Actualización de las recomendaciones sobre el uso de la monitorización ambulatoria de presión arterial. Documento de consenso de la Sociedad Chilena de Hipertensión / Update of consensus reccomendations of the Chilean Hypertension Society about ambulatory blood pressure monitoring

Ambulatory blood pressure monitoring (ABPM) is a valuable tool to evaluate the blood pressure pattern, to identify hypertensive patients, to diagnose white coat and masked hypertension and in situations in which a tight control of hypertension is crucial. This is an update of 1999 consensus recommendations about the use to ABPM, considering that there is new evidence concerning its benefits, and the clinical experience with its application has increased. Equipment programming, its installation, the interpretation and analysis of the data are described, and a report sheet for patients is included. New recommendations have been added to the accepted indications. Normal blood pressure ranges for children and pregnant women have been replaced by new data (Rev Méd Chile 2009; 137:1235-47).

Consenso elaborado por la Sociedad Chilena de Endocrinología y Diabetes sobre resistencia a la insulina(RI) y síndrome metabólico (SM): aspectos clínicos y terapéuticos / Chilean society of endocrinology and diabetes consensus on clinical and therapeutic aspects of insulin resistance and metabolic syndrome

Background: The concept insulin resistance as the basis for a series of metabolic alterations and diseases was introduced by Gerald Reaven in 1988, when he described a cluster of alterations that named syndrome X. Aim: To review and discuss the present information about insulin resistance (IR) and metabolic syndrome (MS). Material and methods: The IR concept is defined,the affected metabolic ways, its consequences and relationship with different diseases are presented. The importance of central obesity with its metabolic, inflammatory and prothrombotic consequences playing a key role in cardiovascular risk, is discussed. The cluster of factors focused on cardiovascular disease and eventually diabetes is named MS. Several definitions of MS are analyzed and compared. A proposition is made about the definition to be used in the Chilean population. Differences between IR syndrome and MS are discussed. Diagnostic methods of IR and MS are presented, recommendations are made about their usefulness and reliability. Non pharmacological and pharmacological treatments of IR and MS are analyzed. Other related diseases, such as polycystic ovary syndrome, non alcoholic steatohepatitis and sleep apnea are discussed. Conclusions. Until further studies are made to define a local waist circumference cut-off associated with high risk, the ATPIII MS definition is preferred. A clinical approach is recommended for diagnosis. A search for all components of the MS is important. There is no evidence about the benefits of MS treatment on the prevention of cardiovascular diseases or diabetes. Evidence supports the use of lifestyle changes and some drugs, such as metformin on the prevention of diabetes in prediabetic states.

Viscocidad sanguínea como factor de riesgo cardiovascular / Blood viscosity as a cardiovascular risk factor

El conocimiento de los factores de riesgo cardiovascular ha permitido identificar mejor a aquellos pacientes con mayor riesgo de infarto agudo del miocardio o accidentes vasculares cerebrales. Sin embargo existe un porcentaje de pacientes que , aun sufriendo estos eventos, al ser estudiados no se les encuentra ningún factor de riesgo conocido. Últimamente se le ha dado mayor importancia a la reología sanguínea, siendo la viscosidad sanguínea la principal. Se revisan conceptos fisiopatológicos, evidencia experimental, estudios clínicos y poblacionales que dan soporte para postitular que el estudio de la viscosidad sanguínea debiera hacerse en pacientes con alto riesgo.