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Patients with heart failure (HF) undergoing noncardiac surgical procedures is rising worldwide. This study was aiming at analyzing the impact of heart failure (HF) on the outcomes (mortality, complications, readmissions, and length of stay) of elderly patients undergoing elective major noncardiac surgical procedures in Spain.A retrospective observational study of patients undergoing noncardiac surgery was conducted. The Minimum Basic Data Set (MBDS) was used to collect information about the demographic characteristics of patients discharged from hospitals of the Spanish National Health System (SNHS), variables related to patients' medical conditions and surgeries conducted during the episode.A total of 996,986 selected procedures in the discharge record were identified in the period 2007-2015. HF was recorded as a secondary diagnosis in 22,367 discharges (2.24%). The mean age of patients was 76.6±7.27 years, with a difference in patients without and with HF: 76.5 (95% CI: 76.47-76.50) vs 82.8 (95% CI: 82.71-82.90). The number of selected surgical procedures increased by 13.2% (117,487 in 2015 vs. 103,744 in 2007), and the proportion of presence HF as a comorbidity increased by 24.4% (2.4% in 2015 v 1.9% in 2007). The proportion of women was higher in the HF group: 53.2% (95% CI: 53.18-53.22) vs 64.3% (95% CI: 64.20-64.44), with a longer average length of stay: 7.9 (95% CI: 7.9-7.9) vs 14.9 (95% CI 14.7-15.0) days, and women had a higher proportion of comorbidities. HF was found to be an independent risk factor in-hospital mortality in the multilevel risk adjustment model (OR=2.3; 95% CI: 2.2-2.4).Patients with HF undergoing any of the selected surgical procedures are older; there was women predominance and there is also an important burden of comorbidities than patients without HF undergoing these surgical procedures. HF in the selected procedures, increasing in-hospital mortality, mean length of stay, and the occurrence of adverse events in the Spanish population. The percentage of patients with HF who underwent the selected surgical procedures increased in the study period.

espanolAntecedentes y objetivo No existen datos poblacionales de masa osea en pacientes con VIH en Espana, ajustados por edad y sexo. Materiales y metodos Se recogieron los datos de densidad mineral osea (DMO) mediante absorciometria dual de rayos X en una cohorte de pacientes con infeccion por VIH, comparandose con los valores observados en cohortes de poblacion general espanolas y estadounidenses. Resultados En 928 pacientes (media 46 anos, 25% mujeres), la prevalencia de osteoporosis en columna lumbar/cuello femoral fue del 18/5% en varones, y 17/10% en mujeres, respectivamente, aumentando desde los 40 anos en varones y desde los 50 anos en mujeres (osteoporosis en 20 y 27%, respectivamente). La DMO fue inferior a la observada en la poblacion general en casi todos los grupos etarios (media, -6%; entre 0-11% inferior respecto a la cohorte espanola, y -8%; entre 0-14% inferior a la estadounidense). Conclusiones Nuestra cohorte de pacientes con VIH tiene una menor DMO en todos los grupos etarios ajustados por edad y sexo, en comparacion con la poblacion general. Este hecho debe ser considerado en las recomendaciones de manejo. EnglishBackground and aims There are no population data on bone mass in individuals with HIV in Spain, adjusted for age and sex. Materials and methods Bone mineral density (BMD) data were obtained by dual X-ray absorptiometry in a cohort of individuals with HIV infection compared with cohort data from the general population in Spain and the United States of America. Results Of 928 individuals (mean 46 years, 25% women), the prevalence of osteoporosis in the lumbar spine/femoral neck was 18%/5% in men, and 17%/10% in women, respectively. The rate increased from the age of 40 in men and from 50 in women (osteoporosis in 20% and 27%, respectively). BMD was lower than that observed in the general population in almost all age groups (mean, -6%; between 0%-11% lower compared to the Spanish cohort, and -8%; between 0%-14% lower than the American cohort). Conclusions Our cohort of individuals with HIV had a lower BMD in all age groups after adjustment for age and sex, compared with the general population. This fact must be considered when making recommendations.

Resumen Antecedentes y objetivo El tabaquismo constituye un importante problema de salud publica, siendo una de las principales causas de morbimortalidad evitable y prematura. El objetivo del estudio es describir la mortalidad atribuible al consumo de tabaco en Espana en 2012, y compararla con resultados de anos anteriores. Pacientes y metodos Estudio descriptivo, transversal, realizado en poblacion espanola de mas de 18 anos. Las fuentes de los datos fueron la encuesta nacional de salud 2011-2012 y las estadisticas vitales del Instituto Nacional de Estadistica. Se calculo la proporcion de muertes atribuibles al tabaco por sexo y grupo de edad a partir de la fraccion etiologica poblacional. Asimismo, se calcularon los anos potenciales de vida perdidos (APVP) y la media de anos potenciales de vida perdidos (MAPVP). Resultados La prevalencia global del tabaquismo en 2012 ha sido del 23,62%, y ha provocado 60.456 muertes. El 15,23% de las muertes ocurridas en Espana en 2012 son atribuibles al consumo de tabaco. El cancer de traquea-bronquios-pulmon en varones y otras cardiopatias en mujeres fueron las que mas contribuyeron a dicha mortalidad. Los APVP fueron 184.426, y la MAPVP fue de 3,25 anos en varones y de 2,42 en mujeres. Conclusiones En el ano 2012 han muerto al dia 125 varones y 40 mujeres por causas atribuibles al consumo de tabaco. La prevalencia global del tabaquismo ha disminuido con respecto a anos anteriores, mientras que el numero y el porcentaje de muertes atribuibles al tabaquismo han aumentado en los ultimos 20 anos.

Resumen Fundamento y objetivo La evidencia sobre el elevado riesgo cardiovascular asociado a la hipertension arterial enmascarada (HTAE) es cada vez mas solida, por lo que conocer su prevalencia en nuestro entorno permitira una mejor estratificacion y manejo de los pacientes hipertensos. Sin embargo, los datos sobre su prevalencia en Espana son escasos y con una elevada variabilidad en funcion de la poblacion estudiada. Por ello, el grupo para el ESTudio de la Hipertension arterial Enmascarada (ESTHEN) de la Sociedad Espanola de Hipertension promovio el siguiente estudio con el objetivo de conocer la prevalencia de la HTAE entre la poblacion de pacientes hipertensos atendidos y controlados en las Unidades de Hipertension de hospitales de todo el territorio espanol. Pacientes y metodos Estudio prospectivo de una cohorte de pacientes hipertensos atendidos en 75 Unidades de HTA de todo el territorio espanol. Se incluyeron hipertensos tratados ≥ 18 anos con buen control de las cifras de presion arterial (PA) clinica definida por cifras de PA Resultados Se analizaron datos de 302 pacientes. La edad media fue de 56,2 anos y el 56% eran varones. La prevalencia de HTAE fue del 48% (intervalo de confianza del 95% [IC 95%] 42-53). En cuanto a los factores de riesgo asociados, el mas prevalente fue la obesidad abdominal (22,5%), fumador activo (24,2%), antecedentes familiares de enfermedad cardiovascular prematura (22,5%) y diabetes (11,6%). La prevalencia de hipertrofia ventricular izquierda fue del 23,8%, el 22,2% tenian enfermedad cardiovascular establecida y el 6,3% enfermedad renal. La HTAE se asocio con la ausencia de enfermedad cardiovascular establecida (odds ratio [OR] 0,306; IC 95% 0,139-0,676) y la proximidad de las cifras de PA clinica a los limites considerados para el control (OR 0,901; IC 95% 0,842-0,963). La OR para el diagnostico de HTAE disminuia en un 10% por cada mmHg que nos alejamos de las cifras definidas como control de la PA clinica. Conclusion La prevalencia de HTAE en los pacientes hipertensos tratados en las Unidades de HTA de Espana es practicamente del 50%, la monitorizacion ambulatoria de la PA es una herramienta imprescindible para un correcto diagnostico y manejo de todos los pacientes hipertensos.

Resumen Fundamento y objetivos La hipertension arterial (HTA) afecta a la mayoria de la poblacion muy anciana. El objetivo de este estudio fue estimar el grado de control de la HTA segun se registre la presion arterial (PA) en la consulta o por monitorizacion ambulatoria de PA (MAPA). Pacientes y metodo Estudio transversal y multicentrico sobre pacientes hipertensos de 80 o mas anos de edad con tratamiento farmacologico antihipertensivo incluidos en el proyecto CARDIORISC–MAPAPRES. Entre junio de 2004 y abril de 2007 se obtuvo una base de datos de 33.829 registros de MAPA que cumplieron estandares de calidad preestablecidos. Se definio como buen control clinico a valores de PA menores de 140/90 mmHg, y como buen control ambulatorio a valores de PA por MAPA en periodo de 24 h menores de 130/80 mmHg. Resultados Se identificaron 2.311 pacientes (6,8%) de 80 o mas anos de edad. La edad media fue de 83,1 anos (DE de 3,2) y un 63% fueron mujeres. El 21,5% (intervalo de confianza [IC] del 95%: 19,1–23,9) presento buen control clinico y un 42,1% (IC del 95%: 39,7–45,3) presento buen control ambulatorio (p Conclusiones Solo 2 de cada 10 pacientes muy ancianos hipertensos tuvieron controlada adecuadamente su HTA por medida casual. Sin embargo, practicamente el doble estaban controlados con el criterio de la MAPA. Estos hallazgos justifican un uso mas amplio de la MAPA en el paciente hipertenso de edad muy avanzada.

Fundamento y objetivo La monitorizacion ambulatoria de la presion arterial (MAPA) constituye una herramienta util en el diagnostico y seguimiento de los pacientes hipertensos. El presente estudio analiza las caracteristicas clinicas de una serie de 31.530 pacientes sometidos a una MAPA dentro del Registro Nacional. Pacientes y metodo Un total de 767 investigadores incluyeron en el estudio a pacientes con sospecha o diagnostico de hipertension en los que se indico la practica de una MAPA de 24 h con un monitor validado. Se registraron las medias de presion durante los periodos diurno, nocturno y de 24 h y se definieron los perfiles circadianos en funcion del descenso nocturno de presion sistolica: dipper extremo (> 20%), dipper (10-20%), no dipper ( Resultados Los valores de presion arterial de 24 h, diurna y nocturna fueron inferiores a los obtenidos en la consulta. Un 20% de los pacientes presentaba cifras elevadas en la consulta y normales en la MAPA (hipertension arterial [HTA] de «bata blanca» o seudorresistencia), y un 9%, cifras altas en la MAPA y normales en la consulta (HTA enmascarada). Los perfiles no dipper o riser estaban presentes en mas de la mitad de los pacientes (el 40,2 y el 13,4%, respectivamente) y se asociaban a grupos de mayor riesgo cardiovascular. Conclusiones Casi una tercera parte de los pacientes presenta cifras de presion arterial no concordantes entre la medida clinica y la MAPA. Mas de la mitad, especialmente los hipertensos de mayor riesgo, presentan un perfil circadiano en el que no se produce un adecuado descenso nocturno de presion.

Fundamento y objetivo Conocer el riesgo cardiovascular absoluto de los pacientes hipertensos mal controlados (presion arterial [PA] ≥ 140/90 mmHg o ≥ 130/80 mmHg en diabeticos) atendidos en las consultas de atencion primaria en Espana y las actitudes de los medicos frente al problema. Pacientes y metodo Estudio transversal y multicentrico, con participacion de 356 medicos de familia de todo el territorio espanol. Se realizo la estimacion del riesgo cardiovascular absoluto, mediante la clasificacion de las sociedades europeas de Hipertension y Cardiologia de 2003, a una muestra consecutiva de 1.710 pacientes atendidos por el colectivo y se valoro la actitud terapeutica del medico ante un paciente hipertenso no controlado. Resultados Se excluyo a 297 pacientes por diferentes motivos y fueron valorables 1.413, cuya media (DE) de edad fue de 65,3 (11,4) anos; el 56,7% eran mujeres. Presento cifras de PA normales ( Conclusiones El riesgo cardiovascular absoluto de los hipertensos no controlados en atencion primaria en Espana es muy relevante. Mas de la mitad de los pacientes mantienen riesgo alto o muy alto, con elevada prevalencia de LOD y ECS. La actitud terapeutica ante estos pacientes sigue siendo conservadora, aunque se observa mejoria respecto a estudios anteriores.

Smoking is an important public health problem, and is one of the main avoidable causes of morbidity and early mortality. The aim was to estimate the mortality attributable to smoking and its impact on premature mortality in Spain in the year 2012.Descriptive, cross-sectional study, carried out on the Spanish population aged ≥ 18 years in 2012. The prevalence of smoking by age and sex was obtained from the National Health Survey 2011-2012, and the number of deaths by age, sex and cause was obtained from the vital statistics of the National Institute of Statistics. The proportion of deaths attributable to smoking was calculated according to sex and age group, from the etiological fraction of the population. Likewise, loss of potential years of life lost (PYLL) and the mean potential years of life lost (MPYLL) were also calculated.In 2012, smoking caused 60,456 deaths which accounted for 15.23% of all deaths. Trachea-bronchial-lung cancer in men and other cardiopathies in women mostly contributed to this mortality. The PYLL were 184,426, and the MPYLL were 3.25 years in men and 2.42 years in women.In 2012, every day, 125 men and 40 women die from smoking-related conditions. The smoking prevalence has diminished in comparison with previous years and the number and percentage of deaths attributable to the smoking have increased in the last 20 years.

Fundamento y objetivo Se ha planteado que la utilizacion de determinados tipos de tratamiento antihipertensivo puede favorecer el desarrollo de insuficiencia cardiaca (IC). El objetivo del estudio fue analizar la posible existencia de una asociacion con los farmacos antihipertensivos en pacientes con nuevo diagnostico de IC Pacientes y metodo Estudio retrospectivo de casos (81 pacientes con un primer ingreso por nuevo diagnostico de IC) y controles (162 pacientes ingresados por otros tipos de complicaciones cardiovasculares secundarias a la hipertension). Se registraron el tipo de tratamiento antihipertensivo utilizado y su asociacion con el desarrollo de IC Resultados No se objetivo asociacion con ninguna de las principales familias de antihipertensivos. Al agrupar estos en 2 tipos, clasicos (diureticos y bloqueadores beta) o modernos (antagonistas del calcio, inhibidores de la enzima de conversion de la angiotensina, bloqueadores alfa y antagonistas de los receptores de angiotensina), se observo una asociacion negativa entre estos ultimos, que se hallaban presentes en el 48,1% de los casos y en el 63,6% de los controles (odds ratio = 0,532; intervalo de confianza del 95%, 0,310–0,913). Esta asociacion desaparecia al ajustar por la presencia de factores de riesgo cardiovascular o enfermedades relacionadas con la hipertension Conclusiones El desarrollo de IC no esta ligado a la utilizacion retrospectiva de ningun tipo determinado de farmaco antihipertensivo. La evidencia disponible no permite recomendar determinados tipos de farmacos en pacientes con riesgo de desarrollo de IC que no presenten sintomas de la enfermedad

a Medico de Familia. Coordinador del Grupo Comunicacion y Salud. SEMFyC. EAP Gavarra, ICS. Cornella de Llobregat. Barcelona. bMedico, Jefe de Proyectos de Bioetica y Educacion Medica. Fundacion de Ciencias de la Salud. Madrid. cJurista. Licenciado en Ciencias Morales. Profesor en el ISP de la Universidad Pontificia de Salamanca. dMedico de Familia. Coordinadora de la Unidad Docente de MFyC. Santander-Laredo. eEnfermera. Centro de Salud Actur Sur.

In recent years the evidence that masked hypertension is associated with a highest cardiovascular risk is well established. Knowing the prevalence of masked hypertension in our country will allow a better cardiovascular risk stratification and management of hypertensive patients, although the information is scant and heterogeneous. For this reason, the working group for the study of masked hypertension (ESTHEN) in Spain developed the present study with the objective to know the prevalence of masked hypertension in a cohort of hypertensive patients follows in several Hypertension Units in Spain.Prospective study of a cohort of hypertensive patients followed in 75 Hypertension Units in Spain. Eligible patients were hypertensive cases aged ≥ 18 years receiving antihypertensive drug treatment and showing an adequate BP control at the clinic (BP140/90 mmHg). Masked hypertension was defined when mean daytime BP ≥ 135/85 mmHg.We analyzed data from 302 patients. Mean age was 56.2 years and 56% were male. Prevalence of masked hypertension was 48% (95%CI 42-53). The most prevalent accompanying risk factors were abdominal obesity (39.7%), smoking (24.2%), family with premature cardiovascular disease (22.5%), and diabetes (11.6%). Prevalence of left ventricular hypertrophy was 23.8%, and 22.2% of patients had established cardiovascular disease, and 6.3% had renal disease. Masked hypertension was related to the absence of established cardiovascular disease (OR 0.306, 95%CI 0.139-0.676) and to the proximity of the clinic BP levels to the control thresholds (0.901, 95%CI 0.842-0.963). The OR of masked hypertension diminished 10% for each mmHg below the threshold of control.The prevalence of masked hypertension was approximately 50% in treated hypertensive patients. ABPM constitutes a basic tool for detection of this abnormality.

Hypertension is highly prevalent in the very elderly. We studied control rates of hypertension according to clinic blood pressure (BP) and ambulatory BP monitoring (ABPM) in treated hypertensives agedor =80 years.Data came from the Spanish Society of Hypertension ABPM Registry (CARDIORISC - MAPAPRES project), which comprises a nation-wide network of more than 1,000 physicians sending standardized ABPM registries via web. Between June 2004 and April 2007 we obtained a 33.829-patient database. Control of hypertension was defined at the clinic when office BP was140/90mmHg and at the ABPM when mean BP during the 24-h period was130/80mmHg.We identified 2,311 patients (6.8%) agedor =80 years. Mean age (SD) was 83.1 (3.2) years and 63% were women. Control of clinic BP was observed in 21.5% of cases (95%CI: 19.1-23.9) and control of 24-h BP in ABPM was 42.1% (95%CI: 39.7-45.3). Prevalence of masked hypertension was 7.0% (95%CI: 6.0-8.0) and prevalence of office-resistant control (white coat) was 27.6% (95% CI: 25.7-29.4). Diabetes, kidney disease, and duration of hypertension were associated with lack of control in ABPM.In very old hypertensives, control of clinic BP was 21.5% but ambulatory-based hypertension control was 42.1%. Physicians should be aware that the likelihood of misestimating BP control is high in these subjects. A wider use of ABPM in the elderly with hypertension should be considered.

Ambulatory blood pressure monitoring (ABPM) is a useful diagnostic and therapeutic tool in hypertensive patients. This study reports the clinical characteristics of 31,530 patients included in the Spanish Registry of ABPM.A total number of 767 investigators recruited patients with suspected or confirmed hypertension to whom an ABPM was indicated with a validated device and included them in the study. Mean blood pressures from daytime, nighttime, and the whole 24-hour period were all measured. Circadian patterns were defined depending on nocturnal systolic blood pressure fall: extreme dipper (20%), dipper (10%-20%), non-dipper (10%) and riser (nocturnal blood pressure increase).24-hour, daytime, and nighttime blood pressure values were lower than those obtained at the office. Twenty percent of patients exhibited elevated office blood pressure with normal values on ABPM (white coathypertensives or false resistant) whereas 9% showed increased values on ABPM, but normal at the office (masked hypertension). The non-dipper or riser circadian patterns were present in more than half of the patients (40.2% and 13.4%, respectively) and were associated with an increased cardiovascular risk.Almost one third of hypertensive patients exhibit blood pressure values that are not concordant between office and ABPM. More than a half of patients, especially those at higher risk, present a circadian pattern with an inadequate nocturnal blood pressure fall.

To assess absolute cardiovascular risk and co-morbidities in uncontrolled hypertensive patients (blood pressure [BP]or=140/90 mmHg oror=130/80 mmHg in diabetics) attending Primary Care Physicians in Spain, and to determine the attitudes of these physicians towards this problem.Cross-sectional, multicenter study involving 356 general practitioners around Spain. Absolute cardiovascular risk was assessed according to ESH-ESC 2003 Guidelines in a sample of 1,710 patients.Two hundred ninety seven patients were excluded by several reasons and a total of 1,413 hypertensive patients were valuable (mean age: 65.3+/-11.4 years; 56.7% women). Normal BP values (140/90 mmHg) were exhibited by 0.2%, high-normal BP (120-139/80-89 mmHg) were exhibited by 2.8%, grade 1 hypertension (140-159/90-99 mmHg) by 49.9%, grade 2 hypertension (160-179/100-109 mmHg) by 39.3%, and grade 3 hypertension (or=180/110 mmHg) by 7.9%. Associated cardiovascular risk factors were observed in 96.0% of patients (95% CI=94.7-97.2%), target organ damage in 34.5% (95% CI=31.6-36.5%), and cardiovascular clinical disease in 36.0% (95% CI=33.5-38.5%). According to ESH-ESC 2003 Guidelines 34.0% (CI=31.5-38.2%) were at very-high risk; 29.4% (95% CI=26.4-32.8%) at high risk; 30.4% (95% CI=27.2-33.7%) at moderate risk and 5.4% (95% CI=3.9-7.2%) at low risk of cardiovascular disease. Despite the high absolute risk, physicians did not do any therapeutic change in 30.4% (95% CI=28.2-33.5%) of uncontrolled hypertensive patients. Most of them (64.26%) considered that bad compliance to life style changes was the reason for inadequate BP control. The most frequent measure introduced was the association of additional drugs.Absolute cardiovascular risk in uncontrolled hypertensive patients attending Primary Care Physicians in Spain is very relevant. Sixty-five percent of these patients are at high or very high risk with a high prevalence of target organ damage or associated cardiovascular clinical disease. Therapeutic attitudes towards these patients are still very conservative although they are improving compared with previous studies.

It has been suggested that the use of some antihypertensive agents may favour the development of congestive heart failure. The aim of the present study was to evaluate such a possible association in patients who had a new diagnosis of congestive heart failure.This was a retrospective case-control study of 81 patients who had a first hospital admission with a new diagnosis of congestive heart failure (cases) and 162 patients admitted for other hypertensive complications (controls). Previous antihypertensive drug use was registered and the possible association with congestive heart failure was evaluated.The presence of congestive heart failure was not associated with the use of any antihypertensive drug class. When treatments were grouped in classic (diuretics and betablockers) or modern (calcium channel blockers, angiotensin-converting-enzyme inhibitors, alphablockers or angiotensin receptor blockers), a negative association was observed with the latter group, which was observed in 48.1% of cases and 63.6% of controls (odds ratio: 0.532; 95% confidence interval, 0.310-0.913). This association was lost after adjustment for other cardiovascular risk factors or previous hypertensive complications.The development of congestive heart failure was not associated with the use of any specific antihypertensive drug class. From the present evidence, it is not possible to recommend a specific antihypertensive agent in patients at risk of developing congestive heart failure but without evidence of such disease.

Our purpose was to describe the time trend in HIV seroprevalence among homo/ bisexual men.We analyzed 9,383 homo/ bisexual men who had a first voluntary test for HIV in 10 Spanish clinics from 1992 to 2000.HIV prevalence decreased from 20.3% in 1992 to 8.4% in 2000. In the multivariate analysis this decline appeared independently associated with the testing year and the birth cohort.New generations of voluntarily tested homo/bisexual men are less infected by HIV, but it is yet necessary to intensify the prevention programs.

Transmembrane Ca2+ fluxes are mediated, at least in part, by the Ca(2+)-dependent ATPase. Thus, genetic or acquired abnormalities of this pump could explain the increase in free cytosolic Ca2+ content that has been observed in essential hypertensive patients.We carried out a kinetic study of the Ca2+ pump in intact erythrocytes from 49 essential hypertensive patients and 27 normotensive healthy persons. We used Sr2+ as a calcium analogue to measure Ca2+ fluxes dependent of the Ca2+ pump. The intracellular concentrations of Sr2+ and Ca2+ were modified using the A-23187 ionophore in a Ringer isotonic solution.Hypertensive patients showed a significant increase of the maximal efflux rate for Sr2+ (Vmax) with respect to controls (6.6 [2.3] vs 5.2 [1.6] mmol/l cel/h; p = 0.006). Mean values of apparent dissociation constants for intracellular Ca2+ (KCa) were also increased in essential hypertensives (80.36 [53.46] vs 55.25 [15.13] mumol/l cel; p = 0.06). A significant correlation between Vmax and age (r = 0.342; p = 0.016), and serum creatinine (r = 0.446; p = 0.001) was observed. The KCa only correlated with serum creatinine (r = 0.402; p = 0.004). Using the KCa confidence interval of 99% as the higher normal limit, patients were segregated into two subgroups depending on normal KCa values (33 patients, 67.3%) or increased KCa values (16 patients, 32.6%). Age (50.8 [13.5] vs 43 [10.2] years; p = 0.02), serum creatinine (1.13 [0.17] vs 0.95 [0.17] mg/dl; p = 0.001) and serum uric acid (7.27 [3.32] vs 6.14 [1.49] mg/dl; p = 0.04) were higher in patients with increased KCa. Finally, patients with increased KCa also showed increased values of Vmax (9.13 [2.02] vs 5.38 [12.81] mmol/l cel/h; p0.0001).Essential hypertensive patients are heterogeneous regarding ion transport abnormalities, only affecting subgroups of hypertensive patients. We have observed abnormalities of the Ca(2+)-dependent ATPase in 33% of essential hypertensive patients. These patients are older and tend to exhibit higher values of serum creatinine and uric acid.

The aim of this study was to analyze the complications derived from the use of intravenous cannulae with particular attention being paid to the possible predisposing factors.A prospective follow up of 569 intravenous cannulae placed in the emergency department or the medical ward of a county hospital was carried out. 492 of these cannulae were peripheral (PC) and 77 central inserted through peripheral veins (CPVC).Fifty-one percent of the catheters were withdrawn due to complications with the most frequent being phlebitis (35%), followed by extravasation (11.5%). The mean time in situ was 3.61 +/- 3.2 days. The daily risk of complications ranged from 2 to 9% for the CPVC (non significant differences) and between 15% (day 1) and 30% (6 or more days) for the PC. In the latter case there were no differences in the daily specific rate of complications after the first 24 hours. The probability of a catheter remaining in place more than three and six days without complications was 51% and 31%, respectively for the CP and 91% and 87% for the CPVC (p0.0001). Of the variables analyzed, age65 years, female sex, insertion of the cannula into the back of the hand, the fact of the route being peripheral without the administration of heparin were significantly associated to the development of complications, while the intravenous administration of aminophillin was associated with the appearance of phlebitis. Thirteen percent of the catheters withdrawn due to phlebitis were infected.The complication most frequent observed in intravenous cannulation was phlebitis, an entity which is generally not of an infectious nature. The risk of unspecific complications every day during catheterization is constant in the case of central peripheral vein cannulae as well as in peripheral cannulae which do show problems during the first 24 hours after placement. Insertion of the cannulae into the veins of the back of the hand, female sex, advanced age and intravenous administration of certain drugs influence in the development of phlebitis.