Hipertensión arterial y obesidad en escolares de cinco a once años de edad

Por: MSc. Dra. Raquel González Sánchez, MSc. Dr. René Llapur Milián, Dra. C. María Elena Díaz Sánchez, Téc. Vilma Moreno López y Téc. Margarita Pavón Hernández.   Revista Cubana de Pediatría. 2013; 85(4).

La hipertensión arterial (HTA) primaria o esencial se ha incrementado en los últimos años en los niños, en parte, relacionada al incremento de la obesidad, y también por otros factores como los estilos de vida inadecuados, el consumo de comidas rápidas con sobrecarga de sal y grasa, y la disminución de la actividad física por el incremento de actividades sedentarias que incluyen la televisión, los juegos de video y la computadora. La prevalencia de HTA en los niños oscila entre 1 y 5 %, y en algunos casos se ha reportado hasta un 10 %; sin embargo, la prevalencia actual no está bien precisada, pues las diferentes investigaciones que se han realizado difieren en los métodos utilizados, unos con esfigmomanómetros aneroides y otros digitales, y diferentes números de mediciones. Se ha reportado el incremento de la prevalencia de prehipertensión y HTA de un 2,3 y 1 % respectivamente, entre los años 1988 a 1999 de la presión arterial sistólica de 1,4 mmHg y de la diastólica 3,3 mmHg en los años 1999-2000, comparado con 1988-1994 en los niños y adolescentes de Estados Unidos.

Racial Differences in the Impact of Elevated Systolic Blood Pressure on Stroke Risk

Por: George Howard, DrPH; Daniel T. Lackland, DrPH; Dawn O. Kleindorfer, MD; Brett M. Kissela, MD; Claudia S. Moy, PhD; Suzanne E. Judd, PhD; Monika M. Safford, MD; Mary Cushman, MD, MSc; Stephen P. Glasser, MD y Virginia J. Howard, PhD.   JAMA Intern Med. 2013;173(1):46-51.

Between the ages 45 and 65 years, incident stroke is 2 to 3 times more common in blacks than in whites, a difference not explained by traditional stroke risk factors. These findings suggest racial differences in the impact of elevated blood pressure on stroke risk. When these racial differences are coupled with the previously documented higher prevalence of hypertension and poorer control of hypertension in blacks, they may account for much of the racial disparity in stroke risk. Similar to racial differences in stroke mortality, the difference between blacks and whites in stroke incidence is substantially larger between the ages of 45 and 65 years. Moreover, “traditional stroke risk factors” explain only approximately half of this excess.

En esta sección les exponemos algunos artículos publicados sobre la hipertensión arterial.

De la Revista: The New England Journal of Medicine

Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients

Por: Kenneth Jamerson, M.D., Michael A. Weber, M.D., George L. Bakris, M.D., Björn Dahlöf, M.D., Bertram Pitt, M.D., Victor Shi, M.D., Allen Hester, Ph.D., Jitendra Gupte, M.S., Marjorie Gatlin, M.D., and Eric J. Velazquez, M.D. for the ACCOMPLISH Trial Investigators.  N. Engl J Med 2008; 359:2417-2428.

Sodium and Potassium in the Pathogenesis of Hypertension

Por: Horacio J. Adrogué, M.D y Nicolaos E. Madias, M.D.  N Engl J Med 2010; 356:1966-1978.

Dietary Therapy in Hypertension

Por: Frank M. Sacks, M.D. y Hannia Campos, Ph.D.  N Engl J Med 2010; 362:2102-2112

Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease

Por: Lawrence J. Appel, M.D., M.P.H., Jackson T. Wright, Jr., M.D., Ph.D., Tom Greene, Ph.D., Lawrence Y. Agodoa, M.D., Brad C. Astor, M.P.H., Ph.D., George L. Bakris, M.D., William H. Cleveland, M.D., Jeanne Charleston, R.N., Gabriel Contreras, M.D., M.P.H., Marquetta L. Faulkner, M.D., Francis B. Gabbai, M.D., Jennifer J. Gassman, Ph.D., Lee A. Hebert, M.D., Kenneth A. Jamerson, M.D., Joel D. Kopple, M.D., M.P.H., John W. Kusek, Ph.D., James P. Lash, M.D., Janice P. Lea, M.D., Julia B. Lewis, M.D., Michael S. Lipkowitz, M.D., Shaul G. Massry, M.D., Edgar R. Miller, Ph.D., M.D., Keith Norris, M.D., Robert A. Phillips, M.D., Ph.D., Velvie A. Pogue, M.D., Otelio S. Randall, M.D., Stephen G. Rostand, M.D., Miroslaw J. Smogorzewski, M.D., Robert D. Toto, M.D. y Xuelei Wang, M.S. for the AASK Collaborative Research Group.  N Engl J Med 2010; 363:918-929.

Aortic Stiffness, Blood Pressure Progression, and Incident Hypertension

Por: Bernhard M. Kaess, MD; Jian Rong, PhD; Martin G. Larson, ScD; Naomi M. Hamburg, MD; Joseph A. Vita, MD; Daniel Levy, MD; Emelia J. Benjamin, MD, ScM; Ramachandran S. Vasan, MD y Gary F. Mitchell, MD.  JAMA. 2012;308(9):875-881.

Vascular stiffness increases with advancing age and is a major risk factor for age-related morbidity and mortality. Vascular stiffness and blood pressure pulsatility are related; however, temporal relationships between vascular stiffening and blood pressure elevation have not been fully delineated.  To examine temporal relationships among vascular stiffness, central hemodynamics, microvascular function, and blood pressure progression. In this cohort, higher aortic stiffness, FWA, and augmentation index were associated with higher risk of incident hypertension; however, initial blood pressure was not independently associated with risk of progressive aortic stiffening.

Hypertension in Children and Adolescents—More Questions Than Answers

Por: Sarah D. de Ferranti, MD, MPH y Matthew W. Gillman, MD.  Arch Pediatr Adolesc Med. 2012;166(9):872-874.

In 2011, the National Heart, Lung, and Blood Institute Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents reiterated the recommendations in the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents published in 2004. These guidelines recommend universal blood pressure screening in pediatric practice starting at age 3 years. If an initial blood pressure (BP) reading exceeds the 90th percentile for age, sex, and height, the practitioner is to repeat the measurement, preferably at least twice on separate occasions. Then he or she can categorize the patient into prehypertensive (90th to 95th percentile), stage 1 hypertension (95th percentile to 5 mm Hg above the 99thpercentile), or stage 2 hypertension (above that high cutpoint).