Fiebre recurrente transmitida por garrapatas: una causa infrecuente de meningitis / Tick-borne relapsing fever: an infrequent cause of meningitis

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Síndrome de la arteria de Percheron / Percheron artery syndrome

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[Can the treatment of arterial hypertension help to prevent dementia?]. / Puede el tratamiento de la hipertension arterial ayudar a prevenir la demencia?

Arterial hypertension (AHT) and cognitive problems, especially dementia, are very prevalent among the elderly. AHT is a direct risk factor for vascular dementia and recent studies have shown that it also has repercussions on the prevalence of Alzheimer's disease. Thus, given the fact that there is currently no effective treatment, the prevention of dementia with the aim of delaying or even preventing its appearance is a priority. Moreover, it leads us to pose the question as to whether treating AHT can help prevent dementia. To answer this question, we present a review of the main studies involving interventions with antihypertensive drugs in the prevention of dementia that have been published to date. These trials and meta-analyses suggest that antihypertensive treatment could reduce the risk of dementia by 3-20%, although with no clear statistical significance. However, there are a number of methodological limitations that largely account for the lack of conclusive results in the different intervention studies and which make it possible to deduce that the treatment of AHT does clearly reduce the appearance of dementia. Therefore, clearly further studies on hypertension need to be conducted with the primary aim of appraising the appearance of cognitive impairment or dementia.

¿Puede el tratamiento de la hipertensión arterial ayudar a prevenir la demencia? / Can the treatment of arterial hypertension help to prevent dementia?

La hipertensión arterial (HTA) y los problemas cognitivos, en particular la demencia, son muy prevalentes en las personas mayores. La HTA es un factor de riesgo directo de demencia vascular, y estudios recientes han señalado que también repercute sobre la prevalencia de la enfermedad de Alzheimer. Entonces, dado que en la actualidad se carece de tratamientos efectivos, la prevención de la demencia con el objetivo de retrasar o incluso evitar su aparición es prioritaria y, además, hace que nos planteemos la cuestión de si tratar la HTA puede ayudar a prevenir la demencia. Para responder a esta cuestión, se presenta una revisión de los principales trabajos de intervención con fármacos antihipertensivos en la prevención de demencia publicados hasta la fecha. Estos ensayos y metaanálisis sugieren que el tratamiento antihipertensivo podría reducir el riesgo de demencia un 3-20%, aunque sin clara significación estadística. No obstante, existen numerosas limitaciones metodológicas que justifican en gran parte la falta de resultados concluyentes en los diferentes estudios de intervención y que permitan inferir que el tratamiento de la HTA reduce de forma evidente la aparición de demencia. Por tanto, se necesita claramente la realización de nuevos estudios en hipertensión cuyo objetivo primario sea valorar la aparición de deterioro cognitivo o demencia (AU)

Arterial hypertension (AHT) and cognitive problems, especially dementia, are very prevalent among the elderly. AHT is a direct risk factor for vascular dementia and recent studies have shown that it also has repercussions on the prevalence of Alzheimer’s disease. Thus, given the fact that there is currently no effective treatment, the prevention of dementia with the aim of delaying or even preventing its appearance is a priority. Moreover, it leads us to pose the question as to whether treating AHT can help prevent dementia. To answer this question, we present a review of the main studies involving interventions with antihypertensive drugs in the prevention of dementia that have been published to date. These trials and meta-analyses suggest that antihypertensive treatment could reduce the risk of dementia by 3-20%, although with no clear statistical significance. However, there are a number of methodological limitations that largely account for the lack of conclusive results in the different intervention studies and which make it possible to deduce that the treatment of AHT does clearly reduce the appearance of dementia. Therefore, clearly further studies on hypertension need to be conducted with the primary aim of appraising the appearance of cognitive impairment or dementia (AU)

Prevención primaria del ictus en el anciano: evidencias actuales en el tratamiento de la hipertensión arterial / Primary stroke prevention in the elderly: current evidence in the treatment of arterial hypertension

La hipertensión arterial (HTA) tras la edad, es el factor de riesgo más importante relacionado con el ictus, y más del 25% de los ictus son atribuibles a la hipertensión. Actualmente en España la prevalencia de HTA en el anciano es aproximadamente del 70%, lo que se traduce que en nuestro país existen más de 5 millones de hipertensos mayores de 65 años. Hoy día son numerosos los ensayos y metaanálisis que demuestran que el tratamiento antihipertensivo reduce claramente el riesgo de ictus en los sujetos ancianos y muy ancianos (≥80 años). No obstante, aún existen numerosas áreas de incertidumbre como son: cuándo iniciar el tratamiento antihipertensivo, hasta dónde bajar las cifras tensionales o cuál es el mejor antihipertensivo en la prevención del ictus en esta población, entre otros. En este artículo presentamos una revisión de las evidencias actuales en la prevención primaria del ictus del paciente mayor mediante el tratamiento de la HTA(AU)

After age, arterial hypertension (AHT) is the most significant risk factor associated with stroke, and accounts for more than 25% of all strokes. The prevalence of AHT in the elderly in Spain is approximately 70%, which means that there are more than 5 million people over 65 years-old with hypertension in our country. There are currently numerous trials and meta-analyses that demonstrate that antihypertensive treatment clearly reduces the risk of stroke in elderly, and very elderly (≥80 years) subjects. However there are many areas of uncertainty such as, for example, when to start antihypertensive treatment, to what level should the blood pressure be lowered, or what is the best antihypertensive in the prevention of stroke in this population. In this article we present a review of the current evidence in the prevention of stroke in the elderly patient by means of treatment of the AHT(AU)

[Primary stroke prevention in the elderly: current evidence in the treatment of arterial hypertension]. / Prevención primaria del ictus en el anciano: evidencias actuales en el tratamiento de la hipertensión arterial.

After age, arterial hypertension (AHT) is the most significant risk factor associated with stroke, and accounts for more than 25% of all strokes. The prevalence of AHT in the elderly in Spain is approximately 70%, which means that there are more than 5 million people over 65 years-old with hypertension in our country. There are currently numerous trials and meta-analyses that demonstrate that antihypertensive treatment clearly reduces the risk of stroke in elderly, and very elderly (≥80 years) subjects. However there are many areas of uncertainty such as, for example, when to start antihypertensive treatment, to what level should the blood pressure be lowered, or what is the best antihypertensive in the prevention of stroke in this population. In this article we present a review of the current evidence in the prevention of stroke in the elderly patient by means of treatment of the AHT.

Echocardiographic assessment of hypertensive left ventricular hypertrophy in patients with acute ischemic stroke or transient ischemic attack.

BACKGROUND: Hypertensive left ventricular hypertrophy (HLVH) is a major risk factor for cardiovascular morbidity, mortality, and stroke. However, little is known about the importance of transthoracic echocardiography (TTE) in the assessment of HLVH in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). METHODS: We studied 203 consecutive patients admitted to our hospital with AIS or TIA and who were referred for TTE over the last 4 years. We included 102 (50.2%) lacunar strokes, 76 (37.1%) nonlacunar strokes, and 25 (12.3%) TIAs. The mean age was 68.9 years (standard deviation ± 11) and 128 patients were male (63.1%). RESULTS: Hypertension was the most common risk factor (131 patients; 64.5%). HLVH was seen in 86 cases (42.3%), in 51.9% of patients with previous hypertension, and in 25% of patients without known hypertension. We found that neither stroke subtype nor any previous risk factor, with the exception of hypertension (P = .0001), were associated with HLVH. Patients with HLVH were younger (67 v 71 yrs; P = .013) and more frequently women (50.6% v 37.5%; P = .078). At discharge, patients with HLVH were more likely to receive antihypertensive treatment (97% v 80%; P = .009) and a higher average number of antihypertensive drugs (2.2 v 1.4; P = .0001). CONCLUSIONS: HLVH was common in patients with AIS or TIA. These individuals had an increased risk of stroke and needed a more intensive therapy. TTE should be carried out in all AIS and TIA patients in order to optimize the management of these patients.

¿Debemos cambiar el tratamiento de la presión arterial en la fase aguda del ictus, tras los resultados del estudio SCAST? / In view of the findings of the SCAST study, must the treatment of arterial pressure in the acute phase of stroke be changed?

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Ecocardiografía en el ictus. Nuevos argumentos para el debate / Echocardiography in strokes: new arguments for the debate

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La mortalidad en el ‘cinturón del ictus’ español: algunas claves andaluzas. Réplica / Mortality in the Spanish ‘stroke belt’: some key points in Andalusia. Reply

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El ‘cinturón del ictus’ español: un nuevo concepto para una vieja realidad / No disponible

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