Sustained-release isosorbide mononitrate as adjuvant treatment in isolated systolic hypertension in the elderly.

Hypertension is one of the main cardiovascular risk factors. In the elderly, the most common form is isolated systolic hypertension, a consequence of the increase in arterial stiffness. None of the antihypertensives currently used affects arterial stiffness, whereas nitrates seem to have an effect. The aim of this work was to assess their effect on elderly patients with uncontrolled isolated systolic hypertension, defined as systolic blood pressure over 140 mmHg and diastolic blood pressure under 90 mmHg. The present study is a phase III, randomized, multicenter, double-blind, placebo-controlled clinical trial, conducted at the University Hospital La Princesa in Madrid. Patients of both sexes, aged 65 years or older, with poorly controlled isolated systolic hypertension, were treated with 40-60 mg of sustained-release isosorbide mononitrate or matching placebo for 12 weeks. The main objective was to assess the effect on clinical pulse pressure (PP); in addition, its effect on vascular function was evaluated. Analysis was performed by intention to treat. The study was registered at the European Union Clinical Trials Register (EUDRACT 2012-002988-10) and was funded by the Spanish Ministry of Health. A total of 58 patients with an average age of 77 years were enrolled, 32 were treated with nitrate, and 26 with placebo. No significant differences were found either in PP decline (5.28 vs 7.49 mmHg, p = 0.79) or in other variables, including parameters of vascular function. There were no differences in adverse events. The results of this study have not confirmed the benefit of nitrate treatment in isolated systolic hypertension or the improvement of vascular function.

Estudio descriptivo del parasuicidio en las urgencias psiquiátricas / Descriptive analysis of parasuicide in the psychiatric emergencies

El parasuicidio supone un importante problema de salud pública, tanto por su elevada incidencia como por las importantes consecuencias a nivel médico y social. La forma habitual de abordar este problema es a través del estudio de las características del paciente parasuicida y del intento de suicidio. Nuestro estudio se compone de una muestra de 184 pacientes atendidos por parasuicidio. Se han valorado características sociodemográficas, clínicas y psicosociales del paciente, así como las características del parasuicidio, sus repercusiones médicas y el grado de intencionalidad suicida. El perfil del paciente fue el de una mujer soltera, de, 36'7 años de media, que convive con otras personas y está en paro. Más de la mitad de la muestra estaba ya en tratamiento psiquiátrico, siendo el diagnóstico más frecuente el de trastorno de personalidad. El método más usado fue el de ingestión de psicofármacos, benzodiacepinas y antidepresivos fundamentalmente. El 20 por ciento requirió ingreso hospitalario y el 50 por ciento fue derivado al Centro de Salud Mental para seguimiento. Respecto a la intencionalidad, se hallaron 2 subgrupos con diferentes frecuencia, diagnóstico, pronóstico y tratamiento (AU)

The parasuicide is an important public health problem because of its high frequency and its medical and social consequences. The patient's clinical features and the suicide attempt's characteristics are the most important clinical topics on studyng this problem. We studied 184 patients who committed parasuicide. Sociodemographic, clinical and psychosocial patient's features, parasuicide's characteristics, medical consequences and suicide intentionality were analyzed. The typical patient's profile was age 36´7, single, unemployed and not living alone woman. 54% of the sample was already receiving psychiatric attention. The most usual diagnose was personality disorder. The most usual method was ingestion of psychotropics drugs. 20% of the sample required hospital admission, and 50% was referred to his Mental Health Center. According to suicide intentionality two groups resulted. These two groups presented differences on frequency, prognosis, diagnosis and treatment. The foregoing are just some of the findings presented in this article (AU)