Tumoraciones post-contusión... ¿es necesario drenar? / Post-contusion tumours: Is it necessary to drain?

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Prolapso uretral: imagen diagnóstica de una enfermedad poco frecuente / Urethral prolapse: Diagnostic image of a rare pathology

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Antioxidant Capacity of Beetroot: Traditional vs Novel Approaches.

Red beetroot has been ranked among the 10 most potent antioxidant vegetables, although only extraction-based methods have been used to evaluate its total antioxidant capacity. Therefore, the present study aims at comparing the traditional extraction-based method with two more recent approaches (QUENCHER -QUick, Easy, New, CHEap and Reproducible- and GAR -global antioxidant response method), in order to establish their suitability in the case of beetroot. Our results indicate that the total antioxidant capacity of beetroot would be underestimated when using extraction-based procedures, since both QUENCHER and GAR methods resulted in a higher total antioxidant capacity. The effect of a thermal treatment on the total antioxidant capacity of beetroot varies among the methods evaluated and our findings suggest different compounds responsible for the total antioxidant capacity detected in each pre-processing method. Remarkably, the present study demonstrates that the traditional extraction-based method seems useful to screen for (changes in) the "bioavailable" antioxidant potential of the root.

Identification of target genes and processes involved in erucic acid accumulation during seed development in the biodiesel feedstock Pennycress (Thlaspi arvense L.).

We studied erucic acid accumulation in the biodiesel feedstock Pennycress (Thlaspi arvense L.) as a first step towards the development of a sustainable strategy for biofuel production in the EU territory. To that end, two inbred Pennycress lines of European origin, "NASC" and "French," were cultivated in a controlled chamber and in experimental field plots, and their growth, seed production and seed oil characteristics analyzed. Differences in some agronomical traits like vernalization (winter-French versus spring-NASC), flowering time (delayed in the French line) and seed production (higher in the French line) were detected. Both lines showed a high amount (35-39%) of erucic acid (22:1Δ13) in their seed oil. Biochemical characterization of the Pennycress seed oil indicated that TAG was the major reservoir of 22:1Δ13. Incorporation of 22:1Δ13 to TAG occurred very early during seed maturation, concomitant with a decrease of desaturase activity. This change in the acyl fluxes towards elongation was controlled by different genes at different levels. TaFAE1 gene, encoding the fatty acid elongase, seemed to be controlled at the transcriptional level with high expression at the early stages of seed development. On the contrary, the TaFAD2 gene that encodes the Δ12 fatty acid desaturase or TaDGAT1 that catalyzes TAG biosynthesis were controlled post-transcriptionally. TaWRI1, the master regulator of seed-oil biosynthesis, showed also high expression at the early stages of seed development. Our data identified genes and processes that might improve the biotechnological manipulation of Pennycress seeds for high-quality biodiesel production.

Urinary albumin excretion at follow-up predicts cardiovascular outcomes in subjects with resistant hypertension.

BACKGROUND: Renal function and albuminuria predict cardiovascular disease (CVD) in general population. However, their prognostic value in patients with resistant hypertension (RH) is somewhat unknown. OBJECTIVE: To determine the ability of renal function and albuminuria to predict CVD in RH patients. METHODS: One hundred and thirty-three RH (blood pressure [BP] ≥140/90mmHg despite treatment with ≥3 drugs) patients were evaluated. Median follow-up was 73 months. Primary endpoint was a composite of non-fatal cardiovascular events or cardiovascular death. Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) were determined. Microalbuminuria was defined as a urinary albumin-to-creatinine ratio (UACR) ≥30mg/g. RESULTS: Twenty-two patients (16.5%) reached the primary endpoint. Long-term elevated UACR (66 vs. 17mg/g, P=0.045), but not at baseline, was associated with the primary endpoint, after adjusting for age, prior CVD, and both eGFR and office systolic-BP at baseline and during follow-up. Although baseline SCr and eGFR were associated with CVD, significance was lost after baseline risk adjustment. Baseline microalbuminuria prevalence was 45% and 41% in patients with and without CVD (P=0.813), while percentages of patients with microalbuminuria at follow-up were 67% and 28%, respectively (P=0.002). More patients with de novo CVD, compared with those without CVD, developed microalbuminuria at follow-up (28% vs. 6%) or had persistent microalbuminuria (39% vs. 21%), while fewer patients with CVD had microalbuminuria regression (11% vs. 19%) or remained normoalbuminurics (22% vs. 53%; overall P=0.005). CONCLUSION: In RH patients, the inability to microalbuminuria regression, either due to persistence or new appearance, independently predicts CVD.

Increased pulse pressure is associated with left atrial enlargement in resistant hypertensive patients.

Resistant hypertension (RH) is frequently associated with a high prevalence of target organ damage, which impairs the prognosis of these patients. Considering cardiac alterations in RH, most attention has been devoted to left ventricular hypertrophy (LVH), but data concerning left atrial enlargement (LAE) is less known. This cross-sectional study assessed the factors associated with LAE, with special focus on blood pressure (BP) estimates obtained by ambulatory blood pressure monitoring (ABPM), in 250 patients with RH, aged 64 ± 11 years. LAE and LVH were observed in 10.0% (95% CI 6.3-13.7) and 57.1% (95% CI 50.8-63.5) of patients, respectively. Compared with patients with normal atrium size, those exhibiting LAE were older, more frequently women, had elevated pulse pressure (PP) measured both at the office and by ABPM, and showed higher prevalence of LVH (83% vs 54%; p = 0.016). In a logistic regression analysis, adjusting for age, gender, body mass index, left ventricular mass index and BP pressure estimates, night-time PP was independently associated with LAE (OR for 5 mmHg = 1.28, 95% CI 1.24-1.32; p = 0.001). In conclusion, besides classical determinants of LAE, such as age and LVH, an elevated night-time PP was independently associated with LAE in patients with RH.

Abnormalities of vascular function in resistant hypertension.

We aimed to evaluate markers of vascular dysfunction in patients with resistant hypertension (RH). A group of 144 patients (61 years, 42% women) with essential RH were divided in two groups based on ambulatory blood pressure monitoring (ABPM). True RH (72%) was considered when 24-h blood pressure (BP) was ≥ 130 and/or 80 mmHg. Otherwise, patients were classified as white coat RH (28%). Hyperemia-induced forearm vasodilation (HIFV), serum inflammatory biomarkers (hs-CRP, s-ICAM-1, s-VCAM-1, e-selectin, p-selectin and MCP-1) and large (C1) and small arterial (C2) compliance (HDI/Pulse Wave CR 2000) were determined in all individuals. In comparison with patients with white coat RH, and after adjustment for age, office systolic BP and diabetes status, those with true RH had a more impaired HIFV (201 ± 159 vs 436 ± 157%; p < 0.001), increased e-selectin (53.1 ± 29.8 vs 40.7 ± 23.5 ng/ml; p = 0.035), and MCP-1 (445 ± 120 vs 386 ± 126 ng/ml; p = 0.027). No significant differences were observed in arterial compliance. Maximal HIFV inversely correlated with urinary albumin excretion (Rho: - 0.278; p = 0.004) and with some inflammatory biomarkers (MCP-1: - 0.441; p < 0.001, e-selectin: - 0.468; p < 0.001 and p-selectin: - 0.329; p = 0.001). We conclude that true RH, diagnosed by ABPM, is associated with a more severe degree of vascular dysfunction, as measured by HIFV and serum biomarkers, whereas other types of vascular alterations, such as compliance, are not directly linked with the level of BP.

Prevalencia de lesión de órganos diana y alteraciones metabólicas en la hipertensión arterial refractaria / Prevalence of target organ damage and metabolic abnormalities in resistant hypertension

Background and objective:Patients with resistant hypertension (RH) are relatively frequently visited in specialized units of hypertension. The aim of this study was to assess the prevalence of target organ damage, central obesity and metabolic syndrome in a cohort of patients with RH consecutively included in the Register of Resistant Hypertension of the Spanish Society of Hypertension (SHE-LELHA).Patients and methods: Cross-sectional, multicenter epidemiologic study in usual clinical practice conditions. Patients with clinical diagnosis of resistant hypertension, that is, office systolic and diastolic blood pressure ≥ 140mmHg and/or ≥ 90mmHg, respectively, despite a prescribed therapeutic schedule with an appropriate combination of three or more full-dose antihypertensive drugs, including a diuretic, were consecutively recruited from specialized hypertension units spread through Spain. Demographic and anthropometric characteristics as well as cardiovascular risk factors and associated conditions were recorded, and all the subjects underwent 24-h ambulatory blood pressure monitoring. Left ventricular hypertrophy was considered as a left ventricular mass index ≥ 125g/m2 in males and ≥ 110g/m2 in females. Left atrial enlargement was defined as an indexed left atrium diameter ≥ 26mm/m2. Microalbuminuria was defined as a urinary albumin/creatinine ratio ≥ 22mg/g in males and ≥ 31mg/g in females.Results: 513 patients were included, aged 64±11 years old, 47% women. Central obesity was present in 65.7% (CI 95% 61.6-69.9), 38.6% (CI 95% 34.4-42.8) had diabetes and 63.7% (CI 95% 59.4-67.9) had metabolic syndrome. The prevalence of left ventricular hypertrophy and left atrial enlargement, determined by echocardiography was 57.1% (CI 95% 50.8-63.5) and 10.0% (CI 95% 6.3-13.7) respectively. Microalbuminuria was found in 46.6% (CI 95% 41.4-51.8) of the subjects (AU)

Fundamento y objetivo: La hipertensión arterial refractaria o resistente (HTR) es frecuente en las unidades especializadas de hipertensión arterial (HTA). El objetivo de este trabajo fue valorar la prevalencia de afectación de órganos diana y alteraciones metabólicas asociadas en una serie de pacientes con HTR que se incluyeron de forma consecutiva en el registro de HTR de la Sociedad Española de Hipertensión/Liga Española para la Lucha contra la Hipertensión arterial (SEH-LELHA).Pacientes y método: Estudio epidemiológico, transversal, multicéntrico, en condiciones de práctica clínica habitual. La HTR fue definida como la persistencia de cifras de presión arterial (PA) sistólica ≥ 140mmHg o PA diastólica ≥ 90mmHg en pacientes tratados con al menos 3 fármacos, a dosis plenas, uno de ellos diurético. Se recogieron los datos demográficos y antropométricos, la presencia de otros factores de riesgo y condiciones clínicas asociadas. A todos los sujetos se les practicó una monitorización ambulatoria de la presión arterial durante 24 horas (MAPA). La afectación de órganos diana se determinó mediante la realización de ecocardiograma, electrocardiograma basal y excreción urinaria de albúmina.Resultados: Se incluyeron 513 sujetos con una edad media (DE) de 64 (11) años; un 47% eran mujeres. Un 65,7% (intervalo de confianza del 95% [IC 95%] 61,6-69,9) tenían obesidad central, un 38,6% (IC 95% 34,4-42,8) presentaban diabetes mellitus y un 63,8% (IC 95% 59,4-67,9) síndrome metabólico. La prevalencia de hipertrofia ventricular izquierda medida ecocardiográficamente fue del 57,1% (IC 95% 50,8-63,5) y la de dilatación de aurícula izquierda del 10,0% (IC 95% 6,3-13,7). Se observó microalbuminuria en un 46,6% de los sujetos (IC 95% 41,4-51,8) (AU)

[Prevalence of target organ damage and metabolic abnormalities in resistant hypertension]. / Prevalencia de lesión de órganos diana y alteraciones metabólicas en la hipertensión arterial refractaria.

BACKGROUND AND OBJECTIVE: Patients with resistant hypertension (RH) are relatively frequently visited in specialized units of hypertension. The aim of this study was to assess the prevalence of target organ damage, central obesity and metabolic syndrome in a cohort of patients with RH consecutively included in the Register of Resistant Hypertension of the Spanish Society of Hypertension (SHE-LELHA). PATIENTS AND METHODS: Cross-sectional, multicenter epidemiologic study in usual clinical practice conditions. Patients with clinical diagnosis of resistant hypertension, that is, office systolic and diastolic blood pressure ≥ 140 mm Hg and/or ≥ 90 mm Hg, respectively, despite a prescribed therapeutic schedule with an appropriate combination of three or more full-dose antihypertensive drugs, including a diuretic, were consecutively recruited from specialized hypertension units spread through Spain. Demographic and anthropometric characteristics as well as cardiovascular risk factors and associated conditions were recorded, and all the subjects underwent 24-h ambulatory blood pressure monitoring. Left ventricular hypertrophy was considered as a left ventricular mass index ≥ 125 g/m(2) in males and ≥ 110 g/m(2) in females. Left atrial enlargement was defined as an indexed left atrium diameter ≥ 26 mm/m(2). Microalbuminuria was defined as a urinary albumin/creatinine ratio ≥ 22 mg/g in males and ≥ 31 mg/g in females. RESULTS: 513 patients were included, aged 64±11 years old, 47% women. Central obesity was present in 65.7% (CI 95% 61.6-69.9), 38.6% (CI 95% 34.4-42.8) had diabetes and 63.7% (CI 95% 59.4-67.9) had metabolic syndrome. The prevalence of left ventricular hypertrophy and left atrial enlargement, determined by echocardiography was 57.1% (CI 95% 50.8-63.5) and 10.0% (CI 95% 6.3-13.7) respectively. Microalbuminuria was found in 46.6% (CI 95% 41.4-51.8) of the subjects. Patients with metabolic syndrome were significantly older (65.4±11 and 62.5±12 years; P=.0052), presented a higher prevalence of diabetes (52.0% vs. 16.6; P<.0001) and were treated more frequently with ≥ 4 antihypertensive drugs (65.1 vs. 50.0%, P=.011). CONCLUSION: The prevalence of central obesity, metabolic syndrome and target organ damage is very high in resistant hypertensive subjects.

Prevalencia de lesión de órganos diana y factores asociados a la presencia de episodios cardiovasculares en sujetos con hipertensión arterial refractaria / Prevalence of target organ damage and factors associated with cardiovascular events in subjects with refractory hypertension

Objetivos: Evaluar la prevalencia de lesión de órganos diana (LOD) y factores asociados a episodios cardiovasculares en sujetos con hipertensión arterial (HTA) refractaria. Pacientes y método: Estudio transversal de 146 pacientes con diagnóstico clínico de HTA refractaria. Se consideró LOD la presencia de microalbuminuria, insuficiencia renal (IR) y la hipertrofia ventricular izquierda (HVI) o dilatación de aurícula izquierda (DAI). Se consideró enfermedad cardiovascular (ECV) el antecedente de ictus, enfermedad coronaria, insuficiencia cardíaca o enfermedad arterial periférica. La monitorización de la presión arterial (PA) ambulatoria (MAPA) se determinó mediante un monitor oscilométrico Spacelabs 90207.Resultados: La prevalencia de HVI fue del 62,3% y se observó DAI en el 27,7%. La prevalencia de IR fue del 28,1% y la de microalbuminuria fue del 41,4%. Se observó una asociación entre la presencia de microalbuminuria y de HVI. Al ajustar por edad, la excreción urinaria de albúmina (EUA) se correlacionó con la PA clínica y la MAPA, mientras que el índice de masa ventricular izquierda se correlacionó con la MAPA pero no con la PA clínica. La prevalencia de ECV previa fue del 22% y en el análisis de regresión múltiple, ajustado por edad, PA clínica, PA de la MAPA y otros factores de riesgo clásicos, la EUA se asoció de forma independiente con el antecedente de ECV. Conclusiones: En sujetos con HTA refractaria, la prevalencia de LOD fue elevada, se observó una asociación entre la lesión cardíaca y la lesión renal. La EUA se asoció de forma independiente con el antecedente de episodios cardiovasculares (AU)

Objectives: To asses the prevalence of target organ damage (TOD) and factors associated with cardiovascular events in subjects with refractory hypertension. Patients and methods: Cross-sectional study of 146 patients with clinical diagnosis of refractory hypertension. TOD was defined as the presence of microalbuminuria (MA), renal failure (RF), left ventricular hypertrophy (LVH) or left atrial enlargement (LAE). Cardiovascular events were defined as the antecedent of stroke, coronary heart disease, heart failure or peripheral arterial disease. 24-h ambulatory blood pressure monitoring was (ABPM) performed with a validated Spacelabs 90207. Results: The prevalence of LVH was 62.3%, and LAE was observed in 27.7% of the subjects. The prevalence of RF was 28.1% and MA was found in 41,4%. An association between MA and LVH was observed. After adjusting by age, the urinary albumin excretion (UAE) correlated with clinical blood pressure (BP) and BP during 24-h ABPM, whereas LVMI correlated with ambulatory BP but not with clinical BP. The prevalence of previous cardiovascular events was 22% and in the multivariate regression analysis, UAE was the only independent factor associated with the antecedent of cardiovascular events. Conclusion: In subjects with refractory hypertension, the prevalence of TOD was high, and an association between heart and renal organ damage was observed. UAE was independently associated with the antecedent of cardiovascular disease (AU)

[Prevalence of target organ damage and factors associated with cardiovascular events in subjects with refractory hypertension]. / Prevalencia de lesión de órganos diana y factores asociados a la presencia de episodios cardiovasculares en sujetos con hipertensión arterial refractaria.

OBJECTIVES: To asses the prevalence of target organ damage (TOD) and factors associated with cardiovascular events in subjects with refractory hypertension. PATIENTS AND METHODS: Cross-sectional study of 146 patients with clinical diagnosis of refractory hypertension. TOD was defined as the presence of microalbuminuria (MA), renal failure (RF), left ventricular hypertrophy (LVH) or left atrial enlargement (LAE). Cardiovascular events were defined as the antecedent of stroke, coronary heart disease, heart failure or peripheral arterial disease. 24-h ambulatory blood pressure monitoring was (ABPM) performed with a validated Spacelabs 90207. RESULTS: The prevalence of LVH was 62.3%, and LAE was observed in 27.7% of the subjects. The prevalence of RF was 28.1% and MA was found in 41,4%. An association between MA and LVH was observed. After adjusting by age, the urinary albumin excretion (UAE) correlated with clinical blood pressure (BP) and BP during 24-h ABPM, whereas LVMI correlated with ambulatory BP but not with clinical BP. The prevalence of previous cardiovascular events was 22% and in the multivariate regression analysis, UAE was the only independent factor associated with the antecedent of cardiovascular events. CONCLUSION: In subjects with refractory hypertension, the prevalence of TOD was high, and an association between heart and renal organ damage was observed. UAE was independently associated with the antecedent of cardiovascular disease.

Papel actual de los antagonistas de los receptores de la angiotensina II y de sus combinaciones en el tratamiento de la hipertensión arterial / Current roleo fangiotens in II receptor antagonist sand their combination in the treatment of hypertension

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Gender differences in office and ambulatory control of hypertension.

BACKGROUND: Gender differences in hypertension control have not been explored fully. METHODS: We studied 15,212 white men and 13,936 white women with treated hypertension who were drawn from the Spanish Ambulatory Blood Pressure Registry. For each participant, we obtained office blood pressure (BP) (average of 2 readings) and 24-hour ambulatory BP (average of measurements performed every 20 minutes during day and night). RESULTS: Only 16.4% of women and 14.7% of men had both office (<140/90 mm Hg) and ambulatory (<130/80 mm Hg) BP controlled (P<.001). Women had a lower frequency of masked hypertension (office BP<140/90 mm Hg and ambulatory BP> or =130/80 mm Hg) than men (5.9% vs 7.9%, P<.001). Women had a higher frequency of isolated office hypertension (office BP> or =140/90 mm Hg and ambulatory BP<130/80 mm Hg) (32.5% vs 24.2%, P<.001). Although office BP control (office BP<140/90 mm Hg, regardless of ambulatory values) was similar in women and men (22.3% vs 22.6%, P=.542), ambulatory BP control (ambulatory BP<130/80 mm Hg, regardless of office values) was higher in women than in men (48.9% vs 38.9%, P<.001). After adjustment for age, number of antihypertensive drugs, hypertension duration, and risk factors, gender differences in BP control remained practically unchanged. CONCLUSION: Ambulatory BP control was higher in women than in men. This may be due to the higher frequency of isolated office hypertension in women, and it is not explained by gender differences in other important clinical characteristics.

Blood pressure in the initial phase of acute ischaemic stroke: evolution and its role as an independent prognosis factor at discharge and after 3 months of follow-up.

BACKGROUND: A prospective observational study was aimed at assessing the role of blood pressure (BP) during the first 24 h from stroke onset on the outcome of acute ischaemic stroke. METHODS: Subjects admitted within the first 3 h from stroke onset were included. Stroke severity was evaluated with the Canadian Stroke Scale (CSS). Functional recovery was defined as a modified Rankin Scale score < or =2. RESULTS: One hundred subjects were included. In a logistic regression model, the independent predictors of poor functional recovery at discharge were: age (OR = 1.12; 95% CI 1.04-1.21; p = 0.0033), non-lacunar stroke subtype (OR = 4.31; 95% CI 1.07-17.31; p = 0.0395), diabetes mellitus (OR = 8.38; 95% CI 1.67-41.95; p = 0.0097), a CSS score at admission < or =8 (OR = 28.64; 95% CI 5.59-146.68; p<0.0001), an average systolic BP during the first 6 h > or =180 mmHg (OR = 13.34; 95% CI 1.34-133.10; p = 0.0272) and a lower diastolic BP average from 6 to 24 h (OR for 5 mmHg increase: 0.57; CI 95% 0.36-0.88; p = 0.0115). Similar results were observed after 3 months of follow-up. CONCLUSION: In ischaemic stroke patients, systolic BP over 180 mmHg in the first 6 h and a decrease of diastolic BP during the 6-24 h from stroke onset were independent predictors of a poor functional recovery.

Clinical characteristics of isolated clinic hypertension.

OBJECTIVE: To analyze the clinical characteristics of patients with isolated clinic hypertension (ICH) compared with other hypertensive patients, and to evaluate the capacity of physicians to predict a diagnosis of ICH. METHODS: A cross-sectional, comparative multicenter descriptive study was made of 6176 hypertensive individuals without pharmacological treatment, subjected to ambulatory blood pressure monitoring (ABPM). In 2611 cases, ABPM was prescribed due to suspected ICH. The participants were consecutively selected in primary care centers and hospital hypertension units in all Spanish Autonomous Communities. ICH was defined by clinical blood pressure (BP) >or= 140 mmHg (systolic) or >or= 90 mmHg (diastolic), with diurnal ambulatory BP < 135 and < 85 mmHg (ICH1) or BP < 130 and < 80 mmHg (ICH2) or 24-h BP < 125 and < 80 mmHg (ICH3). RESULTS: ICH1, ICH2 and ICH3 criteria were met by 1807 (29.2%), 960 (15.5%) or 1133 (18.3%) subjects, respectively. Total sample mean age (SD) was 51.8 (14.1) years, and clinical BP 145.7 +/- 17.3/89.3 +/- 11.3 mmHg. Compared with the rest of the hypertensive individuals, the patients with ICH were predominantly female, of older age, with fewer smokers, and increased frequency of obesity. Moreover, they were more frequently nondippers, and with greater systolic BP in the office (P < 0.05), except when we used ICH3 criteria. The sensitivity and specificity of the physician predictions in relation to suspected ICH1, ICH2 and ICH3 were 48.7 and 60.4%, 52.9 and 59.7%, and 52.3 and 60.0%, respectively. CONCLUSIONS: The prevalence of ICH is between 15 and 29%, depending on the defining criterion used. The 24-h ICH criteria are not affected by awake/sleep biases, and should be preferred. Clinical capacity for predicting ICH is low.

Reproducibility of the circadian blood pressure pattern in 24-h versus 48-h recordings: the Spanish Ambulatory Blood Pressure Monitoring Registry.

OBJECTIVES: To assess the reproducibility of the circadian blood pressure (BP) pattern over a 48-h period by comparing the first 24 h of ambulatory blood pressure monitoring (ABPM) with the following 24 h and with the mean over 48 h. PATIENTS AND METHODS: Patients undergoing 48-h ABPM within the National ABPM Registry of the Spanish Society of Hypertension, based on 800 Spacelabs 90207 monitors distributed throughout Spain in hypertension units and primary healthcare centres, were included. Between June 2004 and September 2005, 611 valid 48-h ABPM recordings were obtained, 235 corresponded to patients without antihypertensive treatment. RESULTS: The percentages of patients classified as non-dipper for the first 24 h, the second 24 h and the 48-h average were 47, 50 and 48%, respectively. When the first and second 24-h periods were compared, 147 (24%) subjects switched from dipper (D) to non-dipper (ND) or vice-versa. When the first 24-h period was compared to the 48-h average, 66 (11%) subjects switched patterns. The proportions were similar separately for systolic blood pressure (SBP) and diastolic blood pressure (DBP) and between treated and untreated patients. In subjects with poor ABPM reproducibility, night-to-day ratios were of an intermediate value between those of subjects always classified as D or ND. CONCLUSION: Categorization of D or ND based on a single 24-h ABPM is moderately reproducible, since one out of every five patients change profile over the following 24 h. Nevertheless, the use of 48-h ABPM in clinical practice should be assessed according to cost-effectiveness criteria. Night-to-day ratios may be helpful in identifying patients with a stable profile.

Ambulatory blood pressure monitoring in hypertensive patients with high cardiovascular risk: a cross-sectional analysis of a 20,000-patient database in Spain.

OBJECTIVE: To evaluate ambulatory blood pressure monitoring (ABPM) parameters in a broad sample of high-risk hypertensive patients. METHODS: The Spanish Society of Hypertension is developing a nationwide project in which more than 900 physicians send ABPM registries and corresponding clinical records to a central database via www.cardiorisc.com. Between June 2004 and July 2005 a 20 000-patient database was obtained; 17 219 were valid for analysis. RESULTS: We identified 6534 patients with high cardiovascular risk according to the 2003 European Society of Hypertension/European Society of Cardiology guidelines stratification score. Office blood pressure (BP) was 158.8/89.9 mmHg and 24-h BP was 135.8/77.0 mmHg. Patients with grade 3 BP in the office showed ambulatory systolic BP values less than 160 mmHg in more than 80%. A non-dipping pattern was observed in 3836 cases (58.7%), whereas this abnormality was present in 47.9% of patients with low-to-moderate risk [odds ratio (OR) 1.54; 95% confidence interval (CI) 1.45-1.64]. The prevalence of non-dippers was higher as ambulatory BP increased ( approximately 70% when 24-h systolic BP > 155 mmHg) and was similar in both groups. At the lowest levels of BP (24-h systolic BP < 135 mmHg) a non-dipping pattern was more prevalent in high-risk cases (56.6 versus 45.7%; OR 1.51; 95% CI 1.40-1.64). CONCLUSION: There was a remarkable discrepancy between office and ambulatory BP in high-risk hypertensive patients. The prevalence of a non-dipper BP pattern was almost 60%. In the lowest levels of ambulatory BP, high-risk patients showed a higher prevalence of non-dipping BP than lower-risk cases. These observations support the recommendation of a wider use of ABPM in high-risk hypertensive patients.