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Objectives Resting heart rate (HR) taken in the office has been shown to be associated with cardiovascular outcomes in the general population, hypertension and heart failure. It is unknown whether 24-h oscillographic pulse rate measurement as an approximation of HR derived from ambulatory blood pressure monitoring (ABPM) associates with cardiovascular outcomes in hypertensive patients. Methods We evaluated ABPM recordings from 56 901 patients with complete 3373 421 HR measures entering the final analysis from the Spanish Blood Pressure Monitoring Registry for a median follow-up time of 5.1 years. We explored the association of office HR, mean 24-h HR, mean day HR, mean night HR as well as day-night HR differences, morning mean HR, morning HR surge and night peak HR to all-cause death, cardiovascular death and noncardiovascular death. Data were analyzed by Cox regression analysis, analysis of variance and chi-square test. Results The Spanish ABPM Registry recorded data in 223 primary care centers in Spain from 2004 until 31 December 2014 at the end of recruitment. Office HR was 3.5 bpm higher than mean 24-h HR, office mean HR versus mean night was 10.4 bpm higher and mean day versus mean night HR 9.3 bpm higher, while there were no relevant difference between office and mean day HR. Office mean, 24-h day and night HR more than 90 bpm were associated with an increased risk for all-cause and noncardiovascular death, whereas for cardiovascular death only mean night HR was predictive. The strongest association to all-cause death was observed with mean night HR [hazard ratio 3.80 (2.87-5.03)], mean 24-h HR [2.85 (2.30-3.54)] and mean day HR [2.22 (1.83-2.70)]. Day-night dipping of more than 8 bpm was associated with a 20% lesser risk on all-cause, cardiovascular and noncardiovascular death. Results were robust after adjusting for relevant risk indicators. Conclusion HR parameters derived from ABPM provide important information, in particular association with death by mean night HR, mean 24-h HR and reduced day-night HR dipping less than 8 bpm superior to office HR.

La pandemia producida por el coronavirus SARS-CoV-2 (COVID-19) ha obligado, en muchos casos a sustituir la consulta presencial por la consulta telemática para reducir el riesgo de contagio asociado a la presencia de pacientes en los centros sanitarios. Este cambio puede representar una oportunidad para una comunicación diferente y más eficiente entre profesionales y pacientes, permitiendo mejorar la accesibilidad a la atención médica y un abordaje más sistemático e integral a los pacientes con hipertensión y riesgo cardiovascular. No obstante, se necesitan herramientas organizativas que faciliten la comunicación entre pacientes y profesionales, específicamente con intercambio de datos clínicos que favorezcan la monitorización remota de las variables asociadas a la hipertensión y riesgo cardiovascular (presión arterial, peso, talla, variables analíticas…) y permitan realizar un seguimiento adecuado en aspectos como la adherencia a los tratamientos, estilos de vida y factores de riesgo. Todo ello sería deseable que fuera realizado por equipos multidisciplinares, tanto de atención primaria como hospitalaria y farmacia comunitaria, con una coordinación adecuada del cuidado en este tipo de pacientes. Este documento de la Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) trata de dar las claves para mejorar la calidad asistencial de las consultas telemáticas de los pacientes con hipertensión y riesgo cardiovascular, proporcionar criterios básicos de atención telemática o presencial y sistematizar el contenido de estas. Así mismo se plantean los criterios de seguimiento por los diferentes profesionales.

Non-adherence to treatment is a known factor for uncontrolled hypertension. We hypothesized that the detection of non-adherence to antihypertensive treatment plus the implementation of a specific nursing program would ameliorate treatment adherence and blood pressure (BP) control.An interventional, prospective, randomized, study of 44 consecutively attended patients (age 58.1±12.9yr, 30 men/14 women) with 24h-BP ≥130/80 mmHg while receiving ≥2 antihypertensive drugs was performed. Partially or fully non-adherent patients (confirmed by urine determination of antihypertensives) were randomized (1:1) to receive a specific 3 month nursing program (group I) to improve adherence - evaluation of knowledge on BP goals, complications of high BP, indicated treatment; detection of causes of non-compliance and proposal of measures to improve it, with fortnightly follow-up -, or to routine follow-up (group C). Urine antihypertensives and 24h-BP were determined at baseline, 3 and 12 months. Baseline office SBP/DBP (mmHg) was 150.4±16.3 / 91.1±15.5, and the number of prescribed non-detected drugs was 2±1.4. Between-groups differences in variation (Δ) of BP at 3 and 12 months are shown (Table). In addition, at 3 months, the percentage of patients with controlled BP was 50%( 11 of 22) and 18.2% (4 of 22) in the I and C groups, respectively (p=0.026), and at 12 months was 60% (12 of 20) and 26.3% (5 of 19), respectively (p=0.034).In conclusion, a specific 3 month nursing intervention improves control of BP in patients with uncontrolled hypertension and inadequate therapeutic compliance. Both the BP decrease and the improvement in therapeutic adherence were maintained at 12 months.

Resistant hypertension (RH) is related to increased risk for cardiovascular events. We aimed to evaluate the risk of total and cardiovascular mortality associated with RH in comparison to controlled hypertension, as well as in true versus “white-coat” RH. From the mortality data of the Spanish ABPM Registry, including 35119 treated patients, we identified 9408 RH, defined as office BP ≥ 140/90 mmHg while treated with ≥ 3 drugs (8577 patients), or treated and controlled (office BP < 140/90 mmHg) with ≥ 4 drugs (831 patients). They were compared against 8144 patients treated with ≤ 3 drugs and having normal office BP. In addition, among 8577 patients with uncontrolled RH, 5288 (61.7%) had true RH (24-h BP ≥ 130/80 mmHg) and 3289 (38.3%) had “white coat” RH (24-h BP < 130/80 mmHg). Median follow-up was 5 years. Total and cardiovascular mortality were assessed through death certificates. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated through Cox-proportional models, adjusted for age and sex. Table shows the number of patients in each group, number of total and cardiovascular deaths and HR of the 2 comparisons performed. Compared to treated and controlled patients, those with RH had and increased risk of total (19%) and cardiovascular (32%) mortality. Likewise, true RH had an increased risk of total (42%) and cardiovascular (81%) mortality, in comparison with “white-coat” RH. We conclude that RH is associated with and increased total and cardiovascular mortality. In RH patients with elevated office BP, the concomitant elevation of 24-hBP (true RH) is also associated with an increased risk of mortality when compared with those with normal 24-h BP (“white-coat” RH).

Puntos para una lectura rapida • Es preciso determinar la presion ambulatoria mediante monitorizacion ambulatoria de la presion arterial (MAPA) (o automedida de la presion arterial [AMPA], segun disponibilidad) en la evaluacion inicial de todo hipertenso con mal control confirmado en la consulta. • Hay que definir la hipertension de bata blanca en funcion la normalidad de los tres periodos de MAPA (dia, noche y 24 horas). • Debemos evaluar su riesgo cardiovascular, porque hasta un 18% puede presentar un alto o muy alto riesgo. • En la consulta, hay que evitar determinaciones de presion arterial rutinarias al hipertenso de bata blanca conocido. No son utiles para tomar decisiones clinicas ni terapeuticas. • Tras el diagnostico de hipertension de bata blanca, es conveniente delegar en el propio paciente la monitorizacion de su presion arterial mediante AMPA. • Hay que realizar regularmente (anual o bianualmente) una MAPA. Un porcentaje anual variable de hipertensos de bata blanca desarrollan hipertension sostenida. • Debemos intervenir precozmente sobre los otros factores de riesgo y sobre los estilos de vida del paciente. En pacientes de alto riesgo, con lesion organica subclinica o con enfermedad cardiovascular concomitante hay que valorar el inicio inmediato de tratamiento antihipertensivo.

Background and aim Blood pressure variability (BPV) is recognized as a prognostic contributor in hypertension. We aimed to assess differences in short-term BPV in treated hypertensive patients depending on the number, classes, combinations and individual compounds of the antihypertensive treatment. Methods We selected 38 188 treated patients from the Spanish Ambulatory BP Monitoring (ABPM) Registry. SBP and DBP standard deviations (SD) from 24-h, daytime and night-time, weighted SD (WSD), and average real variability (ARV) were calculated through ABPM. They were compared (after adjustment for clinical confounders and BP) depending on the number of antihypertensive drugs, antihypertensive drug classes and compounds (in 13 765 patients on monotherapy), or combinations (in 12 716 patients treated with two drugs and 7888 treated with three drugs). Results Systolic and diastolic BPV significantly increased in patients treated with multiple drugs with respect to monotherapy. Among drug classes, calcium channel blockers, especially amlodipine, and diuretics were associated with lower systolic BPV, including daytime and night-time SD, WSD and ARV, compared with beta blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Likewise, in patients treated with two-drug and three-drug combinations, those which included a calcium channel blocker showed lower BPV in comparison to those without such drug class. Conclusion Treatment with calcium channel blockers, especially amlodipine, and with diuretics is associated with slight, but significant lower values of short-term BPV in comparison to other major drug classes, both in monotherapy and in combination. These results could be helpful when considering BPV reduction as an additional treatment target.

Patients with coronary heart disease (CHD) can be particularly susceptible to the adverse effects of excessive blood pressure (BP) lowering by antihypertensive treatment. The identification of hypotension is thus especially important. This study estimated the prevalence of hypotension among CHD-treated hypertensive patients undergoing ambulatory blood pressure monitoring (ABPM) in routine clinical practice. We performed a cross-sectional study with 2892 CHD-treated hypertensive patients from the Spanish ABPM Registry. Based on previous studies, hypotension was defined as systolic/diastolic BP

Introduction: Night BP is the most powerful estimate of cardiovascular prognosis. It has been suggested that bedtime administration of antihypertensive therapy may favour night BP reduction and prognosis. Hypothesis: We aimed to evaluate the mortality risk in treated hypertensives, depending on the schedule of treatment administration (entirely in the morning, entirely at bedtime, or combined morning and evening) at the time ABPM was performed. Methods: Vital status and cardiovascular death were obtained from death certificates in 26751 treated hypertensives (mean age 62, 60% males), enrolled in the Spanish ABPM Registry, and having a valid 24-h ABPM at entry. Cox-models adjusted for clinical confounders and 24-hour systolic BP were used for HR calculation in groups depending on treatment administration. Results: Among the 26751 evaluable patients, most (76.7%) received their medication exclusively in the morning; 13% exclusively in the evening, and 10.3% in a multiple schedule both in the morning and in the evening. Mortality incidence in these 3 groups were 13.7, 17.8 and 21.8 per 1000 patients/year, respectively. Compared to patients receiving their antihypertensive medication entirely in the morning (reference group), those receiving their medication entirely in the evening did not show a significant increase in the HR for total mortality (1.06; 95%CI: 0.93-1.21) or in cardiovascular mortality (1.15; 0.93-1.41) after adjustment for clinical confounders and 24-hour systolic BP. Patients receiving their antihypertensive medication both in the morning and at bedtime had an increased risk for mortality (1.29; 1.14-1.48) and for cardiovascular mortality (1.46; 1.18-1.80). Additional analyses using double-robust propensity score yielded similar results. Conclusions: Morning or bedtime dosing of the antihypertensive medication has no effect on prognosis. We have found that patients receiving their medication in a multiple schedule, including morning and evening dosing have an increased risk of mortality and cardiovascular mortality, even after adjustment for confounders. However, we cannot exclude other aspects, such as a poorer treatment adherence, being the responsible of this worse prognosis.

Ambulatory blood pressure (BP) is associated with mortality, but it is also interesting to expand its association with cardiovascular morbidity. This study sought to evaluate association with cardiovascular morbidity and cardiovascular mortality. Patients without cardiovascular disease who had a first 24-hour ambulatory BP monitoring were followed-up until the onset of the first event (a combined variable of cardiovascular mortality, coronary heart disease, cerebrovascular disease, peripheral arteriopathy, or hospital admission for heart failure). Changes in antihypertensive treatment couldn't be collected. Cox regression analysis was adjusted for risk factors and office BP. We included 3907 patients (mean age, 58.0, SD 13.8 years), of whom 85.5% were hypertensive. The follow up period was 6.6 (95% CI 5.0-8.5) years. A total of 496 (12.7%) events were recorded. The incidence rate was 19.3 (95% CI 17.7-21.1) cases per 1000 person-years. The patients with an event compared to the rest of patients were mostly men, older, with higher office and ambulatory systolic BP, higher prevalence of diabetes, chronic kidney disease, dyslipidemia, and non-dipper or riser circadian profile. In the fully adjusted model, office BP loses its significant association with the main variable. Ambulatory BP association remained significant with cardiovascular morbidity and mortality, HR 1.494 (1.326-1.685) and 0.767 (0.654-0.899) for 24-hour systolic and diastolic BP, respectively. Nighttime systolic BP also maintained this significant association, 1.270 (1.016-1.587). We conclude that nighttime systolic BP and 24-hour BP are significantly associated with cardiovascular events and cardiovascular mortality in patients without cardiovascular disease attended under conditions of routine clinical practice.

OBJECTIVE The arm with the higher blood pressure (BP) is assigned as the follow up arm for hypertensive patients (reference-arm). We evaluated the reproducibility of this assignment. METHODS BP was measured simultaneously on both arms with a double cuff validated device in two visits separated

La medida de presión arterial (PA) en la clínica es el procedimiento más utilizado para el diagnóstico y tratamiento de la hipertensión arterial (HTA), pero presenta una considerable inexactitud debida, por un lado, a la propia variabilidad intrínseca de la PA y, por otro, a sesgos derivados de la técnica y condiciones de medida. Varios estudios han demostrado la superioridad pronóstica de la monitorización ambulatoria de la PA (MAPA), que además detecta la HTA de bata blanca, evitando sobrediagnósticos y sobretratamientos en numerosos casos, y la HTA enmascarada que, al contrario, tiene riesgo de infradetección e infratratamiento. La MAPA está reconocida como la técnica más apropiada para el diagnóstico y seguimiento de la HTA en la mayoría de las guías internacionales. El presente documento, tomando como referencia las recomendaciones de la Sociedad Europea de Hipertensión, tiene como objetivo revisar las evidencias sobre la MAPA, servir de guía a los profesionales sanitarios y fomentar la utilización de esta técnica en el diagnóstico y el seguimiento del paciente hipertenso. Se abordan el procedimiento, los requisitos necesarios para realizar una MAPA y sus indicaciones clínicas. También se analizan las principales aportaciones de la MAPA en el diagnóstico de los fenotipos de HTA de bata blanca y HTA enmascarada, los patrones de variabilidad a corto plazo de la PA, su utilidad en la HTA resistente y de alto riesgo, así como su papel en grupos especiales de población como ancianos, niños y embarazadas. Finalmente, se tratan aspectos sobre la situación actual del Registro español de MAPA y las perspectivas futuras en cuanto a investigación y generalización de la MAPA en la práctica clínica. Conventional blood pressure (BP) measurement in clinical practice is the most used procedure for the diagnosis and treatment of hypertension (HT), but is subject to considerable inaccuracies due to, on the one hand, the inherent variability of the BP itself and, on the other hand biases arising from the measurement technique and conditions, Some studies have demonstrated the prognosis superiority in the development of cardiovascular disease using ambulatory blood pressure monitoring (ABPM). It can also detect “white coat” hypertension, avoiding over-diagnosis and over-treatment in many cases, as well detecting of masked hypertension, avoiding under-detection and under-treatment. ABPM is recognised in the diagnosis and management of HT in most of international guidelines on hypertension. The present document, taking the recommendations of the European Society of Hypertension as a reference, aims to review the more recent evidence on ABPM, and to serve as guidelines for health professionals in their clinical practice and to encourage ABPM use in the diagnosis and follow-up of hypertensive subjects. Requirements, procedure, and clinical indications for using ABPM are provided. An analysis is also made of the main contributions of ABPM in the diagnosis of “white coat” and masked HT phenotypes, short term BP variability patterns, its use in high risk and resistant hypertension, as well as its the role in special population groups like children, pregnancy and elderly. Finally, some aspects about the current situation of the Spanish ABPM Registry and future perspectives in research and potential ABPM generalisation in clinical practice are also discussed. Sin financiación No data JCR 2019 0.130 SJR (2019) Q4, 314/362 Cardiology and Cardiovascular Medicine, 109/139 Internal Medicine No data IDR 2019 UEM

United States and European guidelines have recommended new treatment goals for office blood pressure (BP). We examined 9784 hypertensives of the Spanish Ambulatory BP Monitoring (ABPM) registry with office BP treated to the prior goal (

Objective Several studies have shown that evening intake of aspirin has antihypertensive effect in healthy adults, which has not been proven in patients with cardiovascular disease, who mostly take aspirin in the morning. We have evaluated the antihypertensive effect of bedtime administration of aspirin in patients with cardiovascular disease already treated for hypertension. Methods This is a multicenter randomized triple-blind placebo-controlled crossover trial, with hypertensive patients treated with aspirin for secondary prevention. There was a baseline-randomized assignment to 2-month periods of bedtime aspirin (100 mg) first and morning-time aspirin later, or inversely, both periods separated by an open label 2-4 weeks period of morning-time aspirin. At the start and end of each treatment period, a 24-h ambulatory blood pressure monitoring was performed. The main outcome measure was mean 24-h blood pressure. The analyses were performed according to the intention-to-treat principle. Results Overall, 225 patients were randomized. No significant differences were observed in ambulatory blood pressure by time of intake of usual low doses of aspirin. The mean SBP/DBP was 123.2/69.9 (95% CI 121.58-124.9/68.86-76.86) with bedtime administration and 122.4/68.8 (95% CI 120.76-124.01/67.85-69.83) with daytime administration (P = 0.3 and P = 0.23 for SBP and DBP, respectively). Conclusion Administering aspirin at bedtime rather than in the morning does not modify the 24-h ambulatory blood pressure in hypertensive patients in secondary cardiovascular prevention.The trial was registered with ClinicalTrials.gov (number NCT01741922).

The prognostic relevance of short-term blood pressure (BP) variability in hypertension is not clearly established. We aimed to evaluate the association of short-term BP variability, assessed through ambulatory BP monitoring, with total and cardiovascular mortality in a large cohort of patients with hypertension. We selected 63 910 subjects from the Spanish ABPM Registry from 2004 to 2014, with a median follow-up of 4.7 years. Systolic and diastolic BP SD from 24 hours, daytime, and nighttime, weighted SD (mean of daytime and nighttime SD weighted for period duration), average real variability (mean of differences between consecutive readings), variation independent of the mean, and BP variability ratio (ratio between systolic and diastolic 24-hour SD) were calculated through 24-hour ambulatory BP monitoring performed at baseline. Association with total and cardiovascular mortality (obtained through death certificates) were assessed by Cox regression models adjusted for clinical confounders and BP. Patients who died during follow-up had higher values of BP variability compared with those remaining alive. In fully adjusted models, daytime, nighttime, and weighted SD, systolic and diastolic, as well as diastolic average real variability, were all significantly associated with total and cardiovascular mortality. Hazard ratios for 1 SD increase ranged from 1.05 to 1.09 for total mortality and from 1.07 to 1.12 for cardiovascular mortality. A nighttime systolic SD ≥12 mm Hg was independently associated with total (hazard ratio: 1.13 [95% CI, 1.06–1.21]) and cardiovascular mortality (hazard ratio: 1.21 [95% CI, 1.09–1.36]). We conclude that short-term BP variability is independently associated with total and cardiovascular mortality in patients with hypertension.

BackgroundTo develop and validate a novel, machine learning-derived model for prediction of cardiovascular (CV) mortality risk using office (OBP) and ambulatory blood pressure (ABP), to compare its performance with existing risk scores, and to assess the possibility of predicting ABP phenotypes (i.e. white-coat, ambulatory and masked hypertension) utilizing clinical variables.MethodsUsing data from 63,910 patients enrolled in the Spanish ABP monitoring registry, machine-learning approaches (logistic regression, support vector machine, gradient boosted decision trees, and deep neural networks) and stepwise forward feature selection were used for the classification of the data.ResultsOver a median follow-up of 4.7 years, 3,808 deaths occurred from which 1,295 were from CV causes. The performance for all tested classifiers increased while adding up to 10 features and converged thereafter. For the prediction of CV mortality, deep neural networks yielded the highest clinical performance. The novel mortality prediction models using OBP (CV-MortalityOBP) and ABP (CV-MortalityABP) outperformed all other risk scores. The area under the curve (AUC) achieved by the novel approach, using OBP variables only, was already significantly higher when compared with the AUC of Framingham score (0.685 vs 0.659, p = 1.97×10−22), the SCORE (0.679 vs 0.613, p = 6.21×10−22), and ASCVD (0.722 vs 0.639, p = 8.03×10−30) risk score. However, prediction of CV mortality with ABP instead of OBP data led to a significant increase in AUC (0.781 vs 0.752, p = 1.73×10−42), accuracy, balanced accuracy and sensitivity. The sensitivity and specificity for detection of ambulatory, masked, and white-coat hypertension ranged between 0.653-0.661 and 0.573-0.651, respectively.ConclusionWe developed a novel risk calculator for CV death using artificial intelligence based on a large cohort of patients included in the Spanish ABP monitoring registry. The receiver operating characteristic curves for CV-MortalityOBP and CV-MortalityABP with deep neural networks models outperformed all other risk metrics. Prediction of CV mortality using ABP data led to a significant increase in performance metrics. The prediction of ambulatory phenotypes using clinical characteristics, including OBP, was limited.

Air in urban areas is usually contaminated with particle matter. High concentrations lead to a rise in the risk of cardiovascular and respiratory diseases. Some studies have reported that ultrafine particles (UFP) play a greater role in cardiovascular diseases than other particle matter, particularly regarding hypertensive crises and DBP, although in the latter such effects were described concerning clinical blood pressure (BP). In this study, we evaluate the relationship between 24-h ambulatory BP monitoring (ABPM) and atmospheric UFP concentrations in Barcelona. Methods: An observational study of individual patients’ temporal and geographical characteristics attended in Primary Care Centres and Hypertensive Units during 2009–2014 was performed. Results: The participants were 521 hypertensive patients, mean age 56.8 years (SD 14.5), 52.4% were women. Mean BMI was 28.0 kg/m2 and the most prominent cardiovascular risk factors were diabetes (N = 66, 12.7%) and smoking (N = 79, 15.2%). We describe UFP effects at short-term and up to 1 week (from lag 0 to 7). For every 10 000 particle/cm3 UFP increase measured at an urban background site, a corresponding statistically significant increase of 2.7 mmHg [95% confidence interval = (0.5–4.8)] in 24-h DBP with ABPM for the following day was observed (lag 1). Conclusion: We have observed that a rise in UFP concentrations during the day prior to ABPM is significantly associated with an increase in 24 h and diurnal DBP. It has been increasingly demonstrated that UFP play a key role in cardiovascular risk factors and, as we have demonstrated, in good BP control. Sin financiación 4.844 JCR (2020) Q2, 17/65 Peripheral Vascular Disease 1.249 SJR (2020) Q1, 70/349 Cardiology and Cardiovascular Medicine UEM

Background and aim Treatment-resistant hypertension (TRH) is associated with particular clinical features, nonadherence, and suboptimal treatment. We assessed possible associations of antihypertensive drug classes, specific agents inside each class, and types of combinations, with the presence of non-TRH vs. TRH, and with controlled vs. uncontrolled TRH. Methods Comparisons were done in 14 264 patients treated with three drugs (non-TRH: 2988; TRH: 11 276) and in 6974 treated with at least four drugs (controlled TRH: 1383; uncontrolled TRH: 5591). Associations were adjusted for age, sex, and previous cardiovascular event. Results In both groups of patients treated with three or with at least four drugs, aldosterone antagonists among drug classes [adjusted odds ratio (OR): 1.82 and 1.41, respectively], and ramipril (OR: 1.28 and 1.30), olmesartan (OR: 1.31 and 1.37), and amlodipine (OR: 1.11 and 1.41) inside each class were significantly associated with blood pressure control (non-TRH or controlled TRH). In patients treated with three drugs, non-TRH was also associated with the use of chlorthalidone (OR: 1.50) and bisoprolol (OR: 1.19), whereas in patients treated with at least four drugs, controlled TRH was significantly associated with the triple combination of a renin-angiotensin system blocker, a calcium channel blocker, and a diuretic (OR: 1.17). Conclusion The use of aldosterone antagonists is associated with blood pressure control in patients treated with three or more drugs. Similar results are observed with specific agents inside each class, being ramipril, olmesartan, chlorthalidone, amlodipine, and bisoprolol those exhibiting significant results. An increased use of these drugs might probably reduce the burden of TRH.

Objective: Increased BP-variability predicts cardiovascular morbidity and mortality in hypertensives. This study aimed to examine short-term BP-variability according to renal function stage. Methods: We included 16 546 patients [10 270 (62.1%) without/6276 (38.9%) with CKD Stage 1–5] from the Spanish Ambulatory-Blood-Pressure Monitoring (ABPM) Registry. Stages of CKD were defined according to K/DIGO criteria, based on estimated glomerular filtration rate calculated with the CKD-EPI equation and albumin-to-creatine ratio. BP-variability was assessed with standard deviation (SD), weighted SD (wSD), coefficient of variation (CV), and average real variability (ARV). Results: Compared with those without CKD, a lower proportion of CKD patients were dippers (51.9 versus 39.6%; P

BACKGROUND AND AIM: The prevalence and associated risks of white-coat hypertension (WCH) are still a matter of debate. We aimed to assess differences in prevalence and associated conditions of WCH defined on the basis of the normality of all daytime, night-time, and 24-h blood pressure (BP), only daytime, or only 24-h BP. METHODS: We selected 115 708 patients (45 020 untreated and 70 688 treated) from the Spanish Ambulatory BP Monitoring Registry. WCH was estimated in patients with elevated office BP (≥140 and/or 90 mmHg) by using normal daytime (

Clinic blood pressure (BP) is usually higher than daytime ambulatory BP in hypertensive patients, but some recent studies have challenged this view, suggesting that this relationship is strongly influenced by age. We used the Spanish ambulatory BP monitoring cohort to examine differences between clinic and daytime BP by age among 104 639 adult hypertensive patients (office systolic/diastolic BP ≥140/90 mm Hg or treated) in usual primary-care practice, across the wide age spectrum. To assess the impact of age, cardiovascular variables, and clinic BP on the clinic–daytime BP differences, we built multivariable regression models of the average BP differences, white-coat hypertension (high clinic BP and normal daytime BP), and masked hypertension (normal clinic BP and high daytime BP). In most patients, mean clinic BP values were higher than daytime BP at all ages. Some 36.7% of patients had white-coat hypertension (amounting to 50% at clinic systolic BP of 140–159 mm Hg) and 3.9% had masked hypertension (amounting to 18% at clinic systolic BP of 130–139 mm Hg). Age explained 0.1% to 1.7% of the variance of quantitative or categorical BP differences ( P P P 40% of patients. This misclassification was not importantly influenced by age but was more evident in patients with borderline/grade 1 hypertension. These findings reinforce the importance of ambulatory BP monitoring for defining BP status in routine clinical practice.

Resumen Se presenta una seleccion comentada de articulos originales sobre hipertension arterial publicados en revistas indexadas entre septiembre de 2015 y septiembre de 2016, con relevancia y potencial impacto en la practica clinica. La eleccion de los originales ha sido necesariamente limitada y subjetiva, dado el elevadisimo volumen de publicaciones existente a lo largo del periodo. Se comentan algunos grandes ensayos clinicos (como el SPRINT, el HOPE3 o el PATHWAY-2), estudios epidemiologicos, de cohortes o sobre la medida de la presion ambulatoria. Se discuten aspectos sobre el objetivo de control de la presion arterial y sobre su tratamiento. En todos los casos, se ha pretendido dar a conocer las nuevas evidencias publicadas en este ultimo ano sobre el diagnostico, la evaluacion y el manejo terapeutico de la hipertension. El objetivo es motivar la lectura personal y a fondo de los originales que aqui solo es posible comentar sucintamente. © 2017 SEHLELHA. Publicado por Elsevier Espana, S.L.U. Todos los derechos reservados.

Objectives We aimed to study the value of ambulatory blood pressure monitoring (ABPM) in predicting the global progression of cerebral small vessel disease (cSVD). Design Longitudinal cohort study. Setting Data from the population-based Investigating Silent Strokes in Hypertensives study. Participants Individuals with hypertension who were 50 to 70 years of age and stroke free at baseline. In baseline and follow-up visits, patients underwent magnetic resonance imaging and ABPM. Measurements Ambulatory systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels were studied as continuous variables and dichotomized according to good or poor control on the basis of 125/75 (24 hours), 130/80 (day), and 110/65 (night) mm Hg cutoff values. Whole cSVD progression was qualitatively scored with 1 point when an incident lesion (incident lacunar infarcts, deep cerebral microbleeds, white matter hyperintensities, and basal ganglia enlarged perivascular spaces) was detected. The score ranged from 0 to 4. Results We followed up 233 participants with a median age of 65 years within 4 years. A total of 61 (26.2%) and 23 (9.9%) subjects showed cSVD progression in one and two or more markers, respectively. Baseline ambulatory SBP and DBP and nighttime pulse pressure (PP) values were positively correlated with the number of incident cSVD lesions. Interestingly, patients without incident lesions showed greater differences between office and ambulatory BP, thus suggesting an increased white coat effect. Poor DBP control, nighttime PP, and DBP white coat effect were independently associated with cSVD progression. The inclusion of these metrics in a clinical model resulted in a significant increase in the prediction of incident lesions (integrated discrimination improvement = 9.09%; P value Conclusion ABPM may help assess cSVD risk of progression, especially by the identification of poor BP control, masked hypertension, and increased nighttime PP. J Am Geriatr Soc 68:2232-2239, 2020.

Los autores de este trabajo forman parte de PREDIMED study investigators. Son los siguientes: Principales: Xavier Pintó, Marta Fanlo-Maresma, Emili Corbella, Xavier Corbella, M Teresa Mitjavila, Juan J Moreno, Rosa Casas, Ramon Estruch, Dolores Corella, Mònica Bulló, Miguel Ruiz-Canela, Olga Castañer, J Alfredo Martinez, Emilio Ros, PREDIMED Study Investigators. PREDIMED Study investigators: Estruch R, Martínez-González MA, Corella D, Fitó M, Ros E, Salas-Salvadó J, Arós F, Aldamiz-Echevarría M, Alonso-Gómez AM, Berjón J, Forga L, Gállego J, García-Layana A, Larrauri A, Portu-Zapirain J, Timiraos J, Ros E, Covas MI, Martínez-González MA, Salas-Salvadó J, Pérez-Heras A, Serra-Mir M, Pi-Sunyer X, González CA, Hu FB, Sabaté J, de la Cruz E, Galera A, Gimenez-Garcia M, Lafuente H, Rodríguez-Sanchez MA, Trias F, Sarasa I, Figueras R, Liceran M, Pallarols C, Esteve V, Storniolo C, Serra-Mir M, Pérez-Heras A, Sala-Vila A, Valls-Pedret C, Viñas C, Casas R, Medina-Remón A, Romero S, Baena JM, García M, Oller M, Amat J, Duaso I, García Y, Iglesias C, Simón C, Quinzavos L, Parra L, Liroz M, Benavent J, Clos J, Pla I, Amorós M, Bonet MT, Martín MT, Sánchez MS, Altirriba J, Manzano E, Altés A, Cofán M, Doménech M, Freitas-Simoes TM, Roth I, Amor AJ, Ortega E, Laguna JC, Alegret M, Gilabert R, Bargalló N, Martínez-González MA, Buil-Cosiales P, Toledo E, García-Arellano A, Cenoz-Osinaga JC, Lecea-Juárez O, Razquin C, Sánchez-Tainta A, Sanjulián B, Díez-Espino J, Zazpe I, Basterra-Gortari FJ, Eguaras S, Goñi E, Vazquez Z, Bes-Rastrollo M, Gea A, Martín-Calvo N, Berrade N, Marti A, Alfredo Martínez J, Martínez-Lapiscina EH, García-López M, Cervantes S, Barcena Amigo F, Oreja Arrayago C, Lasanta Saez MJ, Quintana Pedraza L, Cia Lecumberri P, Elcarte Lopez T, Forcen Alonso T, Alvárez-Alvárez I, Salas-Salvadó J, Guasch-Ferré M, González R, Molina C, Márquez F, Babio N, García Roselló J, Diaz-López A, Martin F, Tort R, Isach A, Becerra N, Ferreira C, Cabré JJ, Fernández-Ballart J, Ibarrola-Jurado N, Mestres G, Rosique-Esteban N, Alegret C, Martínez P, Millán S, Piñol JL, Basora T, Salas-Huetos A, Hernández JM, Carrasco P, Ortega-Azorín C, Asensio EM, Osma R, Barragán R, Francés F, Guillén M, González JI, Sáiz C, Portolés O, Giménez FJ, Coltell O, Fernández-Carrión R, Guillem-Sáiz P, González-Monje I, Quiles L, Pascual V, Riera C, Pages MA, Godoy D, Carratalá-Calvo A, Sánchez-Navarro S, Valero-Barceló C, Fitó M, Vila J, Subirana I, Tello S, de la Torre R, Muñoz-Aguayo D, Elosua R, Marrugat J, Schröder H, Molina N, Maestre E, Rovira A, Farré M, Arós F, Timiraos J, Salaverría I, Rekondo J, Belló MC, Del Hierro T, Algorta J, Francisco S, Alonso A, San Vicente J, Sanz E, Felipe I, Alonso Gómez A, Loma-Osorio A, Gómez-Gracia E, Fernández-Crehuet J, Gutiérrez-Bedmar M, Benítez Pont R, Bianchi Alba M, Wärnberg J, Gómez-Huelgas R, Martínez-González J, Velasco García V, de Diego Salas J, Baca Osorio A, Gil Zarzosa J, Sánchez Luque JJ, Vargas López E, Romaguera D, García-Valdueza M, Moñino M, Yáñez A, Proenza A, Prieto R, Munuera S, Vivó M, Bestard F, Munar JA, Coll L, Fiol F, Ginard M, Jover A, García J, Leal M, Martínez E, Santos-Lozano JM, Ortega-Calvo M, Román P, José García F, Iglesias P, Corchado Y, Mellado L, Miró-Moriano L, Lozano-Rodríguez JM, Domínguez-Espinaco C, Vaquero-Díaz S, López-Sabater MC, Castellote-Bargalló AI, Quifer-Rada P, Palmas L, Álvarez-Pérez J, Díaz-Benítez EM, Sánchez-Villegas A, Casañas-Quintana LT, Pérez-Cabrera J, Ruano-Rodríguez C, Bautista-Castaño I, Sarmiento de la Fe F, García Pastor JA, Díaz-González BV, Castillo Anzalas JM, Sosa-Also RE, Medina-Ponce J, Cabezas C, Vinyoles E, Rovira MA, García L, Flores G, Verdú JM, Baby P, Ramos A, Mengual L, Roura P, Yuste MC, Guarner A, Rovira A, Santamaría MI, Mata M, de Juan C, Brau A, Ruiz-Gutiérrez V, Sánchez Perona J, Montero Romero E, García-García M, Jurado-Ruiz E, Portillo MP, Sáez G, Tur J., Background Adherence to a Mediterranean diet (MedDiet) is thought to reduce liver steatosis. Objectives To explore the associations with liver steatosis of 3 different diets: a MedDiet + extra-virgin olive oil (EVOO), MedDiet + nuts, or a control diet. Methods This was a subgroup analysis nested within a multicenter, randomized, parallel-group clinical trial, PREvención con DIeta MEDiterránea (PREDIMED trial: ISRCTN35739639), aimed at assessing the effect of a MedDiet on the primary prevention of cardiovascular disease. One hundred men and women (mean age: 64 ± 6 y), at high cardiovascular risk (62% with type 2 diabetes) from the Bellvitge-PREDIMED center were randomly assigned to a MedDiet supplemented with EVOO, a MedDiet supplemented with mixed nuts, or a control diet (advice to reduce all dietary fat). No recommendations to lose weight or increase physical activity were given. Main measurements were the percentage of liver fat and the diagnosis of steatosis, which were determined by NMR imaging. The association of diet with liver fat content was analyzed by bivariate analysis after a median follow-up of 3 y. Results Baseline adiposity and cardiometabolic risk factors were similar among the 3 treatment arms. At 3 y after the intervention hepatic steatosis was present in 3 (8.8%), 12 (33.3%), and 10 (33.3%) of the participants in the MedDiet + EVOO, MedDiet + nuts, and control diet groups, respectively (P = 0.027). Respective mean values of liver fat content were 1.2%, 2.7%, and 4.1% (P = 0.07). A tendency toward significance was observed for the MedDiet + EVOO group compared with the control group. Median values of urinary 12(S)-hydroxyeicosatetraenoic acid/creatinine concentrations were significantly (P = 0.001) lower in the MedDiet + EVOO (2.3 ng/mg) than in the MedDiet + nuts (5.0 ng/mg) and control (3.9 ng/mg) groups. No differences in adiposity or glycemic control changes were seen between groups. Conclusions An energy-unrestricted MedDiet supplemented with EVOO, a food with potent antioxidant and anti-inflammatory properties, is associated with a reduced prevalence of hepatic steatosis in older individuals at high cardiovascular risk.

Blood pressure variability (BPV) is recognized as an important prognostic contributor in hypertension. We asseseds differences in short-term BPV in treated patients depending on the number of drugs, drug-classes and combinations, and individual compounds. From the Spanish ABPM Registry, we selected 38188 treated patiens. BPV estimates were obtained from ABPM records, and included weighted, daytime and nighttime SD and average real variability (ARV). Comparisons (general linear models adjusted for age, gender, diabetes, dyslipidemia and CV disease) were carried out depending on the number of drugs (1, 2, 3, and more). In patients treated with monotherapy (13765), BPV estimates were compared depending on the drug classes, as well as on individual compounds inside each class. Additional comparisons were performed depending on the type of combination in patients treated with 2 (12716) and 3 drugs (7888). Systolic BPV increased from monotherapy to treatment with 4 or more drugs (p

[Purpose]: To assess the association between the consumption of non-soy legumes and different subtypes of non-soy legumes and serum uric acid (SUA) or hyperuricemia in elderly individuals with overweight or obesity and metabolic syndrome. [Methods]:A cross-sectional analysis was conducted in the framework of the PREDIMED-Plus study. We included 6329 participants with information on non-soy legume consumption and SUA levels. Non-soy legume consumption was estimated using a semi-quantitative food frequency questionnaire. Linear regression models and Cox regression models were used to assess the associations between tertiles of non-soy legume consumption, different subtypes of non-soy legume consumption and SUA levels or hyperuricemia prevalence, respectively., [Results]: Individuals in the highest tertile (T3) of total non-soy legume, lentil and pea consumption, had 0.14 mg/dL, 0.19 mg/dL and 0.12 mg/dL lower SUA levels, respectively, compared to those in the lowest tertile (T1), which was considered the reference one. Chickpea and dry bean consumption showed no association. In multivariable models, participants located in the top tertile of total non-soy legumes [prevalence ratio (PR): 0.89; 95% CI 0.82–0.97; p trend = 0.01, lentils (PR: 0.89; 95% CI 0.82–0.97; p trend = 0.01), dry beans (PR: 0.91; 95% C: 0.84–0.99; p trend = 0.03) and peas (PR: 0.89; 95% CI 0.82–0.97; p trend = 0.01)] presented a lower prevalence of hyperuricemia (vs. the bottom tertile). Chickpea consumption was not associated with hyperuricemia prevalence., [Conclusions]: In this study of elderly subjects with metabolic syndrome, we observed that despite being a purine-rich food, non-soy legumes were inversely associated with SUA levels and hyperuricemia prevalence., The PREDIMED-Plus trial was supported by the official funding agency for biomedical research of the Spanish government, ISCIII, through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund (four coordinated FIS projects led by J.S.-S. and J.Vid., including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, and PI17/00926), the Especial Action Project entitled: Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus grant to J.S.-S., the European Research Council (Advanced Research Grant 2013–2018, 340918) to M.Á.M.-G., the Recercaixa Grant to J.S.-S. (2013ACUP00194), Grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, and PI0137/2018), a Grant from the Generalitat Valenciana (PROMETEO/2017/017), a SEMERGEN Grant, and funds from the European Regional Development Fund (CB06/03). O.C. is supported by ISCIII Grant JR17/00022. M Rosa Bernal-Lopez was supported by “Miguel Servet Type I” program (CP15/00028) from the ISCIII-Madrid (Spain), cofinanced by the Fondo Europeo de Desarrollo Regional-FEDER

[Background]: Inflammation is known to be related to the leading causes of death including cardiovascular disease, several types of cancer, obesity, type 2 diabetes, depression-suicide and other chronic diseases. In the context of whole dietary patterns, the Dietary Inflammatory Index (DII®) was developed to appraise the inflammatory potential of the diet. [Objective]: We prospectively assessed the association between DII scores and all-cause mortality in two large Spanish cohorts and valuated the consistency of findings across these two cohorts and results published based on other cohorts., [Design]: We assessed 18,566 participants in the “Seguimiento Universidad de Navarra” (SUN) cohort followed-up during 188,891 person-years and 6790 participants in the “PREvencion con DIeta MEDiterránea” (PREDIMED) randomized trial representing 30,233 person-years of follow-up. DII scores were calculated in both cohorts from validated FFQs. Higher DII scores corresponded to more proinflammatory diets. A total of 230 and 302 deaths occurred in SUN and PREDIMED, respectively. In a random-effect meta-analysis we included 12 prospective studies (SUN, PREDIMED and 10 additional studies) that assessed the association between DII scores and all-cause mortality., [Results]: After adjusting for a wide array of potential confounders, the comparison between extreme quartiles of the DII showed a positive and significant association with all-cause mortality in both the SUN (hazard ratio [HR] = 1.85; 95% CI: 1.15, 2.98; P-trend = 0.004) and the PREDIMED cohort (HR = 1.42; 95% CI: 1.00, 2.02; P-trend = 0.009). In the meta-analysis of 12 cohorts, the DII was significantly associated with an increase of 23% in all-cause mortality (95% CI: 16%–32%, for the highest vs lowest category of DII)., [Conclusion]: Our results provide strong and consistent support for the hypothesis that a pro-inflammatory diet is associated with increased all-cause mortality. The SUN cohort and PREDIMED trial were registered at clinicaltrials.gov as NCT02669602 and at isrctn.com as ISRCTN35739639, respectively., Supported by the official funding agency for biomedical research of the Spanish Government, Instituto de Salud Carlos III (ISCIII), through grants provided to research networks specifically developed for the trial (RTIC G03/140, to R.E.; RTIC RD 06/0045, to Miguel A. Martínez-González) and through Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), and by grants from Centro Nacional de Investigaciones Cardiovasculares (CNIC 06/2007), Fondo de Investigación Sanitaria–Fondo Europeo de Desarrollo Regional (Proyecto de Investigación (PI) 04-2239, PI 05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/01407, PI10/02658, PI11/01647, P11/02505, PI13/00462, PI13/00615, PI13/01090, PI14/01668, PI14/01798, PI14/01764), Ministerio de Ciencia e Innovación (Recursos y teconologia agroalimentarias(AGL)-2009-13906-C02 and AGL2010-22319-C03 and AGL2013-49083-C3-1- R), Fundación Mapfre 2010, the Consejería de Salud de la Junta de Andalucía (PI0105/2007), the Public Health Division of the Department of Health of the Autonomous Government of Catalonia, Generalitat Valenciana (Generalitat Valenciana Ayuda Complementaria (GVACOMP) 06109, GVACOMP2010-181, GVACOMP2011-151), Conselleria de Sanitat y, PI14/01764 AP; Atención Primaria (CS) 2010-AP-111, and CS2011-AP-042), and Regional Government of Navarra (P27/2011).). Drs. Shivappa and Hébert were supported by grant number R44DK103377 from the United States National Institute of Diabetes and Digestive and Kidney Diseases.

OBJECTIVE The long-term impact of intentional weight loss on cardiovascular events remains unknown. We describe 12-month changes in body weight and cardiovascular risk factors in PREvención con DIeta MEDiterránea (PREDIMED)-Plus, a trial designed to evaluate the long-term effectiveness of an intensive weight loss lifestyle intervention on primary cardiovascular prevention. RESEARCH DESIGN AND METHODS Overweight/obese adults with metabolic syndrome aged 55–75 years (n = 626) were randomized to an intensive weight loss lifestyle intervention based on an energy-restricted Mediterranean diet, physical activity promotion, and behavioral support (IG) or a control group (CG). The primary and secondary outcomes were changes in weight and cardiovascular risk markers, respectively. RESULTS Diet and physical activity changes were in the expected direction, with significant improvements in IG versus CG. After 12 months, IG participants lost an average of 3.2 kg vs. 0.7 kg in the CG (P < 0.001), a mean difference of −2.5 kg (95% CI −3.1 to −1.9). Weight loss ≥5% occurred in 33.7% of IG participants compared with 11.9% in the CG (P < 0.001). Compared with the CG, cardiovascular risk factors, including waist circumference, fasting glucose, triglycerides, and HDL cholesterol, significantly improved in IG participants (P < 0.002). Reductions in insulin resistance, HbA1c, and circulating levels of leptin, interleukin-18, and MCP-1 were greater in IG than CG participants (P < 0.05). IG participants with prediabetes/diabetes significantly improved glycemic control and insulin sensitivity, along with triglycerides and HDL cholesterol levels compared with their CG counterparts. CONCLUSIONS PREDIMED-Plus intensive lifestyle intervention for 12 months was effective in decreasing adiposity and improving cardiovascular risk factors in overweight/obese older adults with metabolic syndrome, as well as in individuals with or at risk for diabetes.

Introduction Since reported evidence is both scarce and controversial, the objective of this study is to determine the risk factors involved in the prognosis of older patients with heart failure (HF) receiving home healthcare from primary care professionals. Methods Retrospective cohort community study was carried out in 52 primary healthcare centers in Barcelona (Spain). A follow-up was performed between January 2009 and December 2012 with 7461 HF patients aged >64years. Information was obtained from primary care electronic medical records containing clinical data, functional and cognitive status, total mortality, and hospital admissions for cardiovascular events. Results Mortality and hospitalization during follow-up were higher in older, HF patients who received home healthcare than those who did not (HR 1.39, 95% CI 1.22–1.58 and 1.92 95% CI 1.72–2.14, respectively). The most relevant determinants for mortality were male gender (HR 1.40, 95%CI 1.10–1.79), previous hospital admission for HF (HR 1.29 95%CI 1.05–1.60), and severe dependence in activities for daily living (ADL) (HR 1.33, 95%CI 1.06–1.67). In contrast, severely dependent ADL patients were not more frequently hospitalized as a consequence of cardiovascular events (0.97, 95% CI 0.77–1.23). Conclusions Due to their greater comorbidity and age, mortality and hospitalization in patients requiring home healthcare were higher than those who did not. Among the HF patients receiving home care, mortality and hospital admissions were higher in men, older patients, and in those previously hospitalized for HF. Severe dependence in ADL determined a higher mortality but was not related to increased hospital admission rates.

Isolated systolic hypertension (ISH) is a clinical condition derived from increased arterial stiffness and associated with a worse cardiovascular prognosis. Increased blood pressure variability (BPV) is also associated to cardiovascular risk. We aimed to estimate short-term BPV in patients with ISH compared to those with systolic and diastolic hypertension (SDH). From the Spanish ABPM Registry database containing 63910 identified patients, we selected 20497 with ISH and 23269 with SDH. BPV estimates were obtained from ABPM records, and included standard deviation (SD), coefficient of variation (CV), weighted SD and average real variability (ARV). Comparisons were carried out by Student’s t test, and by general linear models adjusted for age, gender and office BP. Due to important differences in age between groups, a case-control matching was performed obtaining 14707 pairs matched by gender and with an age difference < 2 years. Comparisons were repeated in this dataset. Patients with ISH were older, more frequently women, with diabetes and with a previous history of CV disease. Office BP was lower (155±13/81±7 vs. 159±16/98±7 mmHg; p

OBJECTIVE: To evaluate the effect of effervescent paracetamol on office and ambulatory blood pressure (BP) compared with noneffervescent paracetamol in hypertensive patients. DESIGN: This was a multicenter open crossover randomized clinical trial. SETTING: Primary care centers in Catalonia and the Basque Country. PARTICIPANTS: Inclusion criteria were office BP 150/95¿mmHg or less and daytime ambulatory BP 140/90¿mmHg or less, stable pharmacologic or nonpharmacologic antihypertensive treatment, and concomitant chronic osteoarticular pain. INTERVENTIONS: Baseline randomized assignment to 3-week periods of effervescent paracetamol (1¿g three times a day) first and noneffervescent paracetamol later, or inversely, during a 7-week study period. At the start and end of each treatment period, 24-h ambulatory BP monitoring was performed. MAIN OUTCOME MEASURES: Differences in 24-h SBP between baseline and end of both treatment periods. The main analyses were performed according to the intention-to-treat principle. RESULTS: In intention-to-treat analysis, 46 patients were analyzed, 21 were treated with paracetamol effervescent and noneffervescent later, and 25 followed the opposite sequence. The difference in 24-h SBP between the two treatments was 3.99¿mmHg (95% confidence interval 1.35-6.63; P¿=¿0.004), higher in the effervescent paracetamol treatment period. Similarly, the per-protocol analysis showed a difference in 24-h SBP between the two groups of 5.04¿mmHg (95% confidence interval 1.80-8.28; P¿=¿0.004), higher in the effervescent paracetamol treatment period. Self-reported pain levels did not differ between groups and did not vary by treatment period. No serious adverse events were reported in either study arm. CONCLUSION: Effervescent paracetamol tablets are responsible for a significant daytime and overall increase in ambulatory 24-h SBP. TRIAL REGISTRATION: NCT: 02514538 EudraCT: 2010-023485-53.

Objective: Various studies have suggested that a delay in the time between diagnosing hypertension and its correct control (D-C, diagnostic-control time) is linked to a worse prognosis. The aim of this study was to examine the relationship between D-C time and all-cause mortality, or the incidence of cardiovascular events, in patients more than 60 years newly diagnosed with hypertension. Methods: This is a longitudinal, retrospective, population study employing data gathered from the electronic medical records of patients recently diagnosed with hypertension in 45 primary healthcare centres located in Barcelona (Catalonia). A multivariable logistic regression and Cox regression models were constructed. Goodness-of-fit was assessed through the Hosmer & Lemeshow test. Results: A total of 18 721 newly diagnosed hypertensive patients were included between 2007 and 2012. The follow-up lasted until October 2015, or the appearance of a cardiovascular event or death because of any cause. The median D-C time was 49 days and its distribution by tertiles was the following: 29 days or less, 30–124 days, and at least 125 days. Higher hypertensive status, obesity, diabetes mellitus, and male sex were independently associated with longer D-C time (≥125 days). At 5.4 years follow-up, patients with longer D-C times presented statistically significant greater incidence of all-cause mortality. Conclusion: A delay in blood pressure control is significantly associated with an increase in the rate of all-cause mortality.

Background & aims: Legumes, a low-energy, nutrient-dense and low glycemic index food, have shown beneficial effects on glycemic control and adiposity. As such, legumes are widely recommended in diabetic diets, even though there is little evidence that their consumption protects against type 2 diabetes. Therefore the aim of the present study was to examine the associations between consumption of total legumes and specific subtypes, and type 2 diabetes risk. We also investigated the effect of theoretically substituting legumes for other protein- or carbohydrate-rich foods. Methods: Prospective assessment of 3349 participants in the PREvención con DIeta MEDiterránea (PREDIMED) study without type 2 diabetes at baseline. Dietary information was assessed at baseline and yearly during follow-up. We used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for type-2 diabetes incidence according to quartiles of cumulative average consumption of total legumes, lentils, chickpeas, dry beans and fresh peas. Results: During a median follow-up of 4.3 years, 266 new cases of type 2 diabetes occurred. Individuals in the highest quartile of total legume and lentil consumption had a lower risk of diabetes than those in the lowest quartile (HR: 0.65; 95% CI: 0.43, 0.96; P-trend = 0.04; and HR: 0.67; 95% CI: 0.46–0.98; P-trend = 0.05, respectively). A borderline significant association was also observed for chickpeas consumption (HR 0.68; 95% CI: 0.46, 1.00; P-trend = 0.06). Substitutions of half a serving/day of legumes for similar servings of eggs, bread, rice or baked potato was associated with lower risk of diabetes incidence. Conclusions: A frequent consumption of legumes, particularly lentils, in the context of a Mediterranean diet, may provide benefits on type 2 diabetes prevention in older adults at high cardiovascular risk. Trial registration: The trial is registered at http://www.controlled-trials.com (ISRCTN35739639). Registration date: 5th October 2005., The authors disclose no conflict of interest related with the article. Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN) is an initiative of the Instituto de Salud Carlos III (ISCIII) of Spain which is supported by FEDER funds (CB06/03). Supported by the official funding agency for biomedical research of the Spanish government, ISCIII, through grants provided to research networks specifically developed for the trial (RTIC G03/140 and RD 06/0045) through CIBEROBN, and by grants from Centro Nacional de Investigaciones Cardiovasculares (CNIC 06/2007), Fondo de Investigación Sanitaria–FondoEuropeo de Desarrollo Regional (PI04–2239, PI05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/01407, PI10/02658, PI11/01647, and PI11/02505; PI13/00462), Ministerio de Ciencia e Innovación (AGL-2009–13906-C02 and AGL2010–22319-C03), Fundación Mapfre 2010, Consejería de Salud de la Junta de Andalucía (PI0105/2007), Public Health Division of the Department of Health of the Autonomous Government of Catalonia, Generalitat Valenciana (ACOMP06109, GVA-COMP2010–181, GVACOMP2011–151, CS2010-AP-111, and CS2011-AP-042), and the Navarra Regional Government (27/2011). The Fundación Patrimonio Comunal Olivarero and Hojiblanca SA (Málaga, Spain), California Walnut Commission (Sacramento, CA), Borges SA (Reus, Spain), and Morella Nuts SA (Reus, Spain) donated the olive oil, walnuts, almonds, and hazelnuts, respectively, used in the study. None of the funding sources played a role in the design, collection, analysis or interpretation of the data or in the decision to submit the manuscript for publication. Acknowledgements: The authors thank all the participants for their collaboration, all the PREDIMED personnel for their assistance and all the personnel of affiliated primary care centers for making the study possible. CIBEROBN is an initiative of ISCIII, Spain.

The recently released American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines1 proposed new values for defining hypertension: office blood pressure (BP) ≥130 systolic or ≥80 mm Hg diastolic. Furthermore, BP goals for hypertensive patients under pharmacological treatment have been recommended

The American College of Cardiology (ACC) and the American Heart Association (AHA) have recently published their guidelines for the prevention, detection, evaluation, and management of hypertension in adults. The most controversial issue is the classification threshold at 130/80 mmHg, which will allow a large number of patients to be diagnosed as hypertensive who were previously considered normotensive. Blood pressure (BP) is considered normal (, El American College of Cardiology (ACC) y la American Heart Association (AHA) han publicado recientemente la guía para la prevención, detección, evaluación y tratamiento d de la hipertensión arterial (HTA) en adultos. El punto más controvertido es el umbral diagnóstico de 130/80 mmHg, lo cual conlleva diagnosticar HTA en un gran número de personas previamente consideradas no hipertensas. La presión arterial (PA) se clasifica como normal (sistólica < 120 clínicas y diastólica 80 mmHg), elevada (120-129 y