Ambulatory Blood Pressure Monitoring in the Elderly

The incidence of hypertension is high in the elderly and is present in 2/3 of the patients older than 65 years. Prevalence can reach 90% in patients older than 80 years. The presence of isolated systolic hypertension (ISH) is characteristic of this population. However, the prevalence of hypertension by ambulatory blood pressure monitoring (ABPM) is not well known. In this study, we analyzed the special characteristics of hypertension in this population, giving special emphasis on ABPM readings

A 30-year-old man with bilateral pretibial pain

Varón de 30 años que consultaba por dolor intenso y progresivo de dos meses de evolución localizado en la cara anterior y distal de ambas piernas sin factor desencadenante aparente y mala respuesta a tratamiento analgésico convencional. El paciente negaba otros síntomas a excepción de un rash eritematoso no pruriginoso generalizado que había afectado tronco, palmas y plantas y que había sido considerado como una reacción de hipersensibilidad a alguna de las medicaciones prescritas para el dolor. El examen físico reveló dolor a la palpación de ambas tibias así como tenues lesiones eritematosas maculopapulares de 1 cm de diámetro en plantas y palma de la mano derecha. La radiografía de tibias y peronés fue normal pero la gammagrafía ósea resultó compatible con periostitis de tibia y peroné en ambos miembros inferiores. Las serologías para sífilis (VDRL + 1/128, TPHA +) confirmaron la sospecha de sífilis secundaria, pero también las serologías para VIH resultaron ser positivas (ELISA y Wetern Blot). El paciente fue tratado con Penicilina G Benzatina 2.4 millones unidades i.m en dosis única. El dolor fue progresivamente remitiendo y el paciente quedó finalmente asintomático después de dos semanas.A 30-year-old man presented with a two-month history of progressive intense pain on the anterior side of both lower legs, with no apparent triggering factor and bad response to conventional analgesic treatment. The patient denied other symptoms except from the presence of a non-pruritic, erythematosus generalized rash that had involved the trunk, the palms and the soles and that had been considered as a hypersensitivity reaction to any of the analgesic drugs previously prescribed. Physical examination revealed tenderness to palpation of both tibia shinbones along with faded maculopapular erythematosus lesions 1 cm in diameter involving the soles and the palm of the right hand. The radiographs of both legs were unremarkable but bone scyntigraphy showed bilateral tibial and fibular periostitis. Serologic tests for syphilis (VDRL + 1/128, TPHA +) confirmed the suspicion of secondary syphilis, but also HIV serology (ELISA and Western Blot) were positive. The patient was treated with a single intramuscular injection of 2.4 million units of Penicillin G Benzathine. The bone pain subsequently improved and the patient became asymptomatic within two weeks

Denervación renal en el tratamiento de la hipertensión arterial. Posicionamiento conjunto de la SEH-LELHA y la ACI-SEC

Hypertension is the most prevalent cardiovascular risk factor. Despite pharmacological treatment, a high percentage of patients do not achieve an adequate blood pressure control. Renal sympathetic denervation is a minimally invasive intervention for the management of hypertension involving the interruption of the renal artery sympathetic nervous system using a catheter-based approach. The early studies showed promising results, but the controversial results coming from the SYMPLICITY HTN-3 trial sent this technique into oblivion. Over the last 3 years, new clinical trials have appeared including new devices used in different populations, which definitively proves the effectiveness of renal sympathetic denervation. This joint position statement from the Spanish Society of Hypertension-Spanish League for Combating High Blood Pressure (SEH-LELHA), and the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) reviews the evidence available on the efficacy and safety profile of renal sympathetic denervation for the management of hypertension. Based on the results of clinical trials, recommendations have been established on what patients may be eligible for renal sympathetic denervation and under what circumstances

Differential diagnosis of systemic lupus erythematosus: Key aspects of day-to-day

Este artículo aborda el diagnóstico diferencial del Lupus eritematoso sistémic

Efectos de olmesartán y lercanidipino sobre el daño vascular y la presión arterial ambulatoria en pacientes hipertensos no tratados

Tesis Univ. Granada. Departamento de Medicina. Leída el 2 de julio de 200

Implications of Renal Denervation Therapy in Patients with Sleep Apnea

Obstructive sleep apnea (OSA) syndrome is a prevalent condition characterized by repeated episodes of obstruction of the upper airway, leading to intermittent hypoxemia and important endothelial and anatomical dysfunctions that cause cardiovascular and cerebrovascular disease. The finding of the relationship between OSA and hypertension, especially resistant hypertension (RHT), has increased the interest in therapeutic strategies that affect renal sympathetic activity in these patients. The observational studies published until now demonstrated that renal denervation therapy can reduce the severity of OSA syndrome. Renal sympathetic denervation (RDN) could be a future therapeutic possibility for conditions other than RHT, such as atrial fibrillation, heart failure, obesity, and OSA syndrome, where renal sympathetic system plays an important physiological role. The aim of this review was to elucidate the implications of renal sympathetic activity in OSA syndrome