ABSTRACT
RESUMEN Objetivo: Evaluar los valores de referencia de la dinámica circulatoria arterial ocular de los pacientes con hipertensión arterial esencial. Métodos: Se realizó un estudio descriptivo y transversal en 105 pacientes hipertensos y en un grupo de 33 sujetos no hipertensos, con edades comprendidas entre 18 y 60 años, sin antecedentes de padecer diabetes mellitus ni enfermedades oculares como glaucoma, o haber recibido tratamiento quirúrgico por catarata, hipertensión ocular u otras. A todos se les realizó la toma de la presión arterial sistémica, el examen clínico oftalmológico y el ultrasonido Doppler a color de carótida y de los vasos orbitarios. Resultados: Se encontró un predominio de mujeres de piel blanca, entre la cuarta y quinta década de la vida. Existió un incremento del pico de velocidad sistólica, la velocidad final diastólica y el índice de resistencia en la arteria oftálmica, que fue desde un rango normal en el grupo de los no hipertensos a valores promedios elevados en el grupo de hipertensos, los cuales fueron más altos en los casos descontrolados. No se encontraron modificaciones en el análisis de estos parámetros en las arterias centrales de la retina ni en las ciliares posteriores cortas. Conclusiones: En la casuística estudiada, el incremento del pico de la velocidad sistólica en la arteria oftálmica pudiera estar relacionado con áreas de obstrucción vascular localizadas o con vasoespasmo. Se encontró una asociación entre el descontrol de la presión arterial y los valores elevados del índice de resistencia en la arteria oftálmica(AU)
ABSTRACT Objective: Evaluate the reference values for ocular arterial circulation dynamics in patients with essential arterial hypertension. Methods: A descriptive cross-sectional study was conducted of 105 hypertensive patients and a group of 33 non-hypertensive subjects aged 18-60 years with no antecedents of diabetes mellitus or ocular conditions such as glaucoma or having undergone cataract surgery, ocular hypertension or others. All the patients underwent systemic arterial pressure measurement, clinical ophthalmological examination and color Doppler carotid and orbital ultrasonography. Results: A predominance was observed of the female sex, white skin color and age between the fourth and fifth decades of life. There was an increase in peak systolic velocity, end diastolic velocity and the resistive index in the ophthalmic artery, which ranged from normal in the non-hypertensive group to high average levels in the hypertensive group, higher in uncontrolled cases. Analysis of these parameters did not find any change in central retinal or short posterior ciliary arteries. Conclusions: In the cases studied, the peak systolic velocity increase in the ophthalmic artery could be related to localized vascular obstruction areas or vasospasm. An association was found between uncontrolled arterial pressure and high resistive index values in the ophthalmic artery(AU)
Subject(s)
Humans , Adolescent , Adult , Middle Aged , Ocular Hypertension/etiology , Ultrasonography, Doppler/methods , Arterial Pressure , Epidemiology, Descriptive , Cross-Sectional StudiesABSTRACT
El diseño experimental de los estudios prospectivos sobre el tratamiento de la hipertensión arterial esencial, ha ignorado un aspecto fundamental de la fisiopatología del paciente hipertenso: Los pacientes hipertensos no son homogéneos, en lo que respecta a los mecanismos responsables del aumento de la presión arterial. La adptación cardiovascular a la hipertensión arterial es anatómica y funcionalmente heterogénea. Investigaciones clínicas recientes indican que, esta heterogeneidad, puede ser minimizada con el uso de la eco-cardiografía. El análisis de los perfiles hemodinámicos y neurohormonales de los pacientes hipertensos permite distinguir la presencia de denominadores comunes: La hipertrofia ventricular concéntrica y la hipertrofia ventricular excéntrica representan los extremos opuestos de adaptación del corazón a la hipertensión arterial. El primero se caracteriza por tener una forma geométrica elíptica, con un perfil hemodinámico de gasto cardíaco normal y resistencias vasculares periféricas elevadas. Los niveles plasmáticos de renina y de los péptidos natriuréticos están elevados.
The experimental design of clinical studies, on the pharmacological treatment of essencial hypertension, has ignored a fundamental issue: Hypertensive patiens are not a homogenous population. The adaptation of the cardiovascular system to hypertension is structurally and funtionally heterogeneous. Recent clinical investigations suggest that this heterogeneity can be minimized by echocardiography. Thus, when the hemodynamic and neurohormonal profiles of untreated hypertensive patients are considered, in the particular context of the cardiac morphologic adaptation to high blood pressure, distinct common denominator emerge. Concentric Hypertrophy is characterized by an elliptic left ventricle, normal stroke volume and high peripheral vascular resistance. Its predominant neurohormonal profile includes elevated plasma renin and natriuretic peptide levels. Conversely, most patients with eccentric hypertrophy have a spheric left ventricle, increased stroke volume and low peripheral vascular resistance. Its corresponding neurohormonal profile shows low serum renin and anhanced sympathetic nervous activity. The therapeutic response, to angiotensin II antagonists and to beta-adrenergic blockers, of these two geometric patterns is also different. Concentric hypertrophy is substantially reversed by angiotensin II blockers, where as, eccentric hypertrophy is refractory to both, angiotensin II blockerds and atenol. These facts raise a relevant question: Should ventricular geometry be considered when deciding which antihypertensive drug is to be prescribed?.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Hypertension/diagnosis , Hypertension/physiopathology , Hypertension/therapy , Hypertrophy, Left Ventricular/physiopathology , Hypertrophy, Left Ventricular/therapyABSTRACT
Background. Prevalence of essential arterial hypertension is 60-80% among cardiovascular diseases and WHO reported that prevalence of essential arterial hypertension was 90-95% of arterial hypertension and 80% of hospitalized arterial hypertension patients. One of risk factors of essential arterial hypertension is (lack) deficiency of physical activity. Therefore we studied a benefit of exercise in essential arterial hypertension therapy. Methods. We examined blood lipid level and some of cardiovascular indicators of essential arterial hypertension patients such as arterial pressure, heart rate before and after treatment of exercise. Results. Prevalence of essential arterial hypertension was higher in the patients with obesity and overweight. Right high and low blood pressures were decreased from 154 to 141 and from 93 to 85, respectively. The other hand left high and low blood pressures were decreased from 154 to 138 and from 94 to 86, respectively. Heart rate was decreased from 76 to 71.9. Conclusions. Arterial pressure, heart rate and lipid level of the patients with essential arterial hypertension were significantly decreased after treated by exercise.
ABSTRACT
Se realizó un estudio exploratorio - descriptivo y se establecieron comparaciones entre un grupo de 25 sujetos normotensos y uno de 25 pacientes con hipertensión arterial esencial (HTA) para evaluar el estrés y el funcionamiento emocional en el segundo grupo. Se halló un predominio en los pacientes hipertensos de vivencias negativas que son experimentadas intensamente y altos niveles de vulnerabilidad al estrés; así como un predominio de moderada depresión y niveles de ansiedad rasgo y estado que oscilan entre medio y alto que distinguen a los pacientes con hipertensión arterial esencial del grupo de sujetos normotensos. Se ofrecieron recomendaciones referidas a la necesidad de una atención integral de estos pacientes.
An exploratory descriptive study was conducted and comparisons were made between a group of 25 normotensive individuals and another group of 25 patients with essential arterial hypertension (AHT) aimed at evaluating the stress and emotional functioning in the second group. A predominance of intensive negative personal experiences that are and high levels of vulnerability to stress were observed in the hypertensive patients. A prevalence of moderate depression and levels of trait anxiety and anxiety state ranging from median to high distinguish patients with essential arterial hypertension from the group of normotensive subjects. Recommendations were made in relation to the need of provinding comprehensive care to these patients.