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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.
(Lead Investigator of the investigation related with HTN and adolescence approved by HAMAD Corporation)
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.
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.
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)
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.”
As we are settled in the Middle East now. I feel it is important to know about how good are dates for cardiovascular disease.
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.”
Really interesting matter. We are looking forward to your comments.
Check out this interesting study on this link.
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