Metabolic syndrome parameters' variability and stroke incidence in hypertensive patients: evidence from a functional community cohort.

BACKGROUND: Stroke is a common complication of hypertension, but the predictive value of metabolic syndrome parameters' variability on stroke risk in individuals with hypertension remains unclear. Therefore, our objective was to investigate the relationship between metabolic syndrome parameters' variability and the risk of total stroke and its subtypes in hypertensive patients. METHODS: This prospective cohort study included 17,789 individuals with hypertension from the Kailuan study since 2006. Metabolic syndrome parameters, including waist circumference (WC), fasting blood glucose (FBG), systolic blood pressure (SBP), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG), were collected at three follow-up visits in the 2006, 2008, and 2010 surveys. We assess the variability utilizing the coefficient of variation (CV), standard deviation (SD), average real variation (ARV), and variability independent of the mean (VIM), with CV initially assessed. Participants were categorized based on the number of high-variability metabolic syndrome parameters (0, 1, 2, ≥ 3). Stroke cases were identified by reviewing medical records. The associations between variability in metabolic syndrome parameters and the risk of total stroke and its subtypes were analyzed using Cox proportional hazard regression models. RESULTS: During a median follow-up of 9.32 years, 1223 cases of stroke were recorded. Participants with ≥ 3 high-variability metabolic syndrome parameters had an increased risk of total stroke (HR: 1.29, 95%CI 1.09-1.52), as well as an increased risk of ischemic stroke (HR: 1.31, 95%CI 1.05-1.63) compared to those without high-variability parameters. The study also examined variability in each metabolic syndrome parameter, and significant associations with an increased risk of total stroke were observed for variability in SBP (HR: 1.24, 95%CI 1.05-1.46) and HDL-C (HR: 1.34, 95%CI 1.09-1.64). CONCLUSIONS: Long-term fluctuations in metabolic syndrome parameters significantly increase the risk of total stroke, especially ischemic stroke. Maintaining low variability in metabolic syndrome parameters could benefit health, and hypertensive individuals must be regularly monitored.

Factors Influencing Self-Care Behaviors in Hypertension Patients With Complications.

Purpose: While hypertension with accompanying complications remains a life-threatening illness, a critical program in its management and prevention is implementing self-care behaviors (SCBs). This study examined the factors associated with SCB that are dominant in hypertension patients with complications. Materials and Methods: This quantitative study was conducted using the regression analytic method and a cross-sectional approach. The non-probability sampling technique was used, and the response rate was 96.2%. Data were collected using a modified hypertension self-care profile (HBP-SCP) questionnaire, hypertension knowledge questionnaire, family support questionnaire, and the brief-illness perception questionnaire (B-IPQ). Results: The mean total SCB score was high at 55.9% with a mean of 191.01, SD = 5.16; 77.5% of the respondents had no disease history, 80.4% had good knowledge, 58.8% had strong family support, and 50% had a good perception of the disease. Factors that were significantly related to SCB were family support (p = 0.00, r = 0.75) and illness perception (p = 0.00, r = 0.77), while disease history (r = 0.47) and knowledge were not significantly related (r = 0.13). Moreover, the analysis of multiple linear regression with the backward method showed that the most dominant factor influencing SCB was illness perception (p = 0.00, = 0.47, B = 0.495, R2 = 0.650). The effect of illness perception on SCB (65%) meant that each 0.50 perception score increased the SCB score by one. Conclusion: It is recommended that health workers increase patient perception using innovative interventions to improve the SCB of hypertension patients with complications.

Efectos de la calidad y cantidad de horas de sueño en pacientes con hipertensión arterial: Una revisión narrativa / Effects of the quality and quantity of sleep hours in patients with arterial hypertension: A narrative review

Introducción :La alta prevalencia de hipertensión arterial (HTA) es un problema de salud pública a nivel global. Diversas condiciones comprometen un adecuado control de esta enfermedad, siendo una de reciente interés las alteraciones del sueño. Describimos mediante una revisión narrativa los hallazgos recientes en la literatura acerca de los efectos de la calidad y cantidad de horas de sueño en pacientes hipertensos. Se seleccionaron 18 artículos que cumplieron los criterios de inclusión para esta revisión. En la presente revisión se detallarán los hallazgos encontrados en relación con las complicaciones que guardan relación con la duración y calidad del sueño en pacientes con HTA, así como factores predictores de una mala calidad del sueño en estos pacientes.

Background: High prevalence of arterial hypertension (HTN) is a global public health problem. Various conditions compromise an adequate control of this disease, being one of recent interest the sleep disturbances. We describe through a narrative review the recent findings in the literature about the effects of the quality and quantity of sleep on hypertensive patients. Eighteen articles that met the inclusion criteria were selected for this review. This review will detail the findings related to complications linked to the duration and quality of sleep in patients with HTN, as well as predictive factors of poor sleep quality in these patients.

Prevalência de hipertensão arterial sistêmica e diabetes mellitus em indivíduos com covid-19: um estudo retrospectivo de óbitos em pernambuco, brasil / Prevalence of systemic arterial hypertension and diabetes mellitus in individuals with covid-19: a retrospective study of deaths in pernambuco, brazil

Resumo Hipertensão arterial sistêmica (HAS) e diabetes mellitus (DM) são dois dos principais fatores de risco para a mortalidade por COVID-19. Descrever a prevalência e o perfil clínico-epidemiológico de óbito por COVID-19 ocorridos em Pernambuco, Brasil, entre 12 de março e 14 de maio de 2020 entre pacientes que possuíam hipertensão arterial sistêmica e/ou diabetes mellitus como doenças prévias. Estudo observacional transversal. Foram analisadas as seguintes variáveis: município de procedência, sexo, faixa etária, tempo entre o início dos sinais/sintomas e o óbito, sinais/sintomas, tipo de comorbidades e hábitos de vida. Variáveis categóricas foram descritas por meio de frequências e variáveis contínuas por meio de medidas de tendência central e de dispersão. Os testes de Mann-Whitney e Kruskal-Wallis foram utilizados. Dos 1.276 registros incluídos no estudo, 410 apresentavam HAS e/ou DM. A prevalência de HAS foi 26,5% (n=338) e de DM foi 19,7% (n=252). Dos registros, 158 (12,4%) eram de pacientes que possuíam somente HAS, 72 (5,6%) somente DM e 180 (14,1%) apresentavam HAS e DM. Dos indivíduos com HAS, 53,3% apresentavam DM e 71,4% dos diabéticos apresentam HAS. A mediana (em dias) do tempo entre o início dos sinais/sintomas e o desfecho óbito foi 8,0 (IIQ 9,0), sem diferença significativa entre os grupos de comorbidades (p=0,633), sexo (p=0,364) e faixa etária (p=0,111). Observou-se maior prevalência de DM e HAS na população masculina (DM — 61,3% eram homens e 38,9% mulheres; HAS — 53,2% eram homens e 46,8% mulheres). Os sinais/sintomas mais frequentes foram dispneia (74,1%; n=304), tosse (72,2%; n=296), febre (68,5%; n=281) e saturação de O2<95% (66,1%; n=271). Dos hipertensos, 73,3% (n=100) apresentavam outras comorbidades/fatores de risco associados, e 54,2% (n=39) dos diabéticos apresentavam outras comorbidades/fatores de risco associados. Destacaramse as cardiopatias (19,5%; n=80), obesidade (8,3%; n=34), doença respiratória prévia (7,3%; n=30) e nefropatia (7,8%; n=32). A prevalência de tabagismo foi 8,8% (n=36) e de etilismo alcançou 3,4% (n=14). O estudo mostrou que a prevalência de HAS foi superior à prevalência de DM nos indivíduos que foram a óbito por COVID-19. Em idosos, a prevalência foi superior à observada em indivíduos não idosos.

Association Between Morning Surge in Systolic Blood Pressure and SYNTAX Score I in Patients With Stable Coronary Artery Disease.

A high morning surge in systolic blood pressure poses a risk in people who have cardiovascular disease. We investigated the relationship between this phenomenon and the SYNTAX score I in patients who had stable coronary artery disease. Our single-center study included 125 consecutive patients (109 men and 16 women; mean age, 54.3 ± 9 yr) in whom coronary angiography revealed stable coronary artery disease. We calculated each patient's sleep-trough morning surge in systolic blood pressure, then calculated the SYNTAX score I. The morning surge was significantly higher in patients whose score was >22 (mean, 22.7 ± 13.2) than in those whose score was ≤22 (mean, 12.4 ± 7.5) (P <0.001). Forward stepwise logistic regression analysis revealed that morning surge in systolic blood pressure was the only independent predictor of an intermediate-to-high score (odds ratio=1.183; 95% CI, 1.025-1.364; P=0.021). To our knowledge, this is the first study to show an association between morning surge in systolic blood pressure and the SYNTAX score I in patients who have stable coronary artery disease.

Health Promotion to Reduce Hypertension Patients' Vulnerability to Coronavirus Disease-19 (COVID-19)

Abstract Hypertension remains a prominent risk factor for cardiovascular diseases. It is not a coincidence that 23% to 30% of coronavirus disease-19 (COVID-19) confirmed cases are hypertensive patients, and the case-fatality rate of adult COVID-19 cases with hypertension was estimated at 6%. It is important that hypertensive patients be aware of their vulnerability to COVID-19, which may be achieved by a health promotion program in addition to preventive measures.

Resultados de la cicatrización con bevacizumab en la degeneración macular relacionada con la edad húmeda / Results of the cicatrization with bevacizumab in the age-related humid macular degeneration

RESUMEN Fundamento: la degeneración macular relacionada con la edad está entre las causas más comunes de pérdida visual severa e irreversible en pacientes mayores de 60 años en el mundo industrializado. Es considerado el aumento de la esperanza de vida en la población de los adultos mayores, la necesidad de un diagnóstico temprano y oportuno, es obvio para esta enfermedad que constituye un problema de salud a resolver. Objetivo: describir los resultados de la cicatrización con el uso del bevacizumab en la degeneración macular relacionada con la edad húmeda. Métodos: se realizó un estudio descriptivo, longitudinal en pacientes con el diagnóstico de degeneración macular relacionada con la edad húmeda. La población la conformaron 25 pacientes que acudieron a la consulta de retina en el periodo de octubre 2018 a abril 2019 y que cumplieron con los criterios de selección. Se les aplicó una encuesta y se estudiaron variables como: edad, sexo, antecedentes patológicos personales, número de inyecciones intravitreas colocadas a cada paciente, complicaciones post inyección y cicatrización de la lesión macular. BMMEM Resultados: según el comportamiento de los grupos de edades y el sexo, se encontró que la edad entre 60 y 69 fue de diez pacientes y el sexo femenino 15 pacientes fueron los más frecuentes. La hipertensión ocular fue la complicación que predominó. El antecedente patológico personal más frecuente fue la hipertensión arterial con cuatro pacientes. La mayor cantidad de ojos cicatrizaron con la administración de una y dos dosis del medicamento. Conclusiones: predominó el grupo de edad de 60 a 69 años y el sexo femenino. La hipertensión ocular fue la complicación más frecuente. Se constató la hipertensión arterial como el antecedente patológico personal más habitual. La cicatrización de los ojos ocurrió con la administración entre una y dos dosis.

ABSTRACT Background: the age-related macular degeneration is among the most common causes of harsh and irreversible visual loss in patient elders of 60 years in the industrialized world. Considering the increase of life expectancy and the rise in population of the senior citizens, the need of an early and opportune diagnosis, it is obvious for this disease that constitutes a health problem we have to solve. Objective: to describe the results of the cicatrization with the use of the bevacizumab in the age-related humid macular degeneration. Methods: a descriptive, longitudinal study in patients with the diagnosis of age-related humid macular degeneration was carried out. 25 patients that attended the retinal consultation in the period October, 2018 to April, 2019 and who fulfilled the criteria constituted the population of selection. They were applied an opinion poll and they studied variables were: Age, sex, pathological personal background, number of intravitreous injections placed to each patient, complications after injection and cicatrization of the macular injury. B Results: according to the age groups and the sex, it was shown that the age between 60 and 69, ten patients and the feminine sex 15 patients were the most frequent. The ocular hypertension was the complication that predominated with four patients. The greatest amount of eyes healed with the administration of one and two doses of the medication. Conclusions: the age group from 60 to 69 years and the feminine sex predominated. The ocular hypertension was the most frequent complication. It was verified high blood pressure as the most frequent pathological antecedent. The cicatrization of the eyes happened with the administration between one and two doses.

Características Clínicas da Hipertensão Arterial Resistente vs. Refratária em uma População de Hipertensos Afrodescendentes / Clinical Characteristics of Resistant vs. Refractory Hypertension in a Population of Hypertensive Afrodescendants

Resumo Fundamentos Afrodescendentes têm sido associados a uma maior gravidade da hipertensão arterial e maior incidência de complicações cardiovasculares. Características na apresentação da hipertensão resistente (HR) ou hipertensão refratária (HRf), especificamente nessa etnia, não têm sido devidamente estudadas. Objetivos O estudo compara características clínicas e epidemiológicas e prevalência de eventos cardiovasculares em afrodescendentes com diagnóstico de HR ou de HRf. Métodos: Estudo transversal realizado em ambulatório de referência para pacientes com Hipertensão Grave. O nível de significância foi de 5%. Resultados Avaliados 146 pacientes consecutivos, dos quais 68,7% eram do sexo feminino. A média de idade foi de 61,8 anos, sendo 88,4% afrodescendentes (pardos ou negros). 51% apresentavam HRf. Houve alta prevalência de fatores de risco cardiovascular: 34,2% tinham diabetes, 69,4% dislipidemia, 36,1% obesidade e 38,3% história de tabagismo. Função renal reduzida foi observada em 34,2%. Eventos cardiovasculares prévios ocorreram em 21,8% para infarto do miocárdio e em 19,9% para acidente vascular cerebral. O escore de risco de Framingham foi moderado/alto em 61%. Os pacientes com HRf eram mais jovens (média de idade de 59,38±11,69 anos versus 64,10±12,23 anos, p=0,02), tinham mais dislipidemia (83,8 versus 66,7%, p=0,021) e acidente vascular cerebral (30,4 versus 12,3%, p=0,011) quando comparados aos com HR. O uso de combinação de ACEi/BRA+CCB+Diurético, clortalidona e espironolactona também foi mais frequente em indivíduos com HRf. Conclusão Afrodescendentes com HR apresentaram alto risco cardiovascular, alta prevalência de HRf, maior frequência de dislipidemia e de acidente vascular cerebral, compatível com alta incidência de lesão a órgãos-alvo. (Arq Bras Cardiol. 2020; 115(1):31-39)

Abstract Background Afrodescendants have been associated with a greater severity of arterial hypertension and a higher incidence of cardiovascular complications. Characteristics in the presentation of resistant hypertension (RH) or refractory hypertension (RfH), specifically in this ethnic group, have not been properly studied. Objectives The study compares clinical and epidemiological characteristics and prevalence of cardiovascular events in people of African descent diagnosed with RH or RfH. Methods Cross-sectional study carried out in a referral clinic for patients with severe hypertension. The level of significance was 5%. Results 146 consecutive patients were evaluated, of which 68.7% were female. The average age was 61.8 years, with 88.4% of Afrodescendants (mixed race or black). 51% had RfH. There was a high prevalence of cardiovascular risk factors: 34.2% of subjects had diabetes, 69.4% dyslipidemia, 36.1% obesity, and 38.3% history of smoking. Reduced renal function was seen in 34.2%. Previous cardiovascular events occurred in 21.8% for myocardial infarction and in 19.9% for stroke. The Framingham's risk score was moderate/high at 61%. RfH patients were younger (mean age 59.38±11.69 years versus 64.10±12.23 years, p=0.02), had more dyslipidemia (83.8 versus 66.7%, p=0.021), and stroke (30.4 versus 12.3%, p=0.011) when compared to those with RH. The use of a combination of ACEi/ARB+CCB+Diuretic, chlortalidone and spironolactone was also more frequent in individuals with RfH. Conclusion Africandescendant people with RH had a high cardiovascular risk, a high prevalence of RfH, a higher frequency of dyslipidemia and stroke, compatible with a high incidence of injury to target organs. (Arq Bras Cardiol.2020; 115(1):31-39)

Diuretics are Similar to Losartan on Echocardiographic Target-Organ Damage in Stage I Hypertension. PREVER-Treatment Study / Diuréticos são Similares à Losartana na Avaliação Ecocardiográfica de Lesão a Órgãos-Alvo no Estágio I da Hipertensão. Estudo PREVER-Treatment

Abstract Blood pressure (BP)-lowering therapy improves left ventricular (LV) parameters of hypertensive target-organ damage in stage II hypertension, but whether there is a drug-class difference in echocardiographic parameters in stage I hypertension patients is less often studied. In the PREVER treatment study, where individuals with stage I hypertension were randomized for treatment with diuretics (chlorthalidone/amiloride) or losartan, 110 participants accepted to participate in a sub-study, where two-dimensional echocardiograms were performed at baseline and after 18 months of antihypertensive treatment. As in the general study, systolic BP reduction was similar with diuretics or with losartan. Echocardiographic parameters showed small but significant changes in both treatment groups, with a favorable LV remodeling with antihypertensive treatment for 18 months when target blood pressure was achieved either with chlorthalidone/amiloride or with losartan as the initial treatment strategy. In conclusion, even in stage I hypertension, blood pressure reduction is associated with improvement in echocardiographic parameters, either with diuretics or losartan as first-drug regimens.

Resumo A terapia de redução da pressão arterial (PA) melhora os parâmetros do ventrículo esquerdo (VE) na lesão a órgãos-alvo causada pela condição hipertensiva na hipertensão de estágio II; no entanto, se existem ou não diferenças relacionadas à classe de medicamentos nos parâmetros ecocardiográficos de pacientes com hipertensão estágio I é menos frequentemente estudado. No estudo PREVER-treatment, em que indivíduos com hipertensão estágio I foram randomizados para tratamento com diuréticos (clortalidona/amilorida) ou losartana, 110 participantes aceitaram participar de um subestudo, no qual foram realizados ecocardiogramas bidimensionais basais e após 18 meses de tratamento anti-hipertensivo. Como no estudo geral, a redução da PA sistólica foi semelhante com diuréticos ou com losartana. Os parâmetros ecocardiográficos mostraram pequenas mas significativas alterações em ambos os grupos de tratamento, com um remodelamento favorável do VE com tratamento anti-hipertensivo por 18 meses, quando a pressão arterial alvo foi atingida com clortalidona/amilorida ou com losartana como estratégia inicial de tratamento. Em conclusão, mesmo na hipertensão estágio I, a redução da pressão arterial está associada à melhora nos parâmetros ecocardiográficos tanto com o uso de diuréticos ou losartana como primeiro esquema de tratamento farmacológico.

Evaluation of the factors associated with sublingual varices: a descriptive clinical study.

BACKGROUND: Age is considered as an important factor for the development of sublingual varices (SV). It has been suggested that some other conditions such as gender, systemic diseases, smoking, denture wearing may play a role in aetiology. However, there are a limited number of studies investigating these associations. This study was perform to evaluate association between SV and the conditions which are described as possible risk factors previously. MATERIALS AND METHODS: A total of 691 patients (470 females, 221 males) who attended for comprehensive clinical examination were included in the study. Age, gender, systemic health, venous varix of the lower extremities, smoking status, denture wearing were recorded during the history taking. SV were classified into two categories: stage 0 (few or none visible) and stage 1 (moderate or severe). Tongue photographs were taken from a group of these patients. For the evalu- ation of intra-observer reliability, 60 photographs of tongue were re-evaluated by the same observer. Intra-observer reliability was evaluated using Kappa statistics. Pearson c2 test and Fisher's exact test were used to assess SV in relation to each variable, and variables showing associations with p < 0.05 were selected for the multivariable analysis, then logistic regression analysis was applied. RESULTS: Kappa value of intra-observer reliability was 0.91. SV were significantly associated with age (odds ratio [OR] = 1.08, p = 0.000), hypertension (OR = 2.3, p = 0.007) and denture wearing (OR = 2.17, p = 0.02). CONCLUSIONS: The presence of SV is associated with hypertension and denture wearing as well as aging. More detailed studies are needed to prove causative relations between SV and systemic diseases.

2017 Guidelines for the management of arterial hypertension in primary health care in Portuguese-speaking countries. / Diretrizes de 2017 para manejo da hipertensão arterial em cuidados primários nos países de língua portuguesa.

The World Health Organization goal's to reduce mortality due to chronic non-communicable diseases by 2% per year demands a huge effort from member countries. This challenge for health professionals requires global political action on implementation of social measures, with cost-effective population interventions to reduce chronic non-communicable diseases and their risk factors. Systemic arterial hypertension is highly prevalent in Portuguese-speaking countries, and is a major risk factor for complications such as stroke, acute myocardial infarction and chronic kidney disease, rivaling dyslipidemia and obesity in importance for the development of atherosclerotic disease. Joint actions to implement primary prevention measures can reduce outcomes related to hypertensive disease, especially ischemic heart disease and stroke. It is essential to ensure the implementation of guidelines for the management of systemic hypertension via a continuous process involving educational actions, lifestyle changes and guaranteed access to pharmacological treatment.

Trends in Hospitalization for Hypertensive Emergency, and Relationship of End-Organ Damage With In-Hospital Mortality.

BACKGROUND: There are no comprehensive guidelines on management of hypertensive emergency (HTNE) and complications. Despite advances in antihypertensive medications HTNE is accompanied with significant morbidity and mortality. METHODS: We queried the 2002-2012 nationwide inpatient sample database to identify patients with HTNE. Trends in incidence of HTNE and in-hospital mortality were analyzed. Logistic regression analysis was used to assess the relationship between end-organ complications and in-hospital mortality. RESULTS: Between 2002 and 2012, 129,914 admissions were included. Six hundred and thirty (0.48%) patients died during their hospital stay. There was an increase in the number of HTNE admissions (9,511-15,479; Ptrend < 0.001) with concurrent reduction of in-hospital mortality (0.8-0.3%; Ptrend < 0.001) by the year 2012 compared to 2002. Patients who died during hospitalization were older, had longer length of stay, higher cost of stay, more comorbidities, and higher risk scores. Presence of acute cardiorespiratory failure [adjusted odds ratio (OR), 15.8; 95% confidence interval (CI), 13.2-18.9], stroke or transient ischemia attack (TIA) (adjusted OR, 7.9; 95% CI, 6.3-9.9), chest pain (adjusted OR, 5.9; 95% CI, 4.4-7.7), stroke/TIA (adjusted OR, 5.9; 95% CI, 4.5-7.7), and aortic dissection (adjusted OR, 5.9; 95% CI, 2.8-12.4) were most predictive of higher in-hospital mortality in addition to factors such as age, aortic dissection, acute myocardial infarction, acute renal failure, and presence of neurological symptoms. CONCLUSION: A rising trend in hospitalization for HTNE, with an overall decrease in in-hospital mortality was observed from 2002 to 2012, possibly related to changes in coding practices and improved management. Presence of acute cardiorespiratory failure, stroke/TIA, chest pain, and aortic dissection were most predictive of higher hospital mortality.

Síndrome hepatopulmonar: revisión narrativa / Hepatopulmonary syndrome: a narrative revision

Resumen: el síndrome hepatopulmonar es una de las tres principales condiciones pulmonares en pacientes con enfermedad hepática o hipertensión portal. Esta alteración es causada por la circulación hiperdinámica, los cortocircuitos intrapulmonares y la vasodilatación pulmonar, lo que lleva a alteraciones que generan un compromiso en el intercambio gaseoso, el cual se manifiesta como hipoxemia y aumento del gradiente alveolo arterial. El diagnóstico del síndrome hepatopulmonar consiste en demostrar las alteraciones del intercambio gaseoso, por medio del análisis de los gases arteriales, y las dilataciones vasculares intrapulmonares, documentadas por ecocardiografía transtorácica contrastada con solución salina agitada, la cual es considerada el estándar de referencia. Por el impacto pronóstico del síndrome hepatopulmonar, se recomienda una tamización activa que permita un diagnóstico temprano, y referir a tiempo al paciente a un centro especializado para la valoración de trasplante hepático como único tratamiento disponible curativo. El objetivo de este artículo es proporcionar una revisión narrativa sobre el síndrome hepatopulmonar, con énfasis en la definición, diagnóstico, fisiopatogénesis y medidas terapéuticas disponibles. (AU)

Abstract: Hepatopulmonary syndrome is one of the three main pulmonary disorders affecting patients with liver disease or portal hypertension. This disease is caused by hyperdynamic circulation, intrapulmonary shunts, and pulmonary vasodilation, which leads to disturbances in gas exchange, evidenced by hypoxemia and increased alveolar-arterial gradient. Diagnosis of hepatopulmonary syndrome requires arterial blood gas analysis and documentation of intrapulmonary vascular dilation by transthoracic echocardiogram with agitated saline contrast; the gold standard for hepatopulmonary syndrome diagnosis. Due to the prognostic value of hepatopulmonary syndrome, active screening is recommended in order to achieve early diagnosis and timely patient referral to a specialized center to be evaluated as a candidate for liver transplant, as it currently is the only available curative treatment. The aim of this article is to provide a narrative review of current literature on hepatopulmonary syndrome, focusing on its definition, diagnosis, physiopathogenesis, and available therapeutic approaches. (AU)

Relationship between cardio-ankle vascular index and homocysteine in hypertension subjects with hyperhomocysteinemia.

BACKGROUND: Arteriosclerosis evaluated by arterial stiffness is the basic pathophysiological change during the development of hypertension. Cardio-ankle vascular index (CAVI) is an index of arterial stiffness. Hyperhomocysteinemia (HHcy) is an independent risk factor for vascular diseases. However, there was little research about the relationship between CAVI and homocysteine (Hcy) in hypertension subjects with HHcy. METHODS: A total of 330 subjects (M/F 133/197) from Vascular Medicine of Peking University Shougang Hospital were divided into four groups: control group (group 1, normotensive with normal Hcy, n = 149), hypertension group (group 2, n = 113), HHcy group (group 3, n = 30), and hypertension with HHcy group (group 4, n = 38). CAVI was measured by VS-1000 apparatus. RESULTS: Our results showed that CAVI was significantly higher in group 4 than in group 1 and group 2 (8.41 ± 1.08 vs. 7.79 ± 1.14; 8.41 ± 1.08 vs. 7.87 ± 1.02, both p < 0.05, respectively). Positive correlation between CAVI and Hcy was found in the entire study group (r = 0.109, p = 0.049) and hypertension subjects (group 2 + group 4; r = 0.202, p = 0.014). Multivariate analysis showed that Hcy was an independent associating factor of CAVI in all subjects (ß = 0.251, p = 0.034). CONCLUSIONS: The present study showed that CAVI was significantly higher in hypertension subjects with HHcy compared to hypertension group. There was significant correlation between CAVI and Hcy, indicating the relationship between arterial stiffness and biomarkers in vascular-related diseases.

Evolving Indications for Tips.

Transjugular intrahepatic portosystemic shunt creation is a well-established therapy for refractory variceal bleeding and refractory ascites in patients who do not tolerate repeated large volume paracentesis. Experience and technical improvements including covered stents have led to improved TIPS outcomes that have encouraged an expanded application. Evidence for other less frequent indications continues to accumulate, including the indications of primary prophylaxis in patients with high-risk acute variceal bleeding, gastric and ectopic variceal bleeding, primary treatment of medically refractory ascites, recurrent refractory ascites following liver transplantation, hepatic hydrothorax, hepatorenal syndrome, Budd-Chiari syndrome, and portal vein thrombosis. Treatment of patients with high-risk acute variceal bleeding with early TIPS and using transjugular intrahepatic portosystemic shunts as a primary therapy rather than large volume paracentesis for refractory ascites would likely be the 2 circumstances that permit expansion in the frequency of TIPS procedures. The remaining populations discussed above are relatively rare.