Search

The study aimed to determine if there is a significant relationship between multiple intelligence and learning. For this reason, the research was carried out in higher education. The type of research is applied, being the level of descriptive and correlational research. The research was cross-sectional; since the survey was carried out only once using the technique of the questionnaire and notes. The sample is simple random 48 students. Naturalistic intelligence was shown to be at the highest level of 3.3750; while interpersonal and emotional is 3.3125, musical is 3.2917; and the lowest is Kinesthetic-Corporal is 3.0833 and the general average is 3.2176. Therefore, multiple intelligences improve student learning; however, it is necessary that teachers take into account in their classes the naturalistic, interpersonal and emotional intelligences are the most representative. It was determined that more than 50% of the respondents are located at 3,0000, since the maximum is five, then it is favorable. Likewise, the most repeated times is 3.00 Likewise, 1.14854 scale units deviate from the average, because it is low it induces less data dispersion. Therefore, it is used in learning the multiple intelligences of the students. Finally, the calculated p value is 0.000, which is less than 0.01 (0.000< 0.001), so the null hypothesis is rejected and the alternative hypothesis is accepted. The rho coefficient is 0.852, which indicates that the relationship between the variables is direct and its degree is very high. In conclusion: It can be stated with 99% confidence that there is a very high positive relationship between the degree of multiple intelligences and the learning of university students.

Measurement of central (aortic) systolic blood pressure has been shown to provide reliable information to evaluate target organ damage. However, non-invasive central blood pressure measurement procedures are still under analysis. To compare human pressure waveforms invasively obtained in the aorta, with the corresponding waveforms non-invasively recorded using an oscillometric device (Mobil-O-Graph). In this research were included 20 subjects in which invasive percutaneous coronary interventions were performed. They were 10 males (68 ± 12 y. o., BMI: 27.4 ± 4.6 kg/m2) and 10 females (77 ± 8 y. o., BMI: 28.5 ± 5.3 kg/m2). During the invasive aortic pressure recording, a synchronized non-invasive Mobil-O-Graph acquisition beat by beat and reconstructed central pressure wave was performed. Both, invasive and non-invasive pressure waves were digitized and stored for subsequent analysis and calculations. A computerized interpolation procedure was developed in our laboratory to compare these pressure waves. A significant correlation between Mobil-O-Graph central blood pressure measurements and the corresponding invasive values was found in males (r

Accurate office blood pressure measurement remains crucial in the diagnosis and management of hypertension worldwide, including Latin America (LA). Office blood pressure (OBP) measurement is still the leading technique in LA for screening and diagnosis of hypertension, monitoring of treatment, and long‐term follow‐up. Despite this, due to the increasing awareness of the limitations affecting OBP and to the accumulating evidence on the importance of ambulatory BP monitoring (ABPM), as a complement of OBP in the clinical approach to the hypertensive patient, a progressively greater attention has been paid worldwide to the information on daytime and nighttime BP patterns offered by 24‐h ABPM in the diagnostic, prognostic, and therapeutic management of hypertension. In LA countries, most of the Scientific Societies of Hypertension and/or Cardiology have issued guidelines for hypertension care, and most of them include a special section on ABPM. Also, full guidelines on ABPM are available. However, despite the available evidence on the advantages of ABPM for the diagnosis and management of hypertension in LA, availability of ABPM is often restricted to cities with large population, and access to this technology by lower‐income patients is sometimes limited by its excessive cost. The authors hope that this document might stimulate health authorities in each LA Country, as well as in other countries in the world, to regulate ABPM access and to widen the range of patients able to access the benefits of this technique.

Introduction Hypertension control reduces cardiovascular and renal risks in type 2 diabetes. Sodium-glucose cotransporter-2 inhibitors prevent renal glucose reabsorption and decrease glucose plasma levels, blood pressure (BP) and weight reduction. Treatment of hypertension and sodium-glucose cotransporter-2 are able to improve arterial stiffness. Aims To evaluate, in patients with type 2 diabetes and hypertension, the effects of 6 months treatment with canagliflozin, or perindopril, an angiotensin converting enzyme inhibitor, on central BP and carotid-femoral pulse wave velocity (cfPWV). Methods Thirty type 2 diabetic patients with hypertension taking amlodipine, 10 mg daily, and metformin, 750-2000 mg daily, were randomized and a third medication was added: canagliflozin, 300 mg daily (n = 15, nine women, mean age: 63 ± 8 years), or perindopril, 10 mg daily (n = 15, five women, mean age 59 ± 4 years), for 6 months. Ambulatory BP monitoring was assessed at baseline and after 3 and 6 months of treatment, whereas cfPWV was measured before and after 6 months of treatment. Plasma fasting glucose, glycated hemoglobin, creatinine, plasma and urinary sodium and potassium were also measured. Results Both treatments significantly reduced BP and cfPWV. Only canagliflozin maintained the PWV action after adjusting for BP values and reduced glycemia, glycated hemoglobin and 24 h urinary sodium. Other security laboratory parameters, including gluthamic oxaloacetic transaminase, gluthamic piruvic transaminase; and bilirubin failed to show any change. Conclusion Canagliflozin reduced BP and improve arterial stiffness, independently of the BP effect. These two conditions could explain the cardiovascular protection observed with canagliflozin compared with perindopril.

Introduction: Silent coronary heart disease is frequently undetected in type 2 diabetes mellitus (DM2) and pre-diabetes determined by glucose intolerance (GI). Pulse wave velocity (PWV) and albumin-creatinine ratio (ACR) have been considered markers of cardiovascular mortality, coronary heart disease and chronic renal failure. Aims: To evaluate the incidence of coronary artery disease (CAD) and the relationship between urinary albumin-creatinine ratio, glomerular filtration rate (GFR) and PWV in type 2 DM with silent CAD. Methods: We analyzed 92 individuals (44 male), 49 (60±7y) type 2 DM non-insulin dependents and 43 prediabetics (43±4y), with Grade I-II hypertension and no symptoms of CAD. : All type 2 DM patients were under antidiabetic treatment with A1C hemoglobin between 5.5 and 6.5%. : Every patient underwent a myocardial perfusion SPECT scan. In those subjects with ischemic patterns, coronary angiography was performed. In addition, PWV, glomerular filtration rate, and ACR were evaluated. Statistics: mean±SEM, and ANOVA among groups. Results: 48.59% of DM2 and 25.58% of GI patients had silent coronary artery had silent coronary artery disease and higher ACR, PWV and reduced GFR. Higher ACR and PWV and reduced GFR. DM2 and GI showed a negative relationship between GFR and ACR. Moreover, this relation was also observed in different levels of GFR (>60 ml/min and Conclusions: Higher PWV, lower GFR and ACR predict the incidence of CAD in DM2. Dysglycemic individuals also represent a group of higher risk for coronary artery disease with similar predictors as in DM2. Diabetic and prediabetics still develop renal microalbuminuria. Thus, PWV seems to represent a reliable marker of renal impairment and coronary artery disease.

Out-of-office blood pressure (BP) monitoring appears to be a very useful approach to hypertension management insofar it allows to obtain multiple measurements in the usual environment of each individual, allows the detection of hypertension phenotypes, such as white-coat and masked hypertension, and appears to have superior prognostic value than the conventional office BP measurements. Out-of-office BP can be obtained through either home or ambulatory monitoring, which provide complementary and not identical information. Home BP monitoring yields BP values self-measured in subjects' usual living environment; it is an essential method for the evaluation of almost all untreated and treated subjects with suspected or diagnosed hypertension, best if combined with telemonitoring facilities, also allowing long-term monitoring. There is also increasing evidence that home BP monitoring improves long-term hypertension control rates by improving patients' adherence to prescribed treatment. In Latin American Countries, it is widely available, being relatively inexpensive, and well accepted by patients. Current US, Canadian, Japanese, and European guidelines recommend out-of-office BP monitoring to confirm and refine the diagnosis of hypertension.

Introduction: Chronic serum uric acid elevation (SUA) is known to be induced by dyslipidemia, hypertension, inflammation, and insulin resistance. Therefore, it has been associated with higher risk for coronary artery disease and cardiovascular mortality. Also, increased levels of SUA have been associated with regional arterial stiffness, assessed by pulse wave velocity (PWV). Aims: To evaluate the relationships of PWV, SUA and different metabolic parameters in essential hypertensive patients. Material and Methods: We evaluated 445 essential hypertensive patients, by measuring office blood pressure (BP), weight, height, and waist circumference. In each patient, blood samples were drawn for biochemical evaluations and 24h urine collection. Body Mass Index (BMI) and Glomerular Filtration Rate (GFR) were calculated. Carotid-Femoral PWV and Left Ventricular Mass Index (LVMI) were measured in all patients. Results: All subjects (n=402), 242 males (55±0.9 yrs.; BMI: 28.9±0.3 Kg/m2) and 160 females (58±1 yrs.; BMI: 28.1±0.4 Kg/m2) had normal renal function. PWV values showed a significant association with SUA (p Conclusions: In this population of essential hypertensive patients, SUA was associated to increased arterial stiffness and to components of the Metabolic Syndrome. These results raise the possibility that a new approach to the role of SUA, linked to cardiovascular stratification, and a most appropriate treatment might be considered.

Adaptive identification systems focus on dynamical approaches based on the observed data from an experiment and/or clinical data. These systems establish a relationship between an input (arterial or vein instantaneous pressure) and an output (instantaneous arterial or vein diameter). Several dynamics relationships and applications can be established because of this adaptive identification as an arterial dynamic range (frequency response), biomechanical behavior of cryopreserved arteries, regional differences in veins as artery substitution, role of vascular smooth muscle in human hypertension and time invariance in the biomechanics of wall arteries. The aim of this review is to summarize some of those relevant results obtained from adaptive filter identification in cardiovascular dynamics research and clinical evaluation.

Introduction: Silent coronary heart disease is frequently undetected in type 2 diabetes mellitus (DM2) and prediabetes determined by glucose intolerance (GI). Pulse wave velocity (PWV) and albumin-creatinine ratio (ACR) have been considered markers of cardiovascular mortality, coronary heart disease and chronic renal failure. Aims: To evaluate the incidence of coronary heart disease (CHD) and its relationship with urinary albumin-creatinine ratio, glomerular filtration rate (GFR) and PWV in type 2 DM with silent CHD. Methods: We analyzed 92 individuals (44 male), 49 (60±7y) type 2 DM non-insulin dependents and 43 prediabetics (43±4y), with Grade I-II hypertension and no symptoms of CHD. All type 2 DM patients were under hypoglycemic treatment with an A1C hemoglobin between 5.5 and 6.5%. Every patient underwent a myocardial perfusion SPECT scan. In those subjects with ischemic patterns, a coronary angiography was performed. In addition, a PWV, glomerular filtration rate (CrCl), and ACR were evaluated. Statistics: mean±SEM, and ANOVA followed by Post Hoc analysis among groups. Results: Silent CHD was found in 48.59% of DM2 and 25.58% of GI. DM2 and GI patients with CHD had higher ACR and PWV and reduced glomerular filtration rate (p Conclusions: Higher PWV, lower GFR and ACR predict the incidence of CHD in DM2. GI also represent a group of higher risk for coronary heart disease with the same predictors showed in DM2. PWV seems to represent a reliable marker. Disclosure R.A. Sanchez: None. M.J. Sanchez: None. A.J. Ramirez: None.

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

Since 1966, a large number of trials of blood pressure (BP) lowering drugs compared with placebo (or no treatment) in hypertensive patients, complemented by trials of more versus less intense BP lowering, have shown that antihypertensive treatment can significantly reduce the incidence of fatal and nonfatal events associated with hypertension.1 A meta-analysis of all BP-lowering trials from 1966 to end of 2013 (68 trials in 245 885 individuals) has calculated that a 10/5 mm Hg systolic BP/diastolic BP (SBP/DBP) reduction significantly decreases stroke by 36%, heart failure by 38%, coronary events by 20%, cardiovascular mortality by 16%, and all-cause mortality by 10%.2 In addition, head-to-head comparisons between treatments based on different antihypertensive drugs (meta-analyses of 50 trials with 58 two-drug comparisons in 247 006 individuals) have shown that what really matters for preventing cardiovascular events is lowering of BP, and how BP is lowered (ie, the types of drugs used) is of minor importance.3 Despite the very large number of trials of antihypertensive treatment, it must be recognized that, except for the benefits of reducing high BP and for the equivalence of the various classes of antihypertensive agents, the majority of questions of practical importance that doctors ask themselves every day when treating hypertension have not been approached by randomized controlled trials or have remained unanswered.1–4 Examples of these unanswered questions are those to be discussed below such as initiation of drug treatment of hypertension, the BP targets to be aimed at, and the role of overall cardiovascular risk in treatment decisions. Although the safest decisions are those that can be found according to results of randomized trials, their concordance, and/or meta-analyses, other decisions should necessarily be taken on the basis of other criteria such as post hoc analysis of trials, observational studies, pathophysiological and pharmacological knowledge, …

We have previously shown a strong relation between high serum uric acid and pulse wave velocity (PWV) as expression of arterial stiffness. This relation was even stronger than with blood pressure. In addition to its hypoglycemic effect, sodium-glucose transport protein 2 inhibitors (SGLT2i) may reduce serum uric acid (SUA) by a uricosuric effect. Aims: to evaluate in type 2 diabetic patients with hypertension and normal renal function the effect of canagliflozin on SUA and carotid femoral PWV. Methods: 20 patients with type 2 diabetes mellitus (DM) 10 females, 59±4y received metformin 2000mg, canagliflozin 100-300mg and amlodipine 10mg daily during 6 months. Laboratory parameters including HbA1C, fasting blood glucose level, glomerular filtration rate, SUA, 24h ambulatory blood pressure monitoring (ABPM) and PWV were determined at baseline and after a 6-month treatment course with canagliflozin 100-300mg. Results: After 6 months of treatment, PWV dropped from 12±3 to 8.5±4 m/sec, p Conclusions: Canagliflozin ameliorates arterial stiffness in patients with type 2 DM and hypertension. This effect seems to be related, among other mechanisms, such as blood pressure drop and plasma volume contraction to the reduction in serum uric acid level. Since SUA has been shown to predict the risk of cardiovascular morbidity and mortality in hypertension and DM, lowering serum uric acid by SGLT2i might be contributing to cardiovascular protection. Disclosure R.A. Sanchez: None. M.J. Sanchez: None. A.J. Ramirez: None.

Non-modulating hypertension (NMHT) is a high renin subtype of salt sensitive hypertension, which fails to achieve renal vasodilatation and a correct Na(+) handling during sodium load. We investigate, in MHT and NMHT, the role of ANP, the renin-angiotensin system and PgI2, in the renal sodium handling mechanisms. After 10 days of low (20mmol.L) or after 72hs of high (250mmol.L) sodium intake, 13 NMHT (34±5y; 9 male) and 13 MHT (32±4y; 10male) were studied. Pro-ANP (1-30) PgI2, PRA and total exchangeable Na(+)24 (ENa(+)) were measured. Under low sodium intake, PRA (4.2±0.5ng.ml.h; p

BACKGROUND AND OBJECTIVES: Modern imaging techniques have increased the incidental detection of renal atherosclerotic disease (RAD). Because immune activation may hasten RAD progression, identifying cellular immune markers might provide clues to clinical activity. In this study, cellular immune markers were assessed in early RAD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Immune cell markers in peripheral blood of two groups of hypertensive patients with normal carotid and coronary arteries were evaluated: 28 patients had incidental RAD and 22 patients had normal renal arteries; 21 renal arteries obtained at necropsy from individuals with history of hypertension and tissue evidence of RAD were examined and matched with 21 individuals with normal renal arteries. Cell subpopulations were measured by flow cytometry in peripheral blood and direct cell count, respectively, using T and dendritic cells monoclonal antibodies. RESULTS: Peripheral blood of RAD patients showed increased numbers of cells expressing CD3, CD4, CD83, and CD86. CD4 to CD8 ratio was 8.3 ± 1.4 (RAD) to 3.4 ± 0.9 (normal; P

Epidemiological and clinical evidence have shown a close association between hypertension, obesity, IGT or NIDDM, and dyslipidemia. The activation of sympathetic nervous system plays a role in the pathogenesis of essential hypertension and its inhibition is of a therapeutic value. Rilmenidine is an oxazoline compound with antihypertensive properties that acts mainly on the brain stem but also in the kidneys, where it selectively binds to I1 imidazoline receptors, distinguishing it from reference α2-agonists. As a consequence, anti-hypertensive treatments that reduce the sympathetic response could also have effects on the metabolic abnormalities of hypertensive patients with metabolic disorders. The aim of the present study was to evaluate the effect of rilmenidine or placebo on insulin resistance and sympathetic activity, in essential hypertensive patients untreated or non-adequately treated. Our results have shown that Rilmenidine was able to decrease sympathetic activity expressed by both a decrease in SBP variability and an increase in baroreflex sensitivity. Together with these effects a significant improvement of insulin resistance index (HOMA), which was not obtained by the adjusted conventional treatment, was also observed. In conclusion, these beneficial effects observed support the idea that Rilmenidine could be comparable to established drugs for first-line therapy in hypertension.

Introduction: Hypertension may increase the risk for stroke and is frequently associated with subcortical and periventricular white matter lesions (WML). This is considered a prognostic factor for the development of stroke and cognitive impairment, particularly in attention processes. Additionally, in elderly subjects, it is known the implications of alterations in the neural cardiovascular regulation and the cardiovascular risk. Aims: To evaluate, in asymptomatic elderly hypertensives, the association of ambulatory blood pressure values and autonomic activity with neurocognitive impairment and WML. In addition, we also evaluated the role of the autonomic nervous system particularly the vagal component, in the pathogenesis of white matter lesions. Methods: We studied 22 elderly essential hypertensive patients (69±1.1y) and as control group, 16 normotensive elderly subjects (age 67±3.2y) were also enrolled. To each one of them, a cerebral MRI was performed to classify them, by a neuro-radiologist blinded of the subject clinical status, using a 0 to 9 scale where 0 denoted no WML and 9 the most severe lesions. Twenty four hours arterial blood pressure monitoring was performed to each one of the subjects under study. Office blood pressure was measured 3 times and the mean value reported. Beat to beat finger arterial pressure monitoring (Finapres) was performed for a 2h period. During the first hour the patient remained lying supine in a quiet darkened room and during the second hour four manoeuvres: stand-up, cold pressor test, handgrip and quiet activity were randomly performed. Mean blood pressure and pulse interval values, from the two periods, and their respective variabilities, baroreflex sensitivity and power spectral analysis were calculated. Regarding neuropsychological assessment: Minimental test, attention evaluation, RAVLT, visual memory, language and executive function, geriatric depression scale, cognitive deficit rate tests were performed in all subject.....

Pulsatile pressure in arteries produces mechanical oscillations. Highfrequency vibrations tend to produce mechanical structure injures. Vascular smooth muscle (VSM) could react modulating viscoelasticity to protect the arterial wall, filtering the highest harmonics component present in the large and rapid slope of blood pressure. The aim of this study was to evaluate the filtering performance exerted by VSM in the human common carotid artery (CCA) in normotensive (NT, smart springdampers turned on), hypertensive (HT, smart spring-dampers in action) and angiotensin converting enzyme (ACE) inhibitors-treated hypertensive patients (HT-treated, smart spring-dampers tuned), and in harvested human CCA segments (smart spring-dampers turned off). Human carotid arteries in vitro experiments (n = 14) and in vivo studies (n = 24) were performed, using adaptive modeling techniques to calculate mechanical impedance and creep (τC) and stress relaxation (τSR) time constants. This adaptive procedure was tested in vitro in harvested CCA mounted in a circulation mock. A confirmatory measure of damping was achieved by using the half-power bandwidth method ( fC) derived from the pressure-diameter frequency dependence using Bode diagrams, i.e., a compliance transfer function (diameter/pressure). Energy dissipation was calculated from the imaginary part of this function. Low-pass frequency responses were verified with a flat plateau up to a relatively stable frequency corner fC in the Bode diagram of the complete third-order model. Simplified first-order model cutoff frequencies were 2.7, 2.8, and 3.0 Hz for NT, HT, and HT-treated, respectively, showing an interesting constancy between groups. Smooth muscle tonus proved to preserve fC as well as τC. Energy dissipation in hypertensive patients (n = 12) three-folded NT values and tended to be restored in HT-treated by means of a decrease in τSR. VSM acts as smart spring-dampers, dissipating high-frequency components that might have damaging effects. VSM alterations found in HT patients could have a mandatory directive of preserving dynamic range near NT values, suggesting that VSM modulates its degree of activation and/or the vessel wall remodeling in order to ensure a suitable protection role.

Renal function and outcome of PTRA and stenting for atherosclerotic renal artery stenosis.BackgroundPrior studies of percutaneous transluminal renal artery angioplasty and stenting (PTRAS) for atherosclerotic renal artery stenosis (RAS) have shown that renal function is improved in about 25%, stabilizes in about 40%, but worsens in about 25% of patients. The factors predicting benefit remain controversial. We tested the hypothesis that the baseline glomerular filtration rate (GFR) predicts the changes in GFR and blood pressure (BP) after PTRAS.MethodsTreated hypertensive patients with positive renal color-coded duplex Doppler velocimetry and clinical criteria were screened by arteriography. Patients (N = 105) were included if they had an RAS ≥70%, a transluminal pressure gradient ≥30mm Hg and, they had more than 100 days of follow-up. GFR was calculated from the serum creatinine concentration (SCr). Patients were divided by baseline GFR into subgroups with normal to mildly impaired (N = 52) or moderately to severely impaired (N = 53) initial GFR, according to a GFR ≥50 or

Background: Nocturnal hypertension, male gender, age and arterial stiffness are important risk factors for cardiovascular morbidity and mortality. The objective of this study was to assess arterial stiffness in nocturnal hypertensive or normotensive men and women >40 years of age. Methods: Twenty-four-hour ambulatory blood pressure monitoring was performed in 144 men and 137 women. Eighty-eight subjects were between 40 and 49 years old (53% men), 98 were between 50 and 59 years old (55% men) and 95 were >60 years old (45% men). They were classified as nocturnal hypertensive if their average night systolic blood pressure and/or diastolic blood pressure was >120/70 mm/Hg. Arterial stiffness was assessed by the Ambulatory Arterial Stiffness Index (AASI), which is calculated as 1 minus the slope of diastolic on systolic blood pressure during the 24-hour recording period. Results were analyzed by analysis of covariance and were adjusted for 24-hour mean arterial pressure, the presence of antihypertensive treatment, height and heart rate. Results: Women showed a higher AASI compared to men, independently of age. In men, the AASI increased with age, being higher in nocturnal hypertensive than in nocturnal normotensive subjects, independently of age. Nocturnal hypertensive women showed higher AASI values than their respective nocturnal normotensive controls in the 50- to 59-year and >60-year age groups only. Conclusion: The results show that arterial stiffness is higher among nocturnal hypertensive subjects, especially in women >50 years old. Fil: Drucaroff, Lucas Javier. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia. Instituto de Investigaciones Neurológicas "Raúl Carrea"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Ramirez, Agustin Jose. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación Favaloro; Argentina Fil: Sanchez, Ramiro. Universidad Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas; Argentina Fil: Cardinali, Daniel Pedro. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Facultad de Ciencias Médicas. Departamento de Docencia e Investigación; Argentina. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; Argentina Fil: Perez Lloret, Santiago. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; Argentina. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Facultad de Ciencias Médicas. Departamento de Docencia e Investigación; Argentina

La presente investigación estudia el funcionamiento del Instituto Federal de Acceso a la Información Pública Gubernamental (IFAI) en el periodo comprendido de 2003 a 2013. Lo que se presentará es qué tanto logró el IFAI transparentar información e hizo que se rindiera cuentas a los sujetos obligados, esto a partir de la resolución de los recursos de revisión. La transparencia y rendición de cuentas son los dos principales objetivos que debe cumplir el IFAI, el cumplimiento de ambos da cuenta de una eficacia institucional.

Objective The aim of this study is to evaluate the relationship between carotid intima-media thickness (IMT) and arterial wall inertial behaviour. Methods The simultaneous and noninvasive assessment of the intima-media complex and arterial diameter waveform was performed using high-resolution ultrasonography. The common carotid artery of eleven normotensive subjects (NTA) and eleven mild-to-moderate essential hypertensive patients (HTA) were measured noninvasively using tonometry and an automatic densitometric analysis of B-mode images to obtain IMT and instantaneous pressure (P) and diameter (D) loops. A linear discrete time model was used to estimate the inertial index (K M ) using a system modelling-identification approach. Results In NTA K M was 0.333 ± 0.256 (mmHg s 2 /mm) and IMT 0.643 ± 0.061 (mm), whereas in HTA K M was 0.798 ± 0.590 (P< 0.05) and IMT 0.760 ± 0.034 (P< 0.025). When all data of K M versus IMT of NTA and HTA were pooled in a linear regression analysis, a correlation coefficient of r = 0.61 (P < 0.05) was obtained. Conclusion Wall inertia increase was associated with a higher IMT, suggesting that the intima-media thickening might be partially related to vascular hypertrophy manifested as increase of inertial behaviour.

Increases in arterial wall viscosity and intima-media thickness (IMT) were found in hypertensive patients. Because smooth muscle cells are responsible for the viscous behavior of the arterial wall and they are involved in the process of thickening of the intima-media complex, this study evaluates the relationship between carotid thickness and wall viscosity. The simultaneous and noninvasive assessment of the intima-media complex and arterial diameter waveform was performed using high-resolution ultrasonography. This technique was contrasted against sonomicrometry in sheep, showing that the waveforms obtained by both methods were similar. The common carotid arteries of 11 normotensive subjects (NTA) and 11 patients with mild to moderate essential hypertension (HTA) were measured noninvasively by using tonometry and an automatic densitometric analysis of B-mode images to obtain IMT and instantaneous pressure and diameter loops. A viscoelastic model was used to derive the wall viscosity index (η) using the hysteresis loop elimination criteria. In NTA, η was 2.73±1.66 (mm Hg · s/mm) and IMT was 0.58±0.08 (mm), whereas in HTA, η was 5.91±2.34 ( P P r =.71 ( P r =.59 ( P

Abstract Non-modulators are a subset of essential hypertensive individuals in whom renal hemodynamic and adrenal aldosterone responses to angiotensin II fail to modulate appropriately during high dietary salt intake. The main aim of this study was to investigate the familial aggregation of non-modulation and several erythrocyte Na + transport systems in normotensive and hypertensive individuals as well as offspring of hypertensive parents. An additional aim was to evaluate the effect of treatment with enalapril on erythrocyte Na + transport. We studied 15 normotensive subjects (6 males, 27±6 years), 14 untreated modulating essential hypertensive subjects (7 males, 38±7 years), 12 untreated non-modulating essential hypertensive subjects (7 males, 38±6 years), 14 modulating offspring of hypertensive parents (8 males, 25±6 years), and 14 non-modulating offspring of hypertensive parents (8 males, 26±4 years). Blood pressure was recorded with an oscillometric device and renal plasma flow and glomerular filtration rate by clearances of para-aminohippurate and inulin, respectively. Non-modulating subjects were identified as individuals who failed to increase effective renal plasma flow by 30% and decrease filtration fraction by at least 30% 10 days after changing from a low (20 mmol/d) to a high (250 mmol/d) sodium intake. Erythrocyte Na + transport was characterized by measurements of the Na + -K + pump, Na + -Li + countertransport, Na + -K + -Cl − cotransport, passive Na + permeability, and Na + content. After the initial studies, hypertensive individuals were treated with enalapril (20 mg/d PO) for 6 months, after which erythrocyte Na + transport measurements were again made. The main findings were that Na + -Li + countertransport is increased in non-modulating hypertensive subjects and non-modulating offspring of hypertensive parents, that the increase in blood pressure in response to high salt intake is greater in non-modulating than modulating hypertensive subjects, and that enalapril decreases Na + -Li + countertransport activity to normal in non-modulating hypertensive subjects. These findings provide support for a possible genetic role in the development of salt sensitivity and suggest that Na + -Li + countertransport and non-modulation are related phenotypes.

El presente documento ha sido preparado por un grupo de expertos, miembros de las sociedades de cardiología, endocrinología, medicina interna, nefrología y diabetes de los países de América Latina, para que sirvan de guía a los médicos que cuidan a pacientes con diabetes, hipertensión y enfermedades concomitantes o complicaciones de ambas condiciones. Aunque el concepto de síndrome metabólico actualmente es discutido, la alta prevalencia en América Latina del conjunto de alteraciones metabólicas que lo conforman sugiere que el síndrome metabólico es una entidad nosográfica común en el contexto de la medicina latinoamericana. Por lo tanto, en el presente documento se presta especial atención a este síndrome con el fin de alertar a los médicos de una particular población de alto riesgo, en la que por lo general es subestimada y no se tratan en forma optima los factores de riego que constituyen el síndrome metabólico. Las presentes recomendaciones son el resultado de las presentaciones y los debates en los paneles de discusión durante una reunión de dos días celebrada en Bucaramanga en octubre de 2012. Todos los participantes han aprobado las conclusiones finales. Los autores reconocen que la publicación y difusión de las guías no serán suficientes para alcanzar los cambios recomendados tanto en las estrategias diagnósticas como terapéuticas, por lo que se ha programado intervenciones que permitan identificar las barreras del conocimiento, de las actitudes y de comportamiento, lo que permitirá tanto a los médicos como a los pacientes una adecuada adherencia a las recomendaciones de las guías. (Acta MedColomb 2013; 38: 154-172). The present document has been prepared by a group of experts, members of cardiology, endocrinology, internal medicine, nephrology and diabetes societies of Latin American Countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of metabolic syndrome is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that metabolic syndrome is useful nosography entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particular high- risk population, usually underestimated and undertreated. These recommendations results from presentation and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming both physicians and patients from effectively adhering to guideline recommendations. Documento licenciado en la revista Acta Médica Colombiana con licencia de atribución. Compartir - copiar y redistribuir el material en cualquier medio o formato. Adaptar - remezcla, transformar y construir sobre el material para cualquier propósito, incluso en el comercio.

Non-modulating hypertensives are a subset of sodium-sensitive hypertensives characterized by a failure to modulate renal, vascular and adrenal glomerulosa responsivenesses to angiotensin II appropriately.To investigate the plasma renin activity (PRA) and urinary kallikrein-like activity (Ku) under different sodium conditions in essential hypertensive patients and in the modulating and non-modulating subsets of hypertensives. Additionally, in these groups of patients, the effects on blood pressure of a sustained Na+ restriction were evaluated.Fifteen normotensives (10 men, aged 29 +/- 5 years) and 54 untreated hypertensives (30 men, aged 34 +/- 7 years) were each administered subsequently three different diets containing 240, 140 and 50 mmol/day Na+, each diet for 10 days. At the end of each period, the PRA, Ku, 24 h urinary volume and urinary Na+ excretion were measured. Afterwards, the essential hypertensives were classified as 29 modulating essential hypertensives (MHT, 20 men, aged 32 +/- 7 years) and 25 non-modulating essential hypertensives (NMHT, 10 men, aged 36 +/- 8 years). Non-modulating ones were identified as individuals who failed to increase their effective renal plasma flow and to decrease their filtration fraction by at least 30% from baseline values, 10 days after changing from a low (10 mmol/day) to a high (260 mmol/day) Na+ intake. Blood pressure was measured with a Dinamap 8100 Critikon device. Both PRA and Ku were measured during normal Na+ intake by standard methods. Patients were administered a low-Na+ diet (10-50 mmol/day) for 12 months.In essential hypertensives, Ku was lower under the three Na+ diets than it was in normotensives (P0.01) whereas the PRA was higher in hypertensives only during the low Na+ intake (P0.01). The non-modulating patients showed significantly higher PRA levels (4.0 +/- 0.8 ng ml h, P0.05) than did modulating ones (2.6 +/- 1.0 ng ml h) or normotensives (2.3 +/- 1.0 ng ml h). Conversely, non-modulating hypertensives had lower Ku (4.1 +/- 1.0 IU/24 h, P0.025) than did modulating ones (6.2 +/- 1.0 IU/24 h) or normotensives (7.8 +/- 2.0 IU/24 h). Blood pressure was significantly reduced during low Na+ intake only in normotensives (month 6: 143 +/- 4/94 +/- 2 mmHg; month 12: 139 +/- 5/89 +/- 3 mmHg) compared with baseline values (169 +/- 4/102 +/- 6 mmHg, P0.025).It was shown that, in non-modulating hypertensives, in addition to an increased PRA, a reduced kallikrein-like activity coexists and seems to be associated with the impaired Na+ handling. Moreover, in these untreated patients the Na+ restriction was able to exert an antihypertensive effect even for long periods.

The diagnosis and management of secondary hypertension has improved in the last decade as a result of the advances in the acknowledgment of some physiopathologic mechanisms and mainly by the development of new diagnostic methods. Furthermore, the treatment of some types of secondary hypertension may be solved by noninvasive techniques. Hypertension of renal and renovascular origin, coarctation of the aorta, primary hyperaldosteronism, and adrenal medullary tumors are analyzed. The main results of some relevant studies on diagnostic and treatment of those diseases are presented. Also, some experimental methods are mentioned, taking into account the possibility of clinical use in the near future.

Type 2 Diabetes Mellitus (DM), or adult-onset diabetes, is being considered as a new pandemic. Cardiovascular disease is the major cause of morbidity and mortality in type 2 DM, due to arterial structure and functional changes. Assessment of arterial structure and biomechanics, by non-invasive methods and parameters, can be used to detect early alterations related to DM. Three markers of vascular disease may help to a better evaluation of vascular dysfunction in type 2 DM patients: carotid intimamedia thickness (IMTc), arterial stiffness, assessed by pulse wave velocity (PWV), and endothelial function, evaluated through the brachial artery flow-mediated dilation (FMD). Among these parameters, IMTc is considered a marker of structural vessel wall properties, and arterial stiffness reflects functional wall properties. Endothelial function represents the arterial way to actively regulate its diameter (smooth muscle-dependent actions) and its visco-elastic properties (wall elasticity and viscosity). IMTc is increased in patients with type 2 DM and other independent risk factors, such as: age, hyperlipidemia and duration of DM. Subjects with DM have shown increased arterial stiffness. Type 2 DM is associated with reductions in FMD (endothelial dysfunction), which has already been reported to be inversely and strongly related to the extent of hyperglycemia. The underlying patho-physiological mechanisms are complex and remain to be fully elucidated. A complete understanding of the association between arterial alterations and early detection, and type 2 DM, may be critical for the primary prevention of DM-related macro-vascular disease.

OBJECTIVE To evaluate the serum aldosterone (Ald)/plasmatic renin activity (PRA) ratio as a surrogate marker of renin-angiotensin-aldosterone system status in unilateral (Uni)- and bilateral (Bi)-renal artery stenosis (RAS). METHODS Seven hundred and eight hypertensive patients (HTP) were studied. Intermediate and high pretest risk of RAS was detected in 66 HTP who subsequently underwent renal gadolinium-enhanced magnetic resonance and arteriography. After application of exclusion criteria 51 HTP remained: 16 with Uni-RAS, 16 with Bi-RAS and 19 essential hypertensives with normal arteries. Nineteen normotensive individuals were also studied. Ald and PRA were determined before and after stenosis resolution by balloon angioplasty and stent implantation. RESULTS Ald/PRA (ng/dl per (ng/ml per h(-1))) was markedly high in Bi-RAS (5.92 +/- 2.30, P < 0.001), and markedly low in Uni-RAS (0.38 +/- 0.17, P < 0.001) versus essential hypertensives (1.52 +/- 2.02). Multilevel likelihood ratios for Bi-RAS were positive for Ald/PRA higher than 3.6, negative for Ald/PRA lower than 0.2, and neutral for Ald/PRA at least 0.2 and 3.6 or less. ROC analysis identified Ald/PRA lower than 0.5 and Ald/PRA higher than 3.7 to have the best sensitivity and specificity to detect Uni-RAS and Bi-RAS, respectively. In Uni-RAS, but not in Bi-RAS, postinterventional PRA was significantly lower than basal PRA. In Uni-RAS and Bi-RAS, postinterventional Ald was approximately 30% and approximately three times lower than basal Ald, respectively. In essential hypertensives, PRA and Ald showed no changes in the same period. CONCLUSION In the population studied, Ald, PRA and Ald/PRA were significantly different among essential hypertensives, and HTP with Uni-RAS or Bi-RAS. Studies with a higher number of patients will allow exploration of the usefulness of pharmacologic aldosterone blockade in Bi-RAS, and to assess the relevance of Ald/PRA to differentiate Uni-RAS from Bi-RAS.

La hipertensión es un factor de riesgo cardiovascular muy prevalente en el mundo, y especialmente abrumador en los países de bajos y medianos ingresos. Informes recientes de la OMS y del Banco Mundial destacan la importancia de las enfermedades crónicas tales como la hipertensión, como obstáculo al logro de un buen estado de salud. Se debe agregar que, para la mayoría de los países de bajos y medianos ingresos, estrategias deficientes de la atención primaria de la salud son obstáculos mayores par el logro del control de la presión arterial. Es más, la epidemiología de la hipertensión y enfermedades relacionadas, los recursos y las prioridades de salud, el estado socioeconómico de la población, varían considerablemente en diferentes países y en diferentes regiones de países individuales. Teniendo en cuenta las bajas tasas de control de la presión arterial logrados en Latinoamérica y los beneficios que se puede esperar de un mejor control, se decidió invitar a especialistas de diferentes países latinoamericanos a analizar la situación de la región y redactar un documento de consenso sobre la detección, evaluación y tratamiento de la hipertensión que podría ser adecuado del punto de vista costo-utilidad. Las recomendaciones incluidas aquí son el resultado de documentos preparatorios escritos por expertos invitados y el muy activo debate posterior en diferentes paneles de discusión, realizados durante dos días en Asunción, Paraguay en Mayo del año 2008. Por último, para mejorar la práctica clínica, la publicación de estas pautas debe ser seguida por la implementación de intervenciones efectivas capaces de vencer las barreras (cognitivas, de comportamiento y afectivas) que previenen los cambios de actitud tanto en médicos como en pacientes.

Hypertension is a highly prevalent cardiovascular risk factor in the world and particularly overwhelming in low and middle-income countries. Recent reports from the WHO and the World Bank highlight the importance of chronic diseases such as hypertension as an obstacle to the achievement of good health status. It must be added that for most low and middle-income countries, deficient strategies of primary healthcare are the major obstacles for blood pressure control. Furthermore, the epidemiology of hypertension and related diseases, healthcare resources and priorities, the socioeconomic status of the population vary considerably in different countries and in different regions of individual countries. Considering the low rates of blood pressure control achieved in Latin America and the benefits that can be expected from an improved control, it was decided to invite specialists from different Latin American countries to analyze the regional situation and to provide a consensus document on detection, evaluation and treatment of hypertension that may prove to be cost-utility adequate. The recommendations here included are the result of preparatory documents by invited experts and a subsequent very active debate by different discussion panels, held during a 2-day sessions in Asuncion, Paraguay, in May 2008. Finally, in order to improve clinical practice, the publication of the guidelines should be followed by implementation of effective interventions capable of overcoming barriers (cognitive, behavioral and affective) preventing attitude changes in both physicians and patients.

Hypertension is a highly prevalent cardiovascular risk factor in the world and particularly overwhelming in low and middle-income countries. Recent reports from the WHO and the World Bank highlight the importance of chronic diseases such as hypertension as an obstacle to the achievement of good health status. It must be added that for most low and middle-income countries, deficient strategies of primary healthcare are the major obstacles for blood pressure control. Furthermore, the epidemiology of hypertension and related diseases, healthcare resources and priorities, the socioeconomic status of the population vary considerably in different countries and in different regions of individual countries. Considering the low rates of blood pressure control achieved in Latin America and the benefits that can be expected from an improved control, it was decided to invite specialists from different Latin American countries to analyze the regional situation and to provide a consensus document on detection, evaluation and treatment of hypertension that may prove to be cost-utility adequate. The recommendations here included are the result of preparatory documents by invited experts and a subsequent very active debate by different discussion panels, held during a 2-day sessions in Asuncion, Paraguay, in May 2008. Finally, in order to improve clinical practice, the publication of the guidelines should be followed by implementation of effective interventions capable of overcoming barriers (cognitive, behavioral and affective) preventing attitude changes in both physicians and patients.

We studied total exchangeable sodium, ion transport activity at maximal rate, and erythrocyte Na+ content in response to angiotensin converting enzyme inhibition in mild-to-moderate essential hypertensive patients with normal renal function. Twenty-five patients (mean age 56 years, range 40-62 years) who had abnormal red blood cell Na(+)-K(+)-Cl- cotransport or red blood cell Li(+)-Na+ countertransport were treated with either enalapril (20 mg daily) or hydrochlorothiazide (50 mg daily) during a 30-day period. During the period of enalapril treatment, Na(+)-K+ pump and Na(+)-K(+)-Cl- cotransport increased significantly from 4,282 +/- 255 to 5,236 +/- 325 mumol/l red blood cell/hr (p less than 0.01) and 166 +/- 21 to 220 +/- 24 mumol/l red blood cell/hr (p less than 0.05), respectively. Mean intracellular Na+ content in erythrocytes decreased from 11.4 +/- 0.40 to 10.0 +/- 0.33 mmol/l (p less than 0.01) and exchangeable Na+ from 39.8 +/- 0.6 mmol/kg to 35.6 +/- 0.6 mmol/kg (p less than 0.001). Sodium reduction correlated with the recovery of Na(+)-K(+)-Cl- cotransport activity (r = -0.65, p less than 0.01). During treatment, systolic and diastolic blood pressures were reduced significantly (p less than 0.01). In 12 patients treated with hydrochlorothiazide, Na(+)-K(+)-Cl- cotransport, Na(+)-K+ pump, Na(+)-Li+ countertransport, and Na+ permeability did not change significantly while Na+ content decreased from 11.7 +/- 0.3 to 10.3 +/- 0.2 mmol/l (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

30 patients (20 male and 10 female, mean age 53 years) with mild to moderate essential hypertension took part in a double-blind randomised study to evaluate the effects of nebivolol (5 mg/day) vs atenolol (100 mg/day). Systolic and diastolic blood pressure (BP) were recorded by 24-hour ambulatory BP monitoring after 4 weeks’ placebo and 8 weeks’ active treatment. Systolic and diastolic left ventricular function were measured using a 2-dimensional ECG and PW Doppler transmitral blood flow velocity recordings. The 2 drugs produced similar reductions in BP, whereas only atenolol significantly decreased heart rate. Cardiac index was unchanged with both drugs. An improvement was observed in different indices of diastolic left ventricular function with both treatments. However, only nebivolol enhanced the peak filling rate normalised to mitral stroke volume, from 5.4 to 6.5 sec−1 (p < 0.05).

Damping is the conversion of mechanical energy of a structure into thermal energy, and it is related to the material viscous behavior. To evaluate the role of damping in the common carotid artery (CCA) wall in human hypertension and the possible improvement of angiotensin-converting enzyme (ACE) inhibition, we used noninvasive CCA pressure (tonometry) and diameter (B-mode echography) waveforms in normotensive subjects (NT group; n=12) and in hypertensive patients (HT group; n=22) single-blind randomized into HT–placebo (n=10) or HT-treated (ramipril, 5 to 10 mg/d during 3 months; n=12). Vascular smooth muscle (VSM) null tonus condition was achieved from in vitro pressure and diameter waveforms (Konigsberg microtransducer and sonomicrometry) measured in explanted human CCA (n=14). Arterial wall dynamics was described by viscous (η), inertial ( M ), and compliance ( C ) parameters, mean circumferential wall stress, viscous energy dissipation ( W D ), peak strain energy ( W St ), damping ratio (ξ= W D / W St ), and modeling isobaric indexes C Iso and W St(Iso) . The lack of VSM tonus isobarically increased wall stress and reduced η, C Iso , and damping ( P W D were greater in HT than in NT ( P P C Iso increased in HT-treated ( P W St increase, the arterial wall reacts increasing W D to maintain ξ. ACE inhibition modulates VSM activation and vessel wall remodeling, significantly improving wall energetics and wall stress. This protective vascular action reduces extra load to the heart and maintains enhanced arterial wall damping.

Diabetes mellitus and hypertension, responsible of a major burden of cardiovascular complications, are increasing their incidence in Latin America in similar proportions to the rest of the world. The metabolic syndrome, a strong predictor of both diabetes and hypertension deserves more attention from the primary care physicians. Evidence based and updated guidelines on detection, prevention and treatment of diabetes and hypertension, issued by local experts, are willing to inform and translate these recommendations to the clinical practice of physicians assisting these patients throughout Latin America.

Microalbuminuria in diabetes is a risk factor for early death and an indicator for aggressive blood pressure (BP) lowering. We compared a combination of 2 mg perindopril/0.625 mg indapamide with enalapril monotherapy on albumin excretion rate (AER) in patients with type 2 diabetes, albuminuria, and hypertension in a 12-month, randomized, double-blind, parallel-group international multicenter study. Four hundred eighty-one patients with type 2 diabetes and hypertension (systolic BP ≥140 mm Hg, 20 and P =0.012; systolic BP −1.5 [95% CI −3.0, −0.1] diastolic BP P =0.019) and AER −42% (95% CI −50%, −33%) versus −27% (95% CI −37%, −16%) with enalapril. The greater AER reduction remained significant after adjustment for mean BP. Adverse events were similar in the 2 groups. Thus, first-line treatment with low-dose combination perindopril/indapamide induces a greater decrease in albuminuria than enalapril, partially independent of BP reduction. A BP-independent effect of the combination may increase renal protection.