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BACKGROUND Our objective of this study was to determine if rate of estimated glomerular filtration rate (eGFR) decline and its intensity was associated with cardiovascular risk and death in patients with hypertension whose baseline eGFR was higher than 60 ml/minute/1.73 m2. METHODS This study comprised 2,516 patients with hypertension who had had at least 2 serum creatinine measurements over a 4-year period. An eGFR reduction of ≥10% per year has been deemed as high eGFR and a reduction in eGFR of less than 10% per year as a low decline. The end points were coronary artery disease, stroke, transitory ischemic accident, peripheral arterial disease, heart failure, atrial fibrillation, and death from any cause. Cox regression analyses adjusted for potentially confounding factors were conducted. RESULTS A total of 2,354 patients with low rate of eGFR decline and 149 with high rate of eGFR decline were analyzed. The adjusted model shows that a −10% rate of eGFR decline per year is associated with a higher risk of the primary end point (HR 1.9; 95% CI 1.1–3.5; P = 0.02) and arteriosclerotic vascular disease (HR 2.2; 95% CI 1.2–4.2; P < 0.001) in all hypertensive groups. The variables associated to high/low rate of eGFR decline in the logistic regression model were serum creatinine (OR 3.35; P < 0.001), gender, women (OR 15.3; P < 0.001), tobacco user (OR 1.9; P < 0.002), and pulse pressure (OR 0.99; P < 0.05). CONCLUSIONS A rate of eGFR decline equal to or higher than −10% per year is a marker of cardiovascular risk for patients with arterial hypertension without chronic kidney disease at baseline. It may be useful to consider intensifying the global risk approach for these patients.

Purpose To describe the distribution of Type 2 DM retinal lesions and determine whether it is symmetrical between the two eyes, is random or follows a certain pattern. Methods Cross-sectional study of Type 2 DM patients who had been referred for an outpatients' ophthalmology visit for diabetic retinopathy screening in primary health care. Retinal photographic images were taken using central projection non-mydriatic retinography. The lesions under study were microaneurysms/haemorrhages, and hard and soft exudates. The lesions were placed numerically along the x- and y-axes obtained, with the fovea as the origin. Results From among the 94 patients included in the study, 4770 lesions were identified. The retinal lesions were not distributed randomly, but rather followed a determined pattern. The left eye exhibited more microaneurysms/haemorrhages and hard exudates of a greater density in the central retina than was found in the right eye. Furthermore, more cells containing lesions were found in the upper temporal quadrants, (especially in the left eye), and tended to be more central in the left eye than in the right, while the hard exudates were more central than the microaneurysms/haemorrhages. Conclusion The distribution of DR lesions is neither homogeneous nor random but rather follows a determined pattern for both microaneurysms/haemorrhages and hard exudates. This distribution means that the areas of the retina most vulnerable to metabolic alteration can be identified. The results may be useful for automated DR detection algorithms and for determining the underlying vascular and non-vascular physiopathological mechanisms that can explain these differences.

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

Glomerular hyperfiltration is well recognized as an early renal alteration in subjects with diabetes mellitus. However, what is not well-known is whether hyperfiltration also occurs in the early stages of hyperglycaemia, for instance in prediabetes. Identifying subjects with glomerular hyperfiltration from among those with prediabetes might be helpful to implement preventive and therapeutic strategies. This study aimed to investigate the association of prediabetes with glomerular hyperfiltration and its associated variables. A representative sample of 9238 people aged ≥ 30 years and whose entire clinical and laboratory data were available, were included in this study. Hyperfiltration was defined as an estimated glomerular filtration rate (eGFR) above the age- and gender-specific 95th percentile. The eGFR was assessed using the Chronic Kidney Disease Epidemiology Collaboration equation. After adjustment for age, gender, body mass index, systolic blood pressure and diastolic blood pressure, cholesterol, log (triglycerides), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, serum uric acid, smoking status, hypertension, and use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, fasting plasma glucose (FPG) was found to be independently positively associated with eGFR. The hazard ratios (95% confidence interval) for hyperfiltration were 1.61 (1.28–2.03) and 2.30 (1.89–2.79) for prediabetes and diabetes, respectively, when compared with participants with normoglycemia. Prediabetes was associated with glomerular hyperfiltration. Longitudinal studies are needed to investigate whether hyperfiltration in prediabetes is associated with a later decline in eGFR.

Proton Pump Inhibitors (PPIs) have been associated with chronic kidney disease (CKD). Our objective was to quantify the association between PPI use and incident CKD in a population-based cohort. Methods and findings We used a population-based retrospective cohort, including people aged 15 years or over, between January 1, 2005 and December 31, 2012. PPI use was measured in a follow-up session by recording prescriptions. Incident CKD was defined as an estimated glomerular filtration rate < 60 ml/ min/1.73 m2 and/or urinary albumin level to creatinine level ≥ 30 mg/g, in two or more determinations over a period of at least 3 months of the follow-up. Proton Pump Inhibitor use was associated with incident CKD in analysis adjusted for different clinical variables (Hazard Ratio (HR) 1.18; 95% CI 1.04–1.51) in individuals who used PPI in the basal visit (HR 1.37; 95% CI 1.25–1.50) and in those who started to use PPI during the follow-up. High doses of PPI increased the risk of incident CKD (HR 1.92; 95%CI 1.00–6.19) for any type of exposure to PPIs (HR 2.40; 95%CI 1.65–3.46) and for individuals who used high doses throughout the follow-up. This risk of incident CKD increased after three months’ exposure to PPIs, (HR1.78; 95% CI 1.39–2.25) between the third and sixth months and (HR 1.30; 95%CI 1.07–1.72) after the sixth month. Conclusions PPI use is associated with a higher risk of incident CKD. This association is greater for high doses and becomes apparent after three months’ exposure This work was partly funded by the research project PI15/00140 from FIS, ‘Instituto de Salud Carlos III’, ISCIII, Spanish Ministry of Economy and Competitiveness and by the project ‘Grant to improve the scientific productivity of the research groups of the University of Girona 2016-2018’ (MPCUdG2016

Background. Control of glycaemic levels as well as cardiovascular risk factors (CVRF) is essen- tial to prevent the onset of complications associated with type 2 diabetes mellitus (T2DM). Aim. T o describe the degree of glycaemic control and CVRF in relation to diabetes duration. Patients and methods. Multicentre cross-sectional study in T2DM patients seen in primary care centres during 2007. Variables: Demographical and clinical characteristics, antidiabetic treat- ments and development of disease complications. Diabetes duration classification: 0-5, 6-10, 11-20 and >20 years. Logistic regression models were used in the analysis. Results. A total of 31 30 patients; 51.5% males; mean age: 68 ± 1 1.7 years; mean diabetes dura- tion:7.0 (±5.6) years, median: 5 (interquartile range:3-9) years; mean HbA 1c : 6.84 (±1.5), were analyzed. There has been a progressive decline in HbA 1c levels (HbA 1c > 7% in 25.8% of patients during the first 5 years and 51.8% after 20 years). Blood pressure values remained relatively sta- ble throughout disease duration. The mean value of low density lipoprotein (LDL) experienced a slight decline with the progression of the disease, but due to the significant increase of cardio- vascular disease (CVD) after 20 years of duration, less patients reached the recommended target (LDL < 100 mg/dl) in secondary prevention. L ogistic regression model controlling for age, sex and CVD showed that diabetes duration was related to glycaemic control (odds ratio: 1.066, 95% confidence interval: 1.050-1.082 per year) but not to blood pressure or LDL control. Conclusions. The degree of glycaemic control and the risk factor s in relation to the duration of T2DM followed different patterns. Diabetes duration was associated with a poorer glycaemic control but in general had a limited role in blood pressure control or lipid profile.

Two aspects arise concerning the use of self-measured blood pressure monitoring to diagnose white-coat hypertension (WCH): the presence of target organ damage (TOD) and the normal cut-off threshold. This study aims to evaluate the cardiovascular risk of WCH according to different self-measured blood pressure normal cut-off thresholds and the influence of TOD at baseline. In all, 678 patients were followed for 6.2 years; 223 normotensive patients, 271 patients with sustained hypertension (HT), and 184 with WCH. TOD was defined as: left ventricular hypertrophy according to ECG, albuminuria, or low estimated glomerular filtration rate. The risk for different cutting points of self-measured blood pressure (

The aim of the study was to determine whether there are differences in subclinical vascular disease (SVD) in hypertensive patients in relation to height. A total of 922 hypertensive, newly diagnosed, treatment‐naive patients were included. Physical examination was conducted, with renal function, electrocardiography, and retinography. Patients were distributed according to quartiles of height and sex. Multivariate analysis adjusted for age, sex, and body mass index showed an association between height above the mean and fasting glucose (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02–1.06), high‐density lipoprotein cholesterol (OR, 0.96; CI, 0.92–0.99), triglycerides (OR, 1.07; CI, 1.01–1.15), and left ventricular hypertrophy (LVH) (OR, 1.57; CI, 1.10–2.24). The authors found an inverse association between arteriole‐to‐venule ratio and height above the mean (OR, 0.97; CI, 0.94–0.99). There are differences in the SVD of hypertensive patients in relation to height. Tall stature is associated with LVH while short stature is associated with increased microvascular involvement. Detection of SVD in hypertensive patients should consider the height.

Purpose To explore the relationship between chronic kidney disease (CKD) and diabetic retinopathy (DR) in a representative population of type 2 diabetes mellitus (DM2) patients in Catalonia (Spain). Methods This was a population-based, cross-sectional study. A total of 28,344 patients diagnosed with DM2 who had recorded ophthalmologic and renal functional examinations were evaluated. Data were obtained from a primary healthcare electronic database of medical records. CKD was defined as an estimated glomerular filtration ratio (eGFR) of

The aim is to evaluate whether cardiovascular (CV) risk stratification in newly diagnosed hypertensive patients according to the European Society of Hypertension (ESH) guidelines, can predict the evolution of target organ damage (TOD) using routine examinations in clinical practice during 1 year.Prospective study of recently diagnosed untreated hypertensives. At the moment of inclusion and 1 year later, urinary albumin excretion rate (UAER), blood analysis, electrocardiogram, retinography, self-monitored blood pressure (BP) and ambulatory BP measurement were performed. TOD was defined following the ESH guidelines and evaluated as having favorable or unfavorable evolution.Four hundred and seventy-nine hypertensive patients were included (58.8 years; 43.4% women). The baseline prevalence of TOD was: high UAER (2.4%), left ventricular hypertrophy (LVH) (20.7%), advanced lesion of the fundus oculi (FO) (10.2%). After 1 year, no differences were found between the final systolic and diastolic BP neither in the high/very high nor in the low/moderate CV risk groups. Patients with low/moderate CV risk had less unfavorable TOD evolution, LVH (9.2% vs 41.7%; p0.001), FO advanced damage (0.99% vs 14.3%; p0.001), high UAER (0.3% vs 5.1%; p0.005) and amount of TOD (9.2% vs 44.0%; 00.001) than those with high/very high CV risk. The odds ratios of favorable TOD evolution adjusted for BP change and antihypertensive drug treatment were (low/moderate vs high/very high CV risk); 5.14 (95% confidence interval, CI, 3.99-6.64) for LVH; 12.42 (6.67-23.14) FO advanced damage; 10.71 (3.67-31.22) high UAER and 13.99 (10.18-19.22) for amount of TOD.It is possible to detect variations in TOD in hypertensive patients with a 1-year follow-up using the examinations available in routine clinic practice. The risk determined by the ESH guidelines predicts the evolution of TOD at 1 year.

UNLABELLED: Self-blood pressure (BP) measurement (SBPM) and ambulatory BP measurement (ABPM) are suitable for the isolated clinical hypertension (ICH) or 'white-coat' hypertension diagnosis. However, patients with ICH have a different cardiovascular risk according to the measurement technique used for the diagnosis. OBJECTIVE: To describe baseline cardiovascular risk of patients with hypertension and with ICH according to SBPM and daytime ABPM. METHODS: Six hundred and sixty-four newly diagnosed and never treated patients with hypertension and with an average age of 59.3 years (standard deviation=12.0) were included (52% men) in this study. Clinical data, analytical data with urinary albumin excretion rate, estimated glomerular filtration rate, retinography, SBPM, and ABPM were performed. Cardiovascular risk was estimated from the European Society of Hypertension and Systemic Coronary Risk Evaluation tables. RESULTS: ICH prevalence varies according to the ambulatory measurement technique used: SBPM=24.2%, daytime ABPM=8.1, and 5.2% if criteria are required from both techniques. In the 403 patients with hypertension and who had SBPM and ABPM, the percentage of patients with high or very high baseline cardiovascular risk, falls progressively from 31.2% of patients with sustained hypertension to 20.0% of patients with ICH measured using SBPM, to 15.1% of patients with ICH measured using ABPM-day and to 9.5% of patients who present ICH using both techniques (P

Fundamento y objetivo Determinar la prevalencia de insuficiencia renal cronica (IRC) oculta y las variables clinicas asociadas en pacientes con diabetes mellitus de tipo 2 (DM2). Pacientes y metodo Estudio observacional, analitico y transversal en pacientes con DM2 ambulatorios de atencion primaria. De la historia clinica electronica se registraron datos demograficos y antropometricos, antecedentes patologicos y medidas de riesgo cardiovascular y de funcion renal. Se determino la prevalencia de IRC oculta, definida en pacientes con valores de creatinina (Cr) plasmatica normales (Cr =1,4mg/dl en las mujeres y Cr =1,5mg/dl en los varones), y la estimacion del filtrado glomerular (eFG) reducida (

Resumen Objetivo Determinar la relacion entre el ejercicio fisico y la calidad de vida (CdV) autopercibida en pacientes hipertensos mayores de 70 anos. Diseno Estudio transversal y analitico de una muestra de pacientes ambulatorios que acudieron a las consultas de atencion primaria de los investigadores. Material y metodo Se incluyeron pacientes de 70 anos de edad o mayores, diagnosticados de hipertension arterial (HTA). Se excluyeron los pacientes institucionalizados o los que no cumplian los criterios del estudio. A todos los participantes se les efectuo analitica, valoracion de la comorbilidad y exploracion fisica basica que incluyo la medida de la presion arterial estandarizada. La actividad fisica se cuantifico en metabolic equivalents (METS) semanales mediante un cuestionario validado. La CdV se midio mediante el cuestionario de autopercepcion de la salud de 12 items (SF-12). Resultados Se incluyeron 191 pacientes (edad 77,8 anos; el 58,1% mujeres). Media de 1.837 METS semanales (DE: 1.906,5). La CdV segun el cuestionario SF-12, 43,2 para la dimension fisica y 52,4 para la psiquica. La puntuacion de la CdV fue inferior en los pacientes situados en los cuartiles inferiores de ejercicio fisico (p Conclusiones Existe una asociacion independiente entre la practica de ejercicio fisico y la CdV autopercibida en los pacientes hipertensos mayores de 70 anos. El nivel de ejercicio que recomienda la Guia Europea de HTA se asocia a una mejor percepcion del componente psiquico de la CdV, mientras que para el componente fisico es necesario un nivel mas elevado de ejercicio.

Fundamento y objetivo Las guias internacionales de hipertension arterial (HTA) recomiendan valores de automedida de la presion arterial (AMPA) con un punto de corte de 135/85 mmHg para diagnosticar hipertension clinica aislada (HCA). En este articulo se defiende un punto de corte inferior. Pacientes y metodo Estudio prospectivo protocolizado con 378 pacientes que incluyo a 250 hipertensos de nuevo diagnostico sin tratamiento. Se efectuo AMPA y monitorizacion de la presion arterial a todos los pacientes. Se evaluaron los factores de riesgo y la lesion en organos diana (LOD) mediante electrocardiograma, funcion renal, microalbuminuria y retinografia. Resultados El punto de corte de 135/85 mmHg solo muestra diferencias en los valores de creatinina serica (78,67 en HCA frente a 83,98 μmol/l en HTA mantenida [HTAM]; p = 0,03), en las lesiones grado l/ll del fondo de ojo (FO) (el 44,7 frente al 62,8%; p = 0,009) y en la presencia de cualquier lesion en el FO (el 48,2 frente al 67,4%; p = 0,005). Con menor significacion estadistica, el menor riesgo de lesiones grado III/IV en el FO se observo en los HCA, con un punto de corte de 130/80 mmHg (riesgo relativo [RR] = 0,59; intervalo de confianza [IC] del 90%, 0,36-0,96; p = 0,06). El mayor riesgo de cualquier LOD se observo en los pacientes con HTAM con un punto de corte de 130/85 mmHg (RR = 12,04; IC del 90%, 1,03-140,28; p = 0,09). Conclusiones El punto de corte de 135/85 mmHg no muestra diferencias en la presencia de LOD entre pacientes con HCA y HTAM. Para un punto de corte de 130 mmHg de presion arterial sistolica, aquellos por debajo de 130 mmHg presentan menor riesgo de lesiones grado III/IV en el FO. Aquellos por encima de 130 mmHg presentan mayor riesgo de cualquier LOD. Si se define la HCA por la probabilidad de presentar LOD, cabe plantearse un punto de corte de AMPA inferior a 130 mmHg de presion arterial sistolica.

Aim. To assess prescribing practices of noninsulin antidiabetic drugs (NIADs) in T2DM with several major contraindications according to prescribing information or clinical guidelines: renal failure, heart failure, liver dysfunction, or history of bladder cancer.Methods. Cross-sectional, descriptive, multicenter study. Electronic medical records were retrieved from all T2DM subjects who attended primary care centers pertaining to the Catalan Health Institute in Catalonia in 2013 and were pharmacologically treated with any NIAD alone or in combination.Results. Records were retrieved from a total of 255,499 pharmacologically treated patients. 78% of patients with some degree of renal impairment (glomerular filtration rate (GFR) < 60 mL/min) were treated with metformin and 31.2% with sulfonylureas. Even in the event of severe renal failure (GFR < 30 mL/min), 35.3% and 22.5% of patients were on metformin or sulfonylureas, respectively. Moreover, metformin was prescribed to more than 60% of patients with moderate or severe heart failure.Conclusion. Some NIADs, and in particular metformin, were frequently used in patients at high risk of complications when they were contraindicated. There is a need to increase awareness of potential inappropriate prescribing and to monitor the quality of prescribing patterns in order to help physicians and policymakers to yield better clinical outcomes in T2DM.

Bakground The objective of this study was to determinate the prevalence of chronic kidney disease (CKD) and the different stages of CKD in patients with type 2 diabetes mellitus (DM2) treated in primary care consults in Spain. Methods A national cross-sectional study was performed in primary care consults. The following data were collected: demographic and anthropometric information; list of present cardiovascular risk factors (CVRF); previous macrovascular and microvascular disease history; physical examination and analytical data from the previous 12 months, including the urine albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) to evaluate renal function. Results With regard to the patients, 27.9% presented some degree of CKD as follows: 3.5% with stage 1; 6.4% with stage 2; 16.8% with stage 3 (11.6% with stage 3A and 5.2% with stage 3B); and 1.2% with stages 4 and 5. The prevalence of patients with UACR ≥ 30 mg/g was 15.4% (13% microalbuminuria and 2.4% macroalbuminuria). Renal impairment (RI) was found in 206 patients (18%) of whom 133 patients (64.6%) was stage 3A, 60 patients (29.1%) was stage 3B and 13 patients (6.3%) stages 4 and 5. Among patients with RI, 143 patients (69.4%) had normoalbuminuria. The following variables were significantly associated with CKD: age; sex (women); systolic arterial blood pressure (SABP) ≥ 150 mmHg; and a previous history of cardiovascular disease. Conclusions The results showed that the prevalence for any type of CKD was 27.9%. A systematic determination of UACR and eGFR may contribute to an early diagnosis, thus allowing intervention during the initial stages of the disease when treatment is more efficient.

Background/aims Retinal photography with a non-mydriatic camera is the method currently employed for diabetic retinography (DR) screening. We designed this study in order to evaluate the prevalence and severity of DR, and associated risk factors, in patients with type 2 diabetes (T2DM) screened in Catalan Primary Health Care. Methods Retrospective, cross-sectional, population based study performed in Catalonia (Spain) with patients with T2DM, aged between 30 years and 90 years (on 31 December 2012) screened with retinal photography and whose DR category was recorded in their medical records. DR was classified as: no apparent retinopathy (no DR), mild non-proliferative DR (mild NPDR), moderate NPDR, severe NPDR, proliferative DR (PDR) and diabetic macular oedema (DMO). Non-vision threatening DR (non-VTDR) included mild and moderate NPDR; VTDR included severe NPDR, PDR and DMO. Clinical data were obtained retrospectively from the SIDIAP database (System for Research and Development in Primary Care). Results 108 723 patients with T2DM had been screened with retinal photography. The prevalence of any kind of DR was 12.3% (95% CI 12.1% to 12.5%). Non-VTDR and VTDR were present in 10.8% (mild 7.5% and moderate NPDR 3.3%) and 1.4% (severe NPDR 0.86%, PDR 0.36% and DMO 0.18%) of the study patients, respectively. Conclusions The prevalence of any type of DR in patients with T2DM screened with retinal photography was lower when compared with earlier studies.

BACKGROUND: The presence of chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) increases the risk of cardiovascular disease (CVD) regardless of the presence of traditional cardiovascular risk factors. There is controversy about the impact of each of the manifestations of CKD on the prevalence of CVD, whether it is greater with decreased estimated glomerular filtration rate (eGFR) or increased urine albumin creatinine ratio (UACR). METHODS: This study is a national cross-sectional study performed in primary care consults. We selected participants of both sexes who were aged 40 years or older, had been diagnosed with T2DM and had complete information on the study variables recorded in their medical records. The participants were classified according to eGFR : ≥ 60; 45-59; 30-44; 60 mL/min/1.73 m(2) those with eGFR between 30-44 mL/min/m(2), (OR = 2.3; 95% CI, 1.4-3.9); and eGFR < 30 mL/min/1.73 m(2) (OR = 4.1 95% CI 1.6-10.2) showed increased likelihood of having CVD. Participants with UACR ≥ 30 mg/g compared to participants with UACR < 30 mg/g increased significantly the likelihood of having CVD, especially with UACR above 300 mg/g, (OR = 1.6; 95% CI 1.1-2.4 for UACR = 30-299 mg/g; OR = 3.9; CI 1.6-9.5 for UACR ≥ 300 mg/g). CONCLUSION: The decrease in eGFR and increase in UACR are independent risk factors that increase the prevalence of CVD in participants with T2DM and these factors are independent of each other and of other known cardiovascular risk factors. In our study the impact of mild decreased eGFR in T2DM on CVD was lower than the impact of increased UACR. It is necessary to determine not only UACR but also eGFR for all patients with T2DM, both at the time of diagnosis and during follow-up, to identify those patients at high risk of cardiovascular complications.

There is no agreement on the systematic exploration of the fundus oculi (FO) in hypertensive patients, and it is unknown whether the evolution of retinal microcirculatory alterations has prognostic value or not. The aim of this study was to investigate whether the evolution of the arteriole-to-venule ratio (AVR) in newly-diagnosed hypertensive patients is associated with better or worse evolution of target organ damage (TOD) during 1 year. A cohort of 133 patients with newly-diagnosed untreated hypertension was followed for 1 year. At baseline and follow-up, all patients underwent a physical examination, self-blood pressure measurement, ambulatory blood pressure monitoring, blood and urine analysis, electrocardiogram, and retinography. The endpoint was the favourable evolution of TOD and the total amount of TOD, according to the baseline AVR and the baseline and final difference of the AVR. A total of 133 patients were analyzed (mean age, 57 ± 10.7 years; 59% men). No differences were found in the decrease in blood pressure or antihypertensive treatment between quartiles of baseline AVR or baseline-final AVR difference. Patients with a difference between baseline and final AVR in the highest quartile (0.0817) had a favorable evolution of left ventricular hypertrophy (odds ratio, 14.9; 95% confidence interval, 1.08-206.8) and the amount of TOD (odds ratio, 2.22; 95% confidence interval, 1.03-6.05). No favorable evolution was found of glomerular filtration rate. There is an association between the evolution of the AVR and the favorable evolution of TOD. Patients with greater increase of AVR have significantly better evolution of left ventricular hypertrophy and amount of TOD.

Background To determine the prognostic value of various self-blood pressure (BP) monitoring (SBPM) cutoff at the time of diagnosis.MethodsCohort of 466 newly diagnosed and never-treated hypertensive patients. At baseline and at 1 year, the patients underwent a physical examination, clinic BP (CBP), SBPM, and ambulatory BP monitoring (ABPM), fasting blood and urine analysis, electrocardiogram (ECG), and retinography. The diagnosis of hypertension was made based on CBP average of two readings, separated by 2 min, taken over three different days, with results ≥140/90 mm Hg. At 1-year follow-up, target organ damage (TOD) evolution was classified as favorable or unfavorable.ResultsMean age was 57.4 years, 56.8% were men. Adjusted multivariate analysis showed that hypertensive patients with baseline SBPM

International guides of hypertension (HT) recommend self-blood -pressure-measurement (SBPM) values higher than 135/85 mmHg to determine isolated clinical hypertension (ICH). This paper suggests a lower cut-off.This prospective, protocol-based study included 378 patients, 250 new hypertensive patients without previous treatment. Both SBPM and ambulatory blood pressure monitoring (ABPM) were measured in all patients. Risk factors and target organ disease (TOD) were evaluated by electrocardiography, renal function, microalbuminuria and retinography.With a 135/85 mmHg ICH cut-off, only differences in serum creatinine levels (78.67 ICH vs 83.98 micromol/l sustained HT -SHT-; p = 0.03), grade I/II fundus oculi (FO) lesions (44.7 vs 62.8%; p = 0.009) and any FO lesions (48.2 vs 67.4%; p = 0.005) were found. With a ICH cut-off of 130/80 mmHg, a lower risk of grade III/IV FO lesions was found (RR = 0.59; 90% confidence interval [CI], 0.36-0.96; p = 0.06). Any TOD risk was related to SHT with a 130/85 mmHg cut-off (RR = 12.04; 90% CI, 1.03-140.28; p = 0.09).Taking a 135/85 mmHg ICH cut-off, no differences in TOD between ICH and SHT were found. Taking a 130 mmHg ICH systolic blood pressure (SBP) cut-off, those who are below 130 mmHg have a lower risk of grade III/IV FO lesions. Those who are above this value have a higher TOD risk. Looking at TOD risk, we should consider a130 mmHg SBP cut-off for ICH diagnosis.

Background Kidney disease is associated with an increased total mortality and cardiovascular morbimortality in the general population and in patients with Type 2 diabetes. The aim of this study is to determine the prevalence of kidney disease and different types of renal disease in patients with type 2 diabetes (T2DM). Methods Cross-sectional study in a random sample of 2,642 T2DM patients cared for in primary care during 2007. Studied variables: demographic and clinical characteristics, pharmacological treatments and T2DM complications (diabetic foot, retinopathy, coronary heart disease and stroke). Variables of renal function were defined as follows: 1) Microalbuminuria: albumin excretion rate & 30 mg/g or 3.5 mg/mmol, 2) Macroalbuminuria: albumin excretion rate & 300 mg/g or 35 mg/mmol, 3) Kidney disease (KD): glomerular filtration rate according to Modification of Diet in Renal Disease < 60 ml/min/1.73 m2 and/or the presence of albuminuria, 4) Renal impairment (RI): glomerular filtration rate < 60 ml/min/1.73 m2, 5) Nonalbuminuric RI: glomerular filtration rate < 60 ml/min/1.73 m2 without albuminuria and, 5) Diabetic nephropathy (DN): macroalbuminuria or microalbuminuria plus diabetic retinopathy. Results The prevalence of different types of renal disease in patients was: 34.1% KD, 22.9% RI, 19.5% albuminuria and 16.4% diabetic nephropathy (DN). The prevalence of albuminuria without RI (13.5%) and nonalbuminuric RI (14.7%) was similar. After adjusting per age, BMI, cholesterol, blood pressure and macrovascular disease, RI was significantly associated with the female gender (OR 2.20; CI 95% 1.86–2.59), microvascular disease (OR 2.14; CI 95% 1.8–2.54) and insulin treatment (OR 1.82; CI 95% 1.39–2.38), and inversely associated with HbA1c (OR 0.85 for every 1% increase; CI 95% 0.80–0.91). Albuminuria without RI was inversely associated with the female gender (OR 0.27; CI 95% 0.21–0.35), duration of diabetes (OR 0.94 per year; CI 95% 0.91–0.97) and directly associated with HbA1c (OR 1.19 for every 1% increase; CI 95% 1.09–1.3). Conclusions One-third of the sample population in this study has KD. The presence or absence of albuminuria identifies two subgroups with different characteristics related to gender, the duration of diabetes and metabolic status of the patient. It is important to determine both albuminuria and GFR estimation to diagnose KD.

Síndrome X de resistència a la insulina; Síndrome metabòlica; Obesitat Síndrome X de resistencia a la insulina; Síndrome metabólico; Obesidad Insulin Resistance Syndrome X; Metabolic syndrome; Obesity BACKGROUND The significant rise in the prevalence of obesity coincides with the considerable increase in the prevalence of metabolic syndrome (MS) currently being observed worldwide. The components of MS are not static and their dynamics, such as the order of their occurrence, or the time of exposure to them are, as yet, unknown but could well be clinically relevant. Our objective was to study the dynamic behaviour of MS and its components in a large population-based cohort from a Mediterranean region. METHODS AND FINDINGS Our study employed a retrospective cohort (between January 1, 2005 and December 31, 2012) made up of individuals from the general population in a region in the northeast of Catalonia, Spain. Given that most of the explicative variables of the risk of having MS were time dependent and, therefore, the risk was not proportional, we used the Andersen-Gill (AG) model to perform a multivariate survival analysis and inferences were performed using a Bayesian framework. Thirty-nine percent of the participants developed MS; 44.6% of them with a single limited episode. Triglycerides and low HDL cholesterol, together with obesity, are components associated with the first occurrence of MS. Components related to the metabolism of glucose are associated with a medium risk of having a first episode of MS, and those related to blood pressure are associated with a lower risk. When the components related to blood pressure and the metabolism of glucose appear first, they determine the appearance of the first episode of MS. The variables concerning the persistence of MS are those that correspond to clinical conditions that do not have well-established drug treatment criteria. CONCLUSIONS Our results suggest that the components related to the metabolism of glucose and to high blood pressure appear early on and act as biomarkers for predicting MS, while the components related to obesity and dyslipidaemia, although essential for the development of MS, appear later. Making lifestyle changes reduces the conditions associated with the persistence of MS.