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Biomedical subjects

J Sobrino

Publications and source records attributed to J Sobrino.

At least 19 recordsLinked to original sources
PubMed2005

Control of hypertension in patients at high risk of cardiovascular disease.

BACKGROUND: Hypertension is a major cardiovascular risk factor, but knowledge about the real magnitude of the problem and its determinants is lacking. AIM: To assess control of hypertension and evaluate medical resource use, in patients at high risk of cardiovascular disease. DESIGN: Multicentric cross-sectional study. METHODS: We collected data for 2205 adult patients from 36 centres, representative of all regions of Spain. Patients had attended out-patient clinics from July 2002 to August 2003, had an absolute cardiovascular risk > or =20% at 10 years (according to the Framingham guidelines), and had a diagnosis of hypertension. Pregnant and terminally ill patients were excluded. RESULTS: Hypertension was inadequately controlled in 1384 patients (62.8%). LDL cholesterol was higher in patients with uncontrolled hypertension (median 130.2 vs. 120.0 mg/dl, p < 0.001). Haemoglobin A(1c) in diabetic patients was also greater in those with uncontrolled hypertension (median 7.10% vs. 6.90%, p = 0.010). Uncontrolled hypertension was associated with the following variables, in descending strength of association: higher LDL cholesterol, taking antihypertensive medication, living in non-metropolitan areas, and higher body mass index. DISCUSSION: Hypertension is poorly controlled in most patients with a high risk of cardiovascular disease. Uncontrolled hypertension is frequently associated with poor control of other risk factors.

Aged↗
PubMed1999

[Calcium pump changes in patients with essential arterial hypertension].

BACKGROUND: Transmembrane Ca2+ fluxes are mediated, at least in part, by the Ca(2+)-dependent ATPase. Thus, genetic or acquired abnormalities of this pump could explain the increase in free cytosolic Ca2+ content that has been observed in essential hypertensive patients. PATIENTS AND METHODS: We carried out a kinetic study of the Ca2+ pump in intact erythrocytes from 49 essential hypertensive patients and 27 normotensive healthy persons. We used Sr2+ as a calcium analogue to measure Ca2+ fluxes dependent of the Ca2+ pump. The intracellular concentrations of Sr2+ and Ca2+ were modified using the A-23187 ionophore in a Ringer isotonic solution. RESULTS: Hypertensive patients showed a significant increase of the maximal efflux rate for Sr2+ (Vmax) with respect to controls (6.6 [2.3] vs 5.2 [1.6] mmol/l cel/h; p = 0.006). Mean values of apparent dissociation constants for intracellular Ca2+ (KCa) were also increased in essential hypertensives (80.36 [53.46] vs 55.25 [15.13] mumol/l cel; p = 0.06). A significant correlation between Vmax and age (r = 0.342; p = 0.016), and serum creatinine (r = 0.446; p = 0.001) was observed. The KCa only correlated with serum creatinine (r = 0.402; p = 0.004). Using the KCa confidence interval of 99% as the higher normal limit, patients were segregated into two subgroups depending on normal KCa values (33 patients, 67.3%) or increased KCa values (16 patients, 32.6%). Age (50.8 [13.5] vs 43 [10.2] years; p = 0.02), serum creatinine (1.13 [0.17] vs 0.95 [0.17] mg/dl; p = 0.001) and serum uric acid (7.27 [3.32] vs 6.14 [1.49] mg/dl; p = 0.04) were higher in patients with increased KCa. Finally, patients with increased KCa also showed increased values of Vmax (9.13 [2.02] vs 5.38 [12.81] mmol/l cel/h; p < 0.0001). CONCLUSIONS: Essential hypertensive patients are heterogeneous regarding ion transport abnormalities, only affecting subgroups of hypertensive patients. We have observed abnormalities of the Ca(2+)-dependent ATPase in 33% of essential hypertensive patients. These patients are older and tend to exhibit higher values of serum creatinine and uric acid.

Adult↗
PubMed1999

Long-acting lacidipine versus short-acting nifedipine in the treatment of asymptomatic acute blood pressure increase.

We compared antihypertensive efficacy and safety of a single administration of equipotent doses of lacidipine versus nifedipine in the hypertensive urgencies. Twenty-nine asymptomatic essential hypertensive patients (nine men, 20 women) with a mean age of 55.03+/-11.19 years and baseline diastolic blood pressure (DBP) of > or =120 mm Hg after resting 30 min, not taking antihypertensive drugs for the last 24 h, were randomized in a single-blind fashion to receive lacidipine, 4 mg (LCD, 15 patients) or short-acting nifedipine, 20 mg (NFD, 14 patients) in a single dose. Blood pressure (BP) and heart rate (HR) were taken every 30 min during the first 8 h and every 2 h until 24 h of follow-up. Baseline BP values were similar in the two groups (LCD, 222.5+/-32.8/124.6+/-8.4 mm Hg vs. NFD, 215.9+/-20.6/128+/-7.7 mm Hg; p = NS). Both drugs promoted a significant reduction of systolic blood pressure (SBP; 169.6+/-27.8 vs. 170.6+/-25.3 mm Hg) and diastolic blood pressure (DBP; 104.1+/-16 vs. 102.9+/-12.4 mm Hg) after 8 h. However, either SBP (165+/-27.3 vs. 190.6+/-18.2 mm Hg; p = 0.008) and DBP (99.9+/-12.3 vs. 117.2+/-11.4 mm Hg; p = 0.001) were significantly higher in the NFD group after 24-h dosing. Eleven patients in the LCD group had a decrease in BP >25% of the baseline value both 8 and 24 h after the dose. Although 10 patients showed the same response in the NFD group 8 h after the dose, only four patients maintained these values at 24 h. One patient treated with NFD had a transient cerebrovascular ischemic attack. No adverse effects were observed in the LCD group. We conclude that the long-acting calcium antagonist lacidipine was more effective than the short-acting nifedipine in both controlling BP and maintaining this BP reduction over 8 h in essential hypertensive patients with acute asymptomatic BP increase.

Adolescent↗
PubMed1997

Trough-to-peak ratio and circadian blood pressure profile after treatment with once-daily extended-release diltiazem, 240 mg, in patients with mild-to-moderate essential hypertension.

Once-daily diltiazem extended-release 240 mg (Lacerol-HTA Retard) was evaluated for safety, efficacy, and trough-to-peak ratio in a multicenter open study by using 24-h blood pressure (BP) monitoring in mild-to-moderate essential hypertension. After a 4-week washout period, 30 patients (17 men, 13 women) aged 25-76 years, showing a mean daytime diastolic BP (DBP) >90 mm Hg, were treated with diltiazem-ER, 240 mg, given once daily for 8 weeks. Ambulatory BP monitoring was obtained at the end of a 4-week placebo run-in period and during the last week of treatment. A significant reduction of the mean values of clinical BP [161.6 +/- 16.2 to 151.2 +/- 15.6 mm Hg; p < 0.01 for systolic BP (SBP); and 101.1 +/- 4.8 to 93.3 +/- 9.2 mm Hg; p < 0.001 for DBP] was observed at the end of treatment in the group of 30 patients, with no significant changes in heart rate (77.1 +/- 9.9 to 73.1 +/- 11.1 beats/min; p = NS). Likewise, mean values of 24-h SBP, DBP, SBP-load, and DBP-load were significantly reduced. In the group of 21 responders, the average reduction at peak was -18.6 +/- 12.9 mm Hg for SBP and -14.7 +/- 9.5 mm Hg for DBP. The residual effect at trough was -12.2 +/- 14.7 and -8.1 +/- 10 mm Hg, respectively. The trough-to-peak ratio was estimated as 0.66 for SBP and 0.55 for DBP. Long-term variability expressed as the mean standard deviation of BP for the 24-h period was reduced in responders (16.2 +/- 4.3 to 14.6 +/- 2.7 mm Hg for SBP; p = 0.0395; and 12.1 +/- 2.7 to 10.7 +/- 2.5 mm Hg for DBP; p = 0.0019), although no changes were observed in the variation coefficient (10.58-10.57% for SBP and 12.88-12.87% for DBP). We conclude that once-daily diltiazem-ER, 240 mg, was effective and well tolerated. Blood pressure was controlled over the entire period of 24 h, preserving the circadian profile and reducing long-term variability in responders. The significant reduction of both BP values and long-term variability may have implications involving protection from end-organ damage in essential hypertension.

Adult↗
PubMed1996

A multicenter, parallel comparative study of the antihypertensive efficacy of once-daily lisinopril vs enalapril with 24-h ambulatory blood pressure monitoring in essential hypertension.

The aim of the study was to compare the antihypertensive efficacy of once-daily lisinopril vs enalapril both during normal daily activity and sleep, in mild-to-moderate essential hypertension. After a 4-week wash-out period, 34 patients (17 M, 17 F) aged 22 to 67 years were randomized in a multicenter, open, parallel fashion: 17 received lisinopril (10-20 mg) and 17 enalapril (10-20 mg) for a 12-week period. Twenty-four hour ambulatory blood pressure monitoring (ABPM) was performed using an oscillometric non-invasive automated device at both the end of the 4-week drug-free baseline period and during the last week of treatment. With no differences in initial blood pressure (BP) between groups, both drugs significantly reduced office and ABPM values. Lisinopril tended to reduce BP in a greater extension than enalapril, but only the reduction of office systolic BP (SBP) (p = 0.0062), 24-h SBP load (P = 0.0182) and night time SBP load (P = 0.0316) reached statistical significance. We conclude that, in spite of a more prominent reduction of SBP by lisinopril, both drugs have a similar efficacy in reducing BP, assessed by both office and ABPM measurements.

Adult↗
PubMed1994

[Intravenous cannulae: complications arising from their use and analysis of their predisposing factors].

BACKGROUND: The aim of this study was to analyze the complications derived from the use of intravenous cannulae with particular attention being paid to the possible predisposing factors. METHODS: A prospective follow up of 569 intravenous cannulae placed in the emergency department or the medical ward of a county hospital was carried out. 492 of these cannulae were peripheral (PC) and 77 central inserted through peripheral veins (CPVC). RESULTS: Fifty-one percent of the catheters were withdrawn due to complications with the most frequent being phlebitis (35%), followed by extravasation (11.5%). The mean time in situ was 3.61 +/- 3.2 days. The daily risk of complications ranged from 2 to 9% for the CPVC (non significant differences) and between 15% (day 1) and 30% (6 or more days) for the PC. In the latter case there were no differences in the daily specific rate of complications after the first 24 hours. The probability of a catheter remaining in place more than three and six days without complications was 51% and 31%, respectively for the CP and 91% and 87% for the CPVC (p < 0.0001). Of the variables analyzed, age > 65 years, female sex, insertion of the cannula into the back of the hand, the fact of the route being peripheral without the administration of heparin were significantly associated to the development of complications, while the intravenous administration of aminophillin was associated with the appearance of phlebitis. Thirteen percent of the catheters withdrawn due to phlebitis were infected. CONCLUSIONS: The complication most frequent observed in intravenous cannulation was phlebitis, an entity which is generally not of an infectious nature. The risk of unspecific complications every day during catheterization is constant in the case of central peripheral vein cannulae as well as in peripheral cannulae which do show problems during the first 24 hours after placement. Insertion of the cannulae into the veins of the back of the hand, female sex, advanced age and intravenous administration of certain drugs influence in the development of phlebitis.

Actuarial Analysis↗
PubMed1992

[Prevalence of lipid disorders and their course after blood pressure control in essential arterial hypertension].

BACKGROUND: Arterial hypertension and hyperlipidemia are the principal factors of cardiovascular risk with an association which appears to obey common pathogenic bonds. In the present study the initial prevalence of hypercholesterolemia and hypertriglyceridemia was determined in a sample of essential hypertensives and the long term effect of different antihypertensive treatments on lipid metabolism has been analyzed. METHODS: Total cholesterol, its LDL and HDL fractions and plasmatic triglycerides were determined in a sample of 158 hypertensive patients prior to the initiation of antihypertensive treatment and following one year of normotension. RESULTS: The initial prevalence of lipid disturbances was of 47% (isolated hypercholesterolemia 17%, isolated hypertriglyceridemia 14% and mixed anomalies 16%). After one year of tension control the initial prevalence was not modified. In the patients controlled with a low sodium diet a decrease in total cholesterol and an increase in cholesterol-HDL were observed in those treated with atenolol, and a decrease in cholesterol-LDL was seen in those receiving captopril. The group treated with nifedipin presented no significant variations of the lipid profile. CONCLUSIONS: The prevalence of lipid disturbances is greater among the hypertensive patient than in the general population. The rational treatment of a hypertensive patient must not only regard blood pressure figures but also control the other risk factors since the drugs commonly used in the treatment of arterial hypertension generally demonstrate a neutral effect on lipid metabolism.

Follow-Up Studies↗
PubMed1991

Therapeutic response may be predicted by some clinical parameters in essential hypertensive patients.

Several clinical parameters have been studied in a sample of 211 essential hypertensives in order to determine their usefulness as predictors of therapeutic response. One hundred and twenty-four patients (58.8%) achieved normotension with monotherapy, whereas 87 hypertensives (41.2%) needed two or more drugs to control their BP values. Patients who required a combination of drugs exhibited higher levels of systolic and diastolic BP, higher frequency of acute severe hypertension before the beginning of treatment, a more advanced stage of hypertension, and higher plasma aldosterone levels when they were compared with those controlled with a single drug. Likewise, previous cardiovascular complications related to hypertension, enlargement of cardiac silhouette on chest x-ray films and left ventricular hypertrophy were more frequent in the former. By means of a logistic regression analysis, these last three parameters showed a significant relationship with the number of required drugs. We conclude that hypertensives exhibiting this clinical profile have a higher probability of requiring a combination of drugs in the pharmacological treatment of essential hypertension.

Adult↗
PubMed1990

[Cardiac tamponade as the initial manifestation of a pulmonary neoplasm].

The development of cardiac tamponade as the presenting feature of neoplastic disease is extremely uncommon. We report three patients with lung adenocarcinoma clinically presenting as cardiac tamponade. The diagnosis was made by the cytological study of pericardial fluid in all three. To update the clinical aspects of this uncommon association we have reviewed the literature and we have found 52 additional patients with different types of neoplasia who presented as cardiac tamponade.

Adenocarcinoma↗