Luis M. Ruilope

Bio: Luis M. Ruilope is an academic researcher from European University of Madrid. The author has contributed to research in topics: Blood pressure & Kidney disease. The author has an hindex of 94, co-authored 841 publications receiving 97778 citations. Previous affiliations of Luis M. Ruilope include Lund University & Mayo Clinic.

The Clinical Significance of Blood Pressure Lowering Treatment: First-Line Drug Choice is Important

Abstract: Arterial hypertension is the most common and relevant burden in cardiovascular disease. Its high prevalence is rising continuously and its frequent association with other cardiovascular risk factors enhances the need for adequate control in the hypertensive population. As recognized by guidelines, an adequate risk stratification is necessary in each hypertensive patient followed by an intervention that not only lowers blood pressure, but can also improve other aspects of the cardiorenal disease that so frequently accompany arterial hypertension. This is, therefore, the reason for starting therapy in patients, for example, with pre-diabetes mellitus (i.e. impaired fasting serum glucose and/or impaired glucose tolerance), diabetes, organ damage or established cardiorenal disease, where, according to guidelines, the suppression of renin must be a suppressor of the renin-angiotensin system. The way in which patients are treated can contribute to a better or worse protection beyond attaining blood pressure goals.

Perfil metabolómico diferenciador asociado a la condición de normoalbuminuria en la población hipertensa

Abstract: Resumen Antecedentes y objetivo La albuminuria es un indicador de dano organico subclinico y un marcador de riesgo cardiovascular y de enfermedad renal. Un porcentaje de pacientes hipertensos desarrollan albuminuria a pesar de estar bajo supresion cronica del sistema renina-angiotensina (SRA). Previamente identificamos metabolitos en orina asociados al desarrollo de albuminuria. En este estudio, investigamos alteraciones metabolicas que reflejen distintos niveles dentro de la condicion de normoalbuminuria. Pacientes, materiales y metodos Se analizo la orina de 48 pacientes hipertensos con supresion cronica del SRA. Se clasificaron segun el cociente albumina/creatinina (ACR) en 3 grupos: normoalbuminuria ( Resultados Oxalacetato, 3-ureidopropionato, guanidoacetato y malato muestran una variacion significativa entre los grupos normo y micro. Ademas, estos metabolitos son capaces de diferenciar entre los pacientes normo y normal-alta. Igualmente se observo correlacion significativa entre el nivel de los metabolitos identificados con el nivel de ACR. Las variaciones observadas senalan una alteracion del metabolismo energetico ya en pacientes con albuminuria en el rango normal-alta. Conclusiones Se confirma la asociacion del panel molecular constituido por 3-ureidopropionato, oxalacetato, malato y guanidoacetato con distintos niveles de albuminuria. Asi mismo, se ha identificado una huella metabolica capaz de mostrar variacion dentro de la condicion de normoalbuminuria, lo que permite una estratificacion molecular mas temprana de los pacientes.

The use of antihypertensive fixed combinations in clinical practice needs a reappraisal

Abstract: wileyonlinelibrary.com/journal/jch J Clin Hypertens. 2018;20:716–717. ©2018 Wiley Periodicals, Inc. The treatment of arterial hypertension requires the use of combination therapy, either fixeddose or freedose, in the majority of patients with hypertension.1 Many different fixeddose combinations have appeared in the past decades in an attempt to facilitate blood pressure (BP) control while maintaining better adherence and compliance. This was initially shown to be the case during the first year of use of fixeddose combinations,2 even in moderate to severe hypertension.3 In fact, the most widely used fixedor freedose combinations, recommended by most guidelines, includes a reninangiotensin blocker (angiotensinconverting enzyme inhibitor or angiotensin receptor blocker) with a calcium channel blocker or a diuretic in double combinations, and the three drugs in triple fixedor freedose combination. The selection of these drugs to be combined either as freeor fixeddose combinations is based on the demonstration of the advantages of using an initial combination that besides attaining a more rapid initial BP control reduces cardiovascular events in patients with hypertension during the followup.4 Furthermore, the combination of an angiotensinconverting enzyme inhibitor with a dihydropyridine calcium channel blocker has been shown to be more protective than an angiotensinconvertingenzyme inhibitor with a diuretic.5 The article by Bramlage and colleagues6 in this issue of the Journal of Clinical Hypertension reviews the data obtained in a cohort of more than 80 000 patients in Germany. Registries of BP are relevant because they contribute to direct practice and also to finding the most adequate apportionment of resources.7 Theoretically, this realworld evidence is perfectly compatible with a planned intervention or the use of a randomization,8 but frequently, as is the case with the data in the present article, the realworld data do not contemplate the application of the conclusions obtained to the most adequately performed clinical trials contained in guidelines. As can be seen in the trial, fixeddose combinations are used only in a minority of the patients compared with free combinations and they are more often used in patients with lower risk according to the presence of comorbidities. In fact, in patients receiving freedose combinations, a higher proportion was receiving three or more drugs before entering the registry. This favors the concept of more difficult to control hypertension, or even resistant hypertension, in this group. Interestingly, the magnitude of the change in BP during followup was not different between the two series of patients, but confirming the available data even in daily life practice9 persistence/ adherence was better when fixeddose combinations were used. The interpretation of the data seen in this article is challenging. First, it can be considered that doctors do not follow guidelines on the use of fixeddose combinations. Second, when the risk is clearly elevated, they may feel more comfortable with free combinations that allow a wider use of doses, albeit the need for addition of new drugs could contribute to the decrease in persistence/adherence. Third, the finding of similar BP control with the two therapeutic attitudes fits well with the hesitation of doctors in relation to reduce elevated BP to goal levels.10 Otherwise, the control should have been more intense in relation to the risk elevation, which is not the case in the present article. The data contained in this publication indicate that a reappraisal of the use of fixeddose combinations in daily clinical practice is required in order to obtain the advantages demonstrated in clinical trials and cohort studies on the protection of cardiovascular and renal damage in patients with hypertension.

Renin Academy in Focus Renin Academy presence at major congresses

Abstract: Ophthalmol Vis Sci 2007;48:422-9. 18.Oh BH, Mitchell J, Herron JR et al. Aliskiren, an oral renin inhibitor, provides dose-dependent efficacy and sustained 24-hour blood pressure control in patients with hypertension. J Am Coll Cardiol 2007;49:1157-63. 19. Andersen K, Weinberger MH, Egan B et al. Comparative efficacy and safety of aliskiren, an oral direct renin inhibitor, and ramipril in hypertension: a 6-month, randomized, double-blind trial. J Hypertens 2008; 26:589-99. 20. Persson F, Rossing P, Schjoedt KJ et al. Time course of the antiproteinuric and antihypertensive effects of direct renin inhibition in type 2 diabetes. Kidney Int 2008 Ma 12 [Epub ahead of print]. 21. Feldman DL, Persohn E, Schutz H et al. Renal localisation of the renin inhibitor aliskiren. J Clin Hypertens 2006;8:A80-A81 (P-178). 22. Feldman DL, Jin L, Xuan H et al. Effects of aliskiren on blood pressure, albuminuria, and (pro)renin receptor expression in diabetic TG(mRen-2)27 rats. Hypertension 2008 [in press]. 23.Muller DN, Luft FC. Direct renin inhibition with aliskiren in hypertension and target organ damage. Clin J Am Soc Nephrol 2006;1:221-8. 24.Uresin Y, Taylor AA, Kilo C et al. Efficacy and safety of the direct renin inhibitor aliskiren and ramipril alone or in combination in patients with diabetes and hypertension. JRAAS 2007;8:190-8. 25.Oparil S, Yarrows, S, Patel S et al. Efficacy and safety of combined use of aliskiren and valsartan in patients with hypertension: a randomised, double-blind trial. Lancet 2007;370:221-9. 26. Parving H-H, Lewis JB, Lewis EJ, Hollenberg NK. Aliskiren in the evaluation of proteinuria in diabetes (AVOID). Abstract and poster #SA-PO1051 presented at American Society of Nephrology Renal Week, San Francisco, USA. 3 November 2007. 27.McMurray JJV. Haemodynamic, neurohumoral, renal and ambulatory electrocardiographic effects of a new oral renin inhibitor in stable heart failure. Oral presentation at European Society of Cardiology Congress, Vienna, Austria. 1–5 September 2007. 28. Azizi M, Webb R, Nussberger J, Hollenberg NK. Renin inhibition with aliskiren: where are we now, and where are we going? J Hypertens 2006;24:243-56. 29. Batenburg WW, de Bruin RJ, van Gool JM et al. Aliskirenbinding increases the half life of renin and prorenin in rat aortic vascular smooth muscle cells. Arterioscler Thromb Vasc Biol 2008;28:1151-7. 30.Nussberger J, Aubert JF, Bouzourene K et al. Renin inhibition by aliskiren prevents atherosclerosis progression: comparison with irbesartan, atenolol, and amlodipine. Hypertension 2008;51:1306-11.

Proteomic Analysis of Blood Extracellular Vesicles in Cardiovascular Disease by LC-MS/MS Analysis

Abstract: Extracellular vesicles are membrane vesicles related to cell communication. These vesicles consist of proteins, RNA, and microRNA and are an interesting and important tool to understand the processes taking place in the secreting cell, especially in diseases in which its release is often enhanced. The used of blood extracellular vesicles in cardiovascular disease as a low invasive, easily accessible source of circulating markers could give us important information related to pathological process even more with the use of proteomic analysis. In this chapter, we describe a protocol to isolate and proteomic analyze extracellular vesicles from blood associated with cardiovascular disease.

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Abstract: The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Abstract: ABCD : Appropriate Blood pressure Control in Diabetes ABI : ankle–brachial index ABPM : ambulatory blood pressure monitoring ACCESS : Acute Candesartan Cilexetil Therapy in Stroke Survival ACCOMPLISH : Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension ACCORD : Action to Control Cardiovascular Risk in Diabetes ACE : angiotensin-converting enzyme ACTIVE I : Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events ADVANCE : Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation AHEAD : Action for HEAlth in Diabetes ALLHAT : Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack ALTITUDE : ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints ANTIPAF : ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation APOLLO : A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People ARB : angiotensin receptor blocker ARIC : Atherosclerosis Risk In Communities ARR : aldosterone renin ratio ASCOT : Anglo-Scandinavian Cardiac Outcomes Trial ASCOT-LLA : Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm ASTRAL : Angioplasty and STenting for Renal Artery Lesions A-V : atrioventricular BB : beta-blocker BMI : body mass index BP : blood pressure BSA : body surface area CA : calcium antagonist CABG : coronary artery bypass graft CAPPP : CAPtopril Prevention Project CAPRAF : CAndesartan in the Prevention of Relapsing Atrial Fibrillation CHD : coronary heart disease CHHIPS : Controlling Hypertension and Hypertension Immediately Post-Stroke CKD : chronic kidney disease CKD-EPI : Chronic Kidney Disease—EPIdemiology collaboration CONVINCE : Controlled ONset Verapamil INvestigation of CV Endpoints CT : computed tomography CV : cardiovascular CVD : cardiovascular disease D : diuretic DASH : Dietary Approaches to Stop Hypertension DBP : diastolic blood pressure DCCT : Diabetes Control and Complications Study DIRECT : DIabetic REtinopathy Candesartan Trials DM : diabetes mellitus DPP-4 : dipeptidyl peptidase 4 EAS : European Atherosclerosis Society EASD : European Association for the Study of Diabetes ECG : electrocardiogram EF : ejection fraction eGFR : estimated glomerular filtration rate ELSA : European Lacidipine Study on Atherosclerosis ESC : European Society of Cardiology ESH : European Society of Hypertension ESRD : end-stage renal disease EXPLOR : Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination FDA : U.S. Food and Drug Administration FEVER : Felodipine EVent Reduction study GISSI-AF : Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation HbA1c : glycated haemoglobin HBPM : home blood pressure monitoring HOPE : Heart Outcomes Prevention Evaluation HOT : Hypertension Optimal Treatment HRT : hormone replacement therapy HT : hypertension HYVET : HYpertension in the Very Elderly Trial IMT : intima-media thickness I-PRESERVE : Irbesartan in Heart Failure with Preserved Systolic Function INTERHEART : Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries INVEST : INternational VErapamil SR/T Trandolapril ISH : Isolated systolic hypertension JNC : Joint National Committee JUPITER : Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin LAVi : left atrial volume index LIFE : Losartan Intervention For Endpoint Reduction in Hypertensives LV : left ventricle/left ventricular LVH : left ventricular hypertrophy LVM : left ventricular mass MDRD : Modification of Diet in Renal Disease MRFIT : Multiple Risk Factor Intervention Trial MRI : magnetic resonance imaging NORDIL : The Nordic Diltiazem Intervention study OC : oral contraceptive OD : organ damage ONTARGET : ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial PAD : peripheral artery disease PATHS : Prevention And Treatment of Hypertension Study PCI : percutaneous coronary intervention PPAR : peroxisome proliferator-activated receptor PREVEND : Prevention of REnal and Vascular ENdstage Disease PROFESS : Prevention Regimen for Effectively Avoiding Secondary Strokes PROGRESS : Perindopril Protection Against Recurrent Stroke Study PWV : pulse wave velocity QALY : Quality adjusted life years RAA : renin-angiotensin-aldosterone RAS : renin-angiotensin system RCT : randomized controlled trials RF : risk factor ROADMAP : Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention SBP : systolic blood pressure SCAST : Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke SCOPE : Study on COgnition and Prognosis in the Elderly SCORE : Systematic COronary Risk Evaluation SHEP : Systolic Hypertension in the Elderly Program STOP : Swedish Trials in Old Patients with Hypertension STOP-2 : The second Swedish Trial in Old Patients with Hypertension SYSTCHINA : SYSTolic Hypertension in the Elderly: Chinese trial SYSTEUR : SYSTolic Hypertension in Europe TIA : transient ischaemic attack TOHP : Trials Of Hypertension Prevention TRANSCEND : Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease UKPDS : United Kingdom Prospective Diabetes Study VADT : Veterans' Affairs Diabetes Trial VALUE : Valsartan Antihypertensive Long-term Use Evaluation WHO : World Health Organization ### 1.1 Principles The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Abstract: 2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization

Abstract: Background End-stage renal disease substantially increases the risks of death, cardiovascular disease, and use of specialized health care, but the effects of less severe kidney dysfunction on these outcomes are less well defined. Methods We estimated the longitudinal glomerular filtration rate (GFR) among 1,120,295 adults within a large, integrated system of health care delivery in whom serum creatinine had been measured between 1996 and 2000 and who had not undergone dialysis or kidney transplantation. We examined the multivariable association between the estimated GFR and the risks of death, cardiovascular events, and hospitalization. Results The median follow-up was 2.84 years, the mean age was 52 years, and 55 percent of the group were women. After adjustment, the risk of death increased as the GFR decreased below 60 ml per minute per 1.73 m2 of body-surface area: the adjusted hazard ratio for death was 1.2 with an estimated GFR of 45 to 59 ml per minute per 1.73 m2 (95 percent confidence interval, 1....