May Measurement Month 2019: an analysis of blood pressure screening results from Venezuela, Latin America.

Cardiovascular diseases are the main cause of death in Venezuela. Raised blood pressure (BP) accompanied by diabetes mellitus, obesity, lipid abnormalities, and tobacco usage are the biggest contributors to mortality. The May Measurement Month (MMM) campaign is a global initiative aimed to raising awareness of hypertension, which has been conducted in Venezuela since 2017. MMM2019 included 24 672 subjects (mean age: 54.7 years, SD 25.2, 63.1% female). The proportion with hypertension was 48.9%; 14.3% were unknown hypertensives, 35.5% of those who receiving treatment had uncontrolled hypertension (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg); when considering all hypertensives, 53.3% were controlled. Sixty per cent of those on anti-hypertensive medication were on monotherapy, 27.7% were on two, and 7.7% were on three or more drugs. Body mass index, calculated for the total population, was on average 25.6 (SD: 4.8) kg/m2. 16.2% of participants were classified as obese, 34.0% as overweight, and 4.0% were classified as underweight. Diabetes mellitus was reported by 9.4%, smoking by 7.3%, and 10.5% reported drinking alcohol regularly. Conditions associated with higher BP levels were obesity, diabetes mellitus, and women with a history of hypertension during a previous pregnancy. These results are consistent with the two previous MMM campaigns and indicate that repeated screening can routinely identify hypertension. There is an urgent need for Venezuela to implement programmes of detection, treatment, and control not only for hypertension but also for other common cardiovascular risk factors.

Results of May Measurement Month 2018 campaign in Venezuela.

Cardiovascular diseases, mainly coronary heart disease and stroke, are the main cause of death in Venezuela; hypertension is the primary risk factor. The May Measurement Month (MMM) study is a global initiative aimed at raising awareness of elevated blood pressure (BP). The previous MMM 2017 campaign showed 48.9% of participants had hypertension, higher than previous Venezuelan epidemiological studies. The MMM 2018 campaign included 28 649 participants screened [mean age: 54.2 (SD 15.13) years; female 62.8%] carried out mainly in pharmacies in 61 sites. Physical measurements included height, weight, and BP, taken in sitting position three times. After multiple imputations, 48.4% had hypertension, of which 87.7% were aware of their diagnosis. Of the individuals not receiving antihypertensive medication, 14.0% had hypertension and 33.7% of those receiving treatment had uncontrolled hypertension. Overall, the percentage of hypertensives with controlled hypertension was 54.8%. Body mass index was calculated for the total population, and it was on average 25.2 (SD: 4.65) kg/m2. Of all, 14.2% was classified as obese and 32.6% as overweight; meanwhile 4.8% as underweight. Diabetes was reported by 9.5%. These results suggest that repeated screening like the MMM campaign can routinely identify hypertension and consequently implement programmes of treatment in Venezuela, also other common risk factors, like obesity or diabetes.

Results of the May Measurement Month 2017: blood pressure campaign in Venezuela-Americas.

Cardiovascular diseases, mainly coronary heart disease and stroke, are the first cause of death in Venezuela; and hypertension is the main risk factor. May Measurement Month (MMM) is a global initiative aimed at raising awareness of elevated blood pressure (BP) and to act as a temporary solution to the lack of regular screening programmes. Some representative studies indicate prevalence of hypertension in Venezuela between 24 and 39%, and control rate around 20%. Sixty-four sites were included to participate in MMM, mainly in pharmacies. Physical measurements included height, weight, and abdominal circumference. Blood pressure was measured in the sitting position three times after resting for 5 min, 1 min apart, using validated oscillometric devices. 21 644 individuals were screened. After multiple imputation, 10 584 individuals [48.9% (50.7% male; 47.7% female)] had hypertension. Of individuals not receiving antihypertensive medication, 1538 (12.2%) were hypertensive. Of individuals receiving antihypertensive medication, 2974 (32.9%) had uncontrolled BP. About 16% had obesity calculated by body mass index; 43.8% of women and 20.7% of men had abdominal obesity. This was the largest BP screening carried out in Venezuela, in which 48.9% of the individuals had elevated BP, untreated hypertension was 12.2%, and one-third of subjects taking treatment were not controlled. About 16% had obesity by body mass index, and abdominal obesity is more common in women. These results suggest that repeated screening like MMM17 can identify hypertension in important numbers and can also evaluate programmes of hypertension treatment and control in Venezuela.

II norma venezolana para el monitoreo ambulatorio de presión arterialy automedición de presión arterial / II venezuelan norms for ambulatory monitoring of arterial pressure and self measurement

Durante los últimos 30 años el monitoreo ambulatorio de la presión arterial ha pasado de ser un método selectivo de investigación farmacológica a ser un método invaluable en el diagnóstico y valoración terapéutica del paciente hipertenso. Sin embargo, ha habido una variedad de criterios en la evaluación e interpretación de los resultados; de ahí la necesidad de presentar el estado del arte en cuanto al uso de esta metodología en la práctica clínica. Los valores de normalidad de la presión arterial medida a través del monitoreo ambulatorio de la presión arterial se diferencian de aquellos tomados en la consulta y en el hogar; así como, si se hacen durante el período de vigilia o sueño. La II Norma Venezolana para el Monitoreo Ambulatorio de la Presión Arterial y Monitoreo de Presión en el Hogar reportalos valores considerados normales; las indicaciones de su uso; la interpretación de los resultados; los equipos validados y recomendados en los ámbitos mundiales y nacionales; así los datos mínimos que debe poseer el reporte del monitoreo ambulatorio de la presión arterial.

During the past 30 years ambulatory blood pressure monitoring has gone from being a selective method of pharmacological research to a valuable method for the diagnosis and therapeutic assessment of patients with hypertension. However, there area variety of criteria for the evaluation and interpretation of results; hence the need for a state of the art approach to the use of this methodology in clinical practice. Normal blood pressure values measured by ambulatory blood pressure monitoring are different from those obtained in the clinic and in the home; as well as, during periods of wakefulness and sleep. The II Venezuelan Standards for Ambulatory Monitoringof Arterial Pressure and Monitoring of Pressure in the Home provide normal values; indications for use; interpretation of results; validated equipment as well as global and national recommendations; and the minimum data that a report should contain.

Asistencia cardiovascular en el tercer nivel de atención médica: tendencia en Venezuela años 1958 a 1994 y 1999 / Cardiovascular attendance in the thrird level of attention prescribes: tendency in Venezuela years 1958 at 1994 and 1999

Las enfermedades del corazón constituyen en Venezuela la primera causa de muerte y la tercera causa de años de vida potencialmente perdidos. La persistencia de tasas elevadas de mortalidad contrasta con el importante descenso de esas tasas en los países industrializados. A ese descenso han contribuido las intervenciones del tercer nivel de atención cardiovascular. El objetivo del presente estudio es documentar la situación de la asistencia cardiovascular en Venezuela en este nivel de atención. Se eligieron como indicadores la práctica de la hemodinamia, que se considerará en este estudio, y la práctica de la cirugía cardiovascular, que se considerará en un estudio sucesivo. Ambas prácticas se documentarán desde sus inicios hasta 1999. Los datos fueron solicitados en 1995 y en 1999 mediante encuestas dirigidas a los hospitales públicos y privados que realizan prácticas de tercer nivel. Se estudió la distribución geográfica de esas prácticas, su carácter asistencial público o privado, y sus tendencias en el tiempo. Se obtuvo respuesta del 88 por ciento de los hospitales en 1995 y del 96 por ciento en 1999. El estudio mostró que la práctica de la hemodinamia no ha sido continua en algunos hospitales públicos y que el número de procedimientos ha sido dispar y muy pequeño en algunos centros. El 70 por ciento de los procedimientos se realizó en Caracas, y ese porcentaje no ha variado en el curso del tiempo. La práctica de la hemodinamia se inició en los hospitales públicos y se ha desplazado a los hospitales privados a lo largo del tiempo, donde predomina actualmente.La hemodinamia terapéutica predomina desde su inicio en los hospitales privados, donde se aplica casi exclusivamente a pacientes coronarios. Por el contrario, en los hospitales públicos estos procedimientos terapéuticos se aplicaron con mayor frecuencia a pacientes valvulares. El predominio metropolitano y privado de la práctica hemodinámica, así como la discontinuidad y escaso número de estudios en varios centros públicos podría permitir formular recomendaciones que hagan viable la prestación de mejores servicios