La alimentación y la actividad física en la hipertensión arterial / Alimentation and physical exercise in the arterial hypertension

La gran prevalencia de la hipertensión arterial (HTA) en las sociedades desarrolladas contrasta con la correspondiente a ciertos países no culturizados. Junto a factores genéticos, los hábitos alimentarios pueden desempeñar un importante papel en el origen y evolución de la HTA. Entre los factores dietéticos se conoce la importancia de la ingesta de sal, generalmente muy superior a las necesidades. Además del sodio, otros cationes que pueden ser importantes en la prevención y control de la HTA son el calcio y el potasio. La ingestión alcohólica excesiva es un factor determinante de HTA. La obesidad se asocia a HTA y desempeña un papel etiológico. La obesidad de tipo superior o central con aumento de índice cintura/cadera parece ser un importante factor de riesgo y en ella la HTA se asocia a otros componentes del síndrome plurimetabólico. Distintos consensos recomiendan para el control y prevención de la HTA dietas más ricas en vegetales, pobres en sal, sustituyendo parcialmente los ácidos grasos saturados por monoinsaturadas y poliinsaturados. En algunos estudios actuales se propugna este tipo de dieta enriquecida en derivados lácteos preferentemente descremados. La llamada dieta mediterránea será una dieta recomendable por su riqueza en vegetales, pescados y aceite de oliva. La realización de ejercicio físico se asocia a una menor frecuencia de HTA. Los programas de actividad física pueden lograr reducciones moderadas, pero significativas de la presión arterial, y junto a ello un mejor control de otros factores de riesgo cardiovascular (AU)

[Changes in lipid profile of young persons after substitution of sunflower oil by olive oil in the diet]. / Cambios en el perfil lipídico de individuos jóvenes tras la sustitución del aceite de girasol de su dieta por aceite de oliva.

BACKGROUND AND OBJECTIVES: There is controversy in determining the effects of olive oil in the lipidic metabolism. We studied the changes produced in the lipid profile after substituting sunflower dietetic oil with virgin olive oil. POPULATION AND METHODS: We studied 154 cadets of Academia General Militar de Zaragoza (AGEMZA), analyzing their smoking habits, anthropometric measures and dietetic intake. Hematologic, biochemical and lipidic parameters were determined in venous blood samples. All sunflower dietetic oil was substituted with olive oil, without making any other qualitative-quantitative variation in the diet 10 weeks after which the morphometric and analytical evaluation was repeated, comparing both measurements. RESULTS: 87% of cadets took part in the study. 34.3% of them were smokers. There were no significant anthropometric changes. After the interventional period, there was a decrease of 12.2% in total cholesterol (166.6 vs 146.2 mg/dl; p < 0.0001), 13.5% in LDL-cholesterol (99.7 vs 86.2 mg/dl; p < 0.0001), 12.2% in triglycerides (71.1 vs 62.4 mg/dl; p < 0.0001), 9.9% in HDL-cholesterol (52.6 vs 47.4 mg/dl; p < 0.001), despite which total-cholesterol/HDL-cholesterol ratio increased 3.1% (3.2 +/- 0.7 vs 3.1 +/- 0.7; p < 0.001). There were no changes in Lp(a) plasmatic concentrations or hematologic or biochemical parameters. CONCLUSION: The improvement of the lipidic parameters can only be explained by the use of olive oil in the diet of the AGEMZA cadets.

[Diuretics and beta-blockers as the first option in the treatment of arterial hypertension]. / Diuréticos y betabloqueantes como primera opción en el tratamiento de la hipertensión arterial.

Diuretics have increasingly come to be used for the treatment of arterial hypertension over the last few decades. Although their precise active mechanism is unknown, it is supposed that their usefulness as antihypertensive is a product mainly of their effect on the transport of ions across the cell wall, which reduces peripheral vascular resistance. The adverse metabolic effects of diuretics can be minimized by prescribing the lowest doses presently recommended, or by administering potassium salts or a potassium-retain diuretic. The antihypertensive action of beta blockers is similar to that of diuretics and other antihypertensive drugs, and again, their active mechanism is poorly understood. There are several contraindications for prescribing beta blockers, as well as side effects that must be considered before starting treatment. Well-controlled studies on large cohorts have demonstrated the usefulness of both diuretics and beta blockers in preventing the cardiovascular complications of hypertension. These studies have also allowed the medical profession to designate indications for using these drugs in various segments of the population defined by factors of age and race. Given the proved therapeutic efficacy of diuretics and beta blockers, as well as economic considerations, these drugs should be considered first-choice options for the arterial hypertension.

[The pathogenesis of the evolution of the atheroma plaque]. / Patogenia de la evolución de la placa de ateroma.

The different theories on the pathogenesis of the atherosclerotic plaque may be integrated into a single multifactorial one. According to this, the atherosclerotic risk factors produce impairement of the endothelial cell function as well as the release of growing factors leading to smooth muscle cells and macrophage activation and subsequent collagen synthesis and foam cells formation, the two main components of the atheroma plaque. The arterial thrombosis is another important factor for the atherosclerotic plaque growth and for the occlusive complications that leads to acute ischemic syndromes. The same etiologic risk factor that initiate the atherosclerotic process are implicated in its progression. Most coronary acute syndromes show the same pathologic syndrome of a fissured atherosclerotic plaque with a superimposed thrombus. The lipid rich plaques with a thin fibrous cap and the presence of monocyte/macrophages are unstable and prone to fissuring more than the old fibrous plaques. The arterial stress can be an important precipitating factor for the plaque disruption. The possibility of slowing human atherosclerosis and even inducing its regression is one of the present therapeutic goals. One of the most useful approaches is the lipid lowering therapy in hyperlipidemic patients with atherosclerosis. These treatments have demonstrated its efficacy in decreasing the arterial occlusive complications even before showing the atherosclerotic plaque regression. Another approach would be the use of aspirin and other antiplatelet and antithrombotic agents that may partially prevent the progression of the atherosclerotic process.