Tag Archive 'presión arterial'

Martes 21 / mayo / 2013

JNC 2013: Simplified BP Goal in Sight

Filed under: noticia — Mario Hernández Cueto — mayo 21st, 2013 — 11:54

JNC 2013: Simplified BP Goal in Sight

Esfigmo digitalThe upcoming JNC 2013 update is likely to go with a hypertension treatment target of 140/90 mm Hg for all but older adults, a panel of experts on the guidelines committee suggested.

A “one-size-fits-most” goal seems to work well, although the higher target is defensible for patients over age 60, particularly those past 80, Raymond Townsend, MD, of the University of Pennsylvania in Philadelphia, told attendees here at the American Society of Hypertension meeting.

He unofficially reviewed the available evidence base for the latest Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines, formerly known as JNC-8 and now renamed JNC 2013.

Although the presentation indicates a commitment to getting the new guidelines out within the year, it’s still not clear when the National Heart, Lung, and Blood Institute will release the document, William Cushman, MD, of the VA Medical Center in Memphis, Tenn., told MedPage Today. He was involved with the guidelines but did not speak at the session.

The major question facing the committee this time around was the treatment target, ASH president-elect Domenic Sica, MD, commented in an interview.

The JNC-7 recommended less than 140/90 mm Hg overall and 130/80 mm Hg in the presence of diabetes, heart failure, or chronic kidney disease. Townsend suggested simplification to a single target in JNC 2013.

“At the end of the day when you boil all this down, you look at the general population, you look at the patients with diabetes, you look at the patients with chronic kidney disease, it turns out the wisdom we’ve used in the past, which we’ve been arguing about for the past decade, turns out to have been fairly wise,” Townsend said.

When asked how to reconcile the stricter American Heart Association and American College of Cardiology guidelines targeting 130/80 mm Hg for blood pressure control, Suzanne Oparil, MD, of the University of Alabama at Birmingham, noted that an update to those guidelines is due out within the next few months as well.

“Without being specific, they’ve pushed back, or pushed up, thresholds and goals for treatment,” she commented. Oparil is a member of both committees.

“Cardiologists are very aggressive, but when we looked back at the evidence, the evidence wasn’t there and … careful analyses of large trials in high-risk people showed that you can do harm from lowering blood pressure too much,” Oparil told the audience.

“JNC is strictly evidence based with some necessity for expert opinion where there is no evidence. We don’t feel obliged to reconcile our recommendations with anybody else’s,” she added.

That’s part of the reason the guidelines won’t dive too deeply into pharmacology, “such as beta-alpha versus beta alone, simply because there’s just not a lot of data to let us do that,” Townsend noted. “So we tended to be a little more generic rather than specific and we tried to provide recommendations that are both defensible as well as actionable.”

However, most of the comments at the session centered on the relative ranking of beta-blockers in therapy lines.

“Based on recent guidelines, but not necessarily JNC-8, the degree of blood pressure reduction achieved, and not the initial anti-hypertensive class of agents chosen, is more important for improving cardiovascular outcome in those with hypertension,” Barry Carter, PharmD, of the University of Iowa in Iowa City, concluded in his talk on pharmacology elements of JNC 2013.

He and all the other committee members at the conference were diligent in stating the opinions expressed were their own.

Nevertheless, reading between the lines probably isn’t too hard when all the component evidence is already known, Cushman acknowledged.

Although written and awaiting the final go-ahead, he suggested the paper isn’t likely to publish before June.

Henry Black, MD, of NYU Langone Medical Center in New York City, who wasn’t on the current committee, blamed the Institute of Medicine for prompting a much more intensive evidence review. “It took us 3 months on JNC-7; it has taken 3 years for JNC 2013,” he said

(Fuente: www.medpagetoday.com) [Actualizado: 21 de mayo 2013]

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Jueves 2 / mayo / 2013

Ethnic differences in the association between blood pressure components and chronic kidney disease in middle aged and older Asian adults

Filed under: factores de riesgo — Mario Hernández Cueto — mayo 2nd, 2013 — 11:56

Ethnic differences in the association between blood pressure components and chronic kidney disease in middle aged and older Asian adults

Riesgo cardiovascularPor: Charumathi Sabanayagam, Boon Wee Teo, E Shyong Tai, Tazeen H Jafar y Tien Yin Wong.  BMC Nephrology 2013, 14:86.

Chronic kidney disease (CKD) is an emerging public health problem worldwide. Previous studies have shown an association between blood pressure (BP) and CKD. However, it is not clear if there are ethnic differences in this association. We examined the association between BP and CKD in a multi-ethnic Asian population in Singapore.
The prevalence of both hypertension and CKD was higher among Malays (68.6, 21%) compared to Chinese (57.9, 5.9%) and Indians (56.0, 7.4%), but treatment for hypertension was lower among Malays (53.4%) compared to Chinese (89.8%) and Indians (83.1%). Hypertension was associated with CKD in all three ethnic groups (OR [95% CI] = 2.71 [1.59-4.63], 2.08 [1.62-2.68], 2.43 [1.66-3.57] in Chinese, Malays and Indians). Among the BP components, both systolic and diastolic BP were associated with CKD in Malays whereas, systolic BP was not significantly associated with CKD, and diastolic BP showed an inverse association which was explained by anti-hypertensive medication use in Chinese and Indians.  [Actuaizado: 02 de mayo 2013]

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Jueves 2 / mayo / 2013

Blacks and whites in the Cuba have equal prevalence of hypertension: confirmation from a new population survey

Filed under: investigaciones — Mario Hernández Cueto — mayo 2nd, 2013 — 11:26

Esta sección expone trabajos actuales, de carácter investigativo sobre la hipertensión arterial.

Blacks and whites in the Cuba have equal prevalence of hypertension: confirmation from a new population survey

InvestigacionesPor: Pedro Ordúñez, Jay S Kaufman, Mikhail Benet, Alain Morejon, Luis C Silva, David A Shoham y Richard S Cooper.  BMC Public Health 2013, 13:169.

The excess burden of hypertension among blacks has been a prominent feature of the heath disparities literature, and many scientists presume it to be a stable and inevitable phenomenon. The underlying causes of this disparity can only be disentangled in a setting in which the population does not experience racial stratification of socioeconomic opportunities. While such conditions of racial equality remain uncommon, they may be approximated in Cuba, a country with a persistent policy of social inclusion over the last 5 decades.
Overall, skin color was unrelated to mean blood pressure or hypertensive status in this population, although among women specifically some racial advantage appears evident in adjusted prevalence and control, and should be investigated further. The overall null result suggests that Cuba may exemplify the social conditions in which racial excess in hypertension, characteristic of much of the western world, is not a necessary reality. [Actualizado: 02 de mayo 2013]

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Jueves 2 / mayo / 2013

The morning blood pressure surge is related to serum cholesterol

Filed under: comentario — Mario Hernández Cueto — mayo 2nd, 2013 — 8:22

Esta sección mostrará algunos trabajos que puedan ser útiles a nuestros facultativos por su interés práctico o teórico.

The morning blood pressure surge is related to serum cholesterol

ComentandoPor: C A Martin, J D Cameron, G A Head, S S Chen, N Eikelis y B P McGrath.  Journal of Human Hypertension (2013) 27, 315–320.

A morning blood pressure surge (MBPS) may be either a mechanism for, or a marker of, increased cardiovascular events. This study has examined factors which may influence the morning surge: age, gender, metabolic factors, sympathetic function, blood pressure and arterial stiffness. Four measures of the MBPS were examined—sleep-trough surge, pre-awake surge, rate of blood pressure rise and a Power function. Subjects underwent ambulatory blood pressure monitoring, glucose tolerance test, central pulse wave velocity, sympathetic autonomic function tests (mental stress and sustained handgrip). MBPS was associated with age, hypertension, blood pressure variability and serum lipids. [Actualizado: 02 de mayo 2013].

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