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Resumen: Objetivo: Estimar la prevalencia de la hipotensión ortostática (HO) en pacientes de 80 o más años de edad que demandan consulta en una unidad de atención primaria. Relacionar la HO con las enfermedades más prevalentes y los fármacos más consumidos. Diseño: Transversal observacional. Localización: Unidad de atención primaria, Santiago de Compostela. Participantes: Se reclutaron 81 pacientes de 80 o más años representativos de una unidad de atención primaria. Se excluyeron 10 pacientes. Mediciones principales: Se realizó la medición de la presión arterial en decúbito y posteriormente en bipedestación en el instante siguiente a la incorporación y tras 3 min. Se revisaron en la historia clínica electrónica los diagnósticos y los tratamientos activos mediante una entrevista al paciente y cuidador. Resultados: En un 26,76% de los pacientes se produjo un descenso mayor o igual de 20 mmHg en la presión arterial sistólica y/o 10 mmHg en la presión arterial diastólica, en el instante siguiente al cambio postural. El descenso se mantuvo tras 3 min de la incorporación de decúbito a bipedestación en el 16,90% de los pacientes. Ningún paciente estaba diagnosticado de HO. La mayor razón de prevalencia se dio con la diabetes mellitus (1,6; p = 0,412), no habiendo diferencias para la hipertensión arterial (p = 0,881). La HO se relacionó de forma estadísticamente significativa con la toma de bloqueadores de sistema renina-angiotensina-aldosterona (OR: 8,174; IC95%: 1,182-56,536; p = 0,033) y benzodiacepinas (OR: 5,938; IC95%: 1,242-28,397; p = 0,026). Conclusión: La HO tuvo una prevalencia del 16,90% en los pacientes de edad avanzada que acudieron a consulta. Debe tenerse en cuenta su relación con algunos fármacos (bloqueadores de sistema renina-angiotensina-aldosterona y benzodiacepinas). Abstract: Objective: To estimate the prevalence of orthostatic hypotension (OH) in patients 80 years old and over attending a primary care unit. To relate OH to the most prevalent pathologies and to the most used drugs. Design: Transversal observational study. Location: Primary care unit, Santiago de Compostela. Participants: Eighty one patients 80 years old or over representative of a primary care unit were recruited. Ten patients were excluded. Main measurements: Blood pressure was measured in decubitus and later in erect position first immediately after standing and then after 3 minutes. Diagnoses and active treatments were reviewed in the electronic clinical history and through an interview with the patient and caregiver. Results: In 26.76% of patients the systolic blood pressure fell by 20 mmHg or more and/or the diastolic blood pressure fell by 10 mmHg in the instant following the postural shift. In 16.90% of patients the drop persisted after 3 minutes of standing from decubitus position. None of the patients was diagnosed with OH. The highest prevalence ratio was observed for diabetes mellitus (1.6; P = .412), not existing differences for arterial hypertension (P = .881). OH related in a statistically meaningful way to the use of renin angiotensin aldosterone system inhibitors (OR: 8.174, CI95%: 1.182-56.536); P = .033] and benzodiazepines (OR: 5.938, CI95%: 1.242-28.397; P = .026)]. Conclusion: OH had a prevalence of 16.90% among the elderly patients who had a consultation. Its connection with some drugs (renin angiotensin aldosterone system inhibitors and benzodiazepines) must be considered. Palabras clave: Hipotensión ortostática, Edad avanzada, Atención primaria, Benzodiacepinas, Keywords: Orthostatic hypotension, Elderly, Primary Care, Benzodiacepines

Background Several studies suggest that there is a pathogenic link between chronic obstructive pulmonary disease (COPD) and cardiovascular diseases. On the other hand, increased sympathetic tone has been described in several respiratory diseases. Our objective was to determine whether hypertension mediated by sympathetic overactivity is a mechanism that explains the association between COPD and cardiovascular diseases. Methods Prospective nested case-control observational study; 67 COPD patients were matched 1:1 by sex and age to controls with smoking history. 24 hour-blood pressure monitoring, urinary catecholamines and their metabolites measurement, echocardiography, carotid ultrasound examination, nocturnal oximetry and retinography were performed. Findings classic cardiovascular risk factors and comorbidities were similarly distributed between cases and controls. No significant differences for blood pressure variables (difference for mean systolic blood pressure: -0·13 mmHg; 95% CI: -4·48,4·20; p = 0·94; similar results for all blood presssure variables) or catecholamines values were found between both groups. There was a tendency for lower left ventricle ejection fraction in the COPD cases, that approached statistical significance (64·8 ± 7·4 vs 67·1 ± 6·2, p = 0·05). There were no differences in the retinal arteriovenous ratio, the carotid intima-media thickness, or the number of carotid plaques, between cases and controls. Fibrinogen values were higher in the COPD group (378·4 ± 69·6 vs 352·2 ± 45·6 mg/dL, p = 0·01) and mean nocturnal oxygen saturation values were lower for COPD patients (89·0 ± 4·07 vs 92·3 ± 2·2%, p < 0·0001). Interpretation Hypertension induced by sympathetic overactivity does not seem to be a mechanism that could explain the association between COPD and cardiovascular disease.

There are some evidence of the association between the calibre of the retinal blood vessels and hypertension. Computer-assisted procedures have been proposed to measure the calibre of retinal blood vessels from high-resolution photopraphs. Most of them are in fact semi-automatic. Our objective in this paper is twofold, to develop a totally automated system to classify retinal vessels into arteries and veins and to compare the measurements of the arteriolar-to-venular diameter ratio (AVR) computed from the system with those computed from observers. Our classification method consists of four steps. First, we obtain the vascular tree structure using a segmentation algorithm. Then, we extract the profiles. After that, we select the best feature vectors to distinguish between veins and arteries. Finally, we use a clustering algorithm to classify each detected vessel as an artery or a vein. Our results show that compared with an observer-based method, our method achieves high sensitivity and specificity in the automated detection of retinal arteries and veins. In addition the system is robust enough independently of the radii finally chosen, which makes it more trustworthy in its clinical application. We conclude that the system represents an automatic method of detecting arteries and veins to measure the calibre of retinal microcirculation across digital pictures of the eye fundus.

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.

Early alterations in retinal microcirculation are observed in most hypertensive patients seen in daily practice and the European guidelines consider it is necessary an objective method to quantify these alterations. We have previously described a semi-automatic computerized system to evaluate the calibre of retinal blood vessels that has shown high sensitivity and specificity to calculate the arteriovenous ratio (AVR), though with limitations. We describe a method based on the snakes model to calculate the arteriovenous ratio.We had compared it with the previously reported lineal method, and we have analyzed 173 digital photographs from 96 hypertensive patients, most of them receiving treatment. Photos were made in two hospitals (A Coruña: 66 and Santiago de Compostela: 107), and were analysed by the same people in each Centre, by the lineal and snake method.We have observed that the arithmetic mean and the differences in AVR between both methods were minimal and showed a normal distribution. Cronbach statistics was 0.974 and intraclass correlation coefficient 0.949 (p0.001), for the images from Santiago and 0.923 with an intraclass correlation coefficient of 0.857 (p0.001) for the images from A Coruña.This semiautomatic method to calculate the AVR ratio has a high sensitivity and a greater specificity than previous method, and the correlation between the results obtained with both is excellent.