RESUMEN
La presión arterial (PA) que persiste sobre140/90mmHg, aun cuando se utilicen tres o más fármacos antihipertensivos a dosis máximas toleradas, incluyendo un diurético, es definida como hipertensión arterial (HTA) resistente. La hiperactividad del sistema nervioso simpático renal influye críticamente en su fisiopatología. El año 2009 se publicó la denervación simpática o simpatectomía renal (DSR), técnica prometedora para tratar la hipertensión resistente, mediante radiofrecuencia. No existen reportes de su uso en Chile. El objetivo del caso es comunicar una nueva alternativa para tratarla HTA resistente, en términos del control de la PA. PRESENTACIÓNDEL CASO: Paciente varón, 64 años, con antecedentes de HTA resistente, infarto al miocardio y accidente vascular encefálico recuperado, fue evaluado para valorar posibilidad de realizar DSR, por persistencia de HTA a pesar de tratamiento con 4 fármacos hipotensores. Se citó en agosto del 2012 al Hospital Las Higueras, Talcahuano, constatándose asintomático,PA: 161/85mmHg, sin otras alteraciones al examen físico. Exámenes laboratorio normales. Se decidió intervenir un mes después, efectuándose el procedimiento sin complicaciones.PA: día post intervención 108/59mmHg; control a dos semanas148/87mmHg, sin usar hipotensores. DISCUSIÓN: La DSR puede reducir sustancialmente la PA (27/17mmHg al año). En Chile, existe una alta prevalencia de HTA y sólo un bajo porcentaje logra normalizar su PA mediante terapia no farmacológica y/o farmacológica. En este caso, se realizó seguimiento con control de PA a los tres, seis, nueve y doce meses, encontrándose valores significativamente menores. Actualmente mantiene su PA bajo control con 2 fármacos hipotensores...
A blood pressure (BP) that remains over140/90mmHg despite the use of three or more antihypertensive drugs at maximum tolerated doses, including a diuretic, is defined as resistant hypertension (HT). The hyperactivity of the sympathetic nervous system critically influences renal pathophysiology. In 2009, a publication showed that sympathetic renal denervation (SRD) or renal sympathectomy, was a promising radiofrequency technique for the treatment of resistant hypertension, with no reports in Chile. The aim of this case is to present a new alternative for the treatment of resistant hypertension, through the control of BP. CASE REPORT: A 64-yearoldmale, with a history of resistant hypertension, myocardial infarction and stroke without squeal, was evaluated at Las Higueras Hospital, Talcahuano, in august 2012, to assess the possibility of RSD, for the treatment of his resistant hypertension.The patient was asymptomatic with no findings in physical examination, but BP 161/58 mmHg. Laboratory results were normal. The procedure was performed, one month later, without complications. The day next to intervention BP 108/59 mmHg. Two weeks later control BP 148/87 mmHg without antihypertensive drugs. DISCUSSION: SDR can significantly reduce BP(-27/-17mmHg per year). In Chile, there is a high prevalence of hypertension and a low percentage of patients normalizes BPwith non-pharmacological and/or pharmacological treatment. The patient was controlled at three, six, nine and twelve month post SDR, with BP values significantly lower than pre-SDR. At present, patient BP is under management with two antihypertensive drugs...
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Hipertensión/cirugía , Simpatectomía , Sistema Nervioso Simpático/cirugía , DesnervaciónRESUMEN
We studied a 23-yr-old woman with scleroderma and type B insulin resistance. The association with autoimmune disease suggested that the insulin resistance resulted from autoantibodies to the insulin receptor. However, in preliminary studies, serum antireceptor antibodies were not detected in an assay that measures the ability of the antibodies to inhibit insulin binding to the insulin receptor. Antireceptor antibodies were subsequently detected by their ability to immunoprecipitate affinity-labeled receptors. After the patient had received immunosuppressive therapy with prednisone and cyclophosphamide for 3 months, her insulin resistance remitted, and she developed hypoglycemia. Simultaneously with the remission of insulin resistance, the titer of serum antireceptor antibody (measured by the immunoprecipitation assay) fell to less than 1% of the previous level. In a series of 21 patients, this is the first patient with antireceptor antibodies that bound to the insulin receptor without inhibiting insulin binding.