RESUMO
Background: Arterial hypertension is highly prevalent in Mexico; nevertheless, there are limited insights regarding its management during the COVID-19 pandemic. Here, we estimate the prevalence of clinical and treatment profiles of arterial hypertension and explore associated factors for undiagnosed and uncontrolled hypertension using a cross-sectional survey endorsed by the Collaborative Group on Arterial Hypertension from the Mexican Institute of Social Security. Methods: Our survey was conducted from May to November 2021 using the May-Measurement Month 2021 protocols of the International Society of Hypertension. Arterial hypertension (defined as: blood pressure [BP] ≥140/90 mmHg, previous diagnosis, or taking antihypertensives) and its clinical and treatment profiles were classified according to the World Hypertension League Expert Committee. Mixed-effects logistic regression models were used to explore associated factors for undiagnosed and uncontrolled hypertension. Results: Among 77,145 screened participants (women: 62.4%; median age: 46 [IQR: 32-59] years), the prevalence of arterial hypertension was 35.7% (95% CI: 35.3-36.0, n = 27,540). Among participants with arterial hypertension, 30.9% (95% CI: 30.4-31.5, n = 8,533) were undiagnosed, 6.6% (95% CI: 6.3%-6.9%, n = 1,806) were diagnosed but untreated, 43.4% (95% CI: 42.9-44.0, n = 11,965) had uncontrolled hypertension, and only 19% (95% CI: 18.6%-19.5%, n = 5,236) achieved hypertension control (BP < 130/80 mmHg). Explored associated factors for undiagnosed and uncontrolled hypertension include being men, living in the central and southern regions, lower educational attainments, higher use of pharmacological agents, and previous COVID-19 infection. Conclusion: Our findings suggest that adverse arterial hypertension profiles, mainly undiagnosed and uncontrolled hypertension, were highly prevalent during the context of the COVID-19 pandemic in Mexico.
Assuntos
Anti-Hipertensivos , COVID-19 , Hipertensão , Humanos , México/epidemiologia , Estudos Transversais , Hipertensão/epidemiologia , Feminino , COVID-19/epidemiologia , Masculino , Pessoa de Meia-Idade , Adulto , Prevalência , Anti-Hipertensivos/uso terapêutico , SARS-CoV-2 , Pandemias , Inquéritos e QuestionáriosRESUMO
Resumen El diagnóstico electrocardiográfico de infarto agudo de miocardio (IAM) en el paciente con marcapasos siempre ha sido un problema en la práctica clínica, provocando retrasos en el manejo y peores desenlaces clínicos. Aunque el bloqueo completo de rama izquierda (BCRI) y la estimulación del ventrículo derecho pueden producir anomalías en el electrocardiograma (ECG), cambios morfológicos específicos a menudo permiten el diagnóstico de IAM o un infarto antiguo. Reporte de caso: Paciente de 76 años con antecedente de implante de marcapasos definitivo por bloqueo auriculoventricular de 3° grado, que ingresó por dolor precordial. A su ingreso hemodinámicamente estable, pero con ECG que muestra ritmo de marcapasos con BCRI cumpliendo Sgarbossa 2 puntos (elevación discordante del segmento ST > 5 mm en derivaciones V1 a V3) y relación ST/S < -0.25 en derivaciones V3-V4. Laboratorios con elevación de troponinas, integrándose diagnóstico de IAM y pasando a angiografía coronaria urgente. Se documentó lesión en arteria coronaria descendente anterior y se implantó stent liberador de fármaco angiográficamente exitoso. Se egresó estable, asintomático y con manejo farmacológico para prevención secundaria. Conclusión: La identificación por ECG de un IAM en pacientes portadores de marcapasos es fundamental para iniciar terapia de reperfusión. Las recomendaciones de las guías cambian constantemente, pero un algoritmo que utiliza la inestabilidad hemodinámica y los criterios de Sgarbossa modificados (CSM) para decidir el manejo de estos pacientes pudiera ser una herramienta con una alta sensibilidad y permitirá a los médicos tener la mejor toma de decisiones sin esperar resultados de laboratorio. Los CSM, que son más sensibles que los criterios originales, continúan siendo útiles en el diagnóstico de IAM. Los médicos deben elegir cuidadosamente el límite de CSM apropiado (relación ST/T -0.20 y -0.25) de acuerdo con cada caso.
Abstract The electrocardiographic diagnosis of acute myocardial infarction (AMI) in patients with pacemakers has always been a problem in clinical practice, causing delays in management and worse clinical outcomes. Although complete left bundle branch block (LBBB) and right ventricular pacing can produce electrocardiogram (ECG) abnormalities, specific morphological changes often allow the diagnosis of AMI or an old infarction. Case report: A 76-year-old patient with history of permanent pacemaker implantation due to a 3rd-degree atrioventricular block was admitted for chest pain. Upon admission, he was hemodynamically stable but with ECG showing pacemaker rhythm with LBBB fulfilling 2 points of Sgarbossa criteria (discordant elevation of the ST segment > 5 mm in leads V1 to V3) and ST/S ratio < -0.25 in leads V3-V4. Laboratories showed elevated troponins, integrating diagnosis of AMI, and moving on to urgent coronary angiography. A lesion on the anterior descending coronary artery was documented, and a drug-eluting stent was successfully implanted. The patient was discharged stable, asymptomatic, and with pharmacological management for secondary prevention. Conclusion: ECG identification of an AMI in patients with pacemakers is essential to initiate reperfusion therapy. Guideline recommendations are constantly changing, but an algorithm that uses hemodynamic instability and the modified Sgarbossa criteria (MSC) to decide these patients' management could be a high-sensitivity tool and allow physicians to make the best decisions without waiting for laboratory results. MSC, which are more sensitive than the original criteria, continue to be helpful in the diagnosis of AMI. Clinicians should carefully choose the appropriate MSC cut-off (ST/T Ratio -0.20 and -0.25) on a case-by-case basis.