Dora I. Molina

Blood-pressure lowering in intermediate-risk persons without cardiovascular disease

BACKGROUND Antihypertensive therapy reduces the risk of cardiovascular events among high-risk persons and among those with a systolic blood pressure of 160 mm Hg or higher, but its role in persons at intermediate risk and with lower blood pressure is unclear. METHODS In one comparison from a 2-by-2 factorial trial, we randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to receive either candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day or placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke; the second coprimary outcome additionally included resuscitated cardiac arrest, heart failure, and revascularization. The median follow-up was 5.6 years. RESULTS The mean blood pressure of the participants at baseline was 138.1/81.9 mm Hg; the decrease in blood pressure was 6.0/3.0 mm Hg greater in the active-treatment group than in the placebo group. The first coprimary outcome occurred in 260 participants (4.1%) in the active-treatment group and in 279 (4.4%) in the placebo group (hazard ratio, 0.93; 95% confidence interval [CI], 0.79 to 1.10; P=0.40); the second coprimary outcome occurred in 312 participants (4.9%) and 328 participants (5.2%), respectively (hazard ratio, 0.95; 95% CI, 0.81 to 1.11; P=0.51). In one of the three prespecified hypothesis-based subgroups, participants in the subgroup for the upper third of systolic blood pressure (>143.5 mm Hg) who were in the active-treatment group had significantly lower rates of the first and second coprimary outcomes than those in the placebo group; effects were neutral in the middle and lower thirds (P=0.02 and P=0.009, respectively, for trend in the two outcomes). CONCLUSIONS Therapy with candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day was not associated with a lower rate of major cardiovascular events than placebo among persons at intermediate risk who did not have cardiovascular disease. (Funded by the Canadian Institutes of Health Research and AstraZeneca; ClinicalTrials.gov number, NCT00468923.).

Guidelines on the management of arterial hypertension and related comorbidities in Latin America

Univ Hosp, Hypertens & Metab Unit, Fdn Favaloro, Belgrano 1782 P 4, RA-1093 Buenos Aires, DF, Argentina

Social disparities explain differences in hypertension prevalence, detection and control in Colombia.

Objective: Hypertension is the principal risk factor for cardiovascular diseases. The global Prospective Urban Rural Epidemiology study showed that the levels of awareness, treatment and control of this condition are very low worldwide and show large regional variations related to a countrys income index. The aim of the present analysis was to identify associations between sociodemographic, geographic, anthropometric, behavioral and clinical factors and the awareness, treatment and control of hypertension within Colombia – a high-middle income country which participated in the global Prospective Urban Rural Epidemiology study. Methods and results: The sample comprised 7485 individuals aged 35–70 years (mean age 50.8 years, 64% women). Mean SBP and DBP were 129.12 ± 21.23 and 80.39 ± 11.81 mmHg, respectively. The overall prevalence of hypertension was 37.5% and was substantially higher amongst participants with the lowest educational level, who had a 25% higher prevalence (<0.001). Hypertension awareness, treatment amongst those aware, and control amongst those treated were 51.9, 77.5 and 37.1%, respectively. The prevalence of hypertension was higher amongst those with a higher BMI (<0.001) or larger waist–hip ratio (<0.001). Being male, younger, a rural resident and having a low level of education was associated with significantly lower hypertension awareness, treatment and control. The use of combination therapy was very low (27.5%) and was significantly lower in rural areas and amongst those with a low income. Conclusion: Overall Colombia has a high prevalence of hypertension in combination with very low levels of awareness, treatment and control; however, we found large variations within the country that appear to be associated with sociodemographic disparities.

Neuropatía autonómica diabética cardiovascular

La neuropatia autonomica diabetica cardiovascular es un trastorno en el cual una alteracion en la regulacion del sistema nervioso cardiovascular, por parte del sistema nervioso autonomo, desemboca en una constelacion de sintomas, que pueden ir desde intolerancia al ejercicio hasta muerte subita. Si bien no se conoce su prevalencia exacta, se estima que es alta en pacientes diabeticos, particularmente en aquellos con diabetes de larga data y con presencia de otras comorbilidades. Su reconocimiento temprano puede facilitar el manejo de estos pacientes y a su vez disminuir los costos asociados a pruebas e intervenciones innecesarias con el objetivo de evitar complicaciones asociadas con la enfermedad.

Role of the Autonomic Nervous System in the Endothelial Dysfunction of the Metabolic Syndrome

In the last decade there has been an accelerated growth in the prevalence of metabolic syndrome (MS), especially in Latin American countries, which has led an increased risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (DM2). Recently has been raised the relationship between the autonomic nervous system (ANS), endothelial dysfunction (ED) and the appearance of MS. In the present article we review the evidence that support the proposal that abdominal obesity (AO) produce adypokines that result in insulin resistance and low degree inflammation, which increase the activity of ANS, causing vasoconstriction, hypertension, decreased peripheral glucose uptake, and decreased secretion of insulin, leading to hyperglycemia and increased lipolysis and hypertriglyceridemia. All these factors cause ED, explaining the higher risk of the patients with MS of developing DM2 and CVD.