J. Merino Sánchez

Cronobiología, cronoterapia y riesgo vascular

The importance of rhythmic activities in humans, and their influence on the diseases are underscored. Clinical chronology is fundamental in order to interpret the physiopathological basis of temporary variations. Knowing the variability of the biological processes also makes it possible improving the effect of drugs utilized and minimize their adverse effects. This is the objective of Chronotherapy. We apply chronology and Chronotherapy in cardiovascular diseases, since many of them adjust their prevalence for specific rhythms. One thinks about the mechanisms or factors that favor cardiovascular diseases, especially those related to the circadian variations of blood pressure. We also review the variations in the pharmacokinetics of the drugs used in the treatment of cardiovascular diseases, delving further into the analysis of its effects according to their administration schedule. We can conclude that the use of those drugs according to the chronological knowledge makes possible to achieve better results in the control of cardiovascular diseases, and a greater safety in its use.

Estudio de farmacovigilancia con lercanidipino. Datos del estudio ZANyCONTROL

Introduction The study has aimed to evaluate the effectiveness of lercanidipine in the control of the hypertension as well as its clinical tolerability and biochemistry.

Utilidad clínica de la automedida de la presión arterial

Estan fuera de toda duda los beneficios que la automedida de presion arterial aporta en el mejor diagnostico, control y tratamiento del hipertenso. Tambien ayuda a la investigacion, permite reducir costes y es un metodo facil, seguro y util. En el nuevo modelo de practica clinica centrada en el enfermo se debe favorecer su uso.Without a doubt blood pressure autoevaluation facilitates hypertension diagnosis, control and treatment. This also helps research, makes possible costs reduction and is an easy, safe, and useful method. Its use should be favored in the new model of patient-based clinical practice.

Tratamiento farmacológico del riesgo cardiovascular metabólico

Se plantean los principales factores que condicionan un aumento del riesgo vascular de causa metabolica. De cada uno de ellos se explican los mecanismos posibles de implicacion, evidencia disponible, niveles en que aumenta el riesgo y posibles medidas para su control.

Valoración de la semiología psicosomática en hipertensos tratados con lercanidipino ( estudio LERCAPSICO )

OBJECTIVE: To value the grade of anxiety and psychosomatic semiology in hypertensive patients treated with lercanidipine and to analyse their evolution. A secondary objective is to carry out a pharmacovigilance study with lercanidipine. MATERIAL AND METHODS: Prospective multicentre observational 6 month study in primary hypertensive patients with SBP between 140-180 mm Hg and/or 90-110 mm Hg DBP. After a washout period of 10 days, treatment with 10 mg (1-0-0) lercanidipine is initiated. If BP is not controlled treatment with ramipril 2.5 mg/day is instaured. Clinical check-ups are carried periodically with measurements of BP, Heart Rate, objective valuation of tolerance to the drug and observance. At the initiation and end of the study biochemical check-ups are carried out, the level of anxiety is measured using the STAI questionnaire (Trait subscale) (Evaluation in decatipes 0-4 without ansiety 4-7 moderate ansiety, 7-10 high ansiety) and the psychosomatic profile with a questionnaire designed by this group. (Scale 0-18; 0 large semiology, 18 without semiology). Clinical tolerance to the drug is valued both subjectively and objectively. RESULTS: On included 538 patients. On registred 54 drop out, with side effects (3.75/). Completed the study 484 (237 M, 247 F), 429 of them with Lercanidipine in monotherapy (88.6/). Mean age 60.9 +/- 10.7. Mean BMI 29.1 +/- 5. The grade of anxiety did not alter during the study passing from 4.6 +/- 1.7 at the beginning of the study to 4.5 +/- 1.7 at the end of the study (valuation in decatypes) (ns). The psychosomatic semiology changed favourably from 10.7 +/-4.2 to 12.5 +/- 3.7 (p<0.00005). The evolution according to sex is similar. The mean SBP decreased from 165.6 +/- 12.2 mm Hg to 137.9 +/- 10.4 mm Hg (p<0.00005) and the mean DBP decreased from 96.5 +/- 8.1 mm Hg to 81.0 +/- 6.1 mm Hg (p<0.00005). Clinical tolerance was very good. Biochemical parameters were modified substantially: initial cholesterolemia 227.7 mg/dl and final cholesterolemia 213.6 mg/dl (p<0.00005); initial glucose 108.4 mg/dl and final glucose 105.7 mg/dl (p<0.00005). CONCLUSIONS: The mean level of anxiety in the group studied is confirmed not to vary during the length of the study. Psychosomatic semiology is reduced being statistically significant. Lercanidipine is shown to be very effective as antihypertensive and well tolerated. 164

Tuberculosis miliar asociada a síndrome de distrés respiratorio agudo y pancitopenia en paciente VIH negativo

:El sindrome de distres respiratorio agudo (SDRA) es una complicacion rara pero muy grave de la tuberculosis miliar que cuando se asocia a pancitopenia se acerca a una mortalidad del 100%. Esta asociacion ha sido escasamente descrita (11 casos en revision Medline, 1966-1999). Presentamos el caso de 1 paciente VIH negativo con una tuberculosis miliar que comienza como un SDRA, al que se asocia pancitopenia. A proposito del mismo se revisa la literatura, describiendose los factores de riesgo, diagnostico y tratamiento. Es fundamental considerar la tuberculosis como etiologia posible en pacientes con factores de riesgo que presentan SDRA.