[Hypertension and anesthesia: consensus statement of the Catalan Associations of Anesthesiology and Hypertension]. / Documento de Consenso sobre Hipertensión Arterial y Anestesia de las Sociedades Catalanas de Anestesiología e Hipertensión Arterial.

The prevalence of hypertension is high in the surgical population. Differing practices and the absence of consensus among physicians involved in caring for hypertensive patients has made it one of the most frequent reasons for cancelling scheduled surgery. The aim of this consensus statement is to outline a practical approach to managing the hypertensive surgical patient. Hypertension is associated with increased risk of perioperative complications, particularly those related to systemic effects and notable fluctuations in blood pressure during surgery. Preoperative assessment should center on a search for signs and symptoms of target organ damage. The anesthesiologist should seek to reduce perioperative fluctuations in arterial pressure, particularly guarding against sustained hypotension. After surgery, antihypertensive medication should be resumed as soon as possible.

Documento de Consenso sobre Hipertensión Arterial y Anestesia de las Sociedades Catalanas de Anestesiología e Hipertensión Arterial / Hypertension and anesthesia: consensus statement of the Catalan associations of anesthesiology and hypertension

La hipertensión arterial (HTA) tiene una elevada prevalenciaen nuestra población quirúrgica. Las diferenciasde criterio y la ausencia de consenso entre los profesionalesimplicados en el cuidado de estos pacientes,han contribuido a que la hipertensión sea una de las causasmás frecuentes de cancelación de una intervención.El objetivo de este documento es ofrecer al clínico unenfoque práctico para abordar el manejo perioperatoriodel paciente hipertenso. La HTA se asocia a un riesgoaumentado de complicaciones perioperatorias, especialmenterelacionado con la repercusión sistémica de lahipertensión y con oscilaciones importantes de la presiónarterial durante la cirugía. La evaluación preoperatoriadebe centrarse en la búsqueda de signos y síntomas delesión de órgano diana. Durante el perioperatorio elanestesiólogo debe minimizar las fluctuaciones de la presiónarterial, evitando especialmente hipotensiones sostenidas,y en el postoperatorio reiniciar lo antes posible lamedicación antihipertensiva(AU)

The prevalence of hypertension is high in the surgicalpopulation. Differing practices and the absence of consensusamong physicians involved in caring for hypertensivepatients has made it one of the most frequent reasons forcancelling scheduled surgery. The aim of this consensusstatement is to outline a practical approach to managing thehypertensive surgical patient. Hypertension is associatedwith increased risk of perioperative complications,particularly those related to systemic effects and notablefluctuations in blood pressure during surgery. Preoperativeassessment should center on a search for signs andsymptoms of target organ damage. The anesthesiologistshould seek to reduce perioperative fluctuations in arterialpressure, particularly guarding against sustainedhypotension. After surgery, antihypertensive medicationshould be resumed as soon as possible(AU)

Diagnóstico de la hipertensión arterial renovascular mediante Eco-Doppler

Objetivo: valorar la fiabilidad del eco-Doppler en la detección de estenosis renales en pacientes con sospecha de hipertensión renovascular. Material y método: estudio prospectivo durante cuatro años de 91 arterias renales en 47 pacientes hipertensos (tres monorrenos) con sospecha de hipertensión arterial renovascular. Edad media: 56 años (r = 25-77); 22 varones y 25 mujeres. Parámetros valorados por dúplex: velocidad sistólica máxima (VSM) y velocidad diastólica final (VDF) en arteria renal, cociente renal-aórtico e índice de resistencia periférica. Análisis estadístico: curvas ROC y análisis multivariante para la obtención del mejor parámetro diagnóstico de estenosis > 60 por ciento. A todos los pacientes se les realizó arteriografía de ambas arterias renales. Resultados: mediante análisis multivariante únicamente la VSM > 180 cm/sg (p = 0,01) y el cociente renal-aórtico > 3 (p = 0,04) son predictivos de estenosis > 60 por ciento. Así hemos identificado 60 de 65 estenosis inferiores al 60 por ciento, 20 de 21 estenosis superiores al 60 por ciento, y 5 de 5 oclusiones (Kappa = 0,85) (p 180 cm/sg es el mejor parámetro para detectar estenosis > 60 por ciento (AU)

Fenómenos oxidativos en la fisiopatología vascular

No disponible (AU)

Effect of long-term antihypertensive therapy with angiotensin converting enzyme inhibitors on red cell sodium transport.

Several sodium transport abnormalities have been reported in erythrocytes from essential hypertensive patients. The possible modification of these parameters under antihypertensive treatment remains controversial. We have measured the maximal rates of the Na+/K+ pump, Na+/K+/Cl- cotransport, and Na+/Li+ countertransport and the rate constant of Na+ leak in erythrocytes from 22 essential hypertensive patient responders to angiotensin converting enzyme inhibitors quinapril or captopril, and from 17 patient nonresponders to these drugs. In the former group, sodium transport measurements were performed at the baseline placebo period and after 6 months of active treatment. The maximal rate of Na+/Li+ countertransport decreased significantly after 6 months of treatment, without differences between both groups of treatment. Angiotensin converting enzyme inhibitors did not significantly modify other sodium transport parameters. The basal activity of erythrocyte sodium transport was not different between patients who responded or not to antihypertensive treatment with those drugs, excluding a predictive value of these measurements concerning the response to angiotensin converting enzyme inhibitors.

Mortality in hypertensive patients in Hospitalet de Llobregat, Barcelona (Spain).

A retrospective cohort study was carried out on 729 hypertensive patients (male and female 40 years and older) in Hospitalet de Llobregat (Barcelona, Spain) to assess possible differences between the mortality of this group of hypertensives and the general population of the same area matched by age and sex. Patient mortality was assessed during a six year period, resulting in a mean follow-up of 2.6 years at the end of the study. The results reflect an increased risk of dying among hypertensives compared with the general population, with standardised mortality ratio by age and sex of 1.88 (95% confidence interval 1.21-2.44). Cardiovascular mortality was significantly higher for males, while noncardiovascular mortality was significantly higher for females. The study also shows that the presence of smoking habit, diabetes or hyperglycaemia, uncontrolled hypertension and age > or = 60 years can increase the risk of dying among hypertensive patients. Although a higher level of BP control is achieved in hypertension hospital clinics than in the primary health care system, the study shows that hypertensives have an excess of mortality than expected considering their own general population by age and sex.

[The prevalence of cardiovascular risk factors in a population of essential hypertension patients]. / Prevalencia de factores de riesgo cardiovascular en una población de hipertensos esenciales.

INTRODUCTION AND OBJECTIVES: High blood pressure is a cardiovascular risk factor whose coincidence with other risk factors considerably increases the probability for coronary heart disease. This study investigates the prevalence of different risk factors in hypertensive subjects. METHODS: We studied 891 patients with high blood pressure in their first visit to a hospital hypertension unit between 1987 and 1991. We assessed their clinical evolution and the prevalence of obesity, smoking, alcohol consumption, elevated blood pressure, diabetes, sedentary lifestyle, left ventricular hypertrophy and family history of high blood pressure. RESULTS: Sixteen per cent of the hypertensive subjects related previous history of evolutive accident. Stroke was the most frequent one. Prevalences of cardiovascular risk factors were as follows: family history of high blood pressure 53%, sedentary lifestyle 52%, elevated blood cholesterol 37%, smoking 35%, obesity 33%, left ventricular hypertrophy 16%, alcohol consumption 13% and diabetes 11%. Obesity prevalence was twice as high in women than in men. Males had higher prevalence for left ventricular hypertrophy, smoking and alcohol consumption. Diabetes was more prevalent in hypertensive patients older than 50 years. Prevalence of high blood cholesterol was greater in the group of women older than 50 years. CONCLUSIONS: Hypertensive patients have high prevalences of other cardiovascular risk factors. Their treatment should be aimed to improving the individual profile of cardiovascular risk.

Percutaneous transluminal angioplasty in the treatment of renovascular hypertension.

In this study we report our experience in 74 patients with hypertension and renal artery stenosis (42 with atherosclerotic stenosis, 32 with fibromuscular dysplasia) who were followed-up for a mean observation period of 21.7 months after percutaneous transluminal angioplasty (PTA). Stenosis was unilateral in 45 cases, bilateral in 16 and located in the renal artery of a solitary functioning kidney in 13 cases. Ostial involvement was observed in 26 cases. A total of 24 patients showed impaired renal function before PTA. Overall results for BP control were 8 cures (13%), 29 improvements (48%) and 24 (39%) who remained unchanged. Five of the 24 patients (21%) with impaired renal function showed improvement with a decrease in serum creatinine levels of more than 30%. Complications of PTA were rare, being limited to two haematomas at the puncture site which resolved spontaneously. These results emphasize that PTA, an easily repeatable procedure of relatively low risk, short hospital stay and low cost, is a first choice technique in the management of renovascular hypertension.

Evaluation of two educative models in a primary care hypertension programme.

This study was planned in the context of a regional high blood pressure programme, to compare the efficacy of two educative methods. The group of 722 hypertensive patients (58.8% women), mean age 61 years, was randomly selected from 19 primary care centres. Initial assessment was based on a patient interview including 22 questions on high blood pressure, its consequences and treatment. Patients agreeing to participate in an active education team programme were distributed into three groups: individual education, team education and a control group. Those who declined to participate formed two groups: individual education and controls. Team education consisted of two audiovisual sessions attended by groups of 8-12 patients and conducted by treating physicians and nurses. Individual education included comments related to the 22 questions. Follow-up assessment was made after two months. An increase in the level of hypertension control was observed only in the accepting group, in which educative action was followed by increased knowledge. Results were similarly favourable for both the individual and team education groups and suggested the need to consider educational factors together with those influencing patient attitude towards an active educational programme.

[Prevalence of arterial hypertension in the rural population of Catalonia]. / Prevalencia de hipertensión arterial en la población rural de Cataluña.

The arterial blood pressure and hypertension data obtained from an epidemiological study of endemic goiter in the rural population of Catalonia was analyzed. The prevalence of hypertension is of 25.1 +/- 2.16%, existing a predominance of women over men. The distribution of the arterial pressure values according to sex are presented, as well as the relationship between arterial blood pressure, weight and obesity.

[Comparative prospective randomized multicenter study of 2 dosage protocols of nitrendipine in patients with mild to moderate hypertension]. / Estudio multicéntrico prospectivo randomizado comparativo de dos esquemas posológicos de nitrendipina en pacientes hipertensos leves-moderados.

134 patients with mild to moderate hypertension received nitrendipine during 6 months in an increasing fashion. Therapeutic goal was achieved in 92% of the patients (DBP less than 95 mmHg) in which BP decreased from 168.4 +/- 13.7/105.0 +/- 1.1 to 140.9 +/- 12.7/84.4 +/- 6.6 (p less than 0.001). In patients whose BP was not controlled with a single initial doses of 20 mg/day, the degree of control was similar with 40 mg single dose and 20 mg twice a day. The most frequently encountered undesirable effects were those caused by the vasodilator action of the drug. No changes in blood glucose and plasma lipid levels were found.