg; P< .001) and 7 mmHg (95% CI, 5-9 mmHg; P< .001), respectively. The decrease was significantly greater with spironolactone for both systolic (P< .001) and diastolic (P=.003) pressures. At the end of follow-up, 30% of all patients had achieved BP control, with control being more frequent with spironolactone (39%) than doxazosin (23%; P=.02). Multivariate logistic regression analysis showed that the only factors that significantly influenced the achievement of BP control were diabetes (odds ratio=0.17; 95% CI, 0.08-0.39; P< .001) and baseline systolic BP <165 mmHg (odds ratio=2.56; 95% CI, 1.11-5.90; P=.03). CONCLUSIONS: In patients with resistant hypertension, the addition of either spironolactone or doxazosin resulted in a significant decrease in BP, though the decrease appeared to be greater with spironolactone. The presence of diabetes complicated BP control.

Uso de espironolactona o doxazosina en pacientes con hipertensión arterial refractaria / Spironolactone and Doxazosin Treatment in Patients With Resistant Hypertension

Introducción y objetivos. Valorar el uso de espironolactona o doxazosina en el tratamiento de pacientes con hipertensión refractaria (HTAR). Métodos. Estudio retrospectivo comparativo de 181 pacientes con HTAR (pacientes tratados con tres fármacos, uno de ellos diurético, sin alcanzar el control de la presión arterial [PA]) a quienes se añadió espironolactona (88 casos) o doxazosina (93 casos). Resultados. La PA sistólica (PAS) se redujo 28 mmHg (intervalo de confianza [IC] del 95%, 24-32 mmHg; p < 0,001), y la PA diastólica (PAD), 12 mmHg (IC del 95%, 9-14 mmHg; p < 0,001) en los tratados con espironolactona, y 16 mmHg (IC del 95%, 13-20 mmHg; p < 0,001) y 7 mmHg (IC del 95%, 5-9 mmHg; p < 0,001), respectivamente con doxazosina. La espironolactona causó mayor descenso de la PAS (p < 0,001) y la PAD (p = 0,003). Al final del periodo de seguimiento, el 30% de todos los pacientes consiguieron el control de la PA; el control fue mayor con espironolactona (39%) que con doxazosina (23%) (p = 0,02). Al realizar una análisis de regresión logística, sólo la diabetes mellitus (odds ratio multivariable [ORm] = 0,17; IC del 95%, 0,08-0,39; p < 0,001), y la PAS inicial < 165 mmHg (ORm = 2,56; IC del 95%, 1,11-5,90; p = 0,03) tenían influencia significativa en alcanzar el control de la PA. Conclusiones. En los pacientes con hipertensión refractaria, tanto al añadir espironolactona como doxazosina se consigue un significativo descenso de la PA, que parece ser mayor con espironolactona. La diabetes dificulta el control de la PA

Introduction and objectives. The aim of this study was to evaluate the use of spironolactone and doxazosin as treatment for patients with resistant hypertension. Methods. This retrospective study involved 181 outpatients with resistant hypertension (defined as a failure of blood pressure [BP] control despite treatment with three drugs, one of which was a diuretic) who received additional spironolactone (n=88) or doxazosin (n=93). results. Mean systolic BP in the spironolactone group fell by 28 mmHg (95% confidence interval [CI], 24-32 mmHg; P<.001) and mean diastolic BP fell by 12 mmHg (95% CI, 9-14 mmHg; P<.001). The corresponding falls in the doxazosin group were 16 mmHg (95% CI, 13-20 mmHg; P<.001) and 7 mmHg (95% CI, 5-9 mmHg; P<.001), respectively. The decrease was significantly greater with spironolactone for both systolic (P<.001) and diastolic (P=.003) pressures. At the end of follow-up, 30% of all patients had achieved BP control, with control being more frequent with spironolactone (39%) than doxazosin (23%; P=.02). Multivariate logistic regression analysis showed that the only factors that significantly influenced the achievement of BP control were diabetes (odds ratio=0.17; 95% CI, 0.08-0.39; P<.001) and baseline systolic BP <165 mmHg (odds ratio=2.56; 95% CI, 1.11-5.90; P=.03). Conclusions. In patients with resistant hypertension, the addition of either spironolactone or doxazosin resulted in a significant decrease in BP, though the decrease appeared to be greater with spironolactone. The presence of diabetes complicated BP control

Association between serum uric acid, metabolic syndrome and microalbuminuria in previously untreated essential hypertensive patients.

BACKGROUND AND OBJECTIVE: The aim of the study was to assess the association of serum uric acid levels with microalbuminuria -urinary albumin excretion (UAE)> or = 30mg/24h-. PATIENTS AND METHOD: Cross-sectional study in 429 (220 women) hypertensive, non diabetic, never treated patients (mean age: 47 years) with glomerular filtration rate > or =60ml/min/1.73m(2). RESULTS: The prevalence of microalbuminuria was 20.5%; 18% had hyperuricemia and 47% fulfilled the criteria for metabolic syndrome (MS). Baseline UAE correlated in the unvaried analysis to diastolic blood pressure, waist circumference, high-density lipoprotein cholesterol and uric acid. In multiple linear regression models, only MS (beta=0.113; p=0.03), and serum uric acid values (beta=0.04; p=0.05) were independently associated with logUAE, after adjustment for age and sex. Hyperuricemia (serum uric acid level > or =7.0mg/dl for men and > or =6.5mg/dl for women; odds ratio=2.18; 95% confidence interval, 1.21-3.92; p=0.010), and MS (odds ratio=2.16; 95% confidence interval, 1.32-3.53; p=0.002) were independently associated with a higher risk of microalbuminuria in multiple logistic regression analyses. The prevalence of microalbuminuria was 45.8% in patients with coexistent MS and hyperuricemia, as compared to 13.6% in hypertensive patients without it (p<0.001). In patients with concomitant MS and hyperuricemia the probability of being microalbuminuric was 3.7 times higher than in patients without those factors. CONCLUSION: Serum uric acid level is associated with microalbuminuria. Coexistence of MS and hyperuricemia in hypertensive patients increases almost 4 times the odds of being microalbuminuric.

Association between serum uric acid, metabolic syndrome and microalbuminuria in previously untreated essential hypertensive patients

Fundamento y objetivo: valorar la relación de lamicroalbuminuria —excreción urinaria de albumina (EUA) X30 mg/24h— con los valores de ácido úrico y la presencia de síndrome metabólico (SM). Pacientes y método: se ha realizado un estudio transversal de 429 pacientes hipertensos(220mujeres), con una edad media de 47años, sin tratamiento previo ni diabetes, y con filtrado glomerular igual o mayor que 60ml/min/1,73m2. Resultados: la prevalencia de microalbuminuria fue del 20,5%. El 18% presentaba hiperuricemia y el 47% SM. La EUA se correlaciono con la presión arterial diastólica, el perímetro de la cintura, los valores de colesterol unido a lipoproteínas de alta densidad y el ácido úrico. En un modelo de regresión lineal múltiple, sólo el SM(beta ¼ 0,113;p ¼ 0,03) y el ácido úrico (beta ¼ 0,04;p ¼ 0,05)se asociaron de forma independiente al logEUA. La hiperuricemia (ácido úrico Z7,0mg/dl en varones y Z6,5mg/dl en mujeres; odds ratio ¼ 2,18; intervalo de confianza del 95%,1,21–3,92;p ¼ 0,010) y la presencia de SM (odds ratio ¼ 2,16; intervalo de confianza del 95%,1,32–3,53;p ¼ 0,002) se asociaron de forma independiente con la microalbuminuria en un análisis deregresion logıstica. La prevalencia de microalbuminuria fue del 45,8% en pacientes con Smehiperuricemia, comparada con el 13,6% en pacientes sin dichos factores(po0,001). Los pacientes con hiperuricemia y SM tenían 3,7 mas posibilidades de presentar microalbuminuria que los pacientes sin esos factores. Conclusiones: en hipertensos no tratados la coexistencia de Smehiperuricemia aumenta casi 4 veces las posibilidades de presentar microalbuminuria

Background and objectiveThe aim of the study was to assess the association of serum uric acid levels with microalbuminuria —urinary albumin excretion (UAE)≥ 30mg/24h—.Patients and methodCross-sectional study in 429 (220 women) hypertensive, non diabetic, never treated patients (mean age: 47 years) with glomerular filtration rate ≥60ml/min/1.73m2.ResultsThe prevalence of microalbuminuria was 20.5%; 18% had hyperuricemia and 47% fulfilled the criteria for metabolic syndrome (MS). Baseline UAE correlated in the unvaried analysis to diastolic blood pressure, waist circumference, high-density lipoprotein cholesterol and uric acid. In multiple linear regression models, only MS (beta=0.113; p=0.03), and serum uric acid values (beta=0.04; p=0.05) were independently associated with logUAE, after adjustment for age and sex. Hyperuricemia (serum uric acid level ≥7.0mg/dl for men and ≥6.5mg/dl for women; odds ratio=2.18; 95% confidence interval, 1.21–3.92; p=0.010), and MS (odds ratio=2.16; 95% confidence interval, 1.32–3.53; p=0.002) were independently associated with a higher risk of microalbuminuria in multiple logistic regression analyses. The prevalence of microalbuminuria was 45.8% in patients with coexistent MS and hyperuricemia, as compared to 13.6% in hypertensive patients without it (p<0.001). In patients with concomitant MS and hyperuricemia the probability of being microalbuminuric was 3.7 times higher than in patients without those factors.ConclusionSerum uric acid level is associated with microalbuminuria. Coexistence of MS and hyperuricemia in hypertensive patients increases almost 4 times the odds of being microalbuminuric

[Spironolactone in patients with resistant hypertension]. / Respuesta antihipertensiva a la espironolactona en pacientes con hipertensión arterial refractaria.

BACKGROUND AND OBJECTIVE: The aim of the study was to assess the effect of adding spironolactone to hypertensive resistant (HTR) patients and characterize those who respond effectively. PATIENTS AND METHOD: Observational retrospective study on outpatients with HTR (being treated with at least 3 drugs at full doses, one of these being a diuretic) not achieving blood pressure (BP) goals, with normal creatinine values (< 1.6 mg/dl for males and < 1.4 mg/dl in women). RESULTS: A total of 95 patients (70% male), average (standard deviation) age of 66 (12) years (40% diabetics), were treated with spironolactone during 4 months (range: 2-13). Mean systolic and diastolic BP fell from 170/86 (20/14) mmHg, by 29/12 mmHg (95% confidence interval [CI], 25 to 33/10 to 14 mmHg; p = 0.001). At the end of follow-up, 38% of all patients achieved the goal of BP control. Initial systolic BP < 165 mmHg (odds ratio [OR] = 3,97; 95% CI, 1.52-10.37; p = 0.005), and diabetes (OR = 0.33; 95% CI, 0.13-0.86; p = 0.02) were the only independent factors related to BP control in a logistic regression analysis. CONCLUSIONS: The addition of spironolactone effectively lowers BP in patients with HTR treated with 3 drugs. BP control is more difficult to achieve in diabetics.

Respuesta antihipertensiva a la espironolactona en pacientes con hipertensión arterial refractaria / Spironolactone in patients with resistant hypertension

FUNDAMENTO Y OBJETIVO: Valorar el efecto de añadir espironolactona al tratamiento de pacientescon hipertensión arterial (HTA) refractaria e intentar caracterizar a los que consiguen buenarespuesta.PACIENTES Y MÉTODO: Se ha realizado un estudio observacional y retrospectivo en pacientes conHTA refractaria –definidos como tratados con 3 fármacos a las dosis habituales, uno de ellosdiurético, sin alcanzar el control de la presión arterial (PA)– y valores de creatinina inferiores a1,6 mg/dl en varones y a 1,4 mg/dl en mujeres.RESULTADOS: A un total de 95 pacientes (un 70% varones y un 40% diabéticos), con una edadmedia (desviación estándar) de 66 (12) años, se les añadió espironolactona al tratamiento durante4 meses (extremos: 2-13). Los valores de la PA sistólica y diastólica se redujeron, desdeunos valores iniciales medios de 170/86 (20/14) mmHg, un promedio de 29/12 mmHg (intervalode confianza [IC] del 95%, 25 a 33/10 a 14 mmHg; p = 0,001). Al final del período deseguimiento, el 38% de los pacientes consiguió el control de la PA. Al realizar un análisis deregresión logística, controlando por edad y sexo, sólo los valores de PA sistólica inicial inferioresa 165 mmHg (odds ratio [OR] = 3,97; IC del 95%, 1,52-10,37; p = 0,005) y la existenciade diabetes mellitus (OR = 0,33; IC del 95%, 0,13-0,86; p = 0,02) fueron los factores independientesque se relacionaron con el control de la PA.CONCLUSIONES: En los pacientes con HTA refractaria en tratamiento con 3 fármacos, al añadir espironolactonase consigue un descenso significativo de la PA y se obtiene el control en un 38%de los casos. La diabetes dificulta el control de la PA

BACKGROUND AND OBJECTIVE: The aim of the study was to assess the effect of adding spironolactoneto hypertensive resistant (HTR) patients and characterize those who respond effectively.PATIENTS AND METHOD: Observational retrospective study on outpatients with HTR (being treatedwith at least 3 drugs at full doses, one of these being a diuretic) not achieving blood pressure(BP) goals, with normal creatinine values (< 1.6 mg/dl for males and < 1.4 mg/dl in women).RESULTS: A total of 95 patients (70% male), average (standard deviation) age of 66 (12) years(40% diabetics), were treated with spironolactone during 4 months (range: 2-13). Mean systolicand diastolic BP fell from 170/86 (20/14) mmHg, by 29/12 mmHg (95% confidence interval[CI], 25 to 33/10 to 14 mmHg; p = 0.001). At the end of follow-up, 38% of all patientsachieved the goal of BP control. Initial systolic BP < 165 mmHg (odds ratio [OR] = 3,97; 95%CI, 1.52-10.37; p = 0.005), and diabetes (OR = 0.33; 95% CI, 0.13-0.86; p= 0.02) were theonly independent factors related to BP control in a logistic regression analysis.CONCLUSIONS: The addition of spironolactone effectively lowers BP in patients with HTR treatedwith 3 drugs. BP control is more difficult to achieve in diabetics

[Cystatin C and other cardiovascular markers in hypertension]. / Relación de la cistatina C con otros parámetros de riesgo vascular en pacientes con hipertensión arterial.

BACKGROUND AND OBJECTIVE: The aim of the study was to assess the relationship of cystatine C to other cardiovascular risk factors in hypertension. PATIENTS AND METHOD: Cross-sectional study in hypertensive outpatients with normal creatinine values (< 1.6 mg/dl for males and < 1.4 mg/dl for women). Cystatin C was analyzed by immunonephelometry. RESULTS: 283 patients (47% male) were evaluated. Cystatin C values were 0.65 (0.27) mg/l (median, intercuartile range, percentile 70 = 0.76 mg/l), and were correlated to the estimated glomerular filtration rate (GFR) (ml/min/1.73 m(2)), C reactive protein, and urinary albumin excretion (UAE). In multiple regression analysis the GFR was the most significant factor and explained 38% of cystatine C variability. GFR, (odds ratio [OR] = 5.84; 95% confidence interval [CI], 2.27-15.03; p < 0.001), age (OR = 1.05; 95% CI, 1.02-1.08; p < 0.001), and CRP (OR = 2.03; 95% CI, 1.07-3.84; p = 0.03), but not UAE > or = 30 mg/24 h, were independent factors related to the presence of high levels (> 0.76 mg/l) of cystatine C in a logistic regression analysis. 58% of patients with UAE > or = 30 mg/24h had cystatin C values < 0,76 mg/l. CONCLUSIONS: In hypertensive patients, the GFR is the most important factor related to cystatine C values. Increased levels of cystatine C do not correspond to UAE augmentation.

Relación de la cistatina C con otros parámetros de riesgo vascular en pacientes con hipertensión arterial / Cystatin C and other cardiovascular markers in hypertension

Fundamento y objetivo: Valorar la relación entre la cistatina C y otros parámetros bioquímicos establecidos como marcadores de riesgo vascular (RV) en pacientes hipertensos. Pacientes y método: Estudio descriptivo transversal de pacientes hipertensos de edad > 18 años, creatinina = 30 mg/24 h, incrementaban de forma significativa e independiente la probabilidad de presentar valores elevados de cistatina. En los pacientes con EUA >= 30 mg/24 h, el 58% tenía valores de cistatina < 0,76 mg/l. Conclusiones: En los pacientes hipertensos, el factor más relacionado con los valores de cistatina C es la tasa de FG. El incremento de la cistatina C no es paralelo al incremento de la EUA

Background and objective: The aim of the study was to assess the relationship of cystatine C to other cardiovascular risk factors in hypertension. Patients and method: Cross-sectional study in hypertensive outpatients with normal creatinine values (= 30 mg/24 h, were independent factors related to the presence of high levels (> 0.76 mg/l) of cystatine C in a logistic regression analysis. 58% of patients with UAE >= 30 mg/24h had cystatin C values < 0,76 mg/l. Conclusions: In hypertensive patients, the GFR is the most important factor related to cystatine C values. Increased levels of cystatine C do not correspond to UAE augmentation