Undiagnosed hypertension in Peru: analysis of associated factors and socioeconomic inequalities, 2019.

OBJECTIVE: To determine the factors associated and measure the socioeconomic inequalities in people with undiagnosed hypertension in Peru. MATERIALS AND METHODS: An observational, cross-sectional, analytical study was performed using data from the 2019 Demographic and Family Health Survey (ENDES, acronym in Spanish) database. The dependent variable was the presence of undiagnosed hypertension (mean systolic blood pressure ≥140 mmHg and/or mean diastolic blood pressure ≥90 mmHg in the two blood pressure measurements and with no prior diagnosis of hypertension by a health care professional). Adjusted prevalence ratios were estimated to determine the factors associated with undiagnosed hypertension. The socioeconomic inequality in undiagnosed hypertension was estimated using concentration curves and the Erreygers concentration index. RESULTS: 67.2% of 3697 persons with hypertension had not been diagnosed. Non-diagnosis of hypertension was more prevalent in men who were residents of the Coast and in inhabitants residing at more than 3000 m above sea level. Being 50 years of age or older, having health insurance, being obese and having diabetes mellitus were associated with a lower prevalence of undiagnosed hypertension. Inequality of the non-diagnosis of hypertension was found to be concentrated in the poorest population. CONCLUSIONS: At least one out of every two adult Peruvians with hypertension have not been diagnosed with this condition. Socioeconomic inequality was found, as well as socio-demographic and health-related factors associated with undiagnosed hypertension. Our findings identify some population subgroups in which interventions for screening and treatment of hypertension should be prioritized in order to reduce both inequalities and complications of hypertension among the most vulnerable.

Registry of "early latecomer" patients with acute ST-segment elevation myocardial infarction at the Instituto Nacional Cardiovascular INCOR - Peru / Registro de pacientes con infarto agudo de miocardio con elevación del ST de más de 12 horas de evolución "early latecomers" en el Instituto Nacional Cardiovascular INCOR-Perú

Abstract Objective To assess the features of asymptomatic patients with acute ST segment elevation myocardial infarction who presents to the emergency with more than 12 h of evolution, and if there is a benefit of an invasive versus medical therapy. Methods Retrospective, cohort study from January 2012 to December 2014, we compare the outcomes at 6 and 12 months of follow up of the invasive group versus the conservative group. Results There were no differences in outcomes at 12 months between an invasive versus a conventional strategy; but, looking at the reperfusion state, we found more risk of death and heart failure at 12 months in the no-reperfused group versus the reperfused group (40% versus 0%, OR: 2, CI: 1.2-3.1, p = 0.028 for mortality and 53% versus 0%, OR: 2.2, CI: 1.3-3.98, p = 0.007 for heart failure). Conclusions In patients with ST elevation acute myocardial infarction with more than 12 h of evolution, the invasive strategy with optimal reperfusion is better than the conservative management or no reperfusion in terms of less mortality and heart failure at 12 months of follow up.

Resumen Objetivo Evaluar las características de pacientes con síndrome coronario agudo con elevación del segmento ST asintomáticos con más de 12 horas de evolución y si existe o no beneficio de la terapia invasiva versus el manejo médico en el seguimiento. Método Estudio retrospectivo, de cohortes desde enero 2012 a diciembre 2014, se comparó los eventos adversos a 6 y 12 meses de seguimiento del grupo en terapia invasiva versus manejo conservador. Resultados No se encontró diferencia entre la estrategia invasiva versus convencional al seguimiento a los 12 meses. Sin embargo comparando el resultado de reperfusión, se encontró mayor riesgo de muerte y falla cardiaca a 12 meses en el grupo no reperfundido versus el reperfundido (40% vs 0%, OR 2, IC: 1.2-3.1, p = 0.028 para mortalidad y 53% vs 0%, OR: 2.2, IC: 1.3-3.98, p = 0.007 para falla cardiaca). Conclusiones En pacientes con infarto agudo de miocardio ST elevado de más de 12 horas de evolución asintomáticos, la estrategia invasiva con resultados óptimos de reperfusión es mejor que el manejo conservador o no reperfusión en cuanto a disminución de la mortalidad y falla cardiaca en el seguimiento al año.

Registry of "early latecomer" patients with acute ST-segment elevation myocardial infarction at the Instituto Nacional Cardiovascular INCOR - Peru.

OBJECTIVE: To assess the features of asymptomatic patients with acute ST segment elevation myocardial infarction who presents to the emergency with more than 12h of evolution, and if there is a benefit of an invasive versus medical therapy. METHODS: Retrospective, cohort study from January 2012 to December 2014, we compare the outcomes at 6 and 12 months of follow up of the invasive group versus the conservative group. RESULTS: There were no differences in outcomes at 12 months between an invasive versus a conventional strategy; but, looking at the reperfusion state, we found more risk of death and heart failure at 12 months in the no-reperfused group versus the reperfused group (40% versus 0%, OR: 2, CI: 1.2-3.1, p=0.028 for mortality and 53% versus 0%, OR: 2.2, CI: 1.3-3.98, p=0.007 for heart failure). CONCLUSIONS: In patients with ST elevation acute myocardial infarction with more than 12h of evolution, the invasive strategy with optimal reperfusion is better than the conservative management or no reperfusion in terms of less mortality and heart failure at 12 months of follow up.

Valoración ecocardiográfica de disincronía ventricular en pacientes con cardiomiopatía dilatada / Valuation echocardiographic of dysinchoronia ventricular in patients with cardiomyopathy expanded

Se evaluó la prevalencia de disincronía ventricular en pacientes con cardiomiopatía dilatada en programade rehabilitación cardiaca. METODOS: Estudio observacional, descriptivo, transversal y prospectivo donde se realizó mediciones ecocardiogrßficas yelectrocardiogrßficas en busca de disincronia intra y/o interventricular a los pacientes con cardiomiopatía dilatada, se realizó test ergométricos para relacionar la disincronía con la clase funcional. RESULTADOS: Se incluyeron 43 pacientes. En su mayoría varones (93 por ciento) con etiología isquémica. Se encontró disincronía intraventricular en 29 pacientes (67.4 por ciento) e interventricular en 14 (32.5 por ciento). El 58 por ciento de pacientes con QRS angosto y el 91 por ciento con QRS ancho tenían disincronía intraventricular. No se encontró relación entre la duración del QRS y la disincronía intraventricular. El QRS predijo disincronía con una sensibilidad del 37 por ciento y especificidad del 92 por ciento. La clase funcional empeoró con la presencia de disincronía. CONCLUSIONES: La duración normal del complejo QRS no es un parßmetro adecuado para descartar disincronía intraventricular. La presencia de un ventrículo disincrónico empeora la capacidad funcional del paciente con cardiomiopatía dilatada.

We evaluated the prevalence of ventricular dissynchrony in patients with dilated cardiomyopathy included in a cardiac rehabilitation program. METHODS: Was a descriptive, observational, transversal and prospective trial, we made ecocardiographycs and electrocardiographycs measures searching for intraventricular or interventricular dissynchrony inthose patients, there were also made ergometrics tests to correlate the dissynchrony with the functional class.RESULTS: A total of 43 patients were included, mostly men (93 per cent), with ischemic aetiology. Intraventriculardissynchrony was present in 29 patients (67.4 per cent) and interventricular dissynchrony in 14 (32.5 per cent). A 58 per cent of patients with narrow QRS complex and a 91 per cent with a wide one, had intraventricular dissynchrony. There was no relationship between the QRS complex duration and the presence of intraventricular dissynchrony. Thesensibility and specifity of QRS complex duration to predict dissynchrony was 37 per cent and 92 per cent respectively.The functional class worsened in patients with dissynchrony. CONCLUSION: The normal durationof the QRS complex is not a good parameter to rule out the presence of intraventricular dissynchrony. Adissynchronous ventricle worsens the functional class of the patient with dilated cardiomyopathy.