Elisenda Gómez-Angelats

Silent cerebral white matter lesions in middle-aged essential hypertensive patients.

Objective Age, hypertension, diabetes mellitus and a history of cardiovascular disease are the most important factors related to the presence of cerebral white matter lesions (WML), which are a common finding in elderly people. This study investigates which factors related to hypertension per se are associated with the presence of WML in asymptomatic, middle-aged, never-treated essential hypertensive patients. Methods A total of 66 untreated essential hypertensive patients of both genders, aged 50–60 years, with neither diabetes mellitus nor evidence of cardiovascular disease, were studied. Hypertensive patients were classified into two groups according to the presence or absence of WML in brain magnetic resonance imaging (MRI). Results A total of 39 (59.1%) hypertensives showed no WML in brain MRI, and 27 (40.9%) exhibited the presence of WML. Compared with hypertensives without WML, patients with WML showed significantly higher values of both office and 24 h ambulatory blood pressure monitoring (ABPM) systolic, diastolic, mean and pulse pressure. No differences were observed in either the nocturnal fall of blood pressure, or in blood pressure variability, assessed by 24 h standard deviation, among hypertensives with WML. In contrast, the nocturnal decline of heart rate was significantly blunted in patients with WML, compared with those without WML. Conclusions Cerebral white matter lesions are a common finding in asymptomatic middle-aged essential hypertensives. The severity of blood pressure elevation seems to be the most important factor related to the presence of WML. Neither the circadian rhythm nor the long-term variability of blood pressure were related to WML.

G-Protein β3 Subunit Gene Variant and Left Ventricular Hypertrophy in Essential Hypertension

A functional genetic variant consisting of a C825T substitution in the GNB3 gene, encoding for the G-protein beta(3) subunit, has been associated with enhanced G-protein activation and cell growth. The aim of the study was to investigate the association of this polymorphism with left ventricular hypertrophy (LVH) in a sample of patients with essential hypertension. Left ventricular mass was assessed by 2-mode echocardiography in 86 patients with essential hypertension, and GNB3 C825T genotype was determined by polymerase chain reaction and restriction digestion. Thirty-seven (0.43) patients were homozygous for the C allele (CC), 40 (0.47) were heterozygous (CT), and 9 (0.10) were homozygous for the T allele (TT). The genotype distribution among the patients was in Hardy-Weinberg equilibrium. Values of left ventricular end-diastolic diameter (52.0+/-0.7 versus 48.9+/-0.9 mm, P=0.007), posterior wall thickness (11.3+/-0.2 versus 10.6+/-0.2 mm, P=0.042), and left ventricular mass index (152.7+/-4.4 versus 135.2+/-6.4 g/m(2), P=0. 023) were significantly higher in patients with CT and TT genotypes considered together (CT+TT) than in CC patients. The distribution of the genotypes was significantly different when comparing patients with LVH: 20 (0.33) CC and 40 (0.67) CT+TT patients had this complication, and 17 (0.65) CC and 9 (0.35) CT+TT patients did not (P<0.01). The frequency of the T allele was significantly different among patients with (0.40) and without (0.20) LVH (P<0.01). A logistic regression analysis showed that the association between the T allele and LVH was independent of age, mean blood pressure, body mass index, and alcohol consumption. The relative risk of LVH in patients bearing the T allele (CT+TT group) compared with CC hypertensive patients was 3.03 (95% CI 1.14 to 8.05). The findings suggest an association between LVH and the 825T allele in hypertensive patients.

Correlation between silent cerebral white matter lesions and left ventricular mass and geometry in essential hypertension

BACKGROUND It has been proposed that concentric left ventricular hypertrophy (LVH) is related to a worse degree of target organ damage in hypertensives with this feature than in those without. Moreover, the presence of cerebral white matter lesions (WMLs) is considered to be an early marker of brain damage in essential hypertension. The aim of this study was to assess the association between the presence of silent WMLs and left ventricular mass and geometry in middle-aged individuals with hypertension that had never been treated. METHODS A total of 62 patients (39 men, 23 women, aged 50 to 60 years, mean age 54.4 +/- 3.2 years) with never-treated essential hypertension and without clinical evidence of target organ damage were studied. All patients underwent brain magnetic resonance imaging and were classified into two groups according to the presence or absence of WMLs. Echocardiography measuring posterior wall thickness (PWT), interventricular septum thickness (IVST) and left ventricular end-diastolic diameter (LVEDD) was also performed. Left ventricular mass index (LVMI) was calculated using the Penn convention criteria, and relative wall thickness ratio (RWT) was estimated by the standard formula: 2 x PWT/LVEDD. RESULTS Hypertensive patients with WMLs exhibited significantly higher PWT, IVST, LVMI, and RWT when compared with hypertensive patients without WMLs. In addition, 23 of 26 hypertensive patients with WMLs showed echocardiographic criteria for LVH that was significantly higher than that observed in hypertensive patients without WMLs (21 of 36; P = .01). Concentric hypertrophy (LVH and RWT > or = 0.45) was present in 14 hypertensive patients with WMLs and in only four patients without WMLs (P = .002). CONCLUSION There is a close association between cerebral WMLs and concentric LVH in asymptomatic middle-aged hypertensive patients, independent of blood pressure values.

Saturación del servicio de urgencias: factores asociados y cuantificación

Fundamento y objetivo La utilizacion de los servicios de urgencias hospitalarios (SUH) es cadavez mayor, lo que conduce a su masificacion. El objetivo del presente trabajo es definir la «saturacion» de un SUH y determinar y cuantificar los factores que la condicionan. Pacientes y metodo Durante tres semanas consecutivas de anos distintos (2000-2002) se contabilizaroncada 3 h las entradas, el indice de ocupacion (IO) de los pacientes que permanecianen el SUH, en el area de primera asistencia (APA) y en el area de observacion (AO) segun lacausa de dicha permanencia. Los datos se sometieron a analisis de regresion logistica multiplecon la variable dependiente «saturacion/no saturacion» de cada una de las areas (SUH, APA yAO). Se definio la saturacion cuando el IO era igual o superior al 100%. Los modelos de cadaarea se calibraron por la prueba de Hosmer-Lemeshow y se discriminaron por metodologia ROC.Los modelos explicativos se armaron separando aleatoriamente dos grupos: seleccion (88% dedatos) y validacion (12% de datos). Resultados Las variables que se asociaron de forma significativa a la saturacion en el modelodel SUH fueron el IO debido a los pacientes que esperaban resultados, ir a una cama, encontrarcama, exploraciones complementarias y en evolucion. En el modelo del APA, lo fueron elIO debido a los que estaban visitandose y esperaban resultados. Finalmente, para el modelodel AO lo fueron el IO debido a los que esperaban ir a una cama, encontrar cama, exploracionescomplementarias y en evolucion. Todos los modelos mostraron sensibilidad y especificidadsuperiores al 85% y un area ROC superior a 0,97. En ningun caso el numero de pacientes queacuden a urgencias participo del modelo explicativo final. En el grupo de validacion se confirmaronestos resultados. Conclusiones Los pacientes que permanecen en el servicio de urgencias por factores dependientestanto del hospital (esperando ir a una cama o encontrar una cama) como del propio serviciode urgencias (esperando evolucion) son la principal causa de saturacion de los SUH.

Lack of association between ACE gene polymorphism and left ventricular hypertrophy in essential hypertension.

The possible association between the insertion/deletion (I/D) polymorphism of the angiotensin I converting enzyme (ACE) gene and left ventricular hypertrophy (LVH) was investigated in a group of essential hypertensive patients. Seventy-one essential hypertensive patients (35 men and 36 women), aged 51 ± 1 years, were genotyped by PCR for the I/D polymorphism of the ACE gene. Cardiac morphology and function were assessed by means of M-mode echocardiography. The relative frequencies of the three genotypes, DD, DI, and II, were respectively: 24%, 55%, and 21%. Mean values of left ventricular mass index were 145, 144, and 150 g/m2 for DD, DI, and II genotypes, without significant differences among them (P = 0.82). Likewise, the prevalence of LVH (76%, 64%, and 87%) was not significantly different among the three genotypes (P = 0.23). We conclude that the ACE gene I/D polymorphism is not associated with LVH in essential hypertension.

Validation of a triage flowchart to rule out acute coronary syndrome

Objective To validate a triage flowchart to rule out acute coronary syndrome (ACS) in chest pain patients attending the emergency department (ED). Methods An observational cohort study of consecutive patients. In all cases, a previously derived five-step triage flowchart (age ≤40 years, absence of diabetes, not previously known coronary artery disease, non-oppressive and non-retrosternal pain) was applied. Patients meeting all five discriminators were grouped as ‘five-step triage non-ACS’, the rest as ‘five-step triage ACS’. The same strategy was used with a four-step model (without age ≤40 years). After ED study and 1-month follow-up, patients were definitively classified as ‘true ACS’ or ‘true non-ACS’. Validity indexes and receiver operating characteristics curves were calculated. Results 4231 patients were included: 918 (21.7%) were ‘true ACS’, 3303 (78.1%) ‘true non-ACS’; 10 (0.2%) were lost to follow-up. The five-step triage flowchart classified 4000 (94.8%) as ‘triage ACS’ and 221 (5.2%) as ‘triage non-ACS’; none of the latter was ‘true ACS’. The four-step model classified 3194 (75.6%) as ‘triage ACS’ and 1027 (24.4%) as ‘triage non-ACS’. A ‘true ACS’ was seen in 26 patients from the latter group. Accordingly, five-step triage flowchart specificity and positive predictive value (PPV) to rule out ACS were 100% (95% CI 100% to 100%). For the four-step model specificity and PPV were 97% (95% CI 96% to 98%). Conclusion The five-step triage flowchart identifies chest pain patients without an ACS. However, only 5% of these patients meet these five criteria. A simpler model allows greater patient inclusion but a higher risk of misclassification of true ACS.

Impacto de los componentes y sistemas de medición de la presión arterial sobre la lesión de órgano diana y las complicaciones cardiovasculares en la hipertensión arterial

Fundamento Evaluar el impacto de los diferentes componentes de la presion arterial (PA), determinados tanto en la consulta como por monitorizacion ambulatoria de la PA (MAPA), sobre el desarrollo de la lesion de organo diana y los episodios cardiovasculares (ECV) de la hipertension arterial (HTA) Pacientes y Metodo Estudio retrospectivo llevado a cabo en 390 pacientes (55% varones; edad media de 56 anos) atendidos en una unidad de HTA entre 1989 y 1998. En todos los pacientes se disponia de las determinaciones iniciales de la PA clinica mediante esfigmomanometro de mercurio y de MAPA de 24 h, con el paciente libre de tratamiento antihipertensivo. Se obtuvieron los indices de Cornell y Sokolow del ECG como reflejo de la afeccion cardiaca hipertensiva y la creatinina serica, aclaramiento de creatinina y excrecion urinaria de proteinas en 24 h, como medida del dano renal. La metodologia estadistica empleada fue la regresion lineal multiple y la regresion logistica Resultados Cuarenta y nueve pacientes desarrollaron ECV (26 accidentes cerebrovasculares, 18 infartos de miocardio y 5 pacientes con ambos episodios). De todas las mediciones de PA, fue el aumento de la presion de pulso (PP) en la clinica el factor independiente mejor relacionado con la aparicion de ECV (odds ratio multivariado=1,03; intervalo de confianza [IC] del 95%, 1,00–1,05; p=0,0095). Respecto a la correlacion con los diferentes indicadores de lesion del organo diana, los analisis de regresion lineal multiple pusieron de manifiesto una asociacion del indice de Cornell del ECG con la PAS nocturna obtenida en MAPA (coeficiente estandarizado s=0,260; p Conclusiones El desarrollo de ECV en la HTA se correlaciona con las cifras de PA clinica (especialmente con la PP), mientras que los indicadores de la lesion del organo diana (hipertrofia cardiaca, lesion renal) se correlacionan mejor con la PA obtenida mediante MAPA (especialmente con la PAS y PP)

Validación del aparato oscilométrico Angelini Línea F1 para la medida clínica y la automedida de presión arterial

Fundamento La utilizacion creciente de aparatos automaticos y semiautomaticos para la medida de la presion arterial (PA) hace necesario que sean sometidos a procesos de validacion a partir de unos criterios estandarizados. El objetivo del presente estudio ha sido el de evaluar la fiabilidad del aparato oscilometrico de medida de presion arterial en el brazo Angelini Linea F tomando como base los criterios propuestos por el Grupo de Trabajo sobre Monitorizacion de la Presion Arterial de la Sociedad Europea de Hipertension. Metodos Se han estudiado 33 individuos con rangos de PA inferiores a 130/60 mmHg (11 sujetos) entre 130-160/80-100 mmHg (11 sujetos) y superiores a 160/100 mmHg (11 sujetos). En cada individuo se han realizado tres pares de medidas de presion con esfigmomanometro de mercurio y con el aparato oscilometrico a validar, obteniendose un total de 99 comparaciones. Resultados De las 99 comparaciones, 47 para la PA sistolica (PAS) y 70 para la PA diastolica (PAD) presentaron diferencias ??5 mmHg, 83 para la PAS y 89 para la PAD diferencias ??10 mmHg y 91 para PAS y PAD diferencias ?15 mmHg, cumpliendo los requisitos establecidos por la Sociedad Europea de Hipertension. Las diferencias medias entre ambos procedimientos fueron de 2,8 ± 8,45 mmHg para la PAS y de 1,2 ± 6,55 mmHg para la PAD. Los coeficientes de correlacion intraclase fueron de 0,969 para la PAS y de 0,925 para la PAD. Conclusiones El aparato oscilometrico de medida de PA en el brazo Angelini Linea F cumple los requisitos de la Sociedad Europea de Hipertension y puede considerarse valido para la medida clinica y la automedida de la PA.