Comparison of the use of blood pressure telemonitoring versus standard medical care in the achievement of short-term therapeutic goals in blood pressure in patients with uncontrolled hypertension: An open-label clinical trial.

Background: In Mexico less than half of the treated hypertensive patients reach blood pressure (BP) targets. Most hypertensive individuals rely on the standard medical care (SMC) to achieve the BP control goals; however, the efficacy of BP telemonitoring (BPT) to achieve BP targets has been poorly studied. Aim: To compare the efficacy of BPT versus SMC to achieve BP goals in patients with uncontrolled hypertension. Methods: A two-arm, open-label clinical trial was conducted in patients ≥18 years with uncontrolled hypertension. The participants were randomized to 2 arms (BPT vs SMC) and followed for 12 weeks. For the statistical analysis, the chi-squared test and covariance were used. Results: One hundred and seventy-eight participants were included, BPT (n = 94) and SMC (n = 84), after 12 weeks of follow up, we observed a baseline-adjusted reduction in systolic BP with both BPT (-13.5 [1.3] mmHg) and the SMC (-5.9 [1.4] mmHg; p < 0.001) but a greater decrease with BPT (p < 0.001). Likewise, we found a baseline-adjusted reduction of diastolic BP with BPT (-6.9 [0.9] mmHg) and SMC (-2.7 [0.9] mmHg) (p = 0.007) with a more significant percentage change from baseline with BPT (-6.8% [1.0] vs 2.5% [1.1]; p = 0.007). In the BPT arm, a larger proportion of patients achieved the BP target versus SMC (30.5% vs 12.8%; p = 0.005). Conclusion: BPT showed a greater proportion of patients achieving office BP control goals (<140/90 mmHg), compared to standard medical care.

[Acute myocardial infarct in the puerperium. A case report and review of the literature]. / Infarto agudo del miocardio en el puerperio. Reporte de un caso y revisión de la literatura.

The occurrence of myocardial infarction during a pregnancy is rare event and it is even less frequent during the puerperium. The literature reports only 23 cases of myocardial infarction during the puerperium. We report a case of a woman of 26 years of age without coronary risk factors, who on the seventh day postpartum presented an acute myocardial infarction of the anterior and lateral walls. On the ninth day postpartum by means of cardiac catheterization we were able to demonstrate the presence of normal coronary arteries and a left ventricular ejection fraction of 50%. Laboratory and other diagnostic tests did not demonstrate the presence of known etiological factors associated with myocardial infarction.