Actualización en el manejo clínico de la hipertensión hiporreninémica / Update in the clinical management of low renin hypertension

The renin-angiotensin-aldosterone system modulates volume, sodium and potassium homeostasis. In the setting of a high sodium diet, up to 30% of patients with hypertension have a low or suppressed renin and increased volume. This phenotype of low renin hypertension (LRH) is multifactorial and includes infrequent inherited genetic syndromes, milder phenotypes of classic diseases and environmental exposures. All these conditions have in common a higher cardiovascular risk mediated by the over activation of the mineralocorticoid receptor (MR), present not only in the kidney, but also in vasculature, myocardium and adipocytes. Consequently, the aim of LRH treatment goes beyond the control of blood pressure and requires antagonizing MR with specific pharmacologic agents, pursuing normalization of renin as a clinical objective. Due to the unusual evaluation of renin status by non-endocrinologists and lack of disease awareness, only a minority of hypertensive patients receive this pathophysiologically-driven treatment that should reduce cardiovascular outcomes.

Un estudio de reclamos hospitalarios: el rol de la relación médico-paciente / A study of hospital complaints and the role of the doctor-patient communication

Background: Medical practice in Chile has changed dramatically over the last few years. Patients have raised their expectations and there is a growing number of complaints, and malpractice lawsuits. The doctor-patient relationship plays a fundamental role in patient satisfaction and has also been identified as an issue in most medical lawsuits. Aim: To analyze the importance of doctor-patient communication in the complaints received in a university hospital in Chile. Material and Methods: Review ofall complaints received at the office for quality of care at a university hospital. Complaints classified in delay, manners and information categories were selected for further analysis. Results: Of a total of8931 complaints registered between 2001 and 2008, 635 (19 percent) involved a doctor. Fifty one per cent of the latter, were related to the doctor-patient relationship. Of these, 146 cases (45 percent) were further classified as "Dysfunctional delivery of Information", 74 cases (23 percent) as "Not understanding the patient/'family's perspective", 54 cases (17 percent) as "Discrediting the patient or family's views" and 49 cases (15 percent) as "Lack of communication". Conclusions: The percentage of complaints related to communication with the doctor is high, though lower than cited in other studies. The most common complaint is the dysfunctional delivery of information.