Revista de hipertensión: acceso abierto

Objectives: Coexistence of primary aldosteronism and obstructive sleep apnea in hypertension is evidenced. However, aldosterone and renin activity is varying with apnea/hypopnea index changes in subjects with resistant hypertension. Thus, the aim is to investigate the optional cutoff value for aldosterone/renin activity to screen primary aldosteronism in patients with different status of apnea/hypopnea index.

Methods: 271 hypertensive male snores were evaluated via polysomnography and divided into two groups, group with apnea/hypopnea index >15 events/h and with apnea/hypopnea index <15 events/h. Primary aldosteronism was determined as following: subjects with plasma renin activity<1.0 ng/mL/h and aldosterone concentration>15 ng/dL performed saline infusion test, after which aldosterone concentration>5 ng/dL was a sign of primary aldosteronism. Receiver operating characteristic curve was applied to explore appropriate cutoff value for aldosterone/renin activity.

Results: 39 (14.4%) of the 271 were diagnosed with primary aldosteronism including 15 with apnea/hypopnea index <15 events/h and 24 with apnea/hypopnea index >15 events/h. Area under receiver operating characteristic curve was 0.97 (95%CI 0.94-0.99) in the group with apnea/hypopnea index >15 events/h and 0.91 (95%CI 0.87-0.96) in the group with apnea/hypopnea index <15 events/h. Appropriate cutoff value for aldosterone/renin activity is 29.1 ng/dL per ng/mL/h for the group with apnea/hypopnea index <15 events/h with sensitivity 100%, specificity 90% and 15.9 ng/dL per ng/mL/h for the group with apnea/hypopnea index >15 events/h with sensitivity 100%, specificity 69.7%. Youden index is 0.9 for the group with apnea/hypopnea index <15 events/h and 0.7 for the group with apnea/hypopnea index >15 events/h.

Conclusions: Optional cutoff values of aldosterone/renin activity to screening for primary aldosteronism should be considered in patients with different status of apnea/hypopnea index.

Introduction: We compared in a prospective open-label study two different protocols of home self-measurement of arterial blood pressure (ABP) for the detection of antiangiogenic drugs (AAG)-induced arterial hypertension (AHT).

Material and methods: We performed 3 measurements every morning and evenings measurements for 3 successive days (hBP-3d) and compared them to a single daily morning measurement of BP for 7 days (hBP-7d) during 2 consecutive treatment cycles with bevacizumab or sunitinib.

Results: Among the 26 patients treated with AAG, there was a significant difference between the number of AHT episode based on hBP-3d and hBP-7d protocol (116 against 183, p<0.0005). AHT did not correlated with tumoral progression/stabilization and no significant predictability could be established using the 2 protocols.

Conclusion: Detection of AHT episod in patients treated with AAG was linked to the BP monitoring protocol and should be specifically designed for cancer patients treated with AAG.

A variety of diseases are included in the expression ‘hypertensive urgencies’. The unifying features of these diseases are a high level of arterial pressure and acute distress of one or more organs.

The aim of the review was to define the idea of the ‘Acute hypertension’ as a new concept. Acute hypertension might be related to ‘organ damage’ because it is the cause, the consequence or an effect of the acute stress.

The structure of the search strategy included a literature search of PubMed, Medline, Cochrane Library and Google Scholar databases. The following inclusion criteria were applied: prospective double-blind randomised controlled trials; experimental animal work studies; case-control studies, recruiting patients representative of the general sick population. The review included analyses of 373 articles.

This review highlights a novel idea: acute hypertension is a common sign of different diseases characterized by sudden surge of arterial pressure, so overwhelming the difference between hypertensive emergencies and urgencies. The judgment of acute hypertension is independent of the initial arterial pressure, normotension or hypertension, and is linked with the transient failure of the baroreflex.

The ‘hypertensive emergencies’ have been grouped together in three subsets: 1) diseases that result from acute hypertension that is caused by faulty regulation of the peripheral circulation (acute primary hypertension); 2) diseases that produce hypertension by a specific pathogenesis (acute secondary hypertension); and 3) diseases that have hypertension as an effect of the acute stress caused by the principle disease (acute associated hypertension). Hypertensive emergencies are grouped together because all of these diseases require prompt therapy to prevent the negative outcomes of acute hypertension.

Background: Stroke is the second leading cause of death globally, and in the Kingdom of Saudi Arabia, with hypertension being the predominant risk factor. At-risk individuals experience stroke symptoms but remain undiagnosed. However, no data exist on stroke symptoms and their associated factors in KSA. We assessed self-reported stroke symptoms and their association with pre-diabetes, diabetes, hypercholesterolemia, hypertension, and health seeking behaviors.

Methods: We conducted a nationally representative multistage survey of individuals aged 15 years or older on socio-demographic characteristics; tobacco consumption, diet, physical activity, health care utilization, different health related behaviors, and self-reported chronic conditions. We used a backward elimination multivariate logistic regression model to measure associations between symptoms of stroke and risk factors.

Results: Between April and June 2013, a total of 12,000 households were contacted and a total of 10,735 participants completed the survey (response rate of 89.4%). Overall, 579 (4.8% age-adjusted) respondents reported experiencing at least one symptom of stroke, while 55 (0.4% age-adjusted) reported being previously diagnosed with a stroke. The likelihood of reporting symptoms of stroke was associated with sex, older age, high levels of physical activity, and a history of diagnoses of any of the following conditions: pre-diabetes, diabetes, hypercholesterolemia, and hypertension. Our study showed that a high percentage of Saudis reporting stroke symptoms have undiagnosed or uncontrolled blood pressure. Moreover, 61%% of those reporting stroke symptoms have never been to a doctor.

Conclusions: Our study showed that a high percentage of individuals with suspected stroke have not sought medical care. Moreover, a large proportion of those with reported symptoms have uncontrolled conditions. To reduce the burden on stroke in KSA, prevention and control strategies should be accelerated with a focus on use of free preventive care services.

Objective: To explore the relationship between plasma homocysteine (Hcy) and micro albuminuria in Chinese patients with hypertension.

Methods: 150 Chinese patients with hypertension were enrolled from October 2012 to April 2013 in Zhabei Central Hospital and Tongji hospital in Shanghai. Plasma level of Hcy, micro albuminuria, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein and fasting blood-glucose were measured, meanwhile possible related risk factors such as smoking, alcohol drinking were assessed. The enrolled patients were divided into two groups according to the plasma level of Hcy: hyperhomocysteinemia (Hcy) group (Hcy>15 μmol/L, male 41 cases, female 39 cases) and non- Hcy group (Hcy ≤ 15 μmol/L, male 32 cases, female 38 cases).

Results: The level of microalbuminuria was increased with the level of plasma Hcy .Microalbuminuria were higher in Hcy group (30.34 ± 8.85 mg/L) than in non- Hcy group (16.65 ± 3.28 mg/L, P<0.05); 2.Correlation analysis showed that the levels of plasma Hcy related positively with micro albuminuria (r=0.946, P<0.01). There were no significant correlation between Hcy and total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, fasting blood glucose (P>0.05).

Conclusion: Hcy is associated with a higher incidence of microalbuminuria in patients with hypertension.

Objectives: Various explanations have been proffered to explain why a large percentage of patients have resistant hypertension, including secondary hypertension and endogenous resistance to treatment. However, the main reason for inadequate control of BP is poor compliance with the treatment regimen; both pharmacological and behavioral (e.g. weight reduction, sodium intake restriction, and exercise). Understanding the reasons for patient noncompliance with antihypertensive treatment is essential if BP is to be more effectively managed. The finding of this study will assist health care professionals to understand factors related to treatment compliance this enables them to manage hypertension appropriately both with medication and advising lifestyle interventions, also this study will be helpful to implement effective strategies that would lead to improved compliance, increased levels of controlled blood pressure and reduced occurrences of complications.

Background: Hypertension is defined as a systolic blood pressure greater than 140 mmHg and a diastolic blood pressure greater than 90 mmHg over a sustained period, based on the average of two or more blood pressure measurements taken in two or more contacts with the health care provider after an initial screening. Uncontrolled high blood pressure increases the risk of ischemic heart disease 3- to 4-fold, and the overall risk of cardiovascular disease 2- to 3-fold. Treatment of hypertension is multifaceted, requiring long-term compliance with both medication regimens and behavior modifications. Multiple factors contribute to the poor level of compliance with long-term antihypertensive therapy.The aim of this study is to assess the factors affecting compliance with antihypertensive treatment among hypertension patients on follow-up in Jimma University Specialized Hospital, South West Ethiopia.

Methods: This study was conducted at the Jimma University Specialized Hospital (JUSH) from February 2013 – April 2013G.C. Simple random sampling techniques were employed to select 332 participants for this institution-based cross sectional study. A structured questionnaire was designed, translated, pre-tested, and utilized. Data were entered using Epidata3.1 and then exported to SPSS version 16 for analysis. Frequency distributions were used to organize the data and responses obtained. Multivariate logistic regression analysis was used to identify the factors, primarily affecting compliance with antihypertensive treatment.

Result: The mean age of participants was 53.8 + 12.8 years. 55.7% of patients were compliant with antihypertensive medications and 24.8% were compliant in making lifestyle modifications. Factors significantly associated with treatment compliance included: age of the patient (p=0.008), educational level (OR=6. 2 95% CI 1.8, 20.9), number of antihypertensive drugs prescribed (p=0.029), knowledge about hypertension treatment (OR=2.2 95% CI 1.1, 4.3), patient perception about disease severity (OR=3.1 95% CI 1.6, 5.8), and patient knowledge about the benefits of treatment compliance (OR=10.3 95% CI 3.8, 27.8).

Conclusion: In this study, compliance with antihypertensive medication was only reported by 55.7% of patients, and compliance with lifestyle modifications was only reported by 24.8% of patients. The findings from this study can be used to pinpoint the factors that are contributing to poor treatment compliance among patients at the Jimma University Specialized Hospital and to educate them about proper management of hypertension.

Objectives: Hypertension was the most important risk factor for ischemic stroke. In China, three fourths of treated hypertensive didn’t meet the standard of control. We analyzed the relationship between systolic blood pressure, diastolic blood pressure, pulse pressure and mean arterial pressure and Ischemic stroke in patients with uncontrolled hypertension.

Methods: In this cross-sectional survey, subjects with uncontrolled hypertension aged above 35 years were recruited from the general medicine clinic of Beijing Anzhen Hospital and its affiliated community health centers from March to December 2012.

Results: After adjusted for 7 covariates, each index was significantly correlated with ischemic stroke according to the result of single index model. SBP ≥ 150 mmHg, DBP ≥ 100 mmHg, high textile and quartile PP and high quartile MAP were associated with higher risk of ischemic stroke. When SBP and DBP or SBP and MAP were introduced into the model together, no significant difference was noted across categories of DBP and MAP, DBP and PP were introduced into the model together, no significant difference was noted across categories of DBP. Four indexes were introduced to the multifactorial model, only SBP entered into the model. Compared with SBP <140 mmHg, relative risk of stroke was 2.777 (95% CI: 1.356∼5.688) for SBP between 150-159 mmHg, 2.116 (95% CI: 1.0384.314) for SBP ≥ 160 mmHg. SBP showed the biggest area under ROC curves, which is 64.3%.

Conclusions: SBP is associated with higher risk of ischemic stroke in patients with uncontrolled hypertension than other three blood pressure indexes. The risk of ischemic stroke would decrease when SBP was less than 150 mmHg.

Background: In the clinical management of cirrhotic portal hypertension, surgery is often necessary; however, the operative mortality rate is high.

Methods: Data from 161 patients who underwent surgery for cirrhotic portal hypertension were analyzed, and 24 potential predictors of surgical outcome were assessed. A Kruskal Wallis rank sum test was used for single-factor comparisons, and multivariate logistic regression for multi-factor comparisons to identify risk factors for poor surgical outcomes and calculate their scores.

Results: Six predictors of poor surgical outcomes were identified: postoperative bleeding within 30h of >2L, with a score of 3; severe liver atrophy (an anteroposterior diameter of the left lobe of ≤55 mm and an oblique diameter of the right lobe ≤ 110mm), with a score of 3; a base excess of <-3mmol/L, with a score of 3; a platelet count of <3T/L, with a score of 2; an amount of intraoperative bleeding of >2 L, with a score of 2; and a red blood cell count of <3G/L, with a score of 1. For patients with a good outcome (n=147), all patients had a score of ≤ 3, except one patient who had a score of 4. With respect to patients that died (n=14), all had a score of ≥ 5, except one patient who had a score of 4. A significant difference was observed between the two groups (P<0.05). The mortality was 100% in patients with a score of ≥ 7.

Conclusions: Six risk factors for poor surgical outcomes were identified in this study. Operative mortality appears to be significantly increased in patients with a score of 5-6. Surgery should be contraindicated in patients with a score of ≥ 7. To reduce mortality, close attention should be paid to preoperative and intraoperative treatment and prevention to achieve a score of <4.

Objectives: Essential hypertension (EH) is a multifactorial disease and oxidative stress has been demonstrated to play an important role in its pathophysiology. Among several genes implicated in the pathophysiology of hypertension, endothelin-2 (ET-2), a potent vasoconstrictor, has been incriminated as a candidate gene for essential hypertension. To find out correlation of in vivo biomarkers of oxidative stress [oxidized low density lipoprotein (Ox-LDL), 8-iso- Prostaglandin F2α (8-iso-PGF2α)] and Nitrite (NO2-) are related to endothelin-2 levels and to determine their value as diagnostic markers in essential hypertension.

Methods: 100 subjects with essential hypertension and 150 age and sex-matched normotensive controls were enrolled to determine levels of ET-2, Ox-LDL, 8-iso-PGF2α and NO2-.

Results: We observed significantly augmented levels of ET-2 (P<0.001), Ox-LDL (P<0.001), 8-iso-PGF2α (P<0.001) and nitrite (P<0.001) in EH subjects as compared to the normal healthy controls. ET-2 demonstrated a positive and significant correlation with Ox-LDL, 8-iso-PGF2α, and nitrite levels in subjects with EH. ROC curve analysis revealed that all these variables were significantly able to distinguish EH subjects and controls with high sensitivity and specificity.

Conclusions: TOur findings highlight implication of these variables as potential markers for the disease and as possible targets for therapeutic management of the essential hypertension.