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Resumen La hipertension arterial (HTA) tiene una elevada prevalencia en nuestra poblacion quirurgica. Las diferencias de criterio y la ausencia de consenso entre los profesionales implicados en el cuidado de estos pacientes, han contribuido a que la hipertension sea una de las causas mas frecuentes de cancelacion de una intervencion. El objetivo de este documento es ofrecer al clinico un enfoque practico para abordar el manejo perioperatorio del paciente hipertenso. La HTA se asocia a un riesgo aumentado de complicaciones perioperatorias, especial-mente relacionado con la repercusion sistemica de la hipertension y con oscilaciones importantes de la presion arterial durante la cirugia. La evaluacion preoperatoria debe centrarse en la busqueda de signos y sintomas de lesion de organo diana. Durante el perioperatorio el anestesiologo debe minimizar las fluctuaciones de la presion arterial, evitando especialmente hipotensiones sostenidas, y en el postoperatorio reiniciar lo antes posible la medicacion antihipertensiva.

En los dos ultimos anos se han publicado dos documentos relevantes relacionados con lahipertension arterial. El primero, de la Sociedad Internacional de Hipertension y Sociedad Europea de Hipertension: Practical solutions to the challenges of uncontrolled hypertension: a white paper. El segundo, Hipertension Arterial y politica de salud en Espana, recoge una Conferencia de Consenso de 23 sociedades cientificas, organizaciones profesionales, Administracion sanitaria y pacientes. En el primero, se hace una llamada urgente para mejorar el continuado fracaso en el control de la hipertension; en la conclusion seexpone textualmente: ‘‘En la critica situacion actual menos de una tercera parte de los pacientes en Europa consigue un control aceptable de la presion arterial. Esto es inexcusable y no puede continuar. El coste de la inaccion o de la accion ineficaz es demasiado alto para los pacientes, sus familias y la sociedad’’. En el segundo, despues de analizar la magnitud del problema y sus consecuencias, se insta al reconocimiento de la hipertension arterial como un problema de salud publica, elabora propuestas para mejorar la situacion y manifiesta: ‘‘es hora de movilizarse a fin de progresar en el manejo del problema de salud publica que representa la hipertension arterial’’. No vamos a repetir la descripcion del problema, ni insistiremos en la gravedad de las consecuencias que estan clara y largamente detalladas en estos documentos. En este articulo proponemos una invitacion a la reflexion sobre algunosaspectos que anuestro parecerpueden tener cierto interes. Desde los ultimos cuarenta anos hemos visto permanecer estancadas, decada tras decada, dos grandes cuestiones

Ignorados hasta hace menos de veinte anos, los radicales libres de oxigeno se encuentran ahora en el ojo del huracan. Parece como si no hubiera proceso biologico en el que de alguna manera no se hallaran implicados. La hipotesis oxidativa de la arteriosclerosis se ha ido consolidando y hoy se acepta que la oxidacion de las lipoproteinas de baja densidad es un fenomeno crucial en el inicio de la placa arteriosclerotica. La disfuncion endotelial parece mediada en gran parte por una de las principales especies reactivas del oxigeno, el anion superoxido, y actualmente los radicales libres de oxigeno se implican tambien en la fisiopatologia de la hipertension arterial. Despues de amplios estudios epidemiologicos sugiriendo el papel beneficioso de los antioxidantes en la prevencion de eventos cardiovasculares, algunos estudios de intervencion parecen confirmar dichas hipotesis. Este articulo pretende exponer comprensiblemente que son los radicales libres de oxigeno, cual es su papel en la disfuncion endotelial, hipertension arterial y arterioesclerosis, y repasar los principales estudios epidemiologicos y de intervencion antioxidante realizados hasta el momento.

Objetivo valorar la fiabilidad del eco-Doppler en la deteccion de estenosis renales en pacientes con sospecha de hipertension renovascular. Material y metodo estudio prospectivo durante cuatro anos de 91 arterias renales en 47 pacientes hipertensos (tres monorrenos) con sospecha de hipertension arterial renovascular. Edad media 56 anos (r = 25-77); 22 varones y 25 mujeres. Parametros valorados por duplex velocidad sistolica maxima (VSM) y velocidad diastolica final (VDF) en arteria renal, cociente renal-aortico e indice de resistencia periferica. Analisis estadistico curvas ROC y analisis multivariante para la obtencion del mejor parametro diagnostico de estenosis > 60 %. A todos los pacientes se les realizo arteriografia de ambas arterias renales. Resultados mediante analisis multivariante unicamente la VSM > 180 cm/sg (p = 0,01) y el cociente renal-aortico >3 (p = 0,04) son predictivos de estenosis > 60 %. Asi hemos identificado 60 de 65 estenosis inferiores al 60 %, 20 de 21 estenosis superiores al 60 %, y 5 de 5 oclusiones (Kappa=0,85) (p Conclusiones nuestros resultados demuestran la fiabilidad del duplex en el diagnostico de la estenosis de la arteria renal, lo cual, por su inocuidad, le convierte en el metodo idoneo de cribaje. La VSM > 180 cm/sg es el mejor parametro para detectar estenosis > 60%.

High blood pressure is a cardiovascular risk factor whose coincidence with other risk factors considerably increases the probability for coronary heart disease. This study investigates the prevalence of different risk factors in hypertensive subjects.We studied 891 patients with high blood pressure in their first visit to a hospital hypertension unit between 1987 and 1991. We assessed their clinical evolution and the prevalence of obesity, smoking, alcohol consumption, elevated blood pressure, diabetes, sedentary lifestyle, left ventricular hypertrophy and family history of high blood pressure.Sixteen per cent of the hypertensive subjects related previous history of evolutive accident. Stroke was the most frequent one. Prevalences of cardiovascular risk factors were as follows: family history of high blood pressure 53%, sedentary lifestyle 52%, elevated blood cholesterol 37%, smoking 35%, obesity 33%, left ventricular hypertrophy 16%, alcohol consumption 13% and diabetes 11%. Obesity prevalence was twice as high in women than in men. Males had higher prevalence for left ventricular hypertrophy, smoking and alcohol consumption. Diabetes was more prevalent in hypertensive patients older than 50 years. Prevalence of high blood cholesterol was greater in the group of women older than 50 years.Hypertensive patients have high prevalences of other cardiovascular risk factors. Their treatment should be aimed to improving the individual profile of cardiovascular risk.

This study was planned in the context of a regional high blood pressure programme, to compare the efficacy of two educative methods. The group of 722 hypertensive patients (58.8% women), mean age 61 years, was randomly selected from 19 primary care centres. Initial assessment was based on a patient interview including 22 questions on high blood pressure, its consequences and treatment. Patients agreeing to participate in an active education team programme were distributed into three groups: individual education, team education and a control group. Those who declined to participate formed two groups: individual education and controls. Team education consisted of two audiovisual sessions attended by groups of 8-12 patients and conducted by treating physicians and nurses. Individual education included comments related to the 22 questions. Follow-up assessment was made after two months. An increase in the level of hypertension control was observed only in the accepting group, in which educative action was followed by increased knowledge. Results were similarly favourable for both the individual and team education groups and suggested the need to consider educational factors together with those influencing patient attitude towards an active educational programme.

Introduction Changes in arterial pressure (PA), especially arterial hypertension, are frequent during the acute phase of a stroke and the best therapeutic approach is controversial since although high blood pressure is associated with a poor prognosis, excessive or too rapid drop in blood pressure may also be associated with progression of the neurological deficit. Objective To reach agreement as to the correct therapeutic approach when the PA is high during the acute phase of a stroke, based on the published data and experience of a group of experts from the Catalan Societies of Neurology and Hypertension. Methods Review of the main recommendations published in the literature and discussion in joint study sessions. Results During the acute phase of a stroke moderate increases in blood pressure should not be treated. Antihypertensive treatment is recommended when the PA figures are of maintained levels of more than 220 mmHg of systolic or 120 mmHg of diastolic pressure in ischemic stroke, and over 180 mmHg of systolic or 105 mmHg of diastolic pressure in hemorrhagic stroke. Conclusions Modifications of arterial pressure, especially of arterial hypertension, should be carefully treated during the acute phase of stroke, because of the risk of causing worsening of the neurological lesion. When treatment is indicated, it is best carried out in a Stroke Unite where this is possible.

The arterial blood pressure and hypertension data obtained from an epidemiological study of endemic goiter in the rural population of Catalonia was analyzed. The prevalence of hypertension is of 25.1 +/- 2.16%, existing a predominance of women over men. The distribution of the arterial pressure values according to sex are presented, as well as the relationship between arterial blood pressure, weight and obesity.

134 patients with mild to moderate hypertension received nitrendipine during 6 months in an increasing fashion. Therapeutic goal was achieved in 92% of the patients (DBP less than 95 mmHg) in which BP decreased from 168.4 +/- 13.7/105.0 +/- 1.1 to 140.9 +/- 12.7/84.4 +/- 6.6 (p less than 0.001). In patients whose BP was not controlled with a single initial doses of 20 mg/day, the degree of control was similar with 40 mg single dose and 20 mg twice a day. The most frequently encountered undesirable effects were those caused by the vasodilator action of the drug. No changes in blood glucose and plasma lipid levels were found.