Examinando por Materia "Hypertension"
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- PublicaciónRestringidoAssociation of urinary sodium excretion with blood pressure and cardiovascular clinical events in 17,033 Latin americans(2016-07) Lamelas, Pablo M.; Mente, Andrew; Diaz, Rafael; Orlandini, Andres; Avezum, Alvaro; Oliveira, Gustavo; Lanas, Fernando; Seron, Pamela; Lopez-Jaramillo, Patricio; Camacho López, Paul Anthony; O’Donnell, Martin J.; Rangarajan, Sumathy; Teo, Koon; Yusuf, SalimBACKGROUND: Information on actual sodium intake and its relationships with blood pressure (BP) and clinical events in South America is limited. The aim of this cohort study was to assess the relationship of sodium intake with BP, cardiovascular (CV) events, and mortality in South America. METHODS: We studied 17,033 individuals, aged 35–70 years, from 4 South American countries (Argentina, Brazil, Chile, and Colombia). Measures of sodium excretion, estimated from morning fasting urine, were used as a surrogate for daily sodium intake. We measured BP and monitored the composite outcome of death and major CV events. RESULTS: Overall mean sodium excretion was 4.70±1.43g/day. A positive, nonuniform association between sodium and BP was detected, with a significant steeper slope for the relationship at higher sodium excretion levels ( P < 0.001 for interaction). With a median follow-up of 4.7 years, the primary composite outcome (all-cause death, myocardial infarction, stroke, or heart failure) occurred in 568 participants (3.4%). Compared with sodium excretion of 5–6g/day (reference group), participants who excreted >7g/day had increased risks of the primary outcome (odds ratio (OR) 1.73; 95% confidence interval (CI) 1.24 to 2.40; P < 0.001), as well as death from any cause (OR 1.87; 95% CI 1.23 to 2.83; P = 0.003) and major CV disease (OR 1.77; 95% CI 1.12 to 2.81; P = 0.014). Sodium excretion of <3g/day was associated with a statistically nonsignificant increased risk of the primary outcome (OR 1.20; 95% CI 0.86 to 1.65; P = 0.26) and death from any cause (OR 1.25; 95% CI 0.81 to 1.93; P = 0.29), and a significant increased risk of major CV disease (OR 1.50; 95% CI 1.01 to 2.24; P = 0.048), as compared to the reference group. CONCLUSIONS: Our results support a positive, nonuniform association between estimated urinary sodium excretion and BP, and a possible J-shaped pattern of association between sodium excretion over the entire range and clinical outcomes.
- PublicaciónAcceso abiertoAssociations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension : A pooled analysis of data from four studies(2016-07-30) Mente, Andrew; O’Donnell, Martin J.; Rangarajan, Sumathy; Dagenais, Gilles; Lear, Scott A.; McQueen, Matthew J.; Diaz, Rafael; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Lanas, Fernando; Li, Wei; Lu, Yin; Yi, Sun; Rensheng, Lei; Iqbal, Romaina; Mony, Prem; Yusuf, Rita; Yusoff, Khalid; Szuba, Andrzej; Oguz, Aytekin; Rosengren, Annika; Bahonar, Ahmad; Yusufali, Afzalhussein; Schutte, Aletta Elisabeth; Chifamba, Jephat; Mann, Johannes F. E.; Anand, Sonia S.; Teo, Koon; Yusuf, Salim; The PURE, EPIDREAM, and ONTARGET/TRANSCEND InvestigatorsBackground: Several studies reported a U-shaped association between urinary sodium excretion and cardiovascular disease events and mortality. Whether these associations vary between those individuals with and without hypertension is uncertain. We aimed to explore whether the association between sodium intake and cardiovascular disease events and all-cause mortality is modified by hypertension status. Methods: In this pooled analysis, we studied 133118 individuals (63559 with hypertension and 69559 without hypertension), median age of 55 years (IQR 45–63), from 49 countries in four large prospective studies and estimated 24-h urinary sodium excretion (as group-level measure of intake). We related this to the composite outcome of death and major cardiovascular disease events over a median of 4·2 years (IQR 3·0–5·0) and blood pressure. Findings: Increased sodium intake was associated with greater increases in systolic blood pressure in individuals with hypertension (2·08 mm Hg change per g sodium increase) compared with individuals without hypertension (1·22 mm Hg change per g; pinteraction<0·0001). In those individuals with hypertension (6835 events), sodium excretion of 7 g/day or more (7060 [11%] of population with hypertension: hazard ratio [HR] 1·23 [95% CI 1·11–1·37]; p<0·0001) and less than 3 g/day (7006 [11%] of population with hypertension: 1·34 [1·23–1·47]; p<0·0001) were both associated with increased risk compared with sodium excretion of 4–5 g/day (reference 25% of the population with hypertension). In those individuals without hypertension (3021 events), compared with 4–5 g/day (18508 [27%] of the population without hypertension), higher sodium excretion was not associated with risk of the primary composite outcome (≥7 g/day in 6271 [9%] of the population without hypertension; HR 0·90 [95% CI 0·76–1·08]; p=0·2547), whereas an excretion of less than 3 g/day was associated with a significantly increased risk (7547 [11%] of the population without hypertension; HR 1·26 [95% CI 1·10–1·45]; p=0·0009). Interpretation: Compared with moderate sodium intake, high sodium intake is associated with an increased risk of cardiovascular events and death in hypertensive populations (no association in normotensive population), while the association of low sodium intake with increased risk of cardiovascular events and death is observed in those with or without hypertension. These data suggest that lowering sodium intake is best targeted at populations with hypertension who consume high sodium diets. Funding: Full funding sources listed at end of paper (see Acknowledgments).
- PublicaciónAcceso abiertoCaracterísticas Clínicas -Epidemiológicas de la Enfermedad Renal Crónica en Algunos Países América Latina: Una Revisión de la Literatura(Univeridad de Santander, 2020-12-14) Meza-Velásquez, Maira Alejandra; Navarro-Garizao, Maryuris; Padilla-Calderón, Mirian KatiuskaLa enfermedad renal crónica (ERC) se considera en la actualidad un problema de salud pública a nivel mundial, debido a su alta incidencia y prevalencia, la cual se calcula cerca del 10% en toda la población. su importancia está relacionada a la carga de la enfermedad, su evolución a la cronicidad y su desenlace irreparable, dado que deteriora el sistema renal, por ende, la salud y la calidad de vida del paciente. El presente artículo es una revisión de la literatura sobre las características clínicas - epidemiológicas de la Enfermedad Renal Crónica en América Latina. La búsqueda se realizó siguiendo las directrices del protocolo prisma. La metodología incluyo: una búsqueda en diferentes bases de datos como: Scopus, Pubmed, SCIENCEDIRECT y SciELO y una revisión de cada artículo para definir su inclusión o exclusión. Para la búsqueda se utilizaron descriptores de acuerdo a la temática planteada y se extrajeron los artículos que cumplieron con los criterios. Es importante resaltar que es una revisión de tipo descriptiva por lo tanto proporciona una idea general de la temática. Luego de la búsqueda y aplicar todas las etapas del protocolo, se tuvo como resultado 11 artículos en total para su revisión y análisis, dentro de los cuales, se evidenció que los factores de riesgo más relacionados para el desarrollo de la Enfermedad Renal Crónica se encuentran: la hipertensión arterial (100%), la edad (100%), la diabetes mellitus tipo II, (55%) y la dislipidemia (36%). Por otra parte, se observó que el 45.4% de los articulo revisados pertenecían a cuba, el 27.2% a Colombia y el 27.2% a otros países como Ecuador, Argentina y Venezuela.
- PublicaciónAcceso abiertoComportamientos de Automanejo de las Personas con Hipertensión y Diabetes en una Institución de Floridablanca(Bucaramanga : Universidad de Santander, 2020, 2020-11-26) Ruíz León, Luz Omaira; Álvarez Maldonado, Kiara; Campos de Aldana, María-Stella; Castañeda Hernández, Álvaro-Hernando; Rivera Carvajal, RaquelIntroducción: La hipertensión arterial y la diabetes son enfermedades que van en aumento, un problema de salud pública, genera impacto mundial donde los costos en salud son incalculables, por esto se requieren estrategias que permitan la prevención y así evitar complicaciones, por esto es necesario realizar seguimientos por parte de enfermería que ayuden a las personas con estas patologías a realizar cambios en los estilos de vida, como seguir las recomendaciones médicas, el tratamiento, la dieta, el ejercicio, teniendo un apoyo emocional, espiritual y terapéutico. Objetivo: Determinar la conducta de automanejo en las personas con hipertensión y diabetes en una institución de Floridablanca, Santander en 2020 B. Materiales y métodos: Estudio cuantitativo, transversal, descriptivo, se utilizó un instrumento para medir el automanejo y la adherencia al tratamiento, con muestreo no probabilístico a conveniencia, se calcularon medidas de frecuencia relativa y absoluta, medida de tendencia central y dispersión, se comparó entre hombres y mujeres, se utilizó la prueba U de Mann Whitney y correlación de Spearman. Resultados: se obtuvo información de 44 pacientes, con un promedio de edad de 67.93 ± 12.03 años, el 56.82% (25) de sexo femenino, con primaria incompleta el 38.64% (17), habitantes de estrato 1-3 especialmente. En el automanejo global una mediana de 6.37(RI: 5; 7.12), en conocimientos = 6(RI: 4; 7.25), en adherencia = 6.91 (RI: 5; 7.17) y en Manejo de síntomas = 5.87 (4.75; 7.25); los hombres presentan tendencia a tener mejores puntajes que las mujeres. Los puntajes de la escala de automanejo y el tiempo con la enfermedad presentan tendencia a correlación positiva RHO=0.20, valor p=0.1931. Conclusión: Los pacientes tienen conocimiento acerca de su estado de salud, de tomar sus medicamentos y llevar a cabo los cuidados indicados por su médico, se puede mejorar en el manejo de síntomas y signos de alerta.
- PublicaciónAcceso abiertoDeterminación de Factores de Riesgo Cardiovascular en Estudiantes de una Privada de Valledupar 2021(Univeridad de Santander, 2021-06-10) Díaz-Vega, Clara Isabel; Narváez-Sánchez, Adriana Paola; De La Hoz, Ibis-MargaritaLas enfermedades cardiovasculares, se han convertido en la causa del mayor número de muertes a nivel mundial, aun cuando existe una clara identificación de los factores de riesgo que la desencadena siendo en su mayoría modificables. Anteriormente las enfermedades cardiovasculares solo se atribuían a la población adulta, llegando a considerarse como una enfermedad propia del adulto mayor. Sin embargo; el patrón epidemiológico ha variado, por lo tanto, ya se encuentran reportes de afectación en todas las edades, debido principalmente a factores como el tabaquismo, sedentarismo, consumo de alcohol y malos hábitos alimenticios. El presente estudio tuvo como objetivo determinar factores de riesgo cardiovascular en estudiantes universitarios, fue un estudio descriptivo de corte transversal con enfoque cuantitativo. Se evaluaron variables como, género, índice de masa corporal (IMC), hábitos alimenticios, consumo de tabaco y alcohol y medición de presión arterial. Se trabajó con una población de 98 estudiantes de los cuales el 75.54% eran el género femenino y 24.49% masculino. Dentro de los principales hallazgos se encontró como factores de riesgo cardiovascular el consumo de alcohol en el 53% de la población, el sedentarismo con un 33%, el sobrepeso y obesidad con 27.27% y 4.08% respectivamente, los valores de presión arterial se encontraron dentro de los parámetros normales (89/74 mm Hg), al igual que la glicemia en ayunas (promedio de 92.1mm/dl) y el perfil lipídico (promedio de colesterol CT 165mm/dl). Se concluye que los principales factores relacionados a riego cardiovascular en la población estudiada son: el consumo de alcohol, sedentarismo y sobre peso u obesidad. Estos factores son modificables, por tanto, la población en riesgo puede trabajar para mejorar su salud.
- PublicaciónRestringidoDeveloping consensus measures for global programs : Lessons from the Global Alliance for Chronic Diseases Hypertension research program(2017-03-15) Lopez-Jaramillo, Patricio; Riddell, Michaela A.; Edwards, Nancy; Thompson, Simon R.; Ortiz, Antonio Bernabe; Praveen, Devarsetty; Johnson, Claire; Kengne, Andre P.; Liu, Peter; McCready, Tara; Ng, Eleanor; Nieuwlaat, Robby; Ovbiagele, Bruce; Owolabi, Mayowa; Peiris, David; Thrift, Amanda G.; Tob, Sheldon; Yusoff, Khalid; On behalf of the GACD Hypertension Research Programme.Background: The imperative to improve global health has prompted transnational research partnerships to investigate common health issues on a larger scale. The Global Alliance for Chronic Diseases (GACD) is an alliance of national research funding agencies. To enhance research funded by GACD members, this study aimed to standardise data collection methods across the 15 GACD hypertension research teams and evaluate the uptake of these standardised measurements. Furthermore we describe concerns and difficulties associated with the data harmonisation process highlighted and debated during annual meetings of the GACD funded investigators. With these concerns and issues in mind, a working group comprising representatives from the 15 studies iteratively identified and proposed a set of common measures for inclusion in each of the teams’ data collection plans. One year later all teams were asked which consensus measures had been implemented. Results: Important issues were identified during the data harmonisation process relating to data ownership, sharing methodologies and ethical concerns. Measures were assessed across eight domains; demographic; dietary; clinical and anthropometric; medical history; hypertension knowledge; physical activity; behavioural (smoking and alcohol); and biochemical domains. Identifying validated measures relevant across a variety of settings presented some difficulties. The resulting GACD hypertension data dictionary comprises 67 consensus measures. Of the 14 responding teams, only two teams were including more than 50 consensus variables, five teams were including between 25 and 50 consensus variables and four teams were including between 6 and 24 consensus variables, one team did not provide details of the variables collected and two teams did not include any of the consensus variables as the project had already commenced or the measures were not relevant to their study. Conclusions: Deriving consensus measures across diverse research projects and contexts was challenging. The major barrier to their implementation was related to the time taken to develop and present these measures. Inclusion of consensus measures into future funding announcements would facilitate researchers integrating these measures within application protocols. We suggest that adoption of consensus measures developed here, across the field of hypertension, would help advance the science in this area, allowing for more comparable data sets and generalizable inferences.
- PublicaciónAcceso abiertoDifferences in health policies for drug availability in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension across Latin America(2022-01-05) Orozco‐Levi, Mauricio; Caneva, Jorge; Fernandes, Caio; Restrepo‐Jaramillo, Ricardo; Zayas, Nayeli; Conde, Rafael; Diez, Mirta; Jardim, Carlos; Pacheco-Gallego, Manuel C.; Melatini, Luciano; Valdez, Héctor; Pulido, Tomas; MasiraTreatment for pulmonary arterial hypertension and chronic thromboembolicpulmonary hypertension in Latin America differs between countries, withregard to disease etiology, health insurance coverage, and drug availability. Agroup of experts from Latin America, met to share regional experiences andpropose possible lines of collaboration. The available evidence, regional clin-ical practice data, and the global context of the proceedings of the 6th WorldSymposium on Pulmonary Hypertension, held in Nice, France, in February2018, were analyzed. Here, we discuss some priority concepts identified that could guide transnational interaction and research strategies in Latin Amer-ica: (1) despite being evidence‐based, the 6th World Symposium on PulmonaryHypertension proceedings may not be applicable in Latin American countries;(2) proactive identification and diagnosis of patients in Latin America isneeded; (3) education of physicians and standardization of appropriate treat-ment for pulmonary arterial hypertension and chronic thromboembolic pul-monary hypertension is vital; (4) our clinical experience for the treatmentstrategy for pulmonary arterial hypertension and chronic thromboembolicpulmonary hypertension is based on drug availability in Argentina, Brazil,Colombia and México; (5) there are difficulties inherent to the consultation ofpatients with pulmonary arterial hypertension and chronic thromboembolicpulmonary hypertension, and access to treatment; (6) the importance of datageneration and research of Latin American‐specific issues related to pul-monary arterial hypertension and chronic thromboembolic pulmonary hy-pertension is highlighted.
- PublicaciónAcceso abiertoDiseño del programa de alta hospitalaria como indicador de institución segura para el cuidador y paciente con hipertensión arterial y diabetes mellitus en una institución de segundo nivel en la Guajira(Bucaramanga : Universidad de Santander, 2019, 2019-04-05) Polanco Carrillo, Margarita M.; Campos de Aldana, María-StellaStudies have reflected the increase in chronic noncommunicable diseases, including hypertension and diabetes mellitus, being a national and international public health problem. Patients and their caregivers should strive to provide a program where these indicators are minimized. The objective to go design the high hospital program as an indicator of a safe institution for the caregiver and patient with arterial hypertension and diabetes mellitus in a second level institution in La Guajira. The methodology of this study was to approach quantitative, descriptive, analytical cross-sectional approach. The population were patients with arterial hypertension and / or Diabetes Mellitus, who attended the program "Hypertensive Club" for the design of the program and the development of the strategies to implement, first a pilot test was carried out. Results: in patients it was found that the predominant sex was female (58%), the median age was 60, the average time with chronic disease was 9.32 (SD ± 7.6) years and with a single caregiver; in conditions of the socio-demographic profile of the caregiver, the female gender predominated, with age between 22 - 78 years. The chronic disease is characterized by increasing and staying on time; the global guidelines emphasize the importance of guaranteeing continuity, safety and comprehensiveness, education, guidance and follow-up towards the recognition and management of pathology. Research on the management of health services, in order to generate proposals and / or programs based on scientific evidence, can improve the provision of nursing care and have a positive impact on the different indicators of morbidity and mortality, time of hospital stay, preventable readmissions, user satisfaction among some other existing indicators.
- PublicaciónAcceso abiertoEstudio piloto de la prevalencia de síndrome metabólico en estudiantes de la institución universitaria Colegio Mayor de Antioquia en Medellín y la Universidad de Santander. Cúcuta, Colombia(Revista Latinoamericana de Hipertensión, 2019-03-01) Gómez Rave, Lyz Jenny; Sierra-Castrillo, Jhoalmis; Bermúdez Pirela, Valmore; Román Marín, Laura-Melisa; Rojas, JoselynAntecedentes: El síndrome metabólico (SM) es una condición que predispone al individuo al desarrollo de enfermedades cardiovasculares, diabetes mellitus tipo 2 y sus complicaciones. Debido a que su prevalencia se encuentra en aumento, se ha convertido en un problema de salud mundial que debe manejarse desde la prevención temprana y la promoción de hábitos saludables. Objetivo: Determinar la prevalencia de SM en un grupo de jóvenes universitarios de la Institución Universitaria Colegio Mayor de Antioquia y la Universidad de Santander. Diseño y método: la investigación es de tipo descriptivo y transversal con una muestra conformada por 80 estudiantes (16 hombres y 64 mujeres), entre los 17 y 32 años, aparentemente sanos. Utilizando la definición de la IDF para el SM, se midieron variables como circunferencia de cintura (CC), presión arterial sistólica y diastólica (PS, PD), glucosa en ayunas (GA), colesterol HDL (HDLc) y triglicéridos (TG). Para el análisis estadístico, la comparación entre grupos se realizó con la medida no paramétrica prueba U de Mann-Whitney, con un nivel de significaticancia p<0,005 y mediante el uso del programa estadístico SPSS versión 24. Resultados: se encontró una prevalencia de SM de 5 %, y en el análisis individual de sus componentes o factores de riesgo asociados se evidenció una mayor prevalencia para CC y GA elevada (38,89% en cada una), seguida de la disminución del HDLc (27,78%). Conclusiones: estos hallazgos concuerdan con estudios previos donde se estima que el SM está presente en adultos jóvenes de acuerdo con criterios de la IDF. A partir de esto se recomienda adoptar medidas institucionales que promuevan la actividad física y la alimentación saludable.
- PublicaciónAcceso abiertoEvaluación del perfil cardiometabólico en profesionales de salud de Latinoamérica(Sociedad Española de Arterioesclerosis, 2021-07-05) Gaibor-Santos, Ivetteh; Garay, Jennifer; Esmeral-Ordoñez, Daniela A.; Rueda-García, Diana; Cohen, Daniel Dylan; Camacho, Paul Antoni; Lopez-Jaramillo, Patricio; MasiraObjetivo Evaluar la presencia de factores de riesgo para enfermedades cardiovasculares (ECV) y diabetes mellitus tipo 2 (DM2) en un grupo de trabajadores de la salud. Métodos Durante el X Congreso Latinoamericano de Medicina Interna realizado en agosto del 2017, en Cartagena, Colombia, se invitó a los asistentes a participar del estudio que incluyó encuesta sobre antecedentes médicos, farmacológicos, familiares, hábitos de vida, medición de presión arterial, antropometría, fuerza muscular y laboratorios. Se utilizaron las escalas INTERHEART y FINDRISC para calcular el riesgo de ECV y diabetes. Resultados En 186 participantes con edad promedio de 37,9 años, 94% médicos (52,7% especialistas) la prevalencia de hipertensión fue 20,4%, sobrepeso 40,3%, obesidad 19,9% y dislipidemia 67,3%. El 20,9% eran fumadores actuales o habían fumado y 60,8% eran sedentarios. Los hipertensos tuvieron mayor edad, índice de masa corporal (IMC), circunferencia de cintura, relación cintura/cadera, porcentaje de grasa corporal, grasa visceral, fueron más fumadores y tuvieron menor fuerza muscular (salto alto: 0,38 vs. 0,42̊cm; p̊=̊0,01). El 44,3% presentaron riesgo cardiovascular alto. La prevalencia de diabetes fue 6,59% y 27,7% estaban en riesgo. Conclusión La prevalencia de factores de riesgo para ECV entre los médicos Latinoamericanos estudiados fue similar a la reportada en la población general. La prevalencia de puntuación de alto riesgo para ECV y DM2 fue alta y los hábitos de vida saludables fueron bajos. Es necesario mejorar la adherencia a estilos de vida saludable entre estos médicos encargados del control de esos factores en la población general.
- PublicaciónRestringidoFixed-dose combination pharmacologic therapy to improve hypertension control worldwide : Clinical perspective and policy implications(Journal of Clinical Hypertension, 2019, 2019) Lopez-Jaramillo, Patricio; Skeete, Jamario; Ridley Pharm, Emily; Campbell, Norm R. C.; Kishore, Sandeep P.; Jaffe, Marc G.; Coca, Antonio; Townsend, Raymond R.; Ordunez, Pedro; DiPette, Donald J.
- PublicaciónRestringidoFixed-dose combination therapy to improve hypertension treatment and control in Latin America(2018-04) Lopez-Jaramillo, Patricio; Meléndez Gomez, Mayra Alejandra; González Gómez, SilviaHypertension is a major risk factor for cardiovascular disease. Its prevalence is increasing worldwide, and is more common in low and middle-income countries. The effectiveness of hypertension treatment is determined by health cost, awareness, and patients’ compliance with the treatment. People worldwide with an adequate control of hypertension correspond to a very small percentage in low and medium income countries as the Latin America ones. Between the causes to explain these are the low availability, affordability and adherence to treatment with multiple pills. It has been proposed that fixed dose combination therapy could improve the availability, affordability, adherence and control of hypertension. This article aims to review the evidence, showing that fixed dose combination can improve adherence, decrease health cost and improve control of hypertension. Improvement in hypertension control with fixed dose combination could make an important contribution to efforts to fight against the global cardiovascular morbidity and mortality.
- PublicaciónAcceso abiertoThe goal of blood pressure in the hypertensive patient with diabetes is defined : Now the challenge is go from recommendations to practice(2014-03-04) Lopez-Jaramillo, Patricio; López López, Jose; López López, Cristina; Rodríguez Alvarez, Miguel IThe recent Latin American and European guidelines published this year has proposed as a goal for blood pressure control in patients with diabetes type 2 a value similar or inferior to 140/90 mmHg. High blood pressure is the leading cause of cardiovascular diseases and deaths globally. Although once hypertension is detected, 80% of individuals are on a pharmacologic therapy only a minority is controlled. Diabetes also is a risk factor for other serious chronic diseases, including cardiovascular disease. Whether specifically targeting lower fasting glucose levels can reduce cardiovascular outcomes remains unknown. Hypertension is present in 20% to 60% of patients with type 2 diabetes, depending on age, ethnicity, obesity, and the presence of micro or macro albuminuria. High blood pressure substantially increases the risk of both macro and micro vascular complications, doubling the risk of all-cause mortality and stroke, tripling the risk of coronary heart disease and significantly hastening the progression of diabetic nephropathy, retinopathy, and neuropathy. Thus, blood pressure lowering is a major priority in preventing cardiovascular and renal events in patients with diabetes and hypertension. During many years the BP goals recommended in patients with diabetes were more aggressive than in patients without diabetes. As reviewed in this article many clinical trials have demonstrated not only the lack of benefits of lowering the BP below 130/80 mmHg, but also the J-shaped relationship in DM patients. Overall we discuss the importance of define the group of patients in whom significant BP reduction could be particularly dangerous and, on the other hand, those with a high risk of stroke who could benefit most from an intensive hypotensive therapy. In any case, the big challenge now is avoid the therapeutic inertia (leaving diabetic patients with BP values of 140/90 mmHg or higher) at all costs, as this would lead to an unacceptable toll in terms of human lives, suffering, and socioeconomic costs.
- PublicaciónRestringidoHypertension Guidelines : Is It Time to Reappraise Blood Pressure Thresholds and Targets?(2016-08-01) Lopez-Jaramillo, Patricio; Coca, Antonio; Sánchez, Ramiro; Zanchetti, Alberto; On behalf of the Latin American Society of Hypertension
- PublicaciónAcceso abiertoHypertension pharmacological treatment in adults. A world health organization guideline executive summary(Hypertension, 2022-01-05) Al-Makki, Akram; DiPette, Donald; Whelton, Paul K.; Murad, M. Hassan; Mustafa, Reem A.; Acharya, Shrish; Mamoun Beheiry, Hind; Champagne, Beatriz; Connell, Kenneth; Cooney, Marie Therese; Ezeigwe, Nnenna; Gaziano, Thomas Andrew; Gidio, Agaba; Lopez-Jaramillo, Patricio; Khan, Unab I.; Kumarapeli, Vindya; Moran, Andrew E.; Mswema Silwimba, Margaret; Rayner, Brian; Sukonthasan, Apichard; Yu, Jing; Saraffzadegan, Nizal; Srinath Reddy, K.; Khan, Taskeen; MasiraHypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient’s values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.
- PublicaciónAcceso abiertoHypertension pharmacological treatment in adults: A world health organization guideline executive summary(2022-01-05) Al-Makki, Akram; DiPette, Donald; Whelton, Paul K.; Murad, M. Hassan; Mustafa, Reem A.; Acharya, Shrish; Beheiry, Hind Mamoun; Champagne, Beatriz; Connell, Kenneth; Cooney, Marie Therese; Ezeigwe, Nnenna; Gaziano, Thomas Andrew; Gidio, Agaba; Lopez-Jaramillo, Patricio; Khan, Unab I.; Kumarapeli, Vindya; Moran, Andrew E.; Mswema-Silwimba, Margaret; Rayner, Brian; Sukonthasan, Apichard; Yu, Jing; Saraffzadegan, Nizal; Reddy, K. Srinath; Khan, Taskeen; MasiraHypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient’s values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.
- PublicaciónRestringidoInflammation and hypertension : Are there regional differences?(2013) Lopez-Jaramillo, Patricio; Velandia Carrillo, Carlos; Álvarez Camacho, Julie; Cohen, Daniel Dylan; Sánchez Solano, Tatiana; Castillo López, GabrielaHypertension is a chronic disease with global prevalence and incidence rapidly increasing in low and medium income countries. The surveillance of cardiovascular risk factors, such as hypertension, is a global health priority in order to estimate the burden and trends, to appropriately direct resources, and to measure the effect of interventions.We propose here that the adoption ofWestern lifestyles in low and middle incomes countries has dramatically increased the prevalence of abdominal obesity, which is the main source of proinflammatory cytokines, and that the vascular systemic inflammation produced by adipose tissue contributes to the development of hypertension. The concentration of proinflammatory cytokines is higher in the Latin American population than that reported in developed countries, suggesting a higher susceptibility to develop systemic low-degree inflammation at a given level of abdominal obesity. These particularities are important to be considered when planning resources for health care programs. Moreover, studying these singularitiesmay provide a better understanding of the causes of the burden of cardiovascular risk factors and the remarkable variability in the prevalence of these medical conditions within and between countries.
- 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.
- PublicaciónAcceso abiertoLong-term exposure to outdoor and household air pollution and blood pressure in the Prospective Urban and Rural Epidemiological (PURE) study(Elsevier, 2020-03-24) Arku, Raphael E.; Brauer, Michael; Ahmed, Suad H.; AlHabib, Khalid F.; Avezum, Álvaro; Bo, Jian; Choudhury, Tarzia; Dans, Antonio; Gupta, Rajeev; Iqbal, Romaina; Ismail, Noorhassim; Kelishadi, Roya; Khatib, Rasha; Koon, Teo; Kumar, Rajesh; Lanas, Fernando; Lear, Scott A.; Wei, Li; Lopez-Jaramillo, Patricio; Mohan, Viswanathan; Poirier, Paul; Puoane, Thandi; Rangarajan, Sumathy; Rosengren, Annika; Soman, Biju; Caklili, Ozge Telci; Yang, Shunyun; Yeates, Karen; Yin, Lu; Yusoff, Khalid; Zatoński, Tomasz; Yusuf, Salim; Hystad, Perry; EverestExposure to air pollution has been linked to elevated blood pressure (BP) and hypertension, but most research has focused on short-term (hours, days, or months) exposures at relatively low concentrations. We examined the associations between long-term (3-year average) concentrations of outdoor PM2.5 and household air pollution (HAP) from cooking with solid fuels with BP and hypertension in the Prospective Urban and Rural Epidemiology (PURE) study. Outdoor PM2.5 exposures were estimated at year of enrollment for 137,809 adults aged 35–70 years from 640 urban and rural communities in 21 countries using satellite and ground-based methods. Primary use of solid fuel for cooking was used as an indicator of HAP exposure, with analyses restricted to rural participants (n = 43,313) in 27 study centers in 10 countries. BP was measured following a standardized procedure and associations with air pollution examined with mixed-effect regression models, after adjustment for a comprehensive set of potential confounding factors. Baseline outdoor PM2.5 exposure ranged from 3 to 97 μg/m3 across study communities and was associated with an increased odds ratio (OR) of 1.04 (95% CI: 1.01, 1.07) for hypertension, per 10 μg/m3 increase in concentration. This association demonstrated non-linearity and was strongest for the fourth (PM2.5 > 62 μg/m3) compared to the first (PM2.5 < 14 μg/m3) quartiles (OR = 1.36, 95% CI: 1.10, 1.69). Similar non-linear patterns were observed for systolic BP (β = 2.15 mmHg, 95% CI: −0.59, 4.89) and diastolic BP (β = 1.35, 95% CI: −0.20, 2.89), while there was no overall increase in ORs across the full exposure distribution. Individuals who used solid fuels for cooking had lower BP measures compared to clean fuel users (e.g. 34% of solid fuels users compared to 42% of clean fuel users had hypertension), and even in fully adjusted models had slightly decreased odds of hypertension (OR = 0.93; 95% CI: 0.88, 0.99) and reductions in systolic (−0.51 mmHg; 95% CI: −0.99, −0.03) and diastolic (−0.46 mmHg; 95% CI: −0.75, −0.18) BP. In this large international multi-center study, chronic exposures to outdoor PM2.5 was associated with increased BP and hypertension while there were small inverse associations with HAP.
- PublicaciónAcceso abiertoMay Measurement Month 2017(ESC - European Society of Cardiology, 2019-04-01) Lopez-Jaramillo, Patricio; Otero, Johanna; Rueda-Quijano, Sandra Milena; Camacho López, Paul Anthony; Rey, Juan José; Sánchez, Gregorio; Narváez, Claudia; Accini, José Luis; Arcos, Edgar; García, Henry; Pérez, Maritza; Aroca, Gustavo; Beaney, Thomas; Kobeissi, Elsa; Poulter, Neil R.; MasiraDespite the availability of efficient methods to evaluate blood pressure (BP) and of safe and efficient medication to treat and control hypertension, the levels of awareness, treatment and control are very low globally, particularly in low- and middle-income countries. To highlight the importance of improving these rates, the International Society of Hypertension (ISH) endorsed by the World Hypertension League have implemented the May Measurement Month initiative. We present here the results obtained in Colombia. The Fundación Oftalmológica de Santander (FOSCAL) led the implementation of this strategy in Colombia and 11 departments participated. The data collection followed the guidelines of the ISH. The information collected was compiled for the report generation and the submission to the Technical Secretariat of the ISH. Data cleaning was performed locally by FOSCAL. Data were collated and analysed centrally. A total of 22 258 participants (58.8% female) were included in the analysis. Mean age was 40.9 ± 17.7 years. Age and sex-standardized BP excluding participants receiving BP medications was 118/74.3 mmHg, and in those on treatment 125/78 mmHg. High BP was present in 5036 (22.8%) individuals, 1637 of 18 644 (8.8%) who were not receiving anti-hypertensive medications were hypertensive, and 961 of 3359 (28.6%) receiving treatment were not controlled. These results highlight the need to develop innovative promotion strategies at individual and population levels to increase the awareness of the importance of BP, and the consequences of not having well-controlled hypertension. This initiative is an effective and easy to implement strategy that should be maintained in the coming years.