Probability of At Least One High Arterial Blood Pressure Measurement in Elderly Patients with Healthy Vascular Aging in Two Years of Follow-Up

Background/Aims: Elderly patients with normal systemic arterial blood pressure associated with femoral carotid pulse velocity (cf-PWV) less than 7.6 m/s and without associated comorbidities are considered to have good vascular health. The aim of the current study was to verify the probability that elderly patients with good vascular health have at least one blood pressure measurement above the different thresholds for systolic blood pressure (120, 130 and 140 mmHg) during two years of follow–up. Methods: We selected 72 normotensive patients (< 140/90 mmHg) without comorbidities and divided them into group A, with cf-PWV < 7.6 m/s (n = 27; 65 ± 4 years), and group B, with cf-PWV ≥ 7.6 m/s (n = 45; 66± 8 years). These patients were followed for two years and were observed in 3 outpatient visits (0, 12 and 24 months). At each visit, the brachial pressures were indirectly measured in triplicate, and applanation tonometry was performed. Results: When group A and group B were compared, the odds ratio (OR) of having a systolic pressure measurement ≥ 140 mmHg in two years of follow-up was 0.22 (P < 0.0001); ≥ 130 mmHg, the OR was 0.49 (P < 0.0007), and ≥ 120 mmHg, the OR was 0.54 (P < 0.001). Group A and group B showed increased values of cf-PWV during the two years of follow-up (P < 0.05). Changes in the average systolic brachial pressure were not significant during the two years in groups A or B. Conclusion: Vascular health in elderly individuals seems to protect against occasional elevations in systemic arterial pressure

Back to Basics: Pitting Edema and the Optimization of Hypertension Treatment in Incident Peritoneal Dialysis Patients (BRAZPD)

Systemic arterial hypertension is an important risk factor for cardiovascular disease that is frequently observed in populations with declining renal function. Initiation of renal replacement therapy at least partially decreases signs of fluid overload; however, high blood pressure levels persist in the majority of patients after dialysis initiation. Hypervolemia due to water retention predisposes peritoneal dialysis (PD) patients to hypertension and can clinically manifest in several forms, including peripheral edema. The approaches to detect edema, which include methods such as bioimpedance, inferior vena cava diameter and biomarkers, are not always available to physicians worldwide. For clinical examinations, the presence of pitting located in the lower extremities and/or over the sacrum to diagnose the presence of peripheral edema in their patients are frequently utulized. We evaluated the impact of edema on the control of blood pressure of incident PD patients during the first year of dialysis treatment. Patients were recruited from 114 Brazilian dialysis centers that were participating in the BRAZPD study for a total of 1089 incident patients. Peripheral edema was diagnosed by the presence of pitting after finger pressure was applied to the edematous area. Patients were divided into 2 groups: those with and without edema according to the monthly medical evaluation. Blood arterial pressure, body mass index, the number of antihypertensive drugs and comorbidities were analyzed. We observed an initial BP reduction in the first five months and a stabilization of blood pressure levels from five to twelve months. The edematous group exhibited higher blood pressure levels than the group without edema during the follow-up. The results strongly indicate that the presence of a simple and easily detectable clinical sign of peripheral edema is a very relevant tool that could be used to re-evaluate not only the patient's clinical hypertensive status but also the PD prescription and patient compliance

Aptamer-based radiopharmaceuticals for diagnostic imaging and targeted radiotherapy of epithelial tumors

In the continuous search for earlier diagnosis and improved therapeutic modalities against cancer, based on our constantly increasing knowledge of cancer biology, aptamers hold the promise to expand on current antibody success, but overcoming some of the problems faced with antibodies as therapeutic or delivery agents in cancer. However, as the first aptamer reached the market as an inhibitor against angiogenesis for the treatment of macular degeneration, aptamers have found only limited applications or interest in oncology, and even less as radiopharmaceuticals for diagnostic imaging and targeted radiotherapy of tumours. Yet, the chemistry for the labelling of aptamers and the options to alter their pharmacokinetic properties, to make them suitable for use as radiopharmaceuticals is now available and recent advances in their development can demonstrate that these molecules would make them ideal delivery vehicles for the development of targeted radiopharmaceuticals that could deliver their radiation load with accuracy to the tumour site, offering improved therapeutic properties and reduced side effects