Diagnóstico de hipertensión arterial. ¿Europa o Norteamérica?

Nota. Este editorial ha sido escrito por el Dr. Guillermo Alberto Perez Fernandez (MD, PhD, FACC)

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Como ha dicho Arthur Schopenhauer (1788-1860), “la opinión es como un péndulo y se rige por la misma ley física: si por un lado se aparta del centro de gravedad, debe recorrer la misma distancia en el lado opuesto y así sucesivamente. Solo después de cierto tiempo encuentra el punto en el cual permanece en descanso”. Esta ley del péndulo también se aplica al conocimiento científico.

En estos días se habla mucho de hipertensión arterial (HTA) en la comunidad médica. Primero fue el lanzamiento de las Guías Norteamericanas de HTA el pasado año 2017; luego la presentación de las Guías Europeas de HTA, hace solo tres meses en este 2018, emitiendo puntos de corte diferentes para diagnosticar HTA a los que habían proclamado las guías norteamericanas del 2017. Lo anterior ha esparcido una marea de opiniones entre seguidores y detractores de ambas guías.

El tema de los puntos de corte para diagnosticar enfermedades es complejo y tiene varias aristas.

Hace unos años expresé mi opinión sobre el tema, la que fue publicada.

En próximos posts de este blog estaremos debatiendo más a fondo sobre el diagnóstico de hipertensión arterial y hacia que parte del globo terráqueo “miramos” para diagnosticar HTA.

Clic sobre la imagen para ver la publicación sobre los puntos de corte a texto completo:  port1

Para lo que gusten de las referencias, aquí les dejo el link a Medline.

Thanks.

This editorial has been written by Dr. Guillermo Alberto Perez Fernandez, author of this blog, and reflects his personal opinion about the topic.

1-minute read. Low school performance and arterial hypertension in children and adolescents. An overlooked link.

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

September is already going on. In most countries, this month denotes the start of the academy year in the school system, thereby, I felt that this post would fit in well.

It has been addressed before on this blog the repercussions of arterial hypertension since early in life. However, there is an effect that most times is missed: the impact on the school performance in our children and adolescence.

Unlike some people might think, there is a connection.

Although it is well-known the influence of hypertension on several organs of the human body as kidney, heart and brain among others in adults. The impact on the brain since childhood has been barely described and most reports in the past were limited to gross neurologic events, such as facial palsy, seizure and stroke in children with malignant hypertension.

Nowadays, the medical community is focusing on the association of arterial hypertension and neurocognition since early in life.

Neurocognition: Any form of cognition (the mental process of thinking and understanding) that is associated with the functioning of one or more specific areas of the brain.

What has the medical community found out on this so far?

Children with newly diagnosed or untreated primary hypertension have decreased performance on neurocognitive measures of attention, learning, memory, and fine motor ability compared with those being normotensive regardless maternal education, race, ethnicity, age and sex.

Hypertension in early in life often clusters with other cardiovascular risk factors with further negative effects on cognition, including obstructive sleep apnea, metabolic syndrome, insulin resistance and hyperlipidemia (1,2)

Therefore, the impact of hypertension early in life on neurocognition is clear.

In addition, to make things more complicated, often the school environment may be stressful and challenging for some children which adds up stress to the equation; another variable proven to be strongly related with high blood pressure as I already published some time ago (3)

Then, my recommendation is this: check on any children or adolescent with a poor school performance. Hypertension might be backstage.

Thanks,

The author

References.

1- Lande, M.B., Kupferman, J.C., and Adams, H.R. Neurocognitive alterations in hypertensive children and adolescents. J Clin Hypertens (Greenwich). 2012; 14: 353–359.

2- Hooper SR. Risk Factors for Neurocognitive Functioning in Children with Autosomal Recessive Polycystic Kidney Disease. Front Pediatr. 2017 May 15;5:107.

3- Perez Fernández GA. Hipertensión arterial, estrés y rendimiento académico para la evaluación integral del adolescente hipertenso o en riesgo. Medicentro. 2011; 15(3). (Available at : http://www.medicentro.sld.cu/index.php/medicentro/article/view/238)

(1-minute read) “Emotional” hypertension. Do not get mixed up. There is more on the table.

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The diagnosis of arterial hypertension has made it increasingly complex over time. It is no longer just to tell a patient “you suffer from arterial hypertension”. Nowadays, there are more abnormal blood pressure categories added to the list as prehypertension, “white-coat” hypertension and “masked” hypertension. No doubts, the complexity of the human been plays its role in all this (1)

Many patients have been said over years that they had “emotional hypertension” since her or his blood pressure (BP) at the medical office was elevated even after several BP readings at prudent intervals during the consultation, whereas at home blood pressure remained normal.

The abovementioned situation was overlooked by the medical community for a long time and there was a long-standing thinking that it was simply the result of patient’s stress arising from the patient-doctor encounter at the clinic. However, as time went by, the so-called white-coat effect was study in-depth and as a result, the “white-coat” hypertension term emerged (2)

Is it dangerous?  Yes indeed, several investigations have shown that: Continue reading “(1-minute read) “Emotional” hypertension. Do not get mixed up. There is more on the table.”