Cardiovascular health and target end-organ damage and comorbidities in hypertensive patients from a Spanish primary care urban population.

We hypothesized that a poorer cardiovascular health status is related to a higher risk of hypertension-mediated organ-damage (HMOD) or hypertension-related comorbidities (HRC). We assessed the relationship between cardiovascular health metrics (CVHM) and HMOD-HRC in 243 hypertensive patients from primary care center followed for two years. We recorded the baseline CVHM score (Life's Simple 7) plus clinical data, including prevalent and incident HMOD-HRC, hospitalization and mortality. The prevalence of ideal CVHM scores was very low in both men and women. The patients with healthier CVHM scores were younger, and had a lower prevalence of diabetes, cardiovascular disease and chronic kidney disease. We recorded 264 cases of HMOD-HRC (225 at baseline and 39 during follow-up). Nine patients died and 64 had any-cause hospitalization during follow-up. A lower prevalence of HMOD-HRC and unfavorable outcomes was observed as the number of ideal CVHM increased (P<0.05). Multivariate logistic regression adjusted for confounders showed a lower CVHM score (0-1) was associated with increased odds of HMOD-HRC (4.04, 95% CI 1.26-12.94; P=0.019) and composite endpoint (HMOD-HRC, death or all-cause hospitalization) (3.43, 95% CI 1.19-9.92; P=0.023). Individual components were less predictive than the cumulative CVHM score. Few hypertensive patients in this urban population had ideal CVHM scores. An inverse relationship between scores and outcomes (HMOD-HRC, death or hospitalizations) was observed. Interventions to increase this score may improve prognosis among community-based hypertensive patients.

Do antihypertensive drugs combinations in single-pill combination improve cardiovascular outcomes? / ¿Las combinaciones de medicamentos antihipertensivos en un solo comprimido mejoran los resultados cardiovasculares?

Abstract Recommendations and guidelines propose to com bine antihypertensive drugs to improve BP control, highlighting the advantages of single-pill combinations (SPCs) to improve treatment adherence. It is speculated that, compared with free-dose combinations (Free-DCs), SPC should achieve a reduction in cardiovascular (CV) events and mortality through better adherence and BP control. However, there is little information in this regard. For this reason, the objective of this review was to provide a descriptive analysis the differences in CV outcomes between SPCs antihypertensive drugs treat ments vs. Free-DCs treatments. Ten studies were found and none had a randomized controlled design. Medi cation adherence was higher with SPCs, but outcomes were not adjusted for the adherence/persistence. When groups were compared according to similar adherence degrees, the statistical significance in favor of SPCs disappeared. Thus, randomized controlled studies are necessary to evaluate if SPCs have any effect beyond the improvement of the adherence to hypertensive treatment.

Resumen Las recomendaciones y las guías proponen combinar fármacos antihipertensivos para mejorar el control de la presión arterial, destacando las ventajas de las combi naciones en un solo comprimido para mejorar la adhe rencia al tratamiento. Se especula que, en comparación con las combinaciones en varios comprimidos, deberían lograr una reducción de los eventos cardiovasculares y de la mortalidad a través de una mejor adherencia y con trol de la presión. Sin embargo, hay poca información al respecto. Por esta razón, el objetivo de esta revisión fue proporcionar un análisis descriptivo de las diferencias en los resultados cardiovasculares y la mortalidad entre los tratamientos con combinaciones de antihipertensi vos en un solo comprimido vs. combinaciones de los mismos grupos de fármacos en varios comprimidos. Se encontraron diez estudios, pero ninguno tenía un dise ño controlado aleatorio. La adherencia a la medicación fue mayor con las combinaciones en un comprimido, pero los resultados no se ajustaron por la adherencia/ persistencia. Cuando se compararon los grupos según grados de adherencia similares, la significación estadís tica a favor de las combinaciones en un comprimido se perdió. Por lo tanto, son necesarios estudios controlados aleatorios para evaluar si las combinaciones de antihi pertensivos en un comprimido tienen algún efecto más allá de la mejora de la adherencia al tratamiento.

Dietary patterns in non-alcoholic fatty liver disease (NAFLD): Stay on the straight and narrow path!

Non-alcoholic fatty liver disease (NAFLD) is the most frequent hepatic disease globally. NAFLD patients are at an increased risk of both liver and cardiovascular morbidity and mortality, as well as all-cause death. NAFLD prevalence is rapidly increasing worldwide and, thus, there is an urgent need for health policies to tackle its development and complications. Currently, since there is no drug therapy officially indicated for this disease, lifestyle interventions remain the first-line therapeutic option. In the present narrative review, we discuss the effects of certain dietary patterns on NAFLD incidence and progression. The Mediterranean diet is regarded as the diet of choice for the prevention/treatment of NAFLD and its complications, based on the available evidence. Other plant-based dietary patterns (poor in saturated fat, refined carbohydrates, red and processed meats) are also beneficial [i.e., Dietary Approaches to Stop Hypertension (DASH) and vegetarian/vegan diets], whereas more data are needed to establish the role of ketogenic, intermittent fasting and paleo diets in NAFLD. Nevertheless, there is no "one-size-fits-all" dietary intervention for NAFLD management. Clinicians should discuss with their patients and define the diet that each individual prefers and is able to implement in his/her daily life.

Building capacity in reducing population dietary sodium intake in the Americas / Creación de capacidad para reducir la ingesta de sodio en los alimentos a nivel de la población en la Región de las Américas / Desenvolvimento de capacidade para a redução da ingestão alimentar de sódio pela população das Américas

ABSTRACT Objective. To present some resources developed as part of the technical support of the Pan American Health Organization (PAHO) to Member States to reduce population dietary sodium intake, and to discuss the main challenges and opportunities to accelerate action toward sodium intake reduction in the Americas. Methods. Sources of information include a mapping of salt reduction policies conducted in 2019, reports from working group meetings, interviews conducted in 2020 and 2021 in seven countries, and technical documents developed around the Updated PAHO Regional Sodium Reduction Targets. Results. These tools show that, despite progress, challenges to succeed in this agenda persist. Priority given to sodium reduction is low in most countries, with insufficient resource allocation. There is a lack of intersectoral coordinated action, and a systemic approach to food systems is commonly missing. Surveillance mechanisms of sodium intake are insufficient, and industry interference in policy processes is commonly identified, undermining policy progress and success. There are also important regional opportunities to address these challenges. These include common ground for future collaborations by updating, strengthening, and complementing these existing tools, and technical and financial support for data generation. Conclusions. PAHO is committed to continue to support countries in the process of promoting, implementing, and monitoring cost-effective sodium reduction interventions. One key policy priority in this agenda is the adoption of the Updated PAHO Regional Sodium Reduction Targets with a mandatory approach, together with the comprehensive and complementary implementation of other strategies. Strong political will and commitment of countries will be critical to translate goals into concrete achievements in the Americas.

RESUMEN Objetivo. Presentar algunos recursos elaborados como parte del apoyo técnico brindado por la Organización Panamericana de la Salud (OPS) a los Estados Miembros para reducir la ingesta de sodio en los alimentos a nivel de la población y abordar los principales desafíos y oportunidades para acelerar las medidas de reducción de la ingesta de sodio en la Región de las Américas. Métodos. Entre las fuentes de información se encontraron un mapeo de las políticas de reducción de la sal realizado en el 2019, varios informes de reuniones de grupos de trabajo, entrevistas realizadas en siete países entre el 2020 y el 2021, y documentos técnicos acerca de las metas regionales actualizadas de la OPS para la reducción del sodio. Resultados. Estas herramientas muestran que, a pesar de los avances, persisten los desafíos en el logro de esta agenda. La prioridad dada a la reducción del sodio en la mayoría de los países es baja y la asignación de recursos es insuficiente. No hay coordinación intersectorial y por lo general no se adopta un enfoque sistémico para los sistemas alimentarios. Los mecanismos de vigilancia de la ingesta de sodio son insuficientes y es común que haya interferencia de la industria en los procesos que siguen las políticas, lo que socava su progreso y éxito. Hay importantes oportunidades regionales para abordar estos desafíos, como un terreno común para futuras colaboraciones mediante la actualización, el fortalecimiento y la complementación de las herramientas existentes, y el apoyo técnico y financiero para la generación de datos. Conclusiones. La OPS mantiene su compromiso de seguir apoyando a los países en el proceso de promoción, ejecución y seguimiento de intervenciones costo-eficaces para la reducción del sodio. Una prioridad política clave en esta agenda es la adopción con carácter obligatorio de las metas regionales actualizadas de la OPS para la reducción del sodio, junto a la ejecución integral y complementaria de otras estrategias. Una fuerte voluntad política y el compromiso de los países serán fundamentales para traducir estos objetivos en logros concretos en la Región de las Américas.

RESUMO Objetivo. Apresentar alguns recursos desenvolvidos como parte do apoio técnico da Organização Pan-Americana da Saúde (OPAS) aos Estados Membros para reduzir a ingestão alimentar de sódio pela população e discutir os principais desafios e oportunidades para acelerar as ações em prol da redução da ingestão de sódio nas Américas. Métodos. As fontes de informação incluem um mapeamento das políticas de redução de sal realizado em 2019, relatórios de reuniões do grupo de trabalho, entrevistas realizadas em 2020 e 2021 em sete países e documentos técnicos relativos às Metas regionais atualizadas da OPAS para a redução do sódio. Resultados. Essas ferramentas mostram que, apesar dos progressos, os desafios para o êxito dessa agenda persistem. Na maioria dos países, a prioridade dada à redução do sódio é baixa, com alocação insuficiente de recursos. Não há ação coordenada intersetorial e, em geral, nem abordagem sistêmica dos sistemas alimentares. Os mecanismos de vigilância da ingestão de sódio são insuficientes e é comum haver interferência da indústria nos processos políticos, o que prejudica o avanço e o êxito das políticas. Há também importantes oportunidades regionais para enfrentar esses desafios, como um consenso para futuras colaborações por meio da atualização, do fortalecimento e da complementação das ferramentas existentes, além de apoio técnico e financeiro para a geração de dados. Conclusões. A OPAS está empenhada em continuar apoiando os países no processo de promoção, implementação e monitoramento de intervenções de redução do sódio com boa relação custo-benefício. Uma prioridade política decisiva nessa agenda é a adoção das Metas regionais atualizadas da OPAS para a redução do sódio, com aplicação obrigatória, associada à implementação ampla e complementar de outras estratégias. A firmeza de vontade e o compromisso político dos países será crucial para materializar os objetivos nas Américas.

Hypertension in Older Adults in Jamaica: Prevalence, Treatment and Control / La Hipertensión en los Adultos Mayores en Jamaica: Prevalencia, Tratamiento y Control

ABSTRACT Objective: To examine the prevalence, treatment and control and associated risk factors for hypertension among older adults in Jamaica. Methods: Four parishes in Jamaica were surveyed using a cross-sectional study design involving 2943 participants. The survey used a cluster sampling methodology with probability-proportional-to-size. A sub sample of 373 persons was randomly selected for assessment with regard to hypertension prevalence, treatment and control. Results: The sample consisted of 373 older adults with the majority (56.6%) being female. The age of the participants ranged from 60 to 100 years, with the median age being 70 (interquartile range = 13) years. Reported prevalence of hypertension was 61.7% and significantly (p < 0.001) more females than males (71.4% vs 49.1%, respectively) reported having hypertension. There was no significant difference in being diagnosed with hypertension by age groups, area of residence, highest level of education and union status. Among older adults who reported having hypertension, the majority (90.0%) were being treated while one in ten (10%) reported not being treated. "Based on the Eighth Joint National Committee (JNC-8) definition of control, among older adults who reported having hypertension, only slightly more than a third (34.8%) were controlled; the majority (65.2%) were uncontrolled. Conclusion: The low level of hypertension control documented is of concern given the availability of medication subsidies and the priority attention being given to chronic disease. Further research is needed regarding facilitators and barriers to hypertension control to identify the best interventions to increase control levels.

RESUMEN Objetivo: Examinar la prevalencia, tratamiento y control, así como los factores de riesgo asociados con la hipertensión entre los adultos mayores en Jamaica. Métodos: Cuatro parroquias en Jamaica fueron encuestadas usando un diseño de estudio transversal que abarcó 2943 participantes. La encuesta utilizó una metodología de muestreo por conglomerados con probabilidad proporcional al tamaño. Una submuestra de 373 personas fue seleccionada aleatoriamente para su evaluación con respecto a la prevalencia, tratamiento y control de la hipertensión. Resultados: La muestra constó de 373 adultos mayores, de los cuales la mayor parte (56. 6%) eran mujeres. La edad de los participantes fluctúo de 60 a 100 años, siendo la edad mediana 70 años (rango intercuartil = 13). La prevalencia de hipertensión reportada fue 61.7%, y significativamente (p < 0.001) más hembras que varones (71.4% vs 49.1%, respectivamente) reportaron tener hipertensión. No hubo diferencia significativa alguna en ser diagnosticado con hipertensión por grupos de edad, área de residencia, nivel más alto de educación, y estado de la unión. Entre los adultos mayores que reportaron tener hipertensión, la mayoría (90.0%) estaban siendo tratados, mientras que uno de cada diez (el 10%) reportaron no tener tratamiento. Basándose en la definición de control ocho del Comité Nacional Conjunto (JNC, siglas en inglés) entre los adultos mayores que reportaron tener hipertensión, sólo poco más de un tercio (34.8%) eran controlados. La mayoría (65.2%) no eran controlados. Conclusión: El bajo nivel de control de la hipertensión documentado es asunto de preocupación, dada la disponibilidad de subsidios para medicamentos y la atención prioritaria que se da a las enfermedades crónicas. Se necesitan investigaciones adicionales sobre facilitadores y barreras al control de la hipertensión para identificar mejores intervenciones para aumentar los niveles de control.

Prevalence, Diagnosis, Treatment, and Control of Hypertension in Spain. Results of the Di@bet.es Study.

INTRODUCTION AND OBJECTIVES: Di@bet.es is a national study designed to estimate the prevalence of diabetes mellitus and other cardiovascular risk factors in the Spanish adult population. The prevalence of hypertension and the degree to which it is recognized, treated, and controlled are described. METHODS: The study included a sample of the Spanish population with 5048 adults aged ≥ 18 years. Patients were questioned and examined, with 3 blood pressure readings while seated and at rest to calculate the mean of the 3 readings. Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or prescription for antihypertensive drug therapy. RESULTS: Hypertension was found in 42.6% of the Spanish adult population aged ≥ 18 years and was more common among men (49.9%) than women (37.1%). The prevalence was higher among prediabetics (67.9%) and diabetics (79.4%). Undiagnosed hypertension was identified in 37.4% of patients and was more common in men (43.3%) than in women (31.5%). Among patients with known hypertension, 88.3% were receiving drug therapy. Well-controlled blood pressure was found in only 30% and was more common among women (24.9%) than men (16%). CONCLUSIONS: The prevalence of hypertension in Spain is high, and a considerable percentage of hypertensive patients have still not been diagnosed. Hypertension is associated with diabetes and prediabetes, and although drug therapy is increasingly common, the degree of control has not improved and remains low. Population campaigns should be developed and promoted for hypertension prevention, detection, and treatment.

Déficit de autocuidado em crianças com risco para hipertensão arterial / Self-care deficit in children at risk for hypertension / Déficit de autocuidado en niños en riesgo de hipertensión arterial

Objetivo: identificar os déficits de autocuidado em crianças com risco para hipertensão arterial. Método: estudo descritivo, transversal, com abordagem quantitativa, realizado com 109 crianças na faixa etária de 7 a 11 anos, em três escolas públicas do Ensino Fundamental de João Pessoa-PB. Os dados foram coletados em março e abril de 2009 utilizando-se um questionário que identificou a predisposição dos escolares para o desenvolvimento da hipertensão, considerando o fator hereditariedade, bem como déficits de autocuidado para prevenção da doença. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa, protocolo nº 1071/07. Resultados: identificou-se que 66% dos escolares possuem familiares com pressão arterial elevada; 55% relataram vivenciar algum tipo de sentimento negativo; apenas 12% costumam verificar a pressão arterial e 64% não foram orientadas sobre a relação dos hábitos alimentares com a hipertensão. Conclusão: sugere-se que os profissionais da saúde desenvolvam estratégias com vista para o autocuidado relacionado à prevenção da HAS.(AU)

Objective: identifying self-care deficits in children at risk for high blood pressure. Method: this is a descriptive, transversal study of a quantitative approach performed with 109 children aged 7-11 years old, in three public schools of Basic Education of João Pessoa-PB. Data were collected between March and April 2009 using a questionnaire that identified the readiness of the children to the development of hypertension, considering the heredity factor, as well as self-care deficits for disease prevention. The research project was approved by the Research Ethics Committee, protocol nº 1071/07. Results: it was found that 66% of students have family members with high blood pressure; 55% reported experiencing some kind of negative feeling; only 12% usually check blood pressure and 64% were not oriented about the relationship of dietary habits with hypertension. Conclusion: it is suggested that health professionals develop strategies for self-care related to the prevention of hypertension.(AU)

Objetivo: identificar los déficits de autocuidado en los niños en riesgo de presión arterial alta. Método: este es un estudio descriptivo, transversal con enfoque cuantitativo realizado con 109 niños de 7-11 años en tres escuelas públicas de Educación Básica de João Pessoa - Paraíba. Los datos fueron recolectados en marzo y abril de 2009 con un cuestionario que identifica la voluntad de los de la escuela para el desarrollo de la hipertensión, teniendo en cuenta el factor de la herencia, así como el déficit de autocuidado para la prevención de enfermedades. El proyecto de investigación fue aprobado por el Comité de Ética en la Investigación, el protocolo nº 1071-07. Resultados: se encontró que 66% de los estudiantes tienen miembros de la familia con presión arterial alta; 55% reportaron haber experimentado algún tipo de sentimiento negativo; sólo el 12% tienden a comprobar la presión arterial y el 64% no fueron orientadas acerca de la relación de los hábitos alimentarios con la hipertensión. Conclusión: se sugiere que los profesionales de la salud desarrollan estrategias de autocuidado relacionado con la prevención de la hipertensión.(AU)

Hypertension in the African American population: A succinct look at its epidemiology, pathogenesis, and therapy.

Arterial hypertension is prevalent in the black population in the United States. It is directly related to cardiovascular and kidney damage. Its pathogenesis is complex and includes the high incidence of obesity, salt sensitivity and the activation of the renin-angiotensin-aldosterone system. This complexity requires a therapeutic combination that includes changes in dietary habits and appropriate antihypertensive regimes. The International Society of Hypertension in Blacks recommends initiating dietary intervention for values of systolic/diastolic arterial blood pressure above 115/75 mmHg and maintaining arterial blood pressure below 135/85 mmHg using appropiate antihypertensive medication. The most adequate antihypertensive drug for this population has yet to be determined.

Rastreamento da insuficiência renal crônica em usuários hipertensos e/ou diabéticos / Tracing of chronic kidney disease in hypertensive and/or diabetic users / Seguimiento de la insuficiencia renal crónica en los usuarios hipertensos y/o diabéticos

Objetivo: rastrear a insuficiência renal crônica (IRC) em usuários hipertensos e/ou diabéticos. Método: estudo descritivo, transversal, quantitativo, realizado com 169 registros de pacientes cadastrados no Sistema Informatizado de Cadastramento e Acompanhamento de Hipertensos e Diabéticos - HIPERDIA. O estudo foi aprovado pelo Comitê de Ética em Pesquisa CAAE 02392912.1.0000.5208. Resultados: dos 169 usuários, 5,9% eram diabéticos, 63,9% hipertensos e 51 30,1% hipertensos e diabéticos. Dentre os usuários hipertensos e/ou diabéticos, a maioria mulheres com idade média de 55,5 anos. Apresentaram índice de massa corpórea entre sobrepeso e obeso (54,4%). A média da pressão arterial sistólica foi de 128,93 ± 14,66 mmHg e a da pressão arterial diastólica foi de 81,23 ± 7,59 mmHg. O rastreamento da IRC apresentou casos nos estágios I, II e III. Conclusão: é possível rastrear precocemente a IRC no âmbito da atenção básica utilizando-se dos instrumentos da prática diária.(AU)

Objective: tracing chronic renal failure (CRF) in hypertensive and/or diabetic users. Method: a descriptive, cross-sectional, quantitative study, conducted with 169 records of patients registered in the Information System of Registration and Monitoring of Hypertensive and Diabetic - HIPERDIA. The study was approved by the Research Ethics Committee CAAE 02392912.1.0000.5208. Results: of the 169 users, 5,9% were diabetic, 63,9% hypertensive and 51 (30,1%) hypertensive/ diabetic. Among the hypertensive and/or diabetic users, mostly women with an average age of 55,5 years old. The body mass index was among overweight and obese (54,4%). The average systolic blood pressure was 128,93 ± 14,66 mmHg and diastolic blood pressure 81,23 ± 7,59 mmHg. Tracing the IRC presented cases in stages I, II and III. Conclusion: it is possible to trace the early IRC, within primary care, using the tools of daily practice.(AU)

Objetivo: el seguimiento de la insuficiencia renal crónica (IRC) en usuarios hipertensivos y/o diabéticos. Método: este es un estudio descriptivo, transversal, cuantitativo, realizado con 169 registros de pacientes registrados en el Sistema Informatizado de Registro y Supervisión de los Hipertensos y Diabéticos - HIPERDIA El proyecto de investigación fue aprobado por el Comité de Ética en Investigación CAAE 02392912.1.0000.5208. Resultados: de los 169 usuarios, un 5,9% eran diabéticos, el 63,9% hipertensos y 51 (30,1%) hipertensos/diabéticos. Entre los usuarios hipertensos y/o diabéticos, en su mayoría mujeres, la edad promedio era de 55,5 años. El índice de masa corporal entre el sobrepeso y la obesidad (54,4%). El promedio de la presión arterial sistólica fue de 128,93 ± 14,66 mmHg y la presión arterial diastólica fue 81,23 ± 7,59 mmHg. El seguimiento de la IRC presentado casos en etapas I, II y III. Conclusión: se puede rastrear temprano la IRC dentro de la atención primaria, utilizando las herramientas de la práctica diaria.(AU)

O enfermeiro frente à mensuração da pressão intra-abdominal: revisão de literatura / The nurse in the measurement of intra-abdominal pressure: literature review

Estudo que objetivou levantar na literatura a técnica de mensuração da pressão intra-abdominal. Revisão bibliográfica de livros e artigos a partir das bases SciELO e MEDLlNE no período de 2004 a 2011. Os resultados apresentaram três vias de mensuração: a intravesical, intraperitoneal e gástrica. O método intravesical por sua fácil execução e vasta aplicabilidade foi caracterizado como técnica universal. Observou-se a importância da realização de estudos posteriores que possam padronizar esta técnica pela enfermagem.

Study aimed to raise the technical literature for measuring intra-abdominal pressure. Literature review was the methodology, consulting books and articles from SciELO (Scientific Electronic Library Online) and MEDLlNE (U. S. National Library of Medicine's® (NLM) database from 2004 to 2011. Results showed three measuring ways, namely intravesical, intraperitoneal, and gastric. Intravesical method was characterized as a universal technique, because of its easy implementation and wide applicability. Offering greater security to professionals at its execution time.

Estudio tuvo como objetivo elevar la literatura técnica para la medición de la presión intraabdominal. Metodología de la revisión de la literatura de libros y artículos de SciELO y MEDLlNE desde 2004 a 2011. Los resultados mostraron tres formas de medir la intravesical, intraperitoneal, y el estómago. E método intravesical debido a su fácil implementación y una amplia aplicación se caracterizó por ser una técnica universal. Se señaló la importancia del estudio, que ofrece una mayor seguridad aios profesionales a la hora de ejecutarlo.

Control de la hipertensión arterial en personas con diabetes tipo 2 / Blood hypertension control in type 2 diabetic persons

Objetivo: Evaluar el control de la hipertensión arterial y su relación con algunas variables clínicas y bioquímicas, en personas con diabetes mellitus tipo 2 de Bayamo, provincia Granma. Métodos: estudio descriptivo transversal con 382 pacientes diabéticos tipo 2, además hipertensos, ingresados en el Centro de Atención al Diabético de Bayamo, Granma, en el período comprendido entre septiembre de 2011 y mayo de 2013. Los pacientes se dividieron en 2 grupos, atendiendo al control de la hipertensión arterial: controlados y no controlados. Resultados: al final del ingreso 345 pacientes con diabetes (90,3 por ciento) obtuvieron un control óptimo de la presión arterial. Para lograr este objetivo fue necesario utilizar 2 o más medicamentos en el 68,4 por ciento de los casos. Los diabéticos que no alcanzaron un buen control de la presión arterial (9,7 por ciento), tenían una edad y un tiempo de evolución de la diabetes significativamente mayor que aquellos que sí lo consiguieron (p= 0,0126 y p= 0,0090, respectivamente). Hubo una asociación notoria entre el descontrol de la glucemia y el de la presión arterial (OR= 6,82, IC= 3,3-13,9, p= 0,0000). Conclusiones: para alcanzar un control óptimo de la presión arterial en la mayoría de los diabéticos tipo 2, en nuestro medio, se necesitan 2 o más medicamentos, y tener en cuenta diferentes factores como: la edad, el tiempo de evolución de la diabetes y el control de la glucemia(AU)

Objective: To evaluate the blood hypertension control and its relationship with some clinical and biochemical variables in type 2 diabetic persons living in Bayamo, Gramma province. Methods: cross-sectional descriptive study of 382 type 2 diabetic and hypertensive patients, who were admitted to the Center of Care for Diabetic Patient in Bayamo, Gramma province in the period of September 2011 through May 2013. The patients were divided into 2 groups according to the blood hypertension control in terms of controlled and uncontrolled hypertensives. Results: on discharge from hospital, 345 diabetic patients (90.3 percent) had reached optimal control of their blood pressure. To attain this goal, it was necessary to use two or more drugs in 68.4 percent of cases. The diabetics that did not succeed in this task were older and had longer time of progression of diabetes than those who did (p= 0.0126 y p= 0.0090, respectively). There was remarkable association of lack of glycemic control and uncontrolled blood pressure (OR= 6.82, IC= 3.3-13.9, p= 0.0000). Conclusions: it was necessary to use two or more drugs to reach optimal control of blood pressure in most of the type 2 diabetic patients and to consider different factors such as age, time of diabetes progression and glycemic control(AU)

Hipertensión ateerial post-parto / Post- partum boood hypertension

Objetivo: Determinar la prevalencia y la duración de la hipertensión arterial posparto (HPP) en pacientes con hipertensión inducida por el embarazo (HIE), con preeclampsia (PE), eclampsia y con hipertensión de inicio en el puerperio, los factores de riesgo asociados y los esquemas terapéuticos utilizados. Material y métodos: Es un estudio observacional, descriptivo y transversal realizado en 196 mujeres embarazadas e hipertensas, hospitalizadas en los servicios de Alto Riesgo Obstétrico, Unidad de Terapia Intensiva, puerperio fisiológico y patológico del Hospital Materno Infantil de la Caja Nacional de Salud en La Paz-Bolivia. El análisis estadístico fue desarrollado utilizando paquetes estadísticos EpiInfo 3.5 y SPSS 15.0; la descripción se realizo por medio de frecuencias y porcentajes totales. Resultados: La prevalencia de hipertensión posparto fue del 78,9%; la mayoría de las pacientes controlaron las cifras tensionales entre las 2 a 4 semanas posparto, en todos los casos asociando cambios en el estilo de vida con tratamiento farmacológico, la mayoría asociando dos fármacos antihipertensivos, generalmente metildopa con calcio-antagonista. Conclusiones: La prevalencia de HPP es alta, estas pacientes deben ser dadas de alta después del cuarto día posparto y seguidas externamente durante los tres meses posparto para prevenir complicaciones cardiovasculares.

Objective: To determine the prevalence and duration of postpartum hypertension in patients with pregnancy-induced hypertension, preeclampsia, eclampsia and hypertension in the postpartum on set, associated risk factors and treatment regimen used. Material and methods: It is an observational, descriptive and cross-sectional study in 196 pregnant women and hypertensive, hospitalized in the high risk obstetric services, intensive care unit, physiological and pathological postpartum. All data were processed with statistical packages SPSS 15.0 and Epi Info 3.5, the description was made by means of frequencies and total percentages. Results: The prevalence of postpartum hypertension was 78.9%, most of the patients kept the blood pressure between 2 to 4 weeks postpartum, in all cases associating changes in the lifestyle with drug treatment, most combining two antihypertensive drugs, usually calcium antagonist with methyldopa. Conclusions: The prevalence of postpartum hypertension is high; these patients should be discharged after the fourth day postpartum and followed externally for the three months postpartum to prevent cardiovascular complications.

Hipertensión pulmonar en las enfermedades respiratorias crónicas: Prueba de marcha de 6 minutos: técnica y utilidad en el diagnóstico funcional, pronóstico y seguimiento

Las enfermedades respiratorias crónicas pueden ser causa de hipertensión pulmonar (HP). La clasificación actual de HP incluye a estas enfermedades en el grupo 3 como HP debida a enfermedad pulmonar y/o hipoxia. Esta causa de HP es responsable de alrededor del 10% de todas las hipertensiones pulmonares. En general la HP suele ser de grado moderado, aunque un porcentaje pequeño pueden tener HP severa. En los estadios avanzados de las enfermedades es mayor la prevalencia de HP. El diagnóstico de patología pulmonar y/o hipoxia se realiza mediante la historia clínica y la ayuda de exámenes complementarios, fundamentalmente pruebas de función pulmonar, diagnóstico por imágenes, en especial tomografía axial computada de alta resolución y centellograma de ventilación perfusión como prueba de screening de la hipertensión arterial pulmonar (HAP) debida a tromboembolismo pulmonar crónico (grupo 4). La utilización de un algoritmo adecuado permite a través de las pruebas de función pulmonar arribar a diagnósticos fisiopatológicos de gran exactitud. Ante la sospecha de HP, por otro lado, la utilización de pruebas de detección, identificación de grupo, evaluación de la capacidad de ejercicio y cateterismo cardíaco permite discriminar entre los diferentes grupos y arribar a un diagnóstico adecuado. La prueba de marcha de 6 minutos es uno de los elementos imprescindibles en la evaluación de la HP; no solamente para realizar comparaciones pre y post tratamiento, sino también para evaluar la capacidad funcional y como predictor de morbilidad y mortalidad. Su realización requiere observar las guías disponibles, respetando las contraindicaciones absolutas y relativas y siguiendo los procedimientos establecidos a nivel internacional. Con los datos obtenidos deben expresar la distancia recorrida, la presencia o no de desaturación durante la misma, la evaluación del esfuerzo percibido (escala de Borg), el motivo de detención y la frecuencia cardíaca. Estos datos forman parte de la predicción de morbi-mortalidad y son un factor pronóstico de la enfermedad. La prueba de marcha de 6 minutos forma parte además de los estudios de seguimiento en cada una de las etapas del manejo clínico de la HAP.

Pulmonary hypertension in chronic respiratory diseases The 6-minute walk test: technical and utility in functional diagnosis, prognosis and monitoring Lung diseases can cause pulmonary hypertension (PH). The current classification of PH includes these diseases in group 3 as PH due to lung disease and/or hypoxia. This cause of PH is responsible for about 10% of all PH. Generally, the PH is often of moderate degree although a small percentage may have severe pulmonary hypertension. In the advanced stages of the disease is higher prevalence of PH. The diagnosis of lung disease and/or hypoxia is made by clinical history and complementary exams help mainly pulmonary function tests, diagnostic imaging, especially computed tomography high resolution and ventilation perfusion scintigraphy as a screening test for pulmonary arterial hypertension (PAH) due to chronic pulmonary thromboembolism (group 4). The use of an adequate algorithm allows through pulmonary function tests arrive at diagnoses pathophysiological great accuracy. Moreover, suspecting PH, the use of screening tests, group identification, assessment of exercise capacity and cardiac catheterization allows discriminating between different groups and arriving at a proper diagnosis. The 6-minute walk test is one of the essential elements in the assessment of PH, not only for comparison before and after treatment, but also to evaluate the functional capacity and as a predictor of morbidity and mortality. Its implementation requires observing guides available, respecting the absolute and relative contraindications and following established procedures worldwide. The data obtained should express the distance walked, the presence or absence of desaturation during it the evaluation perceived effort (Borg scale), the reason for arrest and heart rate. These data are part of the prediction of morbidity and mortality and are a prognostic factor the disease. The 6-minute walk test is also part of ...

Hipertensão pulmonar nas doenças respiratórias crônicas Teste de caminhada de 6 minutos: técnica e utilidade no diagnóstico funcional, prognóstico e monitorização As doenças pulmonares podem ser causa de hipertensão pulmonar (HP). A classificação atual da hipertensão pulmonar inclui a essas doenças no grupo 3, como HP devida a doença pulmonar e/ou hipóxia. Esta causa de HP é responsável torno de 10% de todas as hipertensões pulmonares. Em geral, a HP é frequentemente de grau moderado, embora uma pequena percentagem possa ter HP severa. Nos estágios avançados da doença é maior a prevalência de HP. O diagnóstico de doença pulmonar e/ou hipóxia é feito pela história clínica e apoio de exames complementares, fundamentalmente testes de função pulmonar, diagnóstico por imagem, especialmente tomografia computadorizada de alta resolução e cintilografia de ventilação perfusão como teste de triagem para a hipertensão arterial pulmonar (HAP), devido ao tromboembolismo pulmonar crônico (grupo 4). A utilização de um algoritmo adequado permite que por meio de testes de função pulmonar chegar a diagnósticos fisiopatológicos de grande exatidão. Suspeitando HP, por outro lado, a utilização de testes de triagem, identificação do grupo, avaliação da capacidade de exercício e cateterismo cardíaco permite discriminar entre os diferentes grupos e chegar a um diagnóstico adequado. O teste de caminhada de 6 minutos é um dos elementos essenciais para a avaliação do PH, não só para a comparação antes e após o tratamento, mas também para avaliar a capacidade funcional e como preditor de morbidade e mortalidade. A sua aplicação requer observando guias disponíveis, respeitando as contra-indicações absolutas e relativas e seguindo os procedimentos estabelecidos em todo o mundo. Os dados obtidos devem expressar a distância percorrida, a presença ou ausência de dessaturação durante a mesma, a avaliação da percepção subjetiva de esforço (escala de Borg), o motivo da parada do teste e a frequência cardíaca. Estes dados fazem parte da previsão de morbidade e mortalidade e é um fator prognóstico da doença. O teste de caminhada de 6 minutos também faz parte dos estudos de monitoramento em cada uma das etapas do manejo clínico de HAP.

[2013 Ambulatory blood pressure monitoring recommendations for the diagnosis of adult hypertension, assessment of cardiovascular and other hypertension-associated risk, and attainment of therapeutic goals (summary). Joint recommendations from the International Society for Chronobiology (ISC), American Association of Medical Chronobiology and Chronotherapeutics (AAMCC), Spanish Society of Applied Chronobiology, Chronotherapy, and Vascular Risk (SECAC), Spanish Society of Atherosclerosis (SEA), and Romanian Society of Internal Medicine (RSIM)]. / Recomendaciones 2013 para el uso de la monitorización ambulatoria de la presión arterial para el diagnóstico de hipertensión en adultos, valoración de riesgo cardiovascular y obtención de objetivos terapéuticos (resumen). Recomendaciones conjuntas de la International Society for Chronobiology (ISC), American Association of Medical Chronobiology and Chronotherapeutics (AAMCC), Sociedad Española de Cronobiología Aplicada, Cronoterapia y Riesgo Vascular (SECAC), Sociedad Española de Arteriosclerosis (SEA) y Romanian Society of Internal Medicine (RSIM).

Correlation between systolic (SBP) and diastolic (DBP) blood pressure (BP) level and target organ damage, cardiovascular disease (CVD) risk, and long-term prognosis is much greater for ambulatory BP monitoring (ABPM) than daytime office measurements. The 2013 ABPM guidelines specified herein are based on ABPM patient outcomes studies and constitute a substantial revision of current knowledge. The asleep SBP mean and sleep-time relative SBP decline are the most significant predictors of CVD events, both individually as well as jointly when combined with other ABPM-derived prognostic markers. Thus, they should be preferably used to diagnose hypertension and assess CVD and other associated risks. Progressive decrease by therapeutic intervention in the asleep BP mean is the most significant predictor of CVD event-free interval. The 24 h BP mean is not recommended to diagnose hypertension because it disregards the more valuable clinical information pertaining to the features of the 24 h BP pattern. Persons with the same 24 h BP mean may display radically different 24 h BP patterns, ranging from extreme-dipper to riser types, representative of markedly different risk states. Classification of individuals by comparing office with either the 24 h or awake BP mean as "masked normotensives" (elevated clinic BP but normal ABPM), which should replace the terms of "isolated office" or "white-coat hypertension", and "masked hypertensives" (normal clinic BP but elevated ABPM) is misleading and should be avoided because it disregards the clinical significance of the asleep BP mean. Outcome-based ABPM reference thresholds for men, which in the absence of compelling clinical conditions are 135/85 mmHg for the awake and 120/70 mmHg for the asleep SBP/DBP means, are lower by 10/5 mmHg for SBP/DBP in uncomplicated, low-CVD risk, women and lower by 15/10 mmHg for SBP/DBP in male and female high-risk patients, e.g., with diabetes, chronic kidney disease (CKD), and/or past CVD events. In the adult population, the combined prevalence of masked normotension and masked hypertension is >35%. Moreover, >20% of "normotensive" adults have a non-dipper BP profile and, thus, are at relatively high CVD risk. Clinic BP measurements, even if supplemented with home self-measurements, are unable to quantify 24 h BP patterning and asleep BP level, resulting in potential misclassification of up to 50% of all evaluated adults. ABPM should be viewed as the new gold standard to diagnose true hypertension, accurately assess consequent tissue/organ, maternal/fetal, and CVD risk, and individualize hypertension chronotherapy. ABPM should be a priority for persons likely to have a blunted nighttime BP decline and elevated CVD risk, i.e., those who are elderly and obese, those with secondary or resistant hypertension, and those diagnosed with diabetes, CKD, metabolic syndrome, and sleep disorders.

A hipertensão arterial sistêmica a partir da perspectiva do sujeito: análise de narrativas sobre a experiência da enfermidade e dos significados do tratamento dietético / Hypertension from the perspective of the subject: analysis of narratives on the experience of illness and the meaning of dietary treatment

Objetiva-se analisar os significados do processo de adoecimento e do tratamento dietético atribuído a portadores de Hipertensão Arterial Sistêmica, atendidos por uma equipe da Estratégia Saúde da Família (ESF) na zona urbana no município de Juazeiro do Norte, Ceará. O estudo de abordagem qualitativa entrevistou portadores de hipertensão e profissionais de saúde. A análise das narrativas foi fundamentada pela hermenêutica descrita por Paul Ricoeur, em que o contexto sociocultural associado à enfermidade é impregnado de sentidos. Os resultados foram apresentados em três capítulos que abordaram a experiência do sujeito com a enfermidade e o itinerário terapêutico; o tratamento dietético; o cuidado em saúde para os adoecidos de HAS. A subjetividade presente nesses assuntos é revelada nas falas e na semiótica, oferecendo múltiplas possibilidades de interpretação. Os aspectos socioculturais e econômicos que redefinem práticas de comensalidade dos sujeitos interferem na aceitação do tratamento dietético na medida em que a restrição do sal da comida dá outros significados à vida. Trata-se de um estudo relevante, pois abre espaços para diversas acepções do sujeito que vivencia o problema da hipertensão e contribui para a discussãosobre o cuidado em saúde integral no contexto do atendimento da ESF.

The objective of this academic work is to analyze the meanings on the process of sickness and the dietary treatment attributed to the carriers of Systemic Arterial Hypertension (HAS). The patients have been assisted by a team of the Family Health Strategy (ESF), in the urban zone in the municipality of Juazeiro do Norte, Ceará, northeast Brazil. This is aqualitative study, which used as tool for data collection interviews with patients with high blood pressure (hypertension) and professionals of health. The hermeneutics by Paul Ricoeur based the analysis of the narratives, where the sociocultural contexts associated with thedisease are impregnated with meanings. The results were presented in three chapters that approached the experience of the citizen with the disease and the therapeutic itinerary; the dietary treatment; the health care for patients with HAS. The subjectivity present in these subjects is revealed in the speeches and it offers multiple possibilities of semioticinterpretation. The sociocultural and economic practices that redefine everyday subjects commensality interfere with the acceptance of dietary treatment so that the restriction of salt changes the taste of the food and gives another meaning to life. This is a relevant study as it makes room for several meanings of the subject who experiences the problem of hypertension, and contributes to the discussion about health care in the context of comprehensive care of the ESF.

Este estudio objetiva analizar los significados del proceso de enfermedad y del tratamiento dietético atribuido a los portadores de Hipertensión Arterial Sistémica, atendidos por un equipo de la Estrategia Salud de la Familia (ESF) en la zona urbana en el municipio de Juazeiro do Norte, Ceará. El estudio, de enfoque cualitativo, entrevistó portadores de hipertensión y profesionales de salud. El análisis de las narrativas fue fundamentado en la hermenéutica descrita por Paul Ricoeur, en el cual, el contexto sociocultural asociado a la enfermedad está impregnado de sentidos. Los resultados fueron presentados en tres capítulos que abordaron la experiencia del sujeto con la enfermedad y el itinerario terapéutico; el tratamiento dietético; el cuidado en salud para los enfermos de HAS. La subjetividad presente en esos asuntos es revelada en las hablas y en la semiótica, ofreciendo múltiples posibilidades de interpretación. Los aspectos socioculturales y económicos que redefinen las prácticas de comensalidad de los sujetos, interfieren en la aceptación del tratamiento dietético, en la medida en que la restricción de la sal de la comida da otros significados a la vida. Se trata de un estudio relevante, pues abre espacios para diversas acepciones del sujeto que vivencia elproblema de la hipertensión y contribuye para la discusión sobre el cuidado en salud integral en el contexto de la atención de la ESF.

Incidencia y prevalencia de hipertensión arterial registradas en el Día Mundial de la Hipertensión 2011: experiencia de un grupo de trabajo / Incidence and prevalence of high blood pressure registered at the High Blood Pressure World Day-2011: experience of a working party

Introducción: se realizó un estudio de corte transversal y en 2 centros de trabajo, la Dirección Nacional del INDER y la Facultad de Cultura Física Dr. Manuel Fajardo de La Habana, en el Día Mundial de la Hipertensión Arterial. Objetivos: determinar la frecuencia de hipertensos (conocidos y nuevos) y de prehipertensos, el porcentaje de pacientes tratados y controlados y la presencia de sobrepeso entre los normotensos e hipertensos. Además, demostrar la importancia de que cada persona conozca cuál es su presión arterial y el riesgo de padecerla. Métodos: se investigaron 730 personas de ambos sexos con predominio de jóvenes atletas que voluntariamente respondieron la encuesta y se les midió la presión arterial. Se llenó un modelo que contenía las variables seleccionadas: edad, sexo, talla, peso, si conocían si eran hipertensos, si recibían tratamiento farmacológico y las cifras de presión arterial encontradas. Se confeccionó una base de datos y se empleó el sistema estadístico SPSS de Window 2007. Los resultados se expresaron en frecuencias absolutas y porcentajes. Resultados: el 58,5 por ciento correspondió al sexo masculino. La distribución etaria en los 3 percentiles empleados mostró franco predominio de jóvenes (50 por ciento). De los 730 sujetos encuestados, 114 (15,6 por ciento) conocían que eran hipertensos (15,4 por ciento de los hombres y 16,2 por ciento de las mujeres), 106 (14,5 por ciento) fueron clasificados como prehipertensos y 35 (4,8 por ciento), como nuevos hipertensos. De los 114 hipertensos conocidos, 91 (61,7por ciento) tenían tratamiento y 87 estaban controlados (58,4 por ciento del total y 95,6 por ciento de los tratados) y no controlados 62 (41,6 por ciento del total y 4,4 por ciento de los tratados). De los prehipertensos, 82 (77 por ciento) estaban en edades de 19 a 49 años, 40 porciento de ellos con sobrepeso, mientras que 24 (23 por ciento) tenían 50 o más años, pero con 70 por ciento de sobrepeso...

Introduction: a cross-sectional study was conducted in two institutions: The National Management of Recreation and Sports National Institute and in the Dr. Manuel Fajardo Physical Culture Faculty of La Habana at the High Blood Pressure World Day. Objectives: to determine the frequency of hypertensive patients (known and new) and the pre-hypertensive ones, the percentage of patients treated and controlled as well as the presence of excess weight among those with a normal blood pressure and the hypertensive ones, as well as to demonstrate also the significance that each person knows which is its blood pressure and its risk. Methods: authors studied 730 patients of both sexes with predominance of the young athletes who voluntarily answered the survey, measuring the blood pressure. A form including the select variables was fill out: age, sex, height, weight, if they know on its hypertensive status, if they were receiving drug treatment and the blood pressure figures found. A database was created using the SPSS statistic system of Window 2007. Results were expressed in absolute frequencies and percentages. Results: the 58,5 percent corresponded to male sex. Age distribution in the three percentiles used showed an open predominance of young people (50 percent). From the 730 polled subjects, 114 (15,6 percent) knew its hypertensive status (15,4 percent of men and 16,2 % of women), 106 (14,5 percent) were classified as pre-hypertensives and 35 (4,8 percent) as new hypertensives. From the 114 known hypertensive, 91 (61,7percent) were under treatment and 87 were controlled (58,4 percent of total and the 95,6 percent of those treated) and 62 no-controlled (41,6 percent of total and 4,4 percent of those treated). From the hypertensive ones, 82 (77 percent) were aged 19-49, the 40 percent of them had excess weight, whereas 24 (23 percent) were aged 50 or more, but with a 70 percent of excess weight...

El control de la hipertensión arterial: un problema no resuelto / The high blood pressure control: A problem not solved

Motiva la redacción de este artículo el pobre control de la hipertensión arterial que se reporta en la mayoría de los países del mundo. Se aclararon los criterios que se siguen para considerar a un paciente hipertenso como controlado y se revisaron varios trabajos de investigación sobre prevalencia de hipertensión arterial y porcentaje de control en distintas poblaciones. Se expusieron las experiencias de los autores en la atención protocolizada de la hipertensión arterial refractaria como expresión de inadecuado control de esta afección y se señalaron las principales situaciones o causas que inciden en el pobre control de la enfermedad, tanto por parte del paciente como por parte del médico. Se insistió en la necesidad de que los sistemas de salud de los países den prioridad a la atención de la hipertensión arterial con la participación del propio paciente y la mayor preocupación por médicos e instituciones en garantizar la mejor y más efectiva atención a los casos con dificultades en el control de su afección

The aim of present paper is to analyze the poor control of high blood pressure reported in many countries at world scale. The criteria followed to consider that a patient be hypertensive and under control were clarified and some papers related to a research on the high blood pressure prevalence and the control percentage in different populations were reviewed. Author's experiences with the formalized care of refractory high blood pressure as expression of a inappropriate control of this affection designating the main situations or causes falling into the poor control of this disease by patient on the one hand and by physician by the other. We emphasize on the need that the health systems of the countries give priority to high blood pressure care with the involvement of patient and a greater preoccupation by the physicians and institutions to guarantee a better and more effective care to those cases with difficulties in the control of its affection

Incidencia y prevalencia de hipertensión arterial registrada en el Día Mundial de la Lucha contra la Hipertensión Arterial. Experiencia de un grupo de trabajo / Incidence and prevalence of high blood pressure registered in the World Day of the Fight Against the High Blood Pressure. A working group experience

Introducción: En el Día Mundial de la Lucha contra la Hipertensión Arterial se realizó un estudio de corte transversal en: 2 talleres, un agromercado y 2 unidades del Sistema Nacional de Salud, 332 (60,36 por ciento) personas, y en 3 centros de trabajo de los alrededores del hospital, 218 (39,64 por ciento) personas, 550 sujetos, en total, de 18 años o más, de ambos sexos, que de forma voluntaria respondieron a una encuesta y permitieron se les midiera la presión arterial (PA). Objetivos: Determinar la frecuencia de hipertensos (conocidos y nuevos), evaluar el grado de control de la enfermedad en tratamiento, si se habían medido la presión en la atención primaria de salud, por lo menos una vez en los últimos 12 meses y el sobrepeso. Colaborar al incremento del grado de percepción y riesgo de la HTA en población general, en el marco del Día Mundial de la Lucha contra la Hipertensión Arterial. Métodos: Se midió la PA según criterios y recomendaciones de la Comisión Nacional Técnica Asesora del Programa de Hipertensión Arterial. Los datos se recogieron en modelo que contenía las variables: edad, sexo, talla, peso, si conocían si eran hipertensos, si recibían tratamiento farmacológico, si se habían medido la PA en los últimos 12 meses y las cifras encontradas. Se confeccionó una base de datos y se empleó el sistema estadístico SPSS de Windows 2007. Resultados: Los resultados se expresaron en frecuencias absolutas y porcentajes. La distribución de las personas fue similar en los 3 grupos etarios del estudio. De los 550 sujetos encuestados, 190 (34,5 por ciento) conocían que eran hipertensos, en 35 (10,5 por ciento) se observaron cifras de PA por encima de ....

Introduction: In the World Day of the Fight Against the High Blood Pressure a cross-sectional study was conducted in: 2 workshops, a farming-market and 2 units of the National Health System, 332 (60,36 percent) subjects and also in 3 working center from surrounding areas of our hospital, 218 (39,64 percent) subjects, for a total of 550 subjects aged 18 or more of both sexes that in a voluntary way answered to a survey and allowed the blood pressure (BP) measurement. Objectives: To determine the frequency of hypertensives (known and new), to assess the control level of diseased under treatment, if blood pressure was measured in the primary health care unit at least during the past 12 months as well as the excess weight. The cooperation to increase of perception level and risk of high blood pressure (HBP) in general population within the setting of World Day of the Fight Against the High Blood Pressure. Methods: The blood pressure (BP) was measured according the criteria and recommendations of the Technical National Commission Advisory of the High Blood Pressure Program. Data were registered in a form containing the following variables: age, sex, height, weight if they know to be hypertensives, if they are receiving drug therapy, if the BP was measure during the past 12 months and the figures founded. A database was created and SPSS statistical system of Window 2007 was used. Results: Results were expressed in absolute frequencies and percentages. Subject distribution was similar in the three age groups. From the 550 polled persons...

El desbalance glomérulo-tubular en la fisiopatología de la hipertensión arterial asociada al bajo peso al nacer / Glomerular-tubular imbalance in the pathophysiology of the arterial hypertension associated with low birth weight

La hipertensión arterial constituye un problema de salud mundial. Quedan sin esclarecer mecanismos fisiopatogénicos en su aparición. Se ha asociado el bajo peso al nacer por crecimiento intrauterino retardado con la hipertensión en la edad adulta, relacionado con nefrogénesis incompleta. El desarrollo de hipertensión en ratas, provocando hipertrofia tubular proximal, indica que el desbalance entre las funciones glomerular y tubular genera incapacidad excretora del riñón y esta podría existir en el daño renal del bajo peso. Con el objetivo de valorar la posible implicación del desbalance glomérulo-tubular a preponderancia tubular en los mecanismos fisiopatológicos renales descritos en la hipertensión asociada al crecimiento intrauterino retardado, se utilizaron métodos teóricos. El cuerpo teórico elaborado se fundamentó en datos consultados en revistas científicas. Se concluye que el estado de desbalance glomérulo-tubular con preponderancia tubular, ha sido poco estudiado en relación con el desarrollo de la hipertensión en estos sujetos. Este fenómeno no se reconoce, hasta el momento, como una «anormalidad¼ renal, que puede constituir un mecanismo hipertensógeno primario.

High blood pressure (hypertension) is a global health problem. Pathophysiologic mechanisms are unclear in their appearance. Reports have linked low birth weight and intrauterine growth retardation with hypertension in adulthood, related to incomplete nephrogenesis. The development of hypertension in rats leading to proximal tubular hypertrophy indicates that the imbalance between glomerular and tubular functions generates excretory kidney failure and it could be in renal damage of the low weight. In order to assess the possible involvement of glomerular-tubular imbalance with tubular preponderance, within pathophysiological renal mechanisms described in hypertension associated with intrauterine growth retardation, theoretical methods were used. The theoretical framework developed was based on data accessed in scientific journals. We conclude that the state of glomerular-tubular imbalance with tubular preponderance has been little studied in relation to the development of hypertension in these subjects. This phenomenon is not recognized, so far as «abnormal¼ renal, which may be a primary hypertensogenous mechanism.

Adherencia a los tratamientos farmacológicos y no farmacológicos en personas con hipertensión arterial. Montería, 2010 / Adherence to pharmacological and non-pharmacological treatments in people with arterial hypertension. Monteria, 2010

El presente estudio tuvo como objetivo describir y analizar la adherencia a tratamientos farmacológicos y no farmacológicos en personas con hipertensión arterial, inscritas en el Programa de Control de una Empresa Social del Estado de baja complejidad en la ciudad de Montería. Se utilizó un diseño descriptivo transversal con abordaje cuantitativo que permitió describir la adherencia al tratamiento en una muestra aleatoria de 177 personas que asistieron al servicio de consulta externa a control de la hipertensión arterial, mediante el empleo del Instrumento Factores que influyen en la adherencia a tratamientos farmacológicos y no farmacológicos en pacientes con factores de riesgo de enfermedad cardiovascular de Bonilla y De Reales. Los resultados del estudio revelan que la mayor proporción de las personas que participaron en el estudio se encontraron en riesgo de no desarrollar comportamientos de adherencia al tratamiento farmacológico y no farmacológico, lo cual guarda relación con los factores socioeconómicos y relacionados con el proveedor. Los factores relacionados con la terapia y con el paciente reflejaron una situación de ventaja para la adherencia. La relación entre los 24 ítems del instrumento utilizado y la situación adherencia encontrada es lineal y en general la relación es fuerte con tendencia positiva. Se recomienda a los profesionales de enfermería continuar realizando investigaciones sobre el fenómeno de la adherencia al tratamiento en personas con riesgo cardiovascular con el propósito de contribuir al desarrollo disciplinar y por ende mejorar las prácticas de cuidado como un aporte a la solución del problema de altos índices de morbimortalidad por enfermedades cardiovasculares.

This study has as an aim to describe and analyze the adherence to nonpharmacological and pharmacological treatment on people with arterial hypertension, registered in the control program of a state social enterprise of low complexity at Monteria city. It was used a cross sectional descriptive design with quantitative approach that allowed to describe the adherence to the treatment in a randomize sample of 117 people that attended the outpatient service to arterial hypertension control, through the using the instrumental factors that has influence in the adherence of nonpharmacolocical and pharmacological treatment on patients with risk factors of cardiovascular illness of Bonilla and De Reales. The outcomes of the study disclose that in an upper proportion of people who participate in the research were found on risk of not developing behaviors of adherence to the nonpharmacological and pharmacological treatment, which keeps relation with socioeconomic factors and related with the supplier. The factors related to the therapy and with the patient, showed a situation of advantage for the adherence. The relationship between the 24 items of the used instrument and the adherence situation founded is lineal and in general the relationship is strong and with positive trend. It is recommended for the nursery professionals to continue doing researches about the phenomenon of treatment adherence on people with cardiovascular risk with the aim of contributing to the disciplinary development and therefore improving the practices of care as a contributing to the solution for the problem of high mortality index due to cardiovascular illness. The present study aimed to describe and analyze adherence to pharmacologic and non pharmacologic treatments in people with hypertension, enrolled in a control program of the State Social Enterprise of low complexity for the city of Montería.