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European neuropsychopharmacology : ENP 64, 63-71 (2022). doi:10.1016/j.euroneuro.2022.09.001, Published by Elsevier, Amsterdam

Hypertension; Therapeutics; Weight management Hipertensió; Terapèutica; Gestió del pes Hipertensión; Terapéutica; Control de peso Hypertension is a common chronic medical condition. Treatment is not satisfactory in a significant proportion of patients with primary hypertension, despite the concurrent use of three or more medications with different mechanisms of action. Such treatment-resistant hypertension is a clinical challenge associated with poor prognosis and needs further investigation. The efficacy of lifestyle changes has not been established yet in patients with resistant hypertension, and educational efforts appear clinically irrelevant in patients who must achieve behavioral changes without supervision. A 6-month multidisciplinary pilot intervention enrolled 50 patients with established resistant hypertension. The aims were: (1) to examine whether intensive and supervised lifestyle changes contribute to decreasing blood pressure in this condition, and (2) to identify which components affect compliance and feasibility. The program provided intensive changes in nutrition, physical exercise, and control of sleep disturbances supervised by nutritionists, physiotherapists, and psychologists. Nurses and pharmacists followed up on adherence to the antihypertensive medication. The primary outcome was 24 h blood pressure control. Data in patients with full compliance (n = 30) indicate that lifestyle modifications in resistant hypertension significantly reduced 24 h both systolic and diastolic blood pressure (p < 0.01), body mass index (p < 0.01), medication burden (p = 0.04), improving physical fitness, and cardiovascular risk markers such as heart rate (p = 0.01) and augmentation index (p = 0.02). The adherence to the intervention was moderate, with an attrition rate of 12%. A modified version reducing visits and explorations will likely improve compliance and can be used to assess the long-term maintenance of these benefits in managing resistant hypertension by diverse healthcare providers. The program against Resistant Hypertension was supported, in part, by the Hospital Vall d’Hebron, the Menarini Foundation, and the Instituto de Salud Carlos III grant (PI21/00510) co-funded by the Fondo Europeo de Desarrollo Regional. H.C. is a recipient of a fellowship of the Department of Health of Catalonia (Government of Catalonia) “Pla Estratègic de Recerca i Innovació en Salut” (PERIS-SLT017/3501/2020).

The joint statement is a synergistic action between HyperChildNET and the European Academy of Pediatrics about the diagnosis and management of hypertension in youth, based on the European Society of Hypertension Guidelines published in 2016 with the aim to improve its implementation. The first and most important requirement for the diagnosis and management of hypertension is an accurate measurement of office blood pressure that is currently recommended for screening, diagnosis, and management of high blood pressure in children and adolescents. Blood pressure levels should be screened in all children starting from the age of 3 years. In those children with risk factors for high blood pressure, it should be measured at each medical visit and may start before the age of 3 years. Twenty-four-hour ambulatory blood pressure monitoring is increasingly recognized as an important source of information as it can detect alterations in circadian and short-term blood pressure variations and identify specific phenotypes such as nocturnal hypertension or non-dipping pattern, morning blood pressure surge, white coat and masked hypertension with prognostic significance. At present, home BP measurements are generally regarded as useful and complementary to office and 24-h ambulatory blood pressure for the evaluation of the effectiveness and safety of antihypertensive treatment and furthermore remains more accessible in primary care than 24-h ambulatory blood pressure. A grading system of the clinical evidence is included.

The neutrophil-to-lymphocyte ratio (NLR) is a marker for systemic inflammation. Since inflammation plays a relevant role in vascular aging, the aim of this study was to investigate whether NLR is associated with blood pressure profiles in older adults. This study was performed within the framework of the SCOPE study including 2461 outpatients aged 75 years and over. Mean blood pressure values, namely systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) were investigated across tertiles of NLR. Change in blood pressure levels in 2 years of follow-up were compared across categories of baseline NLR. Data of 2397 individuals were used, of which 1854 individuals had hypertension. Mean values of blood pressure did not differ across categories of baseline NLR in individuals without hypertension. Individuals with hypertension with a high-range NLR had lower SBP and PP when compared to those in low-range NLR (mean difference SBP −2.94 mmHg, p = 0.032 and PP −2.55 mmHg, p = 0.030). Mean change in blood pressure in 2 years did only slightly differ in non-clinically relevant ranges, when compared across tertiles of baseline NLR. NLR as a marker of inflammaging was not associated with unfavorable blood pressure profiles in older individuals with or without hypertension.

Accuracy of blood pressure (BP) measurement is important for the evaluation of hypertension in children and adolescents, and it is critically dependent upon the accuracy of the BP measuring device. A device that could pass validated protocols with reliable accuracy would be desirable in clinical and research settings. Several scientific organizations have published recommendations on the validation of different BP measuring devices. Most of them focus on adults but separate recommendations and validation criteria for BP devices intended for use in children and adolescents are included in some validation protocols. In this review, we compare the validation criteria for BP measuring devices among consensus documents from different scientific organizations focusing on the pediatric population and we discuss the evidence gaps targeting the needs for validated BP measuring devices in children and adolescents. We also highlight common pitfalls in the validation studies of BP measuring devices in children and adolescents using the example of office BP devices.

Objectives: Studies of the diagnosis of hypertension have emphasized longterm cost-effectiveness analysis, but the patient experience and costs of blood pressure monitoring methods at the diagnosis stage remain unclear. We studied four diagnostic methods: a new 1 h-automated office blood pressure (BP) monitoring, office BP measurement, home BP monitoring, and awake-ambulatory BP monitoring. Methods: We carried out a comparative effectiveness study of four methods of diagnosing hypertension in 500 participants with a clinical suspicion of hypertension from three primary healthcare (PHC) centers in Barcelona city (Spain). We evaluated the time required and the intrinsic and extrinsic costs of the four methods. The cost-accuracy ratio was calculated and differences between methods were assessed using ANOVA and Tukey’s honestly significant difference (HSD) post-hoc test. Patient experience data were transformed using Rasch analysis and re-scaled from 0 to 10. Results: Office BP measurement was the most expensive method (€156.82, 95% CI: 156.18–157.46) and 1 h-automated BP measurement the cheapest (€85.91, 95% CI: 85.59–86.23). 1 h-automated BP measurement had the best cost-accuracy ratio (€ 1.19) and office BP measurement the worst (€ 2.34). Home BP monitoring (8.01, 95% CI: 7.70–8.22), and 1 h-automated BP measurement (7.99, 95% CI: 7.80–8.18) had the greatest patient approval: 66.94% of participants would recommend 1 h-automated BP measurement as the first or second option. Frontiers in Medicine 01 frontiersin.org González-de Paz et al. 10.3389/fmed.2022.827821 Conclusion: The relationship between the cost-accuracy ratio and the patient experience suggests physicians could use the new 1 h-automated BP measurement as the first option and awake-ambulatory BP monitoring in complicated cases and cease diagnosing hypertension using office BP measurement. This project received research grants from: The Carlos III Institute of Health, Ministry of Economy and Competitiveness (Spain), awarded on the 2016 call under the Health Strategy Action 2013–2016, within the National Research Program oriented to Societal Challenges, within the Technical, the Scientific and Innovation Research National Plan 2013–2016, with reference PI16/00660, co-funded with European Union ERDF funds (European Regional Development Fund). The Department of Health of the Generalitat de Catalunya, in the call corresponding to the year 2019 of the Strategic Plan of Research and Innovation in Health (PERIS) 2016–2020, with file code SLT008/18/00013.

Arterial hypertension (AH) among adults is known to be associated with worse cognitive outcomes. Similarly, children and adolescents with AH could be expected to underperform during neuropsychological evaluations when compared with healthy peers. Our aims were to review the existing literature on cognitive functioning among children and adolescents with primary AH and to identify what additional evidence may be needed to substantiate the impact of hypertension on poor cognitive outcomes in this population. We conducted a systematic review of articles in PubMed and Web of Science published before 17 January 2022, reporting on cognitive testing among children and adolescents with primary AH. From 1,316 records, 13 were included in the review—7 used battery-testing while other employed indirect measures of cognitive functions. Most of the studies reported worse results among individuals with AH. Results of two prospective trials suggested that cognitive functioning may improve after starting antihypertensive treatment. Ambulatory blood pressure monitoring was shown to be more strongly related to cognitive testing results than office measures of blood pressure. Significant confounders, namely obesity and sleep apnea, were identified throughout the studies. Our review indicates that evidence relating AH with poor cognitive functioning among youth is usually based on indirect measures of executive functions (e.g., questionnaires) rather than objective neuropsychological tests. Future prospective trials set to test different cognitive domains in children and adolescents undergoing treatment for AH are endorsed and should consider using standardized neuropsychological batteries as well as adjust the assessing results for obesity and sleep disorders.

Apples are among the world’s most consumed fruits. However, while the impact of whole-apple intake on cardiovascular disease (CVD) remains unknown. This narrative review summarizes a novel integrated view of whole-apple intake, CVD risk association (through observational studies; OSs), and the effects on CVD risk factors (randomized trials; RTs). In 8 OSs, whole-apple intake was associated with a reduced risk of CVD mortality, ischemic heart disease mortality, stroke mortality, all-cause mortality, and severe abdominal aortic calcification, as well as with lower C-reactive protein (CRP) concentrations. In 8 RTs, whole-apple consumption reduced total cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, pulse pressure, and plasma inflammatory cytokines, and noticeably reduced CRP, whereas it increased high-density lipoprotein cholesterol (HDLc) and improved endothelial function. Thus, consuming between 100 and 150 g/day of whole apples is associated with a lower CVD risk and decreases in blood pressure, pulse pressure, total cholesterol, low-density lipoprotein cholesterol, and inflammation status as well as with increases in HDLc and endothelial function. These results, support the regular consumption of whole apples as an aid in the prevention of CVD. The AppleCOR Project (Subproject AGL2016-76943-C2-2-R and Subproject AGL2016-76943-C2-1-R) has been possible with the support of Ministerio de Economía, Indústria y Competitividad, the Agencia Estatal de Investigación (AEI) and the European Regional Development Fund (ERDF); NFOC-Salut group is a consolidated research group of Generalitat de Catalunya, Spain (2017 SGR 522).

Preventing, diagnosing, and controlling high blood pressure is a global health priority. The self-measurement of blood pressure is therefore fundamental and should be done with devices validated by recognized protocols, although most are not. The most widely used and current protocols are the 2010 European Society of Hypertension (ESH) revision and the 2018 Association for the Advancement of Medical Instrumentation (AAMI)/ ESH/ the International Organization for Standardization (ISO) universal standard, respectively. The aim of this study was to find out which blood pressure measuring devices have been adequately validated by the above protocols. A narrative review of blood pressure device validations was conducted by searching the PubMed database. From 52 records identified, 37 studies were included. Most validations follow the 2010 revision and only six follow the 2018 protocol, which is more demanding. Almost all validated sphygmomanometers are automated oscillometric sphygmomanometers in the general population. Wrist devices and devices combining new technologies are also validated, as well as in specific populations, such as the obese, pregnant women, or children. There is sufficient evidence to confirm that the universal AAMI/ ESH/ISO standard is considered the protocol of the century. However, it is necessary to increase the number of validations following it and, above all, validations of the new technologies that are invading the current market.

Pressió arterial; Hipertensió arterial; Monitorització ambulatoria Presión arterial; Hipertensión arterial; Monitorización ambulatoria Blood pressure; Arterial hypertension; Ambulatory monitoring Amb l’objectiu d’avaluar l’evidència disponible sobre la seguretat, eficàcia/ efectivitat clínica i eficiència dels dispositius de MAPA en pacients adults de 18 anys o més, amb HTA i sospita de patrons circadiaris anormals, com poden ser HTA matutina, HTA diürna, HTA nocturna, hipotensió postprandial, descens tensional nocturn inadequat o augment de la variabilitat tensional a curt termini, es va dur a terme una revisió sistemàtica de la literatura PubMed/Medline, Cochrane Library, Scopus, Web of Science i Trip Database. Les variables de resultat descrites a la literatura que es va incloure i van ser analitzades eren referents a la seguretat. L’eficàcia/efectivitat i l’eficiència de la tecnologia. Els dissenys d’estudis que es van buscar van ser assajos clínics controlats aleatoritzats (ACA), assajos clínics no aleatoritzats, estudis quasiexperimentals, estudis de cohorts, estudis de casos i controls i estudis de cost-efectivitat. Con el objetivo de evaluar la evidencia disponible sobre la seguridad, eficacia/efectividad clínica y eficiencia de los dispositivos de MAPA en pacientes adultos de 18 años o más, con HTA y sospecha de patrones circadianos anormales como la HTA matutina, HTA diurna, HTA nocturna, hipotensión postprandial, descenso tensional nocturno inadecuado o aumento de la variabilidad tensional a corto plazo, se llevó a cabo una revisión sistemática de la literatura PubMed/Medline, Cochrane Library, Scopus, Web of Science y Trip Database. Las variables de resultado descritas en la literatura incluida que fueron analizadas se referían a la seguridad, la eficacia/efectividad y la eficiencia de la tecnología. Los diseños de estudios que se buscaron fueron ensayos clínicos controlados aleatorizados (ECA), ensayos clínicos no aleatorizados, estudios cuasiexperimentales, estudios de cohortes, estudios de casos y controles y estudios de coste-efectividad. In order to evaluate the evidence available on safety, clinical efficacy/effectiveness, and efficiency of the ABPM devices in adult patients aged 18 years or older with HT and suspected abnormal circadian patterns (such as morning HT, daytime HT, nocturnal HT, postprandial hypotension, inadequate nocturnal dipping in BP or increased short-term BP variability), there was a systematic review on the literature of PubMed/Medline, Cochrane Library, Scopus, Web of Science, and Trip Database. The outcome variables analysed from the literature involved safety, efficacy/effectiveness, and efficiency of the technology. The preferred study designs were randomised controlled clinical trials (RCTs), non-randomised clinical trials, quasi-experiments, cohort studies, case-control studies, and cost-effective studies.

BackgroundLeft ventricular hypertrophy (LVH) is the main marker of HMOD in children and young people (CYP). We aimed to assess the prevalence of LVH and its determinants in CYP with primary hypertension (PH).MethodsA meta-analysis of prevalence was performed. A literature search of articles reporting LVH in CYP with PH was conducted in Medline, Embase, and Cochrane databases. Studies with a primary focus on CYP (up to 21 years) with PH were included. Meta-regression was used to analyze factors explaining observed heterogeneity.ResultsThe search yielded a total of 2,200 articles, 153 of those underwent full-text review, and 47 reports were included. The reports evaluated 51 study cohorts including 5,622 individuals, 73% male subjects, and a mean age of 13.6 years. LVH was defined as left ventricle mass index (LVMI) ≥ 95th percentile in 22 (47%), fixed cut-off ≥38.6 g/m2.7 in eight (17%), sex-specific fixed cut-off values in six (13%), and miscellaneously in others. The overall prevalence of LVH was 30.5% (95% CI 27.2–33.9), while heterogeneity was high (I2 = 84%). Subgroup analysis including 1,393 individuals (76% male subjects, mean age 14.7 years) from pediatric hypertension specialty clinics and LVH defined as LVMI ≥95th percentile only (19 study cohorts from 18 studies), reported prevalence of LVH at 29.9% (95% CI 23.9 to 36.3), and high heterogeneity (I2 = 84%). Two studies involving patients identified through community screening (n = 1,234) reported lower LVH prevalence (21.5%). In the meta-regression, only body mass index (BMI) z-score was significantly associated with LVH prevalence (estimate 0.23, 95% CI 0.08–0.39, p = 0.004) and accounted for 41% of observed heterogeneity, but not age, male percentage, BMI, or waist circumference z-score. The predominant LVH phenotype was eccentric LVH in patients from specialty clinics (prevalence of 22% in seven studies with 779 participants) and one community screening study reported the predominance of concentric LVH (12%).ConclusionLeft ventricular hypertrophy is evident in at least one-fifth of children and young adults with PH and in nearly a third of those referred to specialty clinics with a predominant eccentric LVH pattern in the latter. Increased BMI is the most significant risk association for LVH in hypertensive youth.

Arterial hypertension is the main modifiable risk factor for cardiovascular disease, occupying the first place among the causes of loss of life years adjusted for disability. In recent years, arterial hypertension in children and adolescents has gained ground in cardiovascular medicine thanks to progress made in several areas, fundamentally in pathophysiological and clinical research. Despite the advances that have been made in recent years, the prevention, diagnosis and treatment of high blood pressure in children and adolescents still have room for improvement. In this sense, the correct measurement of blood pressure is especially important, since it includes a series of essential elements such as the measurement devices, the regulated procedure and the interpretation of the results based on percentiles according to age, gender and height. The availability of a free access calculator facilitates the diagnosis and monitoring of arterial hypertension https://hyperchildnet.eu/.

Exposure to air pollution influences children's health, however, the biological mechanisms underlying these effects are not completely elucidated. We investigated the association between short- and medium-term outdoor air pollution exposure with protein profiles and their link with blood pressure in 1170 HELIX children aged 6-11 years. Different air pollutants (NO2, PM10, PM2.5, and PM2.5abs) were estimated based on residential and school addresses at three different windows of exposure (1-day, 1-week, and 1-year before clinical and molecular assessment). Thirty-six proteins, including adipokines, cytokines, or apolipoproteins, were measured in children's plasma using Luminex. Systolic and diastolic blood pressure (SBP and DBP) were measured following a standardized protocol. We performed an association study for each air pollutant at each location and time window and each outcome, adjusting for potential confounders. After correcting for multiple-testing, hepatocyte growth factor (HGF) and interleukin 8 (IL8) levels were positively associated with 1-week home exposure to some of the pollutants (NO2, PM10, or PM2.5). NO2 1-week home exposure was also related to higher SBP. The mediation study suggested that HGF could explain 19% of the short-term effect of NO2 on blood pressure, but other study designs are needed to prove the causal directionality between HGF and blood pressure. The study received funding from the European Community’s Seventh Framework Programme (FP7/2007–206) (grant agreement no 308333) (HELIX project), the H2020-EU.3.1.2. - Preventing Disease Programme (grant agreement no 874583) (ATHLETE project) and from the European Union’s Horizon 2020 research and innovation programme (grant Agreement number: 733206) (Early Life stressors and Lifecycle Health (LIFECYCLE)). BiB received funding from the Welcome Trust (WT101597MA), from the UK Medical Research Council (MRC) and Economic and Social Science Research Council (ESRC) (MR/N024397/ 1). The study was supported by the European Union FP7 programmes (FP7/ 2007–2013, HELIX, ESCAPE, ENRIECO, Medall projects). INMA was supported by grants from the Instituto de Salud Carlos III, CIBERESP, and the Generalitat de Catalunya-CIRIT. KANC was funded by the grant of the Lithuanian Agency for Science Innovation and Technology (6-04-2014_31V-66). The Rhea project was financially supported by European projects (EU FP6-2003-Food-3-NewGeneris, EU FP6. STREP Hiwate, EU FP7 ENV. 2007.1.2.2.2. Project No 211250 Escape, EU FP7- 2008-ENV-1.2.1.4 Envirogenomarkers, EU FP7-HEALTH-2009- single stage CHICOS, EU FP7 ENV. 2008.1.2.1.6. Proposal No 226285 ENRIECO, EU- FP7- HEALTH-2012 Proposal No 308333 HELIX). MC received funding from Instituto Carlos III (Ministry of Economy and Competitiveness) (CD12/00563 and MS16/00128). JU is supported by Spanish regional program PERIS (Ref.: SLT017/20/ 000119) Granted by Departament de Salut de la Generalitat de Catalunya. The CRG/UPF Proteomics Unit is part of the Spanish Infrastructure for Omics Technologies (ICTS OmicsTech) and it is member of the ProteoRed PRB3 consortium which is supported by grant PT17/0019 of the PE I + D + i 2013–2016 from the Instituto de Salud Carlos III (ISCIII)

Introduction:Down syndrome (DS) is a chromosomal disorder affecting simultaneously cardiovascular and respiratory systems. There is no research studying the coupling between these systems during cardiorespiratory exercise testing in a population with DS. Cardiorespiratory coordination (CRC), evaluated through principal component analysis (PCA), measures the covariation of cardiorespiratory variables during exercise.Objective:To investigate and compare CRC in adults with and without DS during maximal cardiorespiratory exercise testing.Methods:Fifteen adults with DS and 15 adults without disabilities performed a maximal cardiorespiratory exercise test on a treadmill. First, the slope, and afterward the velocity was increased regularly until participants reached exhaustion. The time series of six selected cardiorespiratory variables [ventilation per minute, an expired fraction of O2, the expired fraction of CO2, heart rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP)] were extracted for the analysis. The number of principal components (PCs), the first PC eigenvalues (PC1), and the information entropy were computed for each group (non-DS and DS) and compared using at-test or a Mann-Whitney U test.Results:Two PCs in the non-DS group and three PCs in the DS group captured the variance of the studied cardiorespiratory variables. The formation of an additional PC in the DS group was the result of the shift of SBP and DBP from the PC1cluster of variables. Eigenvalues of PC1were higher in the non-DS (U= 30;p= 0.02;d= 1.47) than in the DS group, and the entropy measure was higher in the DS compared with the non-DS group (U= 37.5;p= 0.008;d= 0.70).Conclusion:Adults with Down syndrome showed higher CRC dimensionality and a higher entropy measure than participants without disabilities. Both findings point toward a lower efficiency of the cardiorespiratory function during exercise in participants with DS. CRC appears as an alternative measure to investigate the cardiorespiratory function and its response to exercise in the DS population.

Background: Hypertension is a global and national public health issue, with large human and economic costs, both in developed and developing countries. Ambient pollution is one of the leading risk factors on mortality and loss of quality-of-life burden. Recent evidence has shown how these two factors could be related, and how a great part of the cardiovascular disruptions could be explained by the interaction of pollutants with our organism. Particulate matter is especially dangerous and, moreover, the smaller these particles are, the more hazardous they become. Previous studies have linked the exposure to PM2.5 with cardiovascular and blood pressure alterations. Objective: The goal of this study is to measure the association between the exposure to PM2.5 and an increased blood pressure at an individual level, before and after adjusting for comorbidities. Additionally, the strength of this association by socioeconomical status will be evaluated. Study design: We present a prospective cohort study considering a continuous measure of exposure to PM2.5 particles. Participants: This study will require the participation of the Primary Healthcare Centres users in the city of Barcelona (Spain) who meet the inclusion criteria and none of the exclusion ones. The final n will be 462. Methodology: For 8 months, 24-hour data of blood pressure registers and the same period pollution exposure will be collected by an ABPM and a relatively new machine, the UPAS monitor. 24-hour, the diurnal and the nocturnal average blood pressures (systolic and diastolic) and other blood pressure variations will be considered the outcomes. Total PM2.5 exposure during the 24 hours will be used as the exposure variable. Other confounding factors such as age, sex, ethnicities comorbidities and socioeconomical status will be included in the analyses

High blood pressure is a clearly established modifiable risk factor for cardiovascular and renal disease. Although most of its adverse effects develop in adulthood, it has become clear that high BP is a lifelong problem that can manifest early in life. While few would dispute the importance of taking effective steps to identify and manage this condition in middle-aged and elderly individuals, relatively little attention has been paid to the problem of high BP in children and adolescents. Therefore, the development of actions focused on early childhood, childhood and adolescence and the investigation of the underlying causes of this epidemic are of utmost importance. There is a pressing need for comprehensive pan-European action to increase the knowledge on the prevention, diagnosis and treatment of high blood pressure in children and adolescents, the current scarcity of which impedes the development of consensus across different research fields and hinders efforts to introduce changes in clinical practice. There are some aspects that demand urgent action: the definition of hypertension, the prevalence of high BP in Europe, accurate measurement for early identification, the assessment of hypertension-mediated organ damage and the development and implementation of prevention strategies. In order to provide answers to all of these unanswered questions and challenges, a multidisciplinary network was established, maintained and funded by the European Cooperation in Science and Technology (COST) Association. COST is a funding organization for the creation of research networks known as COST Actions. In this case, the network will promote coordinated and collaborative activities on personalized preventive measures for children and adolescents across Europe.

INTRODUCCIÓN: La presión venosa central se ha recomendado durante mucho tiempo como parámetro estimador de las necesidades de fluidoterapia. Estudios recientes han puesto en duda la capacidad de este parámetro proponiendo otros nuevos más precisos. Igual que proponen, otras estrategias de fluidoterapia para evitar la sobrecarga de volumen que ha demostrado ser altamente perjudicial para el paciente crítico. OBJETIVO: Revisar la efectividad de la presión venosa central como parámetro para guiar la fluidoterapia en pacientes críticos con compromiso hemodinámico. METODOLOGÍA: Se ha realizado una revisión sistematizada con 11 búsquedas bibliográficas en 5 bases de datos distintas (Pubmed, Cochrane, Cinhal, ScienceDirect y Scopus) entre diciembre 2019 y abril de 2020. Se han incluido un total de 8 estudios, que han sido evaluados metodológicamente mediante CASPe. RESULTADOS: La PVC presenta mayor mortalidad, duración de la VM, y balance de volumen mayor respecto a otras variables. Existe controversia respecto a los días de ingreso en UCI y a la cantidad de volumen administrado. Los parámetros dinámicos presentan mayores beneficios en estos aspectos. La mayoría de los estudios otorgan valores predictivos pobres para la PVC con AUC 0.90 en varios estudios. CONCLUSIONES: En la línea de los resultados de otros autores, la PVC es un parámetro estático con una capacidad de respuesta de fluidos cuestionable con mayores riesgos frente a otras variables como las dinámicas. Según la evidencia los parámetros dinámicos son mejores predictores de la respuesta a la fluidoterapia por relacionarse mejor con el volumen sanguíneo. INTRODUCTION: Central venous pressure has been recommended for a long time to estimate fluid therapy needs. Recent studies have questioned this parameter proposing new more accurate. They propose other fluids therapies to avoid volume overload, which has been shown to be highly injurious to critically ill patient. OBJECTIVE: To review in current bibliography the effectivity to CVP like a parameter to guide the fluid therapy in critically ill patients. METHODS: It has been a systematic review with eleven searches in five different data bases (Pubmed, Cochrane, Cinhal, Science Direct and Scopus) between December 2019 and april 2020. It has been include eight studies which have been methodologically analyse by CASPe. OUTCOMES: The CVP presents major mortality, days of MV and volume balance regarding other parameters. There is controversy about the length ICU and amount of volume administrated. Dynamic parameters have more advantage in these aspects. Many studies have poor predictive values for CVP with AUC 0.90 in many studies. CONCLUSIONS: In conclusion, like other authors, the CVP is a static parameter with a questionable fluid responsiveness with high risk regarding to dynamic parameters. According to evidence dynamic parameters are better predictors of fluid responsiveness because have better relationship with blood volume. INTRODUCCIÓ: La pressió venosa central s’ha recomanat molt de temps com paràmetre estimador de les necessitats de fluïdoteràpia. Estudis recents han posat en dubte la capacitat d’aquest paràmetre proposant d’altres més precisos. També proposen altres estratègies de fluïdoteràpia per evitar la sobrecarrega de volum, que ha demostrat ser altament perjudicial per el pacient crític. OBJECTIU: Revisar l’efectivitat de la pressió venosa central com paràmetre per guiar la fluïdoteràpia en pacients crítics amb compromís hemodinàmic. METODOLOGÍA: S’ha realitzat una revisió sistemàtica. S’han portat a terme 11 cerques bibliogràfiques a 5 bases de dades diferents (Pubmed, Cochrane, Cinhal, Science Direct i Scopus) entre desembre de 2019 i abril de 2020. S’han inclòs un total de 8 estudis que han sigut avaluats metodològicament mitjançant l’escala CASPe. RESULTATS: La PVC presenta major mortalitat, duració de la VM i un balanç de volum major en vers a unes altres variables. Existeix controvèrsia respecte als dies d’ingrés a la UCI i a la quantitat de volum administrat. Els paràmetres dinàmics presenten majors beneficis en aquests aspectes. La majoria d’estudis donen valors predictius pobres per la PVC amb AUC 0.90 en diferents estudis. CONCLUSIONS: En la línia dels resultats d’altres autors, la PVC es un paràmetre estàtic amb una capacitat de resposta de fluids qüestionable amb elevat risc en vers a altres variables com les dinàmiques. Segons l’evidència, aquests són millors predictors de la resposta a la fluïdoteràpia ja que se relacionen millor amb el volum sanguini.

Resumen La hipertension arterial es un factor de riesgo cardiovascular y renal modificable. Aunque la mayoria de los resultados adversos ocurren en la edad adulta, la hipertension arterial puede estar presente en etapas tempranas de la vida. Mientras pocos cuestionan la importancia de implementar medidas para identificar y manejar esta afeccion en personas adultas, se ha prestado relativamente poca atencion al problema de la hipertension arterial en ninos y adolescentes. Conocer los origenes de la hipertension arterial es un tema que cada vez esta mas presente en los foros de debate. En este sentido, es absoluta la necesidad de una accion paneuropea con el fin de profundizar en los conocimientos sobre la prevencion, el diagnostico y el tratamiento de la hipertension arterial en ninos y adolescentes. En particular, existen algunas areas urgentes de intervencion tales como la definicion de hipertension, su prevalencia en Europa, la medicion precisa para la identificacion temprana de valores anormales, la evaluacion del dano organico mediado por la hipertension y como llevar a cabo estrategias de prevencion. Con el fin de proporcionar respuestas a todas estas preguntas, la Comision Europea ha aprobado y financiado una Asociacion de Cooperacion Europea en Ciencia y Tecnologia (COST). La COST financia la creacion de redes de investigacion, que en nuestro caso promoveran actividades coordinadas y colaborativas sobre los problemas que presenta la hipertension arterial en ninos y adolescentes.

Aims: To determine whether there are differences in blood pressure profile on dynamic assessment by ambulatory blood pressure monitoring (ABPM) according to serum sodium levels in stable heart failure patients. Methods: Data were collected from the Spanish National Registry on Ambulatory Blood Pressure Monitoring in Heart Failure (DICUMAP). Patients underwent ABPM by the oscillometric principle using a Spacelabs 90121 monitor. The sample was divided into three groups according to sodium levels and their clinical and laboratory data and echocardiographic findings were analyzed. Robust statistical methods were used to compare the groups in univariate and multivariate models. Results: A total of 175 patients (44.57% male) were analyzed. We found a predominance of anomalous circadian blood pressure profiles in all three groups, with a significantly higher percentage of risers in the lowest serum sodium group (p=0.05). In addition, in this group there were significant differences in mean 24-hour systolic blood pressure (SBP) (24-h SBP, p=0.05) and in mean daytime SBP (dSBP, p=0.008), with significant differences in nocturnal fall in SBP (p=0.05) and in diastolic blood pressure (p=0.005). In multivariate analysis a significant relationship was found between sodium levels and 24-h SBP (OR 0.97, 95% CI 0.95-0.99, p=0.01) and dSBP (OR 0.96, 95% CI 0.94-0.99, p=0.004). Conclusion: A relationship was found between lower sodium levels and lower systolic blood pressure, especially during waking hours, with a lower decline between daytime and night-time blood pressure. Resumo: Objetivos: Determinar se existem diferenças no perfil da pressão arterial, através da monitorização da pressão ambulatória da pressão arterial como método de avaliação dinâmica nos doentes estáveis com insuficiência cardíaca, dependendo dos níveis de sódio sérico. Métodos: Os dados do doente foram obtidos do Registo Nacional Espanhol para Insuficiência Cardíaca e Medição Ambulatória da Pressão Arterial. Submeteram-se à monitorização ambulatória da pressão arterial através do princípio oscilométrico, utilizando um monitor Spacelabs 90121. Dividimos a amostra em três grupos de acordo com os níveis de sódio e analisámos os dados clínicos e laboratoriais, bem como os achados ecocardiográficos. Utilizámos metodologia estatística consistente para comparar os grupos em modelos univariados e multivariados. Resultados: Foram analisados 175 doentes (44,57%). Relativamente à pressão arterial, constatámos a predominância do perfil circadiano anómalo nos três grupos, com uma percentagem significativa mais elevada de um perfil de elevação no grupo com sódio sérico mais baixo (p=0,05). Além disso, constatámos neste grupo diferenças significativas nos valores médios da pressão arterial sistólica em 24 h (PAS24 h, p=0,05) e nos valores médios da pressão arterial sistólica durante período vígil (PASd, p=0,008), com uma diferença significativa na descida noturna da PAS (p=0,05) e da pressão arterial diastólica (p=0,005). Numa análise multivariada ajustada, constatámos uma relação significativa entre os níveis de sódio e a PAS24 h (OR 0,97, IC 95% 0,95-0,99, p=0,01) e a PASd (OR 0,96, IC 95% 0,94-0,99, p=0,004). Conclusão: Constatámos uma relação entre os níveis mais baixos de sódio e a PAS mais baixa, especialmente durante o período vígil, com uma descida decrescente entre a pressão arterial diurna e noturna. Keywords: Heart failure, Sodium, Ambulatory blood pressure monitoring, Palavras-chave: Insuficiência cardíaca, Sódio, Monitorização ambulatória da pressão arterial

Treballs Finals de Grau de Farmàcia, Facultat de Farmàcia i Ciències de l'Alimentació, Universitat de Barcelona, 2019. Tutor/a: M. Emília Juan i Olivé, Blood pressure (BP) is the hydrostatic force exerted by the blood pushing against the wall of blood vessels as it is pumped by the heart. Hypertension is a chronic progressive disorder in which BP is persistently increased above the considered normal values. This medical condition represents a major risk factor for cardiovascular disease as well as for renal events. It is estimated that hypertension affects one billion people globally, accounting for 9.4 million deaths each year. The aetiology of hypertension is the result of a complex interaction between environmental and pathological factors affecting different systems, along with genetic predisposition. Accurate blood pressure readings are essential for its proper diagnosis and treatment. Lifestyle modifications, including healthy dietary patterns and regular physical activity, play a key role in the prevention of hypertension. The Mediterranean diet has been reported to exert health benefits such as reduced chronic diseases incidence and longer life expectancy. These beneficial effects have been attributed, in part, to olive oil consumption. The olive tree (Olea europaea L.), a typical tree crop from the Mediterranean Basis, has been used in traditional medicine since antient times for its biological and pharmacological properties. In this review, preclinical studies and nutritional interventions in humans assessing the effects of bioactive compounds of Olea europaea L. on BP with potent use in the prevention or treatment of hypertension, have been summarized.

Background: Modern clinical environments are laden with technology devices continuously gathering physiological data from patients. This is especially true in critical care environments, where life-saving decisions may have to be made on the basis of signals from monitoring devices. Hemodynamic monitoring is essential in dialysis, surgery, and in critically ill patients. For the most severe patients, blood pressure is normally assessed through a catheter, which is an invasive procedure that may result in adverse effects. Blood pressure can also be monitored noninvasively through different methods and these data can be used for the continuous assessment of pressure using machine learning methods. Previous studies have found pulse transit time to be related to blood pressure. In this short paper, we propose to study the feasibility of implementing a data-driven model based on restricted Boltzmann machine artificial neural networks, delivering a first proof of concept for the validity and viability of a method for blood pressure prediction based on these models. Summary and Key Messages: For the most severe patients (e.g., dialysis, surgery, and the critically ill), blood pressure is normally assessed through invasive catheters. Alternatively, noninvasive methods have also been developed for its monitorization. Data obtained from noninvasive measurements can be used for the continuous assessment of pressure using machine learning methods. In this study, a restricted Boltzmann machine artificial neural network is used to present a first proof of concept for the validity and viability of a method for blood pressure prediction.

Background: Systolic blood pressure (SBP) is an acknowledged prognostic factor in patients with heart failure (HF). Admission SBP should be a risk factor for 1-year mortality even in elderly patients experiencing a first admission for HF, and this risk may persist in the oldest subset of patients. Design: Methods: We reviewed the medical records of 1031 patients aged 70 years or older admitted within a 3-year period for a first episode of acute heart failure (AHF). The cohort was divided according to admission SBP values in quartiles. We analyzed all-cause mortality as a function of these admission SBP quartiles. Results: Mean age was 82.2 ± 6 years; their mean admission SBP was 138.6 ± 25 mmHg. A statistically significant association was present between mortality at 30 (p < 0.0001), 90 (p < 0.0001), and 365 days (p < 0.0001) after hospital discharge and lower admission SBP quartiles. One-year mortality ranged from 14.7% for patients within the upper SBP quartile to 41.4% for those in the lowest quartile. The multivariate analysis confirmed this association (HR: 0.884; 95% CI: 0.615-0.76; p = 0.0001), which remained significant when admission SBP was evaluated as a continuous variable (HR: 0.980; 95% CI: 0.975-0.985; p = 0.0001). The association between SBP and 1-year mortality remained when the sample was divided into old (70-82 years) and "oldest-old" (>82 years) patients. Conclusions: Lower SBP at admission is an independent predictor of midterm postdischarge mortality for elderly patients experiencing a first admission for AHF.

This study aimed to investigate whether different levels of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) in prediabetes are associated with hyperfiltration. Methods A prospective cohort of 2,022 individuals aged 30–74 years took part in the PREDAPS Study. One cohort of 1,184 participants with prediabetes and another cohort of 838 participants with normal FPG and normal HbA1c were followed for 5 years. Hyperfiltration was defined as an estimated glomerular filtration rate (eGFR) above the age- and gender-specific 95th percentile for healthy control participants, while hypofiltration was defined as an eGFR below the 5th percentile. The prevalence of hyperfiltration was compared for different levels of prediabetes: level 1 of prediabetes: FPG

Introduction Masked uncontrolled hypertension (MUCH) carries an increased risk of cardiovascular (CV) complications and can be identified through combined use of office (O) and ambulatory (A) blood pressure (BP) monitoring (M) in treated patients. However, it is still debated whether the information carried by ABPM should be considered for MUCH management. Aim of the MASked-unconTrolled hypERtension management based on OBP or on ambulatory blood pressure measurement (MASTER) Study is to assess the impact on outcome of MUCH management based on OBPM or ABPM. Methods and analysis MASTER is a 4-year prospective, randomised, open-label, blinded-endpoint investigation. A total of 1240 treated hypertensive patients from about 40 secondary care clinical centres worldwide will be included -upon confirming presence of MUCH (repeated on treatment OBP

We have recently shown that type of supplemented simple sugar, not merely calorie intake, determines adverse effects on metabolism and aortic endothelial function in female rats. The aim of the current study was to investigate and compare the effects of high consumption of glucose or fructose on mesenteric arterial reactivity and systolic blood pressure (SBP). Sprague-Dawley female rats were supplemented with 20% w/v glucose or fructose in drinking water for 8 weeks. Here, we show that both sugars alter insulin signaling in mesenteric arteries (MA), assessed by a reduction in phosphorylated Akt, and increase in SBP. Furthermore, ingestion of glucose or fructose enhances inducible nitric oxide synthase (iNOS) expression and contractile responses to endothelin and phenylephrine in MA of rats. The endothelium-dependent vasodilation to acetylcholine and bradykinin as well as the relaxation responses to the nitric oxide donor sodium nitroprusside are impaired in MA of fructose- but not glucose-supplemented rats. In contrast, only glucose supplementation increases the expression of phosphorylated endothelial NOS (eNOS) in MA of rats. In conclusion, this study reveals that supplementation with fructose or glucose in liquid form enhances vasocontractile responses and increases iNOS expression in MA, effects which are accompanied by increased SBP in those groups. On the other hand, the preserved vasodilatory responses in MA from glucose-supplemented rats could be attributed to the enhanced level of phosphorylated eNOS expression in this group. Keywords: Rat mesenteric arteries; Fructose; Glucose; Endothelial dysfunction; Blood pressure

Background: Insulin-like growth factor-I (IGF-I) is a relevant hormone in growth regulation. However, dysregulation of IGF-I is also implicated in pathologic states, such as cardiovascular diseases (CVD). CVDs are the main cause of death globally. Subclinical CVD has its roots in childhood. It has been demonstrated that high blood pressure (BP) in childhood correlates with higher BP in adulthood and the onset of hypertension and metabolic syndrome. Elevated BP is therefore a major modifiable risk factor for CVD. Justification: Interventions related to CVD prevention and health promotion are needed, especially in paediatric population. There are conflicting data on published studies defining the association between IGF-I levels and the cardiovascular system. Furthermore, there is a lack of studies reviewing this association in the general paediatric population. Additional knowledge is needed to understand the pathophysiologic mechanisms of IGF-I involved in CVD, which may allow us to perform an early CV risk assessment as well as to apply prevention interventions in those patients at higher risk. Objectives: The aim of this study is to analyse the association of IGF-I serum concentrations with blood pressure in a population of apparently healthy children. Both cross-sectional associations (studies at baseline and at follow-up) as well as predictive associations (longitudinal analysis) will be sought. Other associations, as well as possible interactions, between IGF-I and CV risk factors (waist, insulin, insulin resistance, triacylglycerol, high-density lipoprotein cholesterol and carotid intima-media thickness) will be also studied. Methods: This is an observational prospective, population-based study of a cohort of apparently healthy children in Girona. A target population of 528 children (mean age 8.8 years) were studied; a total of 158 of such children were re-studied after a 4-year period of follow-up (mean age 12.8 years). Data have been extracted from a database compiled between 2011 and 2017. Data analyses have been performed for all the studied subjects and in subgroups thereof defined by tertiles of serum levels of phosphate and calcium (PxCa product), as higher concentrations of these mineral have been associated with increased risk for CVD. Results: Basal study (cross-sectional associations at baseline): IGF-I was associated with all the studied variables (age, weight, height, BMI, waist, SBP, DBP, PP, log10 HOMA-IR, log10 triacylglycerol, HDL-cholesterol, carotid IMT), all p

We aimed to evaluate the association of aortic and brachial short-term blood pressure variability (BPV) with the presence of target organ damage (TOD) in hypertensive patients. One-hundred seventy-eight patients, aged 57 +/- 12years, 33% women were studied. TOD was defined by the presence of left ventricular hypertrophy on echocardiogram, microalbuminuria, reduced glomerular filtration rate, or increased aortic pulse wave velocity. Aortic and brachial BPV was assessed by 24-hour ambulatory BP monitoring (Mobil-O-Graph). TOD was present in 92 patients (51.7%). Compared to those without evidence of TOD, they had increased night-to-day ratios of systolic and diastolic BP (both aortic and brachial) and heart rate. They also had significant increased systolic BPV, as measured by both aortic and brachial daytime and 24-hours standard deviations and coefficients of variation, as well as for average real variability. Circadian patterns and short-term variability measures were very similar for aortic and brachial BP. We conclude that BPV is increased in hypertensive-related TOD. Aortic BPV does not add relevant information in comparison to brachial BPV.

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

BACKGROUND: Evidence for the influence of ambulatory blood pressure on prognosis derives mainly from population-based studies and a few relatively small clinical investigations. This study examined the associations of blood pressure measured in the clinic (clinic blood pressure) and 24-hour ambulatory blood pressure with all-cause and cardiovascular mortality in a large cohort of patients in primary care. METHODS: We analyzed data from a registry-based, multicenter, national cohort that included 63,910 adults recruited from 2004 through 2014 in Spain. Clinic and 24-hour ambulatory blood-pressure data were examined in the following categories: sustained hypertension (elevated clinic and elevated 24-hour ambulatory blood pressure), "white-coat" hypertension (elevated clinic and normal 24-hour ambulatory blood pressure), masked hypertension (normal clinic and elevated 24-hour ambulatory blood pressure), and normotension (normal clinic and normal 24-hour ambulatory blood pressure). Analyses were conducted with Cox regression models, adjusted for clinic and 24-hour ambulatory blood pressures and for confounders. RESULTS: During a median follow-up of 4.7 years, 3808 patients died from any cause, and 1295 of these patients died from cardiovascular causes. In a model that included both 24-hour and clinic measurements, 24-hour systolic pressure was more strongly associated with all-cause mortality (hazard ratio, 1.58 per 1-SD increase in pressure; 95% confidence interval [CI], 1.56 to 1.60, after adjustment for clinic blood pressure) than the clinic systolic pressure (hazard ratio, 1.02; 95% CI, 1.00 to 1.04, after adjustment for 24-hour blood pressure). Corresponding hazard ratios per 1-SD increase in pressure were 1.55 (95% CI, 1.53 to 1.57, after adjustment for clinic and daytime blood pressures) for nighttime ambulatory systolic pressure and 1.54 (95% CI, 1.52 to 1.56, after adjustment for clinic and nighttime blood pressures) for daytime ambulatory systolic pressure. These relationships were consistent across subgroups of age, sex, and status with respect to obesity, diabetes, cardiovascular disease, and antihypertensive treatment. Masked hypertension was more strongly associated with all-cause mortality (hazard ratio, 2.83; 95% CI, 2.12 to 3.79) than sustained hypertension (hazard ratio, 1.80; 95% CI, 1.41 to 2.31) or white-coat hypertension (hazard ratio, 1.79; 95% CI, 1.38 to 2.32). Results for cardiovascular mortality were similar to those for all-cause mortality. CONCLUSIONS: Ambulatory blood-pressure measurements were a stronger predictor of all-cause and cardiovascular mortality than clinic blood-pressure measurements. White-coat hypertension was not benign, and masked hypertension was associated with a greater risk of death than sustained hypertension. (Funded by the Spanish Society of Hypertension and others.). Sin financiación 70.670 JCR (2018) Q1, 1/160 Medicine, General & Internal 19.524 SJR (2018) Q1, 3/2844 Medicine (miscellaneous) No data IDR 2018 UEM

Background Few data exist on factors associated with hypertension (HTN) remission post-bariatric surgery. No information on factors that may predict HTN relapse is available. The aims were to assess the HTN remission and relapse rates at 1 and 3 years, respectively, post-bariatric surgery, and determine predictive factors. Methods A nonrandomized prospective cohort study on severely obese patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) with a follow-up of 36 months was conducted between 2005 and 2011. Criteria for HTN diagnosis were current treatment with antihypertensive agents and/or systolic blood pressure (BP) >140 mm Hg and/or diastolic BP >90 mm Hg. HTN remission was defined as normalization of BP maintained after discontinuation of medical treatment. Results A total of 197 patients were included in the study. HTN was present in 47.7%; 68.1% of hypertensive patients showed HTN remission 1 year after the surgical procedure, 21.9% of whom had relapsed at 3 years. The number of antihypertensive drugs prior to surgery was associated with a lower remission rate at the first year and a higher recurrence at 3 years. However, a smaller weight loss during the first year was associated with increased HTN recurrence at 3 years. Conclusion HTN relapses in 1 of 5 hypertensives who have achieved remission at the first year of follow-up. Weight loss during the first postoperative year should be encouraged to avoid HTN relapse at 3 years.

Tutor: Jordi Bosch Garcia Treball de fi de grau en Biomèdica In this final project, a business model of a mobile application that helps to control the arterial hypertension (a chronic disease that unfortunately affects between 16 % and 37 % of the world population) is presented in order to assess if it is viable or not the creation of the company. It will be a cooperative set up in Catalonia, an area of international recognition, very well connected, with high entrepreneurship and where there also are many research centres, hospitals and technological and health companies). Under the name Ctenso this app will offer a careful control of the diet, physical exercise, medication, weight and tension of the patients. It will be accessible for Android and iOS and a premium service with remainders, graphs and the possibility to export the data to the doctors via e-mail in PDF format will be available too. Despite the competition, it seems that this mobile application could be successful due to the presence of certain interesting advantages. Moreover, the legalization as well as all the material, staff, tools, methods and techniques (such as the marketing ones) that will be required to go ahead with this project will be examined and a mock up design will be done in order to show the final result of the app. Finally, it is possible to conclude that the business is financially viable since there are benefits from the third year on, and therefore it is possible to set up this company.

9 Páginas; 2 Tablas; 3 Figuras. Publicado online : 08 October 2015, Purpose Serum nitric oxide (NO) reduction and increased endothelin-1 (ET-1) play a pivotal role in endothelial dysfunction and hypertension. Considering that traditional Mediterranean diet (TMD) reduces blood pressure (BP), the aim of this study was to analyze whether TMD induced changes on endothelial physiology elements such as NO, ET-1 and ET-1 receptors which are involved in BP control. Methods Non-smoking women with moderate hypertension were submitted for 1 year to interventions promoting adherence to the TMD, one supplemented with extra virgin olive oil (EVOO) and the other with nuts versus a control low-fat diet (30 participants/group). BP, NO, ET-1 and related gene expression as well as oxidative stress biomarkers were measured. Results Serum NO and systolic BP (SBP) or diastolic BP (DBP) were negatively associated at baseline, as well as between NO and ET-1. Our findings also showed a DBP reduction with both interventions. A negative correlation was observed between changes in NO metabolites concentration and SBP or DBP after the intervention with TMD + EVOO (p = 0.033 and p = 0.044, respectively). SBP reduction was related to an impairment of serum ET-1 concentrations after the intervention with TMD + nuts (p = 0.008). We also observed changes in eNOS, caveolin 2 and ET-1 receptors gene expression which are related to NO metabolites levels and BP. Conclusions The changes in NO and ET-1 as well as ET-1 receptors gene expression explain, at least partially, the effect of EVOO or nuts on lowering BP among hypertensive women., The authors thank the participants in the PREDIMED study for their continued collaboration. The Fundación Patrimonio Comunal Olivarero, Hojiblanca SA (Málaga, Spain), California Walnut Commission (Sacramento, CA, USA), Borges SA (Reus, Spain) and Morella Nuts SA (Reus, Spain) donated the olive oil, walnuts, almonds and hazelnuts, respectively. We also thank the Scientific and Technical services of the University of Barcelona for malondialdehyde determinations. This study was supported by the Spanish Ministry of Health (FIS PI10/0082, G03/140, RD06/0045), Fondo Europeo de Desarrollo Regional, the Spanish Ministry of Science (BFU2007-61727/BFI) and the Generalitat de Catalunya (2009SGR00438).

IMPORTANCE Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. OBJECTIVE To estimate the association between SBP of at least 110 to 115 mm Hg and SBP of 140 mm Hg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015. DESIGN A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis. MAIN OUTCOMES AND MEASURES Mean SBP level, cause-specific deaths, and health burden related to SBP (>110-115mmHg and also >= 140 mm Hg) by age, sex, country, and year. RESULTS Between 1990-2015, the rate of SBP of at least 110 to 115 mm Hg increased from 73 119 (95% uncertainty interval [UI], 67 949-78 241) to 81 373 (95% UI, 76 814-85 770) per 100000, and SBP of 140 mm Hg or higher increased from 17 307 (95% UI, 17 117-17 492) to 20526 (95% UI, 20283-20746) per 100000. The estimated annual death rate per 100000 associated with SBP of at least 110 to 115 mm Hg increased from 135.6 (95% UI, 122.4-148.1) to 145.2 (95% UI 130.3-159.9) and the rate for SBP of 140 mm Hg or higher increased from 97.9 (95% UI, 87.5-108.1) to 106.3 (95% UI, 94.6-118.1). Loss of disability-adjusted life-years (DALYs) associated with SBP of at least 110 to 115 mm Hg increased from 148 million (95% UI, 134-162 million) to 211 million (95% UI, 193-231 million), and for SBP of 140 mm Hg or higher, the loss increased from 5.2 million (95% UI, 4.6-5.7 million) to 7.8 million (95% UI, 7.0-8.7 million). The largest numbers of SBP-related deathswere caused by ischemic heart disease (4.9 million [95% UI, 4.0-5.7 million]; 54.5%), hemorrhagic stroke (2.0million [95% UI, 1.6-2.3 million]; 58.3%), and ischemic stroke (1.5 million [95% UI, 1.2-1.8 million]; 50.0%). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the global DALYs related to SBP of at least 110 to 115 mm Hg. CONCLUSIONS AND RELEVANCE In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (>= 110-115 and >= 140 mm Hg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this sample suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115 mm Hg and 874 million adults had SBP of 140 mm Hg or higher. Copyright 2016 American Medical Association. All rights reserved.

BACKGROUND: Dental consultation may provoke stress to the patient, especially when a dental surgery is going to be performed, stressful situations can cause a reaction in the sympathetic nervous system that could lead to cardiovascular alterations. Blood pressure and cardiac frequency are used often as an indirect measurement and this parameters combined can serve as good indicators of stress. Objective: Analyze the changes in vital signs and analytical parameters induced by a dental extraction. MATERIAL AND METHODS: 24 healthy patients who required a simple dental extraction underwent to a blood test and motorization of their pre- and post-extraction vital signs before, at 2 and 48 hours after the procedure. Data analysis was performed by means of repeated measures one way ANOVA followed by multiple comparisons Bonferroni's Post-hoc test. RESULTS: The evaluated patients were 13 women and 11 men with an average age of 35.1. Thirteen patients (54.17% of the sample) were smokers and five were regular drinkers (20.8%). No significant differences were observed in the vital signs with the exception of diastolic blood pressure and cardiac rate that were slightly lower after extraction. Only two analytical parameters showed statistical significant changes. Total bilirubin was significantly higher at 48 hours after extraction and leukocyte count was significantly lower at this time. In any case, the magnitude of the changes observed was very low. The analytical parameters and the vital signs did not show any relevant change. CONCLUSIONS: Eventual alterations found after simple tooth extraction should not be attributed to the procedure. Key words:Blood pressure, heart rate, monitoring physiologic, oxygen saturation, tooth extraction.

El objetivo de este trabajo es el estudio in silico de la posibilidad de obtener cerveza que contenga péptidos inhibidores de la enzima convertidora de angiotensina (ACE). Dado que esta enzima está involucrada en el aumento de la presión sanguínea, el objetivo final es la producción de un producto bioactivo que ayude a regular la presión sanguínea de personas que sufran hipertensión. The aim of this work is the in silico study of the possibility of obtaining beer containing peptides ACE inhibitor (ACE). Since this enzyme is involved in the increase in blood pressure, the ultimate goal is the production of a bioactive product that helps regulate blood pressure of people suffering hypertension. L'objectiu d'aquest treball és l'estudi in silico de la possibilitat d'obtenir cervesa que contingui pèptids inhibidors de l'enzim convertidor d'angiotensina (ACE). Atès que aquest enzim està involucrada en l'augment de la pressió sanguínia, l'objectiu final és la producció d'un producte bioactiu que ajudi a regular la pressió sanguínia de persones que pateixin hipertensió.

Background and Objective Twenty per cent of chronic obstructive pulmonary disease (COPD) patients are readmitted for acute exacerbation (AECOPD) within 30 days of discharge. The prognostic significance of early readmission is not fully understood. The objective of our study was to estimate the mortality risk associated with readmission for acute exacerbation within 30 days of discharge in COPD patients. Methods The cohort (n = 378) was divided into patients readmitted (n = 68) and not readmitted (n = 310) within 30 days of discharge. Clinical, laboratory, microbiological, and severity data were evaluated at admission and during hospital stay, and mortality data were recorded at four time points during follow-up: 30 days, 6 months, 1 year and 3 years. Results Patients readmitted within 30 days had poorer lung function, worse dyspnea perception and higher clinical severity. Two or more prior AECOPD (HR, 2.47; 95% CI, 1.51–4.05) was the only variable independently associated with 30-day readmission. The mortality risk during the follow-up period showed a progressive increase in patients readmitted within 30 days in comparison to patients not readmitted; moreover, 30-day readmission was an independent risk factor for mortality at 1 year (HR, 2.48; 95% CI, 1.10–5.59). In patients readmitted within 30 days, the estimated absolute increase in the mortality risk was 4% at 30 days (number needed to harm NNH, 25), 17% at 6-months (NNH, 6), 19% at 1-year (NNH, 6) and 24% at 3 years (NNH, 5). Conclusion In conclusion a readmission for AECOPD within 30 days is associated with a progressive increased long-term risk of death.

AIM. To evaluate the effects of asymmetric dimethylarginine (ADMA) in renal arteries from portal hypertensive and cirrhotic rats. METHODS. Rat renal arteries from Sham (n = 15), pre-hepatic portal hypertension (PPVL; n = 15) and bile duct ligation and excision-induced cirrhosis (BDL; n = 15) were precontracted with norepinephrine, and additional contractions were induced with ADMA (10-6-10-3 mol/L), an endogenous inhibitor of nitric oxide (NO) synthase. Concentration-response curves to acetylcholine (1 × 10-9-3 × 10-6 mol/L) were determined in precontracted renal artery segments with norepinephrine in the absence and in the presence of ADMA. Kidneys were collected to determine the protein expression and activity of dimethylarginine dimethylaminohydrolase (DDAH), an enzyme that catabolizes ADMA. RESULTS. In renal arteries precontracted with norepinephrine, ADMA caused endothelium-dependent contractions. The pD2 values to ADMA were similar in the Sham and PPVL groups (4.20 ± 0.08 and 4.11 ± 0.09, P > 0.05, respectively), but were lower than those of the BDL group (4.79 ± 0.16, P < 0.05). Acetylcholine-induced endothelium-dependent relaxation that did not differ, in terms of pD2 and maximal relaxation, among the 3 groups studied. Treatment with ADMA (3 × 10-4 mol/L) inhibited acetylcholine-induced relaxation in the 3 groups, but the inhibition was higher (P < 0.05) in the BDL group compared with that for the Sham and PPVL groups. The mRNA and protein expression of DDAH-1 were similar in kidneys from the three groups. Conversely, DDAH-2 expression was increased (P < 0.05) in PPVL and further enhanced (P < 0.05) in the BDL group. However, renal DDAH activity was significantly decreased in the BDL group. CONCLUSION. Cirrhosis increased the inhibitory effect of ADMA on basal- and induced-release of NO in renal arteries, and decreased DDAH activity in the kidney.

[spa] La Hipertensión arterial (HTA) sigue siendo el principal factor de riesgo implicado en el desarrollo de enfermedad coronaria, insuficiencia cardíaca congestiva, accidente cerebrovascular y enfermedad renal. Su prevalencia sigue aumentando exponencialmente debido a una mejor detección y un aumento de otros factores asociados como la obesidad, la inactividad física o la diabetes mellitus. Datos recientes estiman que la prevalencia de HTA aumentará al 37,3 % en 2030, extendiendo esta tendencia, incluso a países que tradicionalmente tienen un menor riesgo cardiovascular, como España. Estos datos alertan pues de la magnitud del problema y la necesidad de aumentar los esfuerzos para mejorar el diagnóstico, el tratamiento y, sobre todo, la prevención de la enfermedad hipertensiva. En las últimas décadas se ha incrementado la evidencia que apoya el potencial vasculoprotector de la dieta y sus diferentes nutrientes, siendo cada vez más sólida la evidencia sobre los beneficios de la llamada “Dieta Mediterránea”. La dieta mediterránea (DMed) se caracteriza por un patrón alimentario a base de alto consumo de frutas, verduras y grasas monoinsaturadas, situando al aceite de oliva como principal fuente de grasa. Actualmente el mayor grado de evidencia científica sobre los beneficios de la DMed provienen del estudio PREDIMED. Dicho estudio fue el primer ensayo clínico multicéntrico y aleatorizado que incluyó a 4.774 pacientes con alto riesgo cardiovascular en prevención primaria. Los pacientes fueron asignados a uno de tres grupos de una intervención dietética: DMed suplementadas con aceite de oliva virgen (AOVE), DMed complementa con frutos secos (FS), o una dieta baja en grasas control. Dicho estudio demostró con el máximo nivel de evidencia, que una DM complementado con en AOVE o FS reduce significativamente la incidencia de eventos cardiovasculares mayores, con un CR de 0,70 (95% CI, 0,54 - 0,92) y (IC 95%, 0,54-0,96) 0,72, respectivamente. Sin embargo, la mayor parte de los datos disponibles que evalúan el efecto de la DM sobre la presión arterial (PA) se han basado en la PA clínica, siendo éste un enfoque limitado por la mala reproducibilidad, el efecto de bata blanca así cómo el sesgo del observador y la variabilidad del paciente. La monitorización ambulatoria de la PA (MAPA) de 24 horas se considera el estándar de oro para la evaluación de los efectos de las intervenciones sobre la PA, ya que las mediciones repetidas reflejan con mayor precisión el verdadero valor de la PA, en comparación al valor de la PA clínica. Es por ello que el objetivo de nuestro estudio fue evaluar el efecto de una dieta de la DMed suplementada con AOVE o FS, en comparación con una dieta control baja en grasas, sobre los valores ambulatorios de PA (tanto diurnos como nocturnos) en individuos de alto riesgo cardiovascular, tras un año de intervención dietética, sin modificación de otros parámetros (dietéticos, ejercicio, pérdida de peso, terapia farmacológica antihipertensiva) con un marcado efecto sobre los valores de PA. Los datos de nuestro estudio, enmarcado dentro de la cohorte global del estudio PREDIMED, incluyó 235 sujetos (56,5% mujeres; edad media: 66,5 años) mostraron que la DMed complementada con AOVE o FS comportaban una reducción significativa de los valores ambulatorios de presión sistólica en comparación con una dieta de control en individuos con alto riesgo de enfermedad cardiovascular. Las diferencias netas entre los valores medios de PA ambulatoria entre la DMed suplementada con AOVE y FS y la dieta de control, fueron de -4,0 mmHg y -4.3 mmHG de PA sistólica respectivamente y de -1,9 mm Hg para el componente diastólico ( similar para ambos grupos suplementados frente al grupo control) después del ajuste de entre-dieta desequilibrios en la PA inicial y cambios en la medicación antihipertensiva. Si bien la magnitud del descenso ambulatorio de PA parece pequeña, el impacto podría ser notable a nivel poblacional., [eng] The PREvención con DIeta MEDiterránea (PREDIMED) trial showed that Mediterranean diets (MedDiets) supplemented with either extravirgin olive oil or nuts reduced cardiovascular events, particularly stroke, compared with a control, lower fat diet. The mechanisms of cardiovascular protection remain unclear. We evaluated the 1-year effects of supplemented MedDiets on 24-hour ambulatory blood pressure (BP), blood glucose, and lipids. Randomized, parallel-design, controlled trial was conducted in 2 PREDIMED sites. Diets were ad libitum, and no advice on increasing physical activity or reducing sodium intake was given. Participants were 235 subjects (56.5% women; mean age, 66.5 years) at high cardiovascular risk (85.4% with hypertension). Adjusted changes from baseline in mean systolic BP were −2.3 (95% confidence interval [CI], −4.0 to −0.5) mm Hg and −2.6 (95% CI, −4.3 to −0.9) mm Hg in the MedDiets with olive oil and the MedDiets with nuts,respectively, and 1.7 (95% CI, −0.1 to 3.5) mm Hg in the control group (P

Background: Hypertension and depression are both important risk factors for cardiovascular diseases. Nevertheless, the association of blood pressure on and depression has not been completely established. This study aims to analyze whether depression may influence the control of blood pressure in hypertensive individuals at high cardiovascular risk. Methods: Cross-sectional study, embedded within the PREDIMED clinical trial, of 5954 hypertensive patients with high cardiovascular risk factor profiles. The relationship between blood pressure control and depression was analyzed. A multivariate analysis (logistic and log-linear regression), adjusting for potential confounders (socio-demographic factors, body mass index, lifestyle, diabetes, dyslipidemia, and antihypertensive treatment), was performed. Results: Depressive patients, with and without antidepressant treatment, had better blood pressure control (OR: 1.28, CI 95%: 1.06-1.55, and OR: 1.30, CI 95%: 1.03-1.65, respectively) than non-depressive ones. Regarding blood pressure levels, systolic blood pressure values (mmHg) were found to be lower in both treated and untreated depressive patients (Log coefficient Beta: -1.59, 95% CI: -0.50 to -2.69 and Log coefficient Beta: -3.49, 95% CI: -2.10 to -4.87, respectively). Conclusions: Among hypertensive patients at high cardiovascular risk, the control of blood pressure was better in those diagnosed with depression., This study was 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, RTIC RD 06/0045) and through Centro de Investigacion Biomedica en Red de Fisiopatologia de la Obesidad y Nutricion [CIBERobn]), and by grants from Centro Nacional de Investigaciones Cardiovasculares (CNIC 06/2007), Fondo de Investigacion Sanitaria-Fondo Europeo de Desarrollo Regional (PI04-2239, PI 05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/01407, PI10/02658, PI11/01647, and P11/02505), Ministerio de Ciencia e Innovacion (AGL-200913906-C02 and AGL2010-22319-C03), Fundacion Mapfre 2010, Consejeria de Salud de la Junta de Andalucia (PI0105/2007), Public Health Division of the Department of Health of the Autonomous Government of Catalonia, Generalitat Valenciana (ACOMP06109, GVACOMP2010-181, GVACOMP2011-151, CS2010AP-111, CS2011-AP-042), and Regional Government of Navarra (P27/2011). None of the institutions described above have influenced the design, collection, analysis, and interpretation of data; the writing of the manuscript; and the decision to submit the manuscript for publication.

Some evidence against β-blockers1 has been published in recent years; however, the exclusion of these drugs as initial treatment of uncomplicated hypertension in the report from the panel members appointed to the Eighth Joint National Committee (JNC 8)2 is surprising. First, the evidence against atenolol was presented in only 1 study, the Losartan Intervention for Endpoint Reduction in Hypertension Study (LIFE),3 and the quality of this evidence was classified as weak by the panel. Results from LIFE cannot be extrapolated to the general population because the patients included were a high-risk sample with ventricular hypertrophy by electrocardiography and a high prevalence of diabetes mellitus (13%) and cardiovascular disease (25%). Also, the mean age in LIFE was 66.9 years, and it has been shown that β-blockers can be more effective in patients with hypertension who are younger than 60 years.4 In other studies that analyzed a general population, the performance of β-blockers was similar to that of other drugs or the evidence was not sufficient to draw conclusions.

BACKGROUND: Human evidence on the effects of early life phthalate exposure on obesity and cardiovascular disease risks, reported by experimental studies, is limited to a few cross-sectional studies. OBJECTIVES: We evaluated the associations between prenatal phthalate exposure and childhood growth and blood pressure in a Spanish birth cohort study. METHODS: We assessed exposure using the average of two phthalate metabolite spot-urine concentrations collected from the mothers in the first and third pregnancy trimesters (creatinine-adjusted, n = 391). Study outcomes were the difference in age-and sex-specific z-scores for weight between birth and 6 months of age; and repeated age-and sex-specific z-scores for body mass index (BMI) at 1, 4, and 7 years; waist-to-height ratio at 4 and 7 years; and age-and height-specific z-scores for systolic and diastolic blood pressure at 4 and 7 years. RESULTS: The sum of five high-molecular-weight phthalate metabolites (Sigma HMWPm) was associated with lower weight z-score difference between birth and 6 months (beta per doubling of exposure = -0.41; 95% CI: -0.75, -0.06) and BMI z-scores at later ages in boys (beta = -0.28; 95% CI: -0.60, 0.03) and with higher weight z-score difference (beta = 0.24; 95% CI: -0.16, 0.65) and BMI z-scores in girls (beta = 0.30; 95% CI: -0.04, 0.64) (p for sex interaction = 0.01 and 0.05, respectively). The sum of three low-molecular-weight phthalates (Sigma LMWPm) was not significantly associated with any of the growth outcomes. Sigma HMWPm and Sigma LMWPm were associated with lower systolic blood pressure z-scores in girls but not in boys. CONCLUSIONS: This study suggests that prenatal phthalate exposure may be associated with postnatal growth and blood pressure in a sex-specific manner. Inconsistencies with previous cross-sectional findings highlight the necessity for evaluating phthalate health effects in prospective studies., This study was funded by grants from the RecerCaixa (Register no. 2010ACUP00349), the Instituto Carlos III (Red INMA G03/176, CB06/02/0041 and predoctoral grant PFIS 2010, Register no. FI10/00399), the Spanish Ministry of Health (FIS-PI041436, FIS-PI081151), the Generalitat de Catalunya-CIRIT (1999SGR 00241), and the Fundacio Roger Torne. A full roster of the INMA Project investigators can be found at http://www.proyectoinma.org.

There is a growing interest in accurately measuring the timing of the J peak of the ballistocardiogram (BCG) in order to obtain cardiovascular function markers non-invasively, especially in modern home healthcare applications. In this paper we have studied the effect that some common uncertainty sources have in the time measurement of the J peak. This is a necessary step towards the standardization of modern ballistocardiography systems equivalent to that available for ECG systems. We conclude that, to reduce J peak time uncertainty below the measured intrinsic uncertainty of about ±2 ms, the minimal bandwidth should be from 1.5 Hz to 22.5 Hz; the sampling frequency can be decreased up to 50 Hz when using cubic spline interpolation; 5 bits are required to quantify the signal, and signal-to-noise ratio (SNR) and signal-to-interference ratio (SIR) should be over 40 dB and 3 dB respectively.

SummaryBackgroundLowering of blood pressure prevents stroke but optimum target levels to prevent recurrent stroke are unknown. We investigated the effects of different blood-pressure targets on the rate of recurrent stroke in patients with recent lacunar stroke.MethodsIn this randomised open-label trial, eligible patients lived in North America, Latin America, and Spain and had recent, MRI-defined symptomatic lacunar infarctions. Patients were recruited between March, 2003, and April, 2011, and randomly assigned, according to a two-by-two multifactorial design, to a systolic-blood-pressure target of 130–149 mm Hg or less than 130 mm Hg. The primary endpoint was reduction in all stroke (including ischaemic strokes and intracranial haemorrhages). Analysis was done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT 00059306.Findings3020 enrolled patients, 1519 in the higher-target group and 1501 in the lower-target group, were followed up for a mean of 3·7 (SD 2·0) years. Mean age was 63 (SD 11) years. After 1 year, mean systolic blood pressure was 138 mm Hg (95% CI 137–139) in the higher-target group and 127 mm Hg (95% CI 126–128) in the lower-target group. Non-significant rate reductions were seen for all stroke (hazard ratio 0·81, 95% CI 0·64–1·03, p=0·08), disabling or fatal stroke (0·81, 0·53–1·23, p=0·32), and the composite outcome of myocardial infarction or vascular death (0·84, 0·68–1·04, p=0·32) with the lower target. The rate of intracerebral haemorrhage was reduced significantly (0·37, 0·15–0·95, p=0·03). Treatment-related serious adverse events were infrequent.InterpretationAlthough the reduction in stroke was not significant, our results support that in patients with recent lacunar stroke, the use of a systolic-blood-pressure target of less than 130 mm Hg is likely to be beneficial.FundingNational Institutes of Health-National Institute of Neurological Disorders and Stroke (NIH-NINDS)

[Background]: Hypertension can be prevented by adopting healthy dietary patterns. Our aim was to assess the 4-year effect on blood pressure (BP) control of a randomized feeding trial promoting the traditional Mediterranean dietary pattern., [Methods]: The PREDIMED primary prevention trial is a randomized, single-blinded, controlled trial conducted in Spanish primary healthcare centers. We recruited 7,447 men (aged 55 to 80 years) and women (aged 60 to 80 years) who had high risk for cardiovascular disease. Participants were assigned to a control group or to one of two Mediterranean diets. The control group received education on following a low-fat diet, while the groups on Mediterranean diets received nutritional education and also free foods; either extra virgin olive oil, or nuts. Trained personnel measured participants’ BP at baseline and once yearly during a 4-year follow-up. We used generalized estimating equations to assess the differences between groups during the follow-up., [Results]: The percentage of participants with controlled BP increased in all three intervention groups (P-value for within-group changes: P, [Conclusions]: Both the traditional Mediterranean diet and a low-fat diet exerted beneficial effects on BP and could be part of advice to patients for controlling BP. However, we found lower values of diastolic BP in the two groups promoting the Mediterranean diet with extra virgin olive oil or with nuts than in the control group., This work was 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 Dr Estruch; RTIC RD 06/0045, to Dr 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 (PI04-2239, PI 05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/00802, PI10/01407, PI10/02658, PI11/01647, and P11/02505), Ministerio de Ciencia e Innovación (AGL-2009- 13906-C02 and AGL2010-22319-C03), Fundación Mapfre 2010, Agencia Canaria de Investigación, Innovación y Sociedad de la Información-EU FEDER (PI 2007/050), 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 (ACOM/2012/238, ACOMP06109, GVACOMP2010-181, GVACOMP2011-151, CS2010- AP-111, CS2011-AP-042 ACOMP/2013/159, and ACOMP/213/165), and Regional Government of Navarra (P27/2011). ET is supported by a Rio Hortega post-residency fellowship of the Instituto de Salud Carlos III, Ministry of Economy and Competitiveness, Spanish Government and by the Fundación Mutua Madrileña (Spain).

[Background and aim]: Hypertension is a major public health problem and a leading cause of death and disability in both developed and developing countries, affecting one-quarter of the world's adult population. Our aim was to evaluate whether the consumption of gazpacho, a Mediterranean vegetable-based cold soup rich in phytochemicals, is associated with lower blood pressure (BP) and/or reduced prevalence of hypertension in individuals at high cardiovascular risk., [Methods and results]: We selected 3995 individuals (58% women, mean age 67 y) at high cardiovascular risk (81% hypertensive) recruited into the PREDIMED study. BP, weight, and dietary and physical activity data were collected. In multivariate linear regression analyses, after adjustment, moderate and high gazpacho consumption categories were associated with reduced mean systolic BP of −1.9 mm Hg [95% confidence interval (CI): −3.4; −0.6] and −2.6 mm Hg (CI: −4.2; −1.0), respectively, and reduced diastolic BP of −1.5 mm Hg (CI: −2.3; −0.6) and −1.9 mm Hg (CI: −2.8; −1.1). By multiple-adjusted logistic regression analysis, gazpacho consumption was associated with a lower prevalence of hypertension, with OR = 0.85 (CI: 0.73; 0.99) for each 250 g/week increase and OR = 0.73 (CI: 0.55; 0.98) for high gazpacho consumption groups compared to the no-consumption group., [Conclusions]: Gazpacho consumption was inversely associated with systolic and diastolic BP and prevalence of hypertension in a cross-sectional Mediterranean population at high cardiovascular risk. The association between gazpacho intake and reduction of BP is probably due to synergy among several bioactive compounds present in the vegetable ingredients used to make the recipe., This work was supported by CICYT[AGL2010-22319-C03] and RETICS[RD06/0045] from MICINN.

RATIONALE: Experimental studies have shown a potential blood pressure (BP) lowering effect of red wine polyphenols, whereas the effects of ethanol and polyphenols on BP in humans are not yet clear. OBJECTIVE: The aim of the present work was to evaluate the effects of red wine fractions (alcoholic and nonalcoholic) on BP and plasma nitric oxide (NO) in subjects at high cardiovascular risk. METHODS AND RESULTS: Sixty-seven men at high cardiovascular risk were studied. After a 2-week run-in period, subjects were randomized into 3 treatment periods in a crossover clinical trial, with a common background diet plus red wine (30g alcohol/day), the equivalent amount of dealcoholized red wine, or gin (30g alcohol/day), lasting 4 weeks each intervention. At baseline and after each intervention, anthropometrical parameters, BP and plasma NO were measured. Systolic and diastolic BP decreased significantly after the dealcoholized red wine intervention and these changes correlated with increases in plasma NO. CONCLUSIONS: Dealcoholized red wine decreases systolic and diastolic BP. Our results point out through an NO-mediated mechanism. The daily consumption of dealcoholized red wine could be useful for the prevention of low to moderate hypertension. Trial registered at controlled-trials.com: ISRCTN88720134.

Historical background In 1967 two Australian chest physicians drew attention to the importance of arterial blood gas abnormalities in 12 patients with status asthmaticus (acute severe asthma) and in 64 arterial others with clinically less severe disease.' They documented that in many patients with asthma blood gas abnormalities were commonly present, usually mild to moderate life hypoxaemia. Likewise they outlined that, even when this fall in Pao2 was insufficient to induce threatening hypoxaemia, it rendered patients more vulnerable to effects from any further increase in airways obstruction. Even though there was a correlation between the reduction in forced expiratory volume in one Normal 151.0 E i. 00 0 V .0 C0 ._Servei de Pneumologia i Al.lergia Respiratoria, Hospital Clinic, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain R Rodriguez-Roisin 0-5 0.0 0-60-40.2Chronic severe asthma S second (FEVI) and the extent of arterial blood gas abnormalities, FEVy levels >10 litres were not a reliable predictor of the Pao2.