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INFORMATION

AHU of Ruber International Hospital is headed by Dr. Delgado Lillo. It is a multidisciplinary unit in partnership with Internal Medicine, Cardiology, conventional Radiology and Interventional Vascular Radiology, Nuclear Medicine, Endocrinology, Neurology, Gynaecology and Obstetrics.
Following protocols the study of patients with HTA is carried out by searching the actiological diagnosis, assessing the produced damage and the derived cardiovascular risk factors to apply the more precise treatment.
It is done with the more innovative therapeutics and diagnoses means, including all the interventional radiology techniques, with renal arteries denervation by radiofrequency recently added.

WHAT DO WE TREAT?

Arterial hypertension

The arterial hypertension (HTA) is defined as the rising in figures of arterial blood pressure over 140/90 mmHg, correctly measured.
It is estimated that over 35% of the Spanish adult population is hypertensive, with 40% in middle age and 60% among the population over 65 years. Of these, only 65% are known and only 25% is properly diagnosed and controlled. Henceforth, it follows that a big number of people in high risk of having serious consequences of HTA.
The HTA acts on arteries and organs with more vascularization as heart, central nervous system and kidneys.
Considering that deaths or disabilities are produced by the vascular affectation of these organs are statically leading developed countries, doubtless the fight against HTA is indeed justified.
Currently the HTA classification is as follows:

HTA CLASSIFICATION
ESH – ESC 2007
  Systolic (mmHg)  
Optimum <120 And
Normal 120-129 And/or
High normal 130-139 And/or
Hypertension GRADE 1 140-159 And/or
Hypertension GRADE 2 160-179 And/or
Hypertension GRADE 3 ≥180 And/or

How does Hypertension damage artery?
The pressure increase in arteries affects its walls producing a “tightening,” easing arteriosclerosis, dilatations and favouring the thrombose creation. As a consequence, organs impairment is produced receiving a bigger blood flow: Heart, central nervous system and kidneys.
Heart is affected by two ways: Damaging the arteries that are feeding it (coronary arteries) and by thickening and growth of a left ventricle, which needs to be developed to overcome the peripheral arteries resistances that are expanded. When limits are surpassed, an ischemic cardiopathy arises with strokes, arrhythmias and cardiac failure, causing the big amount of deaths given every year.
The most important damage in central nevous system is related to big vessels which irrigate it. They are called acute cerebrum-vascular stroke (CVA). When there is a break, we have a cerebral bleeding (20% of cases) and lack of irrigation due to a thrombus (ischemia) provoking the labelled cerebral strokes (80%). The consequences are from transitional vascular lesions (transitory ischemic attacks TIA) without neurologic aftermaths, to decease, going through by handicap neurologic big lesions and irreversible, involving enormous expensive economic and social costs. On the other hand, in the central nervous system rises another type of lesion that takes place when small glasses irrigating them are surrendered to many pressures for long time. Dementia events progressively come forth then with a vascular origin.
Renal affectation by HTA starts by small failures in some of the multiple kidney functions (uric acid retention, for example) up to the so called “nephroangiosclerosis” or renal sclerosis phase, which leads the patient to be obliged to dialysis treatment and renal transplant. In Spain, there are more than 1500 people in dialysis treatment due to a lack of diagnosis and control of Arterial Tension, which has become the second cause of advanced chronic renal insufficiency, after Diabetes Mellitus, and it is a cause that can be hugely avoided.
Before previously shown and considering vascular origin deaths, which are heading the mortality in developed countries, doubtless ARTERIAL HYPERTENSION struggle is extremely worthy.
What Arterial Hypertension figures do we have to trust in?
AT figures, properly measured, in patients with other risk factors is 135/85. The measurement of 140/90 is not acceptable for a hypertense patient control.
There are other situations in which it is necessary to apply different figures, as there are the Diabetes Mellitus, renal insufficiency or high coronary risks, they must not exceed 130/80.
How to measure blood pressure?
Blood pressure is measured by a sphygmomanometer, which is a tool with a bracelet or “cuff” pressing the arm with a pneumatic mechanism adjoined to a manometer that is displaying us the pressure in mercury millimetres (mmHg).
There are two methods:
• Korotkoff acoustic system
• Oscillometric system
The first one requires the use of a phonendoscope or a microphone, to hear the beats. At the beginning, while the pressure is lowered of inflated, we will obtain the systolic arterial blood pressure (or maximum) and when the beats disappear, we will have the diastolic blood pressure (or minimum). They can be of a column of mercury, but the current regulation prohibits its use.
The oscillometry method will detect the vibrating changes produced by the cardiac tones when the arm arteries are pressed. It is the method used in automatic sphygmomanometers.
It is important that the cuff to adjust in the arm is the appropriate size of each patient. The wrist sphygmomanometer can be useless in young people not obsesses.
Ways of measuring the blood pressure
The more frequent way to control the blood pressure is at doctor’s consultancy. Often this visit causes an emotional component in a patient who provokes that the pressure is slightly higher than normal, and sometimes it incites a false hypertension, called “white robe hypertension”. In these cases, we have to refer to the arterial pressure auto measuring (MAP) with home dosage in correct conditions to reach an accurate diagnosis of the HTA.
The measuring should be done with the appropriate cuff, without rush. Measurement never should be done just awaked or recently having eaten, it is better 2-3 hours later. It should be done sit around ten minutes and quietly. Without smoking (of course) not having drank excitants as coffee. A first measurement will be done and, after 3 minutes approximately, it should be repeated, which is the one that will serve us to control it.
Sometimes we will have unsure situations about tension figures or difficulties to adjust the medication, and then we will go to a blood pressure monitoring (ABPM) also so-called “Holter pressure monitoring”.
It is a cuff that holds 24 hours the arm, with a recorder and a portable inflating system to allow us to program the measurements during day and night. It will give us the patient’s arterial pressure figures in resting and activity, awake and asleep situations, providing a full data for diagnosis and treatment.

Refractory arterial hypertension (RHTN)

It is so called the RHTN to the one not controlled after the appropriate medical treatment has been applied with three medicines of the different therapeutic groups, included diuretics, in maximum dosage or minimum dosages well tolerated by the patient.
The most frequent RHTN causes are:
• Old age
• Obesity
• Excessive salt intake
• Chronic renal failure
• Mellitus diabetes
• Obstructive sleep apnea
All them related with an activity increase of the sympathetic nervous system.
We know, from the cardiovascular risk viewpoint, that the reduction of two mmHg decreases a 10% the fatality risk of stroke and a 7% the death risk of ischemic cardiopathy. Therefore, patients with RHTN should be the target of the Arterial Hypertension Unit as patients at high risk.

MEDICAL TEAM

Dr. Delgado Lillo, Ramón Team leader
Más información

DrLillo
  • Estudió la licenciatura de medicina en la Universidad Complutense de Madrid. Realizó el Internado Rotatorio y la Residencia en la especialidad de Nefrología en el Hospital Clínica San Cecilio de Granada, obteniendo el título de Especialista en Nefrología por la Universidad de Granada.
  • Médico adjunto en el Servicio de Nefrología del H. San Cecilio de Granada hasta finales de 1982 que regresa a Madrid contratado en la Clínica Ruber para organizar el Servicio de Nefrología y Unidad de Hipertensión Arterial, con categoría de Jefe de Servicio desde 1994, siendo además el Coordinador de Trasplantes de la Clínica.
  • Desde 1984 colabora en el Hospital Ruber Internacional, siendo responsable de la Unidad de Nefrología y  la Unidad de Hipertensión Arterial.
  • Desde 2010 es Jefe del Servicio de Nefrología de Hospital Universitario Quirón Madrid, coordinando y desarrollando la actividad de la nefrología clínica en consulta y hospitalización.
  • Es Profesor Asociado de la Universidad Europea de Madrid de la asignatura de Nefrología.
  • Tiene más de cincuenta publicaciones en revistas especializadas ó comunicaciones a congresos nacionales e internacionales, así como capítulos de libros de la especialidad.
  • En 2002 fue nombrado miembro del Comité de Expertos en Nefrología de la Comunidad de Madrid y posteriormente fue miembro del Comité del Registro de Enfermos Renales (REMER) de la Comunidad de Madrid.
  • Es socio fundador de la Sociedad Madrileña de Nefrología, de la que fue tesorero en de su Junta Directiva durante ocho años. Miembro de la Sociedad Española de Nefrología, Sociedad Española de Diálisis y Trasplante, Sociedad Española de Hipertensión, Sociedad Europea de Diálisis y Trasplante, American Society of Nephrology, National Kidney Foundation y American Society of Hypertension.

 

SERVICES PORTFOLIO

Refractory HTN treatment with renal denervation by radiofrequency

It is a new technique for the RHTN, that is, patients not controlled by three medicines at appropriate dosages or tolerated maximum dosage, giving rise to a high cardiovascular risk.
Sympathetic nervous system intervenes significantly in the arterial hypertension development. It can be blocked by specific medication (through sympathetic nervous system blockages), but they are badly tolerated and have many side effects, decreasing the therapeutic compliance. The denervation technique with radiofrequency overrides the sympathetic nervous system stimulus, only at a renal level, by sympathetic nervous endings blockage moving along the renal arteries periphery.
It is a minimally invasive technique made with the same approach system of renal arteries and arteriographies. In our team, it is performed byDr. Zubicoa Ezpeleta, vascular interventional radiologist with wide experience.
It is performed under sedation and outpatient, in other words, the patient, after the treatment, stay in Day Hospital some hours, and he will be discharged in the afternoon.
Through a percutaneous puncture in femoral artery, a catheter is inserted up to renal arteries. Later on, the Symplicity catheter is inserted up to the distal end of both renal arteries and a low intensity radiofrequency emission (to 8 watts) is done during two minutes in each area to be treated, without exceeding a temperature of 60º. This process is repeated five times along each renal artery and in the entire circle.
It is an accurate treatment for particular patients who must be earlier studied and designated. The results are very good with disclosed data from two years, in which the blood pressure has been controlled in a 84% of treated patients. In the published works with big series of patients, there have not been complications related to technique, only slight incidences solved immediately as regard as puncture. On the other hand, there have not been negative side effects due to the treatment.