Prognostic model of the adaptive changes from hypertensive cardiopathy: from mild diastolic dysfunction to depressed systolic function. / Modelo pronóstico de los cambios evolutivos de la cardiopatía hipertensiva: desde la disfunción diastólica leve hasta la función sistólica deprimida.

INTRODUCTION: By definition, hypertensive cardiopathy is a series of complex and variable effects responsible for the chronic elevation of blood pressure in the heart. It stands out within a broad spectrum of cardiovascular diseases associated with hypertension. OBJECTIVE: To evaluate the capacity to predict the development of adaptive changes to hypertensive cardiopathy within ten years following diagnosis of the condition, using a model based on prognostic factors. METHODS: A prospective cohort study was conducted in hypertensive patients. The patients were followed at the specialized hypertension physicians office of the specialty policlinic attached to Carlos Manuel de Céspedes University Hospital, in the Bayamo Municipality, Granma Province, Cuba, from 1 January 2008 to 31 December 2018. RESULTS: Coxs proportional regression model showed a significant statistical relationship between most of the factors and the development of the adaptive changes in hypertensive cardiopathy within ten years of follow-up after the diagnosis of this condition. The lack of blood pressure control (Hazard ratio: 2.090; confidence interval 95%: 1.688 to 2.588; p: 0.000) followed by stage 2 of hypertension (hazard ratio: 1.987; confidence interval 95%: 1.584 to 2.491; p: 0.000) were the main factors. Internal validation of the model, discriminant capacity (C- statistic: 0.897) and calibration Hosmer-Lemeshow (χ2: 5.384; p: 0.716), was acceptable. CONCLUSIONS: We develop a model to predict the progression of hypertensive cardiopathy from grade I to grade IV with adequate discriminatory capacity. The model is based on prognostic factors, among which characteristic effects of arterial hypertension, diabetes mellitus, and chronic kidney disease stood out.

INTRODUCCIÓN: La cardiopatía hipertensiva sobresale dentro del amplio espectro de las enfermedades cardiovasculares asociadas con la hipertensión. Esta es definida como un complejo y variable conjunto de efectos que provoca en el corazón la elevación crónica de la presión arterial. OBJETIVO: Evaluar la capacidad de vaticinar el desarrollo de los cambios evolutivos de la cardiopatía hipertensiva en los diez años siguientes al diagnóstico, mediante un modelo basado en factores pronósticos. MÉTODOS: Realizamos un estudio de cohortes, prospectivo en pacientes hipertensos atendidos en la consulta especializada de hipertensión arterial de la policlínica de especialidades del Hospital General Universitario Carlos Manuel de Céspedes del municipio de Bayamo, Cuba, desde el uno de enero de 2008 hasta el 31 de diciembre de 2018. RESULTADOS: El modelo de riesgos proporcionales de Cox mostró una relación estadística significativa entre la mayoría de los factores y el desarrollo de los cambios evolutivos de la cardiopatía hipertensiva en los diez años siguientes al diagnóstico. El lugar más relevante lo ocupó la falta de control de la presión arterial (Hazard ratio: 2,090; intervalo de confianza 95%: 1,688 a 2,588; p = 0,000) seguido al de clasificar en el estadio dos de la hipertensión arterial (Hazard ratio: 1,987; intervalo de confianza 95%: 1,584 a 2,491; p = 0,000). La validez interna del modelo fue adecuada: la capacidad discriminativa (estadístico C = 0,897) y la calibración (χ2: 5,384; p = 0,716). CONCLUSIONES: Se obtiene un modelo para pronosticar la progresión de la cardiopatía hipertensiva de grado I a grado IV, con capacidad discriminativa y calibración adecuadas a partir de factores pronósticos. Entre estos últimos sobresalen los efectos propios de la hipertensión arterial, la diabetes mellitus y enfermedad renal crónica.

[Malignant arterial hypertension (HTAM) with severe systolic dysfunction of the reversible left ventricle]. / Hipertensión arterial maligna (HTAM) con disfunción sistólica grave del ventrículo izquierdo reversible.

Malignant arterial hypertension is still present in current clinical care despite the fact that for more than three decades we have had a wide range of antihypertensive drugs to control high blood pressure. It is essential to know how to detect it in time due to its high risk to life, with poor short-term prognosis if not treated properly. It may present with nonspecific, but potentially serious, clinical symptoms or manifest clinically as a hypertensive emergency accompanied by hypertensive encephalopathy and multi-organ failure. We present a case of a 49-year-old woman, attended in our hospital who had an initial hypertension of 223/170mmHg accompanied by multi-organ failure, who progressed satisfactorily with antihypertensive treatment.

Predictive model for the development of hypertensive cardiopathy: A prospective cohort study. / Modelo predictivo para el desarrollo de la cardiopatía hipertensiva: cohorte prospectiva.

INTRODUCTION: Predictive models of cardiovascular conditions are useful tools for risk stratification. The high morbidity and mortality resulting from hypertensive cardiopathy creates a need for the use of tools to predict the risk of cardiovascular disease. OBJECTIVE: To evaluate the capacity of a model based on risk factors to predict the development of hypertensive cardiopathy after ten years in patients with a diagnosis of essential arterial hypertension. METHODS: A prospective cohort study was carried out in hypertensive patients cared for at the specialized arterial hypertension physician’s office of the Specialty Policlinic attached to “Carlos Manuel de Céspedes” Hospital, Bayamo Municipality, Granma Province, Cuba, from January 1, 2000 to December 31, 2009. A predictive model was constructed and validated through a process that included the random split of the whole sample in two parts: one for development (parameters estimation) and the other for validation. RESULTS: The binary regression model adjusted by the “step-by-step backward method,” showed that in step six, 13 variables sufficed to estimate the risk of developing hypertensive cardiopathy. In the estimation sample, the area under the receiver operating characteristic curve obtained for the prediction of hypertensive heart disease was 0.985 (confidence interval: 0.980-0.990; p = <0.0005). In the validation sample the area under the receiver operating characteristic curve was 0.963 (confidence interval: 0.953-0, 0.973, p<0.0005). The calibration of the model was also adequate (p = 0.863). CONCLUSIONS: The model obtained proved is a clinical and epidemiological surveillance instrument, useful to identify subjects with greater likelihood to acquire hypertensive heart disease, and to stratify their risk in the following ten-year period.

INTRODUCCIÓN: Los modelos de predicción cardiovascular son herramientas útiles para estratificar el riesgo. La elevada morbilidad y mortalidad por cardiopatía hipertensiva, hace necesario emplear estos instrumentos para predecir el riesgo de enfermar. OBJETIVO: Evaluar la capacidad de un modelo basado en factores de riesgo para predecir la aparición de cardiopatía hipertensiva en pacientes con hipertensión arterial esencial en los diez años siguientes a su diagnóstico. MÉTODOS: Realizamos un estudio prospectivo de cohorte en pacientes hipertensos, atendidos en la consulta especializada de hipertensión arterial de la policlínica de especialidades del hospital general universitario Carlos Manuel de Céspedes del municipio Bayamo, Cuba, desde el 1 de enero de 2000 hasta el 31 de diciembre de 2009. A partir de factores de riesgo de cardiopatía hipertensiva previamente evaluados, se construyó y validó un modelo predictivo. Este proceso se realizó dividiendo la muestra total de pacientes en dos partes: una para la construcción (estimación de parámetros) y otra para la validación. RESULTADOS: El modelo de regresión logística binaria final obtenido por el método “paso a paso hacia atrás”, puso de manifiesto en el paso seis que con sólo 13 variables se podía estimar aceptablemente el riesgo de cardiopatía hipertensiva. En la muestra de estimación se obtuvo una área bajo la curva característica operativa del receptor para la predicción de cardiopatía hipertensiva de 0,985 (intervalo de confianza: 0,980-0,990; p<0,0005). En la muestra de validación el área bajo la curva fue de 0,963 (intervalo de confianza: 0,953-0, 0,973; p<0,0005), la calibración del modelo también fue adecuada en esta muestra (p=0,863). CONCLUSIONES: Se obtuvo un modelo útil como instrumento de vigilancia clínica y epidemiológica, al identificar a sujetos con mayor probabilidad de enfermar y estratificar su riesgo a los diez años.

Factors associated to hypertensive heart disease development: a prospective cohort study in Bayamo, Cuba. / Factores asociados al desarrollo de cardiopatía hipertensiva: una cohorte prospectiva, en Bayamo, Cuba.

INTRODUCTION: Among the conditions resulting from target organ damage by arterial hypertension, hypertensive cardiopathy is the one that exhibits the highest morbidity and mortality rates. Its prevention should be a target of all high blood pressure medical care programs. OBJECTIVE: To identify risk factors for the development of hypertensive cardiopathy. METHODS: A prospective cohort study was carried out in hypertensive patients assisted at the specialized arterial hypertension physicians’ offices of the “Carlos Manuel de Céspedes” Specialty Policlinic attached to the General University Hospital, Bayamo Municipality, Granma Province, Cuba, from January 1st, 2000 to December 31st, 2009. RESULTS: Multivariate analysis done to estimate the hazard rate (HR) of developing hypertensive cardiopathy, showed significant independent statistic association for most factors. The first place was occupied by lack of blood pressure control (HR=2.022; 95% CI: 1.659-2.465; p<0.005), followed by hypertension stage 2 (HR=2.015; 95% CI: 1.715-2.366; p<0.005). Another factors with significant HRs were microalbuminuria (HR=1.9; 95% CI: 1.6-2.2) and age over 60 years (HR=1.6; 95% CI: 1.4-1.9). CONCLUSIONS: Several risk factors must be considered for the prevention of hypertensive heart disease in high blood pressure patients.

INTRODUCCIÓN: La afección de órganos diana por hipertensión arterial que presenta mayor morbilidad y mortalidad es la cardiopatía hipertensiva. Su prevención debería ser objeto de los programas de atención a pacientes hipertensos. OBJETIVO: Identificar la influencia de los diferentes factores de riesgo para el desarrollo de la cardiopatía hipertensiva. MÉTODOS: Realizamos un estudio prospectivo de cohorte en pacientes hipertensos atendidos en la consulta especializada de hipertensión arterial de la policlínica de especialidades del Hospital General Universitario “Carlos Manuel de Céspedes” del municipio Bayamo, Cuba, desde el 1ro de enero de 2000 hasta el 31 de diciembre de 2009. RESULTADOS: El análisis multivariado mostró una relación estadística significativa independiente entre la mayoría de los factores y el riesgo de aparición de la cardiopatía. El lugar más relevante lo ocupó la falta de control adecuado de la presión arterial (HR: 2,022; IC 95%: 1,659-2,465; p<0,005) seguido por el estadio 2 de la hipertensión arterial (HR: 2,015; IC 95%: 1,715-2,366; p< 0,005). Otros factores con HR significativos fueron la microalbuminuria (HR=1,9; IC 95%: 1,6-2,2) y la edad mayor de 60 años (HR=1,6; IC 95%: 1,4-1,9). CONCLUSIONES: Varios factores de riesgo deberán tenerse en cuenta para la prevención de cardiopatía hipertensiva en pacientes hipertensos.

Importance and repercussions of renal and cardiovascular pathology on stroke in young adults: an anatomopathologic study of 52 clinical necropsies

INTRODUCTION: Stroke in young adults has seldom been studied in a necropsy series. The objective of the present clinical necropsy-based investigation was to analyze stroke and its relationship with cardiovascular and renal pathology in young adults. MATERIALS AND METHODS:The protocols of 52 clinical necropsies with diagnoses of stroke in patients aged 18 - 49 years, performed between the years 1990-2006, were reviewed. RESULTS: Hemorrhagic stroke was diagnosed in 36 patients (69.3 percent), whereas the remaining 16 (30.7 percent) had ischemic stroke. Hypertensive cardiopathy was evident in 88.4 percent of the cases. Chronic renal pathology, directly or indirectly related to hypertension, was observed in 55.7 percent of the patients. Ischemic stroke as a result of occlusive atherosclerotic disease was seen in 50 percent of cases. Cardiogenic emboli were found in 25 percent of the cadavers. Hemorrhagic stroke was associated with hypertension in 43 percent of the cases, with ruptured vascular malformations in 29 percent, and coagulopathies in 17 percent of the cases. Hypertensive cardiopathy was present in patients with either ischemic or hemorrhagic stroke (81.2 percent and 91.6 percent, respectively). The most frequently observed renal ailments were chronic pyelonephritis (23 percent) and nephrosclerosis (21.1 percent). These were associated with ischemic stroke in 43.7 percent, and 12.5 percent of the cases, respectively, and with 13.8 percent and 25 percent of the hemorrhagic stroke cases. DISCUSSION: Hypertensive cardiopathy, occlusive atherosclerotic disease, chronic pyelonephritis and nephrosclerosis are among the pathophysiologycal mechanisms that apparently and eventually interact to induce a significant number of cases of stroke in young adults. A chronic systemic inflammatory state appears to be an important related condition because it possibly constitutes an accelerant of the pathophysiologycal process.