Microalbuminuria y factores de riesgo cardiovascular asociados en pacientes con hipertensión arterial sistémica. Subanálisis del estudio I-Search / Microalbuminuria and associated cardiovascular risk factors in patients with arterial systemic hypertension. A subanalysis of the I-Search study

Objetivo: Establecer la prevalencia de microalbuminuria en un grupo de pacientes con hipertensión arterial sistémica (HAS), para analizar la asociación entre este parámetro con factores de riesgo cardiovascular y el tratamiento para la HAS. Método: Es un sub-análisis con 564 pacientes de México, extraído de un estudio internacional, observacional y transversal seguidos por médicos especialistas. Se incluyeron pacientes con HAS, sin otras causas de microalbuminuria. Resultados: La microalbuminuria en estos pacientes tuvo una prevalencia de 63.8% (95% IC 58.4, 69.3) y correlaciona con una amplia variedad de factores de riesgo y enfermedades cardiovasculares concomitantes. La mayor parte de pacientes con microalbuminuria recibían ya tratamiento con antagonistas de los receptores de angiotensina II (50%), sin pretender establecer el impacto de los fármacos en los valores de microalbuminuria. Conclusiones:La prevalencia de pacientes con HAS y elevado riesgo cardiovascular es alta. Debido a ello, se justifica un tratamiento multifactorial capaz no sólo de controlar la presión arterial sino también de modificar los demás factores de riesgo cardiovascular presentes.

Objectives: To establish the prevalence of microalbuminuria in a group of patients with systemic arterial hypertension (SAH) to analyze the association between this parameter and cardiovascular risk factors as well as with SAH treatment. Methods: This is a sub-analysis of 564 patients of Mexico, extracted from an international, observational, and cross-sectional study followed by specialists, The study included patients with SAH without any other causes of microalbuminuria. Results: Microalbuminuria in these patients had a prevalence of 63.8% (95% IC 58.4, 69,3) and correlated with a wide variety of risk factors and concomitant cardiovascular diseases Most patients with microalbuminuria already received treatment with angiotensin II receptor antagonists (50%), without pretending to establish the impact of the drugs on the microalbuminuria values. Conclusion: The prevalence of patients with SAH and high cardiovascular risk is high in this study and justifies their management and care with multifactorial strategies aimed to adequately control their blood pressure and to modify other current cardiovascular risk factors.

Hipertensión arterial sistémica en el embarazo / Hypertension and pregnancy

Increasing evidence indicates that hypertension in pregnancy is an under recognized risk factor for cardiovascular disease (CVD). Compared with women who have had normotensive pregnancies, those who are hypertensive during pregnancy are at greater risk of cardiovascular and cerebrovascular events and have a less favorable overall risk profile for CVD years after the affected pregnancies. One factor that might underlie this relationship is that hypertensive disorders of pregnancy (pre-eclampsia, in particular) and CVD share several common risk factors (e.g. obesity, diabetes mellitus and renal disease). Alternatively, hypertension in pregnancy could induce long-term metabolic and vascular abnormalities that might increase the overall risk of CVD later in life. In both cases, evidence regarding risk-reduction interventions specific to women who have had hypertensive pregnancies is lacking. While awaiting results of large-scale studies, hypertensive disorders of pregnancy should be screened for during assessment of a woman's overall risk profile for CVD. Women at high risk must be monitored closely for conventional risk factors that are common to both CVD and hypertensive disorders of pregnancy and treated according to current evidence-based national guidelines.

Hipertensión arterial sistémica en la mujer / Hypertension in women

The cardiovascular disease is a crucial cause of morbidity and mortality in the woman mainly when they arrive at menopause. The pathophysiology and neurohormonal mechanisms widely vary with respect to the man. This finding has given the support to think that the estrogens may be playing a protector role in cardiovascular disease. However, the associated risk factors like obesity, diabetes, dislipidemia, smoking and sedentary life are increasing in an exponential form. In Mexico the population age distribution establishes that 60% of the women with hypertension are aged < 54 years old. This is reason why as factor of independent cardiovascular risk is commonest. Nevertheless, after the menopause cardiovascular mortality is greater in the woman than in the man. In this review, the importance of the new pathophysiological mechanisms and the clinical-therapeutic approach are analyzed, making emphasis in the importance of the change in the life style and also in the nutritional aspects. In Mexico the woman still have a unique role in the nutritional culture.

Abordaje clínico terapéutico del paciente adulto mayor con hipertensión arterial sistémica: recomendaciones para la práctica clínica / Therapeutic clinical approach for the elderly patient with hypertension: recommendations for clinical practice

The incidence of hypertension in the geriatric population is very high and is a significant determinant of cardiovascular risk in this group. The tendency for blood pressure to increase with age in westernized societies such as the United States may depend on environmental factors such as diet, stress, and inactivity. Our population tends to become more obese; to consume relatively greater amounts of sodium and lesser amounts of potassium, calcium, and magnesium; and to decrease exercising with increasing age. Senescent changes in the cardiovascular system leading to decreased vascular compliance and decreased baroreceptor sensitivity contribute not only to rising blood pressure but also to an impairment of postural reflexes and orthostatic hypotension. The hallmark of hypertension in the elderly is increased vascular resistance. Greater vascular reactivity in the elderly hypertensive patients may reflect decreased membrane sodium pump activity and decreased beta-adrenergic receptor activity as well as age-related structural changes. Treatment of diastolic hypertension in the elderly is associated with decreased cardiovascular morbidity and mortality. Although treatment of systolic hypertension may not decrease immediate cardiovascular mortality, it appears to decrease the incidence of stroke. The initial therapeutic approach to the elderly hypertensive patient should generally consist of a reduction in salt and caloric intake and an increase in aerobic exercise, i.e., walking. Drug therapy should be initiated with lower doses of medication with a special concern about orthostatic hypotension.

Hipertensión arterial sistémica en el niño y adolescente / Hypertension in children and adolescence

The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking. Secondary hypertension is more common in preadolescent children, with most cases caused by renal disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension. Evaluation involves a through history and physical examination, laboratory tests, and specialized studies. Management is multifaceted. Nonpharmacologic treatments include weight reduction, exercise, and dietary modifications. Although the evidence of first line therapy for hypertension is still controversial, the recommendations for pharmacologic treatment are based on symptomatic hypertension, evidence of end-organ damage, stage 2 of hypertension, or stage 1 of hypertension unresponsive to lifestyle modifications, and hypertension with diabetes mellitus.

Guías clínicas para la detección, prevención, diagnóstico y tratamiento de hipertensión arterial sistémica en México (2008) / Clinical guidelines for detection, prevention, diagnosis and treatment of systemic arterial hypertension in Mexico (2008)

The multidisciplinary Institutional Committee of experts in Systemic Arterial Hypertension from the National Institute of Cardiology [quot ]Ignacio Chávez[quot ] presents its update (2008) of [quot ]Guidelines and Recommendations[quot ] for the early detection, control, treatment and prevention of Hypertension. The boarding tries to be simple and realistic for all that physicians whom have to face the hypertensive population in their clinical practice. The information is based in the most recent scientific evidence. These guides are principally directed to hypertensive population of emergent countries like Mexico. It is emphasized preventive health measures, the importance of the no pharmacological actions, such as good nutrition, exercise and changes in life style, (which ideally it must begin from very early ages). [quot ]We suggest that the changes in the style of life must be vigorous, continuous and systematized, with a real reinforcing by part of all the organisms related to the health education for all population (federal and private social organisms). It is the most important way to confront and prevent this pandemic of chronic diseases[quot ]. In this new edition the authors amplifies the information and importance on the matter. The preventive cardiology must contribute in multidisciplinary entailment. Based mainly on national data and the international scientific publications, we developed our own system of classification and risk stratification for the carrying people with hypertension, Called HTM (Arterial Hypertension in Mexico) index. Its principal of purpose this index is to keep in mind that the current approach of hypertension must be always multidisciplinary. The institutional committee of experts reviewed with rigorous methodology under the principles of the evidence-based medicine, both, national and international medical literature, with the purpose of adapting the concepts and guidelines for a better control and treatment of hypertension in Mexico. This work group recognizes that hypertension is not an isolated disease; therefore its approach must be in the context of the prevalence and interaction with other cardiovascular risk factors such as obesity, diabetes, dislipidemia and smoking among others. The urgent necessity is emphasized to approach in a concatenated form the diverse cardiovascular risk factors, since independently of which they share common pathophysiological mechanisms, its suitable identification and cont

Hipertensión arterial pulmonar en niños con síndrome de Down y cardiopatía congénita. Es realmente más severa? / Pulmonary hypertension in children with Down's syndrome and congenital heart disease. Is it really more severe?

OBJECTIVE: To compare the hemodynamic state, the severity and reversibility of pulmonary arterial hypertension (PAH) in patients with Down's syndrome and congenital heart disease (CHD) with respect to those without chromosomal pathologies. MATERIAL AND METHODS: 30 patients with congenital heart disease and left to right shunt were studied, corroborated by echocardiography; 16 patients had Down's syndrome and CHD and the control group was constituted by 14 patients without chromosomal abnormalities and with CHD. The age was R = 4.7 +/- 5.8 years for the Down's syndrome group and x = 5.3 +/- 4.5 years for the control group. All patients were subjected to a complete hemodynamic study, as well as to structural analysis by pulmonary wedge angiography (PWA), tested with oxygen administration. RESULTS: The most frequent diagnosis was ventricular septal defect for the control group and common atrioventricular canal for the Down's group. The systolic and mean pulmonary pressure depicted very similar values in both groups, with an average of 84.87 +/- 13.16 mm Hg for the Down's group and 84.21 +/- 22.05 for the control group. After oxygen administration, a tendency of increased Qp/Qs was found with a drop in pulmonary resistance in both groups, but being more important in the control group. During PWA assessment no quantitative differences were observed in PAH between both groups nor after the angiography with oxygen administration. CONCLUSIONS: Although patients with Down's syndrome present CHD with greater predisposition to develop irreversible pulmonary arterial hypertension like common atrioventricular canal, the hemodynamic behavior of pulmonary hypertension and during the challenge with oxygen was similar in both groups.