Macrosomía fetal e hipertensión arterial, un dúo olvidado.

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Reciente publicación nuestra en la Revista Cubana De Medicina General Integral (Volumen 34, Número 2 (2018): abril-junio) la cual desde hace algún tiempo  presenta un proceso de evaluación por pares (Peerreviewed) y  se encuentra ya indexada en SCOPUS (the World largest abstract and citation database of peer-reviewed literature: scientific journals, books and conference proceedings). Tomado del Sitio Web.

Esperamos sus comentarios.

Dr. Guillermo Alberto Perez Fernandez

 

 

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.

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.

 

 

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

low perfor

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)

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.”