Aguilera Mt

Effect of Alcohol Abstinence on Blood Pressure Assessment by 24-Hour Ambulatory Blood Pressure Monitoring

Several studies have shown that cessation of alcohol drinking reduces blood pressure (BP). However, attempts to reproduce these findings by ambulatory BP monitoring (ABPM) have shown inconsistent results. The aim of the present study was to assess the effect of 1 month of proven abstinence from alcohol on the 24-hour BP profile in heavy alcohol drinkers. Forty-two men who were heavy drinkers (>100 g of pure ethanol per day) were consecutively admitted to a general ward for voluntary alcohol detoxification. On the day of admission, they received a total dose of 2 g/kg of ethanol diluted in orange juice in 5 divided doses, and a 24-hour ABPM was performed. A new 24-hour BP monitoring in the same environmental conditions was performed after 1 month of proven alcohol abstinence while the subjects were receiving the same amount of fluid but without the addition of alcohol. After 1 month of proven alcohol abstinence, BP and heart rate (HR) significantly decreased. The reduction was 7.2 mm Hg for 24-hour systolic BP (SBP) (95% CI, 4.5 to 9.9), 6.6 mm Hg for 24-hour diastolic BP (DBP) (95% CI, 4.2 to 9.0), and 7.9 bpm for HR (95% CI, 5.1 to 10.7). The proportion of alcoholic patients considered hypertensive on the basis of 24-hour BP criteria (daytime SBP >/=135 mm Hg or daytime DBP >/=85 mm Hg) fell from 42% during alcohol drinking to 12% after 1 month of complete abstinence. Abstinence did not modify either the long-term BP variability, assessed by SD of 24-hour BP, or its circadian profile. We conclude that abstinence in heavy alcohol drinkers significantly reduces BP assessed by 24-hour ABPM and that this reduction is clinically relevant. These results show that heavy alcohol consumption has an important effect on BP, and thus cessation of alcohol consumption must be recommended as a priority for hypertensive alcohol drinkers.

Assessment of salt sensitivity in essential hypertension by 24-h ambulatory blood pressure monitoring

We used ambulatory blood pressure monitoring (ABPM) in the assessment of salt sensitivity in 40 essential hypertensive patients, comparing 24-h mean blood pressure during 7 days of low salt (20 mmol NaCl/day) and high salt (260 mmol NaCl/day) intake. Salt sensitivity was diagnosed in 18 essential hypertensive patients (45%), each of them showing a significant increase in mean blood pressure (P < .05) from low to high salt diet. Salt-sensitive patients exhibited a high-salt-dependent increase in all blood pressure parameters including 24-h systolic, mean, diastolic blood pressure, blood pressure load, area under the curve, and awake and asleep blood pressure values. These patients exhibited a nondipper profile on both low-salt and high-salt diets. Salt-resistant patients (55%) showed a decrease in awake, and an increase in asleep blood pressure values after high salt intake, thus tending to flatten the circadian blood pressure profile. We conclude that ABPM is a useful method to assess salt sensitivity. In salt-resistant patients high salt intake induces a significant increase in asleep blood pressure with no significant changes in 24-h blood pressure, promoting a flattened blood pressure curve and tending to transform a dipper into a nondipper profile, which could have important implications in end-organ damage.

A Multicenter, Randomized, Double-Blind Comparison of the Efficacy and Safety of Irbesartan and Enalapril in Adults with Mild to Moderate Essential Hypertension, as Assessed by Ambulatory Blood Pressure Monitoring: The MAPAVEL Study

Abstract Background: When blood pressure (BP)—lowering efficacy is assessed by measurements taken in a clinic setting, angiotensin II—receptor antagonists show similar efficacy to angiotensin-converting enzyme inhibitors and better tolerability. A search of MEDLINE to date, however, reveals no randomized, double-blind studies using ambulatory BP monitoring (ABPM) to compare the BP-lowering efficacy of irbesartan and enalapril in a large number of patients (>200) with essential hypertension. Objective: This study compared 24-hour BP reduction and BP control, as assessed by ABPM, in patients with mild to moderate essential hypertension treated with irbesartan or enalapril. The relative tolerability of the 2 treatments was also evaluated. Methods: This was a multicenter, randomized, double-blind study in patients with mild to moderate essential hypertension (office diastolic BP [DBP] 90–109 mm Hg or systolic BP [SBP] 140–179 mm Hg). After a 3-week, single-blind placebo washout phase, patients with a mean daytime DBP ≥85 mm Hg, as measured by ABPM between 10 am and 8 pm, were randomized to 12 weeks of active treatment with irbesartan or enalapril. Starting doses were 150 and 10 mg/d, respectively, with titration to 300 or 20 mg/d if clinic DBP was ≥90 mm Hg at week 4 or 8. Based on clinic measurements, BP control was defined as a BP reading Results: A total of 238 patients were randomized to treatment, 115 to irbesartan and 123 to enalapril. The study population was ∼52.0% female and 48.0% male, with a mean (±SD) age of 52.7 ± 10.6 years. The study was completed by 111 patients in the irbesartan group (dose titrated to 300 mg/d in 72.0% of patients) and 115 patients in the enalapril group (dose titrated to 20 mg/d in 76.5% of patients). BP reductions were similar in the 2 groups, both as measured in the clinic (DBP, 12.7 ± 8.8 mm Hg irbesartan vs 12.4 ± 7.4 mm Hg enalapril; SBP, 19.0 ± 14.1 mm Hg vs 17.5 ± 14.0 mm Hg) and by 24-hour ABPM (DBP, 9.4 ± 8.5 mm Hg vs 8.8 ± 8.5 mm Hg; SBP, 14.7 ± 14.7 mm Hg vs 12.6 ± 13.1 mm Hg). As assessed by ABPM, rates of BP control were 40.5% (45/111) for irbesartan and 33.9% (39/115) for enalapril, and the response rates were a respective 71.2% (79/111) and 71.3% (82/115). The overall incidence of adverse events (40.0% irbesartan, 51.2% enalapril) was not statistically different between groups, although the incidence of adverse events considered probably related to antihypertensive treatment was significantly higher with enalapril than with irbesartan (24.6% vs 9.2%, respectively; P = 0.026), essentially because of the higher incidence of cough (8.1% vs 0.9%). Conclusions: As assessed by ABPM, irbesartan 150 to 300 mg/d was as effective in lowering BP and achieving BP control as enalapril 10 to 20 mg/d. Based on the number of treatment-related adverse events, irbesartan was better tolerated than enalapril.

Undiagnosed obesity in hypertension: Clinical and therapeutic implications

Objectives. The aim of this study was to determine the prevalence of obesity in patients with hypertension and to evaluate the relationship between obesity, metabolic syndrome (MetS) and blood pressure (BP) control. Materials and methods. We conducted an epidemiological survey in a sample of 19,039 patients with hypertension who consecutively attended a primary healthcare center. Patients were considered to have hypertension if the BP was ⩾140/90 mmHg or ⩾130/80 mmHg in diabetic patients or if they were undergoing pharmacological treatment for hypertension. The obesity was based on body mass index (BMI). Overweight was if the BMI was ⩾25 kg/m2, obese ⩾30 kg/m2 and severe obesity (SO) if BMI was ⩾40 kg/m2. Abdominal obesity (AO) was considered when the waist circumference was greater than 102 cm in men and 88 cm in women. Results. The prevalence of obesity in our hypertensive patients was 51.6% and among these 3.8% had SO. Furthermore, 38.7% were overweight. AO was observed in 66.1% of the whole. Both obesity and AO were significantly more prevalent in women. When evaluating the patients according to categories of BMI, we observed greater levels of BP (from 145.5/84.5 to 149.5/89 mmHg, p<0.0001), worse control over BP (from 29.6% to 15.4%, p<0.0001) and a greater prevalence of MetS (from 20.8% to 66.9%, p<0.0001) as weight increased. Likewise, an increase in both BMI and AO was associated with worse control of BP (obesity, OR = 1.343 (95% confidence interval, CI, 1.251–1.442); AO, OR = 1.292 (95% CI 1.201–1.389). Conclusions. There is a high prevalence in Spain of obesity and AO in patients with hypertension. These conditions are associated with metabolic alterations and worse BP control.

Effects of Alcohol Withdrawal on 24 Hour Ambulatory Blood Pressure Among Alcohol-Dependent Patients

BACKGROUND Although epidemiologic studies have reported an association between alcohol intake and high blood pressure (BP), the results of intervention studies have shown inconsistent results. We embarked on a study to determine whether different subgroups of alcohol-dependent patients may be identified in relation to the effect of alcohol on BP. METHODS Fifty alcohol-dependent men (mean age, 41.4 years) received 0.4 g of ethanol per kilogram of body weight every 4 hr in 200 ml of orange juice during 24 hr and the same amount of orange juice without ethanol during another 24 hr. Twenty-four hour ambulatory BP monitoring was performed during ethanol and orange juice intakes, as was hormonal and biochemical analysis. RESULTS Thirty-five (75%) alcohol-dependent men were normotensive and 15 (30%) hypertensive. Eighteen (51%) normotensive and 12 (80%) hypertensive subjects showed a significant decrease in 24 hr mean BP after ethanol withdrawal (mean decrease of 8.4 mm Hg [95% confidence interval, -11.2 to -5.7] and 12.5 mm Hg [confidence interval, -16.2 to -8.8], respectively) and were considered as sensitive to alcohol. The remaining alcohol-dependent subjects were considered as resistant to alcohol. Normotensive subjects sensitive to ethanol showed a significantly greater left ventricular mass and a significantly lower ejection fraction than those normotensive patients whose BP did not change after ethanol withdrawal (both p < 0.01). CONCLUSIONS More than three fourths of the hypertensive and more than half of the normotensive alcohol-dependent patients showed sensitivity to the pressor effects of ethanol. Impairment also was observed in heart function in normotensive patients sensitive to the pressor effects of ethanol.

Erythrocyte Sodium Transport, Intraplatelet pH, and Calcium Concentration in Salt-Sensitive Hypertension

We evaluated changes in erythrocyte sodium transport systems, platelet pH, and calcium concentration induced by low and high salt intakes in a group of 50 essential hypertensive patients classified on the basis of their salt sensitivity. Patients received a standard diet with 20 mmol NaCl daily for 2 weeks supplemented in a single-blind fashion by placebo tablets the first 7 days and NaCl tablets the following 7 days. Salt sensitivity, defined as a significant rise (P <.05) in 24-hour mean blood pressure obtained by ambulatory blood pressure monitoring, was diagnosed in 22 (44%) patients. The remaining 28 (56%) were considered to have salt-resistant hypertension. In the entire group of hypertensive patients, high salt intake promoted a significant increase (P <.05) in the maximal rate of erythrocyte NA(+)-Li(+) countertransport (from 271 +/- 19 to 327 +/- 18 microM/(L cells/h) and of the Na(+)-dependent HCO3(-)-CL(-) exchanger (from 946 +/- 58 to 1237 +/- 92 microM/L cells/h) as well as in platelet pH (from 7.15+/-0 0.01 to 7.19+/-0.02 and calcium concentration (from 49+/-2 to 57 +/-2 nmol/L). Depending on salt sensitivity, high salt intake promoted opposing changes in some of the sodium transport systems studied. Salt-sensitive patients increased the maximal rate of the erythrocyte Na(+)-K(+) pump (fom 7.0 +/- 0.4 to 8.8 +/- 0.4 mmol/(L cells/h), Na(+)-K(+)-Cl(-) cotransport (from 416 +/- 37 to 612 +/- 41 micromol/(L cells/h), Na(+)-Li(+) countertransport (from 248 +/- 20 to 389 +/- 17 micromol/(L cells/h) at the end of the high salt period. Conversely, salt-resistant patients decreased the Na(+)-K(+) pump (from 8.0 +/- 0.4 to 6.9 +/- 0.3 mmol/(L cells/h) and Na(+)-K(+)-Cl(-) cotransport (from 578 +/- 53 to 481 +/- 43 micromol/(L cells/h). We conclude that modulation of erythrocyte sodium transport systems by high salt intake depends on salt sensitivity. The Na(+)-K(+) pump, Na(+)-K(+)-Cl(-) cotransport, and Na(+)-Li(+) countertransport increase in salt-sensitive patients, whereas the activity of these sodium transport systems tends to decrease in salt-resistant patients. Independent of salt sensitivity, high salt intake promotes a significant increase in the erythrocyte Na(+)-dependent HCO3(-)-Cl(-) exchanger, platelet pH, and calcium concentration in essential hypertensive patients.

Prevalencia y características clínicas de la microalbuminuria en la población española con hipertensión arterial

BACKGROUND AND OBJECTIVE: The presence of microalbuminuria (MAB) in hypertension is now considered a sign of target organ damage. The aim of this study was to determine the prevalence of MAB in the Spanish hypertensive population and to correlate the degree of urinary albumin excretion (UAE) with the severity of blood pressure (BP) elevation and the presence of other cardiovascular risk factors. PATIENTS AND METHOD: Cross-sectional study of 4,952 hypertensive patients attended in primary care centres. UAE was determined in a fresh urine sample by calculating the ratio of albumin to creatinine excretion (mg/g). RESULTS: Median UAE was 13 mg/g (interquartile range, 4-29). The prevalence of MAB considered as a UAE between 30 and 300 mg/g was 21.4% with an additional 1.8% of patients having overt proteinuria (UAE > 300 mg/g). Compared with hypertensives without MAB, those who presented this feature exhibited significantly higher (p < 0,001) systolic and diastolic BP (146/85 vs 142/83 mmHg). The prevalence of MAB was also significantly higher (p < 0.001) in patients with other cardiovascular risk factors, such as hypercholesterolemia, smoking or a family history of early cardiovascular disease, and in those exhibiting other signs of target organ damage, such as left ventricular hypertrophy or mild renal insufficiency. CONCLUSIONS: MAB is present in more than 20% of the hypertensive Spanish population attended in primary care centres. There is a clear correlation between MAB and both BP elevation and the presence of other cardiovascular risk factors and signs of target organ damage.

Na+-Li+ countertransport in essential hypertension

Several studies on Na+-Li+ countertransport have reported higher rates in essential hypertensive than in normotensives, with a distribution pattern which is dependent on racial and ethnic background. However, it is not well established whether this abnormality in Na+ transport is associated with an abnormal clinical setting. In the present study we have performed a kinetic analysis of the interaction of the Na+-Li+ countertransport system with internal Na+ in erythrocytes from a sample of 72 essential hypertensives and 30 normotensive controls. A significant increase in mean values of the maximal rate of Li+-stimulated Na+ efflux (Vmax; 375.1 +/- 23.8 versus 213.7 +/- 8.5 mumol/l cells per h; mean +/- s.e.m.; Mann-Whitney test: U = 500; P less than 0.0001), as well as in the apparent affinity constant for internal Na+ (KNa; 10.03 +/- 0.08 versus 6 +/- 0.4 mmol/l cells; Mann-Whitney test: U = 718; P less than 0.0079), were observed in essential hypertensives with respect to normotensives. Using the 95% confidence interval of Vmax in normotensives as the normal range, 29 (40.3%) of the essential hypertensives exhibited values above the normal upper limit. The maximal rate (Vmax) and the internal Na+ content required for half-maximal stimulation (K50%) of Na+-K+ ATPase and outward Na+-K+ cotransport, and the rate constant of Na+ leak (KPNa) in this subset were similar to the values observed in the controls.(ABSTRACT TRUNCATED AT 250 WORDS)