Latin American Consensus on management of residual cardiometabolic risk. A consensus paper prepared by the Latin American Academy for the Study of Lipids and Cardiometabolic Risk (ALALIP) endorsed by the Inter-American Society of Cardiology (IASC), the International Atherosclerosis Society (IAS), and the Pan-American College of Endothelium (PACE).

BACKGROUND: Hypertension, hyperglycemia, dyslipidemia, overweight, obesity, and tobacco (smoking, chewing, and vaping), together with a pro-inflammatory and procoagulant state, are the main risk factors related to atherosclerotic cardiovascular disease. OBJECTIVE AND METHODS: A group of experts from the Americas, based on their clinical expertise in cardiology, cardiovascular prevention, and cardiometabolic (CM) diseases, joined together to develop these practical recommendations for the optimal evaluation and treatment of residual CM risk factors in Latin America, using a modified Delphi methodology (details in electronic TSI) to generate a comprehensive CM risk reduction guideline, and through personalized medicine and patient-centered decision, considering the cost-benefit ratio The process was well defined to avoid conflicts of interest that could bias the discussion and recommendations. RESULTS: Residual risk reduction should consider therapeutic options adapted to specific patient needs, based on five treatment objectives: triglyceride-rich lipoproteins, inflammation, impaired glucose metabolism, high blood pressure, and prothrombotic status. Comprehensive control of all CM risk factors should be a priority to deal with this important public health problem and prevent premature deaths. The recommendations in this paper address the evidence-based treatment of CM risk and are intended for clinical application in Latin American countries.

Antecedentes: Un grupo de factores de riesgo cardiometabólicos (hipertensión, hiperglucemia, dislipidemia, sobrepeso, obesidad y tabaco (fumado, masticado, vaporizado), junto con un estado proinflamatorio y procoagulante, son los principales factores de riesgo relacionados con la enfermedad cardiovascular aterosclerótica. Objetivo y métodos: Basándose en su experiencia en cardiología, prevención cardiovascular y enfermedades cardiometabólicas, un grupo de expertos de las Américas se unió para desarrollar estas recomendaciones prácticas para la evaluación y tratamiento óptimos de los factores de riesgo cardiometabólicos residuales en América Latina, utilizando una metodología Delphi modificada con el objetivo de generar una guía integral de pautas para la reducción del riesgo cardiometabólico, mediante la medicina personalizada y la decisión centrada en el paciente teniendo en cuenta la relación costo-beneficio. El proceso fue bien definido para evitar conflictos de intereses que podrían sesgar la discusión y las recomendaciones. Resultados: La reducción del riesgo residual debe considerar opciones terapéuticas adaptadas a las necesidades específicas del paciente, basadas en 5 objetivos de tratamiento: lipoproteínas ricas en triglicéridos inflamación, metabolismo de la glucosa, presión arterial alta y estado protrombótico. El Control integral de todos los factores de riesgo cardiometabólicos debe ser una prioridad para hacer frente a este importante problema de salud pública y prevenir las muertes prematuras. Las recomendaciones de este documento abordan el tratamiento basado en evidencia del riesgo cardiometabólico y están destinadas a la aplicación clínica en los países de América Latina.

Recommendations for home blood pressure monitoring in Latin American countries: A Latin American Society of Hypertension position paper.

Out-of-office blood pressure (BP) monitoring appears to be a very useful approach to hypertension management insofar it allows to obtain multiple measurements in the usual environment of each individual, allows the detection of hypertension phenotypes, such as white-coat and masked hypertension, and appears to have superior prognostic value than the conventional office BP measurements. Out-of-office BP can be obtained through either home or ambulatory monitoring, which provide complementary and not identical information. Home BP monitoring yields BP values self-measured in subjects' usual living environment; it is an essential method for the evaluation of almost all untreated and treated subjects with suspected or diagnosed hypertension, best if combined with telemonitoring facilities, also allowing long-term monitoring. There is also increasing evidence that home BP monitoring improves long-term hypertension control rates by improving patients' adherence to prescribed treatment. In Latin American Countries, it is widely available, being relatively inexpensive, and well accepted by patients. Current US, Canadian, Japanese, and European guidelines recommend out-of-office BP monitoring to confirm and refine the diagnosis of hypertension.

Ambulatory blood pressure monitoring over 24 h: A Latin American Society of Hypertension position paper-accessibility, clinical use and cost effectiveness of ABPM in Latin America in year 2020.

Accurate office blood pressure measurement remains crucial in the diagnosis and management of hypertension worldwide, including Latin America (LA). Office blood pressure (OBP) measurement is still the leading technique in LA for screening and diagnosis of hypertension, monitoring of treatment, and long-term follow-up. Despite this, due to the increasing awareness of the limitations affecting OBP and to the accumulating evidence on the importance of ambulatory BP monitoring (ABPM), as a complement of OBP in the clinical approach to the hypertensive patient, a progressively greater attention has been paid worldwide to the information on daytime and nighttime BP patterns offered by 24-h ABPM in the diagnostic, prognostic, and therapeutic management of hypertension. In LA countries, most of the Scientific Societies of Hypertension and/or Cardiology have issued guidelines for hypertension care, and most of them include a special section on ABPM. Also, full guidelines on ABPM are available. However, despite the available evidence on the advantages of ABPM for the diagnosis and management of hypertension in LA, availability of ABPM is often restricted to cities with large population, and access to this technology by lower-income patients is sometimes limited by its excessive cost. The authors hope that this document might stimulate health authorities in each LA Country, as well as in other countries in the world, to regulate ABPM access and to widen the range of patients able to access the benefits of this technique.

Pharmacological Treatment of Hypertension: Effects in Endothelial Function.

The vascular endothelium plays an important role to maintain the functional integrity of the cardiovascular system. The synthesis and secretion of substances with biological activity such as prostacyclin and NO give endothelium the vasodilator, antithrombotic, and antiatherosclerotic properties. Endothelial dysfunction participates in the genesis of HTA, but also hypertension produces endothelial damage. The major class of antihypertensive drugs has beneficial effects in the recuperation of the endothelial function, actions that are contributing to explain the impact of the adequate control of HTA in the reduction of CV events.

Variability of apparent and inherent optical properties of sediment-laden waters in large river basins - lessons from in situ measurements and bio-optical modeling.

We investigated the relationships between inherent and apparent optical properties (IOP and AOP, respectively) and suspended sediment concentrations (SSC) in the main Amazonian river waters. In situ measurements of SSC, remote sensing reflectance (Rrs), the diffuse light attenuation coefficient (Kd) and the total and non-algal particle (NAP) absorption coefficients (aTOT and aNAP, respectively) were conducted during three sampling trips along different streams of the Amazon River catchment (104 stations). The size distribution and chemical characteristics of the suspended sediment were also determined for 85 stations. We show that the particle size distribution (PSD) in the river water is best described by a segmented Junge power law distribution with a smaller slope value for the smallest particles (J1 = 2.4) and a larger slope value (J2 = 4.1) for the largest particles (> 10 µm). A strong relationship was found between AOPs and IOPs and SSC when the entire data set was considered. However, for the Madeira River, the primary Amazon River tributary in terms of suspended sediment discharge, a significant dispersion was detected for the Rrs - SSC relationship but not for the Kd - SSC relationship. This dispersion has been shown by a previous study, using MODIS data, to display a seasonal pattern, which we investigated in this study using Mie modeling calibrated with suspended sediment characteristics. In the Madeira River, suspended sediment had a finer distribution size and a different mineralogy (e.g., a greater smectite content and a lower kaolinite content) during the rising water stage. Spectral variations of the imaginary part n'(λ) of the refraction index also showed significant differences during the rising water stage. In contrast, other streams of the Amazon basin had very stable properties with respect to granulometry and mineralogy. Model simulations made possible to reproduce both field and satellite observations, showing that the Rrs hysteresis observed in the Madeira River in the near infrared was mainly due to n'(λ) seasonal variations, leading to a decrease of absorption during the rising water stage. Kd was shown to remain stable because of its strong dependency on scattering processes. The model was used to further understand how suspended sediment size distribution and refraction index drive the IOPs in large rivers: n'(λ) variations were shown to control primarily the reflectance variability; Rrs(850) presented limited variations as a function of PSD in the range typical of large rivers (J1 < 3) although it remained sensitive to particle mineralogical composition; Rrs(670) showed the opposite behavior with a higher sensitivity to PSD variation for coarser PSD. Finally, we demonstrate that the use of the Rrs ratio between the red and infrared channels allowed a reduction of the Rrs sensitivity in all cases, by an average of 50% with respect to changes in the mineral composition or size distribution of suspended sediment. In particular, the Rrs ratio varied by less than 5% for PSD representative of surface river waters.