Examinando por Autor "Diaz, Margarita"
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- PublicaciónAcceso abiertoConsenso Latino-Americano de hipertensão em pacientes com diabetes tipo 2 e síndrome metabólica(2014-03) Lopez-Jaramillo, Patricio; Sánchez, Ramiro A.; Diaz, Margarita; Cobos, Leonardo; Bryce, Alfonso; Parra Carrillo, Jose Z.; Lizcano, Fernando; Lanas, Fernando; Sinay, Isaac; Sierra, Iván D.; Peñaherrera, Ernesto; Bendersky, Mario; Schmid, Helena; Botero, Rodrigo; Urina, Manuel; Lara, Joffre; Foss, Milton C.; Márquez, Gustavo; Harrap, Stephen; Ramírez, Agustín J.; Zanchetti, AlbertoO presente documento foi preparado por um grupo de especialistas, membros das Sociedades de Cardiologia, Endocrinologia, Medicina Interna, Nefrologia e Diabetes dos países da América Latina, para que sirva de diretriz para médicos que cuidam de pacientes com diabetes, hipertensão e fatores de risco concomitantes ou complicações de ambas as condições. Embora o conceito de síndrome metabólica seja atualmente muito discutido, a alta prevalência na América Latina do conjunto de alterações metabólicas que a compõem sugere que a síndrome metabólica é uma entidade nosográfica útil no contexto da medicina latino-americana. Devido a isso, no presente documento presta-se especial atenção a essa síndrome com a finalidade de alertar aos médicos sobre uma população particularmente de alto risco, que, por ser subestimada, não é tratada de forma adequada para os fatores de risco que constituem a síndrome metabólica. As recomendações deste documento são o resultado de apresentações e debates que ocorreram durante um encontro de dois dias em Bucaramanga (Colômbia), em outubro de 2012. Todos os participantes aprovaram as decisões finais. Os autores reconhecem que a publicação e difusão das diretrizes não serão suficientes para alcançar as mudanças recomendadas tanto em estratégias diagnósticas como terapêuticas, por isso programaram intervenções que permitirão identificar as barreiras do conhecimento, asatitudes e comportamento, o que permitirá tanto aos médicos como aos pacientes uma adequada adesão às recomendações sugeridas nestas diretrizes.
- PublicaciónAcceso abiertoLatin American consensus on hypertension in patients with diabetes type 2 and metabolic syndrome(2013-02) Lopez-Jaramillo, Patricio; Sánchez, Ramiro A.; Diaz, Margarita; Cobos, Leonardo; Bryce, Alfonso; Parra Carrillo, Jose Z.; Lizcano, Fernando; Lanas, Fernando; Sinay, Isaac; Sierra, Iván D.; Peñaherrera, Ernesto; Bendersky, Mario; Schmid, Helena; Botero, Rodrigo; Urina, Manuel; Lara, Joffre; Foss, Milton C.; Márquez, Gustavo; Harrap, Stephen; Ramírez, Agustín J.; Zanchetti, Alberto; The Latin America Expert GroupThe present document has been prepared by a group of experts, members of cardiology, endocrinology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of ‘metabolic syndrome’ is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that ‘metabolic syndrome’ is a useful nosographic entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particularly high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations.
- PublicaciónRestringidoLatin American Consensus on the management of hypertension in the patient with diabetes and the metabolic syndrome(2019-06) Lopez-Jaramillo, Patricio; Barbosa, Eduardo; Molina, Dora I.; Sánchez, Ramiro; Diaz, Margarita; Camacho López, Paul Anthony; Lanas, Fernando; Pasquel, Miguel; Accini, Jose Luis; Ponte Negretti, Carlos I.; Alcocer, Luis; Cobos, Leonardo; Wyss, Fernando; Sebba-Barroso, Weimar; Coca, Antonio; Zanchetti, AlbertoThe prevalence of hypertension, type 2 diabetes mellitus (DM2) and the metabolic syndrome continues to increase in Latin America, while the rates of diagnosis, treatment and control of these disorders remain low. The frequency of the risk factors that constitute the metabolic syndrome and are associated with an increased risk of cardiovascular disease has not diminished since the publication of the previous consensus. This document discusses the socioeconomic, demographic, environmental and cultural characteristics of most associated Latin American countries and partially explains the lack of better results in improving clinical and public health actions that allow high morbidity and mortality rates caused by cardiovascular diseases and DM2 to be reduced through programs aligned with the so-called precision medicine, which should be predictive, preventive, personalized and participatory. The Consensus ratifies the diagnostic criteria expressed in the previous consensus to define hypertension and DM2 but, for the metabolic syndrome, and in the absence of evidence, the recommendation is to implement a cohort study that determines the abdominal perimeter value associated with hard outcomes, such as DM2 and CVD. Meanwhile, we recommend modifying the criterion to more than 94 cm in men and more than 84 cm in women according to WHO recommendations. We also recommend the carrying out of a study that identifies the situation of hypertension and DM2 in people of African ancestry who, in Latin America, exceed 75 million and whose epidemiology does not include solid studies. With respect to the proposed therapeutic targets, we recommended maintaining those defined in the previous consensus, but insisting that early pharmacological management of prediabetes with metformin should be introduced, as should the treatment of diabetic hypertensive patients with a combination therapy of two fixed-dose antihypertensive drugs and management with statins. To increase adherence, the use of different drugs combined in a single pill (polypill) is recommended. The simplification of the therapeutic regimen is accompanied by greater control of cardiovascular risk factors, both in primary and secondary prevention, and has been shown to be cost-effective. The consensus recommends the use of the currently available polypill combining an angiotensin-converting enzyme inhibitor, a statin and aspirin for secondary cardiovascular prevention and in patients with a high cardiovascular risk, such as hypertension patients with DM2.