Efectividad de la terapia combinada a dosis fijas en una cohorte de hipertensos no controlados con monoterapia

ObjetivoEvaluar la efectividad de lisinoprilhidroclorotiazida a dosis fijas en el control de la presión arterial en hipertensos tratados con monoterapia y mal controlados.DiseñoEstudio observacional, prospectivo.EmplazamientoAtención primaria.ParticipantesCiento noventa y nueve médicos de atención primaria que incluyeron a 931 pacientes (56,7% mujeres), con edad media de 62,0 ± 10,3 años. Finalizaron el estudio 915 pacientes (98%) que se incluyeron en el análisis.Mediciones principalesSe siguieron las recomendaciones de la OMS/SIH en la medición de la presión arterial y el diagnóstico de mal control. Además, se evaluaron presión del pulso, índice de masa corporal y parámetros analíticos básicos. Se realizaron 4 visitas durante 6 meses de seguimiento.ResultadosLisinopril-hidroclorotiazida (20/12,5mg) disminuyó significativamente la PAS (24,6 ± 3,5mmHg) y la PAD (14,3 ± 0,7mmHg) (p < 0,001). El control de la presión arterial aumentó hasta el 52,8% (p < 0,001). La edad fue la única variable que influyó en el control de la presión arterial (OR, 0,81; IC del 95%, 0,71-0,92%; p = 0,001). La presión del pulso disminuyó 10,4 ± 4,3mmHg (p < 0,001). A las 24 semanas de tratamiento, se observó una mejoría en el perfil glucémico y lipídico, y de la HbA1c en los diabéticos.ConclusionesEn atención primaria, lisinopril-hidroclorotiazida (20/12,5mg), controló la presión arterial del 52,8% los de hipertensos mal controlados con monoterapia. Además, disminuyó la presión del pulso y mejoró el perfil lipídico y el glucémico.ObjectiveTo evaluate the effectiveness of the fixed dose of a lisinoprilhydrochlorothiazide combination treatment in the control of blood pressure, in poorly controlled high blood pressure people, treated with monotherapy.DesignProspective observational study.SettingPrimary care frame.Participants931 patients (56.7% women) with an average age of 62.0±10.3 years, were included by 199 primary care physicians. 915 patients (98%) ended the study and finally they were included for the statistical analysis.Main measurementsOMS/SIH recommendations on blood pressure measurement and diagnose of poor control were followed. Pulse pressure, body mass index and basic clinical analyses were assessed. Four continuation visits were made during six months.ResultsLisinopril–hidrochlorothiazide (20/12.5mg) reduced significantly SBP (24.6±3.5mm Hg) and DBP (14,3±0.7mm Hg) (P<.001). Blood pressure control was only influenced by age (OR, 0.81; 95% CI, 0.71-0.92; P=.001). Pulse pressure was reduced in 10.4±4.3mm Hg (P<.001). After 24 weeks of treatment, glycemic and lipidic profiles showed an improvement, as well as HbA1c in diabetic people.ConclusionsIn Primary care, a 52.8% of poorly controlled with monotherapy high blood pressure people were controlled by a combination of lisinoprilhydrochlorothiazide (20/12.5mg). In addition, pulse pressure was decreased and both lipid and glucose blood profiles improved

Complement component C4 structural variation and quantitative traits contribute to sex-biased vulnerability in systemic sclerosis

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER), "A way of making Europe".Copy number (CN) polymorphisms of complement C4 play distinct roles in many conditions, including immune-mediated diseases. We investigated the association of C4 CN with systemic sclerosis (SSc) risk. Imputed total C4, C4A, C4B, and HERV-K CN were analyzed in 26,633 individuals and validated in an independent cohort. Our results showed that higher C4 CN confers protection to SSc, and deviations from CN parity of C4A and C4B augmented risk. The protection contributed per copy of C4A and C4B differed by sex. Stronger protection was afforded by C4A in men and by C4B in women. C4 CN correlated well with its gene expression and serum protein levels, and less C4 was detected for both in SSc patients. Conditioned analysis suggests that C4 genetics strongly contributes to the SSc association within the major histocompatibility complex locus and highlights classical alleles and amino acid variants of HLA-DRB1 and HLA-DPB1 as C4-independent signals

Ideal cardiovascular health and inflammation in European adolescents: The HELENA study

Background and aims Inflammation plays a key role in atherosclerosis and this process seems to appear in childhood. The ideal cardiovascular health index (ICHI) has been inversely related to atherosclerotic plaque in adults. However, evidence regarding inflammation and ICHI in adolescents is scarce. The aim is to assess the association between ICHI and inflammation in European adolescents. Methods and results As many as 543 adolescents (251 boys and 292 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional multi-center study including 9 European countries, were measured. C-reactive protein (CRP), complement factors C3 and C4, leptin and white blood cell counts were used to compute an inflammatory score. Multilevel linear models and multilevel logistic regression were used to assess the association between ICHI and inflammation controlling by covariates. Higher ICHI was associated with a lower inflammatory score, as well as with several individual components, both in boys and girls (p < 0.01). In addition, adolescents with at least 4 ideal components of the ICHI had significantly lower inflammatory score and lower levels of the study biomarkers, except CRP. Finally, the multilevel logistic regression showed that for every unit increase in the ICHI, the probability of having an inflammatory profile decreased by 28.1% in girls. Conclusion Results from this study suggest that a better ICHI is associated with a lower inflammatory profile already in adolescence. Improving these health behaviors, and health factors included in the ICHI, could play an important role in CVD prevention

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

La investigación en el Departamento de Matemáticas de la ETSEIB

Esta nota está pensada con la intención de dar una idea del trabajo que se desarrolla en el Seminario de Matemáticas de la ETSEIB, a una audiencia amplia y no necesariamente especialista. De ahí que se haya procurado sean, tan­to el lenguaje como la exposición, lo menos especializados posible. En aras de la brevedad nos limitaremos a reseñar algunos aspectos de principio relacionados con la actividad del citado Seminario, que esperamos ayuden a com­prender la línea de trabajo que se sigue en el mismo

A Cartan-Eilenberg approach to homotopical algebra

In this paper we propose an approach to homotopical algebra w here the basic ingredient is a category with two classes of distinguished morphisms: s trong and weak equivalences. These data determine the cofibrant objects by an extension property ana logous to the classical lifting property of projective modules. We define a Cartan-Eilenberg categor y as a category with strong and weak equivalences such that there is an equivalence of categorie s between its localisation with respect to weak equivalences and the relative localisation of the subc ategory of cofibrant objets with respect to strong equivalences. This equivalence of categories allow s us to extend the classical theory of derived additive functors to this non additive setting. The main exa mples include Quillen model categories and categories of functors defined on a category endowed with a cotriple (comonad) and taking values on a category of complexes of an abelian category. In the latt er case there are examples in which the class of strong equivalences is not determined by a homotopy relation. Among other applications of our theory, we establish a very general acyclic models theor emPeer Reviewe

A Cartan-Eilenberg approach to homotopical algebra

In this paper we propose an approach to homotopical algebra w here the basic ingredient is a category with two classes of distinguished morphisms: s trong and weak equivalences. These data determine the cofibrant objects by an extension property ana logous to the classical lifting property of projective modules. We define a Cartan-Eilenberg categor y as a category with strong and weak equivalences such that there is an equivalence of categorie s between its localisation with respect to weak equivalences and the relative localisation of the subc ategory of cofibrant objets with respect to strong equivalences. This equivalence of categories allow s us to extend the classical theory of derived additive functors to this non additive setting. The main exa mples include Quillen model categories and categories of functors defined on a category endowed with a cotriple (comonad) and taking values on a category of complexes of an abelian category. In the latt er case there are examples in which the class of strong equivalences is not determined by a homotopy relation. Among other applications of our theory, we establish a very general acyclic models theor emPeer Reviewe