This narrative review highlights strategies proposed by the Mexican Group of Experts on Arterial Hypertension endorsed to prevent, diagnose, and treat chronic kidney disease (CKD) related to systemic ...arterial hypertension (SAH). Given the growing prevalence of CKD in Mexico and Latin America caused by SAH, there is a need for context-specific approaches to address the effects of SAH, given the diverse population and unique challenges faced by the region. This narrative review provides clinical strategies for healthcare providers on preventing, diagnosing, and treating kidney disease related to SAH, focusing on primary prevention, early detection, evidence-based diagnostic approaches, and selecting pharmacological treatments. Key-strategies are focused on six fundamental areas: 1) Strategies to mitigate kidney disease in SAH, 2) early detection of CKD in SAH, 3) diagnosis and monitoring of SAH, 4) blood pressure targets in patients living with CKD, 5) hypertensive treatment in patients with CKD and 6) diuretics and Non-Steroidal Mineralocorticoid Receptor Inhibitors in Patients with CKD. This review aims to provide relevant strategies for the Mexican and Latin American clinical context, highlight the importance of a multidisciplinary approach to managing SAH, and the role of community-based programs in improving the quality of life for affected individuals. This position paper seeks to contribute to reducing the burden of SAH-related CKD and its complications in Mexico and Latin America.
PURPOSETo share a Latin-American perspective of the use of telemedicine, together with blood pressure measurements outside the medical office, as a potential contribution to improving access to the ...health system, diagnosis, adherence, and persistence in hypertension treatment. MATERIAL AND METHODSA document settled by a Writing Group of Mexico Hypertension Experts Group, Interamerican Society of Hypertension, Epidemiology and Cardiovascular Prevention Council of the Interamerican Society of Cardiology, and National Cardiologist Association of Mexico. RESULTSIn almost all Latin American countries, the health sector faces two fundamental challenges: (1) ensure equitable access to quality care services in a growing population that faces an increase in the prevalence of chronic diseases, and (2) optimise the growing costs of health services, maintaining equity, accessibility, universality, and quality. Telehealth proposes an innovative approach to patient management, especially for chronic conditions, intending to provide remote consultation, education, and follow-up to achieve measurements and goals. It is a tool that promises to improve access, empower the patient, and somehow influence their behaviour about lifestyle changes, improving prevention and reducing complications of hypertension. The clinical practitioner has seen increased evidence that the use of out-of-office blood pressure (BP) measurement and telemedicine are helpful tools to keep patients and physicians in contact and promote better pharmacological adherence and BP control. A survey carried out by medical and scientific institutions showed that practitioners are up-to-date with telemedicine, had internet access, and had hardware availability. CONCLUSIONSA transcendent issue is the need to make the population aware of the benefits of taking blood pressure to avoid complications of hypertension, and in this scenario, promote the creation of teleconsultation mechanisms for the follow-up of patients diagnosed with hypertension.
Arterial hypertension is a significant cause of morbidity and mortality in Mexico. However, there is limited data available to understand blood pressure management and cardiometabolic profiles.
To ...assess the prevalence of controlled and uncontrolled blood pressure, as well as the prevalence of cardiometabolic risk factors among patients from the Mexican Registry of Arterial Hypertension (RIHTA).
We conducted a cross-sectional analysis of participants living with arterial hypertension registered on RIHTA between December 2021 and April 2023. We used both the 2017 ACC/AHA and 2018 ESC/ESH thresholds to define controlled and uncontrolled arterial hypertension. We considered eleven cardiometabolic risk factors, which include overweight, obesity, central obesity, insulin resistance, diabetes, hypercholesterolemia, hypertriglyceridemia, low-HDL-C, high-LDL-C, low-eGFR, and high CVD risk.
In a sample of 5,590 participants (female: 61%, n=3,393; median age: 64 IQR: 56-72 years), the prevalence of uncontrolled hypertension varied significantly, depending on the definition (2017 ACC/AHA: 59.9%, 95% CI: 58.6-61.2 and 2018 ESC/ESH: 20.1%, 95% CI: 19.0-21.2). In the sample, 40.43% exhibited at least 5-6 risk factors, and 32.4% had 3-4 risk factors, chiefly abdominal obesity (83.4%, 95% CI: 82.4-84.4), high-LDL-C (59.6%, 95% CI: 58.3-60.9), high-CVD risk (57.9%, 95% CI: 56.6-59.2), high triglycerides (56.2%, 95% CI: 54.9-57.5), and low-HDL-C (42.2%, 95% CI: 40.9-43.5).
There is a high prevalence of uncontrolled hypertension interlinked with a high burden of cardiometabolic comorbidities in Mexican adults living with arterial hypertension, underscoring the urgent need for targeted interventions and better healthcare policies to reduce the burden of the disease in our country.
La muerte súbita cardiaca es un problema de salud pública a nivel mundial. Aunque su incidencia no es conocida, se estima que causa hasta 50% de la mortalidad de origen cardíaco y hasta 20% de la ...mortalidad total en los adultos. En México, estimaciones previas sugieren que causa en promedio 33 000 muertes al año; sin embargo, los datos no son precisos. La mitad de los eventos por muerte súbita cardiaca se deben a un paro cardiaco súbito extrahospitalario que, de no ser atendido oportunamente, deriva en una muerte súbita cardiaca. Por tanto, la capacidad de responder pronta y adecuadamente a estos eventos con las maniobras y equipos necesarios mejora la sobrevida de las víctimas. Para atender este problema, en algunos estados del país se han creado espacios cardioprotegidos que permiten realizar maniobras de reanimación cardiopulmonar y desfibrilación cardiaca de acceso público oportunamente. Como objetivo, los profesionales de la salud establecen la importancia de implementar espacios cardioprotegidos y crear políticas públicas al respecto en todo el país.
Degenerative diseases are becoming more frequent in adults due to the increase in the average life, among them osteoporosis is with one prevalence higher in women mainly due to the lack of estrogen ...after menopause.
Estimate the prevalence of osteoporosis and osteopenia by effectuate a bone densitometry in postmenopausal women and analyze the possible relationship with some recognized risk factors.
Cross-sectional study with 389 patients analyzing the following variables: age; index of body mass and time of treatment with hormone replacement therapy, crossing the information with the result of bone densitometry.
A prevalence rate similar to that reported in our country was obtained. We found that patients with overweight have one higher percentage of osteopenia and osteoporosis than normal weight, which is contrary to what was reported in literature. Also contrary to expectations, untreated patients occupy a higher percentage without bone disorders, while in the leading hormone therapy the lesser percentage was for those whit osteoporosis. We found no differences in terms of age.
Early diagnosis provides an excellent opportunity to address these problems but we must not forget that the best treatment is prevention from an early age.
As part of preventive medicine climacteric and menopause clinics should identify the chronic-degenerative diseases that accompany this stage of women and which are increasing as the age increases.
To ...dentify following chronic degenerative diseases that occur during climacteric: diabetes, hypertension, obesity and dyslipidemia.
A descriptive and transversal study was performed with 688 patients in the clinic of the climacteric and menopause, 98 were removed for failing to comply with all the requirements that included: determining serum glucose and lipids, weight, height, diameter of waist and hip. Controls were done every three to four months forming two groups: menopause and perimenopause.
The average age of menopause was 47.5 years, in which predominated the chronic degenerative diseases, highlighting the overweight and obesity (66%), dyslipidemia (59%), hypertension (22%) and diabetes (19%).
The gynecologist must be attentive to identify early risk factors for chronic degenerative diseases from the reproductive stage.
This manuscript is an addendum to the positioning around the diagnosis and treatment of dyslipidemias of ANCAM and the joint group of associated medical societies, already published. It is the first ...part of a wider reflection aimed on refute several of the theses and arguments of a group of clinicians and researchers who question the validity of the “cholesterol hypothesis”, the usefulness and safety of statins and the most modern inhibitors of proprotein convertase of subtilisin/kexin type 9 (iPCSK9,) and the role of saturated fatty acids consumed in the usual diet in the atherosclerotic risk. This iconoclastic point of view is dangerous insofar as it undermines the scaffolding that supports the primary and secondary prevention of atherosclerosis. In this section of the manuscript, only the cholesterol hypothesis is discussed. The data of comparative zoology are reviewed, and several experimental animal models are analyzed, both supporting the link between cholesterol and the appearance and evolution of atherosclerotic lesions. The methodology and the results of the Study of the 7 Countries are defended and are exposed the numerous epidemiological, pathological, clinical and interventional evidences, which in our opinion give a solid sustenance to the cholesterol hypothesis. Based on this knowledge it is criticized the LDL cholesterol values currently considered adequate. Furthermore, the so-called residual risk is considered, as well as the conflicting evidence about the usefulness of statins in elderly patients.
Caesarean section is the most common surgery performed in all hospitals of second level of care in the health sector and more frequently in private hospitals in Mexico.
To determine the behavior that ...caesarean section in different hospitals in the health sector in the city of Aguascalientes and analyze the indications during the same period.
A descriptive and cross in the top four secondary hospitals in the health sector of the state of Aguascalientes, which together account for 81% of obstetric care in the state, from 1 September to 31 October 2008. Were analyzed: indication of cesarean section and their classification, previous pregnancies, marital status, gestational age, weight and minute Apgar newborn and given birth control during the event.
were recorded during the study period, 2.964 pregnancies after 29 weeks, of whom 1.195 were resolved by Caesarean section with an overall rate of 40.3%. We found 45 different indications, which undoubtedly reflect the great diversity of views on the institutional medical staff to schedule a cesarean section.
Although each institution has different resources and a population with different characteristics, treatment protocols should be developed by staff of each hospital to have the test as a cornerstone of labor, also request a second opinion before a caesarean section, all try to reduce the frequency of cesarean section.
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