May Measurement Month 2021: an analysis of blood pressure screening results from Mexico.

May Measurement Month 2021 (MMM21) in Mexico was an opportunistic survey that aimed to improve blood pressure awareness at the individual and population levels and to analyse the impact of the COVID-19 pandemic on the prevalence, knowledge, and rates of hypertension in the country. This survey followed the methodology of MMM, previously published. The total number of participants screened was 77 547, of which 47 793 (61.6%) were female and 29 178 (37.6%) were male. The mean age (SD) was 46.2 (16.6) years. Of all 77 547 participants, 14 939 (19.3%) had hypertension, of which 48% were aware. The frequency and awareness of hypertension in this survey are similar to those reported before the pandemic (MMM19-Mexico and the 2019 National Health Survey), suggesting that the impact of the COVID-19 pandemic in these parameters of arterial hypertension was not as important as expected. These data are concordant with the official reports in Mexico that showed that the pandemic had a severe impact on cardiovascular mortality but did not modify mortality due to hypertension or stroke.

Clinical and treatment profiles of arterial hypertension in Mexico during the COVID-19 pandemic: a cross-sectional survey endorsed by the "Collaborative Group on Arterial Hypertension".

Background: Arterial hypertension is highly prevalent in Mexico; nevertheless, there are limited insights regarding its management during the COVID-19 pandemic. Here, we estimate the prevalence of clinical and treatment profiles of arterial hypertension and explore associated factors for undiagnosed and uncontrolled hypertension using a cross-sectional survey endorsed by the Collaborative Group on Arterial Hypertension from the Mexican Institute of Social Security. Methods: Our survey was conducted from May to November 2021 using the May-Measurement Month 2021 protocols of the International Society of Hypertension. Arterial hypertension (defined as: blood pressure [BP] ≥140/90 mmHg, previous diagnosis, or taking antihypertensives) and its clinical and treatment profiles were classified according to the World Hypertension League Expert Committee. Mixed-effects logistic regression models were used to explore associated factors for undiagnosed and uncontrolled hypertension. Results: Among 77,145 screened participants (women: 62.4%; median age: 46 [IQR: 32-59] years), the prevalence of arterial hypertension was 35.7% (95% CI: 35.3-36.0, n = 27,540). Among participants with arterial hypertension, 30.9% (95% CI: 30.4-31.5, n = 8,533) were undiagnosed, 6.6% (95% CI: 6.3%-6.9%, n = 1,806) were diagnosed but untreated, 43.4% (95% CI: 42.9-44.0, n = 11,965) had uncontrolled hypertension, and only 19% (95% CI: 18.6%-19.5%, n = 5,236) achieved hypertension control (BP < 130/80 mmHg). Explored associated factors for undiagnosed and uncontrolled hypertension include being men, living in the central and southern regions, lower educational attainments, higher use of pharmacological agents, and previous COVID-19 infection. Conclusion: Our findings suggest that adverse arterial hypertension profiles, mainly undiagnosed and uncontrolled hypertension, were highly prevalent during the context of the COVID-19 pandemic in Mexico.

Prevalent coinfection and associated factors for Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus in patients submitted to renal replacement therapy: A cross-sectional study of 21 dialysis units in the State of Mexico.

BACKGROUND: Chronic kidney disease (CKD) predispose to viral coinfections in patients submitted to renal replacement therapy (RRT); nevertheless, few reports have been performed to elucidate the current epidemiology within this population in Mexico. AIM: To estimate the prevalence of HBV, HCV, and HIV coinfection and to explore factors associated with prevalent coinfection in patients living with renal failure undergoing to RRT. METHODS: A multicenter cross-sectional recruitment across 21 units at the Mexican Institute of Social Security (IMSS) at the State of Mexico was performed during 2019. A standardized clinical questionnaire was performed to elucidate individual and relatives-related conditions. A treatment facility questionnaire was applied to the chief responsible of each unit to explore treatment facility variables. Serological testing, clinical, biochemical, and anthropometrical parameters were extracted from clinical records. RESULT: In 1,304 patients (57.5% male, mean age 45.5 (SD: 15.6) years, and 95.8% in hemodialysis), the prevalence of any viral coinfection was 3.14% (95% CI: 2.32%-4.23%). The highest viral coinfection prevalence were for HCV, HBV, and HIV, in which men and subjects diagnosed after 2010's had the highest rates. We identify that being submitted to peritoneal dialysis, being treated in a surrogated dialysis center and living with a close relative with prior hepatitis coinfection were associated factors for any viral coinfection. CONCLUSION: In patients submitted to RRT, the prevalence of viral coinfection remains high compared with general population. Screening strategies, medical awareness and targeted public healthcare policies should prioritize better care practices within patients submitted to RRT in Mexico.

[Knowledge of PrevenIMSS Programs in users of a primary health care clinic]. / Conocimientos del programa PrevenIMSS en usuarios de una unidad de medicina familiar.

Background: The PrevenIMSS programs are a strategy to promote health self-care at the three levels of prevention, with special emphasis on primary health care. One of its objectives is to have an impact on the morbidity and mortality of chronic non-communicable diseases such as obesity, diabetes and hypertension, the prevention of these illnesses requires knowledge for health self-care contained in these guidelines. Objective: To identify the information that the IMSS beneficiaries have on self-care of health contained in the PrevenIMSS guidelines. Material and methods: Descriptive cross-sectional study. After signing the informed consent, one thousand beneficiaries of a UMF were interviewed, 200 for each PrevenIMSS age group. Questions were asked about: 1. Health promotion, 2. Prevention and control of diseases, 3. Detection of diseases, 4. Nutrition, 5. Sexual and reproductive health, and an open question, to identify their needs for self-care of health. Results: The respondents answered having knowledge about the PrevenIMSS components in: Health promotion: 62%. Nutrition: 43%. Disease prevention: 55.3%. Detection and control of diseases: 51.9%. Sexual and reproductive health: 49.9%. The total score obtained by age group was: 0-9 years 46.35 ± 14.36; 10-19 years 46.02 ± 12.06; women from 20 to 59 years old 46.79 ± 8.19, men from 20 to 59 years old 52.19 ± 14.58; adults aged 60 and over 46.65 ± 13.34. Conclusions: The least information is in nutrition. The group of adolescents was the most affected.

Introducción: los programas PrevenIMSS son una estrategia para promover la salud en los tres niveles de prevención, con especial énfasis en el primer nivel de atención. Uno de sus objetivos es impactar en la morbimortalidad de enfermedades crónicas no transmisibles, como obesidad, diabetes e hipertensión, cuya prevención requiere de conocimientos para el autocuidado de la salud contenidos en estas guías. Objetivo: identificar la información que tienen los derechohabientes del IMSS sobre el autocuidado de la salud contenida en las guías PrevenIMSS. Material y métodos: estudio descriptivo transversal. Previa firma de consentimiento informado se entrevistó a mil derechohabientes de una unidad de medicina familiar; 200 por cada grupo etario PrevenIMSS. Se formularon preguntas acerca de: 1. Promoción de la salud, 2. Prevención y control de enfermedades, 3. Detección de enfermedades, 4. Nutrición, 5. Salud sexual y reproductiva, y una pregunta abierta para identificar sus necesidades sobre el autocuidado de la salud. Resultados: los encuestados respondieron tener conocimientos acerca de los componentes PrevenIMSS en: Promoción de la salud, el 62%; Nutrición, 43%; Prevención de enfermedades, 55.3%; Detección y control de enfermedades, 51.9%, y Salud sexual y reproductiva, 49.9%. El puntaje total obtenido por grupo etario fue: 0-9 años: 46.35 ± 14.36; 10-19 años: 46.02 ± 12.06; mujeres de 20 a 59 años: 46.79 ± 8.19, hombres de 20 a 59 años: 52.19 ±14.58, y adultos mayores de 60 años y más: 46.65 ± 13.34. Conclusiones: la menor información se tiene en nutrición. El grupo de adolescentes fue el más afectado.

Conocimientos del programa PrevenIMSS en usuarios de una unidad de medicina familiar / Knowledge of PrevenIMSS Programs in users of a primary health care clinic

Introducción: los programas PrevenIMSS son una estrategia para promover la salud en los tres niveles de prevención, con especial énfasis en el primer nivel de atención. Uno de sus objetivos es impactar en la morbimortalidad de enfermedades crónicas no transmisibles, como obesidad, diabetes e hipertensión, cuya prevención requiere de conocimientos para el autocuidado de la salud contenidos en estas guías. Objetivo: identificar la información que tienen los derechohabientes del IMSS sobre el autocuidado de la salud contenida en las guías PrevenIMSS. Material y métodos: estudio descriptivo transversal. Previa firma de consentimiento informado se entrevistó a mil derechohabientes de una unidad de medicina familiar; 200 por cada grupo etario PrevenIMSS. Se formularon preguntas acerca de: 1. Promoción de la salud, 2. Prevención y control de enfermedades, 3. Detección de enfermedades, 4. Nutrición, 5. Salud sexual y reproductiva, y una pregunta abierta para identificar sus necesidades sobre el autocuidado de la salud. Resultados: los encuestados respondieron tener conocimientos acerca de los componentes PrevenIMSS en: Promoción de la salud, el 62%; Nutrición, 43%; Prevención de enfermedades, 55.3%; Detección y control de enfermedades, 51.9%, y Salud sexual y reproductiva, 49.9%. El puntaje total obtenido por grupo etario fue: 0-9 años: 46.35 ± 14.36; 10-19 años: 46.02 ± 12.06; mujeres de 20 a 59 años: 46.79 ± 8.19, hombres de 20 a 59 años: 52.19 ±14.58, y adultos mayores de 60 años y más: 46.65 ± 13.34. Conclusiones: la menor información se tiene en nutrición. El grupo de adolescentes fue el más afectado.

Background: The PrevenIMSS programs are a strategy to promote health self-care at the three levels of prevention, with special emphasis on primary health care. One of its objectives is to have an impact on the morbidity and mortality of chronic non-communicable diseases such as obesity, diabetes and hypertension, the prevention of these illnesses requires knowledge for health self-care contained in these guidelines. Objective: To identify the information that the IMSS beneficiaries have on self-care of health contained in the PrevenIMSS guidelines. Material and methods: Descriptive cross-sectional study. After signing the informed consent, one thousand beneficiaries of a UMF were interviewed, 200 for each PrevenIMSS age group. Questions were asked about: 1. Health promotion, 2. Prevention and control of diseases, 3. Detection of diseases, 4. Nutrition, 5. Sexual and reproductive health, and an open question, to identify their needs for self-care of health. Results: The respondents answered having knowledge about the PrevenIMSS components in: Health promotion: 62%. Nutrition: 43%. Disease prevention: 55.3%. Detection and control of diseases: 51.9%. Sexual and reproductive health: 49.9%. The total score obtained by age group was: 0-9 years 46.35 ± 14.36; 10-19 years 46.02 ± 12.06; women from 20 to 59 years old 46.79 ± 8.19, men from 20 to 59 years old 52.19 ± 14.58; adults aged 60 and over 46.65 ± 13.34. Conclusions: The least information is in nutrition. The group of adolescents was the most affected.

Family psychotherapy in patients with uncontrolled hypertension. Preliminary study.

BACKGROUND: Family psychotherapy has been shown to have a positive impact on the evolution of patients with psychosomatic disorders, and in those with arterial hypertension it could improve the level of control of the disease. OBJECTIVE: To evaluate the impact of an intervention in family psychotherapy in patients with uncontrolled systemic arterial hypertension. METHOD: Study with comparative groups. 15 uncontrolled hypertensive patients, assigned to 2 groups: an intervention group of 10 patients who received family psychotherapy and a control group of 5 patients. In both groups, the pharmacological treatment indicated by experts was continued. Both groups were compared before and after the intervention regarding quality of life (InCaViSa), family functioning (Family Functioning Scale), systolic and diastolic blood pressure, body mass index and glucose, cholesterol, triglycerides, uric acid and creatinine. RESULTS: There was qualitative improvement in the domains of the InCaViSa scale to estimate quality of life in the intervention group and there were no statistically significant changes between the groups in family functioning or in body weight. Among the biochemical variables, only cholesterol showed a significant reduction (p = 0.47). Greater mobility of the family towards more functional behaviors was found in the group that received the intervention, and also in this group, systolic and diastolic blood pressure values decreased (p < 0.001), and the use of antihypertensive, anxiolytic and antidepressant drugs, as well. CONCLUSIONS: Family psychotherapeutic intervention can favor the control of blood pressure, reduce the doses of antihypertensive, anxiolytic and antidepressant drugs and it can help to transition to better functionally family states.

ANTECEDENTES: La psicoterapia familiar ha demostrado tener un impacto positivo en la evolución de enfermos con trastornos psicosomáticos, y en aquellos con hipertensión arterial arterial pudiera mejorar el nivel de control de la enfermedad. OBJETIVO: Evaluar el impacto de una intervención en psicoterapia familiar en pacientes con hipertensión arterial sistémica no controlada. MÉTODO: Estudio con grupos comparados. 15 pacientes hipertensos no controlados, asignados a dos grupos: un de intervención, con 10 pacientes que recibieron psicoterapia familiar, y otro de control con 5 pacientes. En ambos grupos se continuó con el tratamiento farmacológico indicado por expertos. Se compararon ambos grupos antes y después de la intervención respecto a calidad de vida (InCaViSa), funcionamiento familiar (Escala de Funcionamiento Familiar), presión arterial sistólica y diastólica, índice de masa corporal, glucosa, colesterol, triglicéridos, ácido úrico y creatinina. RESULTADOS: Hubo una mejoría cualitativa en los dominios de la escala InCaViSa para estimar la calidad de vida en el grupo de intervención y no hubo cambios estadísticamente significativos entre los grupos en cuanto a funcionamiento familiar y peso corporal. Entre las variables bioquímicas, solo el colesterol mostró una reducción significativa (p = 0.47). Se encontró una mayor movilidad de la familia hacia comportamientos más funcionales en el grupo que recibió la intervención, y también en este grupo disminuyeron las cifras de presión sistólica y diastólica (p < 0.001), así como el uso de antihipertensivos, ansiolíticos y antidepresivos. CONCLUSIONES: La intervención psicoterapéutica familiar puede favorecer el control de la presión arterial, reducir las dosis de antihipertensivos, ansiolíticos y antidepresivos, y ayudar en la transición a estados de mejor funcionalidad familiar.

Impact of a comprehensive intervention to families with teenage sons with overweight and obesity in a primary care setting: A case report.

BACKGROUND: Overweight and obesity in adolescence is a public health problem and a risk factor for chronic noncommunicable diseases. To prevent further diseases, preventive interventions are needed, including educational programmes, addressed in a primary care setting, that include the whole family. The objective of this study was to evaluate the impact of a comprehensive intervention, targeting families with teenage sons with overweight and obesity, in the lifestyle, cardiovascular risk factors and metabolic syndrome in a primary care setting. METHODS: A pre-post intervention study was conducted. Twelve families with teenage sons between 10 and 14 years were enrolled; all the families were affiliated to the IMSS (Insituto Mexicano del Seguro Social). The comprehensive strategy was applied for 6 months (educational sessions for self-care, physical activity and nutritional counselling). The following measurements were performed before and after the intervention: the FANTASTIC lifestyle survey was applied. Clinical, anthropometric and biochemical assessments were performed. The changes in life style and cardiovascular risk factors were analyzed with Student's t-test or Mann-Whitney U test. RESULTS: The lifestyle was improved after the intervention in the domains of family and friends, nutrition and alcohol intake (p<0.05). Body mass index, waist circumference and diastolic blood pressure and fasting glucose decreased significantly. CHDL increased (p<0.05). Metabolic syndrome improved (p<0.05). CONCLUSIONS: Our comprehensive intervention for the families in a primary care setting, improved their lifestyle, decreased cardiovascular risk factors and decreased the metabolic syndrome.

Blood pressure rhythmicity in patients with end stage chronic kidney disease: bromocriptine effect / Ritmicidad de la presión arterial en pacientes con enfermedad renal crónica terminal: efecto de bromocriptina

BACKGROUND: The aim of this paper was to characterize the blood pressure CR in patients with end stage chronic kidney disease (ESCKD) before and after treatment with bromocriptine compared to healthy volunteers. METHODS: Fifteen patients and nine healthy volunteers were included. Both groups underwent ambulatory 24 hours blood pressure (24 h ABPM). Patients received 2.5 mg every 8 hours of bromocriptine for eight weeks, at the end of the treatment 24 h ABPM was repeated; blood pressure CR was compared before and after treatment and with healthy volunteers. The CR was identified by the method of Cosinor. RESULTS: 64% of volunteers showed a 24 h CR, against 27% of patients (p < 0.05). After the treatment with bromocriptine 40% of patients showed RC 24 h. The mean arterial pressure decreased from 129 ± 1 mmHg to 106 ± 1 mmHg. A 12 h rhythm was identified in 45% of volunteers and 73% of patients before treatment (p < 0.05) against 60% at the end (p < 0.001), with no statistical difference with volunteers. CONCLUSIONS: The CR in blood pressure is altered in ESCKD and could be restored with bromocriptine. 12 hours rhythmicity was identified predominantly in patients with ESCKD; this rhythm was also present in the healthy volunteers.

INTRODUCCIÓN: el propósito de este estudio es caracterizar el ritmo circadiano (RC) de la presión arterial en pacientes con enfermedad renal crónica terminal (ERCT) en tratamiento con diálisis peritoneal continua ambulatoria (DPCA) antes y después del tratamiento con bromocriptina (BEC) comparándolos con voluntarios sanos. MÉTODOS: se incluyeron 15 pacientes del servicio de Nefrología y 9 voluntarios sanos. Se les realizó monitoreo ambulatorio de presión arterial de 24 horas (MAPA). Los pacientes recibieron 2.5 mg de BEC cada 8 hora durante ocho semanas, al final del tratamiento se repitió el MAPA; el RC de la presión arterial se comparó antes y después del tratamiento y con los voluntarios. Resultados: el 64% de los voluntarios exhibieron RC de 24 horas, frente al 27% de los pacientes (p < 0.05). Después del tratamiento con BEC, el 40% de pacientes mostraron RC de 24 h. El mesor de la presión arterial media disminuyó de 129 ± 1 mmHg a 106 ± 1 mmHg (p < 0.05). Se identificó un ritmo de 12 h en 45% de los voluntarios y en el 73% de los pacientes antes del tratamiento (p < 0.05) frente a 60% al final (p < 0.001), sin diferencia estadística con los voluntarios. CONCLUSIONES: el RC de la presión arterial esta alterado en la IRCT y se restableció con BEC. La ritmicidad de 12 h predominó en los pacientes con ERCT, también presente en los voluntarios sanos.

Thyroid disorders among dialysis patients / Alteraciones tiroideas en pacientes en diálisis

The thyroid gland and the kidney are closely related. Thyroid hormones (TH) contribute to the homeostasis of the human being through complex interactions of fluids and electrolytes, protein synthesis, etc. The effects on the kidney of TH may be pre renal or direct actions. Decreasing glomerular filtration (GF) this balance especially in advanced stages of chronic kidney disease (CKD) is altered. CKD is linked to alterations in TH levels and/or metabolism, resulting in a high prevalence of subclinical hypothyroidism and low free triiodothyronine (FT3) syndrome. These alterations are linked in micro inflammation, endothelial damage, cardiac abnormalities, and high mortality. In this study, we describe the most common thyroid abnormalities reported in CKD with dialytic stage approach.

La glándula tiroides y el riñón están estrechamente relacionados. Las hormonas tiroideas (HT) contribuyen en la homeostasis del ser humano a través de complejas interacciones de líquidos y electrolitos, síntesis de proteínas, etc. Los efectos de las HT sobre el riñón pueden ser pre-renales o directos. Está demostrado que al disminuir la filtración glomerular (FG) se altera este equilibrio, sobre todo en estadios avanzados de la enfermedad renal crónica (ERC). La ERC está vinculada con alteraciones en los niveles de HT y/o su metabolismo, lo que resulta en una alta prevalencia de hipotiroidismo subclínico y el síndrome de T3 libre baja. Estas alteraciones están relacionadas con micro inflamation, daño endotelial, alteraciones cardiacas y alta mortalidad. El presente estudio, describe las alteraciones tiroideas más frecuentes reportadas en ERC con enfoque en la etapa dialítica.

[Consensus on Systemic Arterial Hypertension In México]. / Consenso de Hipertensión Arterial Sistémica en México.

This Consenso Nacional de Hipertensión Arterial Sistémica (National Consensus on Systemic Arterial Hypertension) brings together experiences and joint work of 79 specialists who have been in contact with the patient affected by systemic arterial hypertension. All concepts here presented were outlined on the basis of the real world practice of Mexican hypertensive population. The consensus was developed under strict methodological guidelines. The Delphi technique was applied in two rounds for the development of an appropriate statistical analysis of the concepts exposed by all the specialists, who posed key questions, later developed by the panel of experts of the Hospital de Cardiología, and specialists from the Centro Médico Nacional. Several angles of this illness are shown: detection, diagnosis, pathophysiology, classification, treatment and prevention. The evidence analysis was carried out using PRISMA method. More than 600 articles were reviewed, leaving only the most representative in the references. This document concludes with practical and useful recommendations for the three levels of health care of our country.

Este Consenso Nacional de Hipertensión Arterial Sistémica reúne las experiencias y el trabajo conjunto de 79 especialistas que han estado en contacto con el paciente que padece hipertensión arterial sistémica. Todos los conceptos aquí presentados se plantearon con base en la práctica del mundo real de la población hipertensa de México. El consenso se desarrolló bajo lineamientos metodológicos estrictos. La técnica de Delphi se aplicó en dos vueltas para el desarrollo de un análisis estadístico apropiado de los conceptos vertidos por todos los especialistas con preguntas clave que desarrolló el panel de expertos del Hospital de Cardiología y especialistas del Centro Médico Nacional. Se presentan los aspectos de detección, diagnóstico, fisiopatología, clasificación, tratamiento y prevención. El análisis de la evidencia en la literatura se hizo utilizando el método de PRISMA para análisis de evidencia. Se revisaron más de 600 artículos y se dejaron en la bibliografía solo los más representativos. Este documento concluye con recomendaciones prácticas y de utilidad para los tres niveles de atención en salud de nuestro país.

Cardiovascular and renal effects of bromocriptine in diabetic patients with stage 4 chronic kidney disease.

OBJECTIVE: The objective of this study was to investigate the effect of bromocriptine (BEC) on left ventricular mass index (LVMI) and residual renal function (RRF) in chronic kidney disease (CKD) patients with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: A 6-month double-blind randomized controlled trial was conducted in 28 patients with T2D and stage 4 CKD with increased LVMI. Fourteen patients received BEC (2.5 mg, initially 1 tablet with subsequent increase to three times a day) and 14 received a placebo (PBO; initially 1 tablet with subsequent increase to three times a day). Cardiovascular changes were assessed by monitoring 24 h ambulatory blood pressure, two-dimensional-guided M-mode echocardiography, and N-terminal brain natriuretic peptide (NT-proBNP) plasma levels. RRF was evaluated by creatinine clearance and cystatin-C plasma levels. RESULTS: Both BEC and PBO groups decreased blood pressure-but the effect was more pronounced in the BEC group. Average 24 h, diurnal and nocturnal blood pressures, and circadian profile showed improved values compared to the PBO group; LVMI decreased by 14% in BEC and increased by 8% in PBO group. NT-proBNP decreased in BEC (0.54 ± 0.15 to 0.32 ± 0.17 pg/mL) and increased in PBO (0.37 ± 0.15 to 0.64 ± 0.17 pg/mL). Creatinine clearance did not change in the BEC group and decreased in the PBO group. CONCLUSIONS: BEC resulted in a decrease on blood pressure and LVMI. BEC also prevented the progression of CKD while maintaining the creatinine clearance unchanged.

[Factors associated with uncontrolled hypertension]. / Factores relacionados con el descontrol de la presión arterial.

OBJECTIVE: To assess health care characteristics for hypertensive patients and their association with uncontrolled hypertension in a primary care outpatient clinic. DESIGN: Cross-sectional.A review was conducted of 50% of 8080 (n= 4040) files. Patient, physician and primary health care clinic characteristics were recorded. RESULTS: The factors associated with uncontrolled hypertension were: age (OR, 1.43; CI95% : 1.015-1.030), BMI (OR, 1.03; CI95%: 1.02-1.05), creatinine serum levels (OR, 1.16; CI95%: 1.03-1.30), three or more different antihypertensive drugs (OR, 1.48; CI95%: 1.31-1.07), to be treated by a physician with more than 20 years of medical practice (OR, 1.21; CI95%; 1.06-1.39) or by a non-specialist physician (OR, 1.43; CI95%: 1.20-1.71) and to be treated in the morning shift (OR, 1.21; CI95%: 1.07- 1.56). CONCLUSIONS: Hypertension is well-controlled in the majority of patients. Patient-related factors are important in uncontrolled hypertension; however, health care system characteristics also play an important role.

Factores relacionados con el descontrol de la presión arterial / Factors associated with uncontrolled hypertension

Objetivo. Evaluar las características de la atención del paciente hipertenso, y su relación con el descontrol de la presión arterial, en una unidad de medicina familiar. Material y métodos. Diseño: estudio transversal. Se revisó la mitad de 8 080 (4 040) expedientes. Se registraron las características de los pacientes, los médicos tratantes y la unidad de atención. Resultados. Se encontraron como factores asociados a la hipertensión descontrolada la edad (RM, 1.43; IC95%: 1.015-1.030), IMC (RM, 1.03; IC95%: 1.02-1.05), creatinina (RM, 1.16; IC95%: 1.03-1.30), tomar tres o más fármacos antihipertensivos (RM, 1.48; IC95%: 1.31-1.07), ser atendido por un médico con más de 20 años de antigüedad (RM, 1.21; IC95%: 1.06-1.39), sin especialidad (RM, 1.43; IC95%: 1.20-1.71) y ser atendido en el turno matutino (RM, 1.21; IC95%: 1.07-1.56). Conclusiones. La presión arterial está bien controlada en la mayoría de los pacientes. En el descontrol de la presión arterial intervienen factores relacionados con el paciente mismo, pero las características del sistema de salud también tienen un papel significativo.

Objective. To assess health care characteristics for hypertensive patients and their association with uncontrolled hypertension in a primary care outpatient clinic. Material and Methods. Design: cross-sectional. A review was conducted of 50% of 8080 (n= 4040) files. Patient, physician and primary health care clinic characteristics were recorded. Results. The factors associated with uncontrolled hypertension were: age (OR, 1.43; CI95% : 1.015-1.030), BMI (OR, 1.03; CI95%: 1.02-1.05), creatinine serum levels (OR, 1.16; CI95%: 1.03-1.30), three or more different antihypertensive drugs (OR, 1.48; CI95%: 1.31-1.07), to be treated by a physician with more than 20 years of medical practice (OR, 1.21; CI95%; 1.06-1.39) or by a non-specialist physician (OR, 1.43; CI95%: 1.20-1.71) and to be treated in the morning shift (OR, 1.21; CI95%: 1.07- 1.56) Conclusions. Hypertension is well-controlled in the majority of patients. Patient-related factors are important in uncontrolled hypertension; however, health care system characteristics also play an important role.

Modificaciones en el peso de las mujeres del área rural y urbana durante el embarazo de curso normal / Changes in gestational weight gain pattern in women from rural vs urban areas in normal pregnancy

Las diferencias etnográficas, alimenticias y genéticas determinan manifestaciones clínicas de diversa índole en los conglomerados de todo el orbe y se acentúan de acuerdo a su ubicación geográfica, En Michoacán 50.7 por ciento de la población es rural y 20 por ciento son mujeres en edad fértil, con una tasa de natalidad de 37.8 por cada mil habitantes al año, lo que hace significativo evaluar el comportamiento ponderal durante el embarazo. El objetivo del presente trabajo fue evaluar el patrón de incremento ponderal gestacional (PIPG) en el área rural, región oriente de Michoacán en comparación con mujeres del área urbana de la ciudad de Morelia. Se realizó un estudio durante seis meses en el que se evaluaron 68 mujeres con embarazo normal que acudieron a control prenatal regular a su Unidad Médica Rural con atención del evento obstétrico en medio hospitalario, con criterio de inclusión de una primera consulta prenatal antes de las 14 semanas, el manejo prenatal y la atención del parto se realizaron de acuerdo a la Norma Oficial Mexicana. Los resultados indicaron que el aumento de peso evaluado cada tres meses y globalmente fue significativamente diferente en ambas poblaciones en el segundo y tercer trimestres así como también globalmente, excepto en el primero, siendo significativamente mayor para el área urbana, p>.05. La edad al embarazo, la escolaridad, el número de consultas prenatales fueron menores en mujeres indígenas; la paridad fue significativamente mayor en el área rural, p>.05. No se encontraron diferencias con respecto al índice de Masa Corporal (IMC).

El patrón de incremento ponderal durante el embarazo normal / Weigth gain pattern during normal pregnancy

El incremento de peso que alcanza la mujer durante el embarazo, se ha establecido como criterio de aceptación común, alrededor de los 11 Kg., y su evaluación es de interés en Ginecobstetricia. El objetivo del presente estudio fue evaluar el Patrón de Incremento Ponderal Gestional (PIPG) durante el embarazo normal y su asociación con la talla y peso materno antes del embarazo, índice de masa corporal (IMC), escolaridad, intervalo intergenésico y peso del producto al nacer. Se encontró a través de un estudio longitudinal y prospectivo en mujeres de área urbana, bajo control prenatal en el IMSS de Morelia, Mich. México, que el PIPG global promedio fue de 9.3 Kg, estableciéndose una banda de normalidad con límites de PIPG global promedio fue de 9.3 Kg, estableciéndose una banda de normalidad con límites de 6,6 a 12 kg., que es menor a los criterios obstétricos establecidos, no se encontró correlación entre el PIPG y el peso de los recién nacidos, ya que 94.3 por ciento de ellos tuvieron peso normal; la edad, peso, el IMC y la escolaridad de la madre no mostraron correlación en el incremento de peso materno durante la gestación, se demostró que la talla de la madre y el número de gestaciones influye notablemente en el PIPG. Es conveniente la adopción de este nuevo criterio durante el control prenatal para determinar la normalidad en la evaluación del PIPG acorde con las características de la mujer mexicana