My Academic Journal #2

World Hypertension Day Celebration

Meeting organized by ACMI.

Prof . Dra. Dora Inés Molina de Salazar

It gives me great pleasure to share with teachers such as Dr. Luis Alcocer, Dr. Luis Moya, Dr. Dagnobar Aristizábal, and Dr. Isabel Cristina Cárdenas and Dr. Tatiana Espinosa, experts on the subject of high blood pressure.

I want to emphasize that the blood pressure goal in patients between the ages of 18 and 65 should be less than 130/80 mm of mercury, if tolerated. And we should never have figures less than 120/70 mm of mercury.

Patients over 65 years of age should have pressures below 140/80 mm of mercury, if tolerated. And never less than 120/70.

Here the intervention of Dr. Alcocer stood out, who spoke of the management of blood pressure in elderly patients. It is clear that an elderly patient, a non-frail elderly patient, must have the same therapeutic objectives as an adult or young adult.

The important thing is to have control and follow-up of this patient.

We only have to be careful in the therapeutic goals of blood pressure goals in those frail elderly, the frail elderly do have special considerations. and postural hypotension should be avoided in them.

Dr. Luis Moya

Dr. Luis Moya, the first speaker, makes a very important academic analysis of the entire history of arterial hypertension guidelines. It shows how in the first guidelines we started with very high figures as a frame of reference for good control of blood pressure, until we reached this moment with the European and American guidelines, where in general we can say that:

Most of our patients have to be in blood pressure goals below 130/80.

He also highlighted that all the hypertension guidelines worldwide coincide in pointing out the need for stratification of the global cardiovascular risk in our patients, before making therapeutic decisions, since the level of risk is decisive for the selection of the initial drug strategy.

Therefore, it is fundamental to always classify the risk, review the comorbidities and based on that, the pharmacological treatment will be prescribed.

Dr. Dagnobar Aristizábal

The doctor . Dagnobar Aristizábal gave us an excellent presentation on how those patients with systolic hypertension, especially people over 50 years of age, have a higher cardiovascular risk, since this systolic hypertension is considered a predictor of cardiovascular disease.

It also showed us how diastolic blood pressure, in people under 50 years of age, is also a predictor of cardiovascular disease, despite being younger people.

Dra. Isabel Cristina Cárdenas

Dr. Isabel Cristina Cárdenas, a specialist in women’s hypertension, a cardiologist, emphasizes the importance of early diagnosis of hypertension in women, which coincides exactly with the stage of menopause, at ages between 50 and 55 years. It is generally systolic hypertension, it has to do with increased sympathetic activity.

But it is also important to keep in mind that the lack of estrogens or hormones that protect the endothelium is the trigger for hypertension in women.

We have to be very alert to make early diagnoses in them and avoid future cardiovascular events. In women, poorly controlled hypertension is the cause of the increased frequency of strokes.

He also spoke of the importance of controlling hypertension in women during pregnancy.

We have to define if a woman who becomes pregnant is Chronic Hypertensive, that is, if she is diagnosed with hypertension prior to pregnancy or if it is hypertension during pregnancy.

And also define if it is in a stage of preeclampsia and eclampsia.

Hypertensive pregnant women are considered to be at high risk for their pregnancy and are advised to have an early diagnosis and appropriate treatment with different medications than women who are not pregnant.

Hypertensive pregnant women are considered to be at high risk for their pregnancy and are advised to have an early diagnosis and appropriate treatment with different medications than women who are not pregnant.

It is essential that those women who suffer from hypertension during pregnancy have permanent follow-up, because it is likely that after pregnancy they will have normal blood pressure, but in the future they may be future hypertensive.

Therefore, the follow-up that must be done in women who develop hypertension during pregnancy is essential.

Dr. Luis Alcocer

Dr. Luis Alcocer, a Mexican cardiologist, who is the current president of the Inter-American Society of Arterial Hypertension, presented a very important conference on aging, ageism, senescence in patients with arterial hypertension, and highlighted from his conference the clarity with which he left us this concept. :

Every older person who, due to his age and due to his phenomenon of stiffening of the arterial wall and his atherosclerosis, develops arterial hypertension, which we are clear that it is not a normal process, it is a physiological process with age, which leads to rigidity of the vascular wall and that should be treated as a priority.

It is essential that we control the blood pressure figures very well for all NON-FRAGILE elderly patients, with goals equal to those of young adults, but also take into account the indication of combined therapy in a single pill.

Impact of combined antihypertensive therapy on therapeutic adherence and goal achievement.

He highlighted from my talk that fixed-dose combinations today, in a single pill, have been associated with better adherence and better clinical outcomes without increasing healthcare costs.

This has been seen in most clinical studies.

The use of single pill combinations is a treatment approach that could be considered more cost effective than the use of free drug combinations.

Reflections from this talk:

Which patients should be treated with fixed combination therapy in a single pill?

First:

Any patient with systolic blood pressure greater than 150 mm of mercury, regardless of cardiovascular risk, is indicated to start therapeutic changes in lifestyle, plus combined therapy in a single pill.

También pacientes con presiones arteriales no controladas, a pesar de tener un tratamiento inicial y esto corresponde más o menos al 54 % de los pacientes ..

Second:

Those patients who, with monotherapy at the maximum dose, have failed to control blood pressure figures are indicated for combined therapy in a single pill.

Those patients who are at high cardiovascular risk, with subclinical target organ damage, also have an indication for fixed combined therapy in a single pill.

And those patients with high blood pressure in whom, when setting the therapeutic goal, we find that the systolic blood pressure is 20 mm of mercury above the set goal and the diastolic blood pressure is 10 mmHg from the set goal.

Finally.

I end with a very important reflection and a message to take home.

What is the reason for the use of combinations in a single pill in the treatment of arterial hypertension?

Efficacy, effectiveness and efficiency have been demonstrated.
We are going to have several sources of attack.
Anti-counterregulation in improving therapeutic adherence in the patient.
The improvement of the therapeutic adherence of the patient.
Fewer side effects.
The conduct of monotherapy today must be considered as prudent, not as evidence.
Combining two drugs at low doses is five times more effective than doubling the dose of monotherapy.
The risk of cardiovascular hard outcomes has been shown to be reduced by 34% in patients starting on combinations, compared to patients starting on monotherapy.

We invite you all to watch the full talks. You can see them here.

In this link you can also listen to the complete presentation that I made.

Thank you.

Prof. Dra Dora Inés Molina de Salazar

High blood pressure day meeting