Lupus eritematoso cutáneo subagudo secundario a tratamiento con diuréticos tiazídicos / Thiazide diuretics induce subacute cutaneous lupus erythematosus

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Distribución del grosor íntima-media carotídeo en función de la estratificación del riesgo cardiovascular según las funciones de Framingham-REGICOR y SCORE / Carotid intima-media thickness distribution according to the stratification of cardiovascular risk by means of Framingham-REGICOR and score function charts

Objetivos: El grosor íntima-media carotídeo (GIMc) ha sido propuesto como complemento a las escalas de cálculo del riesgo cardiovascular (RCV). El objetivo del presente estudio es describir la asociación entre el GIMc y el grado de RCV estimado según las funciones SCORE y Framingham-REGICOR. Método: Estudio observacional, transversal de una cohorte de 362 pacientes hipertensos. Se les realizó de forma sistemática una evaluación clínico-epidemiológica, analítica, ultrasonográfica y una estimación del RCV según las tablas SCORE y Framingham-REGICOR. Mediante el software SPSS (versión 20,0), se llevó a cabo el análisis de datos utilizando los análisis estadísticos t de Student, chi-cuadrado, coeficiente de Pearson y el análisis de la varianza (ANOVA). Resultados: Se demuestran diferencias significativas en la media de GIMc entre los pacientes con RCV estimado bajo (GIMc: 0,73 mm en ambas funciones) y los de riesgo moderado (GIMc: 0,89 y 0,85 mm según SCORE y Framingham-REGICOR) o elevado (0,88 y 0,87 mm respectivamente). No existen diferencias entre los de riesgo moderado y elevado. El GIMc se correlaciona positivamente con el valor de RCV estimado mediante las tablas SCORE (r = 0,421; p < 0,01), así como con la función Framingham-REGICOR (r = 0,363; p < 0,01). Conclusiones: El GIMc se correlaciona positivamente con el grado de RCV estimado mediante las funciones SCORE y Framingham-REGICOR. Aquellos pacientes con riesgo moderado presentan un GIMc similar al de aquellos con riesgo elevado. Se destaca la utilidad del estudio ultrasonográfico carotídeo para la detección precoz de lesión silente en pacientes con RCV moderado

Background: Carotid intima-media thickness (cIMT) has been suggested as a further tool for risk function charts. The aim of this study was to describethe relationship between cIMT and cardiovascular risk (CVR) estimation according to Framingham-REGICOR and SCORE equations. Methods: Observational, cross-sectional cohort study from 362 hypertensive subjects. Demographic and clinical information were collected as well as laboratory, ultrasonographic and CVR estimation by the Framingham-REGICOR and SCORE functions. Statistical analysis was performed using SPSS software (version 20,0). To analyze the data, statistical tests such as Chi-square, T-test, ANOVA, and Pearson correlation coefficient were used. Results:According to both functions, differences on mean cIMT were found between low CVR group and intermediate to high groups. No differences were found between intermediate and high risk groups (cIMT: 0,73 mm low risk patients vs. 0,89 or 0,88 mm respectively according to SCORE function and cIMT: 0,73 vs. 0,85 or 0,87 mm respectively according to Framingham-REGICOR function). cIMT correlated positively with CVR estimation according to both SCORE (r = 0,421; P<.01), and Framingham-REGICOR functions (r = 0,363; P<.01). Conclusions: cIMT correlates positively with CVR estimated by SCORE and Framingham-REGICOR functions. cIMT in those subjects at intermediate risk is similar to those at high risk. Our findings highlight the importance of carotid ultrasound in identifying silent target-organ damage in those patients at intermediate CVR

Comparación del valor predictivo cardiovascular de MDRD y CKD-EPI en la estimación de la enfermedad renal crónica / Comparison of the cardiovascular predictive value of MDRD and CKD-EPI in estimating chronic kidney disease

Objetivo. Comparar el valor predictivo, en el pronóstico cardiovascular, de las fórmulas más empleadas para la estimación del filtrado glomerular en pacientes hipertensos. Material y métodos. Se diseñó un estudio de cohortes retrospectivo, que incluyó los 405 pacientes diagnosticados de HTA esencial que fueron remitidos a la Unidad de Hipertensión y Riesgo Vascular, desde atención primaria, entre el 1 de enero de 1998 y el 31 de agosto de 1999 y a los que se les realizó simultáneamente un estudio de MAPA, análisis de sangre y orina y ecocardiográfico. Se realizó el seguimiento a lo largo de 12,5 años (mediana [± RiQ]: 10,61 [± 3,11] años) y se registraron 174 eventos. Resultados. Se incluyeron 405 pacientes (53,8% mujeres), con una edad media de 55,5 años. El filtrado glomerular estimado según las fórmulas MDRD y CKD-EPI fue de 73,9 ± 2,6 ml/min/1,73 m2 y 76,9 ± 2,2 ml/min/1,73 m2, respectivamente. La prevalencia de enfermedad renal crónica fue del 31,6 y del 23,9%, respectivamente. El uso de la ecuación CKD-EPI obligó a reclasificar al 22,9% de los pacientes. La RTI [IC 95%] para la enfermedad renal crónica identificada por la ecuación MDRD fue de 2,4 [1,8-3,3], y para el cálculo con CKD-EPI fue de 2,5 [1,8-3,3]). Conclusiones. Ambas fórmulas estiman magnitudes semejantes de función renal, aunque la ecuación CKD-EPI evita algunos falsos positivos, y ambas tienen similar valor pronóstico en pacientes tanto de alto como bajo riesgo cardiovascular (AU)

Objective. To assess predictive value of the cardiovascular prognosis by comparing the two most used formulas for the estimation of glomerular filtration rate in hypertensive patients. Material and methods. A retrospective cohort study was designed that included 405 patients diagnosed with essential hypertension. The patients were referred from Primary Care to the Hypertension and Vascular Risk Unit between January 1, 1998 and August 31, 1999. Blood pressure measurements, blood and urine analysis, and echocardiography were simultaneously performed. They were followed up for 12.5 years (mean [± IQR]: 10.61 [± 3.11] years) and 174 events were recorded. Results. The study included 405 patients (53.8% women), with a mean age of 55.5 years. The estimated glomerular filtration rate according to the MDRD and CKD-EPI equations was 73.9 ± 2.6 mL/min/1.73 m2 and 76.9 ± 2.2 mL/min/1.73 m2, respectively. The prevalence of chronic kidney disease was 31.6% and 23.9%, respectively. Using the CKD-EPI equation led to the re-classification of 22.9% of patients. The incidence rate ratio (IRR [95% CI] for chronic kidney disease identified by the MDRD equation was 2.4 [1.8-3.3], and for the CKD-EPI calculation it was 2.5 [1.8 to 3.3]). Conclusions. Both equations estimate similar magnitudes of renal function, although the CKD-EPI equation has less false positives, and both have similar prognostic values in patients at high cardiovascular risk as well those at low risk (AU)

[Carotid intima-media thickness distribution according to the stratification of cardiovascular risk by means of Framingham-REGICOR and score function charts]. / Distribución del grosor íntima-media carotídeo en función de la estratificación del riesgo cardiovascular según las funciones de Framingham-REGICOR y SCORE.

BACKGROUND: Carotid intima-media thickness (cIMT) has been suggested as a further tool for risk function charts. The aim of this study was to describethe relationship between cIMT and cardiovascular risk (CVR) estimation according to Framingham-REGICOR and SCORE equations. METHODS: Observational, cross-sectional cohort study from 362 hypertensive subjects. Demographic and clinical information were collected as well as laboratory, ultrasonographic and CVR estimation by the Framingham-REGICOR and SCORE functions. Statistical analysis was performed using SPSS software (version 20,0). To analyze the data, statistical tests such as Chi-square, T-test, ANOVA, and Pearson correlation coefficient were used. RESULTS: According to both functions, differences on mean cIMT were found between low CVR group and intermediate to high groups. No differences were found between intermediate and high risk groups (cIMT: 0,73mm low risk patients vs. 0,89 or 0,88mm respectively according to SCORE function and cIMT: 0,73 vs. 0,85 or 0,87mm respectively according to Framingham-REGICOR function). cIMT correlated positively with CVR estimation according to both SCORE (r=0,421; P<.01), and Framingham-REGICOR functions (r=0,363; P<.01). CONCLUSIONS: cIMT correlates positively with CVR estimated by SCORE and Framingham-REGICOR functions. cIMT in those subjects at intermediate risk is similar to those at high risk. Our findings highlight the importance of carotid ultrasound in identifying silent target-organ damage in those patients at intermediate CVR.

[Comparison of the cardiovascular predictive value of MDRD and CKD-EPI in estimating chronic kidney disease]. / Comparación del valor predictivo cardiovascular de MDRD y CKD-EPI en la estimación de la enfermedad renal crónica.

OBJECTIVE: To assess predictive value of the cardiovascular prognosis by comparing the two most used formulas for the estimation of glomerular filtration rate in hypertensive patients. MATERIAL AND METHODS: A retrospective cohort study was designed that included 405 patients diagnosed with essential hypertension. The patients were referred from Primary Care to the Hypertension and Vascular Risk Unit between January 1, 1998 and August 31, 1999. Blood pressure measurements, blood and urine analysis, and echocardiography were simultaneously performed. They were followed up for 12.5 years (mean [± IQR]: 10.61 [± 3.11] years) and 174 events were recorded. RESULTS: The study included 405 patients (53.8% women), with a mean age of 55.5 years. The estimated glomerular filtration rate according to the MDRD and CKD-EPI equations was 73.9±2.6 mL/min/1.73m(2) and 76.9±2.2 mL/min/1.73m(2), respectively. The prevalence of chronic kidney disease was 31.6% and 23.9%, respectively. Using the CKD-EPI equation led to the re-classification of 22.9% of patients. The incidence rate ratio (IRR [95%CI] for chronic kidney disease identified by the MDRD equation was 2.4 [1.8-3.3], and for the CKD-EPI calculation it was 2.5 [1.8 to 3.3]). CONCLUSIONS: Both equations estimate similar magnitudes of renal function, although the CKD-EPI equation has less false positives, and both have similar prognostic values in patients at high cardiovascular risk as well those at low risk.

Hipertrofia ventricular izquierda y variación circadiana de la presión arterial / Left ventricular hypertrophy and circadian variation in blood pressure

Antecedentes y objetivos: Son múltiples los estudios que avalan el papel pronóstico que han mostrado tanto la presión arterial (PA) ambulatoria como la hipertrofia ventricular izquierda (HVI) en el paciente hipertenso. Por ello, nos planteamos evaluar la correlación existente entre determinados parámetros de la PA ambulatoria y la masa ventricular izquierda (MVI) medida por ecocardiografía, en una muestra de pacientes hipertensos. Material y métodos Se diseñó un estudio transversal retrospectivo, que incluyó a 405 pacientes (53,8% mujeres), con una edad media de 55,5 años, diagnosticados de HTA esencial, remitidos a la Unidad de HTA y Riesgo Vascular, desde atención primaria, entre el 1 de enero de 1998 y el 31 de agosto de 1999. En todos los casos se realizó una evaluación clínica y biológica (según protocolo estandarizado), estudio ecocardiográfico y MAPA de 24 h (monitor Space Labs 90207).Resultados La MAPA demostró un mal control de la HTA en 320 pacientes (79%); la profundidad de la PA sistólica fue del 10,6 ± 0,9%. La prevalencia de perfil dipper fue del 43,8%, del dipper-extremo 13,4%, del no dipper 30,2% y del riser 12,6%. Se identificó a 248 pacientes (61,23%) con HVI. El aumento de la PA ambulatoria nocturna se asoció con un incremento de la MVI (p < 0,0001) y se objetivó una correlación estadísticamente significativa y negativa entre la disminución de la profundidad de la PA y el incremento del índice de MVI (p < 0,0001).Conclusión El incremento de la MVI se asocia con HTA nocturna y disminución de la profundidad nocturna de la PA (AU)

Background and objectives: Multiple studies support the prognostic role of both ambulatory blood pressure (BP) monitoring and left ventricular hypertrophy (LVH) in patients with hypertension. Consequently, we evaluated the correlation between certain ambulatory BP monitoring parameters and left ventricular mass (LVM) measured by echocardiography in a sample of hypertensive patients. Material and methods: A cross sectional, retrospective study was performed in 405 patients(53.8% women; mean age, 55.5 years), diagnosed with essential hypertension and referred to the Hypertension and Vascular Risk Unit by their primary care centers between 1 January,1998 and 31 August, 1999. All patients underwent clinical and biological evaluation (using a standardized protocol), echocardiography, and 24-hour ambulatory BP monitoring (SaceLabs90207).Results: Ambulatory BP monitoring revealed poor BP control in 320 patients (79%); the meandip in systolic BP was 10.6 ± 0.9%. The dipper pattern was observed in 43.8%, the extreme dipper pattern in 13.4%, the non-dipper pattern in 30.2%, and the riser pattern in 12.6%. Left ventricular hypertrophy was identified in 248 patients (61.23%). An increase in ambulatory nocturnal BP was associated with an increase in LVM (p < 0.0001) and a statistically significant negative correlation was observed between the drop in BP and the increase in LVM (P<.0001).Conclusion: An increase in LVM was associated with nocturnal hypertension and a decrease in the nocturnal drop in BP (AU)

Liraglutida en el tratamiento de la diabetes tipo 2: recomendaciones para una mejor selecci¨®n de los pacientes, desde una visi¨®n multidisciplinar / Liraglutide in the treatment of type 2 diabetes: recommendations for better patients¡¯ selection from a multidisciplinary approach

Liraglutida es el primer an¨¢logo humano del p¨¦ptidosimilar al glucag¨®n tipo 1 (GLP-1) administrado unavez al d¨ªa, y con el que presenta una homolog¨ªa del97%. El f¨¢rmaco ha sido recientemente aprobadopor la European Medicines Agency y por la Food andDrug Administration para su uso en el tratamiento dela diabetes mellitus tipo 2. La aprobaci¨®n inicial espara su uso una vez al d¨ªa en combinaci¨®n, bien conmetformina o con una sulfonilurea, as¨ª como encombinaci¨®n con metformina m¨¢s una sulfonilurea ouna tiazolidindiona. En Estados Unidos, tambi¨¦n est¨¢indicada en monoterapia. Los resultados del programade estudios LEAD (Liraglutide Effect and Action inDiabetes) demuest ran que liraglutida disminuye deforma significativa la hemoglobina glucosilada(HbA1c) con muy bajo riesgo de hipoglucemia. El tratamientocon liraglutida tambi¨¦n se asocia con unap¨¦rdida de peso signifi cativa y mantenida en el tiempo,disminuci¨®n de la presi¨®n arterial sist¨®lica, mejor¨ªade la funci¨®n de las c¨¦lulas ¦Â y reducci¨®n deotros factores de riesgo cardiovascular. En este art¨ªculose revisa la evidencia m¨¢s actualizada obtenidadel programa LEAD, centr¨¢ndose en consideracionespr¨¢cticas sobre la manera de utilizar de forma ¨®ptimaesta nueva terapia para la diabetes mellitus tipo 2(AU)

Liraglutide is the first once daily human glucagonlikepeptide-1 (GLP-1) analogue, with a 97% homology.Liraglutide has recently been approved bythe European Medicines Agency and by the Foodand Drug Administration to be used in the medicalmanagement of type 2 diabetes mellitus. Initial approvalis for be using in combination with metformin,a sulphonylurea or a combination of metforminwith a sulphonylurea or thiazolidinedione. Monotherapywith liraglutide is also approved in UnitedStates. Results from the LEAD (Liraglutide Effectand Action in Diabetes) clinical trials programmeshow that liraglutide significantly lowers HbA1c, witha very low risk of hypoglycemia. Liraglutide treatmentwas also associated with significant and sustainedweight loss, decreased systolic blood pressure,improved ¦Â-cell function, and reductions inother cardiovascular risk markers. In this article wereview the most up-to-date evidence emanatingfrom the LEAD programme, focussing on practicalconsiderations on how to optimally use this new therapyfor type 2 diabetes mellitus(AU)

Cronobiología y cronoterapia en la hipertensión arterial: implicaciones diagnósticas, pronósticas y terapéuticas / Chronobiology and chronotherapy in hypertension: diagnostic, prognostic and therapeutic implications

La presión arterial se caracteriza por una marcada variación circadiana. La cronoterapia de la hipertensión arterial toma en cuenta los aspectos clínicos relevantes de la variación de la presión arterial a lo largo del día; en concreto, la elevación matutina y el descenso durante el período de descanso nocturno, así como las posibles modificaciones en las características farmacocinéticas y farmacodinámicas de los fármacos antihipertensivos en función del instante circadiano de su administración. Las diferencias dependientes de la hora de ingesta en la cinética (es decir, cronocinética) y los efectos tanto beneficiosos como adversos (cronodinámica) de los fármacos antihipertensivos son conocidos. Así, el patrón de variación circadiano de presión arterial claramente alterado en pacientes hipertensos con fallo renal crónico sólo se normaliza cuando se administra isradipino en la tarde, pero no en la mañana. Por su parte, la curva dosis-respuesta, la cobertura terapéutica y la eficacia de la doxazosina GITS dependen marcadamente del instante circadiano de administración del fármaco. Además, la administración de valsartán a la hora de acostarse, pero no a la hora de levantarse, mejora significativamente la relación de medias diurna/nocturna de la presión arterial. De esta forma la hora óptima de administración de valsartán podría elegirse en función del perfil circadiano basal dipper o no-dipper de cada paciente para una mejor eficacia terapéutica y reducción del riesgo cardiovascular. La hipertensión nocturna, caracterizada por la pérdida del descenso esperado en la presión arterial del 10 por ciento-20 por ciento durante las horas de descanso nocturno, aumenta el riesgo de eventos cerebrocardiovasculares. La cronoterapia proporciona soluciones para el tratamiento individualizado en función del perfil circadiano de presión arterial de cada paciente y podría así suponer un nuevo avance hacia una mejora en la optimización del control de presión arterial y en la reducción del riesgo cardiovascular (AU)

Eficacia y tolerabilidad de irbesartán en pacientes con hipertensión arterial y diabetes mellitus tipo 2 / Effectiveness and tolerability of irbesartan in patients with arterial hypertension and type 2 diabetes mellitus

Fundamento. La coexistencia de hipertensión arterial (HTA) y diabetes tipo 2 constituye una combinación de incidencia creciente y de elevado riesgo cardiovascular. El bloqueo del sistema renina angiotensina con inhibidores de la enzima convertidora (IECA) o con antagonistas de los receptores de angiotensina confiere a los pacientes con HTA y diabetes una mayor protección frente a la enfermedad cardiovascular (ECV) y renal (ER). El presente estudio tiene como objetivo evaluar la eficacia y la tolerabilidad del antagonista de los receptores de angiotensina irbesartán en una cohorte de pacientes con HTA y diabetes mellitus tipo 2.Diseño y métodos. Estudio prospectivo observacional en una cohorte de 1.184 pacientes diagnosticados de diabetes mellitus tipo 2, con cifras de tensión arterial (TA)>= 130 y/o 85 mmHg. El tratamiento antihipertensivo se realizó con irbesartán a dosis entre 75 y 300 mg añadiendo posteriormente hidroclorotiazida 12,5 mg/día si no se había alcanzado el objetivo de reducir la TA a un nivel inferior a 130/85 mmHg. El seguimiento clínico fue de 12 semanas. La eficacia del fármaco se evaluó mediante la disminución de la TA determinada por un sistema de medida oscilométrico semiautomático. Las variables de seguridad fueron los niveles de creatinina y de potasio séricos, así como la aparición de reacciones adversas. Resultados. El tratamiento con irbesartán produjo un descenso significativo (p = 0,0001), tanto de la TA sistólica (TAS) (de 157,6 ñ 17,1 a 141,8 ñ 18,8 mmHg) como de la TA diastólica (TAD) (de 90,5 ñ 10,2 a 81,0 ñ 9,9 mmHg). El porcentaje de pacientes controlados a las 12 semanas fue del 70,4 por ciento para la TAD (< 85 mmHg) y del 17 por ciento para la TAS (< 130 mmHg). No se verificaron cambios significativos en los valores medios de creatinina (de 0,97 ñ 0,19 a 0,98 ñ 0,19 mg/dl) ni en las cifras de potasio sérico (de 4,34 ñ 0,46 a 4,34 ñ 0,48 mmol/l). Igualmente, la tasa de reacciones adversas fue mínima, pues sólo el 3,1 por ciento de los pacientes presentaron alguna reacción adversa. Conclusiones. El irbesartán es un fármaco eficaz, seguro y bien tolerado para el tratamiento de la HTA en pacientes con diabetes tipo 2. Produce descensos significativos de la TA con una tasa muy baja de reacciones adversas (AU)

A comparison of indapamide SR 1.5 mg with both amlodipine 5 mg and hydrochlorothiazide 25 mg in elderly hypertensive patients: a randomized double-blind controlled study.

OBJECTIVE: To analyse the efficacy of indapamide sustained-release (SR) 1.5 mg in reducing blood pressure versus amlodipine 5 mg and hydrochlorothiazide 25 mg, in elderly hypertensive patients. DESIGN: Double-blind, randomized, 12 week study using three parallel groups. SETTING: European teaching hospitals and general practices. PATIENTS: Randomized patients, (n = 524) including 128 patients with isolated systolic hypertension (ISH); mean age: 72.4 years; mean systolic/diastolic blood pressures (SBP/DBP): 174.5/97.9 mmHg. MAIN OUTCOME MEASURES: Clinic systolic and diastolic blood pressure variations. RESULTS: Indapamide SR 1.5 mg demonstrates a similar efficacy to that of amlodipine 5 mg, as well as to that of hydrochlorothiazide 25 mg (equivalence P < 0.001); the mean decreases in SBP/DBP were -22.7/-11.8 mmHg, -22.2/-10.7 mmHg and -19.4/-10.8 mmHg, respectively. In the ISH subgroup, indapamide SR 1.5 mg tends to have greater efficacy than hydrochlorothiazide 25 mg in reducing the SBP (-24.7 versus -18.5 mmHg, respectively; equivalence P = 0.117), while similar results are obtained with amlodipine 5 mg (-23 mmHg, equivalence P < 0.001). The normalization rate was relatively high for indapamide SR 1.5 mg (75.3%), when compared with amlodipine (66.9%) and hydrochlorothiazide (67.3%), especially in the subgroup of isolated systolic hypertensive patients: 84.2 versus 80.0% for amlodipine, and versus 71.4% for hydrochlorothiazide. CONCLUSIONS: Indapamide SR 1.5 mg shows similar antihypertensive efficacy to amlodipine 5 mg and hydrochlorothiazide 25 mg in elderly hypertensive patients, while in patients with isolated systolic hypertension, indapamide SR 1.5 mg shows a similar efficacy to amlodipine 5 mg but a greater efficacy than hydrochlorothiazide 25 mg.

Effects on left ventricular mass and function of low doses of enalapril for systemic hypertension.

After 7 years of treatment with 20 mg of enalapril twice daily, regression of the initial left ventricular hypertrophy in a group of 24 patients with essential arterial hypertension was achieved: gradual reduction in the dosage to 10 or 5 mg twice daily caused no worsening of either blood pressure or ventricular structure or function.

[Cerebrovascular disease and associated risk factors]. / Enfermedad cerebrovascular y factores de riesgo asociados.

In this report we are analysing the clinical history of 193 patients who were admitted to our medical department due to stroke during a period of two years. The patients were divided into two groups depending on wether they had ischemic or hemorrhagic pathology, analysing the presence of vascular risk factors in both groups. From the obtained results we have to point out, in both groups of patients, hypertension together with mellitus diabetes, giving clear proof of this, being the most frequent association of risk factors. We also have to point out the low percentage of patients with a lack of all the analysed risk factors, being also, that the average age was notably superior than the global.

Left ventricular systolic function after marked reduction of ventricular hypertrophy induced by 5 years' enalapril treatment.

OBJECTIVES: To determine the effects of long-term treatment of essential hypertension with an angiotensin-converting enzyme inhibitor as regards arterial pressure at rest and during exercise, left ventricular mass and functional sequelae. PATIENTS AND METHODS: Twenty-six patients with previously untreated essential hypertension took enalapril 20 mg twice daily for 5 years. Cardiovascular parameters were determined by two-dimensionally guided M-mode echocardiography in a pre-treatment placebo phase, 8 weeks and 1, 3 and 5 years after the start of therapy, and 8 weeks after drugs were discontinued. RESULTS: Therapy reduced resting arterial pressure from 156/105 to 128/84 mmHg (P < 0.001) and arterial pressure during exercise from 205/113 to 172/94 mmHg (P < 0.0011). After 1, 3 and 5 years' therapy, left ventricular mass index had decreased by 15, 28 and 39% respectively (P < 0.001 in each case). Eight weeks after treatment was halted, arterial pressure at rest and during exercise had returned to pre-treatment values, but decreased left ventricular mass was maintained. Left ventricular pump function had improved after 5 years' treatment, and this improvement was maintained during the 8 weeks without treatment. CONCLUSIONS: Significant reductions in arterial pressure at rest and during exercise were achieved by 8 weeks' treatment with enalapril and maintained during 5 years' further treatment, while a marked reduction in left ventricular mass took place progressively throughout the 5 year period. Reduction of myocardial hypertrophy by enalapril appeared to be beneficial rather than detrimental to cardiac pump performance.

[The midterm inefficacy of 2 different dosages of chlorthalidone (50 and 25 mg/day) in the regression of left ventricular mass in arterial hypertension]. / Ineficacia a medio plazo de dos diferentes dosificaciones de clortalidona (50 y 25 mg/día) en la regresión de la masa ventricular izquierda en la hipertensión arterial.

BACKGROUND: To evaluate the antihypertensive efficacy at rest and under exercise, and the modifications induced on the left ventricular mass in patients treated with two different doses of a diuretic. METHODS: Fifty hypertensive males, mean age 51 years, received during nine months 50 mg/day of chlortalidone and thirteen 25 mg/day for the next nine months. Baseline tension control and echocardiogram and each three months after starting therapy during the two phases of the study were performed. Thickness of the interventricular septum and posterior left ventricular wall in mm, left ventricular mass index in g/m2 were determined. RESULTS: The baseline septum was 15 +/- 3.3 mm, 14.6 +/- 3.1 mm at 9 months and 14.5 +/- 2.9 mm at 18 months, the posterior wall was 14.1 +/- 3.1 mm at baseline, 13.7 +/- 2.9 mm at 9 months and 13.6 +/- 2.9 mm at 18 months. The left ventricular mass index was 153 +/- 45 g/m2 at baseline, 146 +/- 36 g/m2 at 9 months and 144 +/- 39 g/m2 at 18 months. The antihypertensive efficacy at rest and under exertion was similar for the two doses of chlortalidone. CONCLUSIONS: After nine months of therapy the two doses of chlortalidone (50 and 25 mg/day) failed in reducing left ventricular mass. However, the design of the study and the small number of subjects enrolled introduce several important limitations to both the interpretation of our results and conclusions.

[Renal oncocytoma and arterial hypertension. Report of a case]. / Oncocitoma renal e hipertensión arterial. A propósito de un caso.

We present the case of a patient with refractory arterial hypertension, during the study of which a renal mass was discovered and diagnosed after the surgical intervention of an oncocytoma. We review the clinical, diagnostic and therapeutic characteristics of this entity. In addition, the lack of a clear association between renal oncocytoma and arterial hypertension is stressed.

[Effect of verapamil and nitrendipine on the left ventricular mass and function (systolic and diastolic) in arterial hypertension]. / Efecto de verapamilo y nitrendipino sobre la masa y función (sistólica y diasólica) ventricular izquierda en la hipertensión arterial.

BACKGROUND: To evaluate the effect of two calcium antagonists (verapamil and nitrendipine) on the regression of left ventricular mass and function (systolic and diastolic) by echocardiography-Doppler, in not treated hypertensive subjects. METHODS: 31 hypertensive subjects were studied in a randomized, placebo controlled, prospective and double blind trial. Verapamil (120-240 mg/day) was administered in 16 and nitrendipine (10-20 mg/day) in 15. The active drug therapy phase was 12 months with rest and effort tensional evaluation. Echo-Doppler was performed in the placebo phase, 6 and 12 months, evaluating left ventricular structure (septal and posterior-wall thicknesses, diameters and mass) and function (systolic and diastolic). RESULTS: Tensional control at rest and under effort was similar with both drugs, heart rate decreased only with verapamil. Left ventricular mass index decreased with verapamil and nitrendipine, due to reduction in the wall thicknesses (with verapamil from 158.5 +/- 31 to 135.7 +/- 20 g/m2 and with nitrendipine from 167.3 +/- 26 to 146.9 +/- 21 g/m2, p < 0.05). Left ventricular systolic function was not modified during the follow-up with both drugs. Only in the verapamil group some left ventricular diastolic function parameters improved (E from 0.82 +/- 0.11 to 0.95 +/- 0.14 and E/A/Age from 0.013 +/- 0.005 to 0.017 +/- 0.005; p < 0.05). CONCLUSIONS: Verapamil and nitrendipine exerts a similar tensional control at rest and under effort and left ventricular mass regression. The improvement of some diastolic function parameters in the verapamil group was probably due to bradycardia.

[Nitrendipine in the treatment of mild-moderate essential arterial hypertension. Ambulatory study in Primary Care]. / Nitrendipino en el tratamiento de la hipertensión arterial esencial ligera-moderada. Estudio ambulatorio en Atención Primaria.

A non-comparative open clinical pharmacological surveillance study was conducted, in which 427 patients from both sexes with diagnosis of light to moderate essential arterial hypertension were included. All patients were treated with nitrenpine, a dihydropyridinic calcium antagonist during a 28-week period. The initial dosage was 10 mg/day, increasing such dosage to 20 and 40 mg/day and associating it with a thiazidic diuretic in those patients showing no antihypertensive response (diastolic arterial pressure (DAP) of 90 mmHg or a reduction of 10 mmHg in baseline figures). A significant decrease was observed in systolic arterial pressure (from 159.3 +/- 12.6 to 149.2 +/- 12.2 mmHg) and in Dap (from 94.8 +/- 9.6 to 86.7 +/- 10.5 mmHg), p < 0.001, with effectivity in 66.3% of patients (65% receiving monotherapy; 10.3% combined therapy: nitrendipine and diuretic). No modifications were observed in heart rate nor in the biological-metabolic parameters under study. Side effects had a low incidence (15.9% of patients, with a 4.7% of drop-outs) and were well-tolerated in most cases. Given these results, we can conclude that nitrendipine is an effective and safe drug for the treatment of light to moderate arterial hypertension.