OBJECTIVES: To analyze the effect of differing diet on the acid load content on bone metabolism. DESIGN: Multicentric, randomized, single-blind, parallelgroup clinical trial. SETTING: Outpatient clinics. PARTICIPANTS: Two hundred thirty-eight elderly men and women aged 60 to 80 at high risk for cardiovascular disease were randomly assigned to three interventional groups: a recommended low-fat diet (control diet group), a Mediterranean diet supplemented with virgin olive oil, or a Mediterranean diet supplemented with mixed nuts. MEASUREMENTS: Main outcomes were 12-month changes from baseline in bone formation and resorption markers and bone mass measured according to quantitative ultrasound scanning. RESULTS: The baseline data on the anthropometric, bone densitometry, and biochemical variables did not differ between the three groups. Dietary potential renal acid load (PRAL) and daily net endogenous acid production (NEAP) at baseline did not differ between groups. After intervention, subjects allocated to the Mediterranean diet with mixednutshad asignificantincrease ofPRAL andNEAP. In comparison, subjects in the Mediterranean diet with nuts group had higher parathyroid hormone (PTH) levels (2.63, 95% confidence interval (CI) 5 � 1.01‐6.35, P 5.02) and a nonsignificantly higher (0.31, 95% CI 5 � 0.13‐0.74, P 5.14) urine free deoxypyridoxine:creatinine ratio, a marker of bone resorption, than the control group and the Mediterranean diet with virgin olive oil group. CONCLUSION: A Mediterranean dietary pattern associated with a high dietary acid load derived from consumption of mixed nuts does not seem to have a much greater effect on bone metabolism biomarkers, with the exception of PTH levels, than a Mediterranean diet without mixed nuts or a control diet in elderly subjects. J Am Geriatr Soc 57:1789–1798, 2009.

Mediterranean diet and high dietary acid load associated with mixed nuts: effect on bone metabolism in elderly subjects.

Clinical practice guidelines on the management of hypertension such as the 2007 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) Guidelines were developed with the objective of allowing a greater number of patients with high blood pressure to be detected and effectively treated. The acceptance of hypertension guidelines and their implementation in clinical practice by ‘front-line’ physicians continues to be less than optimal for a variety of reasons, however, including the gap between academic guideline writers and those whose task it is to implement the guidelines, the physicians’ own attitudes and knowledge, the characteristics of the guideline itself, patient-related factors, and external barriers such as a lack of adequate resources. In Spain, a survey of the opinions of Spanish physicians on the 2007 ESH/ESC hypertension Guidelines found that there was agreement that the guidelines allow a better stratification of cardiovascular risk, better control of risk factors related to hypertension, better implementation of an individualized treatment programme, and facilitate choice of the best therapeutic approach for each patient, but there was no consensus that adherence to the guidelines achieves better control of hypertension or that it is more likely to prevent future cardiovascular events. In future, there needs to be a continuous process involving education and audit that takes into account the full spectrum of barriers to acceptance and implementation of hypertension guidelines to ensure that their full potential in reducing the strain on healthcare delivery systems imposed by undiagnosed, untreated and uncontrolled hypertension can be realized.

Application of hypertension guidelines in clinical practice: implementation of the 2007 ESH/ESC European practice Guidelines in Spain.

BACKGROUND AND OBJECTIVE OSA and PLMS are known to induce acute BP swings during sleep. Our current study aimed to address the independent effect of PLMS on BP in an unselected OSA patient cohort. METHODS This cross-sectional analysis included 1487 patients (1110 males, no previous hypertension diagnosis or treatment, mean age: 52.5 years, mean BMI: 30.5 kg/m2 ) with significant OSA (defined as AHI ≥ 10) recruited from the European Sleep Apnoea Cohort. Patients underwent overnight PSG. Patients were stratified into two groups: patients with significant PLMS (PLMSI > 25 events/hour of sleep) and patients without significant PLMS (PLMSI < 25 events/hour of sleep). SBP, DBP and PP were the variables of interest. For each of these, a multivariate regression linear model was fitted to evaluate the relationship between PLMS and outcome adjusting for sociodemographic and clinical covariates (gender, age, BMI, AHI, ESS, diabetes, smoking and sleep efficiency). RESULTS The univariate analysis of SBP showed an increment of BP equal to 4.70 mm Hg (P < 0.001) in patients with significant PLMS compared to patients without significant PLMS. This increment remained significant after implementing a multivariate regression model (2.64 mm Hg, P = 0.044). No significant increment of BP was observed for DBP and PP. CONCLUSION PLMS is associated with a rise in SBP regardless of AHI, independent of clinical and sociodemographic confounders. A PLMS phenotype may carry an increased risk for cardiovascular disease in OSA patients.

Periodic limb movements during sleep and blood pressure changes in sleep apnoea: Data from the European Sleep Apnoea Database

Introduction: the Hypertension European Society Recommendations under the supervision of The European Cardiology Society for the treatment of high blood pressure (HBP) in children and adolescents recognize that HBP in the pediatric age is an increasing medical problem with current and future negative repercussions. In addition they refer to the lack of strategies or organized health policies dealing with the problem. It is unknown due to the scantiness of following studies from adolescence to adulthood when is possible the conversion from the risk to the disease. Objectives: to determine the interactions among several risk factors in the developing of HBP from adolescence to adulthood. To design a predictive model in order to predict the developing of HBP from adolescence to adulthood. Material and methods: a representative sample of 125 prehypertensive adolescents were followed up through 8 years till year 2009. A predictive model based in a decision tree was done using the CHAID (chi square automatic interaction) technique with the evaluation by areas under the ROC (receiver operating characteristic) curve. Results: a decision tree was designed that was able to classify accurately 80 % of the cases. With this model 67.4 % and 86.6 % of true negative cases and true positive cases, respectfully. Conclusions: the age of the diagnosis of the prehypertension, the birth weight, the familiar obesity and the unfavorable familiar environment were the situations that had the strongest interaction among them in the timing from adolescence to adulthood. The prediction model is an instrumental contribution for predicting HBP in adulthood from adolescence.

Toward the prediction of arterial hypertension in adulthood from adolescence

The updated and recently released 2007 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) Guidelines for the Management of Arterial Hypertension (1), emphasize the assessment of total cardiovascular (CV) risk, along with proper measurement of blood pressure (BP) and novel recommendations to appropriately guide treatment strategies. The information from both is needed to improve patient management. Importantly, the BP threshold for initiating treatment and the treatment targets are lowered. In highrisk patients, the treatment target is v130/ 80 mmHg, and treatment strategies should include consideration of prescribing aspirin and a statin.

Thomas Hedner T

Papers

New ESH/ESC guidelines signal progress in hypertension management.