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1.
J Hypertens ; 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31977571

RESUMO

INTRODUCTION: Air in urban areas is usually contaminated with particle matter. High concentrations lead to a rise in the risk of cardiovascular and respiratory diseases. Some studies have reported that ultrafine particles (UFP) play a greater role in cardiovascular diseases than other particle matter, particularly regarding hypertensive crises and DBP, although in the latter such effects were described concerning clinical blood pressure (BP). In this study, we evaluate the relationship between 24-h ambulatory BP monitoring (ABPM) and atmospheric UFP concentrations in Barcelona. METHODS: An observational study of individual patients' temporal and geographical characteristics attended in Primary Care Centres and Hypertensive Units during 2009-2014 was performed. RESULTS: The participants were 521 hypertensive patients, mean age 56.8 years (SD 14.5), 52.4% were women. Mean BMI was 28.0 kg/m and the most prominent cardiovascular risk factors were diabetes (N = 66, 12.7%) and smoking (N = 79, 15.2%). We describe UFP effects at short-term and up to 1 week (from lag 0 to 7). For every 10 000 particle/cm UFP increase measured at an urban background site, a corresponding statistically significant increase of 2.7 mmHg [95% confidence interval = (0.5-4.8)] in 24-h DBP with ABPM for the following day was observed (lag 1). CONCLUSION: We have observed that a rise in UFP concentrations during the day prior to ABPM is significantly associated with an increase in 24 h and diurnal DBP. It has been increasingly demonstrated that UFP play a key role in cardiovascular risk factors and, as we have demonstrated, in good BP control.

2.
Hypertension ; : HYPERTENSIONAHA11914508, 2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-31983311

RESUMO

The prognostic relevance of short-term blood pressure (BP) variability in hypertension is not clearly established. We aimed to evaluate the association of short-term BP variability, assessed through ambulatory BP monitoring, with total and cardiovascular mortality in a large cohort of patients with hypertension. We selected 63 910 subjects from the Spanish ABPM Registry from 2004 to 2014, with a median follow-up of 4.7 years. Systolic and diastolic BP SD from 24 hours, daytime, and nighttime, weighted SD (mean of daytime and nighttime SD weighted for period duration), average real variability (mean of differences between consecutive readings), variation independent of the mean, and BP variability ratio (ratio between systolic and diastolic 24-hour SD) were calculated through 24-hour ambulatory BP monitoring performed at baseline. Association with total and cardiovascular mortality (obtained through death certificates) were assessed by Cox regression models adjusted for clinical confounders and BP. Patients who died during follow-up had higher values of BP variability compared with those remaining alive. In fully adjusted models, daytime, nighttime, and weighted SD, systolic and diastolic, as well as diastolic average real variability, were all significantly associated with total and cardiovascular mortality. Hazard ratios for 1 SD increase ranged from 1.05 to 1.09 for total mortality and from 1.07 to 1.12 for cardiovascular mortality. A nighttime systolic SD ≥12 mm Hg was independently associated with total (hazard ratio: 1.13 [95% CI, 1.06-1.21]) and cardiovascular mortality (hazard ratio: 1.21 [95% CI, 1.09-1.36]). We conclude that short-term BP variability is independently associated with total and cardiovascular mortality in patients with hypertension.

4.
F1000Res ; 82019.
Artigo em Inglês | MEDLINE | ID: mdl-31583081

RESUMO

Since the association of microalbuminuria (MAU) with cardiovascular (CV) risk was described, a huge number of reports have emerged. MAU is a specific integrated marker of CV risk and targets organ damage in patients with hypertension, chronic kidney disease (CKD), and diabetes and its recognition is important for identifying patients at a high or very high global CV risk. The gold standard for diagnosis is albumin measured in 24-hour urine collection (normal values of less than 30 mg/day, MAU of 30 to 300 mg/day, macroalbuminuria of more than 300 mg/day) or, more practically, the determination of urinary albumin-to-creatinine ratio in a urine morning sample (30 to 300 mg/g). MAU screening is mandatory in individuals at risk of developing or presenting elevated global CV risk. Evidence has shown that intensive treatment could turn MAU into normoalbuminuria. Intensive treatment with the administration of an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker, in combination with other anti-hypertensive drugs and drugs covering other aspects of CV risk, such as mineralocorticoid receptor antagonists, new anti-diabetic drugs, and statins, can diminish the risk accompanying albuminuria in hypertensive patients with or without CKD and diabetes.


Assuntos
Albuminúria/diagnóstico , Anti-Hipertensivos/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Hipertensão/tratamento farmacológico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Diabetes Mellitus , Humanos , Hipertensão/complicações , Insuficiência Renal Crônica/complicações , Fatores de Risco
5.
Artigo em Inglês | MEDLINE | ID: mdl-31598644

RESUMO

Resistant hypertension (RH) is a concept that currently goes beyond the classical definition of blood pressure (BP) ≥140/90 mmHg in subjects receiving three or more drugs of different classes at maximally tolerated doses. Here we review the clinical relevance of RH and the different types of RH-associated phenotypes, namely refractory hypertension, controlled resistant hypertension, and masked uncontrolled hypertension. We also discuss current drug strategies and future treatments for these high-risk phenotypes.

6.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31561981

RESUMO

INTRODUCTION AND OBJECTIVES: Renal denervation is a percutaneous intervention for the treatment of resistant hypertension. Randomized studies have shown contradictory results on its efficacy. We present the results of a renal denervation registry for the treatment of resistant hypertension in real-life patients in Spain. METHODS: Multicenter registry of consecutive patients with resistant hypertension treated with renal denervation in Spain between 2009 and 2018. RESULTS: We included 125 patients (mean age, 56 years; 41% female; mean onset of hypertension 14±9 years previously). Office systolic and diastolic blood pressure and ambulatory blood pressure monitoring decreased 6 months after the intervention (166±20/95±16 to 149±22/87±16 mmHg and 151±14/89±12 to 143±15/84±11, both P <.0001). At 12 months, the blood pressure reduction was maintained and the number of antihypertensive drugs decreased from 4.9±1.2 to 4.4±1.5 (P=.0001). There were no significant procedure-related complications. The response rate to denervation at 1 year was 80%, but there were wide differences between centers. CONCLUSIONS: In patients with resistant hypertension, treatment with renal denervation was related to a decrease in office blood pressure and, more importantly, in ambulatory blood pressure monitoring, with a significant reduction in pharmacological treatment.

9.
Hypertension ; 74(1): 130-136, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31132953

RESUMO

United States and European guidelines have recommended new treatment goals for office blood pressure (BP). We examined 9784 hypertensives of the Spanish Ambulatory BP Monitoring (ABPM) registry with office BP treated to the prior goal (<140/90 mm Hg); and evaluated the frequency and all-cause mortality of 4 BP strata depending on whether or not they attained more conservative or new office BP goal (130-139/80-89 and <130/80 mm Hg, respectively) and whether or not BP was controlled according to ABPM criteria in the European and US guidelines (24-hour ambulatory BP <130/80 and <125/75 mm Hg, respectively). Whether achieving or not the new office BP goal, the total-mortality risk during a 5-year follow-up was only significantly higher than the reference (normal office BP and ABPM) when 24-hour ambulatory BP was above goal (hazard ratio from multivariable Cox models was in the range of 2.4-2.9; P<0.001). The frequency of patients achieving the new office BP goal was 34.4%, and the frequencies of those not achieving the ABPM goal were 31.6% and 53.7% using the 130/80 or the 125/75 ABPM goal, respectively. Mean office systolic BP was 129 mm Hg for patients not achieving the ABPM goal. In hypertensive patients controlled under prior office BP goal, the frequency of those achieving new office BP goal <130/80 was high, suggesting this goal can be attained. In addition, patients had a higher mortality risk only when ABPM was above goal despite having mean office systolic BP under control, a condition that was also common.


Assuntos
Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial/normas , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Guias de Prática Clínica como Assunto/normas , Sistema de Registros , Idoso , Determinação da Pressão Arterial/normas , Estudos de Coortes , Feminino , Metas , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Valores de Referência , Espanha , Resultado do Tratamento
10.
Nefrología (Madrid) ; 39(2): 184-191, mar.-abr. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181326

RESUMO

Antecedentes y objetivo: Las enzimas metaloproteinasas de matriz (MMP) están involucradas en el remodelado tisular deletéreo asociado al daño de órganos diana de la enfermedad renal. El objetivo de este estudio fue explorar la asociación entre la caída de la función renal y la actividad sistémica de la metaloproteinasa inflamatoria MMP-9 en el paciente hipertenso con enfermedad renal crónica (ERC) leve-moderada. Material y métodos: Se analizaron los niveles plasmáticos de MMP-9 activa, MMP-9 total, su inhibidor tisular (TIMP-1), el cociente MMP-9/TIMP-1 y la interacción entre MMP-9 y TIMP-1 en 37 pacientes hipertensos distribuidos según su tasa de filtración glomerular estimada (TFGe) en 3 grupos: > 90, 90-60 y 60-30 mL/min/1,73m2. Resultados: La MMP-9 total no fue diferente con respecto a la disminución en la TFGe. TIMP-1 estaba significativamente incrementado en los pacientes hipertensos con TFGe entre 60-30 mL/min/1,73 m2 (p < 0,01 versus > 90 mL/min/1,73 m2). Estos resultados fueron apoyados por la disminución significativa de la interacción MMP-9-TIMP-1 observada en los pacientes con TFGe entre 60-30 mL/min/1,73 m2 (p < 0,01 versus > 90 mL/min/1,73 m2). A pesar de la elevación sistémica de TIMP-1 encontramos un incremento significativo de MMP-9 activa en los pacientes hipertensos con TFGe entre 60-30 mL/min/1,73m2 (p < 0,05 y p < 0,01 versus > 90 y 90-60 mL/min/1,73 m2, respectivamente). Los niveles de TIMP-1, MMP-9 activa e interacción proteica MMP-9-TIMP-1 correlacionaron significativamente con el deterioro de la función renal, lo cual no se observó para la MMP-9 total. Conclusiones: La progresión de la ERC, incluso en estadios donde la caída de la función renal es aún moderada, se asocia con un aumento específico de la actividad MMP-9, lo cual podría considerarse como una potencial diana terapéutica


Background and objective: Matrix metalloproteinases (MMPs) are involved in deleterious tissue remodeling associated with target organ damage in renal disease. The aim of this study was to study the association between renal dysfunction and activity of the inflammatory metalloproteinase MMP-9 in hypertensive patients with mild-moderate chronic kidney disease (CKD). Material and methods: Plasmatic active MMP-9, total MMP-9, tissue inhibitor of MMP-9 (TIMP-1), MMP-9/TIMP-1 ratio and MMP-9-TIMP-1 interaction were analyzed in 37 hypertensive patients distributed by estimated glomerular filtration rate (eGFR) in 3 groups:> 90, 90-60 y 60-30 mL/min/1.73 m2. Results: Total MMP-9 was not different as eGFR declines. TIMP-1 was significantly increased in hypertensive patients with eGFR 60-30 mL/min/1.73 m2 (P < .01 versus > 90 mL/min/1.73 m2). This relates to the significant decrease in the interaction between MMP-9-TIMP-1 observed in patients with eGFR 60-30mL/min/1.73 m2 (P < .01 versus > 90 mL/min/1.73 m2). Despite the systemic elevation of TIMP-1, active MMP-9 was significantly increased in hypertensive patients with eGFR 60-30 mL/min/1.73 m2 (P<.05 and P < 0.01 versus > 90 and 90-60 mL/min/1.73 m2, respectively). TIMP-1, active MMP-9 and MMP-9-TIMP-1 interaction significantly correlate with the decline in renal function, which was not observed with total MMP-9. Conclusions: The progression of CKD, even in stages where the decline of renal function is still moderate, is associated with an increase in MMP-9 activity, which could be considered as a potential therapeutic target


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Metaloproteinase 9 da Matriz/metabolismo , Insuficiência Renal Crônica/enzimologia , Hipertensão Essencial/complicações , Taxa de Filtração Glomerular , Análise de Variância , Inibidores da Enzima Conversora de Angiotensina/metabolismo
11.
Hypertension ; 73(4): 794-802, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30712426

RESUMO

Resistant hypertension prevalence is progressively increasing, and prolonged exposure to suboptimal blood pressure control results in higher cardiovascular risk and end-organ damage. Among various antihypertensive agents, spironolactone seems the most effective choice to treat resistant hypertension once triple therapy including a diuretic fails. However success in blood pressure control is not guaranteed, adverse effects are not negligible, and no clinical tools are available to predict patient's response. Complementary to our previous study of resistant hypertension metabolism, here we investigated urinary proteome changes with potential capacity to predict response to spironolactone. Twenty-nine resistant hypertensives were included. A prospective study was conducted and basal urine was collected before spironolactone administration. Patients were classified in responders or nonresponders in terms of blood pressure control. Protein quantitation was performed by liquid chromatography-mass spectrometry; ELISA and target mass spectrometry analysis were performed for confirmation. Among 3310 identified proteins, HP (haptoglobin) and HPR (haptoglobin-related protein) showed the most significant variations, with increased levels in nonresponders compared with responders before drug administration (variation rate, 5.98 and 7.83, respectively). Protein-coordinated responses were also evaluated by functional enrichment analysis, finding oxidative stress, chronic inflammatory response, blood coagulation, complement activation, and regulation of focal adhesions as physiopathological mechanisms in resistant hypertension. In conclusion, protein changes able to predict patients' response to spironolactone in basal urine were here identified for the first time. These data, once further confirmed, will support clinical decisions on patients' management while contributing to optimize the rate of control of resistant hypertensives with spironolactone.


Assuntos
Antígenos de Neoplasias/urina , Pressão Sanguínea/efeitos dos fármacos , Resistência a Medicamentos , Haptoglobinas/urina , Hipertensão/tratamento farmacológico , Espironolactona/uso terapêutico , Idoso , Biomarcadores/urina , Feminino , Humanos , Hipertensão/fisiopatologia , Hipertensão/urina , Masculino , Pessoa de Meia-Idade , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Prognóstico , Estudos Prospectivos
12.
Nefrologia ; 39(2): 184-191, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30509751

RESUMO

BACKGROUND AND OBJECTIVE: Matrix metalloproteinases (MMPs) are involved in deleterious tissue remodeling associated with target organ damage in renal disease. The aim of this study was to study the association between renal dysfunction and activity of the inflammatory metalloproteinase MMP-9 in hypertensive patients with mild-moderate chronic kidney disease (CKD). MATERIAL AND METHODS: Plasmatic active MMP-9, total MMP-9, tissue inhibitor of MMP-9 (TIMP-1), MMP-9/TIMP-1 ratio and MMP-9-TIMP-1 interaction were analyzed in 37 hypertensive patients distributed by estimated glomerular filtration rate (eGFR) in 3 groups:>90, 90-60 y 60-30mL/min/1.73 m2. RESULTS: Total MMP-9 was not different as eGFR declines. TIMP-1 was significantly increased in hypertensive patients with eGFR 60-30mL/min/1.73 m2 (P<.01 versus>90mL/min/1.73 m2). This relates to the significant decrease in the interaction between MMP-9-TIMP-1 observed in patients with eGFR 60-30mL/min/1.73 m2 (P<.01 versus>90mL/min/1.73 m2). Despite the systemic elevation of TIMP-1, active MMP-9 was significantly increased in hypertensive patients with eGFR 60-30mL/min/1.73 m2 (P<.05 and P<0.01 versus>90 and 90-60mL/min/1.73 m2, respectively). TIMP-1, active MMP-9 and MMP-9-TIMP-1 interaction significantly correlate with the decline in renal function, which was not observed with total MMP-9. CONCLUSIONS: The progression of CKD, even in stages where the decline of renal function is still moderate, is associated with an increase in MMP-9 activity, which could be considered as a potential therapeutic target.


Assuntos
Hipertensão/enzimologia , Metaloproteinase 9 da Matriz/sangue , Insuficiência Renal Crônica/enzimologia , Inibidor Tecidual de Metaloproteinase-1/sangue , Idoso , Análise de Variância , Biomarcadores/metabolismo , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/fisiopatologia , Fatores de Tempo
13.
Eur Heart J Cardiovasc Pharmacother ; 5(1): 37-46, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30165588

RESUMO

Hypertensive emergencies are those situations where very high blood pressure (BP) values are associated with acute organ damage, and therefore, require immediate, but careful, BP reduction. The type of acute organ damage is the principal determinant of: (i) the drug of choice, (ii) the target BP, and (iii) the timeframe in which BP should be lowered. Key target organs are the heart, retina, brain, kidneys, and large arteries. Patients who lack acute hypertension-mediated end organ damage do not have a hypertensive emergency and can usually be treated with oral BP-lowering agents and usually discharged after a brief period of observation.


Assuntos
Anti-Hipertensivos/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Anti-Hipertensivos/efeitos adversos , Consenso , Progressão da Doença , Emergências , Humanos , Hipertensão/complicações , Hipertensão/mortalidade , Hipertensão/fisiopatologia , Fatores de Risco , Resultado do Tratamento
14.
Environ Pollut ; 242(Pt A): 539-543, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30005266

RESUMO

In 2015, a controversial bicycle lane was installed on Paulista Avenue -a thoroughfare in the heart of the megacity of São Paulo with a high rate of motorised vehicles. For the first time, on-bicycle air pollution concentrations were assessed along this lane using black carbon (BC) as an indicator of fossil fuel combustion. We measured BC concentrations with a hand-held microaethalometer at a high temporal resolution, enabling the capture of fine spatial gradients along the route. Although this new link expanded the city's cycling network, our pioneering study showed that BC concentrations were large (mean 8.5 µg m-3) with extreme values reaching 24.0 µg m-3, comparable to concentrations found in many megacities. In agreement with other studies, we observed that concentrations decreased about 1.6 times on a section of the bicycle lane running through a calmer neighbourhood, which could indicate the potential to safeguard the health of cyclists by installing lanes with greater separation from main roads, such as Paulista Avenue. This pilot work paves the way to more detailed studies aiming to map out the spatial distribution of other traffic-related pollutants across the city's 458-km long bicycle network.


Assuntos
Poluentes Atmosféricos/análise , Ciclismo , Monitoramento Ambiental , Fuligem/análise , Poluição do Ar/análise , Brasil , Carbono , Cidades/estatística & dados numéricos , Exposição Ambiental/análise , Humanos , Veículos Automotores , Projetos Piloto , Emissões de Veículos/análise
16.
N Engl J Med ; 378(16): 1509-1520, 2018 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-29669232

RESUMO

BACKGROUND: Evidence for the influence of ambulatory blood pressure on prognosis derives mainly from population-based studies and a few relatively small clinical investigations. This study examined the associations of blood pressure measured in the clinic (clinic blood pressure) and 24-hour ambulatory blood pressure with all-cause and cardiovascular mortality in a large cohort of patients in primary care. METHODS: We analyzed data from a registry-based, multicenter, national cohort that included 63,910 adults recruited from 2004 through 2014 in Spain. Clinic and 24-hour ambulatory blood-pressure data were examined in the following categories: sustained hypertension (elevated clinic and elevated 24-hour ambulatory blood pressure), "white-coat" hypertension (elevated clinic and normal 24-hour ambulatory blood pressure), masked hypertension (normal clinic and elevated 24-hour ambulatory blood pressure), and normotension (normal clinic and normal 24-hour ambulatory blood pressure). Analyses were conducted with Cox regression models, adjusted for clinic and 24-hour ambulatory blood pressures and for confounders. RESULTS: During a median follow-up of 4.7 years, 3808 patients died from any cause, and 1295 of these patients died from cardiovascular causes. In a model that included both 24-hour and clinic measurements, 24-hour systolic pressure was more strongly associated with all-cause mortality (hazard ratio, 1.58 per 1-SD increase in pressure; 95% confidence interval [CI], 1.56 to 1.60, after adjustment for clinic blood pressure) than the clinic systolic pressure (hazard ratio, 1.02; 95% CI, 1.00 to 1.04, after adjustment for 24-hour blood pressure). Corresponding hazard ratios per 1-SD increase in pressure were 1.55 (95% CI, 1.53 to 1.57, after adjustment for clinic and daytime blood pressures) for nighttime ambulatory systolic pressure and 1.54 (95% CI, 1.52 to 1.56, after adjustment for clinic and nighttime blood pressures) for daytime ambulatory systolic pressure. These relationships were consistent across subgroups of age, sex, and status with respect to obesity, diabetes, cardiovascular disease, and antihypertensive treatment. Masked hypertension was more strongly associated with all-cause mortality (hazard ratio, 2.83; 95% CI, 2.12 to 3.79) than sustained hypertension (hazard ratio, 1.80; 95% CI, 1.41 to 2.31) or white-coat hypertension (hazard ratio, 1.79; 95% CI, 1.38 to 2.32). Results for cardiovascular mortality were similar to those for all-cause mortality. CONCLUSIONS: Ambulatory blood-pressure measurements were a stronger predictor of all-cause and cardiovascular mortality than clinic blood-pressure measurements. White-coat hypertension was not benign, and masked hypertension was associated with a greater risk of death than sustained hypertension. (Funded by the Spanish Society of Hypertension and others.).


Assuntos
Determinação da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial , Hipertensão/diagnóstico , Idoso , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/mortalidade , Causas de Morte , Estudos de Coortes , Feminino , Humanos , Hipertensão/complicações , Masculino , Hipertensão Mascarada/complicações , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Espanha/epidemiologia , Hipertensão do Jaleco Branco/complicações
17.
Sci Rep ; 8(1): 4154, 2018 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-29500379

RESUMO

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

18.
J Hypertens ; 36(7): 1563-1570, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29601411

RESUMO

BACKGROUND AND AIM: Treatment-resistant hypertension (TRH) is associated with particular clinical features, nonadherence, and suboptimal treatment. We assessed possible associations of antihypertensive drug classes, specific agents inside each class, and types of combinations, with the presence of non-TRH vs. TRH, and with controlled vs. uncontrolled TRH. METHODS: Comparisons were done in 14 264 patients treated with three drugs (non-TRH: 2988; TRH: 11 276) and in 6974 treated with at least four drugs (controlled TRH: 1383; uncontrolled TRH: 5591). Associations were adjusted for age, sex, and previous cardiovascular event. RESULTS: In both groups of patients treated with three or with at least four drugs, aldosterone antagonists among drug classes [adjusted odds ratio (OR): 1.82 and 1.41, respectively], and ramipril (OR: 1.28 and 1.30), olmesartan (OR: 1.31 and 1.37), and amlodipine (OR: 1.11 and 1.41) inside each class were significantly associated with blood pressure control (non-TRH or controlled TRH). In patients treated with three drugs, non-TRH was also associated with the use of chlorthalidone (OR: 1.50) and bisoprolol (OR: 1.19), whereas in patients treated with at least four drugs, controlled TRH was significantly associated with the triple combination of a renin-angiotensin system blocker, a calcium channel blocker, and a diuretic (OR: 1.17). CONCLUSION: The use of aldosterone antagonists is associated with blood pressure control in patients treated with three or more drugs. Similar results are observed with specific agents inside each class, being ramipril, olmesartan, chlorthalidone, amlodipine, and bisoprolol those exhibiting significant results. An increased use of these drugs might probably reduce the burden of TRH.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Anlodipino/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Bisoprolol/uso terapêutico , Pressão Sanguínea , Bloqueadores dos Canais de Cálcio/uso terapêutico , Clortalidona/uso terapêutico , Diuréticos/uso terapêutico , Resistência a Medicamentos , Quimioterapia Combinada , Humanos , Hipertensão/fisiopatologia , Imidazóis/uso terapêutico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Ramipril/uso terapêutico , Tetrazóis/uso terapêutico
19.
J Hypertens ; 36(5): 1076-1085, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29465710

RESUMO

OBJECTIVE: Increased BP-variability predicts cardiovascular morbidity and mortality in hypertensives. This study aimed to examine short-term BP-variability according to renal function stage. METHODS: We included 16 546 patients [10 270 (62.1%) without/6276 (38.9%) with CKD Stage 1-5] from the Spanish Ambulatory-Blood-Pressure Monitoring (ABPM) Registry. Stages of CKD were defined according to K/DIGO criteria, based on estimated glomerular filtration rate calculated with the CKD-EPI equation and albumin-to-creatine ratio. BP-variability was assessed with standard deviation (SD), weighted SD (wSD), coefficient of variation (CV), and average real variability (ARV). RESULTS: Compared with those without CKD, a lower proportion of CKD patients were dippers (51.9 versus 39.6%; P < 0.001). Across CKD stages, a progressive decrease in dipper (from 39.1 to 20.4%; P < 0.001) and increase in riser proportion (from 12.3 to 36.7%; P < 0.001) were noted. Patients with CKD had significantly higher SBP SD, wSD, CV and ARV and lower DBP SD compared with those without CKD (P < 0.001). Within CKD Stages, an increasing trend from Stage 1 towards Stage 5 was observed for SBP SD (from 13.8 ±â€Š3.7 to 15.6 ±â€Š5.4 mmHg), wSD (from 12.0 ±â€Š3.2 to 13.9 ±â€Š5.1 mmHg), CV (from 10.4 ±â€Š2.7 to 11.5 ±â€Š4.1%), ARV (from 9.9 ±â€Š2.3 to 11.4 ±â€Š3.2 mmHg); P < 0.001 for all comparisons. DBP SD (P < 0.001), wSD and ARV (P = 0.002) were slightly decreasing, whereas DBP CV increased from Stage 1 to Stage 4 (P < 0.001). In multivariate analysis, male gender, older age, abdominal obesity, diabetes, number of antihypertensive medications, and clinic SBP were independent factors for higher SBP 24-h ARV in CKD. CONCLUSION: An increase in short-term SBP-variability was present with advancing CKD stages in a large cohort. This increased SBP-variability may be involved in the sharp elevation of cardiovascular risk with worsening renal function.


Assuntos
Pressão Sanguínea , Insuficiência Renal Crônica/fisiopatologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial , Monitorização Ambulatorial da Pressão Arterial , Ritmo Circadiano , Estudos Transversais , Diabetes Mellitus/fisiopatologia , Feminino , Humanos , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/complicações , Obesidade Abdominal/fisiopatologia , Insuficiência Renal Crônica/complicações , Índice de Gravidade de Doença , Fatores Sexuais
20.
J Am Heart Assoc ; 6(12)2017 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-29217663

RESUMO

BACKGROUND: We aimed to estimate the prevalence of refractory hypertension (RfH) and to determine the clinical differences between these patients and resistant hypertensives (RH). Secondly, we assessed the prevalence of white-coat RfH and clinical differences between true- and white-coat RfH patients. METHODS AND RESULTS: The present analysis was conducted on the Spanish Ambulatory Blood Pressure Monitoring Registry database containing 70 997 treated hypertensive patients. RH and RfH were defined by the presence of elevated office blood pressure (≥140 and/or 90 mm Hg) in patients treated with at least 3 (RH) and 5 (RfH) antihypertensive drugs. White-coat RfH was defined by RfH with normal (<130/80 mm Hg) 24-hour blood pressure. A total of 11.972 (16.9%) patients fulfilled the standard criteria of RH, and 955 (1.4%) were considered as having RfH. Compared with RH patients, those with RfH were younger, more frequently male, and after adjusting for age and sex, had increased prevalence of target organ damage, and previous cardiovascular disease. The prevalence of white coat RfH was lower than white-coat RH (26.7% versus 37.1%, P<0.001). White-coat RfH, in comparison with those with true RfH, showed a lower prevalence of both left ventricular hypertrophy (22% versus 29.7%; P=0.018) and microalbuminuria (28.3% versus 42.9%; P=0.047). CONCLUSIONS: The prevalence of RfH was low and these patients had a greater cardiovascular risk profile compared with RH. One out of 4 patients with RfH have normal 24-hour blood pressure and less target organ damage, thus indicating the important role of ambulatory blood pressure monitoring in guiding antihypertensive therapy in difficult-to-treat patients.


Assuntos
Pressão Sanguínea/fisiologia , Hipertensão do Jaleco Branco/epidemiologia , Monitorização Ambulatorial da Pressão Arterial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Espanha/epidemiologia , Hipertensão do Jaleco Branco/diagnóstico , Hipertensão do Jaleco Branco/fisiopatologia
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