Julian Segura

• MD, PhD
• Head of Department at Hospital 12 de Octubre

Background and objective: In acute kidney injury (AKI), a strong inflammatory component is activated in response to the renal damage, and one of the main mediators behind this process is the pro-inflammatory interleukin 6 or IL-6. Beside to this phenomenon, there are also alterations in different components of mineral metabolism, such as those dep...

Background Current definition of chronic kidney disease (CKD) identifies only advanced stages, but effective management demands early detection. Urinary albumin‐to‐creatinine ratio (ACR) 30 mg/g is a cut‐off point for CKD clinical diagnosis. Patients with lower values (normoalbuminuria) and eGFR > 60 mL/min/1.73 m² are considered at no increased ca...

BACKGROUND Resistant hypertension is characterized by elevated blood pressure (BP) despite using 3 antihypertensive agents. Ambulatory BP monitoring (ABPM) detects the presence of white-coat resistant hypertension (24-hour BP <130/80 mm Hg). The aim of the study was to evaluate risks of death in resistant hypertension compared with controlled hyper...

Early diagnosis and treatment of chronic kidney disease (CKD) is a worldwide challenge. Subjects with albumin-to-creatinine ratio (ACR) ≥ 30 mg/g and preserved renal function are considered to be at no cardiorenal risk in clinical practice, but prospective clinical studies evidence increased risk, even at the high-normal (HN) ACR range (10–30 mg/g)...

Introduction: Oxidative stress has been implicated in complications after kidney transplantation (KT), including delayed graft function and rejection. However, its role in long-term post-transplant outcomes remains unclear. Methods: We investigated oxidative damage and antioxidant defense dynamics, and their impact on the graft outcomes, in 41 K...

Background and Aims Guidelines suggest similar blood pressure (BP) targets in patients with and without diabetes and recommend ambulatory BP monitoring (ABPM) to diagnose and classify hypertension. It was explored whether different levels of ambulatory and office BP and different hypertension phenotypes associate with differences of risk in diabete...

Objective To explore whether different levels of ambulatory and office blood pressure (BP) and different hypertension phenotypes associate with differences of risk in diabetes and no-diabetes. Design and method This analysis assessed outcome data from patients with complete data included in the Spanish Ambulatory BP (ABP) Monitoring Registry. The...

BACKGROUND Quantification of total cardiovascular risk is essential for individualizing hypertension treatment. This study aimed to develop and validate a novel, machine-learning–derived model to predict cardiovascular mortality risk using office blood pressure (OBP) and ambulatory blood pressure (ABP). METHODS The performance of the novel risk sc...

BACKGROUND The prognostic relevance of short-term blood pressure (BP) variability in hypertension is not clearly established. We aimed to evaluate the association of short-term BP variability, with all-cause and cardiovascular mortality in a large cohort of patients with hypertension. METHODS We selected 59 124 patients from the Spanish Ambulatory...

Objective It has been suggested that a blunted nocturnal blood pressure (BP) decline is associated with a poor prognosis. Nevertheless, it remains unclear if an abnormal dipping is deleterious per se or it merely reflects an elevated BP during sleep. We aimed to assess the prognostic value of nocturnal BP decline, with or without concomitant elevat...

Introduction Intravitreal administration of vascular endothelial growth factor inhibitors (anti-VEGF) is the treatment of choice in retinal pathology associated with type 2 diabetes mellitus (DM2). We aimed to analyze the effect of intravitreal anti-VEGF administration on renal function in patients with DM2. Methods This is a single-center retrosp...

Heart and kidney have a closely interrelated pathophysiology. Acute kidney injury (AKI) is associated with significantly increased rates of cardiovascular events, a relationship defined as cardiorenal syndrome type 3 (CRS3). The underlying mechanisms that trigger heart disease remain, however, unknown, particularly concerning the clinical impact of...

Background and aims Whether bedtime versus morning administration of antihypertensive therapy is beneficial on outcomes is controversial. We evaluated the risk of total and cardiovascular mortality in a very large observational cohort of treated hypertensive patients, according to the timing of their usual treatment administration (morning versus e...

Objective To evaluate total and cardiovascular mortality in different forms of Resistant Hypertension (RH). Design and method A total of 35129 treated patients were included from the Spanish ABPM Registry. Mean follow-up was 10 years. Total and cardiovascular mortality were compared in Cox models adjusted for clinical confounders. The following gr...

Background: Ambulatory blood pressure provides a more comprehensive assessment than clinic blood pressure, and has been reported to better predict health outcomes than clinic or home pressure. We aimed to examine associations of clinic and 24-h ambulatory blood pressure with all-cause and cardiovascular mortality in a large cohort of primary care...

Introduction and objectives: Hypertension is highly common in heart failure (HF). However, there is limited information on its prevalence, circadian variation, and relationship with the various HF phenotypes. The objective of this study was to describe the prevalence of hypertension and its patterns in HF. Methods: This was a cross-sectional obs...

Background The current definition of chronic kidney disease applied to patients over the age of 80 has increased the number of referrals to Nephrology. However not all of these patients may benefit from its assessment. This study aims to analyze the evolution of ≥80 years old patients referred to Nephrology. Methods Single-center study including p...

Resistant hypertension (RH) is related to increased risk for cardiovascular events. We aimed to evaluate the risk of total and cardiovascular mortality associated with RH in comparison to controlled hypertension, as well as in true versus “white-coat” RH. From the mortality data of the Spanish ABPM Registry, including 35119 treated patients, we ide...

Resumen La hipertensión arterial es el principal factor de riesgo de enfermedad y muerte en España. El diagnóstico y el tratamiento de la hipertensión arterial constituyen objetivos básicos de salud porque el control adecuado reduce la morbimortalidad relacionada. El objetivo de esta guía práctica sobre el manejo de la hipertensión arterial de la S...

Chronic kidney disease (CKD) is a major public health problem worldwide that affects more than 10% of the Spanish population. CKD is associated with high comorbidity rates, poor prognosis and major consumption of health system resources. Since the publication of the last consensus document on CKD seven years ago, little evidence has emerged and few...

Objective: A blunted nocturnal BP decline is associated with an increased cardiovascular risk. Nevertheless, patients with a reduced BP dip usually have higher levels of nighttime BP, being both parameters clearly related. The aim of the study was to assess the prognostic value of nocturnal BP decline, independently of the presence or not of noctu...

Objective: Night BP is the most powerful estimate of cardiovascular prognosis. It has been suggested that bedtime administration of antihypertensive therapy may favour night BP reduction and prognosis. We aimed to evaluate the risk of total and cardiovascular mortality in a large cohort of treated hypertensives, depending on the schedule of treatm...

Ambulatory blood pressure (BP) is associated with mortality, but it is also interesting to expand its association with cardiovascular morbidity. This study sought to evaluate association with cardiovascular morbidity and cardiovascular mortality. Patients without cardiovascular disease who had a first 24-hour ambulatory BP monitoring were followed-...

Hypertension mediated organ damage (HMOD) refers to structural or functional changes in arteries or target organs that can be present in long-standing hypertension, but it can be also found in naïve never treated patients. Traditionally, cardiovascular risk is stratified with charts or calculators that tend to underestimate the real cardiovascular...

Introduction: Night BP is the most powerful estimate of cardiovascular prognosis. It has been suggested that bedtime administration of antihypertensive therapy may favour night BP reduction and prognosis. Hypothesis: We aimed to evaluate the mortality risk in treated hypertensives, depending on the schedule of treatment administration (entirely in...

Introduction: A blunted nocturnal BP decline is associated with an increased cardiovascular risk. Nevertheless, patients with a blunted BP dip usually have high levels of nighttime BP, being both parameters clearly related. Thus, it is unclear if an abnormal dipping is deleterious per se or it merely reflects an elevated BP during sleep. Hypothesis...

Resumen La enfermedad renal crónica (ERC) es un importante problema de salud pública a nivel mundial afectando a mas del 10% de la población española. Se asocia a elevada comorbilidad, mal pronóstico, así como a un gran consumo de recursos en el sistema sanitario. Desde la publicación del último documento de consenso sobre ERC publicado hace siete...

Objective: A continuous association between albuminuria and cardiorenal risk exists further below moderately increased albuminuria ranges. If only based in albumin to creatinine ratio (ACR) higher than 30 mg/g, a significant percentage of individuals may be out of the scope for therapeutic management. Despite epidemiological outcomes, the identifi...

Moderately increased albuminuria, defined by an albumin to creatinine ratio (ACR) > 30 mg/g, is an indicator of subclinical organ damage associated with a higher risk of cardiovascular and renal disease. Normoalbuminuric subjects are considered at no cardiorenal risk in clinical practice, and molecular changes underlying early development are uncle...

Background Increasing prevalence in type 2 diabetes mellitus (T2DM) have influenced in an increasing prevalence of chronic kidney disease (CKD). Little is known about the influence of non-alcoholic fatty liver disease (NAFLD) on progression of CKD. The aim of this study was to analyse the role of NAFLD and its severity in the progression of renal f...

Resumen La pandemia producida por el coronavirus SARS-CoV-2 (COVID-19) ha obligado, en muchos casos a sustituir la consulta presencial por la consulta telemática para reducir el riesgo de contagio asociado a la presencia de pacientes en los centros sanitarios. Este cambio puede representar una oportunidad para una comunicación diferente y más efici...

Background and aim: Blood pressure variability (BPV) is recognized as a prognostic contributor in hypertension. We aimed to assess differences in short-term BPV in treated hypertensive patients depending on the number, classes, combinations and individual compounds of the antihypertensive treatment. Methods: We selected 38 188 treated patients f...

Objectives: Resting heart rate (HR) taken in the office has been shown to be associated with cardiovascular outcomes in the general population, hypertension and heart failure. It is unknown whether 24-h oscillographic pulse rate measurement as an approximation of HR derived from ambulatory blood pressure monitoring (ABPM) associates with cardiovas...

Aims: The aim of present study was to determine whether arterial stiffness assessed with the biochemical parameter active matrix metalloproteinase (MMP)-9 and the clinical parameters pulse pressure (PP) and pulse wave velocity predicts the response to spironolactone in resistant hypertension (RH). Methods and results: Ambulatory blood pressure (...

Background and aim Albuminuria is an indicator of sub-clinical organ damage and a marker of cardiovascular risk and renal disease. A percentage of hypertensive patients develop albuminuria despite being under chronic suppression of the renin-angiotensin system (RAS). We previously identified urinary metabolites associated with the development of al...

Background and Aims Nowadays, there is growing evidence that non-alcoholic fatty liver disease (NAFLD) may be associated with renal impairment and have an impact on the evolution of renal function in patients with type 2 diabetes mellitus (DM). Our aim was to compare the effect on renal function and proteinuria in patients with type 2 DM according...

Patients with coronary heart disease (CHD) can be particularly susceptible to the adverse effects of excessive blood pressure (BP) lowering by antihypertensive treatment. The identification of hypotension is thus especially important. This study estimated the prevalence of hypotension among CHD-treated hypertensive patients undergoing ambulatory bl...

Renal replacement therapy (RRT) is complicated by a chronic state of inflammation and a high mortality risk. However, different RRT modalities can have a selective impact on markers of inflammation and oxidative stress. We evaluated the levels of active matrix metalloproteinase (MMP)-9 in patients undergoing two types of dialysis (high-flux dialysi...

Resumen Antecedentes y objetivo La albuminuria es un indicador de daño orgánico subclínico y un marcador de riesgo cardiovascular y de enfermedad renal. Un porcentaje de pacientes hipertensos desarrollan albuminuria a pesar de estar bajo supresión crónica del sistema renina-angiotensina (SRA). Previamente identificamos metabolitos en orina asociad...

The prognostic relevance of short-term blood pressure (BP) variability in hypertension is not clearly established. We aimed to evaluate the association of short-term BP variability, assessed through ambulatory BP monitoring, with total and cardiovascular mortality in a large cohort of patients with hypertension. We selected 63 910 subjects from the...

Introduction: Air in urban areas is usually contaminated with particle matter. High concentrations lead to a rise in the risk of cardiovascular and respiratory diseases. Some studies have reported that ultrafine particles (UFP) play a greater role in cardiovascular diseases than other particle matter, particularly regarding hypertensive crises and...

Background: To develop and validate a novel, machine learning-derived model for prediction of cardiovascular (CV) mortality risk using office (OBP) and ambulatory blood pressure (ABP), to compare its performance with existing risk scores, and to assess the possibility of predicting ABP phenotypes (i.e. white-coat, ambulatory and masked hypertension...

Resistant hypertension (RH) is a concept that currently goes beyond the classical definition of blood pressure (BP) ≥140/90 mmHg in subjects receiving three or more drugs of different classes at maximally tolerated doses. Here we review the clinical relevance of RH and the different types of RH-associated phenotypes, namely refractory hypertension,...

Blood pressure variability (BPV) is recognized as an important prognostic contributor in hypertension. We asseseds differences in short-term BPV in treated patients depending on the number of drugs, drug-classes and combinations, and individual compounds. From the Spanish ABPM Registry, we selected 38188 treated patiens. BPV estimates were obtained...

Background and objective Matrix metalloproteinases (MMPs) are involved in deleterious tissue remodelling associated with target organ damage in renal disease. The aim of this study was to study the association between renal dysfunction and activity of the inflammatory metalloproteinase MMP-9 in hypertensive patients with mild-moderate chronic kidne...

Resistant hypertension prevalence is progressively increasing, and prolonged exposure to suboptimal blood pressure control results in higher cardiovascular risk and end-organ damage. Among various antihypertensive agents, spironolactone seems the most effective choice to treat resistant hypertension once triple therapy including a diuretic fails. H...

Resumen: Antecedentes y objetivo: Las enzimas metaloproteinasas de matriz (MMP) están involucradas en el remodelado tisular deletéreo asociado al daño de órganos diana de la enfermedad renal. El objetivo de este estudio fue explorar la asociación entre la caída de la función renal y la actividad sistémica de la metaloproteinasa inflamatoria MMP-9 e...

Isolated systolic hypertension (ISH) is a clinical condition derived from increased arterial stiffness and associated with a worse cardiovascular prognosis. Increased blood pressure variability (BPV) is also associated to cardiovascular risk. We aimed to estimate short-term BPV in patients with ISH compared to those with systolic and diastolic hype...

Hypertensive emergencies are those situations where very high blood pressure (BP) values are associated with acute organ damage, and therefore, require immediate, but careful, BP reduction. The type of acute organ damage is the principal determinant of: (i) the drug of choice, (ii) the target BP, and (iii) the timeframe in which BP should be lowere...

The recently released American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines1 proposed new values for defining hypertension: office blood pressure (BP) ≥130 systolic or ≥80 mm Hg diastolic. Furthermore, BP goals for hypertensive patients under pharmacological treatment have been recommended <130/80 mm Hg. New...

Background Evidence for the influence of ambulatory blood pressure on prognosis derives mainly from population-based studies and a few relatively small clinical investigations. This study examined the associations of blood pressure measured in the clinic (clinic blood pressure) and 24-hour ambulatory blood pressure with all-cause and cardiovascular...

Resumen El American College of Cardiology (ACC) y la American Heart Association (AHA) han publicado recientemente la guía para la prevención, detección, evaluación y tratamiento de la hipertensión arterial (HTA) en adultos. El punto más controvertido es el umbral diagnóstico de 130/80 mmHg, lo cual conlleva diagnosticar HTA en un gran número de per...

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Background and aim: Treatment-resistant hypertension (TRH) is associated with particular clinical features, nonadherence, and suboptimal treatment. We assessed possible associations of antihypertensive drug classes, specific agents inside each class, and types of combinations, with the presence of non-TRH vs. TRH, and with controlled vs. uncontrol...

Objective: Increased BP-variability predicts cardiovascular morbidity and mortality in hypertensives. This study aimed to examine short-term BP-variability according to renal function stage. Methods: We included 16 546 patients [10 270 (62.1%) without/6276 (38.9%) with CKD Stage 1-5] from the Spanish Ambulatory-Blood-Pressure Monitoring (ABPM) R...

Background: There is a frequent association between renal insufficiency and cardiovascular disease in patients with essential hypertension (HTN). The aim of this study was to analyze the relationship between ECG parameters and the progress of renal damage in patients with treated HTN. Methods: 109 patients with HTN had their microalbuminuria mon...

Background: We aimed to estimate the prevalence of refractory hypertension (RfH) and to determine the clinical differences between these patients and resistant hypertensives (RH). Secondly, we assessed the prevalence of white-coat RfH and clinical differences between true- and white-coat RfH patients. Methods and results: The present analysis wa...

Resistant hypertension (RH) affects 9% to 12% of hypertensive adults. Prolonged exposure to suboptimal blood pressure control results in end-organ damage and cardiovascular risk. Spironolactone is the most effective drug for treatment, but not all patients respond and side effects are not negligible. Little is known on the mechanisms responsible fo...

We aimed to evaluate the use of specific antihypertensive drugs and drug classes, as well as combinations in patients treated with 3 or more drugs classified as having or not resistant hypertension (RH), controlled or uncontrolled RH and true versus white-coat RH. From the Spanish ABPM Registry, we identified 21238 patients treated with 3 (14264) o...

Albuminuria development in hypertensive patients is an indicator of higher cardiovascular (CV) risk and renal damage. Chronic renin-angiotensin system (RAS) suppression facilitates blood pressure control but it does not prevent from albuminuria development. We pursued the identification of protein indicators in urine behind albuminuria development...

The protocol describes a novel, rapid, and no-wash one-step immunoassay for highly sensitive and direct detection of the complexes between matrix metalloproteinases (MMPs) and their tissue inhibitor of metalloproteinases (TIMPs) based on AlphaLISA® technology. We describe two procedures: (i) one approach is used to analyze MMP-9–TIMP-1 interactions...

Background and aim: The prevalence and associated risks of white-coat hypertension (WCH) are still a matter of debate. We aimed to assess differences in prevalence and associated conditions of WCH defined on the basis of the normality of all daytime, night-time, and 24-h blood pressure (BP), only daytime, or only 24-h BP. Methods: We selected 11...

Albuminuria is an indicator of cardiovascular risk and renal damage in hypertensive individuals. Chronic renin-angiotensin system (RAS) suppression facilitates blood pressure control and prevents development of new-onset-albuminuria. A significant number of patients, however, develop albuminuria despite chronic RAS blockade, and the physiopathologi...

Despite of the great advances in anti-hypertensive therapies, many patients under Renin-Angiotensin- System (RAS) suppression develop albuminuria, which is a clear indicator of therapeutic inefficiency. Hence, indicators of vascular function are needed to assess patients’ condition and help deciding future therapies. Proteomic analysis of circulati...

Background and objective: Elderly patients can be particularly susceptible to the adverse effects of excessive blood pressure (BP) lowering by antihypertensive treatment. The identification of hypotension is thus especially important. Ambulatory BP monitoring (ABPM) is a more accurate technique than office for classifying BP status. This study exa...

Objective: The European Guidelines on Hypertension define an office pulse pressure (PP) at least 60 mmHg in the elderly patient as asymptomatic organ damage. Our objective was to estimate the cutoff point of 24-h PP that best predicts office PP associated with higher cardiovascular risk (≥60 mmHg) in hypertensive older patients. Methods: We stud...

Clinic blood pressure (BP) is usually higher than daytime ambulatory BP in hypertensive patients, but some recent studies have challenged this view, suggesting that this relationship is strongly influenced by age. We used the Spanish ambulatory BP monitoring cohort to examine differences between clinic and daytime BP by age among 104 639 adult hype...

We aimed to characterize 24-hour blood pressure (BP) values and categories in patients with inclusion/exclusion criteria of the SPRINT trial from the Spanish ABPM Registry. We selected patients older than 50 years, with office systolic BP above 130 mmHg and at high cardiovascular risk, but without diabetes, previous stroke or symptomatic heart fail...

Resumen El riñón está implicado en la homeostasis de la glucosa a través de 3 mecanismos principales: la gluconeo-énesis renal, el consumo de glucosa para satisfacer las necesidades energéticas renales y la reabsorción de glucosa en el túbulo proximal. La reabsorción de glucosa es una de las funciones fisiológicas renales de más relevancia, gracias...

Objective: 1) Compare blood pressure (BP) control treated based on impedance cardiography. 2) Compare the hemodynamic differences between groups. Design and Method: Inclusion: 50 to 75 y/o with >=2 drugs and poor office BP control. A 24h ambulatory blood pressure monitoring (ABPM) study and impedance cardiography with Hotman(R) device were done. Th...

The SPRINT trial has demonstrated the benefit of intensive BP reduction in hypertensive patients at high cardiovascular risk. Values of ABPM are of potential interest in such patients to better select those who will benefit of a lower BP target. We aimed to evaluate ABPM values in a large cohort of patients potentially candidates (meeting inclusion...

OBJECTIVE Nighttime blood pressure (BP) and albuminuria are two important and independent predictors of cardiovascular morbidity and mortality. Here, we examined the quantitative differences in nighttime systolic BP (SBP) across albuminuria levels in patients with and without diabetes and chronic kidney disease. RESEARCH DESIGN AND METHODS 16,54...

Hypertension (HTN) is increasing in prevalence, and albuminuria is a strong indicator of cardiovascular risk and renal damage progression. Despite blood pressure control with chronic treatment, a relevant subgroup of patients develop albuminuria. However, the biological factors responsible for albuminuria development and progression are underexplor...