Manuel Gorostidi | University of Oviedo / Universidad de Oviedo (original) (raw)
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Papers by Manuel Gorostidi
European journal of clinical investigation, Jan 6, 2015
Many patients are hypertensive at the medical settings but show normal blood pressure out of the ... more Many patients are hypertensive at the medical settings but show normal blood pressure out of the doctor's office, and are classified as white-coat hypertensives. On the other hand, many patients with controlled hypertension at the clinic show ambulatory blood pressure levels above the thresholds considered for an adequate blood pressure control, known as having masked hypertension. Using data from the Spanish Ambulatory Blood Pressure Monitoring Registry (Spanish ABPM Registry), a national program developed to promote the use of the ambulatory technique for hypertension management in daily practice, we have reviewed the main strengths of this approach, i.e. the ability to detect discrepancies of blood pressure status with respect to office blood pressure measurement, and to better assess accurate rates of hypertension control. White-coat hypertension within patients with elevated office blood pressure, and masked hypertension within office-controlled patients affected to one of ...
Journal of Hypertension, 2015
Increased blood pressure (BP) variability has been related to cardiovascular morbidity and mortal... more Increased blood pressure (BP) variability has been related to cardiovascular morbidity and mortality in hypertensive patients. We aimed to assess short-term BP variability by means of ambulatory BP monitoring (ABPM) according to renal function status. We conducted a cross-sectional analyses with data from 14 382 hypertensives included in the Spanish ABPM Registry. Performance of ABPM was standardized according to guideline recommendations. Kidney function was graded according to current KDIGO definitions for chronic kidney disease (CKD) staging. Estimated glomerular filtration rate was calculated by the CKD-EPI equation. Short-term (reading-to-reading) BP variability was assessed by standard deviation (SD) of mean daytime and nighttime systolic BP (SBP) and diastolic BP (DBP). Mean age of the population was 61.0 ± 13.9 years and 52.6% of patients were male. Distribution according to renal function status was: 8,689 (60.4%) with no CKD, 765 (5.3%) with stage 1 CKD, 494 (3.4%) with stage 2 CKD, 3893 (27.1%) with stage 3 CKD, 413 (2.9%) with stage 4 CKD, and 128 (0.9%) with stage 5 CKD. SD of daytime SBP was higher at more advanced CKD stage (13.6 in CKD-free patients, and 15.7, 16.7, 15.7, 17.5, and 19.0 mmHg in stage 1 to 5 CKD patients respectively, p-trend < 0.001). SD of nighttime SBP also increased with progressive CKD stage, with the change being proportionally higher than that observed for daytime SBP (15.1 in CKD-free patients, and 17.5, 18.8, 17.7, 20.1, and 23.8 mmHg in stage 1 to 5 CKD patients respectively, p-trend < 0.001). SD of daytime DBP and nighttime DBP also increased as renal function worsened but with only marginal statistical significance. Increased short-term BP was significantly associated with progressive CKD stages in a large sample of hypertensive patients. This association was stronger for SBP than for DBP, and for nighttime than for daytime BP. We suggest that increased SBP variability, particularly at night, may partially explain the sharp elevation of cardiovascular risk with worsening renal function.
We evaluated 864 pregnant women with hypertension observed during a 24-year period and assessed c... more We evaluated 864 pregnant women with hypertension observed during a 24-year period and assessed changes in the different forms of hypertension in pregnancy. Each patient data included a clinical history, blood and urine analysis, and maternal-fetal morbidity and mortality. The control group consisted of 607 time-matched women with normotensive pregnancies. The observation time was divided into three year periods for evolutive assessing: 1973-80, 1981-88, and 1988-96. Women with hypertensive pregnancies were older than controls (29.5 + 6 vs 26.2 :l: 5 years, p<0.05) and suffered from a higher fetal (7.1% vs 0.3%, p<0.001) and maternal (0.3% vs 0%) mortality. No maternal deaths were observed during the last 11 years. The highest rates of preterm delivery and fetal mortality corresponded to eclampsia (45% and 21%, respectively) and prceclampsia superimposed on chronic hypertension (500 and 21%, respectively). The lowest fetal morbidity and mortality were observed in the gestatianal hypertensives (10% and 2%, respectively). The prevalences varied as shown:
Transplantation Proceedings
Journal of Human Hypertension
Nephrology Dialysis Transplantation
ABSTRACT
Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia
Nephroangiosclerosis and nephrosclerosis are terms used to define the renal disease induced by es... more Nephroangiosclerosis and nephrosclerosis are terms used to define the renal disease induced by essential hypertension. The predominant histologic changes occur in the preglomerular microvasculature. Epidemiological data about the risk of hypertensive patients from developing renal failure offer conflicting results. Nevertheless, renal vascular disease, including nephroangiosclerosis and/or ischemic nephropathy, appears to be an important cause of end-stage renal disease. Presumably, nephrosclerosis is the renal expression of systemic atherosclerosis: male sex, age > 55-60 years, black race, high serum cholesterol and/or uric acid levels, and coronary heart disease, peripheral artery disease, and/or cerebrovascular disease are common associations with the renal alteration. Treatment strategy should include an intensive blood pressure control, probably below 130/80 mmHg, together with antiplatelet and lipid-lowering agents when necessary. Although specific studies are lacking, ACE inhibitors and angiotensin II antagonists may offer additional benefits in slowing the renal disease progression.
Hipertensión y Riesgo Vascular
... JAMA 1994;271:275-9. Pubmed 15. Gæde P, Vedel P, Parving HH, Pedersen O. Intensified multifac... more ... JAMA 1994;271:275-9. Pubmed 15. Gæde P, Vedel P, Parving HH, Pedersen O. Intensified multifactorial intervention in patients with type 2 diabetes melli-tus and microalbuminuria: the Steno type 2 randomised study. Lancet 1999;353:617-22. Pubmed 16. ...
Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia
Medicina Clínica
1. Med Clin (Barc). 2005 Jun 4;125(1):24-34. [2005 Spanish guidelines in diagnosis and treatment ... more 1. Med Clin (Barc). 2005 Jun 4;125(1):24-34. [2005 Spanish guidelines in diagnosis and treatment of arterial hypertension]. [Article in Spanish]. Marín R, de la Sierra A, Armario P, Campo C, Banegas JR, Gorostidi M; Sociedad ...
Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia
Journal of Hypertension, 2004
Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia
European journal of clinical investigation, Jan 6, 2015
Many patients are hypertensive at the medical settings but show normal blood pressure out of the ... more Many patients are hypertensive at the medical settings but show normal blood pressure out of the doctor's office, and are classified as white-coat hypertensives. On the other hand, many patients with controlled hypertension at the clinic show ambulatory blood pressure levels above the thresholds considered for an adequate blood pressure control, known as having masked hypertension. Using data from the Spanish Ambulatory Blood Pressure Monitoring Registry (Spanish ABPM Registry), a national program developed to promote the use of the ambulatory technique for hypertension management in daily practice, we have reviewed the main strengths of this approach, i.e. the ability to detect discrepancies of blood pressure status with respect to office blood pressure measurement, and to better assess accurate rates of hypertension control. White-coat hypertension within patients with elevated office blood pressure, and masked hypertension within office-controlled patients affected to one of ...
Journal of Hypertension, 2015
Increased blood pressure (BP) variability has been related to cardiovascular morbidity and mortal... more Increased blood pressure (BP) variability has been related to cardiovascular morbidity and mortality in hypertensive patients. We aimed to assess short-term BP variability by means of ambulatory BP monitoring (ABPM) according to renal function status. We conducted a cross-sectional analyses with data from 14 382 hypertensives included in the Spanish ABPM Registry. Performance of ABPM was standardized according to guideline recommendations. Kidney function was graded according to current KDIGO definitions for chronic kidney disease (CKD) staging. Estimated glomerular filtration rate was calculated by the CKD-EPI equation. Short-term (reading-to-reading) BP variability was assessed by standard deviation (SD) of mean daytime and nighttime systolic BP (SBP) and diastolic BP (DBP). Mean age of the population was 61.0 ± 13.9 years and 52.6% of patients were male. Distribution according to renal function status was: 8,689 (60.4%) with no CKD, 765 (5.3%) with stage 1 CKD, 494 (3.4%) with stage 2 CKD, 3893 (27.1%) with stage 3 CKD, 413 (2.9%) with stage 4 CKD, and 128 (0.9%) with stage 5 CKD. SD of daytime SBP was higher at more advanced CKD stage (13.6 in CKD-free patients, and 15.7, 16.7, 15.7, 17.5, and 19.0 mmHg in stage 1 to 5 CKD patients respectively, p-trend &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). SD of nighttime SBP also increased with progressive CKD stage, with the change being proportionally higher than that observed for daytime SBP (15.1 in CKD-free patients, and 17.5, 18.8, 17.7, 20.1, and 23.8 mmHg in stage 1 to 5 CKD patients respectively, p-trend &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). SD of daytime DBP and nighttime DBP also increased as renal function worsened but with only marginal statistical significance. Increased short-term BP was significantly associated with progressive CKD stages in a large sample of hypertensive patients. This association was stronger for SBP than for DBP, and for nighttime than for daytime BP. We suggest that increased SBP variability, particularly at night, may partially explain the sharp elevation of cardiovascular risk with worsening renal function.
We evaluated 864 pregnant women with hypertension observed during a 24-year period and assessed c... more We evaluated 864 pregnant women with hypertension observed during a 24-year period and assessed changes in the different forms of hypertension in pregnancy. Each patient data included a clinical history, blood and urine analysis, and maternal-fetal morbidity and mortality. The control group consisted of 607 time-matched women with normotensive pregnancies. The observation time was divided into three year periods for evolutive assessing: 1973-80, 1981-88, and 1988-96. Women with hypertensive pregnancies were older than controls (29.5 + 6 vs 26.2 :l: 5 years, p<0.05) and suffered from a higher fetal (7.1% vs 0.3%, p<0.001) and maternal (0.3% vs 0%) mortality. No maternal deaths were observed during the last 11 years. The highest rates of preterm delivery and fetal mortality corresponded to eclampsia (45% and 21%, respectively) and prceclampsia superimposed on chronic hypertension (500 and 21%, respectively). The lowest fetal morbidity and mortality were observed in the gestatianal hypertensives (10% and 2%, respectively). The prevalences varied as shown:
Transplantation Proceedings
Journal of Human Hypertension
Nephrology Dialysis Transplantation
ABSTRACT
Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia
Nephroangiosclerosis and nephrosclerosis are terms used to define the renal disease induced by es... more Nephroangiosclerosis and nephrosclerosis are terms used to define the renal disease induced by essential hypertension. The predominant histologic changes occur in the preglomerular microvasculature. Epidemiological data about the risk of hypertensive patients from developing renal failure offer conflicting results. Nevertheless, renal vascular disease, including nephroangiosclerosis and/or ischemic nephropathy, appears to be an important cause of end-stage renal disease. Presumably, nephrosclerosis is the renal expression of systemic atherosclerosis: male sex, age > 55-60 years, black race, high serum cholesterol and/or uric acid levels, and coronary heart disease, peripheral artery disease, and/or cerebrovascular disease are common associations with the renal alteration. Treatment strategy should include an intensive blood pressure control, probably below 130/80 mmHg, together with antiplatelet and lipid-lowering agents when necessary. Although specific studies are lacking, ACE inhibitors and angiotensin II antagonists may offer additional benefits in slowing the renal disease progression.
Hipertensión y Riesgo Vascular
... JAMA 1994;271:275-9. Pubmed 15. Gæde P, Vedel P, Parving HH, Pedersen O. Intensified multifac... more ... JAMA 1994;271:275-9. Pubmed 15. Gæde P, Vedel P, Parving HH, Pedersen O. Intensified multifactorial intervention in patients with type 2 diabetes melli-tus and microalbuminuria: the Steno type 2 randomised study. Lancet 1999;353:617-22. Pubmed 16. ...
Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia
Medicina Clínica
1. Med Clin (Barc). 2005 Jun 4;125(1):24-34. [2005 Spanish guidelines in diagnosis and treatment ... more 1. Med Clin (Barc). 2005 Jun 4;125(1):24-34. [2005 Spanish guidelines in diagnosis and treatment of arterial hypertension]. [Article in Spanish]. Marín R, de la Sierra A, Armario P, Campo C, Banegas JR, Gorostidi M; Sociedad ...
Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia
Journal of Hypertension, 2004
Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia