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Hypertension is a haemodynamic disorder resulting from a persistent mismatch between cardiac output and peripheral resistance. Hypertension undergoes haemodynamic progression during its natural history. Impedance cardiography is a method of evaluating the cardiovascular system that obtains haemodynamic information from beat to beat through the analysis of variations in the impedance of the thorax on the passage of an electric current. Impedance cardiography unmasks the haemodynamic deterioration underlying the increase in blood pressure as age and systolic blood pressure increases. This method may help to improve blood pressure control through individualized treatment with reduction of peripheral resistance, maintenance of cardiac output or its increase, improvement of arterial compliance and preservation of organ-tissue perfusion. It is useful in the management of patients with resistant hypertension, since a greater percentage of patients controlled with changes in the treatment in relation to the haemodynamic measurements are obtained. Impedance cardiography is important and has prognostic utility in relation to a haemodynamic deterioration pattern and increased cardiovascular events.

As the number of patients with newly diagnosed renal artery stenosis increases, so has the number of percutaneous transluminal renal-artery angioplasties in the last few years. Deciding the preferred treatment in the clinical setting is fraught with difficulties related to many factors, and there is limited evidence to support angioplasty/stent for any indication. These considerations emphasize the urgent need for improved noninvasive assessment of kidney function in patients with vascular disease. This review will attempt to summarize the available techniques that may potentially be used for measurement of renal function in this context.

Resumen Introduccion Las cirugias de reemplazo de cadera (RTC) y rodilla (RTR) requieren profilaxis extendida de la trombosis venosa profunda (TVP). Este estudio describe la utilizacion en la practica clinica habitual de dabigatran etexilato (DE) en adultos mayores con RTC y RTR en un sistema de hospitalizacion a domicilio. Material y metodos Estudio descriptivo, retrospectivo de cohorte, incluye pacientes posquirurgicos programados de RTC o RTR bajo cuidados domiciliarios, que recibieron DE (n = 76) o enoxaparina (n = 80). Se indico DE usando los criterios de seleccion y dosificacion de los estudios RE-NOVATE y RE-MODEL. Se incluyeron como controles historicos los pacientes con enoxaparina 40 mg/d cuando cumplian los mismos criterios de seleccion que los pacientes con DE. Se analizo la tasa de sangrados, TVP sintomatica, reinternaciones y mortalidad durante los 90 dias siguientes desde la cirugia. Resultados Edad promedio del grupo DE 74 (5) anos, 74% mujeres. No hubo diferencias significativas en la edad, sexo y tipo de reemplazo entre ambos grupos. Hubo 4 TVP en cada grupo (50% proximales), sin diferencias significativas entre los grupos. Hubo un tromboembolismo pulmonar en el grupo DE y un sangrado mayor en el de enoxaparina. No se produjo ninguna muerte durante el seguimiento (90 dias), sin embargo, hubo 2 reinternaciones en el grupo DE. Se describen tambien los detalles sobre la implementacion de DE en nuestra hospitalizacion a domicilio. Conclusiones En adultos mayores adecuadamente seleccionados DE seria una opcion efectiva de profilaxis para TVP en un sistema de hospitalizacion a domicilio en la practica clinica habitual.