Disminución de la función renal con la edad en Chile: diferencias de género y efecto de comorbilidades

La velocidad de filtración glomerular estimada (VFGe) mediante creatinina sérica es ampliamente utilizada para evaluar la función renal. Su disminución con la edad y en presencia de enfermedades crónicas como diabetes, hipertensión y obesidad es bien conocido, sin embargo, no existen datos representativos en la población chilena. Objetivo: Estimar la disminución de VFGe con la edad según género y presencia de enfermedades crónicas en población adulta chilena. Métodos: Estudio transversal en 5.638 participantes ≥18 años de la Encuesta Nacional de Salud 2009 y 2017. Se estimó VFGe mediante CKD-EPI a partir de creatinina sérica. Se comparó la disminución de VFGe por género y presencia de enfermedades crónicas (diabetes, hipertensión, dislipidemia y/u obesidad). Resultados: La VFGe disminuyó con la edad en ambos géneros, con mayor pendiente en mujeres (-0,88 vs -0,78 mL/min/1,73 m2/año, p<0,01). La VFGe disminuyó temprana y homogéneamente a partir de los 18 años. En presencia de enfermedades crónicas la pendiente fue significativamente mayor (-0,94 vs -0,83 mL/min/1,73 m2/ año, p<0,001). Las mujeres con enfermedades crónicas tuvieron la mayor disminución (-1,00 mL/min/1,73 m2/año). Conclusión: La VFGe disminuyó progresivamente con la edad en población chilena, observándose una disminución temprana a partir de los 18 años, acentuándose en mujeres y presencia de enfermedades crónicas. Nuestros hallazgos entregan información poblacional relevante para la interpretación de la VFGe en distintos grupos etarios y de riesgo

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the region of the Americas

Cardiovascular disease (CVD) is the leading cause of death in the Americas and raised blood pressure accounts for over 50% of CVD. In the Americas over a quarter of adult women and four in ten adult men have hypertension and the diagnosis, treatment and control are suboptimal. In 2021, the World Health Organization (WHO) released an updated guideline for the pharmacological treatment of hypertension in adults. This policy paper highlights the facilitating role of the WHO Global HEARTS initiative and the HEARTS in the Americas initiative to catalyze the implementation of this guideline, provides specific policy advice for implementation, and emphasizes that an overarching strategic approach for hypertension control is needed. The authors urge health advocates and policymakers to prioritize the prevention and control of hypertension to improve the health and wellbeing of their populations and to reduce CVD health disparities within and between populations of the Americas.Fil: Campbell, Norm R.C.. University of Calgary; Canadá. Pan American Health Organization; Estados UnidosFil: Paccot Burnens, Melanie. Ministerio de Salud de Chile; ChileFil: Whelton, Paul K.. University of Tulane; Estados UnidosFil: Angell, Sonia Y.. Columbia University; Estados UnidosFil: Jaffe, Marc G.. Kaiser Permanente San Francisco Medical Center; Estados UnidosFil: Cohn, Jennifer. University of Pennsylvania; Estados UnidosFil: Espinosa Brito, Alfredo. Hospital “Dr. Gustavo Aldereguía Lima”; CubaFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Brettler, Jeffrey W.. Kaiser Permanente Bernard J. Tyson School of Medicine; Estados UnidosFil: Roccella, Edward J.. Lung and Blood Institute National Institutes of Health Bethesda; Estados UnidosFil: Maldonado Figueredo, Javier Isaac. Pan American Health Organization; Estados UnidosFil: Rosende, Andres. Pan American Health Organization; Estados UnidosFil: Ordunez, Pedro. Pan American Health Organization; Estados Unido

Diretrizes de 2021 da Organização Mundial da Saúde sobre o tratamento medicamentoso da hipertensão arterial: repercussões para as políticas na região das Américas

Las enfermedades cardiovasculares son la principal causa de muerte en la Región de las Américas y la hipertensión es la causa de más del 50% de ellas. En la Región, más de una cuarta parte de las mujeres adultas y cuatro de cada diez hombres adultos tienen hipertensión y su diagnóstico, tratamiento y control son deficientes. En el 2021, la Organización Mundial de la Salud (OMS) publicó directrices actualizadas sobre el tratamiento farmacológico de la hipertensión en personas adultas. En este artículo se destaca el papel facilitador de la iniciativa mundial HEARTS de la OMS y la iniciativa HEARTS en las Américas para catalizar la implementación de estas directrices, a la vez que se proporciona asesoramiento específico sobre políticas para dicha implementación y se destaca la necesidad de adoptar un enfoque estratégico general para el control de la hipertensión. Los autores instan a quienes abogan por la salud y a los responsables de las políticas a priorizar la prevención y el control de la hipertensión para mejorar la salud y el bienestar de la población, y a reducir las disparidades de salud en relación con las enfermedades cardiovasculares dentro de la población y entre las poblaciones de la Región de las Américas.Cardiovascular disease (CVD) is the leading cause of death in the Americas and raised blood pressure accounts for over 50% of CVD. In the Americas over a quarter of adult women and four in ten adult men have hypertension and the diagnosis, treatment and control are suboptimal. In 2021, the World Health Organization (WHO) released an updated guideline for the pharmacological treatment of hypertension in adults. This policy paper highlights the facilitating role of the WHO Global HEARTS initiative and the HEARTS in the Americas initiative to catalyze the implementation of this guideline, provides specific policy advice for implementation, and emphasizes that an over-arching strategic approach for hypertension control is needed. The authors urge health advocates and policymakers to prioritize the prevention and control of hypertension to improve the health and wellbeing of their populations and to reduce CVD health disparities within and between populations of the Americas.A doença cardiovascular (DCV) é a principal causa de morte nas Américas, e a pressão arterial elevada é responsável por mais de 50% dos casos de DCV. Nas Américas, mais de um quarto das mulheres adultas e quatro de cada dez homens adultos têm hipertensão arterial, sendo que diagnóstico, tratamento e controle estão abaixo do ideal. Em 2021, a Organização Mundial da Saúde (OMS) divulgou uma atualização das diretrizes para o tratamento medicamentoso da hipertensão arterial em adultos. Essa publicação ressalta o papel facilitador da iniciativa Global HEARTS da OMS e da iniciativa HEARTS nas Américas para catalisar a implementação dessas diretrizes, oferece recomendações específicas de políticas para sua implementação e enfatiza a necessidade de uma abordagem estratégica abrangente para o controle da hipertensão arterial. Os autores clamam para que tanto as pessoas que advogam pela Saúde, quanto as autoridades responsáveis, priorizem a prevenção e o controle da hipertensão arterial como forma de melhorar a saúde e o bem-estar das populações e reduzir as disparidades de saúde cardiovascular dentro das populações das Américas e entre elas.Fil: Campbell, Norm R.C.. Pan American Health Organization; Estados Unidos. University of Calgary; CanadáFil: Paccot Burnens, Melanie. Ministerio de Salud de Chile; ChileFil: Whelton, Paul K.. University of Tulane; Estados UnidosFil: Angell, Sonia Y.. Columbia University; Estados UnidosFil: Jaffe, Marc G.. Centro Médico Kaiser Permanente de San Francisco; Estados UnidosFil: Cohn, Jennifer. University of Pennsylvania; Estados UnidosFil: Espinosa Brito, Alfredo. Hospital General Universitario Dr. Gustavo Aldereguía; CubaFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Brettler, Jeffrey W.. Centro Médico Kaiser Permanente de San Francisco; Estados UnidosFil: Roccella, Edward J.. National Heart, Lung And Blood Institute ; National Institutes Of Health;Fil: Maldonado Figueredo, Javier Isaac. Pan American Health Organization; Estados UnidosFil: Rosende, Andres. Pan American Health Organization; Estados UnidosFil: Ordunez, Pedro. Pan American Health Organization; Estados Unido

Primary stroke prevention worldwide: translating evidence into action

Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course