La hipertensión arterial (HTA) es una dolencia frecuente en los pacientes con neoplasias oncohematológicas activas o supervivientes a estas. Se estima que la prevalencia de HTA en esta población oscila entre el 30 y el 70%. La relación entre cáncer e HTA es multifactorial: factores de riesgo comunes, neoplasias que producen HTA a través de la secreción hormonal y, especialmente, fármacos quimioterápicos que producen HTA.

Hypertension (HT) is a frequent pathology in patients with active or surviving onco-haematological malignancies. It is estimated that the prevalence of HT in this population ranges between 30 and 70%. The relationship between cancer and HT is multifactorial: common risk factors, neoplasia that cause HT through hormonal secretion, and, especially, chemotherapy drugs that cause HT.Ambulatory blood pressure monitoring (ABPM) is a fundamental tool in the diagnosis and ade-quate control of blood pressure, avoiding having to suspend or reduce the dose of chemotherapy treatment. In addition, it can help in the diagnosis of autonomic dysfunction related to certain neoplastic pathologies.(c) 2023 SEH-LELHA. Published by Elsevier Espana, S.L.U. All rights reserved.

Los inhibidores de la tirosinacinasa son una familia de fármacos quimioterápicos utilizados en primera y segunda línea de muchas neoplasias sólidas y hematológicas. Su toxicidad es relativamente baja, ya que el mecanismo de acción se fundamenta en la inhibición de algunas tirosinacinasas involucradas en la proliferación de las células neoplásicas. Sin embargo, este bloqueo no es selectivo, por lo que pueden producir efectos secundarios. Sorafenib se ha relacionado con la aparición de hipertensión arterial, alteraciones tiroideas, dolor abdominal o hiperamilasemia, entre otros. Deben conocerse los efectos secundarios de estos fármacos para una adecuada monitorización de los pacientes que evite la suspensión de estos agentes quimioterápicos.

Tyrosine kinase inhibitors are a family of chemotherapy drugs used in first and second line for many solid and hematological neoplasms. Its toxicity is relatively low, since the mechanism of action is based on the inhibition of some tyrosine kinases involved in the explosion of neoplastic cells. However, this blockade is not selective, so it can produce secondary effects. Sorafenib can produce arterial hypertension, thyroid disorders, abdominal pain or hyperamylasemia, among others. We must monitor these patients during treatment to avoid side effects.(c) 2022 SEH-LELHA. Published by Elsevier Espana, S.L.U. All rights reserved.

Introducción: Los inhibidores de la tirosina cinasa (ITC) han mejorado el pronóstico de la leucemia mieloide crónica (LMC).Sin embargo, los ITC se han relacionado con un incremento en los eventos cardiovasculares que se producen fundamentalmente en pacientes que ya presentaban factores de riesgo cardiovascular (FRCV).Material y métodos: Estudio observacional, descriptivo y transversal de pacientes con LMC en tratamiento con ITC.Se estudió la prevalencia de FRCV, lesión de órgano diana y enfermedad cardiovascular aterosclerótica (ECVA) subclínica y sintomática.Resultados: Se reclutaron 73 pacientes.El 63,01% eran varones con una mediana de edad de 56 años (intervalo intercuartílico [IQR]: 45-67,50).El 47,95% presentó hipertensión arterial (HTA), el 17,33% diabetes mellitus, el 40,79% dislipidemia, el 50,68% sobrepeso, el 26,03 obesidad y el 21,92% eran fumadores.El 19,20% presentaron microalbuminuria, el 8,20% hipertrofia ventricular izquierda y el 19,18% enfermedad renal crónica.El 32,90% tuvieron valores elevados de proteína C reactiva ultrasensible y el 26% valores de velocidad onda de pulso elevados.Un 11,07% tuvieron ECVA.Los pacientes tratados con nilotinib tuvieron mayor prevalencia de dislipidemia, tabaquismo, enfermedad arterial periférica y ECVA.Conclusiones: La prevalencia de FRCV es mayor a la descrita en población general española.Los pacientes tratados con nilotinib presentaron mayor prevalencia de HTA no controlada, dislipidemia, tabaquismo, enfermedad arterial periférica y ECVA establecida que los pacientes tratados con imatinib y dasatinib. Palabras clave:

Background and Aims: Analyze the prescription of Alirocumab ot evaluate the safety profile, the rate of adverse effects, adherence and evolution of the lipid profile to i-PCSK9 in clinical practice during 12 months of treatment.

Survival of neoplasms has improved significantly in recent years. An increase in the incidence of cardiovascular disease has been observed. This is due to increasing age of patients and the side effects of chemotherapy. Anti-angiogenic drugs frequently cause hypertension. This may force the reduction or suspension of chemotherapy treatment. We present the cases of three patients treated with different anti-angiogenic drugs. All three developed secondary arterial hypertension.

Secondary arterial hypertension (HTN) can be caused by primary hyperaldosteronism, renovascular disease, sleep apnea syndrome, chronic kidney disease, drug use, etc. In addition, some urological disorders such as hydronephrosis can cause hypertension due to an increase in intraglomerular pressure that activates the renin angiotensin system.

Background and Aims: Familial hypercholesterolemia (FH) is a genetic disorder with an autosomal dominant Mendelian inheritance pattern. In its heterozygous form (HeFH) it has a prevalence of 1:250. FH accelerates atherosclerotic disease constituting the genetic disorder most frequently associated with premature coronary artery disease (CPD). The prevalence and high risk of developing DBS make FH a public health problem, although the majority of FH patients are underdiagnosed and undertreated.

Secondary arterial hypertension (HT) is an increase in blood pressure due to a recognisable cause. It is estimated that the prevalence of people with HT is around 5%-15%. The search for secondary HT in all hypertensive patients is neither feasible nor cost-effective. However, there are a series of signs that force us to discount its diagnosis such as newly diagnosed hypertension before the age of 40, acute worsening of hypertension, resistant hypertension, the presence of extensive organ injury or clinical-analytical alterations, etc. It is important to diagnosis these patients since treatments can be curative, especially in young people. We present the case of a 46-year-old man with hypertensive emergency and subarachnoid haemorrhage due to aneurysmal rupture. The study of secondary causes was diagnostic for renal artery stenosis due to Takayasu arteritis in the scarring stage. (c) 2020 SEH-LELHA. Published by Elsevier Espana, S.L.U. All rights reserved.

Autonomic dysfunction is a common condition in the alpha-synucleinopathies (Parkinson's disease, dementia with Lewy bodies, multiple system atrophy). Cardiovascular symptoms may include orthostatic hypotension, supine hypertension or decreased heart rate response. A clinical suspicion and physical examination are essential for diagnosis, taking blood pressure in supine and standing positions. The electrocardiogram may show a prolongation of the PR and QT intervals, while 24-hour ambulatory blood pressure monitoring provides information on blood pressure patterns. Cardiac sympathetic dysfunction can be confirmed by an innervation myocardial scintigraphy with 123-I-methylbenzylguanidine (123-I-MIBG). This can reflect specific neuronal noradrenergic uptake. We present the case of a man with Parkinson's disease who was diagnosed with cardiovascular autonomic dysfunction after a complete study.

The number of patients who suffer refractory arterial hypertension and chronic heart failure in advanced stages is currently increasing. The case is presented of a patient with an implantable cardioverter defibrillator, and with the dual indication of chronic heart failure and refractory arterial hypertension, who required the implanting of a baroreceptors activation therapy device of the carotid sinus. As far as it is known, it is the first case reported in Spain?

### Learning point for clinicians Mucocutaneous leishmaniasis is an increasingly common opportunistic infection that should be considered during treatment with mycophenolate mofetil, especially when other immunosuppressant drugs (such as corticosteroids) or diseases (such as systemic lupus erythematosus) are present. Leishmaniasis is an infectious disease in which immunosupression is a well-known risk factor for its development. We report the first case of a patient with systemic lupus erythematosus (SLE) who was diagnosed of mucocutaneous leishmaniasis (ML) while taking mycophenolate mofetil (MMF) for lupus nephritis. A 51-year-old woman from the south of Spain with an 8-year history of SLE was diagnosed with diffuse proliferative glomerulonephritis 6 years after her SLE diagnosis, which was satisfactorily treated until complete remission was achieved with MMF (1 g b.i.d) and decreasing doses of prednisone (from 30 mg to 10 mg q.d). The …

La miastenia gravis es el trastorno más común dentro de las enfermedades que afectan a la transmisión neuromuscular. Actualmente es uno de los trastornos autoinmunes mejor definidos y entendidos. Esta se caracteriza por debilidad y fatiga de forma fluctuante y en combinación variable de los músculos oculares, funciones bulbares, de las extremidades y de los músculos respiratorios. Estos síntomas son el resultado de un ataque inmunológico contra la membrana postsináptica de la unión neuromuscular.El diagnóstico de la miastenia gravis depende tanto de pruebas clínicas como serológicas. Es una enfermedad que puede ser controlada de forma efectiva con las distintas líneas terapéuticas actuales, incluso logrando la remisión de esta. A continuación, presentamos una actualización de esta interesante enfermedad.Myasthenia gravis is one of the most common disorders that affect neuromuscular transmission. It is currently one of the most understood and characterised autoimmune disorders Its typical symptoms are fluctuating weakness and fatigue that affects a combination of ocular muscles, bulbar functions, as well as limb and respiratory muscles, which are due to an immune attack against the postsynaptic membrane of the neuromuscular junction. The diagnosis of myasthenia gravis is based on clinical and serological test. It is a disease that can be effectively controlled with the current therapeutic lines, even achieving a complete remission. An update of this interesting disorder is now presented.

Objective: New drugs that inhibit angiogenesis, including Sunitinib, can cause arterial hypertension (HT). This side effect contributes to morbidity in these patients. It[Combining Acute Accent]s not well known how can be affected arterial blood pressure (BP) in hypertensive patients and in previosly non hypertensive ones. In this study we analyzed 18 patients who received Sunitinib in the past year, 2014.Design and method: We have collected data from the medical records of patients receiving sunitinib in the past year by renal carcinoma metastatic. We have analyzed demographics and clinical characteristics with emphasis on acumulative dose received, incidence of new HT onset, control of HT in hypertensive patients, medications received for BP control and hypertensive crisis. Results: Our sample has18 patients (70% male) with a mean age 7.7 ± 57’05 who received sunitinib. 44% were not-known-hypertensive patients prior to treatment, 37,5% of this group develop to hypertension (Fig 1). Among the known-hypertensive, 57’3% worsened their BP control (Fig 2). We found a 35% of patients who had hypertensive crisis which need emergency hospital attention. No hypertensive emergency were presented. To get BP control, at least two antihypertensive drugs were necessary to treat not previously known hypertensive patients. Previously hypertensive patients need to be adjusted his antihypertensive treatment in most of the cases to get BP control. No statistical significances were found between the accumulative dose of sunitinib and the degree of HT. Conclusions: Sunitinib can trigger hypertension in non-hypertensive patients and may worsen the degree of control of BP in previously hypertensive patients. Hypertensive crises may occur in 35% of patients. These findings were not associated with the cumulative dose of Sunitinib and were not statistically significant due to the small sample in our study. It[Combining Acute Accent]s necessary to analyzed more data in further studies.

Objective: New drugs that inhibit angiogenesis, including Sunitinib, can cause arterial hypertension (HT). This side effect contributes to morbidity in these patients. It[Combining Acute Accent]s not well known how can be affected arterial blood pressure (BP) in hypertensive patients and in previosly non hypertensive ones. In this study we analyzed 18 patients who received Sunitinib in the past year, 2014.Design and method: We have collected data from the medical records of patients receiving sunitinib in the past year by renal carcinoma metastatic. We have analyzed demographics and clinical characteristics with emphasis on acumulative dose received, incidence of new HT onset, control of HT in hypertensive patients, medications received for BP control and hypertensive crisis. Results: Our sample has18 patients (70% male) with a mean age 7.7 ± 57’05 who received sunitinib. 44% were not-known-hypertensive patients prior to treatment, 37,5% of this group develop to hypertension (Fig 1). Among the known-hypertensive, 57’3% worsened their BP control (Fig 2). We found a 35% of patients who had hypertensive crisis which need emergency hospital attention. No hypertensive emergency were presented. To get BP control, at least two antihypertensive drugs were necessary to treat not previously known hypertensive patients. Previously hypertensive patients need to be adjusted his antihypertensive treatment in most of the cases to get BP control. No statistical significances were found between the accumulative dose of sunitinib and the degree of HT. Conclusions: Sunitinib can trigger hypertension in non-hypertensive patients and may worsen the degree of control of BP in previously hypertensive patients. Hypertensive crises may occur in 35% of patients. These findings were not associated with the cumulative dose of Sunitinib and were not statistically significant due to the small sample in our study. It[Combining Acute Accent]s necessary to analyzed more data in further studies.