[2022 Practice guidelines for the management of arterial hypertension of the Spanish Society of Hypertension]. / Guía práctica sobre el diagnóstico y tratamiento de la hipertensión arterial en España, 2022. Sociedad Española de Hipertensión - Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA).

Hypertension is the most important risk factor for global disease burden. Detection and management of hypertension are considered as key issues for individual and public health, as adequate control of blood pressure levels markedly reduces morbidity and mortality associated with hypertension. Aims of these practice guidelines for the management of arterial hypertension of the Spanish Society of Hypertension include offering simplified schemes for diagnosis and treatment for daily practice, and strategies for public health promotion. The Spanish Society of Hypertension assumes the 2018 European guidelines for management of arterial hypertension developed by the European Society of Cardiology and the European Society of Hypertension, although relevant aspects of the 2017 American College of Cardiology/American Heart Association guidelines and the 2020 International Society of Hypertension guidelines are also commented. Hypertension is defined as a persistent elevation in office systolic blood pressure ≥ 140 and/or diastolic blood pressure ≥ 90 mmHg, and assessment of out-of-office blood pressure and global cardiovascular risk are considered of key importance for evaluation and management of hypertensive patients. The target for treated blood pressure should be < 130/80 for most patients. The treatment of hypertension involves lifestyle interventions and drug therapy. Most people with hypertension need more than one antihypertensive drug for adequate control, so initial therapy with two drugs, and single pill combinations are recommended for a wide majority of hypertensive patients.

Key Messages for a Frailty Prevention and Management Policy in Europe from the ADVANTAGE JOINT ACTION Consortium.

In the 2015 Ageing Report, the European Commission (EC) and the Economic Policy Committee stated that coping with the challenge posed by an ageing population will require determined policy action in Europe, particularly in reforming pension, health care and long-term care systems. The concern for this situation motivated the EC, the Parliament and many of the Member States (MS) to co-fund, in the 2015 call of the Third European Health Programme of the European Union 2014-2020, the first Joint Action (JA) on the prevention of frailty. ADVANTAGE JA brings together 33 partners from 22 MSs for 3 years. It aims to build a common understanding on frailty to be used in the MSs by policy makers and other stakeholders involved in the management, both at individual and population level, of older people who are frail or at risk for developing frailty throughout the European Union (EU). It is a formidable challenge but also a great opportunity for concerted action resulting in fostering effective and successful policies in frailty prevention and management in the participating MS. The Consortium has 2 years of hard work ahead to contribute to the needed change for frailty related disability free Europe. The first practical step towards this aim was the preparation of a document: the State of the Art on Frailty Report to support an overview of evidence of what works and what does not work on frailty prevention and management. Subsequently, this will be reflected in the advice that the JA will give to policy makers at MS level. Overall, these messages intend to be an instrument of added value to advocate for policy driven decisions on frailty prevention and management in the JA participating MSs and subsequently towards a frailty related disability free older population in Europe. The aim of this paper is to describe ADVANTAGE JA general structure, approach and recommendations towards a European health and social policy which will support frailty prevention in the participating MS.

Documento de la Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) sobre las guías ACC/AHA 2017 de hipertensión arterial / Spanish Society of Hypertension position statement on the 2017 ACC/AHA hypertension guidelines

El American College of Cardiology (ACC) y la American Heart Association (AHA) han publicado recientemente la guía para la prevención, detección, evaluación y tratamiento de la hipertensión arterial (HTA) en adultos. El punto más controvertido es el umbral diagnóstico de 130/80 mmHg, lo cual conlleva diagnosticar HTA en un gran número de personas previamente consideradas no hipertensas. La presión arterial (PA) se clasifica como normal (sistólica < 120 y diastólica 80 mmHg), elevada (120-129 y < 80 mmHg), grado 1 (130-139 o 80-89 mmHg) y grado 2 (≥ 140 o ≥ 90 mmHg). Se recomienda la medida de PA fuera de la consulta para confirmar el diagnóstico de HTA o para aumentar el tratamiento. En la toma de decisiones sería determinante el riesgo cardiovascular (RCV), ya que precisarían tratamiento farmacológico personas con HTA grado 1 con riesgo a 10 años de enfermedad cardiovascular aterosclerótica ≥ 10% y aquellas con enfermedad cardiovascular establecida, enfermedad renal crónica y diabetes, siendo el resto susceptibles de medidas no farmacológicas hasta umbrales de 140/90 mmHg. Dichas recomendaciones permitirían a los sujetos con HTA grado 1 y alto RCV beneficiarse de terapias farmacológicas y podrían mejorar las intervenciones no farmacológicas en todos los sujetos. Sin embargo, habría que ser cauteloso ya que sin poder garantizar una toma correcta de PA, ni el cálculo sistemático del RCV, la aplicación de dichos criterios podría sobrestimar el diagnóstico de HTA y suponer un sobretratamiento innecesario. Las guías son recomendaciones, no imposiciones, y el abordaje y manejo de la PA debe ser individualizado, basado en decisiones clínicas, preferencias de los pacientes y en un balance adecuado del beneficio y riesgo al establecer los diferentes objetivos de PA

The American College of Cardiology (ACC) and the American Heart Association (AHA) have recently published their guidelines for the prevention, detection, evaluation, and management of hypertension in adults. The most controversial issue is the classification threshold at 130/80mmHg, which will allow a large number of patients to be diagnosed as hypertensive who were previously considered normotensive. Blood pressure (BP) is considered normal (<120mmHg systolic and <80mmHg diastolic), elevated (120-129 and <80mmHg), stage 1 (130-139 or 80-89mmHg), and stage 2 (≥140 or ≥90mmHg). Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication. In management, cardiovascular risk would be determinant since those with grade 1 hypertension and an estimated 10-year risk of atherosclerotic cardiovascular disease ≥10%, and those with cardiovascular disease, chronic kidney disease and/or diabetes will require pharmacological treatment, the rest being susceptible to non-pharmacological treatment up to the 140/90mmHg threshold. These recommendations would allow patients with level 1 hypertension and high atherosclerotic cardiovascular disease to benefit from pharmacological therapies and all patients could also benefit from improved non-pharmacological therapies. However, this approach should be cautious because inadequate BP measurement and/or lack of systematic atherosclerotic cardiovascular disease calculation could lead to overestimation in diagnosing hypertension and to overtreatment. Guidelines are recommendations, not impositions, and the management of hypertension should be individualized, based on clinical decisions, preferences of the patients, and an adequate balance between benefits and risks

LDL particle size and composition and incident cardiovascular disease in a South-European population: The Hortega-Liposcale Follow-up Study.

BACKGROUND: The association of low-density lipoprotein (LDL) particle composition with cardiovascular risk has not been explored before. The aim was to evaluate the relationship between baseline LDL particle size and composition (proportions of large, medium and small LDL particles over their sum expressed as small-LDL %, medium-LDL % and large-LDL %) and incident cardiovascular disease in a population-based study. METHODS: Direct measurement of LDL particles was performed using a two-dimensional NMR-technique (Liposcale®). LDL cholesterol was assessed using both standard photometrical methods and the Liposcale® technique in a representative sample of 1162 adult men and women from Spain. RESULTS: The geometric mean of total LDL particle concentration in the study sample was 827.2 mg/dL (95% CI 814.7, 839.8). During a mean follow-up of 12.4 ±â€¯3.3 years, a total of 159 events occurred. Medium LDL particles were positively associated with all cardiovascular disease, coronary heart disease (CHD) and stroke after adjustment for traditional risk factors and treatment. Regarding LDL particle composition, the multivariable adjusted hazard ratios for CHD for a 5% increase in medium and small LDL % by a corresponding decrease of large LDL % were 1.93 (1.55, 2.39) and 1.41 (1.14, 1.74), respectively. CONCLUSIONS: Medium LDL particles were associated with incident cardiovascular disease. LDL particles showed the strongest association with cardiovascular events when the particle composition, rather than the total concentration, was investigated. A change in baseline composition of LDL particles from large to medium and small LDL particles was associated with an increased cardiovascular risk, especially for CHD.

[Spanish Society of Hypertension position statement on the 2017 ACC/AHA hypertension guidelines]. / Documento de la Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) sobre las guías ACC/AHA 2017 de hipertensión arterial.

The American College of Cardiology (ACC) and the American Heart Association (AHA) have recently published their guidelines for the prevention, detection, evaluation, and management of hypertension in adults. The most controversial issue is the classification threshold at 130/80mmHg, which will allow a large number of patients to be diagnosed as hypertensive who were previously considered normotensive. Blood pressure (BP) is considered normal (<120mmHg systolic and <80mmHg diastolic), elevated (120-129 and <80mmHg), stage 1 (130-139 or 80-89mmHg), and stage 2 (≥140 or ≥90mmHg). Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication. In management, cardiovascular risk would be determinant since those with grade 1 hypertension and an estimated 10-year risk of atherosclerotic cardiovascular disease ≥10%, and those with cardiovascular disease, chronic kidney disease and/or diabetes will require pharmacological treatment, the rest being susceptible to non-pharmacological treatment up to the 140/90mmHg threshold. These recommendations would allow patients with level 1 hypertension and high atherosclerotic cardiovascular disease to benefit from pharmacological therapies and all patients could also benefit from improved non-pharmacological therapies. However, this approach should be cautious because inadequate BP measurement and/or lack of systematic atherosclerotic cardiovascular disease calculation could lead to overestimation in diagnosing hypertension and to overtreatment. Guidelines are recommendations, not impositions, and the management of hypertension should be individualized, based on clinical decisions, preferences of the patients, and an adequate balance between benefits and risks.

Multimorbidity and acute heart failure in internal medicine.

AIMS: To analyse the characteristics of hospitalized patients for AHF, with special attention to the clustering of morbidities. METHODS AND RESULTS: Clinical records of patients, admitted in Internal Medicine due to AHF, during three years, were reviewed. The characteristics of patients-episodes were registered and key indicators of performance. Multiple correspondence analysis (MCA) was used to assess the distribution of morbidities. LR models were used to study clinical variables related with death or readmission. The median age was 80y, predominantly women and with multiple morbidities. As it was expected, CVRF were the main associated comorbidities followed by respiratory diseases, CKD and chronic anaemia. In the MCA, all the CVRF clustered around the origin so they explained little of the total inertia. Male sex, young age, IHD, obesity and lung disease were more common in reduced EF whereas female, older age and thyroid disease were more common in preserved EF. The confidence ellipses for death in hospitalization or during the follow-up or for readmissions overlapped, so it was not possible to identify clusters of morbidities to predict outcomes. The main causes for AHF were infections, anaemia and RVR in AF. Nearly 16% died during the hospitalization whereas 25.6% died and 56.3% were re-hospitalized during the following year after the discharge. Previous or repeated admissions to the hospital were the best single predictors for death or readmission. CONCLUSIONS: Strategies to control infections, anaemia and AF, in the outpatient settings, might help to reduce the burden of AHF, although this remains to be proven.

Risk factors associated with retinal vein occlusion.

AIMS: Retinal vein occlusion (RVO) is the most frequent retinal vascular disease after diabetic retinopathy in which arterial risk factors are much more relevant than venous factors. The objective was to evaluate the role of risk factors in the development of the first episode of RVO. SUBJECTS AND METHODS: One hundred patients with RVO [mean age 56 years, 42% females and mean body mass index (BMI) 27.5 kg/m(2)] were recruited consecutively from the outpatient clinic of a tertiary hospital in Valencia (Spain). All subjects underwent clinical assessment including anthropometric and blood pressure measurements and laboratory test including homocysteine, antiphospholipid antibodies (aPLAs) and thrombophilia studies. In half of the subjects, a carotid ultrasonography was performed. Three control populations matched by age, sex and BMI from different population-based studies were used to compare the levels and prevalence of arterial risk factors. One cohort of young patients with venous thromboembolic disease was used to compare the venous risk factors. RESULTS: Blood pressure levels and the prevalence of hypertension were significantly higher in the RVO population when compared with those for the general populations. There was also a large proportion of undiagnosed hypertension within the RVO group. Moreover, carotid evaluation revealed that a large proportion of patients with RVO had evidence of subclinical organ damage. In addition, homocysteine levels and prevalence of aPLAs were similar to the results obtained in our cohort of venous thromboembolic disease. CONCLUSIONS: The results indicate that hypertension is the key factor in the development of RVO, and that RVO can be the first manifestation of an undiagnosed hypertension. Furthermore, the majority of these patients had evidence of atherosclerotic disease. Among the venous factors, a thrombophilia study does not seem to be useful and only the prevalence of hyperhomocysteinaemia and aPLAs is higher than in the general population.

Evolución temporal de la afectación renal en una serie necrópsica de pacientes VIH de las eras pre y TARGA / Temporal evolution of renal involvement in a necropsy study of HIV patients from the pre and HAART eras

Fundamento: El objetivo del estudio es analizar la evolución de las lesiones anatomopatológicas renales en VIH que hubiesen recibido o no medicación antirretroviral de alta actividad (TARGA).Sujetos y métodos: Se revisaron las historias clínicas de 100 pacientes fallecidos entre 1984 y 2006, con registros clínico-analíticos y muestras anatomopatológicas. Sesenta y uno habían fallecido antes de 1997 (grupo I) y 39 pacientes después, de los cuales24 no habían recibido TARGA (grupo II) y 15 sí (grupo III). Las muestras renales se tiñeron con hematoxilina-eosina, PAS, tricrómico de Masson y plata-meteramina. Se registraron para todos los pacientes los diagnósticos anatomopatológicos finales, así como las lesiones a cada uno de los tres niveles: glomérulo, túbulo e intersticio. Se definió NAVIH como la presencia de glomerulosclerosis segmentaria y focal, con colapso glomerular y lesiones microquísticas túbulo-intersticiales. Resultados: Las principales causas de muerte fueron infecciones (68%) o tumores (14%), y el resto (18%) fueron otras causas, especialmente hepatopatías. Un42% de los individuos presentaban insuficiencia renal en el momento del fallecimiento. En los tres grupos de estudio predominaban las lesiones tubulares, seguidas de las lesiones intersticiales y de las glomerulares. Cuando se compararon aquellos sujetos en tratamiento con TARGA con aquellos sin tratamiento, encontramos un porcentaje significativamente mayor de lesiones en el intersticio en el grupo con TARGA. En este grupo hubo también más casos de necrosis tubular aguda NTA, si bien estas diferencias no fueron estadísticamente significativas. Conclusiones: Las lesiones renales son frecuentes en pacientes afectados de VIH en el momento de la muerte, independientemente del período de estudio considerado y del tratamiento recibido (AU)

Background: The aim of the present study is to analyze the impact of high activity antiretroviral therapy (HAART)in the renal lesions observed in autopsies of HIV patients. Subjets and methods: Clinical records and renal pathologic samples from 100 HIV patients, dead from 1984 to 2006,were reviewed, 61 before 1997 (group I) and 39 after. Among them, 24 did not receive HAART (group II) and 15did (group III). Clinical and analytical data premortem were obtained. Renal samples were stained with hematoxilin eosin, PAS, Masson thricromic and silver-meteramine. Final pathologic diagnosis was recorded along with the finding sat glomerular, tubular and interstitial levels. HIVAN was defined by the presence of focal or segmental glomerulosclerosis with glomerular collapse and tubule-interstitial microcystic lesions. Results: The main causes of dead were infections 68%, tumors 14%, and others 18%, especially liver diseases. Renal failure was present in 42% at the time of the dead. A predominance of tubular lesions exists in the three study groups. The main diagnosis were acute tubular necrosis (ATN) and septic nephritis. Four cases of HIVAN were found. In subjects under HAART more interstitial lesions have been observed. There were also more cases of acute tubular necrosis but these differences were not statiscally significant. Conclusions: Renal lesions were frequent in HIV patients independent of the presence or the absence of HAART (AU)

[Management of high blood pressure in children and adolescents: Recommendations of the European Society of hypertension]. / Manejo de la hipertensión arterial en niños y adolescentes: recomendaciones de la Sociedad Europea de Hipertensión.

Hypertension in children and adolescents has been gaining ground in cardiovascular medicine, mainly due to the advances made in several areas of pathophysiological and clinical research. These guidelines arose from the consensus reached by specialists in the detection and control of hypertension in children and adolescents. Furthermore, these guidelines are a compendium of scientific data and the extensive clinical experience it contains represents the most complete information that doctors, nurses and families should take into account when making decisions. These guidelines, which stress the importance of hypertension in children and adolescents, and its contribution to the current epidemic of cardiovascular disease, should act as a stimulus for governments to develop a global effort for the early detection and suitable treatment of high pressure in children and adolescents. J Hypertens 27:1719-1742 Q 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.

[Temporal evolution of renal involvement in a necropsy study of HIV patients from the pre and HAART eras]. / Evolución temporal de la afectación renal en una serie necrópsica de pacientes VIH de las eras pre y TARGA.

BACKGROUND: The aim of the present study is to analyze the impact of high activity antiretroviral therapy (HAART) on renal lesions observed in autopsies of HIV patients. SUBJECTS AND METHODS: Clinical records and renal pathologic samples from 100 HIV patients, who had died between 1984 and 2006, were reviewed, 61 before 1997 (group I) and 39 after. 24 of them had not received HAART (group II) and 15 had (group III). Premortem clinical and analytical data were obtained. Renal samples were stained with hematoxilin-eosin, PAS, Masson trichrome and silver-methenamine. The final pathologic diagnosis was recorded along with the findings at glomerular, tubular and interstitial levels. HIVAN was defined as the presence of focal or segmental glomerulosclerosis with glomerular collapse and microcystic tubulo -interstitial lesions. RESULTS: The main causes of death were infections 68%, tumours 14%, and others 18%, especially liver diseases. Renal failure was present in 42% at the time of death. A predominance of tubular lesions exists in the three study groups, followed by interstitial lesions and glomerular lesions. The main diagnoses were acute tubular necrosis (ATN) and septic nephritis. Four cases of HIVAN were found. When the subjects who received HAART treatment were compared with those who did not, a significantly higher percentage of interstitial lesions in the group with HAART was observed. There were also more cases of acute tubular necrosis but these differences were not statistically significant. CONCLUSIONS: Renal lesions were frequent in HIV patients independent of the presence or absence of HAART.

Manejo de la hipertensión arterial en niños y adolescentes: recomendaciones de la Sociedad Europea de Hipertensión / Management of high blood pressure in children and adolescents: Recommendations of the European Society of hypertension

La hipertensión en niños y adolescentes ha ido ganando terreno en la medicina cardiovascular, gracias a los avances producidos en distintas áreas de la investigación fisiopatológica y clínica. Estas guías nacen del consenso al que han llegado los especialistas en la detección y control de la hipertensión en niños y adolescentes. Por otra parte, dichas guías son un compendio de los datos científicos y la extensa experiencia clínica con la que se cuenta, y constituyen la información clínica más completa que los médicos, enfermeras y familiares deberían tener en cuenta a la hora de tomar decisiones. Estas guías, que hacen hincapié en la importancia de la hipertensión en niños y adolescentes, así como en el papel que desempeña en la actual epidemia de enfermedades cardiovasculares, deberían constituir un estímulo para que los gobiernos desarrollaran un esfuerzo global para una detección precoz y un tratamiento adecuado de la hipertensión arterial en niños y adolescentes. J Hypertens 27:1719-1742 Q 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins(AU)

Hypertension in children and adolescents has been gaining ground in cardiovascular medicine, mainly due to the advances made in several areas of pathophysiological and clinical research. These guidelines arose from the consensus reached by specialists in the detection and control of hypertension in children and adolescents. Furthermore, these guidelines are a compendium of scientific data and the extensive clinical experience it contains represents the most complete information that doctors, nurses and families should take into account when making decisions. These guidelines, which stress the importance of hypertension in children and adolescents, and its contribution to the current epidemic of cardiovascular disease, should act as a stimulus for governments to develop a global effort for the early detection and suitable treatment of high pressure in children and adolescents. J Hypertens 27:1719-1742 Q 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins(AU)

European Society of Hypertension practice guidelines for home blood pressure monitoring.

Self-monitoring of blood pressure by patients at home (home blood pressure monitoring (HBPM)) is being increasingly used in many countries and is well accepted by hypertensive patients. Current hypertension guidelines have endorsed the use of HBPM in clinical practice as a useful adjunct to conventional office measurements. Recently, a detailed consensus document on HBPM was published by the European Society of Hypertension Working Group on Blood Pressure Monitoring. However, in daily practice, briefer documents summarizing the essential recommendations are needed. It is also accepted that the successful implementation of clinical guidelines in routine patient care is dependent on their acceptance by involvement of practising physicians. The present document, which provides concise and updated guidelines on the use of HBPM for practising physicians, was therefore prepared by including the comments and feedback of general practitioners.

Increased plasma xanthine oxidase activity is related to nuclear factor kappa beta activation and inflammatory markers in familial combined hyperlipidemia.

BACKGROUND AND AIMS: Xanthine oxidase (XO) has been described as one of the major enzymes producing free radicals in blood. Oxidative stress and inflammatory processes have been implicated in the pathogenesis of endothelial dysfunction and the progression of atherosclerosis but until now, there is little data about the influence of vascular prooxidant systems and inflammation in familial combined hyperlipidemia (FCH). Our goal was to evaluate whether XO activity was altered in FCH and if it was related to the inflammatory process represented by NFkB, IL-6 and hsCRP, and assessing the correlation between XO activity and insulin resistance (IR). METHOD AND RESULTS: 40 Non-related subjects with FCH and 30 control subjects were included, all of them non-diabetic, normotensive and non-smokers. We measured lipid profile, glucose, insulin, uric acid, XO activity, malondialdehyde (MDA), IL-6 and hsCRP in plasma and NFkB activity in circulating mononuclear cells. Patients with FCH showed significantly higher levels of uric acid, XO activity, MDA, NFkB activity, IL-6 and hsCRP than controls. XO activity was independently related to NFkB activity with an odds ratio of 4.082; to IL-6 with an odds ratio of 4.191; and to IR with an odds ratio of 3.830. Furthermore, mean NFkB activity, IL-6 levels, and IR were highest in the highest percentile of XO activity. CONCLUSIONS: Subjects with FCH showed increased XO and NFkB activities and low grade inflammatory markers related to atherosclerosis. XO activity was correlated with higher inflammatory activity and IR. These data could explain, in part, the high cardiovascular disease risk present in these patients.

Prevalence of low HDL cholesterol, and relationship between serum HDL and cardiovascular disease in elderly Spanish population: the PREV-ICTUS study.

OBJECTIVE: To assess the prevalence of low serum high-density lipoprotein cholesterol (HDL-C) concentration and the relationship between HDL-C and established cardiovascular disease (CVD) in an elderly Mediterranean population. METHODS: Analysis of Prevención del Riesgo de Ictus, a population-based study on Spanish subjects aged > or = 60 years. Low HDL-C was defined following the European guidelines for cardiovascular prevention [men: < 40 mg/dl (< 1.0 mmol/l); women: < 46 mg/dl (< 1.2 mmol/l)]. The relationship between low HDL-C or HDL-C concentration (in quintiles) and CVD was assessed through multivariate models that included cardiovascular risk factors, statins and subclinical organ damage. RESULTS: On 6010 subjects (71.7 years, 53.5% women), low HDL-C was present in 17.5% [95% confidence interval (CI): 16.5-18.5] and was more frequent in women [20.4% (19.0-21.8) vs. 14.1% (12.8-15.4) in men p < 0.001] and in patients with diabetes, CVD or statin therapy. Low HDL-C was independently associated with CVD [adjusted odds ratio (OR): 1.46, 95% CI: 1.22-1.74, p < 0.001]. The prevalence of CVD was higher as HDL-C concentration was lower (chi-square trend < 0.001). Compared with the highest quintile [> 65 mg/dl (> 1.67 mmol/l)], adjusted OR for CVD were 1.39 (1.10-1.76), 1.41 (1.11-1.80), 1.49 (1.18-1.89) and 1.91 (1.52-2.39), respectively for those in the fourth [57-65 mg/dl (1.46-1.67 mmol/l)], third [51-56 mg/dl (1.31-1.45 mmol/l)], second [46-50 mg/dl (1.18-1.30 mmol/l)] and first [< 46 mg/dl (< 1.18 mmol/l)] quintiles of HDL-C. This association was seen in males and females. CONCLUSIONS: A total of 17.5% of this Spanish population aged > or = 60 years had low HDL-C. We found a strong, independent and inverse association between HDL-C concentrations and established CVD, even at ranges of HDL-C considered as normal.

Impact of the components of metabolic syndrome on oxidative stress and enzymatic antioxidant activity in essential hypertension.

The objective of the present study was to analyze the impact of metabolic syndrome (MS) and its individual components on oxidative stress (OX) and on the activity of antioxidant enzymes of patients with essential hypertension. One hundred and eighty-seven hypertensives, 127 (61.9%) of them having criteria for MS according to the International Diabetes Federation criteria and 30 healthy normotensive subjects were included. OX status was assessed by measuring glutathione oxidized/glutathione reduced and reactive oxygen species-induced byproducts of lipid peroxidation, malondialdehyde, and DNA damage, 8-oxo-dG genomic and mitochondrial. Antioxidant enzymatic activity of Cu/Zn extracellular-superoxide dismutase (SOD) and catalase (CAT) was measured in plasma and glutathione peroxidase 1 in hemolysed erythrocytes. In mononuclear cells, total-SOD activity, CAT and glutathione peroxidase 1, were assessed as well. The OX state in both blood and peripheral mononuclear cells observed in hypertensives were not enhanced by the addition of components of the so-called MS. Likewise, the reduction in the activity of antioxidant enzymes, both extracellular and cytoplasmic, was not affected by the presence of additional components of the MS. Neither the number of components nor the individual addition of each of them, low high-density lipoprotein, triglycerides, abdominal obesity or fasting glucose, further impact in the OX abnormalities observed in those with only hypertension in absence of other components. In conclusion, the present data indicates that contribution of MS components to the OX burden generated by high blood pressure is minimal.

Catastrophic antiphospholipid syndrome related to severe ovarian hyperstimulation.

Antiphospholipid syndrome (APS) is a cause of infertility and fetal loss. Ovarian stimulation can induce previously unknown APS. Ovarian hyperstimulation syndrome (OHS) is uncommon but potentially life-threatening, as well as catastrophic APS. A woman that simultaneously developed a severe OHS and a catastrophic APS is described in this paper. Both entities produced thrombotic cardiac and brain thrombosis. A peculiar mechanism of cardiac ischemia is also described. In spite of the life-threatening risk of this situation, the indication for preventive anti-aggregation and/or anticoagulation is not clear.

Utilidad de la monitorización ambulatoria de presión arterial en la evaluación inicial y en el seguimiento del paciente diabético / Benefits of ambulatory blood pressure monitoring at initial evaluation and in the follow-up of patients with diabetes

La prevalencia de hipertensión en la diabetes es muy elevada y diversos estudios de intervención han demostrado el beneficio que comporta el control de la presión arterial ya que el diabético es un paciente altamente vulnerable a las elevaciones de PA, por lo que se precisa de una evaluación adecuada y de la mayor precisión. La monitorización ambulatoria de PA permite realizar múltiples medidas durante las actividades normales del individuo. Este método ha proporcionado una mayor información respecto al riesgo de sufrir daño orgánico por la elevación de la PA y a la importancia clínica de establecer un control adecuado y mantenido de los mismos a lo largo de las 24 horas. En el paciente diabético existe un predominio marcado de la elevación a expensas de la PA sistólica que se acompaña de una gran amplitud en la presión del pulso como consecuencia de una alteración precoz y severa de la elasticidad de los grandes vasos y frecuente alteración de la variabilidad circadiana. Se proponen indicaciones para el uso de la monitorización ambulatoria de la presión arterial tanto en diabetes mellitus tipo 1 como tipo 2

The prevalence of arterial hypertension in diabetes is very high. Several interventional studies have demonstrated the benefits of blood pressure (BP) control in diabetes, because diabetic patients are especially vulnerable to elevations of BP. Then, an appropriate and accurate evaluation of BP is mandatory. The ambulatory BP monitoring is a technique which permits frequent determination of BP during normal activities of subjects. This method has shown more information on the risk of end-organ lesion by elevations of BP and the clinical relevance of an appropriate and sustained BP control during 24 h. In the diabetic patient there is a marked systolic BP elevation besides an augmented pressure pulse in relation to an early and severe disruption of large vessels elasticity and the frequent alteration of circadian variability. Indications for the ambulatory blood pressure monitoring both in type 1 and type 2 diabetes are proposed

Renin-angiotensin system gene polymorphisms: relationship with blood pressure and microalbuminuria in telmisartan-treated hypertensive patients.

This study analyzed the relationship between four renin-angiotensin system (RAS) gene polymorphisms and the response to blood pressure lowering and development of microalbuminuria in 206 patients with essential hypertension treated once daily for 12 months with telmisartan 80 mg. Seated cuff blood pressure and urinary albumin excretion (UAE) were measured throughout the study. Patients were screened for the presence of the A-6G variant of the angiotensinogen gene, angiotensin-converting enzyme insertion/deletion polymorphism, and the A1166C and C573T polymorphisms of the angiotensin II type 1 receptor gene. No significant association was found between the presence of any gene polymorphism and the reduction of blood or UAE following telmisartan treatment. The results indicate that these RAS gene polymorphisms do not affect the antihypertensive activity and renoprotection in mild-to-moderate hypertensive patients treated with telmisartan.