Cristina Sierra - Academia.edu (original) (raw)
Papers by Cristina Sierra
Medicina Clinica, Jun 1, 2002
The goal of this study was to evaluate the relative association of several components of blood pr... more The goal of this study was to evaluate the relative association of several components of blood pressure (BP), as measured in the office and by ambulatory monitoring (ABPM), with clinically useful indicators of target organ damage and cardiovascular events (CE) in essential hypertensive patients. We retrospectively included 390 hypertensives (55% men; mean age: 56 years) between 1989 and 1998. All them had a baseline office BP measurement and a valid 24-hour ABPM record, both performed while the patient was free of antihypertensive therapy. Estimates of target organ damage included electrocardiographic indexes of left ventricular hypertrophy (Cornell and Sokolow-Lyon), serum creatinine, 24-hour urine protein excretion and creatinine clearance. Multiple linear regression and logistic regression analyses were used to evaluate the relationship between BP and target organ damage or CE. Forty-nine patients had CE (26 stroke, 18 myocardial infarction and 5 both). The BP parameter correlating better with cardiovascular events was office pulse pressure (multivariate odds ratio: 1.03; CI 95%: 1.00-1.05; p = 0.0095). Nevertheless, cardiac growth indexes correlated better with ABPM measurements. In fact, Cornell index correlated with night-time systolic BP (standardized regression coefficient beta: 0.260; p < 0.001) and Sokolow-Lyon index correlated with day-time systolic BP ( beta: 0.257; p < 0.001). Creatinine clearance inversely correlated with night-time pulse pressure ( beta: 0.122; p = 0.017) while proteinuria correlated better with 24-hour systolic BP ( beta: 0.390; p < 0.001). Whereas office BP (especially pulse pressure) is associated with the development of CE, ABPM estimates show a better association with target organ damage, especially systolic and pulse pressures.
Medicina Clinica, 2002
Recibido el 9-1-2002; aceptado para su publicación el 16-4-2002. FUNDAMENTO: Evaluar el impacto d... more Recibido el 9-1-2002; aceptado para su publicación el 16-4-2002. FUNDAMENTO: Evaluar el impacto de los diferentes componentes de la presión arterial (PA), determinados tanto en la consulta como por monitorización ambulatoria de la PA (MAPA), sobre el desarrollo de la lesión de órgano diana y los episodios cardiovasculares (ECV) de la hipertensión arterial (HTA). PACIENTES Y MÉTODO: Estudio retrospectivo llevado a cabo en 390 pacientes (55% varones; edad media de 56 años) atendidos en una unidad de HTA entre 1989 y 1998. En todos los pacientes se disponía de las determinaciones iniciales de la PA clínica mediante esfigmomanómetro de mercurio y de MAPA de 24 h, con el paciente libre de tratamiento antihipertensivo. Se obtuvieron los índices de Cornell y Sokolow del ECG como reflejo de la afección cardíaca hipertensiva y la creatinina sérica, aclaramiento de creatinina y excreción urinaria de proteínas en 24 h, como medida del daño renal. La metodología estadística empleada fue la regresión lineal múltiple y la regresión logística. RESULTADOS: Cuarenta y nueve pacientes desarrollaron ECV (26 accidentes cerebrovasculares, 18 infartos de miocardio y 5 pacientes con ambos episodios). De todas las mediciones de PA, fue el aumento de la presión de pulso (PP) en la clínica el factor independiente mejor relacionado con la aparición de ECV (odds ratio multivariado = 1,03; intervalo de confianza [IC] del 95%, 1,00-1,05; p = 0,0095). Respecto a la correlación con los diferentes indicadores de lesión del órgano diana, los análisis de regresión lineal múltiple pusieron de manifiesto una asociación del índice de Cornell del ECG con la PAS nocturna obtenida en MAPA (coeficiente estandarizado β = 0,260; p < 0,001), del índice de Sokolow con la PAS diurna (β = 0,257; p < 0,001), del aclaramiento de creatinina con la PP nocturna (correlación inversa β = -0,122; p = 0,017) y de la proteinuria con la PAS de 24 h (β = 0,390; p < 0,001). CONCLUSIONES: El desarrollo de ECV en la HTA se correlaciona con las cifras de PA clínica (especialmente con la PP), mientras que los indicadores de la lesión del órgano diana (hipertrofia cardíaca, lesión renal) se correlacionan mejor con la PA obtenida mediante MAPA (especialmente con la PAS y PP).
High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension, Jan 13, 2016
Hypertension, one of the main risk factors for cardiovascular disease, is thought to play a cruci... more Hypertension, one of the main risk factors for cardiovascular disease, is thought to play a crucial role in the pathophysiology of cognitive impairment. Studies have associated hypertension with subjective cognitive failures and objective cognitive decline. Subjective cognitive failures may reflect the early phase of a long pathological process leading to cognitive decline and dementia that has been associated with hypertension and other cardiovascular risk factors. The underlying cerebral structural change associated with cognitive decline may be a consequence of the cerebral small-vessel disease induced by high blood pressure and may be detected on magnetic resonance imaging as white matter hyperintensities, cerebral microbleeds, lacunar infarcts or enlarged perivascular spaces. The increasing interest in the relationship between hypertension and cognitive decline is based on the fact that blood pressure control in middle-aged subjects may delay or stop the progression of cognitiv...
Amer J Hypertens, 2003
intakes. Participants who ate the DASH diet had lower blood pressure over time once the controlle... more intakes. Participants who ate the DASH diet had lower blood pressure over time once the controlled feeding intervention was discontinued and were more likely to change their dietary intakes in ways that were consistent with the DASH diet.
Se estima que la prevalencia de hipertensión arterial (HTA) en la población española de edad > 60... more Se estima que la prevalencia de hipertensión arterial (HTA) en la población española de edad > 60 años es superior al 65%, a expensas principalmente de una elevación de la presión arterial sistólica. Es conocido que la HTA es el factor de riesgo más importante para el desarrollo de una enfermedad cardiovascular, y que ésta sigue siendo la primera causa de muerte en la población occidental. La necesidad de tratamiento de la HTA en la población anciana es un hecho ya ampliamente demostrado en numerosos ensayos clínicos aleatorizados y controlados con placebo, en los que el tratamiento antihipertensivo se asocia a una reducción del riesgo de presentar una complicación cardiovascular. Sin embargo, el tratamiento de la HTA en el anciano puede resultar una tarea complicada por la necesidad de tener presente en su manejo clínico una serie de características propias de este grupo de pacientes, como son una farmacocinética alterada, la comorbilidad o la polifarmacia. Por otra parte, aunque existen evidencias recientes del beneficio del tratamiento antihipertensivo en pacientes muy ancianos (> 85 años), una valoración geriátrica integral y el tratamiento individualizado es lo que debiera realizarse en nuestra práctica clínica habitual.The prevalence of essential hypertension in the Spanish population aged more than 60 years old is greater than 65%, mainly due to the high prevalence of elevated systolic pressure. Essential hypertension is known to be the most important risk factor for the development of cardiovascular disease, which continues to be the leading cause of death among adults in the developed world. Several randomized, placebo-controlled clinical trials have demonstrated the beneficial effects of antihypertensive treatment in hypertensive elderly people. However, the management of high blood pressure in the elderly population can be difficult due to a series of factors in this group such as altered pharmacokinetics, comorbidity, and polypharmacy. In addition, although there is recent evidence of the benefit of antihypertensive treatment in the oldest old (> 85 years), comprehensive geriatric assessment and individualized treatment should be applied in daily clinical practice.
Hypertension, Feb 1, 2002
It has been reported that both the DD genotype of the angiotensin converting enzyme (ACE) gene an... more It has been reported that both the DD genotype of the angiotensin converting enzyme (ACE) gene and the presence of cerebral white matter lesions (WML) may represent risk factors for the development of stroke. The present study investigates a possible association between 3 different genetic polymorphisms of the renin-angiotensin system and the presence of WML in 60 never-treated essential hypertensive patients (36 men, 24 women), aged 50 to 60 years, without clinical evidence of target organ damage. All patients underwent brain magnetic resonance imaging to establish the presence or absence of WML. The insertion/deletion (I/D) ACE gene, the M235T angiotensinogen (AGT) gene, and the A1166C angiotensin II type 1 receptor gene polymorphisms were determined by standard polymerase chain reaction. Twenty-five hypertensive patients (41.6%) were found to have WML on brain magnetic resonance imaging. No significant association between the M235T angiotensinogen or A1166C angiotensin II type 1 receptor genotypes and the presence of WML was found. However, the frequency of the DD genotype in patients with WML (64%) was significantly higher than that observed in patients without WML (28.6%; P=0.022). The DD genotype odds ratio for the presence of WML was 4.44 (95% confidence interval: 1.48 to 13.3). Likewise, the proportion of the D allele in patients with WML (74%) was significantly higher (P=0.014) than that observed in patients without WML (51.4%). We conclude that the presence of the DD genotype and/or the D allele of the ACE gene may be a predisposing factor for developing WML in essential hypertensive patients. However, because of the small sample size, these results require confirmation in a larger study.
Amer J Hypertens, 1999
During the past decade, most ambulatory blood pressure (BP) monitoring research has been conducte... more During the past decade, most ambulatory blood pressure (BP) monitoring research has been conducted in White patients in Europe and North America. Far less is known about relationships among ambulatory BP, office BP, and indices of hypertensive heart disease in African-American patients. Thus, we studied 34 previously untreated African-American hypertensives with triplicate office BPs, 24-hour ambulatory BP, ecbocardiography, and metabolic profiles (lipids, insulin, glucose, creatinine clearance). The patient group included 17 men and 17 women, had an average age of 45 + 10 years, BMI of 29 + 5 kg/m 2, and normal renal function. Awake systolic BP and awake systolic BP load were better predictors for left ventricular (LV) mass and LV mass index than office BP (figure). For diastolic BP parameters, sleep diastolic BP load was the best correlate of LV mass (r = 0.46, p = 0.03) and LV mass index (r = 0.45, p = 0.02). Neither ambulatory BP nor LV mass were related to serum insulin or insulin:glucose ratios.
Revista Espanola De Cardiologia, Mar 25, 2009
Amer J Hypertens, 2000
Arteriolosclerosis is an important vascular change induced by hypertension. Blood flow of kidney ... more Arteriolosclerosis is an important vascular change induced by hypertension. Blood flow of kidney and perforating artery area in the brain in essential hypertensive patients are determined by the severity of arteriolosclerosis in each region. The aim of the study was to evaluate relation of effective renal plasma flow (ERPF) and regional cerebral blood flow (rCBF) including basal ganglia as perforating artery region in essential hypertension using renography and brain SPECT imaging. The study subjects were 28 essential hypertensive patients (56.2 Ϯ 10.5 years, M/F ϭ 16/12). ERPF was determined by dynamic renal scintigraphy by clearance method using 99m Tc-mercapto acetyl triglycine. The rCBF was quantitatively measured by N-isopropyl-p-[ 123 I]iodoamphetamine autoradiography method. Regions of interest on rCBF images were set in the frontal, temporal, parietal, occipital cortex, the basal ganglia and the cerebellum. The rCBF in the frontal, temporal, parietal, occipital cortexes and the cerebellum were not correlated to ERPE However, the rCBF in the basal ganglia is significantly correlated to ERPF (r ϭ 0.38, p Ͻ 0.05). We conclude that hypertensive arteriolosclerosis at the kidney and at perforating artery region in the brain develops in parallel.
Revista Espanola De Geriatria Y Gerontologia, Oct 1, 2008
The prevalence of essential hypertension in the Spanish population aged more than 60 years old is... more The prevalence of essential hypertension in the Spanish population aged more than 60 years old is greater than 65%, mainly due to the high prevalence of elevated systolic pressure. Essential hypertension is known to be the most important risk factor for the development of cardiovascular disease, which continues to be the leading cause of death among adults in the developed world. Several randomized, placebo-controlled clinical trials have demonstrated the beneficial effects of antihypertensive treatment in hypertensive elderly people. However, the management of high blood pressure in the elderly population can be difficult due to a series of factors in this group such as altered pharmacokinetics, comorbidity, and polypharmacy. In addition, although there is recent evidence of the benefit of antihypertensive treatment in the oldest old (> 85 years), comprehensive geriatric assessment and individualized treatment should be applied in daily clinical practice.
American Journal of Hypertension, 2003
intakes. Participants who ate the DASH diet had lower blood pressure over time once the controlle... more intakes. Participants who ate the DASH diet had lower blood pressure over time once the controlled feeding intervention was discontinued and were more likely to change their dietary intakes in ways that were consistent with the DASH diet.
American Journal of Hypertension, 2004
American Journal of Hypertension, 2003
intakes. Participants who ate the DASH diet had lower blood pressure over time once the controlle... more intakes. Participants who ate the DASH diet had lower blood pressure over time once the controlled feeding intervention was discontinued and were more likely to change their dietary intakes in ways that were consistent with the DASH diet.
Revista Española de Cardiología (English Edition), 2015
Journal of Aging Research, 2011
Chronic hypertension leads to concomitant remodeling of the cardiac and vascular systems and vari... more Chronic hypertension leads to concomitant remodeling of the cardiac and vascular systems and various organs, especially the brain, kidney, and retina. The brain is an early target of organ damage due to high blood pressure, which is the major modifiable risk factor for stroke and small vessel disease. Stroke is the second leading cause of death and the number one cause of disability worldwide and over 80% of strokes occur in the elderly. Preclinical hypertensive lesions in most target organs are clearly identified: left ventricular hypertrophy for the heart, microalbuminuria for the kidney, fundus abnormalities for the eye, and intima-media thickness and pulse wave velocity for the vessels. However, early hypertensive brain damage is not fully studied due to difficulties in access and the expense of techniques. After age, hypertension is the most-important risk factor for cerebral white matter lesions, which are an important prognostic factor for stroke, cognitive impairment, dementia, and death. Studies have shown an association between white matter lesions and a number of extracranial systems affected by high BP and also suggest that correct antihypertensive treatment could slow white matter lesions progression. There is strong evidence that cerebral white matter lesions in hypertensive patients should be considered a silent early marker of brain damage.
Medicina Clínica, 2002
Recibido el 9-1-2002; aceptado para su publicación el 16-4-2002. FUNDAMENTO: Evaluar el impacto d... more Recibido el 9-1-2002; aceptado para su publicación el 16-4-2002. FUNDAMENTO: Evaluar el impacto de los diferentes componentes de la presión arterial (PA), determinados tanto en la consulta como por monitorización ambulatoria de la PA (MAPA), sobre el desarrollo de la lesión de órgano diana y los episodios cardiovasculares (ECV) de la hipertensión arterial (HTA). PACIENTES Y MÉTODO: Estudio retrospectivo llevado a cabo en 390 pacientes (55% varones; edad media de 56 años) atendidos en una unidad de HTA entre 1989 y 1998. En todos los pacientes se disponía de las determinaciones iniciales de la PA clínica mediante esfigmomanómetro de mercurio y de MAPA de 24 h, con el paciente libre de tratamiento antihipertensivo. Se obtuvieron los índices de Cornell y Sokolow del ECG como reflejo de la afección cardíaca hipertensiva y la creatinina sérica, aclaramiento de creatinina y excreción urinaria de proteínas en 24 h, como medida del daño renal. La metodología estadística empleada fue la regresión lineal múltiple y la regresión logística. RESULTADOS: Cuarenta y nueve pacientes desarrollaron ECV (26 accidentes cerebrovasculares, 18 infartos de miocardio y 5 pacientes con ambos episodios). De todas las mediciones de PA, fue el aumento de la presión de pulso (PP) en la clínica el factor independiente mejor relacionado con la aparición de ECV (odds ratio multivariado = 1,03; intervalo de confianza [IC] del 95%, 1,00-1,05; p = 0,0095). Respecto a la correlación con los diferentes indicadores de lesión del órgano diana, los análisis de regresión lineal múltiple pusieron de manifiesto una asociación del índice de Cornell del ECG con la PAS nocturna obtenida en MAPA (coeficiente estandarizado β = 0,260; p < 0,001), del índice de Sokolow con la PAS diurna (β = 0,257; p < 0,001), del aclaramiento de creatinina con la PP nocturna (correlación inversa β = -0,122; p = 0,017) y de la proteinuria con la PAS de 24 h (β = 0,390; p < 0,001). CONCLUSIONES: El desarrollo de ECV en la HTA se correlaciona con las cifras de PA clínica (especialmente con la PP), mientras que los indicadores de la lesión del órgano diana (hipertrofia cardíaca, lesión renal) se correlacionan mejor con la PA obtenida mediante MAPA (especialmente con la PAS y PP).
American Journal of Hypertension, 2006
Background: Salt sensitivity in essential hypertension is associated with both endothelial dysfun... more Background: Salt sensitivity in essential hypertension is associated with both endothelial dysfunction and increased cardiovascular risk. We evaluated several serum markers of atherosclerosis and endothelial function in a group of essential hypertensive patients classified on the basis of their salt sensitivity.
American Journal of Hypertension, 1995
We used ambulatory blood pressure monitoring (ABPM) in the assessment of salt sensitivity in 40 e... more We used ambulatory blood pressure monitoring (ABPM) in the assessment of salt sensitivity in 40 essential hypertensive patients, comparing 24-h mean blood pressure during 7 days of low salt (20 mmol NaCl/day) and high salt (260 mmol NaC1/ day) intake. Salt sensitivity was diagnosed in 18 essential hypertensive patients (45%), each of them showing a significant increase in mean blood pressure (P < .05) from low to high salt diet. Salt-sensitive patients exhibited a high-salt--dependent increase in all blood pressure parameters including 24-h systolic, mean, diastolic blood pressure, blood pressure load, area under the curve, and awake and asleep blood pressure values. These patients exhibited a nondipper profile on both low-salt and high-salt diets. Salt-resistant patients (55%) showed a decrease in awake, and an increase in asleep blood pressure values after high salt intake, thus tending to flatten the circadian blood pressure profile. We conclude that ABPM is a useful method to assess salt sensitivity. In salt-resistant patients high salt intake induces a significant increase in asleep blood pressure with no significant changes in 24-h blood pressure, promoting a flattened blood pressure curve and tending to transform a dipper into a nondipper profile, which could have important implications in end-organ damage. Am J Hypertens 1995;8:970--977 KEY WORDS: Ambulatory blood pressure monitoring, salt sensitivity, blood pressure, circadian rhythm.
Hipertensión, 2006
La hipertensión arterial (HTA) es una de las patologías más prevalentes en el mundo actual y afec... more La hipertensión arterial (HTA) es una de las patologías más prevalentes en el mundo actual y afecta alrededor del 25% de la población adulta en los países desarrollados. Esta proporción se incrementa en la población anciana debido a los cambios asociados al envejecimiento, y se estima que la prevalencia de HTA en la población mayor de 65 años de edad es superior al 50%, a expensas particularmente de una eleva-ción de la presión arterial sistólica (PAS) 1 . Por otra parte, es conocido que la HTA es el factor de riesgo más importante para el desarrollo de una enfermedad cardiovascular (cardiopatía isquémica, insuficiencia cardíaca, ictus) y que ésta sigue siendo la primera causa de muerte en la población occidental. Así, las tres cuartas partes de los ictus afectan a individuos mayores de 65 años, por lo que se puede considerar una enfermedad de anciano. La HTA es sin duda alguna, además de la edad, el factor de riesgo más importante para el ictus, tanto isquémico como hemorrágico. La presión de pulso (diferencia entre PAS y presión arterial diastólica [PAD]) es una medida de la distensibilidad arterial y se relaciona con el proceso arterioscleroso y el envejecimiento. En un subanálisis del Estudio SHEP (Systolic Hypertension in the Elderly Program) realizado en 4.736 individuos con HTA sistólica aislada, se ha podido objetivar que por cada 10 mmHg que aumente la presión de pulso se 118
Revista Española de Cardiología, 2015
Medicina Clinica, Jun 1, 2002
The goal of this study was to evaluate the relative association of several components of blood pr... more The goal of this study was to evaluate the relative association of several components of blood pressure (BP), as measured in the office and by ambulatory monitoring (ABPM), with clinically useful indicators of target organ damage and cardiovascular events (CE) in essential hypertensive patients. We retrospectively included 390 hypertensives (55% men; mean age: 56 years) between 1989 and 1998. All them had a baseline office BP measurement and a valid 24-hour ABPM record, both performed while the patient was free of antihypertensive therapy. Estimates of target organ damage included electrocardiographic indexes of left ventricular hypertrophy (Cornell and Sokolow-Lyon), serum creatinine, 24-hour urine protein excretion and creatinine clearance. Multiple linear regression and logistic regression analyses were used to evaluate the relationship between BP and target organ damage or CE. Forty-nine patients had CE (26 stroke, 18 myocardial infarction and 5 both). The BP parameter correlating better with cardiovascular events was office pulse pressure (multivariate odds ratio: 1.03; CI 95%: 1.00-1.05; p = 0.0095). Nevertheless, cardiac growth indexes correlated better with ABPM measurements. In fact, Cornell index correlated with night-time systolic BP (standardized regression coefficient beta: 0.260; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and Sokolow-Lyon index correlated with day-time systolic BP ( beta: 0.257; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Creatinine clearance inversely correlated with night-time pulse pressure ( beta: 0.122; p = 0.017) while proteinuria correlated better with 24-hour systolic BP ( beta: 0.390; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Whereas office BP (especially pulse pressure) is associated with the development of CE, ABPM estimates show a better association with target organ damage, especially systolic and pulse pressures.
Medicina Clinica, 2002
Recibido el 9-1-2002; aceptado para su publicación el 16-4-2002. FUNDAMENTO: Evaluar el impacto d... more Recibido el 9-1-2002; aceptado para su publicación el 16-4-2002. FUNDAMENTO: Evaluar el impacto de los diferentes componentes de la presión arterial (PA), determinados tanto en la consulta como por monitorización ambulatoria de la PA (MAPA), sobre el desarrollo de la lesión de órgano diana y los episodios cardiovasculares (ECV) de la hipertensión arterial (HTA). PACIENTES Y MÉTODO: Estudio retrospectivo llevado a cabo en 390 pacientes (55% varones; edad media de 56 años) atendidos en una unidad de HTA entre 1989 y 1998. En todos los pacientes se disponía de las determinaciones iniciales de la PA clínica mediante esfigmomanómetro de mercurio y de MAPA de 24 h, con el paciente libre de tratamiento antihipertensivo. Se obtuvieron los índices de Cornell y Sokolow del ECG como reflejo de la afección cardíaca hipertensiva y la creatinina sérica, aclaramiento de creatinina y excreción urinaria de proteínas en 24 h, como medida del daño renal. La metodología estadística empleada fue la regresión lineal múltiple y la regresión logística. RESULTADOS: Cuarenta y nueve pacientes desarrollaron ECV (26 accidentes cerebrovasculares, 18 infartos de miocardio y 5 pacientes con ambos episodios). De todas las mediciones de PA, fue el aumento de la presión de pulso (PP) en la clínica el factor independiente mejor relacionado con la aparición de ECV (odds ratio multivariado = 1,03; intervalo de confianza [IC] del 95%, 1,00-1,05; p = 0,0095). Respecto a la correlación con los diferentes indicadores de lesión del órgano diana, los análisis de regresión lineal múltiple pusieron de manifiesto una asociación del índice de Cornell del ECG con la PAS nocturna obtenida en MAPA (coeficiente estandarizado β = 0,260; p < 0,001), del índice de Sokolow con la PAS diurna (β = 0,257; p < 0,001), del aclaramiento de creatinina con la PP nocturna (correlación inversa β = -0,122; p = 0,017) y de la proteinuria con la PAS de 24 h (β = 0,390; p < 0,001). CONCLUSIONES: El desarrollo de ECV en la HTA se correlaciona con las cifras de PA clínica (especialmente con la PP), mientras que los indicadores de la lesión del órgano diana (hipertrofia cardíaca, lesión renal) se correlacionan mejor con la PA obtenida mediante MAPA (especialmente con la PAS y PP).
High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension, Jan 13, 2016
Hypertension, one of the main risk factors for cardiovascular disease, is thought to play a cruci... more Hypertension, one of the main risk factors for cardiovascular disease, is thought to play a crucial role in the pathophysiology of cognitive impairment. Studies have associated hypertension with subjective cognitive failures and objective cognitive decline. Subjective cognitive failures may reflect the early phase of a long pathological process leading to cognitive decline and dementia that has been associated with hypertension and other cardiovascular risk factors. The underlying cerebral structural change associated with cognitive decline may be a consequence of the cerebral small-vessel disease induced by high blood pressure and may be detected on magnetic resonance imaging as white matter hyperintensities, cerebral microbleeds, lacunar infarcts or enlarged perivascular spaces. The increasing interest in the relationship between hypertension and cognitive decline is based on the fact that blood pressure control in middle-aged subjects may delay or stop the progression of cognitiv...
Amer J Hypertens, 2003
intakes. Participants who ate the DASH diet had lower blood pressure over time once the controlle... more intakes. Participants who ate the DASH diet had lower blood pressure over time once the controlled feeding intervention was discontinued and were more likely to change their dietary intakes in ways that were consistent with the DASH diet.
Se estima que la prevalencia de hipertensión arterial (HTA) en la población española de edad > 60... more Se estima que la prevalencia de hipertensión arterial (HTA) en la población española de edad > 60 años es superior al 65%, a expensas principalmente de una elevación de la presión arterial sistólica. Es conocido que la HTA es el factor de riesgo más importante para el desarrollo de una enfermedad cardiovascular, y que ésta sigue siendo la primera causa de muerte en la población occidental. La necesidad de tratamiento de la HTA en la población anciana es un hecho ya ampliamente demostrado en numerosos ensayos clínicos aleatorizados y controlados con placebo, en los que el tratamiento antihipertensivo se asocia a una reducción del riesgo de presentar una complicación cardiovascular. Sin embargo, el tratamiento de la HTA en el anciano puede resultar una tarea complicada por la necesidad de tener presente en su manejo clínico una serie de características propias de este grupo de pacientes, como son una farmacocinética alterada, la comorbilidad o la polifarmacia. Por otra parte, aunque existen evidencias recientes del beneficio del tratamiento antihipertensivo en pacientes muy ancianos (> 85 años), una valoración geriátrica integral y el tratamiento individualizado es lo que debiera realizarse en nuestra práctica clínica habitual.The prevalence of essential hypertension in the Spanish population aged more than 60 years old is greater than 65%, mainly due to the high prevalence of elevated systolic pressure. Essential hypertension is known to be the most important risk factor for the development of cardiovascular disease, which continues to be the leading cause of death among adults in the developed world. Several randomized, placebo-controlled clinical trials have demonstrated the beneficial effects of antihypertensive treatment in hypertensive elderly people. However, the management of high blood pressure in the elderly population can be difficult due to a series of factors in this group such as altered pharmacokinetics, comorbidity, and polypharmacy. In addition, although there is recent evidence of the benefit of antihypertensive treatment in the oldest old (> 85 years), comprehensive geriatric assessment and individualized treatment should be applied in daily clinical practice.
Hypertension, Feb 1, 2002
It has been reported that both the DD genotype of the angiotensin converting enzyme (ACE) gene an... more It has been reported that both the DD genotype of the angiotensin converting enzyme (ACE) gene and the presence of cerebral white matter lesions (WML) may represent risk factors for the development of stroke. The present study investigates a possible association between 3 different genetic polymorphisms of the renin-angiotensin system and the presence of WML in 60 never-treated essential hypertensive patients (36 men, 24 women), aged 50 to 60 years, without clinical evidence of target organ damage. All patients underwent brain magnetic resonance imaging to establish the presence or absence of WML. The insertion/deletion (I/D) ACE gene, the M235T angiotensinogen (AGT) gene, and the A1166C angiotensin II type 1 receptor gene polymorphisms were determined by standard polymerase chain reaction. Twenty-five hypertensive patients (41.6%) were found to have WML on brain magnetic resonance imaging. No significant association between the M235T angiotensinogen or A1166C angiotensin II type 1 receptor genotypes and the presence of WML was found. However, the frequency of the DD genotype in patients with WML (64%) was significantly higher than that observed in patients without WML (28.6%; P=0.022). The DD genotype odds ratio for the presence of WML was 4.44 (95% confidence interval: 1.48 to 13.3). Likewise, the proportion of the D allele in patients with WML (74%) was significantly higher (P=0.014) than that observed in patients without WML (51.4%). We conclude that the presence of the DD genotype and/or the D allele of the ACE gene may be a predisposing factor for developing WML in essential hypertensive patients. However, because of the small sample size, these results require confirmation in a larger study.
Amer J Hypertens, 1999
During the past decade, most ambulatory blood pressure (BP) monitoring research has been conducte... more During the past decade, most ambulatory blood pressure (BP) monitoring research has been conducted in White patients in Europe and North America. Far less is known about relationships among ambulatory BP, office BP, and indices of hypertensive heart disease in African-American patients. Thus, we studied 34 previously untreated African-American hypertensives with triplicate office BPs, 24-hour ambulatory BP, ecbocardiography, and metabolic profiles (lipids, insulin, glucose, creatinine clearance). The patient group included 17 men and 17 women, had an average age of 45 + 10 years, BMI of 29 + 5 kg/m 2, and normal renal function. Awake systolic BP and awake systolic BP load were better predictors for left ventricular (LV) mass and LV mass index than office BP (figure). For diastolic BP parameters, sleep diastolic BP load was the best correlate of LV mass (r = 0.46, p = 0.03) and LV mass index (r = 0.45, p = 0.02). Neither ambulatory BP nor LV mass were related to serum insulin or insulin:glucose ratios.
Revista Espanola De Cardiologia, Mar 25, 2009
Amer J Hypertens, 2000
Arteriolosclerosis is an important vascular change induced by hypertension. Blood flow of kidney ... more Arteriolosclerosis is an important vascular change induced by hypertension. Blood flow of kidney and perforating artery area in the brain in essential hypertensive patients are determined by the severity of arteriolosclerosis in each region. The aim of the study was to evaluate relation of effective renal plasma flow (ERPF) and regional cerebral blood flow (rCBF) including basal ganglia as perforating artery region in essential hypertension using renography and brain SPECT imaging. The study subjects were 28 essential hypertensive patients (56.2 Ϯ 10.5 years, M/F ϭ 16/12). ERPF was determined by dynamic renal scintigraphy by clearance method using 99m Tc-mercapto acetyl triglycine. The rCBF was quantitatively measured by N-isopropyl-p-[ 123 I]iodoamphetamine autoradiography method. Regions of interest on rCBF images were set in the frontal, temporal, parietal, occipital cortex, the basal ganglia and the cerebellum. The rCBF in the frontal, temporal, parietal, occipital cortexes and the cerebellum were not correlated to ERPE However, the rCBF in the basal ganglia is significantly correlated to ERPF (r ϭ 0.38, p Ͻ 0.05). We conclude that hypertensive arteriolosclerosis at the kidney and at perforating artery region in the brain develops in parallel.
Revista Espanola De Geriatria Y Gerontologia, Oct 1, 2008
The prevalence of essential hypertension in the Spanish population aged more than 60 years old is... more The prevalence of essential hypertension in the Spanish population aged more than 60 years old is greater than 65%, mainly due to the high prevalence of elevated systolic pressure. Essential hypertension is known to be the most important risk factor for the development of cardiovascular disease, which continues to be the leading cause of death among adults in the developed world. Several randomized, placebo-controlled clinical trials have demonstrated the beneficial effects of antihypertensive treatment in hypertensive elderly people. However, the management of high blood pressure in the elderly population can be difficult due to a series of factors in this group such as altered pharmacokinetics, comorbidity, and polypharmacy. In addition, although there is recent evidence of the benefit of antihypertensive treatment in the oldest old (> 85 years), comprehensive geriatric assessment and individualized treatment should be applied in daily clinical practice.
American Journal of Hypertension, 2003
intakes. Participants who ate the DASH diet had lower blood pressure over time once the controlle... more intakes. Participants who ate the DASH diet had lower blood pressure over time once the controlled feeding intervention was discontinued and were more likely to change their dietary intakes in ways that were consistent with the DASH diet.
American Journal of Hypertension, 2004
American Journal of Hypertension, 2003
intakes. Participants who ate the DASH diet had lower blood pressure over time once the controlle... more intakes. Participants who ate the DASH diet had lower blood pressure over time once the controlled feeding intervention was discontinued and were more likely to change their dietary intakes in ways that were consistent with the DASH diet.
Revista Española de Cardiología (English Edition), 2015
Journal of Aging Research, 2011
Chronic hypertension leads to concomitant remodeling of the cardiac and vascular systems and vari... more Chronic hypertension leads to concomitant remodeling of the cardiac and vascular systems and various organs, especially the brain, kidney, and retina. The brain is an early target of organ damage due to high blood pressure, which is the major modifiable risk factor for stroke and small vessel disease. Stroke is the second leading cause of death and the number one cause of disability worldwide and over 80% of strokes occur in the elderly. Preclinical hypertensive lesions in most target organs are clearly identified: left ventricular hypertrophy for the heart, microalbuminuria for the kidney, fundus abnormalities for the eye, and intima-media thickness and pulse wave velocity for the vessels. However, early hypertensive brain damage is not fully studied due to difficulties in access and the expense of techniques. After age, hypertension is the most-important risk factor for cerebral white matter lesions, which are an important prognostic factor for stroke, cognitive impairment, dementia, and death. Studies have shown an association between white matter lesions and a number of extracranial systems affected by high BP and also suggest that correct antihypertensive treatment could slow white matter lesions progression. There is strong evidence that cerebral white matter lesions in hypertensive patients should be considered a silent early marker of brain damage.
Medicina Clínica, 2002
Recibido el 9-1-2002; aceptado para su publicación el 16-4-2002. FUNDAMENTO: Evaluar el impacto d... more Recibido el 9-1-2002; aceptado para su publicación el 16-4-2002. FUNDAMENTO: Evaluar el impacto de los diferentes componentes de la presión arterial (PA), determinados tanto en la consulta como por monitorización ambulatoria de la PA (MAPA), sobre el desarrollo de la lesión de órgano diana y los episodios cardiovasculares (ECV) de la hipertensión arterial (HTA). PACIENTES Y MÉTODO: Estudio retrospectivo llevado a cabo en 390 pacientes (55% varones; edad media de 56 años) atendidos en una unidad de HTA entre 1989 y 1998. En todos los pacientes se disponía de las determinaciones iniciales de la PA clínica mediante esfigmomanómetro de mercurio y de MAPA de 24 h, con el paciente libre de tratamiento antihipertensivo. Se obtuvieron los índices de Cornell y Sokolow del ECG como reflejo de la afección cardíaca hipertensiva y la creatinina sérica, aclaramiento de creatinina y excreción urinaria de proteínas en 24 h, como medida del daño renal. La metodología estadística empleada fue la regresión lineal múltiple y la regresión logística. RESULTADOS: Cuarenta y nueve pacientes desarrollaron ECV (26 accidentes cerebrovasculares, 18 infartos de miocardio y 5 pacientes con ambos episodios). De todas las mediciones de PA, fue el aumento de la presión de pulso (PP) en la clínica el factor independiente mejor relacionado con la aparición de ECV (odds ratio multivariado = 1,03; intervalo de confianza [IC] del 95%, 1,00-1,05; p = 0,0095). Respecto a la correlación con los diferentes indicadores de lesión del órgano diana, los análisis de regresión lineal múltiple pusieron de manifiesto una asociación del índice de Cornell del ECG con la PAS nocturna obtenida en MAPA (coeficiente estandarizado β = 0,260; p < 0,001), del índice de Sokolow con la PAS diurna (β = 0,257; p < 0,001), del aclaramiento de creatinina con la PP nocturna (correlación inversa β = -0,122; p = 0,017) y de la proteinuria con la PAS de 24 h (β = 0,390; p < 0,001). CONCLUSIONES: El desarrollo de ECV en la HTA se correlaciona con las cifras de PA clínica (especialmente con la PP), mientras que los indicadores de la lesión del órgano diana (hipertrofia cardíaca, lesión renal) se correlacionan mejor con la PA obtenida mediante MAPA (especialmente con la PAS y PP).
American Journal of Hypertension, 2006
Background: Salt sensitivity in essential hypertension is associated with both endothelial dysfun... more Background: Salt sensitivity in essential hypertension is associated with both endothelial dysfunction and increased cardiovascular risk. We evaluated several serum markers of atherosclerosis and endothelial function in a group of essential hypertensive patients classified on the basis of their salt sensitivity.
American Journal of Hypertension, 1995
We used ambulatory blood pressure monitoring (ABPM) in the assessment of salt sensitivity in 40 e... more We used ambulatory blood pressure monitoring (ABPM) in the assessment of salt sensitivity in 40 essential hypertensive patients, comparing 24-h mean blood pressure during 7 days of low salt (20 mmol NaCl/day) and high salt (260 mmol NaC1/ day) intake. Salt sensitivity was diagnosed in 18 essential hypertensive patients (45%), each of them showing a significant increase in mean blood pressure (P < .05) from low to high salt diet. Salt-sensitive patients exhibited a high-salt--dependent increase in all blood pressure parameters including 24-h systolic, mean, diastolic blood pressure, blood pressure load, area under the curve, and awake and asleep blood pressure values. These patients exhibited a nondipper profile on both low-salt and high-salt diets. Salt-resistant patients (55%) showed a decrease in awake, and an increase in asleep blood pressure values after high salt intake, thus tending to flatten the circadian blood pressure profile. We conclude that ABPM is a useful method to assess salt sensitivity. In salt-resistant patients high salt intake induces a significant increase in asleep blood pressure with no significant changes in 24-h blood pressure, promoting a flattened blood pressure curve and tending to transform a dipper into a nondipper profile, which could have important implications in end-organ damage. Am J Hypertens 1995;8:970--977 KEY WORDS: Ambulatory blood pressure monitoring, salt sensitivity, blood pressure, circadian rhythm.
Hipertensión, 2006
La hipertensión arterial (HTA) es una de las patologías más prevalentes en el mundo actual y afec... more La hipertensión arterial (HTA) es una de las patologías más prevalentes en el mundo actual y afecta alrededor del 25% de la población adulta en los países desarrollados. Esta proporción se incrementa en la población anciana debido a los cambios asociados al envejecimiento, y se estima que la prevalencia de HTA en la población mayor de 65 años de edad es superior al 50%, a expensas particularmente de una eleva-ción de la presión arterial sistólica (PAS) 1 . Por otra parte, es conocido que la HTA es el factor de riesgo más importante para el desarrollo de una enfermedad cardiovascular (cardiopatía isquémica, insuficiencia cardíaca, ictus) y que ésta sigue siendo la primera causa de muerte en la población occidental. Así, las tres cuartas partes de los ictus afectan a individuos mayores de 65 años, por lo que se puede considerar una enfermedad de anciano. La HTA es sin duda alguna, además de la edad, el factor de riesgo más importante para el ictus, tanto isquémico como hemorrágico. La presión de pulso (diferencia entre PAS y presión arterial diastólica [PAD]) es una medida de la distensibilidad arterial y se relaciona con el proceso arterioscleroso y el envejecimiento. En un subanálisis del Estudio SHEP (Systolic Hypertension in the Elderly Program) realizado en 4.736 individuos con HTA sistólica aislada, se ha podido objetivar que por cada 10 mmHg que aumente la presión de pulso se 118
Revista Española de Cardiología, 2015