Jesús Castillo

Prevalencia de fibrilación auricular y uso de fármacos antitrombóticos en el paciente hipertenso ≥ 65 años. El registro FAPRES

INTRODUCTION AND OBJECTIVES Age and arterial hypertension are two of the main factors associated with atrial fibrillation and an increased risk of embolism. The objective of this study was to determine the prevalence of atrial fibrillation and the extent of antithrombotic use in hypertensive patients aged ≥65 years in the Spanish region of Valencia. METHODS Each study investigator enrolled the first three hypertensive patients aged ≥65 years who came for a consultation on the first day of each week for 5 weeks. Each patients risk factors, history of cardiovascular disease, CHADS(2) score and medical treatment were noted and an ECG was recorded. Data were analyzed centrally. A patient was regarded as having atrial fibrillation if it was observable on the ECG or reported in medical records. RESULTS The study included 1,028 hypertensive patients with a mean age of 72.8 years. Overall, 10.3% had atrial fibrillation: in 6.7%, it was observable on the ECG while 3.6% were in sinus rhythm but had a history of the condition. Factors associated with atrial fibrillation were age, alcohol intake, structural heart disease and glomerular filtration rate. In total, 76.2% of patients with ECG evidence of atrial fibrillation and a CHADS(2) score >1 were taking anticoagulants compared with 41.7% of those who had a history of the condition but were currently in sinus rhythm. CONCLUSIONS The prevalence of atrial fibrillation in our group of hypertensives was 10.3%; in 1.7%, it was previously undiagnosed. Antithrombotic use was high in patients with current atrial fibrillation, but lower in those who had experienced an episode previously.

Usefulness of the fractional flow reserve derived by intracoronary pressure wire for evaluating angiographically intermediate lesions in acute coronary syndrome.

INTRODUCTION AND OBJECTIVES In contrast to findings in stable ischemic heart disease, in acute coronary syndrome (ACS), measurement of the fractional flow reserve (FFR) using an intracoronary pressure wire has not been shown to be useful for evaluating angiographically equivocal coronary lesions. The aim of this study was to analyze outcomes at 1 year in ACS patients with lesions that were classed as intermediate on coronary angiography and which were not nonrevascularized because of the FFR value determined by intracoronary pressure wire. METHODS The observational study involved a cohort of patients admitted for ACS who had intermediate lesions on coronary angiography that were not revascularized because the FFR was >0.75. Functional studies were not carried out if there was angiographic evidence of instability. All-cause mortality, non-fatal myocardial infarction, revascularization of the target lesion and readmission for cardiac causes in the first year of the study were recorded. RESULTS The study included 106 patients with 127 lesions that were not revascularized because the FFR was >0.75. Their mean age was 69.9+/-10 years, 92 (86.8%) had non-ST-elevation ACS, the mean angiographic stenosis was 40.5+/-7.8%, and the mean FFR was 0.88+/-0.06. There were no complications during the procedure. The follow-up rate at 1 year was 95.1%. Events observed at 1 year were: 2 deaths (total mortality 1.9%), 0 fatal acute myocardial infarctions, 1 (0.9%) target lesion revascularization and 5 (4.7%) readmissions for cardiac causes. CONCLUSIONS Once lesions with clear angiographic signs of instability are excluded, intracoronary pressure wire measurement could be useful in ACS patients for avoiding unnecessary revascularization of angiographically intermediate coronary lesions.

¿Qué medida del grosor íntima-media carotídeo caracteriza mejor la carga aterosclerótica del paciente hipertenso: valor máximo o medio?

Recent guidelines on arterial hypertension regard increased carotid intima-media thickness (IMT) as a marker of end-organ damage. However, these guidelines do not specify whether the maximum or mean IMT should be used as an indicator. The aim of this study was to compare these two measures and their relationship to atherosclerotic burden. The study involved 215 consecutive hypertensive patients who were divided into three groups according to their IMT: maximum IMT>0.9mm (with mean IMT<0.9mm); mean IMT>0.9mm (i.e. mean and maximum IMT>0.9mm); and normal IMT. Patients with a pathologically raised IMT (whether maximum or mean value) were more likely to be dyslipidemic, were older, had a longer history of hypertension, and had a poorer glomerular filtration rate and ankle-brachial index. Patients with a mean IMT>0.9mm were more likely to have carotid plaque, carotid stenosis and a low ankle-brachial index than those with a maximum IMT>0.9mm. The mean IMT provided a better indication of atherosclerotic burden in patients with hypertension.

Choice of New Oral Anticoagulant Agents Versus Vitamin K Antagonists in Atrial Fibrillation FANTASIIA Study

Introduction: Atrial fibrillation (AF) is associated with an increased risk of thromboembolic events. Many patients with AF receive chronic anticoagulation, either with vitamin K antagonists (VKAs) or with non-VKA oral anticoagulants (NOACs). We sought to analyze variables associated with prescription of NOAC. Methods: Patients with AF under anticoagulation treatment were prospectively recruited in this observational registry. The sample comprised 1290 patients under chronic anticoagulation for AF, 994 received VKA (77.1%) and 296 NOAC (22.9%). Univariate and multivariate analyses were performed to identify variables associated with use of NOAC. Results: Mean age was 73.8 ± 9.4 years, and 42.5% of the patients were women. The CHA2DS2-VASc score was 0 in 4.9% of the population, 1 in 24.1%, and ≥2 in 71% (median = 4, interquartile range = 2). Variables associated with NOAC treatment were major bleeding (odds ratio [OR] = 3.36; confidence interval [CI] 95%: 1.73-6.51; P < .001), hemorrhagic stroke (OR = 3.19; CI 95% 1.00-10.15, P = .049), university education (OR = 2.44; CI 95%: 1.55-3.84; P < .001), high diastolic blood pressure (OR = 1.02; CI 95%: 1.00-1.03; P = .006), and higher glomerular filtration rate (OR 1.01, CI 95% 1.00-1.01; P = .01). And variables associated with VKA use were history of cancer (OR = 0.46; CI 95%: 0.25-0.85; P = .013) and bradyarrhythmia (OR = 0.40; CI 95% 0.19-0.85; P = .020). Conclusion: Medical and social variables were associated with prescription of NOAC. Major bleeding, hemorrhagic stroke, university education, and higher glomerular filtration rate were more frequent among patients under NOAC. On the contrary, patients with history of cancer or bradyarrhythmias more frequently received VKA.

Usefulness of NT-proBNP Level for Diagnosing Left Ventricular Hypertrophy in Hypertensive Patients. A Cardiac Magnetic Resonance Study

The presence of left ventricular hypertrophy (LVH) is associated with an increase in cardiovascular morbidity and mortality in hypertensive patients. We investigated the diagnostic value of the N-terminal probrain natriuretic peptide (NT-proBNP) level for detecting LVH in hypertensive patients with a conserved left ventricular ejection fraction. The study involved 27 consecutive patients. Cardiac magnetic resonance imaging was performed to determine left ventricular mass and the plasma NT-proBNP level was measured. A significant correlation was found between the NT-proBNP level and left ventricular mass (r=0.598; P=.001). Use of a cut-off point of 35 pg/mL enabled the presence of LVH to be identified with a sensitivity of 100% (95% confidence interval [CI], 69%-100%) and a specificity of 70.6% (95% CI, 44.1%-89.6%). The area under the receiver operating characteristic (ROC) curve was 0.867 (95% CI, 0.73-1; P< .05). The plasma NT-proBNP level may be useful for identifying patients with LVH.

Prevalence of Atrial Fibrillation and Use of Antithrombotics in Hypertensive Patients Aged ≥65 Years. The FAPRES Trial

INTRODUCTION AND OBJECTIVES Age and arterial hypertension are two of the main factors associated with atrial fibrillation and an increased risk of embolism. The objective of this study was to determine the prevalence of atrial fibrillation and the extent of antithrombotic use in hypertensive patients aged >or=65 years in the Spanish region of Valencia. METHODS Each study investigator enrolled the first three hypertensive patients aged >or=65 years who came for a consultation on the first day of each week for 5 weeks. Each patients risk factors, history of cardiovascular disease, CHADS2 score and medical treatment were noted and an ECG was recorded. Data were analyzed centrally. A patient was regarded as having atrial fibrillation if it was observable on the ECG or reported in medical records. RESULTS The study included 1,028 hypertensive patients with a mean age of 72.8 years. Overall, 10.3% had atrial fibrillation: in 6.7%, it was observable on the ECG while 3.6% were in sinus rhythm but had a history of the condition. Factors associated with atrial fibrillation were age, alcohol intake, structural heart disease and glomerular filtration rate. In total, 76.2% of patients with ECG evidence of atrial fibrillation and a CHADS2 score >1 were taking anticoagulants compared with 41.7% of those who had a history of the condition but were currently in sinus rhythm. CONCLUSIONS The prevalence of atrial fibrillation in our group of hypertensives was 10.3%; in 1.7%, it was previously undiagnosed. Antithrombotic use was high in patients with current atrial fibrillation, but lower in those who had experienced an episode previously.

Prevalencia del hiperaldosteronismo primario y afección cardiaca en el paciente hipertenso

El hiperaldosteronismo primario (HAP) es una causa creciente de hipertension arterial (HTA) en los ultimos anos, y se lo ha asociado a un efecto deletereo cardiovascular. Con el objetivo de conocer la prevalencia real de HAP en nuestro medio y sus alteraciones cardiacas, hemos estudiado a 183 pacientes hipertensos consecutivos. Se realizo un completo cribado de HTA secundaria, ECG y ecocardiografia. Se establecio el diagnostico de HAP en 11 (6%) pacientes. Estos presentaban mayores cifras de presion arterial sistolica, mayor prevalencia de hipertrofia ventricular izquierda en el ECG (el 45,5 frente al 11,6%; p

Nuevas herramientas en la estratificación del riesgo cardiovascular

Resumen Una de las manifestaciones mas frecuentes de la enfermedad aterosclerotica, verdadera plaga de la sociedad moderna, es su manifestacion clinica a traves de eventos cardiovasculares (infarto de miocardio, infarto cerebral) sin sintomas previos que sirvan de aviso, lo cual pone de relieve la importancia trascendental que adquiere la posible identificacion de individuos en riesgo. La piedra angular de todas las estrategias preventivas ha sido la identificacion de los pacientes en riesgo mediante el uso de escalas de riesgo cardiovascular, como Framingham, SCORE, REGICOR, QRISK, Reynolds, etc., y el manejo adecuado de los factores de riesgo. Dicha aproximacion se ve limitada por la incompleta exactitud de las escalas de riesgo cardiovascular, su uso no universal y el incumplimiento terapeutico de los pacientes. En los pacientes en riesgo intermedio, se puede estratificar aun mas su valoracion de riesgo mediante tecnicas de imagen no invasiva o el uso de biomarcadores. En la presente revision, se realiza una aproximacion conceptual a la identificacion del riesgo cardiovascular generada por los diferentes biomarcadores y tecnicas de imagen en la deteccion de aterosclerosis subclinica.

Impacto del control de las cifras de presión arterial sobre el índice tobillo-brazo en el paciente hipertenso

BACKGROUND AND OBJECTIVE The guidelines for arterial hypertension recommend a systematic determination of ankle-brachial index (ABI) in the initial risk stratification in hypertensive patients, while not indicating whether controls should be evolutionary. Our aim was to analyze the evolution of the ABI value in hypertensive patients in terms of control of blood pressure (BP) after one year follow-up. PATIENTS AND METHODS We included 209 hypertensive patients, in whom ABI was determined at baseline and after one year of antihypertensive treatment. Patients were divided into 2 groups in terms of good/poor clinical control of BP (<140/90 mmHg). RESULTS A total of 82.8% of the population showed a good control of the BP after one year of treatment and it was associated with significant increase in the ABI value (1.081 versus 1.046 at baseline, P=.002). By contrast, there was no difference of ABI value in patients with poor BP control (1.054 versus 1.093 at baseline). CONCLUSIONS A good clinical control of BP is associated with an increase in the value of the ABI.

Aldosterona plasmática y filtrado glomerular en el paciente hipertenso con función renal conservada

Hay un interes creciente en el papel de la aldosterona en la fisiopatologia de la hipertension arterial, la enfermedad cardiovascular y el deterioro de la funcion renal. El objetivo de nuestro trabajo es analizar la relacion entre la aldosterona y el filtrado glomerular (FG) en pacientes hipertensos con funcion renal conservada. Hemos estudiado a 186 pacientes hipertensos consecutivos con filtrado renal > 60 ml/min, a quienes se determinaron las concentraciones plasmaticas de aldosterona y el FG mediante la formula MDRD (Modification of Diet in Renal Disease). Los pacientes con FG de 60-89 ml/min presentaban concentraciones plasmaticas de aldosterona significativamente mas elevadas que aquellos con FG > 90 ml/min (20,02 frente a 15,3 ng/dl; p