Isolated systolic hypertension: a new challenge in medicine.

In the elderly, isolated systolic hypertension (ISH) is a particularly good predictor of subsequent cardiovascular events. The purpose of this article is to review the evidence provided by the Systolic Hypertension Elderly Program (SHEP) and the Systolic Hypertension in Europe Study (Syst-Eur) on the benefits of lowering systolic blood pressure (SBP) and to report on the preliminary findings of the Maracaibo Aging Study (MAS) on ISH. These two trials, the SHEP using chlorthalidone and atenolol as step 2 and the Syst-Eur using nitrendipine and hydrochlorothyazide as step 2, demonstrated a decrease of more than 30% for all cardiovascular complications, including stroke and coronary events. MAS is a population-based study that included all the subjects older than 55 years of age that resided in a defined area of the city of Maracaibo. There was a high prevalence of ISH (45.7%) being higher among women than in men, and significantly increased with advancing age. SBP was associated with dementia when it was measured by an ambulatory blood pressure monitor (ABPM), while there was no association when it was assessed by the casual method. Diastolic blood pressure (DBP) as casual or measured by ABPM was not related to dementia. In conclusion, ISH is a serious public health problem and benefits from lowering elevated SBP to reduce the risk of cardiovascular events. It was shown there was a strong correlation between high SBP and cognitive dysfunction and this was best demonstrated by using ABPM. Research should address the impact of using modern diagnostic tools and to compare the efficacy of the different types of antihypertensive drugs.

Electron microscopy of umbilical cord endothelial cells in preeclampsia.

We have studied by means of transmission electron microscopy the umbilical cord endothelial cells in 11 preeclamptic women. Endothelial cells exhibited oval, round, elongated, flattened, triangular or polygonal shapes. The nuclei displayed shallow and deep invaginations of nuclear envelope. The endoplasmic reticulum appeared highly dilated and vacuolated. The swollen mitochondria showed cristae fragmentation. Areas of focal necrosis were appreciated throughout the cytoplasm. A marked enlargement of subendothelial space and the presence of an electron dense granular material were also found. The findings reveal activation and injury of endothelial cells and disruption of endothelial cell layer.

[Nutritional and metabolic factors as risk factors for cardiovascular diseases in an adult population in the city of Maracibo, Estado Zulia, Venezuela]. / Factores nutricionales y metabólicos como riesgo de enfermedades cardiovasculares en una población adulta de la ciudad de Maracaibo, Estado Zulia, Venezuela.

To analyze the nutritional and metabolic risk factors for Cardiovascular Diseases (CVD) present in a group of people in the city of Maracaibo a study was performed with 209 volunteers (145 women and 64 men) between 20 and 89 years of age who underwent: a) Anthropometric Evaluation: Body Mass Index (BMI) and Waist-to-Hip Ratio (WHR) and Physical Examination: Systolic (SBP) and Diastolic Blood Pressure (DBP); b) Dietetic Evaluation (24 hours recall), and c) Biochemical Evaluation: Glycemia (GLYC), Triglycerides (TG), Total Cholesterol (CHOL), HDL-C, LDL-C and VLDL-C, applying enzymatic methods. It was also investigated, their Age, Family History of Metabolic Alterations (FHMA), physical activity, smoking habits and alcohol consumption. More than 50% of the individuals showed a BMI > 25; 64% of women showed a WHR value > 0.8; 34 and 28% of men and women respectively had a high fat ingestion (HFI); 36% of men had hypertriglyceridemia and high levels of VLDL-C; 41% of women and 30% of men showed decreased HDL-C. A high frequency of FHMA was found in 85% of women and 78% of men followed by sedentary life in 64% of men and 79% of women. The age significantly (p < 0.05) affected the values for WHR, SBP, DBP, GLYC, CHOL, TG, HDL-C, LDL-C and VLDL-C. The dietetic evaluation showed a diet that was low in calories, high in protein, normal in fat and low in carbohydrates. It is concluded that the population elected for this study might be considered under a high risk for CVD, since both nutritional and metabolic factors, as well as the other risk factors analyzed, were present in a high percentage of the individuals studied.

[Effect of stress electrocardiogram on platelet function, concentration of von Willebrand factor and fibrinogen in hypertensive patients and healthy subjects]. / Efecto del electrocardiograma de esfuerzo sobre la función plaquetaria, concentración del factor von Willebrand y del fibrinógeno en pacientes hipertensos e individuos sanos.

The aim of the present study was to investigate the effect of the treadmill electrocardiogram (TMECG) on thrombotic risk factors in hypertensive patients and normal individuals. Twenty patients, 10 males and 10 females between 40 and 55 years of age, were studied and twenty normal persons of matching sex and age were chosen as controls. Blood samples were obtained before and immediately after the TMECG. Platelet counts and function as well as fibrinogen and von Willebrand factor (vWF) levels were determined in each sample. A significant increase in platelet number and aggregation with collagen and ristocetin was observed in all groups after the TMECG. Fibrinogen and von Willebrand factor levels were also significantly increased in all individuals. It is known that platelets play an important role in the formation of thrombi and the enhancement in their number and activity, in certain circumstances, might favor the development of a thrombotic episode. Elevated fibrinogen concentrations are considered an independent cardiovascular risk factor. The above changes in patients with other predisponent factors for cardiovascular events, such as arterial hypertension, enhances the possibility of a vasooclusive episode. It is recommended therefore, that before suggesting a physical activity to a hypertensive patient, other parameters, such as age, previous training and the existence of other cardiovascular risk factors should be considered.

Epidemiologic aspects of arterial hypertension in Maracaibo, Venezuela.

The purpose of this study was to determine the prevalence of arterial hypertension (HT) awareness and the influence of age, sex and body mass index on the degree of control of HT in the population of Maracaibo, State of Zulia, Venezuela. It included 7424 subjects, 3640 males (M) and 3784 females (F). Information was collected through domiciliary visits with a questionnaire designed for this purpose. Hypertension was defined as such when values were > or =140 mm Hg for systolic blood pressure (SBP) and > or =90 mm Hg for diastolic blood pressure (DBP). In the total sample, 36.9% were hypertensive. A higher prevalence in M (45.2%) than in F (28.9%), was observed. The percentage of HT increased with age in both genders. There was a high percentage of hypertensives with obesity (73.5%) which did not vary when discriminating for gender and age. Obese subjects were more prone to have HT until age 50. Those younger than 40 took less medication but were proportionally better controlled. Of the hypertensive population 54.3% were not aware of their condition, of 45.7% remaining, 22.8% did not have regular control visits, 18.4% inspite of medication were not controlled and only 4.5% were well controlled. Better control was observed in F (6.2%) than in M (3.3%), P < 0.001. It is concluded that HT is a serious public health problem because of its high prevalence and lack of control, and it is necessary to implement educational and medical programmes for the detection and control of this disease.

[Epidemiological aspects of arterial hypertension among the adult population of Maracaibo City]. / Aspectos epidemiológicos de la hipertensión arterial en la población adulta del Municipio Maracaibo.

The purpose of this study was to determine the prevalence of arterial hypertension (H) and its distribution according to gender, age group, body mass index (BMI) in the population of Maracaibo, Venezuela. 7.424 subjects were included, 3.640 males (M) and 3.784 females (F). Information was collected by means of domiciliary visits with a History and Physical Exam designed for this purpose. H was defined as Systolic Blood Pressure > or = 140 mmHg and/or Diastolic Blood Pressure > or = 90 mmHg. A prevalence of 36.9% of H in the total sample was found with a higher prevalence in M, 45.2%, than in F 28.9%. It increased progressively with age in both genders. Only 4.5% of hypertensive patients were well controlled, 41.2% of patients diagnosed as hypertensive, were not well controlled (DBP > or = 90 mmHg), and 54.3% hypertensives did not know about their condition. Patients with BMI > or = 25 Kg/m2 had a prevalence twice as patients with BMI < 25 Kg/m2 (47.6% Vs 24.2%). It is concluded that H is a serious problem of public health because of it's high prevalence and lack of control, and it is necessary to implement educational and medical programs for the detection and control of this disease.

[Normal values during ambulatory blood pressure monitoring in male adolescents]. / Valores normales de monitoreo ambulatorio de presión arterial en adolescentes masculinos.

UNLABELLED: To establish the normal values for Ambulatory Blood Pressure Monitoring (ABPM) in normotensive, non-obese, male adolescents without family history of High Blood Pressure (HBP), a 24 hours ABPM study using oscillometric method (Space Lab 90207) was preformed on 102 subjects, 10-18 years of age, classified in 3 age groups: Group 1: 10-12, group 2: 13-15 and group 3: 16-18. RESULTS: Systolic and Diastolic Blood Pressure (SBP, DBP) mean values (+/- standard deviation), during 24 hours were: 109/64 (7.0/4.4), 114/65 (5.5/4.5) and 116/65 (6.5/5.1) mmHg; during awake period were: 111/66 (7.0/4.5), 116/68 (5.8/4.8) and 118/68 (6.3/5.6) mmHg; and during sleep period were: 99/56 (7.6/5.0), 104/55 (5.7/4.7) and 105/55 (8.1/5.8) mmHg, respectively. Statistically significant differences in the SBP between group 1 vs. 2 and 3 were found (p < 0.0002). The DBP did not increase with age. Casual BP values were similar to those obtained with ABPM during awake period. A nocturnal fall of 10.8/15.2, 10.3/19.1 and 11/19.1 percent in SBP and DBP respectively, were observed. CONCLUSION: The normal ABPM values in male adolescents, age 10 to 18, were established. These, are of great importance for the diagnosis of hypertension in the studied population. Contrary to other studies, no differences were found between casual BP and ABPM values, which implies than adolescents whose casual BP is higher that ABPM values (awake period) should be considered abnormal and be further evaluated.

[The use of sublingual captopril in hypertensive crises]. / Uso del captopril sublingual en crisis hipertensivas.

The purpose of this study was to evaluate the antihypertensive efficacy of captopril (C) and its correlation with body mass index (BMI), age and initial blood pressure (BP) in hypertensive crises. The time of the beginning of the antihypertensive effect of C and its side effects were evaluated. Twenty patients, aged between 22 and 59 years, were included in this investigation. BP was measured after 15 min of rest; age, weight and height were recorded and BMI was calculated using the standard formula (Kg/m2). Patients were not taking antihypertensive medications. After the placebo was given to the patients, BP was measured at 30 and 60 min. Sublingual captopril 25 mg was administered and BP was again measured at 5, 10, 15, 30, 60, 120 y 240 min. There was not statistically significant difference between the values of BP before and after placebo. A significant decrease was observed post C, from 182.6/123.6 to 174.6/117.3 (p:SN/p < 0.02) in 10 min., to 169.9/114.9 (p < 0.04/p < 0.001) in 15 min., to 167.7/112.2 (p < 0.02/p < 0.0001) in 30 min., to 164.3/108.8 (p < 0.002/p < 0.0001) in 60 min., to 156.9/106.5 (p < 0.0001/p < 0.0001) in 120 min., to 161.3/107.0 (p < 0.0002/p < 0.0001) in 240 min. In 15 patients there was a decrease in diastolic BP > or = 5 mmHg, 10 min. post C. No correlation was found between decrease in BP and age, nor with BMI. Pearson r correlation index between the decrease in systolic BP and initial systolic BP was 0.63 (p < 0.003) and between the decrease in diastolic BP and initial diastolic BP, 0.59 (p < 0.005). Secondary effects were mild and well tolerated. In conclusion, C effectively reduced BP in hypertensive crises. Because the efficacy of C, its rapid onset of action and minimal side effects, sublingual Captopril should be considered a first line drug for hypertensive crises.

Mitral valve aneurysm: M-mode and two-dimensional echocardiographic features.

The following report presents M-mode and two-dimensional echocardiographic findings in a case of mitral valve aneurysm. M-mode echocardiography showed abnormal intravalvular echoes during diastole and a linear echo in the left atrium, with a motion pattern similar to that of the anterior mitral valve leaflet. By allowing visualization of the aneurysmal sac, two-dimensional echocardiography proved to be a more specific diagnostic method.

Platelet activity in mitral valve prolapse: a study of platelet aggregation, malondialdehyde production, and plasma beta-thromboglobulin.

Platelet aggregation, malondialdehyde (MDA) production, and recovery after aspirin (ASA) administration and plasma levels of beta-thromboglobulin (BTG) were determined in 40 asymptomatic patients with mitral valve prolapse (MVP) and 17 normal subjects. Platelet aggregation was similar in patients and controls, although two patients presented spontaneous aggregation. Production of MDA and plasma levels of BTG were higher in MVP than in controls; however, recovery after ASA was similar in both groups. The results further indicate that platelet hyperactivity is present in a significant number of asymptomatic patients with MVP.

Saphenous vein bypass from the aorta to the anterior interventricular vein.

A patient is described who had myocardial revascularization with saphenous vein grafts. One of the grafts was inadvertently anastomosed to the anterior interventricular vein instead of the anterior descending coronary artery. He also underwent saphenous vein bypass to the right coronary artery and resection of a left ventricular aneurysm. The patient remained free of angina up to 3 1/2 years after operation, at which time he was seen with tachyarrhythmia and a continuous murmur. Coronary arteriography revealed patent bypass grafts to both the distal right coronary artery and the anterior interventricular vein. Whether the patient benefited from the graft to the anterior interventricular vein remains indeterminable because of the successful bypass to the right coronary artery and the left ventricular aneurysmectomy. He did experience clinical improvement for 3 1/2 years, and the symptom when he was seen at our institution was tachyarrhythmia, not chest pain. Additionally, his exercise tolerance had improved markedly. We believe the potential advantages of bypass from the aorta to the coronary veins is still unexplored.