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.

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.”

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.”