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The uncertain beginnings and the “why” of this blog.

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If you want to see the spanish translation click here.

Back in 1998. I was doing my Residence in General Medicine in Santa Clara. Villa Clara. Cuba, it was noon and I was set out to see my last patient. He was a 10-year-old boy brought to the clinic by his mother. He looked like a bit overweight and reported intermittent headache for more than two days. Upon taking medical history, the only positive complain was a frontal headache lasting about an hour with no other accompanying symptom.

At physical examination, there was nothing relevant, in my opinion, to point out. I must confess that I was somewhat bewildered about the cause of the headache. However, I explained to the mother that this pain could be the result of multiple causes while I was ordering a routine checkup. The patient was prescribed pain killers and I advised the mother that if something new raised to go the nearest health center. At the stage, the patient was ready to leave the office I came up with the idea to measure his blood pressure (BP) and to my surprise, he had 140 mmHg of systolic blood pressure with 95 mmHg of diastolic blood pressure. Undoubtedly, that was the cause of the persistent headache. I said to myself: “this patient is hypertensive and he is only 11 years old, what should I do?” Continue reading “The uncertain beginnings and the “why” of this blog.”

Late sinus bradycardia: An unreported adverse effect of intravenous ondansetron.

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Dar clic en la imagen de arriba.

One of our latest publications on hypertension in children and adolescents. Click below.

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My latest publication about Complex interactions leading to cardiovascular disease. Click below.

Fight against hypertension is on. We are back!!!

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After several months of inactivity due to reasons beyond my control I am back again trying to do my hardest in the fight against arterial hypertension (HTN).

During this time I got the fortune of being designated as a Fellow of the American Colleague of Cardiology which fills me with pride and creates at the same time a new commitment in my medical practice (see video) striving to keep cardiovascular disease away and if this is true for adults, when is comes to adolescence or childhood is imperative.

Taking into account the above mentioned, I would like to make a point regarding the latest Clinical Practice Guideline for the Management of High Blood Pressure in Children and Adolescents just published at the end of last year 2017. Just three things I want to stress:

  • The authors of the Guideline continue to emphasize the importance of life style modifications in children and adolescents, which is something that at times is unfulfilled with many factors on the table taking turns. This will be a subject will go into later on a new post.

  • The matter of the early cardiac impairment related with hypertension from childhood is another important issue to look at.

  • Last but not least, a smart prevention by using a proper prediction since early in life is key.

These topics will be covered further in-depth.

I also want to add that the first HAMAD Corporation-approved investigation from the Cuban Hospital just kicked off this month and will enroll adolescent from all over Qatar (national reach) in order to go deeper over the matter.

Please keep awaiting more posts with new updates and details.

Regards.

Dr. Guillermo Perez Fdez (MD, Ph.D, FACC)

(Lead Investigator of the investigation related with HTN and adolescence approved by HAMAD Corporation)

Reference.

1- New Clinical Practice Guideline for the Management of High Blood Pressure in Children and Adolescents. Flynn JT, Falkner BE. New Clinical Practice Guideline for the Management of High Blood Pressure in Children and Adolescents. Hypertension. 2017 Oct;70(4):683-686.

Commentary: Left Ventricular Hypertrophy in Pediatric Hypertension: A Mini Review. I am very proud of this publication of mine.

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Left ventricular hypertrophy in pediatric hypertension. A new publication of mine stressing this important topic just published in the medical journal Frontiers in Pediatric (peer-reviewed journal with high impact. Click on the hyperlink)

Just awaiting for your comments.

Thanks,

Dr. Guillermo.

1-minute read. Aged cardiovascular system early in life. A new direction to act on. 

This post has been written by Dr. Guillermo Perez and represents his personal opinion on the topic. 

“A man is as old as his arteries”                                                                      

                                Thomas Sydenham. 

Vascular aging represents a progressive process involving biochemical, enzymatic, and cellular changes of the vascular tree.

In short, early vascular aging (EVA), is defined as a vascular damage inappropriate for age. Increased arterial stiffness, dilated elastic arteries of central type and impaired endothelial function are main aspects of this process.

EVA is common in patients with hypertension and increased burden of cardiovascular risk factors. Several studies have indicated that this process starts early in life and could be programmed during foetal life or influenced by adverse growth patterns in early postnatal life.

Determinants of EVA can be classified as prenatal and postnatal factors. Prenatal factors are related to mothers’ behavior regarding food, smoking, or alcohol consumption. Some of the genetic mutations from prenatal life seem to influence the development of EVA in children, by starting even from intrauterine life without having clinical or subclinical manifestations in childhood. Posnatal factors comprise the presence of known cardiovascular risk factors that might impact negatively over life speeding up the vascular aging.

Nowadays, the early recognition of the EVA process has become the target of many investigations seeking going ahead in the early identification of individuals at cardiovascular risk.

This is and will be the smartest way to act, it is time to detect the risk early in life. When it comes to cardiovascular risk, the earlier the better. Once the disease is in place, things may turn very unfavorable for the patient and often migh be late for an efective treatment.

Thus, we have another tool to work with, kowing how to use it is key. 

References

1- Nilsson P, Boutouyrie P, Cunha P. Early vascular ageing in translation a: from laboratory investigations to clinical applications in cardiovascular prevention. J Hypertens. 2013;(31):1517–1526.

2- Rana S, Pugh PC, Katz E, et al. Independent effects of early-life experience and trait aggression on cardiovascular function. Am J Physiol Regul Integr Comp Physiol. 2016;311(2):R272–R286.

 

 

Trending in the web. PURE Study Shakes Up Nutritional Field: Finds High Fat Intake Beneficial. Do you believe it?

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The new study of dietary habits in 135,000 people around the world found that high fat intake, including saturated fat, was associated with a reduced risk of mortality

Source: PURE Shakes Up Nutritional Field: Finds High Fat Intake Beneficial