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.

ESC. ESH 2018 Guidelines for the Management of Arterial Hypertension

It is really great to post the European Society of Cardiology/European Society of Hypertension Guidelines about Arterial Hypertension. Just presented at the 28 th European Meeting of HTN and cardiovascular protection held last June in Barcelona.

Such a great honor having been there when the guideline was publicly released for first time.

Thanks

Guillermo (author of this blog)

Click below: It will start from minute 1.00 forward. Avancen el video hasta el minuto 1 y desde allí comienza.

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

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                                             Dar clic en la imagen de arriba.

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.

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.

 

 

Long screen time and cardiovascular disease in children and adolescents. Social media and video games might be taking their toll.

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Whenever someone have asked me- What makes so difficult to approach and control arterial hypertension and its related health conditions?

My response is loud and clear: The complexity of the tangled skein we must deal with as health care providers.   

The problem is that there is a growing number of risk factors with a very complex interrelation.

Nowadays, another has been summed up to the list: the screen time or in other words, the time spent on social media, video games, watching television, music videos, advertising, etc.

It is not a secret that is increasingly rare to see kids and adolescents playing games outdoor unless these are part of the school program they belong to. Children are no longer playing hide-and-seek outside or reading a good hard-cover book. Instead, they’ve dived into a world of constant digital media through television, mobile devices and video games.

According to the latest statistics about the topic: Continue reading “Long screen time and cardiovascular disease in children and adolescents. Social media and video games might be taking their toll.”

Poor buccal hygiene might lead to an acute myocardial infarction. Time to make the difference.

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Dedicated to Dental Department at the Cuban Hospital in Qatar.

After several years studying the subject of cardiovascular disease early in life and with some papers published recently about it (1-5) I can say that nowadays, as health care providers, we are facing several cardiovascular disease contributing risk factors (hypertension, obesity, smoking, unhealthy diet, etc.) which prompts a large burden on our shoulders as they keep leading to a long-lasting and quite steady worldwide prevalence of heart conditions, stroke, kidney failure, premature death and disability for the last 20 years. (6)

Even, children and adolescents are not spared from this. For instance, according to the latest European (7) and North American Guidelines about the subject (8), the prevalence of high blood pressure in children and adolescents ranges between 3 to 11 % and rises up to 40 % when obesity is in place as well.

The above mentioned is a known fact that unfortunately is ongoing with some ups and downs but continue to be a pending endeavor yet to be solved by the medical community. Thus, I do not want to dwell on it on this post.

At the moment, I am more interested on reflecting how these spotlighted main risk factors might be blindfolding us from seeing “little facts” that are having also an impact on the complex setting related with the development of cardiovascular disease and sadly are often overlooked.

In this light, there is one fact which is not as publicized as the main risk factors mentioned above which is critical my opinion. I am referring to the buccal hygiene and its links to cardiovascular disease.

To get started, it is worth mentioning that the surfaces of the human body are heavily colonized by a varied microbial ecosystem called the microbiota, in other words, this is a mixed community of microorganisms composed of bacteria, viruses, archaea, and eukaryotic microbes that coinhabit in our body . The gathering of those microbes and their genes is named the human microbiome  and each person has a unique microbiome which varies along with our genetic background, age and life style (9)

As per the aim of this paper, I will point out at the oral microbiome, which is considered one of the most highly dynamic ecosystems in the human body.

According to the latest investigations, the estimated number of bacteria in the mouth is up to 100 billion and comprised nearly 700 identified bacterial species being the most prevalent Firmicutes and Proteobacteria, along with Bacteroidetes, Actinobacteria, and Fusobacteria (10)

Though, the oral microbiome is dynamic in terms of functioning, as ecosystem must be stable in its composition and structure. Any disruption in it leads to a state called dysbiosis.

Recently, multiple animal and human studies have examined the relationship between the oral microbiome disruption (dysbiosis) and blood pressure and have reported important insights explaining such links.

The most important proposed links to hypertension would be the following:

  • Increasing sympathetic nervous system activity.
  • Inflammation and endothelial dysfunction with vascular remodeling (11)

The above links, in turn are known triggering factors for high blood pressure through complex mechanisms beyond the scope of this article.

Now, I will lay out a question: How many time have you been asked by a doctor (no a dentist) in a clinic when feeling some cardiac-like symptoms about your buccal hygiene habits?

The response to this question will come later… Continue reading “Poor buccal hygiene might lead to an acute myocardial infarction. Time to make the difference.”