SEA 2022 Standards for Global Control of Cardiovascular Risk. / Estándares SEA 2022 para el control global del riesgo cardiovascular.

One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to better knowledge of vascular disease, its prevention and treatment. It is well known that cardiovascular diseases are the leading cause of death in our country and entail a high degree of disability and health care costs. Arteriosclerosis is a multifactorial disease and therefore its prevention requires a global approach that takes into account the different risk factors with which it is associated. Therefore, this document summarizes the current level of knowledge and includes recommendations and procedures to be followed in patients with established cardiovascular disease or at high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or requested for those in special situations. It also includes vascular risk estimation, the diagnostic criteria of the different entities that are cardiovascular risk factors, and makes general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not usually referenced in the literature, such as the organization of a vascular risk consultation.

Apolipoprotein E gene polymorphism is related to metabolic abnormalities, but does not influence erythrocyte membrane lipid composition or sodium-lithium countertransport activity in essential hypertension.

The aim of this study was to analyze the influence of the apolipoprotein E (apoE) gene polymorphism on insulin resistance and plasma lipid composition of essential hypertensive patients. A secondary objective was to analyze if differences regarding plasma lipids had an effect on the erythrocyte membrane lipid composition and the activity of the erythrocyte membrane sodium-lithium countertransport. We studied 128 untreated nondiabetic essential hypertensive patients enrolled from our outpatient clinic. We considered as hyperinsulinemic all subjects having more than 80 mU/L of plasma insulin 120 minutes after a 75-g oral glucose intake. The number of hyperinsulinemic subjects among carriers of the epsilon4 allele was higher that in epsilon4 noncarrier subjects (13 of 19 v45 of 109, P < .05; odds ratio [OR], 3.08; confidence interval [CI], 0.99-10.57). Plasma insulin at baseline and plasma insulin and glucose at 120 minutes after overload was higher in carriers of the epsilon4 allele (respectively, 17.5 +/- 6.9 v 12.4 +/- 4.9 mU/L, P < .01; 111.9 +/- 39.9 v 88.7 +/- 48.2, P < .05; and 143.8 +/- 29.3 v 121.2 +/- 30.8 mg/dL, P < .005). Subjects with the epsilon4 allele had a plasma lipid profile more atherogenic than those without this allele. This profile was mainly characterized by higher levels of low-density lipoprotein (LDL) cholesterol (150.1 +/- 31.2 v 133.0 +/- 34.3 mg/dL, P < .05) and very-low-density lipoprotein (VLDL) triglycerides (134.7 +/- 85.5 v 99.2 +/- 68.8 mg/dL, P < .05) and by lower levels of high-density lipoprotein (HDL) cholesterol (41.8 +/- 10.7 v 50.0 +/- 14.7 mg/dL, P < .05). There were no differences between groups regarding erythrocyte membrane cholesterol or phospholipids composition and sodium-lithium countertransport (SLC) activity.

[Hypertensive subpopulations as defined by their natriuretic response to ambulation]. / Subpoblaciones de hipertensos definidas por la respuesta natriurética a la deambulación.

BACKGROUND: The heterogeneity among patients with essential hypertension is known. We observed in an earlier study a large spread in the values of fractional excretion of sodium in a group of subjects with mild essential hypertension after ambulation, suggesting possible subgroups among them. We defined as the retainer (R) group that which presented a reabsorption index (RI = fractional excretion of sodium during supine/fractional excretion of sodium after ambulation) < 2.5 and the non-retainer (NR) group as that whose RI < 2.5. We analyzed at what level the reabsorption of Na was produced and the differences between the possible groups. PATIENTS AND METHODS: We studied 51 mild essential hypertensive patients, 22 men and 29 women, in two consecutive periods -recumbent, 90 minutes; ambulation, 90 minutes-. We calculated the clearance of creatinine and lithium, fractional proximal and distal reabsorption of Na, plasma renin activity (PRA), plasma aldosterone (ALDO) and elimination of PGE2 and kallikrein in the urine; the plasma catecholamines at the end of the recumbent position and after 10 minutes in the upright position. The study was taken after at least ten days without treatment and following a diet with free Na intake. RESULTS: We did not encounter significant differences between the retainer (n = 19) and non-retainer (32) group with regard to age, sex, body mass index or elimination of Na/24 h. The lower natriuresis in ambulation in the R group compared with the NR group is due to a higher fractional reabsorption of sodium, proximal (83.7 +/- 4.9% vs 79 +/- 5.2; p < 0.01) as well as distal (96.8 +/- 2 vs 95.3 +/- 2%; p < 0.05). The increment in the PRA was greater in the R group (1.3 +/- 1.4 vs 0.8 +/- 0.8; p < 0.05) after ambulation; in the R group showed a lower index -increment in ALDO/increment in PRA- in response to postural change although without significancy. We observed a lower elimination of PGE2 and kallikrein in the R group as compared with NR group (p < 0.05). We did not find differences with regard to plasma catecholamines. CONCLUSIONS: Ambulation allows to distinguish two groups of essential hypertensive patients according to natriuresis. The lower natriuresis in ambulation on the part of the R group could be due to the increase in PRA and therefore of the angiotensin II at the level of the proximal tubule, and to a lower activity of natriuretic hormones (PGE21 kallikrein) at the distal level.

Erythrocyte Na(+)-Li+ countertransport in essential hypertension: correlation with membrane lipids levels.

OBJECTIVE: To examine whether Na(+)-Li+ countertransport (SLC) activity is linked to erythrocyte membrane lipid content. DESIGN: An observational case-control study. The maximal efflux rate of SLC, plasma cholesterol, triglycerides, phospholipids, low- and high-density lipoprotein cholesterol levels and the erythrocyte membrane cholesterol, phospholipids and fatty acids contents were determined both in fasting normolipaemic normotensive subjects and in hypertensive patients. METHODS: The Li(+)-stimulated Na+ efflux was measured in Li(+)-preloaded erythrocytes. Membrane cholesterol and phospholipids levels were determined by the latroscan technique. Membrane fatty acids were identificated by gas chromatography. Several derived indices were also obtained. RESULTS: Erythrocyte membranes of hypertensive patients showed an increase in cholesterol: phospholipid ratio and a decrease in the total amount of polyunsaturated fatty acids, mainly at the expense of arachidonic acid and docosatetraenoic acid. SLC activity was higher in hypertensive patients and correlated positively with the plasma triglycerides level and negatively with the ratio of C20:4 to C20:3. CONCLUSION: Our data from untreated normolipaemic hypertensive patients show that a higher SLC activity was accompanied by parameters that indicate a lower membrane fluidity.

Modifications induced by -10 degrees Trendelenburg's posture in sodium tubular handling in patients with essential hypertension.

In essential hypertensive patients "exaggerated natriuresis" is a response to acute volume expansion. However, the underlying mechanisms for this remain to be determined. We studied 19 patients with essential hypertension (HP) and 9 normotensive subjects (NS). In all examined subjects the response to acute central volume expansion, without the plasma compositional change that Trendelenburg's position involves, was evaluated during 90 min (period T) after a similar period of deambulation (period D). Mean blood pressure (MBP), tubular sodium handling by the lithium clearance technique, plasma renin activity (PRA), plasma aldosterone (PA), plasma catecholamines and urine prostaglandine E2 and kallikrein were assessed after D and T. MBP was significantly higher in HP than in NS (p = 0.00001). HP showed "exaggerated natriuresis" after T (fractional excretion of sodium increased from 0.55 +/- 0.1% after D to 1.20 +/- 0.2% after T, p < 0.01). This was because of a decrease in their proximal fractional reabsorption of sodium (from 74.96 +/- 1.8% after D to 62.50 +/- 2.8% after T, p < 0.01). Plasma epinephrine and plasma dopamine after T were significantly lower than in standing position in HP (p < 0.01) but no in NS. The decrease in plasma renin activity after T in HP was 53%, and 32% in NS. There were not any significant differences between groups in the other neurohormonal systems studied. We conclude that the major determinant of "exaggerated natriuresis" in hypertensive patients is a higher stimulation of the cardiopulmonary receptors following Trendelenburg's position and consequently stronger reflex inhibition of sympathetic system activity and renin-angiotensin II activity. The "exaggerated natriuresis" after Trendelenburg's position in HP was an expression of abnormal pressure natriuresis.

Ambulatory blood pressure monitoring in physicians working in a hospital: is there an increase in the number of subjects with high workplace blood pressures?

Sixty-two physicians from our hospital who were normotensives, as supported by casual blood pressure measurements, underwent 24-h blood pressure monitoring which included their normal work, home rest and sleep periods. During working hours, 19% of the subjects showed mean diastolic and/or diastolic plus systolic blood pressures higher than those admitted as normal by the WHO for casual measurements for out of work subjects. Both mean systolic and diastolic blood pressure measurements, during the work at the hospital, were significantly higher in males (P < 0.01 and P < 0.005, respectively) than the mean of the readings obtained during the 24-h period, but this phenomenon did not occur among the females. Male's mean systolic (129.8 +/- 10.6 vs. 117.1 +/- 9.7 mmHg, P < 0.0001) and diastolic pressures (83.4 +/- 8 vs. 74.9 +/- 7.3 mmHg, P < 0.001) were significantly higher during the working period in relation to those of the female group. Discussing the influence of the kind of work on blood pressure, we came to the conclusion of the existence in our environment of a group of subjects (generally males), presenting high blood pressure values during their working period at the hospital and normal or borderline values during the rest of the day. This should be of interest, since it has been reported that subjects with high workplace blood pressure have an increased risk of hypertension and target-organ damage.

[Eosinophilic enteritis with mucosal predominance and with a 4 years' course]. / Enteritis eosinofílica de predominio mucoso y cuatro décadas de evolución.

We report a case of eosinophilic enteritis without eosinophilia in a 42-year-old woman with symptoms presumably due to the disease since her childhood. We comment the clinical evolution after surgery and some anatomo-clinico and management features of this rare entity.

[Influence of arterial pressure and plasma renin activity on tubular reabsorption of sodium]. / Influencia de la presión arterial y de la actividad de renina plasmática sobre la reabsorción tubular de sodio.

BACKGROUND: With the aim of confirming the possible existence of an increase in the fractional proximal reabsorption of sodium in the development of essential hypertension, the tubular dynamics of sodium were compared by the lithium clearance technique in a group of hypertensive patients and controls. METHODS: Following a week of drug suspension 186 patients with slight or moderate essential hypertension and 37 normal subjects with homogeneous sodium ingestion were studied. A clearing period of 90 minutes prior to the administration of a tracing doses of lithium was considered to calculate the fractional proximal and distal reabsorption of sodium in terms of glomerular filtration. In addition to global comparison of the measurements, the hypertensives were classified and compared according to mean arterial pressure (MAP) and percentages of plasma renin activity (PRA). RESULTS: No differences were found in tubular dynamics of sodium between hypertensive and normotensive patients. Neither did the degree of hypertension induce differences. However, upon classifying the patients according to PRA, it was found that those with PRA higher than 0.5 ng/ml-1/h-1 had less secondary natriuresis to a greater fractional distal reabsorption of sodium (p < 0.05). CONCLUSIONS: The findings of the this study do not support the possible existence of a primary defect of the transport of sodium in the proximal tubule in the origin and/or maintenance of essential arterial hypertension.

[The influence of changes in the blood pressure and plasma renin activity on the natriuretic effect of nifedipine]. / Influencia de las modificaciones tensionales y de la actividad de renina plasmática sobre el efecto natriurético de nifedipino.

BACKGROUND: The possible influence of the variations in blood pressure and the plasma renin activity (PRA) after the administration of nifedipine (NIF) on the natriuretic effect of this calcium antagonist were evaluated. METHODS: The differences in the values of sodium excretion and tubular reabsorption were evaluated in 18 patients with essential hypertension with the method of the lithium clearance before and after the administration of a sublingual NIF dose. RESULTS: An increase in sodium excretion at the expense of a smaller distal reabsorption was found after NIF administration, without differences in patients with (n = 9) or without (n = 9) increase in PRA after NIF administration. The differences in several parameters when patients were classified depending on whether their mean blood pressure was reduced (n = 8) in more than 10% or not (n = 10) 90 minutes after NIF administration are discussed. CONCLUSIONS: Natriuresis induced by nifedipine is due to a diminished distal reabsorption of sodium. This effect is independent of PRA or its changes. On the other hand, the differences found in subgroups with different blood pressure response support the hypothesis that there are two populations of patients with essential hypertension depending on their acute response to calcium antagonists.

[Differences in the renal handling of sodium according to the response to captopril]. / Diferencias en el manejo renal de sodio según la respuesta al captopril.

We study the modifications of sodium tubular resorption, measured by lithium clearance after a single dosage of sublingual captopril, administered to 24 patients afflicted with nonfiltration after captopril produced an increase of proximal resorption of sodium, compensated by minor distal resorption, keeping a constant natriuresis. The different effects of captopril on blood pressure create 2 groups: a) patients who showed a decrease of blood pressure (n = 14), where a fall of distal resorption of sodium simultaneous with an increase of fractional sodium excretion was registered, and b) patients who did not experience changes in blood pressure nor changes after tubular function tests.