Obesity-related eating behaviours in the adult population of Spain, 2008-2010.

Knowledge of the socio-demographic distribution of eating behaviours can aid our understanding of their contribution to the obesity epidemic and help to address healthy eating interventions to those who can benefit most. This cross-sectional study assessed the frequency of self-reported eating behaviours among 11,603 individuals representative of the non-institutionalized Spanish population aged ≥ 18 years in the period 2008-2010. In the adult population of Spain, 24.3% had lunch and 18.2% had dinner away from home >3 times per month. About three-fourths of adults did not plan the amount of food to be eaten, and did not choose light foods and/or skim dairy products. Also, 26% did not trim visible fat from meat, and 74.7% usually ate while watching television. Compared with individuals with primary or less education, those with university studies were more likely to remove fat from meat (age- and sex-adjusted odds ratio [aOR] 1.25; 95% confidence interval [CI] 1.08-1.44), and to choose light food and/or skim dairy (aOR 1.50; 95% CI 1.30-1.77), and less likely to eat while watching television (aOR 0.54; 95% CI 0.47-0.63). In conclusion, the prevalence of several obesity-related eating behaviours is high in Spain, which indicates a deficient implementation of dietary guidelines. Socioeconomic inequalities in eating behaviours should also be addressed.

Tratamiento de la hipertensión arterial: medidas no farmacológicas

En la actualidad, todas las directrices coinciden en recomendar las medidas no farmacológicas como la primera acción a desarrollar por el médico frente a la hipertensión arterial (HTA).Las medidas no farmacológicas más útiles son la restricción de la ingesta de cloruro sódico y de bebidas alcohólicas, y la reducción del sobrepeso. Asimismo, otras modificaciones dietéticas o del estilo de vida pueden tener un efecto beneficioso en algunos subgrupos de hipertensos (AU)

Evaluación clínica del paciente hipertenso

La evaluación clínica de un paciente al que se le detectan por primera vez cifras elevadas de presión arterial engloba todos los principios de la práctica médica correcta y se basa en una completa historia clínica, el examen físico y en la utilización razonada de las pruebas de laboratorio apropiadas. En la mayoría de los casos ello debe realizarse en un ambiente ambulatorio y sin el uso de fármacos. Excepto en los casos de hipertensión arterial (HTA) grave o ante la presencia de complicaciones cardiovasculares evidentes, no debe instaurarse el tratamiento hasta que se haya completado dicha evaluación. En los pacientes con grados ligeros de HTA la sucesión de visitas médicas puede servir igualmente para establecer la persistencia o la labilidad de la HTA, mientras que para aquellos pacientes que ya reciben tratamiento debe valorarse la suspensión del mismo, especialmente si éste es inefectivo. (AU)

Microalbuminuria in essential hypertension: clinical and biochemical profile.

This study aims to evaluate the clinical and biochemical profile associated with the presence of microalbuminuria in a group of essential hypertensive patients referred to a hypertension clinic. A total of 188 non-diabetic, untreated essential hypertensive patients (100 men, 88 women) aged 55.8 +/- 11.7 years are studied. Urinary albumin excretion was determined in two 24-h urine collections. Clinical and biochemical evaluations and 24-h ambulatory blood pressure (BP) monitoring were performed at baseline. Forty-two patients (22.3%) showed an increased urinary albumin excretion rate (20-200 micrograms/min). These patients showed significantly higher values (P < 0.01) for 24-h, daytime and night-time systolic and diastolic BP, compared with essential hypertensives with normal urinary albumin excretion. However, nocturnal reduction in BP did not differ between the groups. Furthermore, patients with microalbuminuria showed significantly higher (P < 0.01) creatinine, serum uric acid and triglycerides, as well as lower high-density lipoprotein (HDL)-cholesterol. In a multiple logistic regression analysis, a 24-h systolic BP > 140 mmHg (odds ratio: 3.19; 95% confidence interval [CI 95%]: 1.44-7.06) and a serum creatinine > 88 mumol/L (odds ratio: 3.08; CI 95%: 1.39-6.84) were the two factors associated independently with increased urinary albumin excretion. We conclude that, in essential hypertensive patients, the presence of microalbuminuria is associated with elevated BP, but not with its circadian pattern. Likewise, microalbuminuria is associated with the degree of renal impairment, and with increased uric acid and triglycerides and decreased HDL-cholesterol.

[Calcium pump changes in patients with essential arterial hypertension]. / Alteraciones de la bomba de calcio en pacientes con hipertensión arterial esencial.

BACKGROUND: Transmembrane Ca2+ fluxes are mediated, at least in part, by the Ca(2+)-dependent ATPase. Thus, genetic or acquired abnormalities of this pump could explain the increase in free cytosolic Ca2+ content that has been observed in essential hypertensive patients. PATIENTS AND METHODS: We carried out a kinetic study of the Ca2+ pump in intact erythrocytes from 49 essential hypertensive patients and 27 normotensive healthy persons. We used Sr2+ as a calcium analogue to measure Ca2+ fluxes dependent of the Ca2+ pump. The intracellular concentrations of Sr2+ and Ca2+ were modified using the A-23187 ionophore in a Ringer isotonic solution. RESULTS: Hypertensive patients showed a significant increase of the maximal efflux rate for Sr2+ (Vmax) with respect to controls (6.6 [2.3] vs 5.2 [1.6] mmol/l cel/h; p = 0.006). Mean values of apparent dissociation constants for intracellular Ca2+ (KCa) were also increased in essential hypertensives (80.36 [53.46] vs 55.25 [15.13] mumol/l cel; p = 0.06). A significant correlation between Vmax and age (r = 0.342; p = 0.016), and serum creatinine (r = 0.446; p = 0.001) was observed. The KCa only correlated with serum creatinine (r = 0.402; p = 0.004). Using the KCa confidence interval of 99% as the higher normal limit, patients were segregated into two subgroups depending on normal KCa values (33 patients, 67.3%) or increased KCa values (16 patients, 32.6%). Age (50.8 [13.5] vs 43 [10.2] years; p = 0.02), serum creatinine (1.13 [0.17] vs 0.95 [0.17] mg/dl; p = 0.001) and serum uric acid (7.27 [3.32] vs 6.14 [1.49] mg/dl; p = 0.04) were higher in patients with increased KCa. Finally, patients with increased KCa also showed increased values of Vmax (9.13 [2.02] vs 5.38 [12.81] mmol/l cel/h; p < 0.0001). CONCLUSIONS: Essential hypertensive patients are heterogeneous regarding ion transport abnormalities, only affecting subgroups of hypertensive patients. We have observed abnormalities of the Ca(2+)-dependent ATPase in 33% of essential hypertensive patients. These patients are older and tend to exhibit higher values of serum creatinine and uric acid.

Effect of alcohol abstinence on blood pressure: assessment by 24-hour ambulatory blood pressure monitoring.

Several studies have shown that cessation of alcohol drinking reduces blood pressure (BP). However, attempts to reproduce these findings by ambulatory BP monitoring (ABPM) have shown inconsistent results. The aim of the present study was to assess the effect of 1 month of proven abstinence from alcohol on the 24-hour BP profile in heavy alcohol drinkers. Forty-two men who were heavy drinkers (>100 g of pure ethanol per day) were consecutively admitted to a general ward for voluntary alcohol detoxification. On the day of admission, they received a total dose of 2 g/kg of ethanol diluted in orange juice in 5 divided doses, and a 24-hour ABPM was performed. A new 24-hour BP monitoring in the same environmental conditions was performed after 1 month of proven alcohol abstinence while the subjects were receiving the same amount of fluid but without the addition of alcohol. After 1 month of proven alcohol abstinence, BP and heart rate (HR) significantly decreased. The reduction was 7.2 mm Hg for 24-hour systolic BP (SBP) (95% CI, 4.5 to 9.9), 6.6 mm Hg for 24-hour diastolic BP (DBP) (95% CI, 4.2 to 9.0), and 7.9 bpm for HR (95% CI, 5.1 to 10.7). The proportion of alcoholic patients considered hypertensive on the basis of 24-hour BP criteria (daytime SBP >/=135 mm Hg or daytime DBP >/=85 mm Hg) fell from 42% during alcohol drinking to 12% after 1 month of complete abstinence. Abstinence did not modify either the long-term BP variability, assessed by SD of 24-hour BP, or its circadian profile. We conclude that abstinence in heavy alcohol drinkers significantly reduces BP assessed by 24-hour ABPM and that this reduction is clinically relevant. These results show that heavy alcohol consumption has an important effect on BP, and thus cessation of alcohol consumption must be recommended as a priority for hypertensive alcohol drinkers.

Increased left ventricular mass in salt-sensitive hypertensive patients.

Clinical, biochemical and echocardiographic characteristics were evaluated from 50 essential hypertensive patients classified asccording to their salt-sensitivity status. Salt-sensitive hypertension was diagnosed by means of ambulatory blood pressure monitoring (ABPM) in 22 (44%) patients showing a significant increase in mean BP (P < 0.05) from a 7-day period of low salt (20 mmol NaCl/day) intake, to a 7-day period of high salt (260 mmol NaCl/day) intake. The remaining 28 (56%) patients were considered as having salt-resistant hypertension. Compared with salt-resistant patients, salt-sensitive ones showed an increased left ventricular mass index (P = 0.0118), septal (P = 0.0021) and posterior wall thickness (P = 0.0026), without differences in the internal diastolic diameter. Decreased values of HDL-cholesterol (P = 0.0475) and increased total cholesterol/HDL-cholesterol ratio (P = 0.0098) were also observed in the salt-sensitive, compared with the salt-resistant hypertensive patients. Age, gender, body mass index, systolic and diastolic BP, fasting plasma glucose, creatinine and uric acid did not differ between salt-sensitive and salt-resistant patients. We conclude that, at the same level of BP, salt-sensitive patients exhibit an increased prevalence of left ventricular hypertrophy and a worse lipid profile. These two aspects may confer to salt-sensitive patients an increased risk in terms of cardiovascular morbidity and mortality.

Fluid, ionic and hormonal changes induced by high salt intake in salt-sensitive and salt-resistant hypertensive patients.

1. The aim of the study was to detect differences between salt-sensitive and salt-resistant hypertensive patients in the response of the renin-aldosterone axis, plasma noradrenaline and atrial natriuretic peptide to high salt intake. 2. Fifty essential hypertensive patients followed 2 weeks of a standard diet with 20 mmol of NaCl daily, supplemented by placebo tablets for the first 7 days and by NaCl tablets for the last 7 days, in a single-blind fashion. Salt sensitivity was defined as a significant rise (P < 0.05) in 24 h mean blood pressure obtained by ambulatory blood pressure monitoring from the low- to the high-salt period. Biochemical and hormonal measurements were performed on the last day of both periods. 3. Twenty-two (44%) patients fulfilled criteria of salt-sensitive hypertension, whereas the remaining 28 (56%) were considered salt-resistant. High salt intake promoted a significant decrease (P < 0.05) in plasma creatinine, potassium, glucose, cholesterol, low-density lipoprotein-cholesterol, triacylglycerols, uric acid and plasma renin activity, and a significant increase in plasma atrial natriuretic peptide and 24 h urinary calcium excretion. The direction of these changes did not differ between salt-sensitive and salt-resistant patients. Salt-resistant hypertensive patients exhibited a significant decrease in plasma aldosterone induced by high salt intake (from 446 +/- 35 to 226 +/- 35 pmol/l; P < 0.001), whereas this parameter was not significantly modified in salt-sensitive patients (from 485 +/- 76 to 364 +/- 83 pmol/l; P not significant). Salt-sensitive patients showed an increase in plasma noradrenaline after high salt intake (from 1.15 +/- 0.11 to 1.56 +/- 0.14 nmol/l; P < 0.05), whereas salt-resistant patients presented a decrease in this parameter (from 1.48 +/- 0.08 to 1.12 +/- 0.08 nmol/l; P < 0.05). The change in plasma noradrenaline was directly correlated with the change in mean blood pressure induced by high salt intake (r = 0.479; P = 0.003). 4. We conclude that the increase in blood pressure induced by high salt intake in salt-sensitive patients is associated with a stimulation of the sympathetic nervous system and a blunted decrease in plasma aldosterone. Conversely, changes in renal function, electrolyte excretion and plasma concentrations of atrial natriuretic peptide induced by high salt intake seem to be similar in both salt-sensitive and salt-resistant patients.

Erythrocyte sodium transport, intraplatelet pH, and calcium concentration in salt-sensitive hypertension.

We evaluated changes in erythrocyte sodium transport systems, platelet pH, and calcium concentration induced by low and high salt intakes in a group of 50 essential hypertensive patients classified on the basis of their salt sensitivity. Patients received a standard diet with 20 mmol NaCl daily for 2 weeks supplemented in a single-blind fashion by placebo tablets the first 7 days and NaCl tablets the following 7 days. Salt sensitivity, defined as a significant rise (P <.05) in 24-hour mean blood pressure obtained by ambulatory blood pressure monitoring, was diagnosed in 22 (44%) patients. The remaining 28 (56%) were considered to have salt-resistant hypertension. In the entire group of hypertensive patients, high salt intake promoted a significant increase (P <.05) in the maximal rate of erythrocyte NA(+)-Li(+) countertransport (from 271 +/- 19 to 327 +/- 18 microM/(L cells/h) and of the Na(+)-dependent HCO3(-)-CL(-) exchanger (from 946 +/- 58 to 1237 +/- 92 microM/L cells/h) as well as in platelet pH (from 7.15+/-0 0.01 to 7.19+/-0.02 and calcium concentration (from 49+/-2 to 57 +/-2 nmol/L). Depending on salt sensitivity, high salt intake promoted opposing changes in some of the sodium transport systems studied. Salt-sensitive patients increased the maximal rate of the erythrocyte Na(+)-K(+) pump (fom 7.0 +/- 0.4 to 8.8 +/- 0.4 mmol/(L cells/h), Na(+)-K(+)-Cl(-) cotransport (from 416 +/- 37 to 612 +/- 41 micromol/(L cells/h), Na(+)-Li(+) countertransport (from 248 +/- 20 to 389 +/- 17 micromol/(L cells/h) at the end of the high salt period. Conversely, salt-resistant patients decreased the Na(+)-K(+) pump (from 8.0 +/- 0.4 to 6.9 +/- 0.3 mmol/(L cells/h) and Na(+)-K(+)-Cl(-) cotransport (from 578 +/- 53 to 481 +/- 43 micromol/(L cells/h). We conclude that modulation of erythrocyte sodium transport systems by high salt intake depends on salt sensitivity. The Na(+)-K(+) pump, Na(+)-K(+)-Cl(-) cotransport, and Na(+)-Li(+) countertransport increase in salt-sensitive patients, whereas the activity of these sodium transport systems tends to decrease in salt-resistant patients. Independent of salt sensitivity, high salt intake promotes a significant increase in the erythrocyte Na(+)-dependent HCO3(-)-Cl(-) exchanger, platelet pH, and calcium concentration in essential hypertensive patients.

Assessment of salt sensitivity in essential hypertension by 24-h ambulatory blood pressure monitoring.

We used ambulatory blood pressure monitoring (ABPM) in the assessment of salt sensitivity in 40 essential hypertensive patients, comparing 24-h mean blood pressure during 7 days of low salt (20 mmol NaCl/day) and high salt (260 mmol NaCl/day) intake. Salt sensitivity was diagnosed in 18 essential hypertensive patients (45%), each of them showing a significant increase in mean blood pressure (P < .05) from low to high salt diet. Salt-sensitive patients exhibited a high-salt-dependent increase in all blood pressure parameters including 24-h systolic, mean, diastolic blood pressure, blood pressure load, area under the curve, and awake and asleep blood pressure values. These patients exhibited a nondipper profile on both low-salt and high-salt diets. Salt-resistant patients (55%) showed a decrease in awake, and an increase in asleep blood pressure values after high salt intake, thus tending to flatten the circadian blood pressure profile. We conclude that ABPM is a useful method to assess salt sensitivity. In salt-resistant patients high salt intake induces a significant increase in asleep blood pressure with no significant changes in 24-h blood pressure, promoting a flattened blood pressure curve and tending to transform a dipper into a nondipper profile, which could have important implications in end-organ damage.

Increased activity of the Mg2+/Na+ exchanger in red blood cells from essential hypertensive patients.

Epidemiological, clinical, and experimental evidence suggests a relation between Mg2+ metabolism and essential hypertension. The aim of the present study was the detection of abnormalities of the erythrocyte Mg2+/Na+ exchanger in essential hypertensive patients. We studied 66 untreated essential hypertensive patients and 36 normotensive control subjects. Maximal efflux rates of total Mg2+ efflux and the Na(+)-dependent and Na(+)-independent components of Mg2+ efflux were determined in Mg(2+)-loaded red blood cells. Mg2+/Na+ exchanger was calculated as the Na(+)-dependent component of the Mg2+ efflux. Mean values of Mg2+/Na+ exchanger were clearly elevated in hypertensive subjects with respect to normotensive control subjects [184.7 +/- 15.7 versus 84.4 +/- 6 mumol(L.cell.h)-1; P < .001]. This elevation was due primarily to the increased total Mg2+ efflux [324.2 +/- 21.9 versus 257.9 +/- 17.3 mumol(L.cell.h)-1; P < .05], whereas the Na(+)-independent component was not significantly different between the groups [154.5 +/- 11.8 versus 173.4 +/- 15.5 mumol(L.cell.h)-1; P = NS]. Moreover, total erythrocyte Mg2+ content was slightly reduced in hypertensive patients with respect to normotensive control subjects (1.84 +/- 0.04 versus 2.07 +/- 0.04 mmol/L.cell; P < .001). Using the 99% confidence limits of the normotensive population as the normal range, 30 (45.5%) hypertensive subjects showed values of Mg2+/Na+ exchanger higher than 160 mumol(L.cell.h)-1. The Mg2+/Na+ exchanger was inversely correlated with basal intraerythrocyte Mg2+ content (r = -.323; P = .001). From a clinical point of view, we found a positive correlation between diastolic blood pressure values and Mg2+/Na+ exchanger (r = .246; P < .05) in the sample of essential hypertensive patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative evaluation of the antihypertensive efficacy of once-daily amlodipine versus nitrendipine with 24-hour ambulatory blood pressure monitoring in essential hypertension.

We compared the antihypertensive efficacy of once-daily amlodipine (AM) versus nitrendipine (NTR) by 24-h ambulatory blood pressure monitoring (24-h ABPM) in 32 patients with mild to moderate essential hypertension (EH). After a 2-week single-blind, placebo run-in period, patients were randomized in a double-blind, parallel fashion: 14 received AM 5 mg and 18 NTR 10 mg. After 2 weeks, dose was adjusted if necessary (AM 10 mg or NTR 20 mg) and continued for another 6-week period. At the end of the placebo period and during the last week of treatment, patients underwent 24-h ABPM. Initial office BP mean values were similar in both groups (169.8 +/- 14/102.5 +/- 6 vs. 167.1 +/- 14/98.7 +/- 5 mm Hg, respectively, p = NS). A comparable decrease in office mean values of systolic BP (SBP, -22.3 +/- 13 vs. -19.1 +/- 16 mm Hg) and diastolic BP (DBP, -12.0 +/- 5 vs. -8.1 +/- 8 mm Hg) was observed. Nevertheless, 24-h ABPM mean values differed significantly between patients treated with AM or NTR with regard to 24-h SBP (120.0 +/- 10 vs. 132.5 +/- 1 mm Hg, p = 0.01). Moreover, the average decrease in 24-h SBP (-19.3 +/- 6 vs. -5.2 +/- 11 mm Hg, p = 0.0036) and 24-h DBP (-10.7 +/- 4 vs. -3.7 +/- 6 mm Hg, p = 0.0047) was higher in the AM group, with no changes in 24-h heart rate (HR). At equivalent once-daily dosage, AM was more effective than NTR in decreasing BP assessed by 24-h ABPM.

Chronic alcohol intake induces reversible disturbances on cellular Na+ metabolism in humans: its relationship with changes in blood pressure.

The effect of chronic alcohol consumption on Na(+)-K+ ATPase, Na(+)-Li+ countertransport, outward Na(+)-K(+)-Cl- cotransport system and the Na+ leak was investigated in red blood cells from 18 normotensive subjects with a daily alcohol intake of more than 150 g. The study was repeated after 3 months of alcohol withdrawal, and results were compared with a group of 20 healthy normotensive teetotalers. Maximal efflux rate (Vmax) and apparent dissociation constant for internal Na+ (KNa) of the Na(+)-K+ pump and the Na(+)-Li+ countertransport were significantly higher in alcohol consumers. A positive correlation between daily alcohol intake and Vmax of both transport systems (p less than 0.05) was observed. These values significantly decreased after alcohol withdrawal. A simultaneous stimulation of the Na(+)-K(+)-Cl- cotransport system after alcohol withdrawal was also observed. Blood pressure values were higher in alcoholics (133.7/82.3) than in abstainers (121.4/75 mmHg) and significantly decreased (128.5/76.9 mmHg) after withdrawal. A positive correlation between the stimulation of the Na(+)-K(+)-Cl- cotransport and the decrease of blood pressure after withdrawal was observed. In conclusion, chronic alcohol intake induces disturbances on red blood cell Na+ metabolism that dissipate with the cessation of drinking. Similar abnormalities also reported in humans and animals with primary hypertension have been associated in the pathogenesis of essential hypertension. Therefore, the pressor effect of chronic alcohol intake could be mediated through these changes in cellular Na+ metabolism.

[Prevalence of lipid disorders and their course after blood pressure control in essential arterial hypertension]. / Prevalencia de los trastornos lipídicos y su evolución tras el control tensional en la hipertensión arterial esencial.

BACKGROUND: Arterial hypertension and hyperlipidemia are the principal factors of cardiovascular risk with an association which appears to obey common pathogenic bonds. In the present study the initial prevalence of hypercholesterolemia and hypertriglyceridemia was determined in a sample of essential hypertensives and the long term effect of different antihypertensive treatments on lipid metabolism has been analyzed. METHODS: Total cholesterol, its LDL and HDL fractions and plasmatic triglycerides were determined in a sample of 158 hypertensive patients prior to the initiation of antihypertensive treatment and following one year of normotension. RESULTS: The initial prevalence of lipid disturbances was of 47% (isolated hypercholesterolemia 17%, isolated hypertriglyceridemia 14% and mixed anomalies 16%). After one year of tension control the initial prevalence was not modified. In the patients controlled with a low sodium diet a decrease in total cholesterol and an increase in cholesterol-HDL were observed in those treated with atenolol, and a decrease in cholesterol-LDL was seen in those receiving captopril. The group treated with nifedipin presented no significant variations of the lipid profile. CONCLUSIONS: The prevalence of lipid disturbances is greater among the hypertensive patient than in the general population. The rational treatment of a hypertensive patient must not only regard blood pressure figures but also control the other risk factors since the drugs commonly used in the treatment of arterial hypertension generally demonstrate a neutral effect on lipid metabolism.

[Do clinical parameters exist that permit predicting the need to combine a diuretic with captopril in the initial treatment of essential arterial hypertension?]. / Existen parámetros clínicos que permitan predecir la necesidad de asociar un diurético al captopril en el tratamiento inicial de la hipertensión arterial esencial?

In the present work the clinical, biological, radiological, electrocardiographic and hormonal characteristics are analyzed in 51 patients suffering mild essential hypertension, in whom treatment with captopril in monotherapy or associated to chlortalidone managed to normalize arterial pressure and maintained the pressure control during a period of one year. Captopril in monotherapy at a dose of 50 to 150 mg/day normalized blood pressure in 34 patients (66.7%) while in the remaining 17 patients (33.3%) the association of 25 mg of Chlortalidone was required. When comparing the subgroup of patients whose blood pressure levels were controlled with captopril as the only used drug (Group A) against those who required the association with diuretics (Group B), we could only observe significant differences regarding the blood pressure level and cardiothoracic index, being these higher in the group of patients who required pharmacologic association. We conclude that only the severity of hypertension allows to predict the necessity of associating a diuretic to captopril in order to obtain the control of blood pressure levels.

[The clinical profile of hypertensive patients can predict the need for combining a second or third drug with atenolol in the initial treatment of light and moderate essential arterial hypertension]. / El perfil clínico de los pacientes hipertensos puede predecir la necesidad de asociar un segundo o tercer fármaco al atenolol en el tratamiento inicial de la hipertensión arterial esencial leve y moderada.

In this study the clinical, biological, radiologic, electrocardiographic, and hormonal characteristics of 80 patients with slight or moderate essential arterial hypertension in whom the treatment with atenolol alone or associated with chlorthalidone or with a third agent normalized the arterial pressure during a period of one year, are revised. Atenolol given alone at the dose of 50 to 100 mg per day normalized the blood tension in 44 (55%) patients, in 26 cases (32.5%) the association of chlorthalidone 25 mg/day was required, and in the remaining 10 patients (12.5%) a third pharmacologic agent was needed. Patients who required the association of three agents (group C) had systolic arterial pressures significantly higher than those observed in patients treated with atenolol alone (group A) (176.6 +/- 14.3 vs 161.4 +/- 12.9 mmHg, p less than 0.01) and higher to those measured in patients who required the association of chlorthalidone (group B) (176.6 +/- 14.3 vs 162.8 +/- 15 mmHg, p less than 0.05). On the other hand the 44 hypertensive patients controlled with monotherapy showed a lower incidence of cardiovascular complications (6.8% in group A, 38.5% in group B, and 30% in group C, p = 0.0042), they required acute treatment for hypertensive crisis (34.1% in group A, 73.1% in group B, and 66.7% in group C, p = 0.0041), and they showed electrocardiographic signs of left ventricular hypertrophy or overload (26.2% in group A, 60% in group B, and 42.9% in group C, p = 0.0228).(ABSTRACT TRUNCATED AT 250 WORDS)

[Prevalence, forms of clinical presentation and treatment of arterial hypertension at an emergency unit]. / Prevalencia, formas clínicas de presentación y tratamiento de la hipertensión arterial en una unidad de urgencias.

In order to determine the prevalence of arterial hypertension and clinical presentation of the hypertensive crisis, as well as the need and efficacy of treatment, 3626 patients who were seen at an Emergency care Unit during a period of 37 randomly chosen days in a total time period of three months, have been studied. Two hundred and fifty one patients presented arterial hypertension, defined as a systolic arterial pressure above 160 mmHg and/or diastolic above 95 mmHG, which represents 6,92% of medical emergencies and 1.79% of total emergencies. Only 104 patients (2.86%) seeked help for some pathology related to hypertension, of whom 49 (19.5% of hypertense patients) presented as a hypertensive emergency, being the acute lung edema and unstable angina the most frequently encountered emergencies. Nifedipine was the most frequently used drug in both groups and managed to control pressure levels in almost 90% of patients with a hypertensive emergency in a mean time of less than one hour.

Disturbances of transmembranous sodium transport systems induced by ethanol in human erythrocytes. An approach to the pressor effect of alcohol.

Several epidemiological and clinical studies have established a clear association between alcohol consumption and hypertension. The mechanism of the pressor effect of ethanol is not well understood. We studied the in vitro effects of increasing amounts of ethanol on different Na+ transport systems from human erythrocytes. Ethanol at concentrations higher than 32 mmol/L stimulated ouabain-sensitive Na+ efflux, the Na+ efflux depending on the Na+:Li+ countertransport and Na+ leak. At the same concentrations, ethanol inhibited bumetanide-sensitive Na+ efflux. We conclude that, with the exception of Na+-K+ pump, alcohol-induced alterations and those observed in erythrocytes from essential hypertensives may overlap. Therefore, alcohol consumption could potentiate those genetic abnormalities of Na+ transport and contribute to the pathogenesis of essential hypertension.