Bacteriemia por Ochrobactrum anthropi en paciente en hemodiálisis por catéter tunelizado permanente: Caso clínico / Catheter associated bacteremia caused by Ochrobactrum anthropi in a patient on hemodialysis: Report of one case

Ochrobactrum anthropi is a rare pathogen in humans that is usually related to infections in inmunocompromised patients or people with indwelling medical devices. There are very few reported cases of O. anthropi bacteremia in patients on hemodialysis. We report a 19-year-old female on hemodialysis through a jugular catheter, with fever and malaise lasting one month. The catheter was withdrawn and Ochrobactrum anthropi was isolated from it and from blood cultures. The patient was successfully treated with levofloxacin.

La hipertensión arterial, ¿Sólo un biomarcador de la enfermedad ateroesclerótica sistémica? / Hypertension as a biological marker of systemic atherosclerotic disease

There is a close link between hypertension and atherosderosis. Hypertension causes atherosclerotic damage of several organs, called target organs and the risk factors for hypertension and atherosderosis are very similar. The risk of mortality associated to hypertension increases with blood pressure values below the cutoff point of normality (140/90 mm Hg), even below 130/85 mm Hg, and includes a stage called pre hypertension. Moreover, the initial damage of the arterial walls and target organs are present before there is a significant elevation of blood pressure. Therefore, hypertension could become a biological marker of the evolution of an underlying atherosclerotic process. A new pathophysiological paradigm has been proposed in which the severity of hypertension is not classified according to blood pressure values, but rather on the initiation and progression of vascular damage among target organs. These alterations determine the prognosis and management of systemic vascular damage that can be called "hypertensive atherosclerotic disease" or simply systemic atherosclerotic disease.

Morbi-mortalidad de la hipertensión arterial según magnitud del cambio de los factores de riesgo: seguimiento a 30 años / Morbimortality of arterial systemic hypertension according to risk factor control: a 30 years follow up study

Antecedentes: El tratamiento integral de la hipertensión arterial esencial involucra el tratamiento farmacológico y el control de los factores de riesgo cardiovascular. Objetivo: Estudiar a largo plazo la magnitud y frecuencia del cambio de los factores de riesgo, incluida la presión arterial, sobre la morbi-mortalidad de la hipertensión. Método: Estudio observacional durante 30 años de una cohorte de 1.360 hipertensos esenciales tratados con fármacos habituales (tiazidicos, B-bloqueadores, antagonistas del Ca++ e inhibidores ECA) y medidas dietéticas, educacionales y farmacológicas tendientes a mejorar el estilo de vida (cigarrillo, alcohol y sedentarismo) y controlar adecuadamente las enfermedades concomitantes (diabetes, dislipidemia, obesidad, gota). Se analizó el cambio individual de los 8 factores de riesgo fijando como éxito: PA <140/90 mmHg, cero consumo de cigarrillos, alcohol > 2 vasos de vino al día, colesterol total <200 mg por ciento, glicemia < 120mg por ciento e índice de masa corporal <30 peso/talla². De acuerdo al éxito individual, se separaron dos grupos: B con cambio adecuado de 4 o más FR y M, sin ese resultado. Se comparó la morbi-mortalidad entre ellos, en total y en forma separada para pacientes complicados y no complicados al ingreso. Estadística según tasas acumulativas y diferencias según método de Cox. Resultados: mortalidad general 0.91 por ciento/año y morbilidades comparables a las de la literatura reciente. Cambio de los factores de riesgo inferior al 50 por ciento, en especial diabetes (26 por ciento) obesidad (18 por ciento) y sedentarismo (15 por ciento). El grupo B con control adecuado de más de 4 factores de riesgo presentó significativamente una menor mortalidad, menor morbilidad total y menor incidencia de Infarto miocárdico, tanto en pacientes previamente complicados como sin ellas al ingreso. Conclusión: Este resultado positivo, a pesar del moderado control de los FR, enfatiza la necesidad de realizar no solo prevención primaria sino también secundaria en forma más intensa y agresiva.

Perfil del hipertenso adulto mayor tratado / Morbidity and mortality of treated elderly hypertensive patients

Background: There is concern about the consequences that hypertension has on the well being and mortality of elderly people. Aim: To compare the morbidity and mortality of young and old treated hypertensive subjects. Material and methods: Retrospective analysis of hypertensive subjects treated and followed for a period of 10 ñ 9 years. Subjects that started treatment at an age of less than 65 years and those that started treatment after 65 years of age, were analyzed separately. The antihypertensive drugs used for treatment and blood pressure reduction were similar in both groups. Results: Subjects that started treatment after 65 years of age (157 females and 133 males) had lower serum cholesterol levels and a higher prevalence of end organ damage than their younger counterparts. Women over 65 had a higher body mass index than women of less than 65. Males over 65 years had a higher prevalence of diabetes than younger males. Mortality and complications of hypertension were higher in subjects that started treatment after 65 years of age. Conclusions: The higher mortality of subjects that start hypertensive treatment after 65 years of age, is indicative of the need to detect and treat hypertension at the earliest possible moment

Optimización de la reducción de la presión arterial en hipertensos esenciales / Optimization of antihypertensive treatment

Background: A blood pressure below or equal to 140/90 mmHg, the aim of antihypertensive treatment, is rarely achieved. Only 16 percent of patients controlled by our group reach this goal. Aim: To analyze the causes of suboptimal treatment and to assess the effects of an optimization of antihypertensive therapy. Patients and methods: A random sample of 160 patients was analyzed and followed during one year. Results: Sixty six patients (41 percent) had a normal blood pressure, maintained during the first three months of follow up. The main causes of suboptimal reduction of blood pressure in the remaining 94 patients were an incorrect prescription or dosage of medications in 37.5 percent, lack of compliance in 34 percent, insufficient delivery of medications by the health service in 24 percent and secondary effects of drugs in 5 percent. When these factors were corrected, blood pressure normalized in 41 of them. In other 37, a reduction of 5 mmHg or more in blood pressure, was obtained. The most frequent changes introduced were modifications in dosage and addition of a new medication. Therefore, in 90 percent of these patients, blood pressure was reduced or normalized. Conclusions: A correct identification of the cause of antihypertensive treatment failure is imperative. The correction of this cause leads to a further reduction in blood pressure in 90 percent of those subjects with suboptimal treatment

Morbimortalidad de la hipertensión arterial esencial tratada en un seguimiento de 26 años / Mortality and morbidity of treated essential arterial hypertension: a 26 years follow up

Background: Treatment has a definitive impact on mortality in hypertension. The magnitude of blood pressure reduction, the type of drug used and the associated risk factors may modulate the effect of treatment on mortality. Aim: To report the effects of treatment of essential hypertension, in a cohort followed for up to 26 years. Patients and methods: A cohort of 1,172 essential hypertensive patients followed up to 26 years. Patients were treated with different antihypertensive drugs, alone or in combination (diuretics, beta blockers, calcium channel blockers and angiotensin converting enzyme inhibitors) according to international rules and consensus. Subjects were followed until death or loss from follow-up. Blood pressure reduction was aimed to obtain figures near 140/ 90 mm Hg. Causes of death and complications were obtained from hospital records, phone and death certificates. Survival was studied using life tables (Kaplan Meier method and intention to treat analysis) and Cox proportional hazard analysis. Results: Initial blood pressure dropped significantly from 181/109 to 154/92 mm Hg, p <0.001. Mean follow-up time was 10.6ñ6.1 years. There were 143 cardiovascular deaths, 142 acute myocardial infarctions, 101 strokes, 83 subjects had cardiac failure and 49 had renal failure. The observed rates were 0.92 percent per year for cardiovascular mortality, 1.36 percent per year for coronary heart disease, 0.94 percent per year for stroke. Conclusions: Our mortality rate is lower than that found in classical randomized studies but similar or slightly higher than the more recent ones. Morbidity rates were also very similar. Except for mortality rate, frequency of complications did not change in comparison to our previous report after 15 year of follow up. Aging did not seem to negatively influence mortality rates in adequately treated hypertensive patients

Factores predictores de riesgo de morbimortalidad en hipertensos esenciales seguidos 25 años / Risk factors for morbidity and mortality in subjects with essential hypertension, followed for 25 years

Background: Among hypertensive patients, other risk factors for mortality and morbidity, besides blood pressure, must be considered when therapeutic decisions are done. Aim: To assess the incidence and relevance of cardiovascular risk factors in a cohort of patients with essential hypertension. Material and methods: A cohort of 1.072 treated patients with essential hypertension was followed for a period up to 25 years. Four hundred eighty six were men and 586 were women, age ranged from 31 to 70 years. At entry, 56 percent of subjects did not have any organic complications associated to hypertension (stage I WHO criteria), 30 percent had mild alterations (Stage II) and 14 percent had major complications (myocardial infarction, stroke, heart failure or renal failure). Likewise, 43.8 percent had mild, 14.5 percent, moderate and 41.7 percent, severe hypertension. Patients were treated with monotherapy or combined therapy based on diuretics, beta blockers, calcium antagonists and angiotensin converting enzyme inhibitors. Goal of therapy was 140/90 mm Hg. Risk factors associated diseases and complications were registered carefully. Causes of death were obtained from hospital records and death certificates. Mortality was analyzed using life tables (intention to treat method included). Results: Blood pressure dropped significantly during follow up from a mean of 182/110 to 154/92 mm Hg. During follow up, 143 patients died and 429 complications (lethal or non lethal) were recorded. Twenty four percent of patients smoked, 24 percent reported alcohol intake, 56 percent had hypercholesterolemia, 11 percent were obese, 13 percent had diabetes and 3 percent had gout. The proportional hazard model showed that the existence of previous complications, the presence of more than 3 risk factors, and age over 60 and mean systolic and diastolic pressure during therapy, were independent and significant risk factors for mortality. Conclusions: The incidence of risk factors among our hypertensive patients is very similar to that of other national or international cohorts