Diastolic heart failure.
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Diabetes Complications↗
Biomedical subjects
Alberto Alonso
Publications and source records attributed to Alberto Alonso.
White coat hypertension in patients with obstructive sleep apnea-hypopnea syndrome.
BACKGROUND: The strength of the association between obstructive sleep apnea-hypopnea syndrome (OSAHS) and systemic hypertension could be affected by methodologic problems in the definition of hypertension. STUDY OBJECTIVES: To determine the frequency of white coat hypertension (WCH) in patients with OSAHS, and to analyze the characteristics of patients with OSASH and WCH. PATIENTS AND INTERVENTIONS: Ninety-nine consecutive patients with OSAHS and 20 healthy control subjects were included into the study. Twenty-four-hour ambulatory BP monitoring (ABPM) and urinary catecholamines were determined simultaneously with the polysomnographic study. Arterial blood gases and lung volumes were also measured. RESULTS: Office hypertension was diagnosed in 45 patients, while the control group included 54 normotensive patients with OSAHS. After ABPM, hypertension was confirmed in 30 patients with OSAHS and office hypertension. WCH was diagnosed in the remaining 15 patients (33%). Patients with WCH presented higher values of sleep onset latency and wake after sleep onset than normotensive and sustained hypertensive patients. No other differences in sleep parameters, function tests, or urinary catecholamines were found between the OSAHS groups. CONCLUSION: The results indicate that WCH is a frequent phenomenon in patients with OSAHS, and that it is not predictable by clinical variables.
Anxiety↗
Additive effect of drospirenone/17-beta-estradiol in hypertensive postmenopausal women receiving enalapril.
BACKGROUND: Aldosterone has been implicated in the pathogenesis of progressive cardiovascular disease. Drospirenone (DRSP) is a novel progestin with aldosterone receptor antagonist activity developed for hormone replacement therapy (HRT) as DRSP/17beta-estradiol (DRSP/ E2). We investigated the additive effect of DRSP/E2 versus placebo on 24-h ambulatory blood pressure (BP) in postmenopausal women with hypertension treated with enalapril maleate (ENA). METHODS: This was a double-blind, randomized, two-parallel group trial. Twenty-four nonsmoking postmenopausal women receiving 10 mg of ENA twice a day before study were randomized to DRSP/E2 + ENA (n = 12) or placebo (P) + ENA (n = 12) for 14 days. Twenty-four-hour ambulatory BP, plasma renin activity, and serum aldosterone were determined at baseline and on day 14. RESULTS: Compared to placebo, 24-h mean [SD] BP in the DRSP/E2 + ENA group decreased significantly from baseline (139/80 mm Hg), systolic (-9 [51 mm Hg, P = .014) and diastolic (-5 [4] mm Hg, P = .007). Essentially no change from baseline (139/83 mm Hg) in systolic or diastolic 24-h ambulatory BP were observed in the P + ENA group. Aldosterone (mean [SD]) increased from baseline by 2.6 [4.5] ng/dL in the DRSP/E2 + ENA group, and decreased by 0.3 [5.5] ng/dL in the P + ENA group (P = .08) consistent with an antimineralocorticoid effect. CONCLUSIONS: Our results suggest a significant additive BP-lowering effect of DRSP/E2 on both systolic and diastolic BP in hypertensive postmenopausal women receiving ENA, consistent with an antimineralocorticoid effect. DRSP/E2, a HRT with antimineralocorticoid effects, could offer a novel potential mechanism for reducing cardiovascular end points in postmenopausal women.
Aldosterone↗
Effects of severe, uncontrolled hypertension on endothelial activation: soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1 and von Willebrand factor.
OBJECTIVES: The molecular mechanisms whereby severe, uncontrolled hypertension (SHT) is translated into acute vascular target organ dysfunction have not been completely defined. We sought to determine whether SHT is associated with pressure-dependent endothelial activation as assessed by soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1) and von Willebrand Factor (vWF). METHODS: We determined sVCAM-1, sICAM-1 and vWF in three groups: (i) untreated patients referred specifically for treatment of SHT [diastolic blood pressure (DBP) > or = 120 mm Hg; n = 24]; (ii) untreated patients with established mild hypertension (MHT; DBP 95-100 mmHg; n = 19); and (iii) normotensive volunteers (DBP < or = 90; n = 16). RESULTS: By analysis of variance, sVCAM-1 (P = 0.002), sICAM-1 (P = 0.02) and vWF (P = 0.009) were greater in SHT and MHT than in normotensives but did not differ between SHT and MHT. We observed a significant positive correlation between blood pressure and soluble activation markers at lower blood pressures (normotensives and MHT considered together) that was not present in SHT. CONCLUSIONS: Even mild elevation of blood pressure may be sufficient to activate the expression of adhesion molecules. Mechanisms other than the endothelial expression of adhesion molecules may be important in mediating the accelerated target organ injury produced by SHT in humans. Concentrations of soluble adhesion molecules and vWF may depend more strongly upon factors in the hypertensive microenvironment other than the absolute level of blood pressure.
Adult↗
Right gastric artery embolization prior to treatment with yttrium-90 microspheres.
PURPOSE: Intra-arterial infusion of yttrium-90 microspheres is a form of radiation treatment for unresectable hepatic neoplasms. Misdeposition of particles in the gastroduodenal area such as the right gastric artery (RGA) may occur with serious consequences. We present a series of patients who underwent a detailed vascular study followed by RGA embolization. Special emphasis is placed on anatomic variations and technical considerations. METHODS: In a 1 year period, 27 patients were treated. Initial vascular evaluation was performed, with careful attention to anatomic variants or extrahepatic arterial supply, especially to the gastroduodenal area. Embolization of such arteries was planned if needed. RGA embolization was performed antegradely from the hepatic artery or retrogradely via the left gastric artery (LGA). Postprocedural follow-up included clinical interview and gastroscopy if necessary. RESULTS: RGA embolization was performed in 9 patients presenting with primary (n = 3) or metastatic liver tumors (n = 6). Six patients underwent antegrade RGA embolization and 3 had embolization done retrogradely via the LGA. Retrograde access was chosen for anatomic reasons. None of the patients complained of gastroduodenal symptoms. CONCLUSION: RGA embolization can help minimize the gastroduodenal deposition of radioactive particles. RGA embolization should routinely be carried out. The procedure can be performed, with similar technical success, by both anterograde and retrograde approaches.
Antineoplastic Agents↗
Phleboliths detected on mammography.
Phleboliths are commonly found on conventional radiographs of the pelvis. However, phleboliths detected on mammography are extremely rare. We report one case of phleboliths detected on mammography that were in varicosities adjacent to a venous aneurysm.
Breast Neoplasms↗