Comparison of two surrogate estimates of insulin resistance to predict cardiovascular disease in apparently healthy individuals.

BACKGROUND AND AIMS: Insulin resistance is associated with a cluster of abnormalities that increase cardiovascular disease (CVD). Several indices have been proposed to identify individuals who are insulin resistant, and thereby at increased CVD risk. The aim of this study was to compare the abilities of 3 indices to accomplish that goal: 1) plasma triglyceride × glucose index (TG × G); 2) plasma triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-C); and 3) Metabolic Syndrome (MetS). METHODS AND RESULTS: In a population sample of 723 individuals (486 women and 237 men, 50 ± 16 and 51 ± 16 years old, respectively), baseline demographic and metabolic variables known to increase CVD risk and incident CVD were compared among individuals defined as high vs. low risk by: TG × G; TG/HDL-C; or MetS. CVD risk profiles appeared comparable in high risk subjects, irrespective of criteria. Crude incidence of CVD events was increased in high risk subjects: 12.2 vs. 5.3% subjects/10 years, p = 0.005 defined by TG/HDL-C; 13.4 vs. 5.3% subjects/10 years, p = 0.002 defined by TG × G; and 13.4% vs. 4.5% of subjects/10 years, p < 0.001 in subjects with the MetS. The area under the ROC curves to predict CVD were similar, 0.66 vs. 0.67 for TG/HDL-C and TG × G, respectively. However, when adjusted by age, sex and multiple covariates, hazard ratios for incident CVD were significantly increased in high risk patients classified by either TG/HDL-C ratio (2.18, p = 0.021) or MetS (1.93, p = 0.037), but not by TG × G index (1.72, p = 0.087). CONCLUSION: Although the 3 indices identify CVD risk comparably, the TG × G index seems somewhat less effective at predicting CVD.

[Consequence of hypertensive disorders during pregnancy (THE) on women's cardiovascular health]. / Consecuencia de los trastornos hipertensivos durante el embarazo (THE) sobre la salud cardiovascular de la mujer.

Patients with hypertensive disorders of pregnancy (HDP) are at increased risk of maternal-fetal complications and represent the third leading cause of maternal mortality. To date, it is known that women experiencing this condition during pregnancy have a higher future risk of cardiovascular events (CVD). Our objective was to report the incidence of new-onset hypertension in the postpartum period. We conducted a cohort study in high-risk pregnant patients who underwent ambulatory blood pressure monitoring (ABPM) between weeks 20-30. Patients were categorized as normotensive (NT) or gestational hypertensive (GH), excluding those with chronic hypertension, and were followed until the end of pregnancy with a postpartum assessment after 3months. Patients with HDP (39%) had a higher incidence of preeclampsia and newborns with low birth weight and preterm birth. A total of 177 pregnant women were analyzed for the primary outcome. Among those with GH, 33.3% vs 17.2% of NT (P=.014) reported new-onset hypertension. The odds ratio for developing new-onset hypertension was 2.3 (95%CI: 1.20-4.77), for those with GH. In conclusion, pregnant patients with GH assessed by ABPM between 20-30weeks are at higher risk of developing new-onset hypertension in the postpartum period, emphasizing the need for closer monitoring and control to prevent future cardiovascular complications.

Time in therapeutic range and risk of preeclampsia in chronic hypertensive pregnant women.

Pregnancy Hypertensive Disorders (PHD), particularly Preeclampsia (PE), are significant contributors to maternal-fetal morbidity and mortality, with chronic arterial hypertension (CH) being a major risk factor. The prevalence of CH has risen alongside obesity and advanced maternal age. While antihypertensive treatment mitigates adverse pregnancy outcomes, the duration of effective blood pressure (BP) control, termed Time in Therapeutic Range (TTR), has not been extensively studied in pregnant women. TTR, reflecting the proportion of time BP remains within target ranges, predicts long-term cardiovascular and renal events in the general population but remains unexplored in pregnancy. This study investigates the association between TTR, assessed through office BP (OBP) and ambulatory BP monitoring (ABPM), and PE development in pregnant women with CH. In a retrospective longitudinal study, data from 166 pregnant women with HA referred to our hospital analyzed. BP was measured using OBP and ABPM from 10 weeks of gestation, with TTR calculated as the percentage of visits where BP remained within target ranges. The study defined four TTR control groups: 0%, 33%, 50-66%, and 100%. Results showed that 28% of the participants developed PE, with a higher incidence correlating with lower TTR in ABPM. TTR in ABPM was a significant predictor of PE risk, with the best-controlled group (100% TTR) demonstrating a 92% reduced risk compared to those with 0% TTR. The agreement between OBP and ABPM TTR was low, emphasizing the importance of ABPM for accurate BP monitoring in pregnancy. This study indicates that integrating ABPM for TTR assessment in high-risk pregnancies has the potential to reduce maternal and fetal complications.

Prognostic performance of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio for mortality in patients with acute stroke.

OBJECTIVE: To evaluate the prognostic performance of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) for mortality in patients with acute stroke treated at a Peruvian hospital. DESIGN: Retrospective cohort study. SETTING: Tertiary care hospital. PATIENTS: Patients aged ≥18 years with a diagnosis of acute stroke and admitted to the hospital from May 2019 to June 2021. INTERVENTIONS: None. MAIN VARIABLES OF INTERESTS: Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mortality. RESULTS: A total of 165 patients were included. The mean age was 66.1±14.2 years, and 59.4% were male. Only NLR had a performance superior to 0.7 (AUC: 0.75; 95%CI: 0.65-0.85), and its elevated levels were associated with an increased risk of mortality (aRR: 3.66; 95%CI: 1.77-8.85) after adjusting for confounders. CONCLUSION: The neutrophil-to-lymphocyte ratio has an acceptable prognostic performance for mortality in patients with acute stroke. Its use may be considered to stratify patients' risk and to consider timely alternative care and management.

[Prevalence, knowledge and control of arterial hypertension in vulnerable neighborhoods of Argentina: A Cross-sectional Study]. / Estudio de prevalencia, conocimiento y control de la hipertensión arterial en barrios vulnerables de Argentina.

INTRODUCTION: Hypertension (HTN) represents the primary individual risk factor, contributing significantly to the global burden of cardiovascular diseases (CVD). In our country, epidemiological research has highlighted substantial variations in the prevalence of these risk factors across different populations. However, there is a lack of epidemiological studies assessing exclusive cardiovascular risk factors within vulnerable neighborhoods characterized by extremely limited economic resources, sociocultural challenges, and inadequate healthcare access. METHODS: A multicenter cross-sectional observational study was conducted among individuals residing in economically deprived and marginalized communities, including informal settlements and underprivileged neighborhoods. Simple random sampling of households was employed. Blood pressure measurements, anthropometric assessments, and epidemiological, economic, and sociocultural questionnaires were administered. Results encompass prevalence rates, awareness levels, and blood pressure control across diverse regions. Logistic regression was utilized to identify independent variables influencing primary outcomes. RESULTS: A total of 989 participants were analyzed. The overall prevalence of hypertension was 48.2%. About 82% had a body mass index (BMI) >25. Approximately 45.3% had less than 6 years of formal education. Independent association was established between education levels below 6 years and higher hypertension prevalence. Among hypertensive individuals, 44% were unaware of their condition, with only 17.2% achieving control, correlated with having health insurance and a higher educational background. Merely 24% were receiving combined therapy. CONCLUSION: The prevalence of hypertension within vulnerable neighborhoods is alarmingly high, surpassing rates in other social strata. Knowledge, treatment, and control levels of hypertension are suboptimal, comparable to other populations. Inadequate use of combination therapy was observed. This study underscores the urgent need for targeted interventions addressing cardiovascular risk factors in poor areas to mitigate the burden of CVD.

Identifying cardiovascular disease risk and outcome: use of the plasma triglyceride/high-density lipoprotein cholesterol concentration ratio versus metabolic syndrome criteria.

BACKGROUND: Metabolic syndrome (MetS) has been shown to predict both risk and CVD events. We have identified sex-specific values for the triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio associated with an unfavourable cardio-metabolic risk profile, but it is not known whether it also predicts CVD outcome. METHODS: To quantify risk for CVD outcomes associated with a high TG/HDL-C ratio and to compare this risk with that predicted using MetS, a population longitudinal prospective observational study was performed in Rauch City, Buenos Aires, Argentina. In 2003 surveys were performed on a population random sample of 926 inhabitants. In 2012, 527 women and 269 men were surveyed again in search of new CVD events. The first CVD event was the primary endpoint. Relative risks for CVD events between individuals above and below the TG/HDL-C cut-points, and with or without MetS, were estimated using Cox proportional hazard. MAIN OUTCOME: The first CVD event was the primary endpoint. Relative risks for CVD events between individuals above and below the TG/HDL-C cut-points, and with or without MetS, were estimated using Cox proportional hazard. RESULTS: The number of subjects deemed at 'high' CVD risk on the basis of an elevated TG/HDL-C ratio (30%) or having the MetS (35%) was relatively comparable. The unadjusted hazard risk was significantly increased when comparing 'high' versus 'low' risk groups no matter which criteria was used, although it was somewhat higher in those with the MetS (HR = 3.17, 95% CI:1.79-5.60 vs. 2.16, 95% CI:1.24-3.75). However, this difference essentially disappeared when adjusted for sex and age (HR = 2.09, 95% CI:1.18-3.72 vs. 2.01, 95% CI:1.14-3.50 for MetS and TG/HDL-C respectively). CONCLUSIONS: An elevated TG/HDL-C ratio appears to be just as effective as the MetS diagnosis in predicting the development of CVD.

[Isolated nocturnal hypertension in individuals with human immunodeficiency virus]. / Hipertensión nocturna aislada en individuos con el virus de la inmunodeficiencia humana.

INTRODUCTION: Isolated nocturnal hypertension is associated with a greater number of cardiovascular events and target organ damage due to arterial hypertension. It has been observed that patients in the general population with this entity do not have high blood pressure figures in the office; and it is necessary to perform an outpatient measurement to unmask it. The prevalence in special populations is not fully described. The objective of the following study is to describe the prevalence of isolated nocturnal hypertension in a population living with the human immunodeficiency virus and to observe its relationship with the categories of office blood pressure and the phenotypes of the 24-hour ambulatory blood pressure measurement. METHODOLOGY: A retrospective cohort was carried out in a population with human immunodeficiency virus in a public hospital in Spain, clinical epidemiological characteristics, office blood pressure measurements and 24-hour ambulatory blood pressure measurement (ABPM) were recorded. An analysis was performed based on the different ABPM blood pressure phenotypes, as well as based on the different office blood pressure categories, the risks for isolated nocturnal hypertension were calculated. RESULTS: One hundred and sixteen individuals, without antihypertensive medication or history of established cardiovascular disease, were included in the analysis. A prevalence of nocturnal hypertension of 23.3% was described. It was not possible to demonstrate significant differences between phenotypes by ABPM of any variable specific to HIV. There were no adjusted risk differences between the different categories of office normotensives. CONCLUSIONS: Isolated nocturnal hypertension is more frequent in patients with HIV and office blood pressure values in normotensive patients are not sufficient to predict isolated nocturnal hypertension.

Use of the triglyceride/high-density lipoprotein cholesterol ratio to identify cardiometabolic risk: impact of obesity?

There is evidence that the plasma concentration ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) identifies insulin resistance and increased cardiometabolic risk and outcome in apparently healthy individuals. Since use of the TG/HDL-C ratio to accomplish this task in persons over a wide range of adiposity has not been studied, the ability of previously defined sex-specific TG/HDL-C cut-points to identify increased cardiometabolic risk was evaluated in apparently healthy normal weight, overweight, and obese individuals. Data were analyzed from a population-based study of apparently healthy men (n=416) and women (n=893), subdivided into categories by body mass index (BMI, kg/m2): normal weight (BMI 20.0-24.9), overweight (BMI 25.0-29.9) and obese (BMI 30.0-34.9). The adiposity groups were further stratified on the basis of their TG/HDL-C ratio into groups defined as being either at 'high risk' versus 'low risk' of cardiometabolic disease. Multiple cardiometabolic risk factors were compared between these subgroups, as was their degree of insulin resistance assessed by fasting plasma insulin concentration and homeostasis model assessment of insulin resistance. The proportion of high-risk individuals varied with BMI category, ranging from 14% (normal weight) to 36% (obese). However, within each BMI category high-risk individuals had a significantly more adverse cardiometabolic risk profile. Finally, the adjusted OR of being insulin resistant was significantly greater in those with a high TG/HDL-C ratio in the normal (3.02), overweight (2.86), and obese (2.51) groups. Thus, irrespective of differences in BMI, the TG/HDL-C ratio identified apparently healthy persons with a more adverse cardiometabolic risk profile associated with an increased prevalence of insulin resistance.

Should the first blood pressure reading be discarded?

We evaluated the consequences of excluding the first of three blood pressure (BP) readings in different settings: a random population sample (POS, n=1525), a general practice office (GPO, n=942) and a specialized hypertension center (SHC, n=462). Differences between systolic and diastolic BP (SBP and DBP) estimates obtained including and excluding the first reading were compared and their correlation with ambulatory BP monitoring (ABPM) was estimated. The samples were divided into quartiles according to the difference between the third and the first SBP (3-1ΔSBP). SBP decreased through sequential readings, 3-1ΔSBP was -5.5 ± 9.7 mm Hg (P<0.001), -5.1 ± 10.4 mm Hg (P<0.001) and -6.1 ± 9.3 mm Hg (P<0.001) for POS, GPO and SHC, respectively. However, individuals included in the top quartile of 3-1ΔSBP showed their highest values on the third reading. The mean SBP estimate was significantly higher excluding the first reading (P<0.001), but the differences among both approaches were small (1.5-1.6 mm g). Moreover, the correlation between SBP values including and excluding the first reading and daytime ABPM were comparable (r = 0.69 and 0.68, respectively). Similar results were observed for DBP. In conclusion, our study does not support the notion of discarding the first BP measurement and suggests that it should be measured repeatedly, regardless the first value.

Ten-year blood pressure trends in nonhypertensive inhabitants of La Plata, Argentina.

OBJECTIVES: To compare, according to blood pressure (BP) categories, 10-year trends in BP measurements in nonhypertensive subjects and the relative risk of developing hypertension. DESIGN: Population study. BP was recorded as the average of two measures taken on a single occasion with a mercury sphygmomanometer and the auscultation method. SETTING: Residents of La Plata, aged 15 to 64 years. PARTICIPANTS: The study was based on randomly chosen individuals who, during a previous survey in 1985, were 15 to 64 years old and whose BP was below 140/90 mmHg. They were grouped according to sex and BP categories. Random age- and sex-stratified sampling of 151 men and 193 women was performed. Categories were high normal BP, optimal BP (as defined by the fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure) and normal but not optimal BP defined as BP 120 to 129/80 to 84 mmHg. RESULTS: BP increased in all categories; this increase was significant (P < 0.01) except for diastolic BP in women with high normal BP. BP increases were higher in optimal BP subjects and lower in high normal BP subjects (P < 0.01 for women and not significant for men). The relative risk of developing hypertension in high normal BP subjects was triple that in optimal BP subjects (P < 0.01). CONCLUSIONS: Increases in BP observed in optimal BP subjects stress the importance of monitoring BP changes and recommending primary prevention in the whole population.

Alpha lipoic acid: a novel treatment for depression.

Insulin resistance has been associated with people diagnosed with depression. Conversely, it has also been documented that diabetics have an increased risk of depression. Evidence suggests that insulin activity plays a role in serotonergic activity by increasing the influx of tryptophan into the brain. This increased influx of tryptophan has been shown to result in an increase in serotonin synthesis. In accordance with the serotonin theory of depression, it may be possible to treat depression by increasing insulin activity. The antioxidant alpha lipoic acid has been shown to increase insulin sensitivity and is used to treat people with diabetes. Therefore, the nutrient alpha lipoic acid should be clinically tested as an adjunct treatment for depression.

[Prevalence of high normal blood pressure and progression to hypertension in a population sample of La Plata]. / Prevalencia de presión sanguínea normal alta y progresión a hipertensión arterial en una muestra poblacional de La Plata.

In 1985 we investigated the prevalence of high normal blood pressure in 6387 inhabitants (range 15-75 years old) of the city of La Plata and its progression to arterial hypertension after four years. High normal blood pressure was defined as a systolic blood pressure (BP) < 140 mmHg and diastolic BP between 85-89 mmHg (average value of two measurements) on one occasion. Arterial hypertension was defined as a systolic BP > or = 140 mmHg and/or diastolic BP > or = 90 mmHg, both as an average of two measurements on two occasions. High normal BP prevalence was 6.62%, being higher in men than in women (p < 0.0005, Table 1). General progression to hypertension was 41.79%, being higher in the older individuals (p < 0.0005). Of the 423 individuals with high normal BP (Table 2), 268 (63.36%) were found in 1989 (Table 3). They had an incidence of hypertension of 10.45% per year, also higher in older subjects (Table 4). There were no differences between sexes. Subjects with high normal BP who subsequently developed hypertension had higher systolic BP in 1985 than those who remained normotensive (p < 0.001, Table 5). Most of them progressed to mild diastolic hypertension (29.48%) or borderline isolated systolic hypertension (6.72%, Fig. 1). In this study, progression to arterial hypertension was higher than that reported in similar studies for general population in other countries.

[Knowledge and treatment of hypertension in La Plata, Argentina]. / Conocimiento y tratamiento de la hipertensión en La Plata.

Hypertensive subjects, aged 15-75 years, detected by the survey of Prevalence of Hypertension in La Plata, were evaluated to settle the rates of awareness, treatment, control status and the efficacy of pharmacologic therapy (EPT). The survey was composed of 2,090 subjects when the threshold of hypertension was equal to blood pressure (BP) greater than or equal to 140-90 mm Hg and of 1,203 subjects with a BP threshold greater than or equal to 160-95 mm Hg (Table I). The rates of awareness, treatment and control for the 140-90 mm Hg threshold were 43.97%, 33.06%, 4.9%, respectively, and the EPT was 15.03%. For the 160-95 mm Hg threshold the rates were 69.41%, 54.44% and 27.76% and the EPT was 48.32% (Table 2 and Fig. 1). The awareness and treatment rates for women were greater than those for men (p less than 0.0005) (Table 2). The EPT was similar in both sexes when the 140-90 mm Hg threshold was used while it was greater in women than in men with the 160-95 threshold (p less than 0.014) (Table 2). The rates of awareness and treatment increased with age and with the severity of the disease (Table 3-5). The EPT decreased from 85.71% in the 15-24 yr. age group to 10.56% in the 65-75 yr. age group (Table 4). Although the rates of awareness and treatment of hypertension found in La Plata were similar to those found in USA, the control of the disease was lower.(ABSTRACT TRUNCATED AT 250 WORDS)

[Associated variables to hypertension in a region of Argentina]. / Variables asociadas a hipertensión arterial en una región de la Argentina.

We conducted a study in a random sample of 1523 inhabitants (15-75 years old) of Rauch city to determine risk factors prevalence to development hypertension and cardiovascular diseases. We measured blood pressure, weight, height, waist circumference, cholesterol and glucose levels, sodium excretion, and alcohol and tobacco consumption. We found a high prevalence of hypertension (43.20% in men and 28.50% in women), and obesity-overweight (54.81% in men and 44.65% in women), both of them augmented with aging. Only 4% of hypertensive subjects were being controlled and only 32% of them were aware of their condition. Men showed a marked increment of prevalence of hypertension and obesity-overweight between groups of 15-24 years and 25-34 years. Women had delayed and more gradual increments. In male and female respectively, the prevalence of hypercholesterolemia was 26.86 and 13.81, the prevalence of diabetes was 3.42 and 1.53, and the prevalence of tobacco consumption was 34.61 and 20.83. Higher BMI and waist circumference identified subjects with higher blood pressure up to 54 and 65 years, in men and women, respectively. Age and waist circumference in the whole group, and alcohol consumption in men, were independently correlated with blood pressure; sodium excretion had no correlation. High prevalence of hypertension and obesity-overweight and their association suggest that the most important primary prevention measure in this community should be to prevent obesity. Low levels of awareness indicate the need of ongoing detection programs, and low grade to control of hypertension could be modified with education programs for health providers.

Prognostic performance of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio for mortality in patients with acute stroke / Rendimiento pronóstico de la razón neutrófilos/linfocitos y la razón plaquetas/linfocitos para la mortalidad en pacientes con ictus agudo

Objective: To evaluate the prognostic performance of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) for mortality in patients with acute stroke treated at a Peruvian hospital. Design: Retrospective cohort study. Setting: Tertiary care hospital. Patients: Patients aged ≥18 years with a diagnosis of acute stroke and admitted to the hospital from May 2019 to June 2021. Interventions: None. Main variables of interests: Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mortality. Results: A total of 165 patients were included. The mean age was 66.1±14.2 years, and 59.4% were male. Only NLR had a performance superior to 0.7 (AUC: 0.75; 95%CI: 0.65–0.85), and its elevated levels were associated with an increased risk of mortality (aRR: 3.66; 95%CI: 1.77–8.85) after adjusting for confounders. Conclusion: The neutrophil-to-lymphocyte ratio has an acceptable prognostic performance for mortality in patients with acute stroke. Its use may be considered to stratify patients’ risk and to consider timely alternative care and management.(AU)

Objetivo: Evaluar el desempeño pronóstico de la relación neutrófilos-linfocitos (NLR) y la relación plaquetas-linfocitos (PLR) para la mortalidad en pacientes con stroke agudo tratados en un hospital peruano. Diseño: Estudio de cohorte retrospectivo. Ámbito: Hospital de atención terciaria. Participantes: Pacientes ≥18 años con diagnóstico de stroke agudo e ingresados en el hospital entre mayo de 2019 y junio de 2021. Intervenciones: Ninguna. Variables de interés principales: Razón neutrófilos/linfocitos, razón plaquetas/linfocitos y mortalidad. Resultados: Se incluyeron un total de 165 pacientes. La edad media fue de 66,1±14,2 años, y el 59,4% eran varones. Sólo el NLR tuvo un rendimiento superior a 0,7 (AUC: 0,75; IC95%: 0,65-0,85), y sus niveles elevados se asociaron con un mayor riesgo de mortalidad (RRa: 3,66; IC95%: 1,77-8,85) tras ajustar por factores de confusión. Conclusiones: La razón neutrófilos/linfocitos tiene un rendimiento pronóstico aceptable para la mortalidad en pacientes con stroke. Su uso puede ser considerado para estratificar el riesgo de los pacientes y considerar oportunamente cuidados y manejo alternativos.(AU)

Hipertensión nocturna aislada en individuos con el virus de la inmunodeficiencia humana / Isolated nocturnal hypertension in individuals with human immunodeficiency virus

Introducción: La hipertensión nocturna aislada se asocia a mayor cantidad de eventos cardiovasculares y daño de órgano blanco por hipertensión arterial. La prevalencia en poblaciones especiales no se encuentra del todo descrita. El objetivo del siguiente estudio es describir la prevalencia de hipertensión nocturna aislada en población conviviendo con el virus de la inmunodeficiencia humana, y observar su relación con las categorías de presión arterial en el consultorio y los fenotipos de la medición ambulatoria de presión arterial de 24h. Metodología: Se realizó una cohorte retrospectiva en una población con el virus de la inmunodeficiencia humana en un hospital público de España, se registraron características clínico epidemiológicas, mediciones de presión arterial en consultorio y medición ambulatoria de presión arterial de 24h (MAPA). Se realizó un análisis en función de los diferentes fenotipos de presión arterial por MAPA, así como también en función de las diferentes categorías de presión arterial de consultorio se calcularon los riesgos para la hipertensión nocturna aislada. Resultados: Se incluyeron en el análisis 116 individuos, sin medicación antihipertensiva ni antecedentes de enfermedad cardiovascular establecida. Se describió una prevalencia de hipertensión nocturna del 23,3%. No se pudo demostrar diferencias significativas entre fenotipos por MAPA de ninguna variable propia del VIH. No hubo diferencias de riesgo ajustadas entre las diferentes categorías de normotensos en consultorio. Conclusiones: La hipertensión nocturna aislada es más frecuente en pacientes con VIH, y los valores de presión arterial de consultorio en normotensos no son suficientes para predecir HTA nocturna aislada. (AU)

Introduction: Isolated nocturnal hypertension is associated with a greater number of cardiovascular events and target organ damage due to arterial hypertension. It has been observed that patients in the general population with this entity do not have high blood pressure figures in the office; and it is necessary to perform an outpatient measurement to unmask it. The prevalence in special populations is not fully described. The objective of the following study is to describe the prevalence of isolated nocturnal hypertension in a population living with the human immunodeficiency virus and to observe its relationship with the categories of office blood pressure and the phenotypes of the 24-hour ambulatory blood pressure measurement. Methodology: A retrospective cohort was carried out in a population with human immunodeficiency virus in a public hospital in Spain, clinical epidemiological characteristics, office blood pressure measurements and 24-hour ambulatory blood pressure measurement (ABPM) were recorded. An analysis was performed based on the different ABPM blood pressure phenotypes, as well as based on the different office blood pressure categories, the risks for isolated nocturnal hypertension were calculated. Results: One hundred and sixteen individuals, without antihypertensive medication or history of established cardiovascular disease, were included in the analysis. A prevalence of nocturnal hypertension of 23.3% was described. It was not possible to demonstrate significant differences between phenotypes by ABPM of any variable specific to HIV. There were no adjusted risk differences between the different categories of office normotensives. Conclusions: Isolated nocturnal hypertension is more frequent in patients with HIV and office blood pressure values in normotensive patients are not sufficient to predict isolated nocturnal hypertension. (AU)

A qualitative evaluation of an assisted self-help group for drug-addicted clients in a structured outpatient treatment setting.

We conducted a qualitative evaluation of a semi-structured, client-led support group that addressed drug use recovery issues and was assisted by a psychological consultant. Seven regular group members and their counselors were interviewed about the effect of the assisted self-help group on drug use and the clients' quality of life, and these interviews were content analyzed. In addition, the psychological consultant made group process observations for each session of the first three months. Clients reported group strengths as: Feeling supported and understood, being able to speak freely without fear of staff reprisals, obtaining information/feedback, improved mood, and decreased drug use. With the provision of professional support and guidance, this group shows promise as an adjunct to standard outpatient drug abuse treatment by allowing for some degree of client independence and extending the scarce resource of professional counseling.

Ion mobility spectrometry of hydrazine, monomethylhydrazine, and ammonia in air with 5-nonanone reagent gas.

Hydrazine (HZ) and monomethylhydrazine (MMH) in air were monitored continuously using a hand-held ion mobility spectrometer equipped with membrane inlet, 63Ni ion source, acetone reagent gas, and ambient temperature drift tube. Response characteristics included detection limit, 6 ppb; linear range, 10-600 ppb; saturated response, >2 ppm; and stable response after 15-30 min. Ammonia interfered in hydrazines detection through a product ion with the same drift time as that for MMH and HZ. Acetone reagent gas was replaced with 5-nonanone to alter drift times of product ions and separate ammonia from MMH and HZ. Patterns in mobility spectra, ion identifications from mass spectra, and fragmentation cross-sections from collisional-induced dissociations suggest that drift times are governed by ion-cluster equilibria in the drift region of the mobility spectrometer. Practical aspects including calibration, stability, and reproducibility are reported from the use of a hand-held mobility spectrometer on the space shuttle Atlantis during mission STS-37.