Penile microvascular endothelial function in hypertensive patients: effects of acute type 5 phosphodiesterase inhibition

The primary aim of this study was to evaluate penile endothelial microvascular function in patients with primary arterial hypertension and age-matched normotensive subjects using laser speckle contrast imaging (LSCI). Additionally, we analyzed the acute penile microvascular effects induced by oral phosphodiesterase type 5 inhibitor (sildenafil; SIL) administration. Endothelium-dependent microvascular reactivity was evaluated in the penises and forearms of hypertensive patients (aged 58.8±6.6 years, n=34) and age-matched healthy volunteers (n=33) at rest and 60 min following oral SIL (100 mg) administration. LSCI was coupled with cutaneous acetylcholine (ACh) iontophoresis using increasing anodal currents. Basal penile cutaneous vascular conductance (CVC) values were not significantly different between control subjects and hypertensive individuals. Penile CVC values increased significantly after SIL administration in control (P<0.0001) and hypertensive (P<0.0001) subjects. Peak CVC values were not different between the two groups during penile ACh iontophoresis before SIL administration (P=0.2052). Peak CVC values were higher in control subjects than in hypertensive subjects after SIL administration (P=0.0427). Penile endothelium-dependent microvascular function is, to some extent, preserved in patients presenting with primary arterial hypertension under effective anti-hypertensive treatment. LSCI may be a valuable non-invasive tool for the evaluation of penile vascular responses to phosphodiesterase type 5 inhibitor.

Hypertension in Latin America: Current perspectives on trends and characteristics / Hipertensión en América Latina: perspectivas actuales de las tendencias y características

The region of Latin America, which includes Central America, the Caribbean and South America, is one that is rapidly developing. Signified by socio-economic growth, transition and development over the last few decades, living standards in countries like Brazil and Mexico have improved dramatically, including improvements in education and health care. An important marker of socio-economic change has been the epidemiological shift in disease burden. Cardiovascular disease is now the leading cause of death in Latin America, and the drop in prevalence of infectious diseases has been accompanied by a rise in non-communicable diseases. Hypertension is the major risk factor driving the cardiovascular disease continuum. In this article we aim to discuss the epidemiological and management trends and patterns in hypertension that may be specific or more common to Latin-American populations - what we term 'Latin American characteristics' of hypertension - via a review of the recent literature. Recognizing that there may be a specific profile of hypertension for Latin-American patients may help to improve their treatment, with the ultimate goal to reduce their cardiovascular risk. We focus somewhat on the countries of Brazil, Mexico and Venezuela, the experience of which may reflect other Latin American countries that currently have less published data regarding epidemiology and management practices

La región de América Latina, que incluye Centroamérica, el Caribe y Sudamérica, está atravesando una rápida evolución. Esto se refleja en el crecimiento socioeconómico, la transición y el desarrollo durante las últimas décadas; las condiciones de vida en países como Brasil o México han mejorado drásticamente, lo que incluye reformas educativas y sanitarias. Un marcador importante de cambio socioeconómico ha sido el giro epidemiológico en la carga que suponen las enfermedades. Los trastornos cardiovasculares son la principal causa de mortalidad en América Latina, y la reducción en la prevalencia de enfermedades infecciosas se ha visto acompañada de un aumento de las enfermedades no contagiosas. La hipertensión es el factor de riesgo que lidera la continuidad de las enfermedades cardiovasculares. En este artículo pretendemos analizar las tendencias y los patrones en materia de epidemiología y gestión de la hipertensión que podrían ser específicos o más comunes en la población latinoamericana -lo que hemos llamado «características latinoamericanas» de la hipertensión- por medio de una revisión de la literatura reciente. Reconocer que podría existir un perfil específico de hipertensión para los pacientes latinoamericanos podría mejorar su tratamiento, con el objetivo final de reducir su riesgo cardiovascular. Nos centramos levemente en los países de Brasil, México y Venezuela, cuyas experiencias podrían verse reflejadas en otros países de América Latina que en la actualidad disponen de menos datos publicados en lo que respecta a las prácticas de epidemiología y gestión