Hypertension: Baglivo H

Sanchez RA, Ayala M, Baglivo H, Velazquez C, Burlando G, Kohlmann O, Jimenez J, Jaramillo PL, Brandao A, Valdes G, Alcocer L, Bendersky M, Ramirez AJ, Zanchetti A, Anonymous00032. · Sección Hipertensión Arterial y Unidad Metabólica, Fundación Favaloro. Belgrano 1782 P: 4, Buenos Aires, Argentina. · J Hypertens. · Pubmed #19349909 No free full text.

Abstract: Hypertension is a highly prevalent cardiovascular risk factor in the world and particularly overwhelming in low and middle-income countries. Recent reports from the WHO and the World Bank highlight the importance of chronic diseases such as hypertension as an obstacle to the achievement of good health status. It must be added that for most low and middle-income countries, deficient strategies of primary healthcare are the major obstacles for blood pressure control. Furthermore, the epidemiology of hypertension and related diseases, healthcare resources and priorities, the socioeconomic status of the population vary considerably in different countries and in different regions of individual countries. Considering the low rates of blood pressure control achieved in Latin America and the benefits that can be expected from an improved control, it was decided to invite specialists from different Latin American countries to analyze the regional situation and to provide a consensus document on detection, evaluation and treatment of hypertension that may prove to be cost-utility adequate. The recommendations here included are the result of preparatory documents by invited experts and a subsequent very active debate by different discussion panels, held during a 2-day sessions in Asuncion, Paraguay, in May 2008. Finally, in order to improve clinical practice, the publication of the guidelines should be followed by implementation of effective interventions capable of overcoming barriers (cognitive, behavioral and affective) preventing attitude changes in both physicians and patients.

Armentano RL, Graf S, Ramírez AJ, Espinosa JD, Brandani L, Baglivo H, Sánchez R. · Proyecto Dinámica del Sistema Arterial, Universidad Favaloro, Buenos Aires, Argentina. · Medicina (B Aires). · Pubmed #11721319 No free full text.

Abstract: The aim of this study was to compare the mechanical and intrinsic effects of an angiotensin converting enzyme inhibitor, vs a beta-blocker, on brachial arterial compliance. In a double blind study, 34 essential hypertensive patients were treated for 3 months with either ramipril 2.5-5.0 mg daily (n = 17, age 57 +/- 7 y, 11 males) or atenolol 50-100 mg daily (n = 17, age 53 +/- 8 y, 11 males). Blood pressure (BP), brachial artery diameter (D), brachial-radial pulse wave velocity (PWV) and effective compliance (Ceff), were measured before and at the end of the study. Isobaric evaluation (Ciso) was performed in the entire population studied at an average mean BP of 110 mmHg. Ramipril significantly reduced BP from 155 +/- 16/94 +/- 6 mmHg to 140 +/- 15/85 +/- 7 mmHg (p < 0.001) without affecting heart rate (HR; 74 +/- 10 vs. 75 +/- 12 bpm). In addition, it significantly improved both PWV (18%; p < 0.001) and arterial compliance (45%; p < 0.001), from which 35% was related to a pressure independent effect (p < 0.01). Atenolol also induced a reduction in both BP (159 +/- 17/96 +/- 10 to 133 +/- 13/81 +/- 8 mmHg; p < 0.001) and HR (76 +/- 10 to 57 +/- 7 bpm; p < 0.001). In a similar way, PWV (11%; p < 0.05) and Ceff (30%; p < 0.05) were significantly improved without significant change in Ciso. This suggests that blood pressure reduction was responsible for compliance improvement. In conclusion, it is suggested that atenolol induces only hemodynamic changes, mediated mainly by BP reduction. In contrast, the improved brachial buffering function observed after ramipril involves not only hemodynamic changes, but also changes mediated by other mechanisms, such as modification of wall structures.

Ramos F, Kotliar C, Alvarez D, Baglivo H, Rafaelle P, Londero H, Sánchez R, Wilcox CS. · Instituto de Cardiologia y Cirugia Cardiovascular (ICYCC), Fundación Favaloro, Buenos Aires, Argentina. · Kidney Int. · Pubmed #12472793 No free full text.

Abstract: BACKGROUND: Prior studies of percutaneous transluminal renal artery angioplasty and stenting (PTRAS) for atherosclerotic renal artery stenosis (RAS) have shown that renal function is improved in about 25%, stabilizes in about 40%, but worsens in about 25% of patients. The factors predicting benefit remain controversial. We tested the hypothesis that the baseline glomerular filtration rate (GFR) predicts the changes in GFR and blood pressure (BP) after PTRAS. METHODS: Treated hypertensive patients with positive renal color-coded duplex Doppler velocimetry and clinical criteria were screened by arteriography. Patients (N = 105) were included if they had an RAS >or=70%, a transluminal pressure gradient >or=30 mm Hg and, they had more than 100 days of follow-up. GFR was calculated from the serum creatinine concentration (SCr). Patients were divided by baseline GFR into subgroups with normal to mildly impaired (N = 52) or moderately to severely impaired (N = 53) initial GFR, according to a GFR >or=50 or <50 mL. min-1 respectively. All received PTRAS. RESULTS: For the entire group, after a mean follow-up period of 371 days, there were significant reductions in systolic and diastolic BP (before, 160 +/- 26/91 +/- 12 vs. after, 145 +/- 20/83 +/- 10 mm Hg, respectively; mean +/- SD; P < 0.0001), and a modest increase in the calculated GFR (before, 54 +/- 26 vs. after, 62 +/- 28 mL. min-1; mean +/- SD; P < 0.007). However, in the subgroup of patients with an initially lower GFR there was a significant increase in the calculated GFR (from 33.3 +/- 10 to 54 +/- 24 mL. min-1; mean +/- SD; P < 0.0001) despite no significant change in BP (161 +/- 27/90 +/- 12 vs. 151 +/- 21/86 +/- 12; P = NS). In contrast, in the subgroup with an initially higher GFR, there were significant (P < 0.0001) reductions in systolic BP (from 159 +/- 25 to 138 +/- 16 mm Hg) and diastolic BP (from 91 +/- 11 to 81 +/- 9 mm Hg), but no significant change in the calculated GFR (from 75 +/- 21 to 70.2 +/- 30 mL. min-1; P = NS). The significance of GFR variation in subgroups remained after correction of baseline data to exclude the influence of the expected regression to the mean. CONCLUSIONS: Patients with atherosclerotic RAS fulfilling strict criteria of severity may have significant improvements in BP one year after PTRAS but only modest in GFR. The initial GFR may anticipate whether the benefits in the outcome will be in renal function enhancement (those with an initially depressed GFR) or in hypertension control (those with an initially normal or mildly impaired GFR).