Manuel A. Gómez-Marcos

Abdominal obesity vs general obesity for identifying arterial stiffness, subclinical atherosclerosis and wave reflection in healthy, diabetics and hypertensive

BackgroundOur aim was to analyze the relationship between abdominal obesity and general obesity, with subclinical atherosclerosis, arterial stiffness and wave reflection in healthy, diabetics and hypertensive subjects.MethodsA cross-sectional descriptive study was made of 305 individuals (diabetics 32.8%, hypertensive subjects 37.0% and healthy individuals 30.2%). Measurements: Body mass index (BMI), waist circumference (WC), body fat percentage (BFP) and waist/height ratio (WHtR). Arterial stiffness was assessed according to pulse wave velocity (PWV), intima-media thickness of the common carotid artery (C-IMT), augmentation index (central and peripheral), ankle-brachial index (ABI), and central and peripheral pulse pressure.ResultsWC and WHtR showed a positive correlation to PWV and C-IMT in the studied groups. After adjusting for age, gender, high sensitivity c-reactive protein, serum glucose and the presence of diabetes, hypertension, smoking, dyslipidemia, antidiabetic drugs, lipid-lowering drugs, and atherosclerotic plaques, it was seen that for every 0.1 point increase in WHtR, and for every cm increase in WC, the PWV increased 0.041 and 0.029 m/sec, and C-IMT increased 0.001 mm and 0.001 mm, respectively.ConclusionsThe measures of abdominal obesity (WHtR and WC) correlates better than BMI and BFP with arterial stiffness evaluated by PWV, and with subclinical atherosclerosis evaluated by C-IMT, independently of the presence of diabetes or hypertension.Trial RegistrationClinical Trials.gov Identifier: NCT01325064

Increased plasma soluble endoglin levels as an indicator of cardiovascular alterations in hypertensive and diabetic patients

BackgroundEndoglin is involved in the regulation of endothelial function, but there are no studies concerning its relation with hypertension- and diabetes-associated pathologies. Thus, we studied the relationship between plasma levels of soluble endoglin and cardiovascular alterations associated with hypertension and diabetes.MethodsWe analyzed 288 patients: 64 with type 2 diabetes, 159 with hypertension and 65 healthy patients. We assessed the relationship of soluble endoglin plasma levels measured by enzyme-linked immunosorbent assay with basal glycemia, glycosylated hemoglobin, blood pressure, endothelial dysfunction (assessed by pressure wave velocity), hypertensive retinopathy (by Keith-Wagener classification), left ventricular hypertrophy (by Cornell and Sokolow indexes), cardiovascular risk and target organ (heart, vascular, kidney) damage.ResultsThere are significant correlations between endoglin and glycemia, systolic blood pressure, pulse pressure, pressure wave velocity and electrocardiographically assessed left ventricular hypertrophy. Endoglin levels were significantly higher in patients with diabetes who had nondipper and extreme dipper circadian blood pressure patterns than in dipper circadian patterns, in patients with hypertension and diabetes who had riser pattern than in the other patients, and in patients with diabetes but not hypertension who had extreme dipper pattern than in dipper, nondipper and riser groups. There was also a significant correlation between plasma-soluble endoglin and lower levels of systolic night-day ratio. Higher endoglin levels were found in patients with diabetes who had retinopathy, in patients with diabetes who had a high probability of 10-year cardiovascular risk, and in patients with diabetes and hypertension who had three or more damaged target organs (heart, vessels, kidney) than in those with no organs affected.ConclusionsThis study shows that endoglin is an indicator of hypertension- and diabetes-associated vascular pathologies as endothelial dysfunction and cardiovascular damage.

Physical exercise, fitness and dietary pattern and their relationship with circadian blood pressure pattern, augmentation index and endothelial dysfunction biological markers: EVIDENT study protocol.

AbstractBackgroundHealthy lifestyles may help to delay arterial aging. The purpose of this study is to analyze the relationship of physical activity and dietary pattern to the circadian pattern of blood pressure, central and peripheral blood pressure, pulse wave velocity, carotid intima-media thickness and biological markers of endothelial dysfunction in active and sedentary individuals without arteriosclerotic disease.Methods/DesignDesign: A cross-sectional multicenter study with six research groups. Subjects: From subjects of the PEPAF project cohort, in which 1,163 who were sedentary became active, 1,942 were sedentary and 2,346 were active. By stratified random sampling, 1,500 subjects will be included, 250 in each group. Primary measurements: We will evaluate height, weight, abdominal circumference, clinical and ambulatory blood pressure with the Radial Pulse Wave Acquisition Device (BPro), central blood pressure and augmentation index with Pulse Wave Application Software (A-Pulse) and SphymgoCor System Px (Pulse Wave Analysis), pulse wave velocity (PWV) with SphymgoCor System Px (Pulse Wave Velocity), nutritional pattern with a food intake frequency questionnaire, physical activity with the 7-day PAR questionnaire and accelerometer (Actigraph GT3X), physical fitness with the cycle ergometer (PWC-170), carotid intima-media thickness by ultrasound (Micromax), and endothelial dysfunction biological markers (endoglin and osteoprotegerin).DiscussionDetermining that sustained physical activity and the change from sedentary to active as well as a healthy diet improve circadian pattern, arterial elasticity and carotid intima-media thickness may help to propose lifestyle intervention programs. These interventions could improve the cardiovascular risk profile in some parameters not routinely assessed with traditional risk scales. From the results of this study, interventional approaches could be obtained to delay vascular aging that combine physical exercise and diet.Trial RegistrationClinical Trials.gov Identifier: NCT01083082

Ambulatory arterial stiffness indices and target organ damage in hypertension

BackgroundThe present study was designed to evaluate which arterial stiffness parameter - AASI or the home arterial stiffness index (HASI) - correlates best with vascular, cardiac and renal damage in hypertensive individuals.MethodsA cross-sectional study was carried out involving 258 hypertensive patients. AASI and HASI were defined as the 1-regression slope of diastolic over systolic blood pressure readings obtained from 24-hour recordings and home blood pressure over 6 days. Renal damage was evaluated by glomerular filtration rate (GFR) and microalbuminuria; vascular damage by carotid intima-media thickness (IMT), pulse wave velocity (PWV) and ankle/brachial index (ABI); and left ventricular hypertrophy by the Cornell voltage-duration product (VDP) and the Novacode index.ResultsAASI and HASI were not correlated with microalbuminuria, however AASI and HASI- blood pressure variability ratio (BPVR) showed negative correlation with GRF. The Cornell PDV was positively correlated with AASI- BPVR-Sleep (r = 0.15, p < 0.05) and the left ventricular mass index with HASI-BPVR (r = 0.19, p < 0.01). Carotid IMT and PWV were positively correlated with all the parameters except the HASI, while ABI was negatively correlated with AASI and Awake-AASI. After adjusting for age, gender and 24 hours heart rate, statistical significance remains of the IMT with AASI, Awake AASI and AASI-BPVR. PWV with the AASI, Awake-AASI and Sleep-AASI. ABI with AASI and Awake-AASI. Odd Ratio to presence target organ damage was for AASI: 10.47(IC95% 1.29 to 65.34), Awake-AASI: 8.85(IC95% 1.10 to 71.04), Sleep-AASI: 2.19(IC95% 1.10 to 4.38) and AASI-BPVR-night: 4.09 (IC95% 1.12 to 14.92).ConclusionsAfter adjusting for age, gender and 24-hour heart, the variables that best associated with the variability of IMT, PWV and ABI were AASI and Awake-AASI, and with GFR was HASI-BPVR.

Pulse pressure and nocturnal fall in blood pressure are predictors of vascular, cardiac and renal target organ damage in hypertensive patients (LOD-RISK study).

ObjectivesTo analyse the relationship between various parameters derived from ambulatory blood pressure monitoring (ABPM) and vascular, cardiac and renal target organ damage. MethodsA cross-sectional, descriptive study. It included 353 patients with short-term or recently diagnosed hypertension. Primary measurements: ABPM, carotid intima–media thickness (IMT), Cornell voltage–duration product (Cornell VDP), glomerular filtration rate and albumin/creatinine ratio to assess vascular, cardiac and renal damage. ResultsTwo hundred and twenty-three patients (63.2%) were males, aged 56.12±11.21 years. The nocturnal fall in blood pressure was 11.33±8.41, with a dipper pattern in 49.0% (173), nondipper in 30.3% (107), extreme dipper in 12.7% (45) and riser in 7.9% (28). The IMT was lower in the extreme dipper (0.716±0.096 mm) and better in the riser pattern (0.794±0.122 mm) (P<0.05). The Cornell VDP and albumin/creatinine ratio were higher in the riser pattern (1818.94±1798.63 mm/ms and 140.78±366.38 mg/g, respectively) than in the other patterns. In the multivariate analysis after adjusting for age, sex and antihypertensive treatment, with IMT as dependent variable the 24-h pulse pressure (&bgr; = 0.003), with Cornell VDP the rest pulse pressure (&bgr; = 12.04), and with the albumin/creatinine ratio the percentage of nocturnal fall in systolic blood pressure (&bgr; = −3.59), the rest heart rate (&bgr; = 1.83) and the standard deviation of 24-h systolic blood pressure (&bgr; = 5.30) remain within the equation. ConclusionThe estimated pulse pressure with ABPM is a predictor of vascular and cardiac organ damage. The nocturnal fall and the standard deviation in 24-h systolic blood pressure measured with the ABPM is a predictor of renal damage.

Relationships between quality of life and family function in caregiver

BackgroundThere are caregivers who see their quality of life (QoL) impaired due to the demands of their caregiving tasks, while others manage to adapt and overcome the crises successfully. The influence of the family function in the main caregivers situation has not been the subject of much evaluation. The aim of this study is to analyse the relationship between the functionality of the family and the QoL of caregivers of dependent relatives.MethodsWe conducted a cross-sectional study including 153 caregivers. Setting: Two health centers in the city of Salamanca(Spain). Caregiver variables analysed: demographic characteristics, care recipient features; family functionality (Family APGAR-Q) and QoL (Ruiz-Baca-Q) perceived by the caregiver. Five multiple regressions are performed considering global QoL and each of the four QoL dimensions as dependent variables. The Canonical Correspondence Analysis (CCA) was used to study the influence of the family function questionnaire on QoL.ResultsFamily function is the only one of the variables evaluated that presented an association both with global QoL and with each of the four individual dimensions (p < 0.05). Using the CCA, we found that the physical and mental well-being dimensions are the ones which present a closer relationship with family functionality, while social support is the quality dimension that is least influenced by the Family APGAR-Q.ConclusionWe find an association between family functionality and the caregivers QoL. This relation holds for both the global measure of QoL and each of its four individual dimensions.

Relationship between ambulatory arterial stiffness index and subclinical target organ damage in hypertensive patients

Increased arterial stiffness has been shown to predict cardiovascular risk in hypertensive patients. Our objective was to evaluate the relationship between the ambulatory arterial stiffness index (AASI) and subclinical organ damage (SOD). The design was a cross-sectional study. Subjects included 554 hypertensive patients with and without drug treatment (mean age 57±12 years, 60.6% men). The AASI was defined as 1 minus the regression slope of diastolic over systolic blood pressure (BP) readings obtained from 24-h recordings. Renal damage was evaluated on the basis of glomerular filtration rate (GFR) and microalbuminuria; vascular damage was measured by carotid intima–media thickness (IMT) and ankle/brachial index (ABI); and cardiac damage was evaluated on the basis of the Cornell voltage–duration product (VDP) and left ventricular mass index. The mean AASI was 0.38±0.07 (0.39±0.07 in treated patients and 0.37±0.06 in nontreated subjects). The AASI showed a positive correlation with IMT (r=0.417, P<0.001) and Cornell VDP (r=0.188, P<0.001), and a negative correlation with GFR (r=−0.205, P=0.001) and the ABI. The variables associated with the presence of SOD were AASI (odds ratio (OR)=3.89) and smoking (OR=1.55). The variables associated with IMT were smoking and waist circumference, whereas those associated with GFR were AASI, body mass index and waist circumference. In turn, smoking, total cholesterol and glycosylated hemoglobin A1c were associated with the ABI. Increased AASI implies a greater presence of SOD in primary hypertensive patients with or without BP-lowering drug treatment.

Prevalence of cognitive impairment in individuals aged over 65 in an urban area: DERIVA study

BackgroundFew data are available on the prevalence of cognitive impairment (CI) in Spain, and the existing information shows important variations depending on the geographical setting and the methodology employed. The aim of this study was to determine the prevalence of CI in individuals aged over 65 in an urban area, and to analyze its associated risk factors.MethodsDesign: A descriptive, cross-sectional, home questionnaire-based study; Setting: Populational, urban setting. Participants: The reference population comprised over-65s living in the city of Salamanca (Spain) in 2009. Randomized sampling stratified according to health district was carried out, and a total of 480 people were selected. In all, 327 patients were interviewed (68.10%), with a mean age of 76.35 years (SD: 7.33). Women accounted for 64.5% of the total. Measurements: A home health questionnaire was used to obtain the following data: age, sex, educational level, family structure, morbidity and functionality. All participants completed a neuropsychological test battery. The prevalence data were compared with those of the European population, with direct adjustment for age and sex. Diagnoses were divided into three general categories: normal cognitive function, cognitive impairment - no dementia (CIND), and dementia.ResultsThe prevalence of CI among these over-65s was 19% (14.7% CIND and 4.3% dementia). The age-and sex-adjusted global prevalence of CI was 14.9%. CI increased with age (p < 0.001) and decreased with increasing educational level (p < 0.001). Significant risk factors were found with the multivariate analyses: age (OR = 1.08, 95%CI: 1.03-1.12), anxiety-depression (OR = 3.47, 95%CI: 1.61-7.51) and diabetes (OR = 2.07, 95%CI: 1.02-4.18). In turn, years of education was found to be a protective factor (OR = 0.79, 95%CI: 0.70-0.90). Although CI was more frequent among women and in people living without a partner, these characteristics were not significantly associated with CI risk.ConclusionsThe observed raw prevalence of CI was 19% (14.9% after adjusting for age and sex). Older age and the presence of diabetes and anxiety-depression increased the risk of CI, while higher educational level reduced the risk.

Relationship of 24-h blood pressure variability with vascular structure and function in hypertensive patients.

ObjectivesTo analyze the relationship of 24-h blood pressure variability (BPV) with vascular structure and function using the SD and the coefficient of variation (CV). Patients and methodsA cross-sectional study was carried out in 344 hypertensive patients (aged 54.1±11.7 years, 59.6% men). BPV was estimated with the SD and CV over 24-h, both awake and sleep, by ambulatory blood pressure monitoring. Vascular structure and function were evaluated by the ambulatory arterial stiffness index (AASI), the pulse wave velocity (PWV) using SphygmoCor and the carotid intima-media thickness (IMT) as assessed by ultrasound. ResultsThe systolic blood pressure (SBP) variability was greater than the diastolic blood pressure (DBP) variability using the SD and less using CV (P<0.001). SBP variability showed a positive correlation with the IMT, PWV and AASI. The CV of the DBP showed a positive correlation with the PWV and the AASI, whereas the SD of the DBP showed a negative correlation with the AASI. In the multiple regression analysis, after adjustment, the BPV measure that maintained their associations with the IMT was the CV of awake DBP and that with the PWV were the CV and the SD of 24-h and awake SBP/DBP. The AASI maintained the associations with the BPV measure in 24-h DBP, but not in SBP. The odds ratio of the SD and the CV for vascular damage varied between 1.182 and 1.276. ConclusionBPV in hypertensive patients, as evaluated by both SD and CV, is associated with arterial stiffness as evaluated with the PWV. The ambulatory blood pressure monitoring is more accessible at the clinic than the PWV; therefore, the assessment of BPV (24-h, awake and sleep) may be useful for assessment of arterial stiffness.

Osteoprotegerin is associated with cardiovascular risk in hypertension and⁄or diabetes

Eur J Clin Invest 2012; 42 (5): 548–556