Hypertension: Attie F

Rosas M, Pastelín G, Vargas-Alarcón G, Martínez-Reding J, Lomelí C, Mendoza-González C, Lorenzo JA, Méndez A, Franco M, Sánchez-Lozada LG, Verdejo J, Sánchez N, Ruiz R, Férez-Santander SM, Attie F, Anonymous00054. · Departamento de Cardiología Adultos III, Instituto Nacional de Cardiología "Ignacio Chávez", Tlalpan, México DF. · Arch Cardiol Mex. · Pubmed #18928127 No free full text.

Abstract: The multidisciplinary Institutional Committee of experts in Systemic Arterial Hypertension from the National Institute of Cardiology "Ignacio Chávez" presents its update (2008) of "Guidelines and Recommendations" for the early detection, control, treatment and prevention of Hypertension. The boarding tries to be simple and realistic for all that physicians whom have to face the hypertensive population in their clinical practice. The information is based in the most recent scientific evidence. These guides are principally directed to hypertensive population of emergent countries like Mexico. It is emphasized preventive health measures, the importance of the no pharmacological actions, such as good nutrition, exercise and changes in life style, (which ideally it must begin from very early ages). "We suggest that the changes in the style of life must be vigorous, continuous and systematized, with a real reinforcing by part of all the organisms related to the health education for all population (federal and private social organisms). It is the most important way to confront and prevent this pandemic of chronic diseases". In this new edition the authors amplifies the information and importance on the matter. The preventive cardiology must contribute in multidisciplinary entailment. Based mainly on national data and the international scientific publications, we developed our own system of classification and risk stratification for the carrying people with hypertension, Called HTM (Arterial Hypertension in Mexico) index. Its principal of purpose this index is to keep in mind that the current approach of hypertension must be always multidisciplinary. The institutional committee of experts reviewed with rigorous methodology under the principles of the evidence-based medicine, both, national and international medical literature, with the purpose of adapting the concepts and guidelines for a better control and treatment of hypertension in Mexico. This work group recognizes that hypertension is not an isolated disease; therefore its approach must be in the context of the prevalence and interaction with other cardiovascular risk factors such as obesity, diabetes, dislipidemia and smoking among others. The urgent necessity is emphasized to approach in a concatenated form the diverse cardiovascular risk factors, since independently of which they share common pathophysiological mechanisms, its suitable identification and control will affect without any doubt the natural history of the other concatenated risk factor. By all means that to greater participation of factors, greater it will be the global cardiovascular risk but never, however, the specific weight is due to avoid that each one has on the global cardiovascular risk. In this Second edition we try to amplify and give systematic forms for the clinical approach for the suspicion of secondary hypertension and we emphasizes that hypertension in the woman with or without menopause should be careful analyzed, and special recommendations are given for the hypertension in pregnancy. Also we have approached some aspects related to the hypertensive emergencies and other special situations. In this second version some recommendations are presented for boarding hypertension in children and adolescents.

Rosas M, Pastelín G, Martínez Reding J, Herrera-Acosta J, Attie F, Anonymous00101. · Instituto Nacional de Cardiología Ignacio Chavez, Tlalpan, México, DF. · Arch Cardiol Mex. · Pubmed #15291043 No free full text.

This publication has no abstract.

Lomelí C, Rosas M, Mendoza-González C, Lorenzo JA, Pastelín G, Méndez A, Ferez SM, Attie F. · Departamento de Cardiología Adultos III, Instituto Nacional de Cardiología "Ignacio Chávez", INCICH Juan Badiano Núm. 1, Sección XVI, Tlalpan 14080, México, DF. · Arch Cardiol Mex. · Pubmed #18938690 No free full text.

Abstract: The cardiovascular disease is a crucial cause of morbidity and mortality in the woman mainly when they arrive at menopause. The pathophysiology and neurohormonal mechanisms widely vary with respect to the man. This finding has given the support to think that the estrogens may be playing a protector role in cardiovascular disease. However, the associated risk factors like obesity, diabetes, dislipidemia, smoking and sedentary life are increasing in an exponential form. In Mexico the population age distribution establishes that 60% of the women with hypertension are aged < 54 years old. This is reason why as factor of independent cardiovascular risk is commonest. Nevertheless, after the menopause cardiovascular mortality is greater in the woman than in the man. In this review, the importance of the new pathophysiological mechanisms and the clinical-therapeutic approach are analyzed, making emphasis in the importance of the change in the life style and also in the nutritional aspects. In Mexico the woman still have a unique role in the nutritional culture.

Velázquez Monroy O, Rosas Peralta M, Lara Esqueda A, Pastelín Hernández G, Attie F, Tapia Conyer R, Anonymous00206. · Centro Nacional de Vigilancia Epidemiológica, Benjamín Franklin #132, Colonia Escandón, Delegación Miguel Hidalgo C.P. 11800, Mexico D.F. · Arch Cardiol Mex. · Pubmed #11933703 No free full text.

Abstract: AIMS: Hypertension remains as a major cause of cardiovascular morbidity in México. The Health National Survey 2000 of México was performed to analyze the current status of the prevalence of some risk factors such as diabetes, hypertension (HTA), obesity, smoking, and proteinuria. METHODS: A National Survey was carried out in México where 45,300 individuals between 20 to 69-y.o. were screened. The estimated sample size was calculated considering the total number of persons into the mentioned age; a minimal prevalence of 6% of the included risk factors, at a significance level of 0.05; a maximum relative error of 0.145, and a rate of response of at least 70%. Diagnosis of HTA was accepted in: previous medical diagnosis with prescription of antihypertensive drugs, or high blood pressure (> or = 140/90 mmHg) detected during the interview. Data were adjusted for the national distribution of age-groups and gender (established in 2000, INEGI). RESULTS: 38,377 (98.8%) individuals were correctly screened for blood pressure. The prevalence of hypertension in México was 30.05% (34.2% in men and 26.3% in women). The prevalence was directly related with age and gender. The percentage of mexicans with HTA after 50-y.o. is > 50%. The prevalence was greater in women after 50-y.o. Among persons with hypertension, treatment was detected in 46% and approximately 20% of them were controlled (< 140/90 mmHg). The percentage of mexicans with HTA who were unaware that they have high blood pressure was 61%. The total percentage of HTA controlled was 14.6%. The North states had the greater prevalence (approximately 34%) of HTA while South states had the lower prevalence (27%). The odds ratio (age/sex-adjusted) for HTA were: for diabetes 1.54(CI95%, 1.44-1.63); for obesity 2.3 (CI 95%, 2.22-2.43); for smoking 1.26 (CI 95%, 1.21-1.32). For proteinuria subjects, 40% had HTA. CONCLUSIONS: Around 15 millions of mexicans between 20 to 69-y.o. had hypertension, 60% of them are unaware. The prevalence of hypertension in México (30.05%) has increased. Among persons with hypertension -15% are controlled. The North of México has the higher prevalence of hypertension. Diabetes, smoking, and obesity increase the risk of hypertension. The 2000 National Survey of Health shows the epidemiological trend in several important chronic diseases in México and declare an urgent need of new strategies for detection, control and treatment of hypertension.

Rosas M, Lomelí C, Mendoza-González C, Lorenzo JA, Méndez A, Férez Santander SM, Attie F. · Departamento de Cardiología Adultos III, Instituto Nacional de Cardiología, "Ignacio Chávez", (INCICH, Juan Badiano Núm. 1, Sección XVI, Tlalpan 14080, México, DF. · Arch Cardiol Mex. · Pubmed #18938691 No free full text.

Abstract: Increasing evidence indicates that hypertension in pregnancy is an under recognized risk factor for cardiovascular disease (CVD). Compared with women who have had normotensive pregnancies, those who are hypertensive during pregnancy are at greater risk of cardiovascular and cerebrovascular events and have a less favorable overall risk profile for CVD years after the affected pregnancies. One factor that might underlie this relationship is that hypertensive disorders of pregnancy (pre-eclampsia, in particular) and CVD share several common risk factors (e.g. obesity, diabetes mellitus and renal disease). Alternatively, hypertension in pregnancy could induce long-term metabolic and vascular abnormalities that might increase the overall risk of CVD later in life. In both cases, evidence regarding risk-reduction interventions specific to women who have had hypertensive pregnancies is lacking. While awaiting results of large-scale studies, hypertensive disorders of pregnancy should be screened for during assessment of a woman's overall risk profile for CVD. Women at high risk must be monitored closely for conventional risk factors that are common to both CVD and hypertensive disorders of pregnancy and treated according to current evidence-based national guidelines.

Rosas M, Pastelín G, Lomelí C, Mendoza-González C, Méndez A, Lorenzo-Negrete JA, Martínez-Reding J, Férez Santander SM, Attie F. · Departamento de Cardiología Adultos III, Instituto Nacional de Cardiología "Ignacio Chávez", INCICH, Juan Badiano 1, secc. XVI, Tlalpan 14080, México DF. · Arch Cardiol Mex. · Pubmed #18938689 No free full text.

Abstract: The incidence of hypertension in the geriatric population is very high and is a significant determinant of cardiovascular risk in this group. The tendency for blood pressure to increase with age in westernized societies such as the United States may depend on environmental factors such as diet, stress, and inactivity. Our population tends to become more obese; to consume relatively greater amounts of sodium and lesser amounts of potassium, calcium, and magnesium; and to decrease exercising with increasing age. Senescent changes in the cardiovascular system leading to decreased vascular compliance and decreased baroreceptor sensitivity contribute not only to rising blood pressure but also to an impairment of postural reflexes and orthostatic hypotension. The hallmark of hypertension in the elderly is increased vascular resistance. Greater vascular reactivity in the elderly hypertensive patients may reflect decreased membrane sodium pump activity and decreased beta-adrenergic receptor activity as well as age-related structural changes. Treatment of diastolic hypertension in the elderly is associated with decreased cardiovascular morbidity and mortality. Although treatment of systolic hypertension may not decrease immediate cardiovascular mortality, it appears to decrease the incidence of stroke. The initial therapeutic approach to the elderly hypertensive patient should generally consist of a reduction in salt and caloric intake and an increase in aerobic exercise, i.e., walking. Drug therapy should be initiated with lower doses of medication with a special concern about orthostatic hypotension.

Lomelí C, Rosas M, Mendoza-González C, Méndez A, Lorenzo JA, Buendía A, Férez-Santander SM, Attie F. · Departamento de Cardiología Adultos III, Instituto Nacional de Cardiología "Ignacio Chávez", INCICH, Juan Badiano Núm. 1, Col. Sección XVI, Tlalpan 14080, México, DF. · Arch Cardiol Mex. · Pubmed #18938688 No free full text.

Abstract: The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking. Secondary hypertension is more common in preadolescent children, with most cases caused by renal disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension. Evaluation involves a through history and physical examination, laboratory tests, and specialized studies. Management is multifaceted. Nonpharmacologic treatments include weight reduction, exercise, and dietary modifications. Although the evidence of first line therapy for hypertension is still controversial, the recommendations for pharmacologic treatment are based on symptomatic hypertension, evidence of end-organ damage, stage 2 of hypertension, or stage 1 of hypertension unresponsive to lifestyle modifications, and hypertension with diabetes mellitus.

Mendoza-González C, Rosas M, Lomelí Estrada C, Lorenzo JA, Méndez A, Martínez-Reding J, Martínez-Sánchez C, Pastelín G, Férez-Santander SM, Attie F. · Departamento de Cardiología Adultos, Instituto Nacional de Cardiología, "Ignacio Chávez", INCICH, Juan Badiano Núm. 1, Col. Sección XVI, Tlalpan 14080, México, DF. · Arch Cardiol Mex. · Pubmed #18938687 No free full text.

Abstract: From beginnings of last century the hypertensive emergency was defined as the association of acutely elevation from the arterial pressure and the appearance of damage to end organ. At present is recognized the effects of the hypertensive emergency, the aspects of its patophysiology in which are included phenomenon of vasomotricity and the participation of different substances with vasoactives properties. The clinical presentation includes not only the manifestations of the increase of the arterial pressure, the end organ damage too; for this reason the hypertensive emergency needs the immediate reduction of the arterial tension to prevent the damage to specific organs. The treatment in every case will have to be individualized, with a wide knowledge of the characteristics of every medicament to obtain the best results. The diagnosis and treatment of the hypertensive emergencies needs often of the attention of its complications if they have appeared and later, of a treatment of support for the arterial hypertension.

Mendoza-González C, Rosas M, Estrada CL, Lorenzo JA, Méndez A, Martínez-Reding J, Martínez-Sánchez C, Pastelín G, Férez-Santander SM, Attie F. · Departamento de Cardiología Adultos, Instituto Nacional de Cardiología "Ignacio Chávez", INCICH, Juan Badiano Núm. 1, Col. Sección XVI, Tlalpan 14080, México, DF. · Arch Cardiol Mex. · Pubmed #18938686 No free full text.

Abstract: The association between arterial systemic hypertension arterial coronary disease has been demonstrated by cumulated evidence of several epidemiological studies. Hypertension is an important independent risk factor for the development of coronary artery disease, vascular cerebral disease and nephropathy. Important advances exist in the knowledge of neurohumoral and hemodynamic factors that come together in the pathophysiology of the hypertension and in the development of coronary disease that allow to establish better strategies not only of treatment, but also of prevention, with the purpose of diminishing the cardiovascular mortality. The spectrum of the coronary artery disease secondary to atherosclerosis is wide and the strategies of treatment of hypertension must be adapted to each particular case. The treatment of both conditions needs of specific limits of agreement to the conditions of the patient and the form of presentation of each one of these disease.

Cervantes Salazar JL, Ramírez Marroquín S, Benita Bordes A, Rosas Peralta M, Attie F. · Servicio de Cirugía de Cardiopatías Congénitas, Departamento de Cirugía, Institute Nacional de Cardiología "Ignacio Chávez" (INCICH, Juan Badiano Num. 1, Col. Sección XVI, Tlalpan 14080, México, DF. · Arch Cardiol Mex. · Pubmed #16749504 No free full text.

Abstract: OBJECTIVES: Evaluate long-term evolution of patients submitted to surgery for coarctation of the aorta. Compare event free survival in younger vs older patients at the time of surgical correction. METHODS: We reviewed the clinical records of patients operated for coarctation of the aorta from January 1 1980 to December 31 1994. The mean follow-up ranged from 9 to 23 years (mean 10.9 y). Final events registered were recoarctation, death, systemic hypertension, endocarditis, stroke, aneurisms. RESULTS: Two hundred and sixteen patients were found with mean age 13 +/- 12 y male gender was most frequent (61%). Recoarctation was found in 13 patients (6.02%), persistent hypertension in 14.1%. Event free survival at 10 years was 86.2%. In patients less than 10 y was 89% vs 80.2% in older patients. Hypertension free survival in patients less than 10 y was 98.3% vs 80.1% in older patients (p < 0.001). CONCLUSIONS: Our data confirms that surgical treatment for coarctation of the aorta is associated with low morbidity and mortality at long-term with reduced rate of recoarctation (7%). Early correction (< 10 y) is associated with a better long term survival. Hypertension and use of pharmacologic treatment are reduced after surgery and persist in the long-term evolution.

Rosas-Peralta M, Sandoval-Zárate J, Attie F, Pulido T, Santos E, Granados NZ, Miranda T, Escobar V. · Departamento de Investigación Cardiopulmonar, Instituto Nacional de Cardiología Ignacio Chávez, México, DF México. · Gac Med Mex. · Pubmed #16548288 No free full text.

Abstract: BACKGROUND: A reduction of heart rate variability (HRV) is currently considered an independent risk factor for morbidity, mortality and severity of severalcardiac disease, however, the dynamic sympathovagal modulation on HRV during 24 hr in primary pulmonary hypertension (PPH) had not been described. METHODS: 24 hr Holter monitoring (HA) were recorded in 32 patients (mean age 34, +/-12, 90% female) with severe primary pulmonary hypertension (mean pulmonary pressure, 90:t:12 mm Hg), and in 34 patients (mean age 36 +/-14, 60% female) with Eisenmenger syndrome (ES) secondary to septal ventricular defect or atent ductus arteriosus. A control group (n=44) paired for age, gender and arterial pulmonary pressure was included. HRV time and spectral parameters (mean, SDNN, SDANN, rMSSD, PNN50, LF, HF and LF/HF ratio) were analyzed during three periods: 24 hr; day (8-22:00), night (23-07:00) and also every hour of recording at 5 min-intervals). After detection of sympatho-vagal balance 15 patients were randomized, Treprostinil (prostaglandin) was administered to 6 patients and subcutaneous placebo to 9. RESULTS: HRV frequency parameters during 24 hr HM were significantly different among groups. LF/HF (day) 5.9:1:12.5:1:1P.001 and LF/HF night) 2.8:tlvs.1.5:l:.8.034. Sympathovagal modulation on 24 hr HRV showed that heart rate circadian rhythm is clearly altered in both PPH and ES, but the sympathetic tone in PPH is higher at l 24 hr. (p < .05), after administering treprostinil a recovery of sympathovagal balance was observed CONCLUSIONS: Autonomic cardiac disturbance is clearly present in PPH and ES. The circadian rhythm of HRV is first lost due to an increase of sympathetic tone. These changes may be markers of autonomic disbalance that favor the development of arrhythmias and sudden death. The sympathovagal balance in PPH could be considered an important risk marker.

Rosas M, Attie F, Pastelin G, Lara A, Velazquez O, Tapia-Conyer R, Martinez-Reding J, Mendez A, Lorenzo-Negrete A, Herrera-Acosta J. · National Institute of Cardiology and Ministry of Health, Juan Badiano 1, Sección XVI Tlalpan, México City, México 14080. · Kidney Int Suppl. · Pubmed #16014088 No free full text.

Abstract: BACKGROUND: A number of cross-sectional or serial studies have demonstrated the clinical impact of microproteinuria and macroproteinuria by identifying individuals at risk of both end-stage renal disease and major cardiovascular events. This study focused on the prevalence of proteinuria in Mexico and its relationship with other cardiovascular risk factors such as hypertension, type 2 diabetes mellitus, body mass index, smoking, age, and gender. METHODS: The prevalence of proteinuria in Mexico was obtained from the probabilistic cross-sectional national health survey performed in the year 2000. The proportion of urine dipstick samples that tested positive for protein (defined as > or =1+) in adults from 20 to 69 years of age was determined. The analysis was performed using both algebraic and multicategorical models. Potential interactions between proteinuria and other major cardiovascular risk factors were investigated. RESULTS: A total of 46,523 adult survey participants were included in the analysis. In the general population, 9.2% had proteinuria. By univariate, multivariate, and multicategorical analysis, hypertension, diabetes, obesity, and age were strongly associated with the prevalence of proteinuria (P < 0.001). However, in Mexico, the specific distribution of age groups demonstrated that the absolute number of patients without hypertension that had proteinuria is not irrelevant. To identify 1 case of proteinuria, one would need to screen 3 persons with diabetes mellitus, 5 patients with hypertension without diabetes, or 6 persons over the age of 55 years. When proteinuria is present, the probability of having a noncommunicable chronic disease or other major cardiovascular risk factor is more than 85%. CONCLUSION: Proteinuria is prevalent. When considered together, dipstick-positive proteinuria, blood pressure level, body mass index > or =30 m(2)/kg, and abnormal fasting blood glucose measured on a single occasion identifies different segments of the population. Studies such as this may be a suitable initial clinical approach to general population screening for renal and cardiovascular risk stratification.

Rosas Peralta M, Lara Esqueda A, Pastelín Hernández G, Velázquez Monroy O, Martínez Reding J, Méndez Ortiz A, Lorenzo Negrete JA, Lomelí Estrada C, González Hermosillo A, Herrera Acosta J, Tapia Conyer R, Attie F. · Cardiología Clínica- 3er Piso, Instituto Nacional de Cardiología "lgnacio Chávez", Juan Badiano #1, Col. Sección XVI, Delegación Tlálpan, C.R 14080, México, DF. · Arch Cardiol Mex. · Pubmed #15909748 No free full text.

Abstract: OBJECTIVE: Based on a National Re-survey on Hypertension (HTA) and other cardiovascular risk factors performed in Mexico during 2003 and 2004 in the adult population with HTA, as identified in the 2000 National Survey of Health, this study was planed to determine: 1) morbidity and mortality rates; 2) the incidence and interrelation with other risk factors, such as overweight, obesity, dyslipidemia, nephropathy and diabetes; 3) the main risk factors associated to HTA involved in its complications, need for hospitalization and number of days; and, 4) the degree of therapeutical adhesion and the type of antihypertensive drugs used. METHODS: The survey was of type III using the step by step method described by WHO. Sampling was weighed a priori taking into account a national prevalence average of HTA of 30.05% and its corresponding rate for each federal state. Permissible maximum error in the estimation = 0.28. Effect of design = 4.5; and, Rate of awaited answer (0.70). RESULTS: From the initial 14,567 interviewed patients, 1,165 (8%) subjects were considered non-hypertensive or false positives at the 2000 survey. From the 13,402 remaining patients, 335 died during the first 2 years of pursuit, which implies an annual mortality of approximately 1.15% in the hypertensive population. Thus, 13,067 survivors were subjected to the final analysis. The mean age at the re-survey was 45.6 +/- 12.6; 40.5% were men (n = 5,295). There was a statistically significant difference in height, but not in weight between both genders. The control HTA was raised 14.6% in the year 2000 and 19.2% in 2004. The prevalence of diabetes was duplicated from 16% to 30% (< .001). Fifty four percent of the whole population required hospitalization at least once during the period of study. The rates of overweight, obesity, and dyslipidemia rose significantly (p < 0.05) independently from age, federal state, and gender. CONCLUSION: RENAHTA shows the impact of hypertension on the morbidity and mortality during the 3.1 +/- 1.5 years of follow-up in Mexico. It alerts us on the need to reinforce the strategies of attention and prevention of this crucial risk factor and of screening the dynamic nonlinear interaction between the main cardiovascular risk factors in Mexico. New hypotheses are proposed for the metabolic syndrome.

Lara A, Rosas M, Pastelín G, Aguilar C, Attie F, Velázquez Monroy O. · Secretaría de Salud. · Arch Cardiol Mex. · Pubmed #15559877 No free full text.

Abstract: AIMS: To know the prevalence and the interaction among the principal cardiovascular risk factors such as hypercholesterolemia (HCL), hypertension (HTA), overweight, carbohydrates metabolism disturbances, and smoking, an urban survey was performed in the six Mexican Republic states, where the national population is more concentrated. METHODS: This survey was transversally designed using the WHO type-III model in 120,005 adults from 6 highly populated urban centers (Mexico City, Guadalajara, León, Puebla, Monterrey andTijuana) were included. A blood sample from each person was obtained to quantify fasting glucose and cholesterol. Blood pressure, height and weight were measured using daily validated systems. Data were analyzed by a multicategorical conjunctive consolidation model and by multiple regression models. RESULTS: HCL global prevalence showed to be 43.3% for a population with an average age of 44.1 years. Female gender showed a slightly but statistically significant greater prevalence of HCL than male gender (44% vs 42.2%). From whole women population 33.2% declared to be in menopause, and 59.7% of them had HCL. In addition, HCL was directly related to body mass index (BMI). Thus, in those subjects with BMI < 25 showed a HCL prevalence 34.1%; while those with BMI was between 25 and 29.9, the HCL prevalence was 45.9%, and in those subjects with BMI > or = 30 Kg/m2, ranked a HCL prevalence of 47.3%. The prevalence of hypertension was 30.2% and 52.5% of them had HCL prevalence. Type-2 diabetes mellitus prevalence (DM-2) was 10.7%, 55.2% of them had HCL. In the group aged between 20 to 34 years old, the obesity was the principal determinant for higher HCL prevalence. The HCL prevalence showed to be quite similar in population with and without smoking. In conclusion, HCL prevalence shows 4 progressively increasing gradients associated with age, HTA, DM-2 and BMI.

Calderón-Colmenero J, Flores A, Ramírez S, Patiño-Bahena E, Zabal C, García-Montes JA, Rizo S, Buendía A, Attie F. · Instituto Nacional de Cardiología Ignacio Chávez, INCICH, Juan Badiano No. 1 Col. Sección XVI, Tlalpan, 14080 México, D.F. · Arch Cardiol Mex. · Pubmed #15125265 No free full text.

Abstract: We made a retrospective study of patients with Down's syndrome that were surgically treated for correction or palliation for their congenital heart disease between january 1996 to december of the 2000 in the National Institute of Cardiology "Ignacio Chávez". We analyzed these variables: age at the surgical moment, sex, congenital heart defect, pulmonary arterial pressure, type of surgery, time of stay in the intensive care unit, complications and mortality. In this period they were surgically treated 37 patients. The mean age was of 2 years with 8 months with a range of 2 months to 17 years. The interventricular defect was the most frequent one (35%) and it was associated to persistent ductus arteriosus in the 61% of the cases. Six patients (16%) had atrioventricular septal defect, the half of them type A and other half type C of Rastelli classification. Twelve patients (32%) had one lesion persistent ductus arteriosus. Three patients had tetralogy of Fallot and two atrial septal defect. Pulmonary hypertension was found in 90% of the patients, in 23 was severe (62%), moderate in 5 and slight in 6 (16%). The surgical treatment was corrective in 89% patients and the average time of stay in intensive care unit was of 2.5 days. The most frequent complication was rhythm and conduction disorders, in 8 patients (22%), three with complete AV block and the mortality was of 8%. In the patients with Down's syndrome is important a complete clinical evaluation with an eye toward establishing an opportune surgical treatment.

Rosas M, Attie F, Sandoval J, Castellano C, Buendía A, Zabal C, Granados N. · Department of Adult Congenital Heart Disease, Mexico, Mexico. · Int J Cardiol. · Pubmed #14975540 No free full text.

Abstract: BACKGROUND: Although good prognosis and clinical long-term outcome have been commonly reported in minimally symptomatic adult patients with ASD, this information has been based on studies with a relatively small number of adult patients. We studied unoperated patients aged over 40 years to define the patterns of presentation, anatomical characteristics, outcome and predictive factors for free-event survival of major cardiovascular and pulmonary events. METHODS AND RESULTS: Two-hundred survivors of atrial septal defect aged over 40-yr attended from 1985 to 1998 were reviewed and followed-up from 1.6 to 22 years. Patients were classified in three groups according to age at entry: Group 1, between 40 and 49; Group 2; 50 and 59; and Group 3, > or =60 years old. The mean age at presentation was 48.8+/-9.2 years, and the most common clinical presentations were arrhythmia and dyspnea (51.4%). There were 37 (18.5%) events: 7 heart failure-related, 5 sudden death, 13 severe pulmonary infections, 5 embolisms, and 4 strokes. According to Cox's regression analysis, predictors of primary end point included age group at presentation (hazard ratio 1.71, 95% confidence limits 1.16 to 2.54), and either pulmonary hypertension (mean pulmonary pressure >35 mmHg; hazard ratio=0.65 (4.6, confidence limits 2.2 to 9.5) or, arterial oxygen saturation <80% (hazard ratio 1.71, 95% confidence limits 1.16 to 2.54). CONCLUSIONS: This study supports that long term outcome of patients aged >40 years with unoperated ASD is importantly determined by the mPAP (>35 mmHg), SaO2% (_80) and the age at diagnosis. Nevertheless we identified an inverse association between the mPAP level and SaO2% (interaction). The event-free survival expectancy may be estimated using the age at diagnosis and either SaO2% or mPAP. This prognostic stratification based on pathophysiological principles, may help in making decisions for therapeutic interventions. SaO2% should always be measured as a part of the initial clinical approach of those patients with atrial septal defect aged over 40 years.

Velázquez-Monroy O, Rosas Peralta M, Lara Esqueda A, Pastelín Hernández G, Sànchez-Castillo C, Attie F, Tapia Conyer R, Castillo C. · Centro Nacional de Vigilancia Epidemiológica, Benjamín Franklin #132, Colonia Escandón, Delegación Miguel Hidalgo C.P. 11800, México, D.F. · Arch Cardiol Mex. · Pubmed #12820496 No free full text.

Abstract: PURPOSE: To determine the prevalence and interrelation of noncommunicable chronic diseases (NCCD), obesity, smoking, and proteinuria in the adult population (between 20 and 69 years of age) of Mexico, and their stratification according to age, gender, and geographical area. METHOD: During the year 2000, a probabilistic national survey was performed in 45,300 persons. The sample size was calculated to approach NCCD with a minimal estimated prevalence of 6%. The survey corresponds to type III of the step-by-step method described by WHO. Data were weighted for the distribution of the population and gender, according to the national survey of population and housing (National Institute of Statistics and Geography, INEGI). RESULTS: A total of 38,377 (98.8%) of individuals were included in the analysis; 69.4% were women. Average age for men was 39.4 +/- 12.9 and for women 38.6 +/- 13.0. National average prevalence for hypertension was 30.05%, for diabetes of 10.7%, for obesity of 24.4%, for abnormal capillary glucose of 12.7%, and for proteinuria of 9.2%. Prevalence for hypertension and diabetes were directly related with age, body mass index, and waist perimeter. The pyramidal distribution of the Mexican population determined that the greatest proportion of prevalence of NCCD was given by those under 54 years of age with a statistical significance (> 75%). CONCLUSION: ENSA 2000 demonstrates the marked increase in NCCD prevalence in the Mexican population and alerts on the urgent need of national strategies to restrain this important public health problem. Strategies must be oriented towards an integrated approach of the NCCD, since their clinical and physiopathological interrelation is clearly demonstrated through ENSA 2000.

Munayer Calderón J, Zabal Cerdeira C, Ledesma Velazco M, Aldana Pérez T, Ramírez Reyes H, Lázaro Castillo JL, Attie F, Alva Espinoza C, Buendía Hernández A, Jiménez Zepeda D, Martínez Ríos MA, Jiménez Arteaga S, Luis Miranda RS, Calderón Colmenero J, Martínez Sánchez A, Maza Juárez G, Gómez FD, Ortegón Cárdenas J, García Montes JA, Quintero LR, Campos Gómez A, Sánchez Soberanes A. · Hospital General Centro Médico Nacional La Raza, IMSS, México D.F. · Arch Cardiol Mex. · Pubmed #11933695 No free full text.

Abstract: OBJECTIVES: To analyze immediate and long-term results of balloon dilation for aortic coarctation in a three-center experience in Mexico, and to determine factors associated with increased risk. BACKGROUND: Results demonstrated that the procedure is effective and safe, however its use in some groups is still controversial, specially in neonates and infants. METHODS: In a ten-year period, 333 patients with aortic coarctation on underwent balloon dilation with an immediate success rate of 93.7% and a major complication incidence of 1.8%. Of the total cohort, 272 patients were followed for a period of 24.3 +/- 20 months. Demographic and procedural data were analyzed to determine factors related to a poor outcome or to sustained high blood pressure. RESULTS: Cox regression analysis found age (risk ratio 3.42 p = 0.0001), isthmic hypoplasia (risk ratio 4.64, p < 0.0001), and post-dilation gradient (risk ratio 2.19, p = 0.0113) as independent risk factors for a follow-up event, mainly restenosis. Age at dilation was the only independent factor related to sustained hypertension with a seven-fold increase in the risk. CONCLUSIONS: Balloon dilation is an effective and safe alternative to treat aortic coarctation. Patients younger than one year of age, with severe isthmic hypoplasia and a post-dilation gradient > 20 mmHg have the highest risk to develop an event in the follow-up period. When the dilation procedure is performed in patients older than 10 years of age, and specially those older than 20 years, the probability that they remain or develop high blood pressure is increase.