Alvaro Bonet

Kidney function and cardiovascular disease in the hypertensive population: the ERIC-HTA study.

Background and objectives Epidemiological data on the incidence and prevalence of cardiovascular disease in chronic renal failure are scant The objective of the present study is to assess the relationship between renal function, measured by the estimated glomerular filtration rate, and the presence of early or established cardiovascular disease, in a population of hypertensives from primary care. Patients and methods Cross-sectional, multicentre study carried out in primary care centres all over Spain. Hypertensive subjects, older than 55 years, were included. In all of them a structured interview including cardiovascular risk factors or disease was performed. Blood pressure was measured following a standard procedure, and serum biochemistry and an electrocardiogram were obtained. Renal function was estimated using the abbreviated MDRD (Modification of Diet in Renal Disease Study Group) equation. For each glomerular filtration rate stratum the odds ratio and 95% confidence interval (CI) of left ventricular hypertrophy or cardiovascular disease were calculated, adjusted by confounding variables. Results A total of 13 687 patients (mean age 68.1 years, women 55.4%, diabetics 30.6%, body mass index 28.6 kg/m2) were included. Of these, 26.4% had established cardiovascular diseases and 20.3% electrocardiographic left ventricular hypertrophy. The average serum creatinine was 1.01 mg/dl, creatinine clearance 70.0 ml/min, and glomerular filtration rate 74.0 ml/min per 1.73 m2. Thirty-three patients (0.24%) had glomerular filtration rate < 5 ml/min per 1.73 m2; 89 (0.65%) from 15 to 29; 3745 (27.36%) from 30 to 59; 7798 (56.97%) from 60 to 89; and 2019 (14.75%) higher than 89 ml/min per 1.73 m2. In a multiple regression analysis, after adjusting by age, sex, body mass index, diabetes, systolic and diastolic blood pressure, and smoking, a lower glomerular filtration rate was associated with a higher prevalence of left ventricular hypertrophy. Likewise, a reduction in the glomerular filtration rate was also associated with a higher prevalence of cardiovascular disease. Conclusions In hypertensive patients from primary care, the prevalence of cardiovascular disease is inversely proportional to the level of renal function. Estimated glomerular filtration is easy to determine and complements evaluation of the hypertensive patient.

Hipertrofia ventricular izquierda en la población hipertensa española. Estudio ERIC-HTA☆

Introduccion y objetivos El objetivo del presente estudio es evaluar la prevalencia de hipertrofia del ventriculo izquierdo (HVI) en el electrocardiograma y el perfil epidemiologico en pacientes hipertensos atendidos en atencion primaria. Pacientes y metodo Estudio transversal, multicentrico, realizado en 15.798 pacientes hipertensos ≥ 55 anos de centros de atencion primaria. Se midio la presion arterial y se recogieron los antecedentes cardiovasculares de la historia clinica de los pacientes. La HVI se evaluo segun los criterios de Cornell. Resultados Se evaluo a 15.798 pacientes (edad media, 68,0 anos; 55,3% mujeres; 30,4% diabeticos). El 20,3% presento HVI en el electrocardiograma. La prevalencia fue mayor en varones, diabeticos, fumadores, pacientes con presion arterial no controlada y pacientes con enfermedad renal o con cualquier antecedente de enfermedad cardiovascular. Respecto a los pacientes sin HVI, los pacientes con HVI eran de edad mas avanzada, habia un mayor porcentaje de varones, y mas prevalencia de diabetes mellitus (el 40,5 frente al 27,8%), enfermedad renal (el 34,2 frente al 26,9%) y enfermedad cardiovascular (el 52,1 frente al 20,2%). En el analisis multivariante, la HVI se asocio, de forma independiente, con una edad mas avanzada, el sexo masculino, la diabetes, el tabaquismo, la ausencia de control de la presion arterial, y la presencia de enfermedad cardiovascular y renal. El porcentaje de pacientes que cumplian objetivos de control de presion arterial fue menor entre los pacientes con HVI respecto a aquellos sin HVI. Conclusiones La prevalencia de HVI en el electrocardiograma es elevada y se asocia con una mayor prevalencia de diabetes, y enfermedad renal y cardiovascular, ademas de un control de la presion arterial deficiente.

Metabolic syndrome, organ damage and cardiovascular disease in treated hypertensive patients. The ERIC-HTA study.

The aim of this study is to assess the relationship among metabolic syndrome (MS), target organ damage (TOD) and established cardiovascular disease (CVD) in non‐diabetic hypertensive elderly patients. ERIC‐HTA is cross‐sectional, multicentre study carried out in primary care, on hypertensive patients aged 55 or older. MS was defined by the NCEP‐ATP III criteria, using body mass index (>28.8 kg/m2) instead of abdominal perimeter. In 8331 non‐diabetic hypertensive patients (3663 men and 4668 women, mean age 67.7 years), the prevalence of MS was 32.6% (men: 29.0%; women: 36.8%). A linear association was observed between a greater number of components of MS and a greater prevalence of left ventricle hypertrophy (LVH) on the electrocardiogram (p<0.001), impaired kidney function (p<0.001) and established CVD (p = 0.001). In a multivariate model, MS in non‐diabetic hypertensive patients was related to a greater prevalence of LVH (OR 1.31 [95% CI: 1.15–1.48]), impaired kidney function (OR 1.45 [95% CI: 1.29–1.63]) and established CVD (OR 1.22 [95% CI: 1.08–1.37]). This relationship persisted after stratifying by gender. In conclusion, in this elderly non‐diabetic hypertensive population, the presence of MS was independently related to a greater prevalence of hypertensive TOD and established CVD, suggesting a role of MS as a cardiovascular risk marker in hypertension.

Evaluación del riesgo de un primer ictus en la población hipertensa española en atención primaria. Estudio ERIC-HTA

BACKGROUND AND OBJECTIVE Stroke is a major cause of morbidity and mortality in hypertensive population. The aim of this study is to estimate the 10-year risk of a first stroke in Spanish hypertensive population using the Framingham scale. PATIENTS AND METHOD Cross-sectional multicenter study in primary care environment, on hypertensive patients aged 55 or more (10 consecutive patients each physician). Blood pressure (BP) was measured according to standardized rules. Stroke and coronary risk were estimated using the Framingham scale. RESULTS 16,129 patients (mean age 67.7 years; 57.1% women; 30.4% with diabetes mellitus; 26.6% with previous history of cardiovascular disease) were analyzed. 20.3% showed electrocardiographic left ventricular hypertrophy (more prevalent in males, diabetics, with systolic BP > or = 140 mmHg; p < 0.001). The goal of BP control was reached in 30.1% of non-diabetic patients and only in 5.9% of diabetics. The estimated 10-year risk of a first stroke (standard deviation) was estimated to be 19.9% (16.8), and the coronary risk 19.2% (14.0). While males had an estimated risk of coronary disease above the stroke risk, women had an estimated risk of a first stroke greater than the estimated risk of coronary disease. CONCLUSIONS The estimated risk of stroke among Spanish hypertensive population is high, and the main risk factors (age, systolic BP, diabetes and left ventricular hypertrophy) tend to aggregate. In women estimated risk of stroke in greater than estimated coronary risk. The risk of stroke must be taken into account in the assessment and treatment of hypertensive patients.

Left Ventricular Hypertrophy in the Spanish Hypertensive Population. The ERIC-HTA Study

INTRODUCTION AND OBJECTIVES Left ventricular hypertrophy (LVH) is the earliest manifestation of cardiac damage in hypertension. Its appearance is associated with a poor cardiovascular prognosis. The objectives of this study were to determine the prevalence of electrocardiographic LVH and to assess the epidemiological characteristics of hypertensive patients receiving primary care. PATIENTS AND METHOD A cross-sectional multicenter study of hypertensive patients aged 55 years or more was carried out in a primary care setting. Blood pressure was measured using the standard method. Cardiovascular history was determined from medical records and LVH was assessed electrocardiographically using Cornells criteria. RESULTS In total, 15 798 patients (mean age 68.0 years, 55.3% women, and 30.4% with diabetes mellitus) were evaluated. Of these, 3207 (20.3%) had electrocardiographic signs of LVH. The prevalence was higher in males, diabetics, smokers, and patients with high blood pressure or renal or cardiovascular disease. Compared to patients without LVH, those with the condition were older, were more often male, and were more likely to have diabetes or renal or cardiovascular disease. Multivariate analysis showed that LVH was independently associated with advanced age, male gender, diabetes, smoking, poor blood pressure control, and the presence of cardiovascular or renal disease. Blood pressure control was poorer in patients with LVH than in those without it. CONCLUSIONS The prevalence of electrocardiographic LVH is high, with affected patients being more likely to have diabetes or renal or cardiovascular disease. Moreover, blood pressure control is poor in these patients, and more aggressive pharmacological management is needed.

Colesterol HDL y enfermedad cardiovascular en mujeres hipertensas de España. Estudio RIMHA

La enfermedad cardiovascular constituye una serie de entidades patologicas que tienen tratamientos medicos diferentes. La terapia celular es un enfoque del siglo xxi para abordar el tratamiento de la enfermedad cardiovascular y se aplica en todo el mundo. Sin embargo, no se ha abordado de manera adecuada la definicion de la mejor poblacion celular a utilizar ni las mejores condiciones de tratamiento. Seria ingenuo creer que se pueda encontrar un tratamiento unico (ni siquiera con celulas madre) que permita tratar todo el espectro de las enfermedades cardiovasculares. Describimos el espectro de la cardiopatia isquemica, los posibles usos de celulas para su tratamiento adecuado y las cuestiones basicas que hay que abordar al contemplar la terapia celular cardiovascular. El objetivo clinico es la regeneracion cardiaca y vascular, pero todavia esta por determinar si las celulas pueden conseguir estos efectos. La eleccion de la celula correcta, la ventana terapeutica ideal y el paciente «adecuado» tambien son cuestiones abiertas al debate. Este articulo se ha disenado para aportar una perspectiva respecto a las fases inicial, media y avanzada de la enfermedad cardiovascular y describir como podrian usarse las celulas de un modo diferenciado para el tratamiento de cada fase.

High-Density Lipoprotein Cholesterol and Cardiovascular Disease in Spanish Hypertensive Women. The RIMHA Study

INTRODUCTION AND OBJECTIVES To determine the prevalence of a low high-density lipoprotein cholesterol (HDL-C) concentration in 11,042 hypertensive Spanish women aged >or=55 years, to identify factors associated with a low concentration, and to evaluate its relationship with cardiovascular disease (CVD). METHODS Analysis of RIMHA cross-sectional study findings. Data on demographic, biochemical and clinical variables were obtained. Relationships between a low HDL-C concentration (<46 mg/dL) and CVD and between the HDL-C concentration (in quintiles) and CVD were studied by multivariate logistic regression modeling. RESULTS The prevalence of a low HDL-C concentration was 24.3% (95% confidence interval [CI], 23.5-25.1%), and was higher in women with diabetes or CVD. A low HDL-C concentration was independently associated with excess weight, smoking, diabetes and the presence of CVD, and inversely with age. The prevalence of CVD was higher in women with a low HDL-C concentration (24.7% vs. 18.4% in those with a normal concentration; P< .001). There was an independent association between a low HDL-C concentration and CVD after adjustment for other risk factors (odds ratio [OR]=1.42; 95% CI, 1.26-1.60; P< .001) and with silent target organ damage (OR=1.31; 95% CI, 1.15-1.49; P< .001). Similarly, there was an independent inverse association between the HDL-C concentration (in quintiles) and the prevalence of CVD, particularly for HDL-C concentrations <58 mg/dL. CONCLUSIONS One in four hypertensive women aged >or=55 years had a low HDL-C concentration, which was independently associated with the presence of CVD. Moreover, there was an inverse association between the HDL-C concentration and the prevalence of CVD, even at normal HDL-C concentrations.

Estimated risk of a first stroke and conditioning factors in Spanish hypertensive women. The RIMHA study

Stroke is the leading cause of mortality in women in Spain. RIMHA is a cross‐sectional multicenter study in hypertensive women aged 55 or more in primary care to estimate the 10‐year risk for a first stroke. Clinical history, cardiovascular risk factors and diseases, electrocardiogram, blood samples and blood pressure (BP) were recorded. Stroke and coronary risk were estimated using the appropriate Framingham scales; 12 875 patients were included (mean age 68.0±8.5 years, 29.1% with diabetes, 19.7% with cardiovascular disease). Electrocardiographic left ventricular hypertrophy (LVH) was present in 19.2%. BP was controlled in 42.9% of non‐diabetic (BP<140/90 mmHg) and 9.7% of diabetic patients (BP<130/80 mmHg). The 10‐year risk (±SD) for a first stroke was estimated as 15.8±16.3%, and the coronary risk as 12.0±6.3. In the multivariate analysis, the most contributing factors for stroke risk estimation were age, systolic BP, LVH and atrial fibrillation. In conclusion, the 10‐year estimated stroke risk for Spanish hypertensive women aged 55 years or more was higher than the estimated coronary risk, in accordance with the high rates of morbidity and mortality due to stroke among women in Spain. The most powerfull risk factors were older age, poor BP control, LVH and atrial fibrillation.