El aumento gradual de la presión arterial relacionado con el envejecimiento es un fenómeno consen... more El aumento gradual de la presión arterial relacionado con el envejecimiento es un fenómeno consentido. Además, la aparición de la hipertensión arterial (HTA) se convierte en un importante problema de salud para los adultos mayores, dados los diversos retos que plantea su tratamiento y gestión. Un tratamiento eficaz podría influir sustancialmente en la calidad de vida. En esta revisión describimos las vías fisiopatológicas en las que la presión arterial podría verse influida por los procesos de envejecimiento, cómo podríamos caracterizar mejor la enfermedad y cómo dar un enfoque inicial en el manejo dentro de los adultos mayores. La administración de un tratamiento antihipertensivo adecuado debe centrarse en la disminución de los mmHg, ya que sus propiedades ventajosas son similares en todas las edades; sin embargo, en términos absolutos, los beneficios adquiridos son mayores en los individuos de edad avanzada que en los jóvenes. Los datos actuales sugieren que la medicación antihipertensiva no debe ser rechazada, modificada o interrumpida sólo por la edad avanzada. Aunque esto puede parecer razonable, el edadismo es un determinante social importante para iniciar la antihipertensiva, ya que restringe su acceso sólo por la edad avanzada. Se deben realizar esfuerzos clínicos para optimizar las estrategias para mejorar la presión arterial en los adultos mayores.
Los niveles de presion arterial inadecuados representan para los adultos un problema mayor de sal... more Los niveles de presion arterial inadecuados representan para los adultos un problema mayor de salud, son la fuente principal de perdida de tiempo de vida con calidad, especialmente para los habitantes de paises con ingresos economicos medianos como Mexico. Ademas, representan una carga economica muy importante. El tratamiento y la prevencion de la hipertension arterial han demostrado tener un beneficio claro en reducir las complicaciones de la enfermedad y su aplicacion es costo-util. Estas razones justifican el desarrollo de estrategias para el control del problema. Las estrategias que se proponen son poblacionales, conjuntas para la prevencion del sobrepeso, la dislipidemia y la diabetes, el combate del sedentarismo y el tabaquismo; y estrategias de alto riesgo guiadas por los niveles de presion y el riesgo global, dirigidas a la consecucion de metas de presion arterial, LDLcolesterol, glucosa, peso y cesacion del tabaquismo. La adherencia y constancia en el tratamiento deben ser ...
The recent advances and the potential application of cardiovascular health research have become o... more The recent advances and the potential application of cardiovascular health research have become of great interest for the psychologists, especially in the developing countries. The main contribution of the behavioral medicine has been the behavior modification related to cardiovascular diseases. Behavioral cardiology is an area of the behavioral medicine that studies the psychosocial factors related to the beginning and maintenance of the cardiovascular disease. Its field is the primary and secondary prevention, and the heart patient’s rehabilitation supporting the diagnostic phases, and the multidisciplinary treatment in the control and prevention of cardiovascular diseases.
*Traducción no oficial al español del artículo original en inglés, revisada por los autores. En c... more *Traducción no oficial al español del artículo original en inglés, revisada por los autores. En caso de discrepancia entre ambas versiones, prevalecerá la original (en inglés). Traducido con autorización de Current Problems in Cardiology, Elsevier.
Aims May Measurement Month is a global screening campaign to raise awareness regarding elevated b... more Aims May Measurement Month is a global screening campaign to raise awareness regarding elevated blood pressure (BP). With the growing burden of hypertension, it is imperative to regularly assess the disease’s prevalence, risk factors, and awareness levels in a country. The current prevalence of hypertension in India as per the National Family Health Survey Data stands at 25.3%. May Measurement Month mobilizes healthcare professionals and sensitizes them to regularly measure BP, and impart lifestyle modification advice to the community. It also complements the deficiency in screening programmes at a national and international level. Methods and results May Measurement Month was carried out in May 2019 as an opportunistic screening campaign for adults (≥18 years). It was carried out by over 5000 trained volunteers across approximately 1000 screening sites (hospitals, public places, pharmacies, villages, and malls) in India. A total of 362 708 (57% males and 42.7% females) people were ...
on behalf of the Latin American Society of Hypertension Consensus Expert Group The prevalence of ... more on behalf of the Latin American Society of Hypertension Consensus Expert Group The prevalence of hypertension, type 2 diabetes mellitus (DM2) and the metabolic syndrome continues to increase in Latin America, while the rates of diagnosis, treatment and control of these disorders remain low. The frequency of the risk factors that constitute the metabolic syndrome and are associated with an increased risk of cardiovascular disease has not diminished since the publication of the previous consensus. This document discusses the socioeconomic, demographic, environmental and cultural characteristics of most associated Latin American countries and partially explains the lack of better results in improving clinical and public health actions that allow high morbidity and mortality rates caused by cardiovascular diseases and DM2 to be reduced through programs aligned with the socalled precision medicine, which should be predictive, preventive, personalized and participatory. The Consensus ratifies the diagnostic criteria expressed in the previous consensus to define hypertension and DM2 but, for the metabolic syndrome, and in the absence of evidence, the recommendation is to implement a cohort study that determines the abdominal perimeter value associated with hard outcomes, such as DM2 and CVD. Meanwhile, we recommend modifying the criterion to more than 94 cm in men and more than 84 cm in women according to WHO recommendations. We also recommend the carrying out of a study that identifies the situation of hypertension and DM2 in people of African ancestry who, in Latin America, exceed 75 million and whose epidemiology does not include solid studies. With respect to the proposed therapeutic targets, we recommended maintaining those defined in the previous consensus, but insisting that early pharmacological management of prediabetes with metformin should be introduced, as should the treatment of diabetic hypertensive patients with a combination therapy of two fixed-dose antihypertensive drugs and management with statins. To increase adherence, the use of different drugs combined in a single pill (polypill) is recommended. The simplification of the therapeutic regimen is accompanied by greater control of cardiovascular risk factors, both in primary and secondary prevention, and has been shown to be cost-effective. The consensus recommends the use of the currently available polypill combining an angiotensin-converting enzyme inhibitor, a statin and aspirin for secondary cardiovascular prevention and in patients with a high cardiovascular risk, such as hypertension patients with DM2.
In conclusions both drugs nifedipine GITS and Lecidipine increased significantly cognitive functi... more In conclusions both drugs nifedipine GITS and Lecidipine increased significantly cognitive function in patients with hypertension.
Therapeutic advances in cardiovascular disease, 2009
High blood pressure (BP) is an enormous global problem, and is especially challenging for low- an... more High blood pressure (BP) is an enormous global problem, and is especially challenging for low- and middle-income countries such as those of Latin America. Although developed countries have benefited from significant reductions in cardiovascular and cerebrovascular disease in recent decades, comparable reductions have not been achieved in Latin America. In fact, the prevalence of high BP is increasing in many Latin American countries, and the situation will worsen without definitive efforts to correct it. The growing preponderance of hypertension and chronic diseases, coupled with expected increases in population growth, present a mounting threat to Latin American economies. This report provides a comprehensive overview of the burden of high BP throughout Latin America, and presents recommendations for change. The dismal observations warrant a call to action for improved control of high BP and other cardiovascular risk factors across Latin America. Achieving these ambitious goals wil...
Int. Journal of Clinical Pharmacology and Therapeutics, 2001
The main objective of this study was to evaluate well being and physical activity of two hundred ... more The main objective of this study was to evaluate well being and physical activity of two hundred and forty eight hypertensive patients, of which, one hundred and seventy seven were female, who had previously finished the Latin Amerícan Study on Lacidipine in Hypertension (LASTLHY). This was an open study carried out in twelve clinical centers situated in Argentina, Brazil, Colombia, Mexico and Venezuela, to compare, over a period of sixteen weeks, the antihypertensive actions of fixed-dose once daily oral monopharmacotherapy of 4 rng of lacidipine (n = 120) patients VS. 30 mg of nifedipine (n = 128) patients aged between 40-65 years old, with mild to moderate hypertension beginning at the end of a four weeks placebo run-in (end of week-1). Well being and physical activity were assessed through an experimental single questionnaire, which was administered taking into consíderation the physical and cultural diversities amongst the clinical centers and patients. The questionnaire included thirteen multiplechoice and eight contingent open questions. The score to each question was multiplied by a coefficient according to the importance of each question for each patient (semipersonal ization); the coefficient was evaluated from cultural and socioeconomic information collected at the time of enrollment. The semipersonalization was carried out by a blind psychological study with respect to the medication and had a high repeatability in the assignment of personalized coefficients to the score of each question. The scores of each question were added to obtain an overall weil being and activity scoring. The possible theoretical range for the overall scoring in this study was 10-124.
The aim of this 3-month double-blind study was to assess the antihypertensive effect and acceptab... more The aim of this 3-month double-blind study was to assess the antihypertensive effect and acceptability of perindopril in comparison with enalapril in patients with mild to moderate essential hypertension. After a 4-week placebo run-in period, 161 patients with supine diastolic blood pressure (DBP) between 95 and 115 mmHg were randomized to receive perindopril 4 mg or enalapril 10 mg once daily. If supine DBP was higher than 90 mmHg, treatment was adjusted monthly, first by doubling the dose and then by addition of hydrochlorothiazide 12.5 mg. After 3 months of active treatment the decrease in supine and standing blood pressures was statistically significant within both groups but was not statistically different between groups. The percentage of patients (65%) who achieved supine DBP of < or = 90 mmHg in the perindopril group was not significantly different from the enalapril group (73%). Monotherapy resulted in control of supine DBP in 56% of the perindopril group and 58% of the enalapril group; the addition of hydrochlorothiazide resulted in control of supine DBP in 6% and 15% respectively. The number of withdrawals for adverse events was statistically significant between groups (0 in the perindopril group and 7 in the enalapril group, p = 0.01). During active treatment the most frequently reported complaints were headaches and cough; there was not statistically difference between groups. Changes in laboratory parameters were minor and not significantly different between the two groups except for serum glucose, potassium, and triglyceride levels. In conclusion, there was no significance between perindopril and enalapril in terms of efficacy. Clinical acceptability seems to be better in the perindopril group.(ABSTRACT TRUNCATED AT 250 WORDS)
A. Dalfó Baqué et al.-Validación del cuestionario de calidad de vida en hipertensión arterial (CH... more A. Dalfó Baqué et al.-Validación del cuestionario de calidad de vida en hipertensión arterial (CHAL) para su uso en España. Relación entre variables clínicas y calidad de vida
En la actualidad, la mortalidad por enfermedad coronaria ha disminuido en los países occidentales... more En la actualidad, la mortalidad por enfermedad coronaria ha disminuido en los países occidentales. Sin embargo, la Insuficiencia Cardiaca (IC) permanece como un problema creciente de salud pública, quizá por la mayor supervivencia de la población al mejorar el tratamiento de la enfermedad isquémica. Los pacientes con IC no sólo presentan las mayores tasas de readmisión hospitalaria y por tanto, un alto costo en su tratamiento, también exhiben diversas consecuencias psicosociales durante el proceso y desarrollo de la IC, tales como restricciones conductuales, estrés, depresión, ansiedad comórbida y disminución en la calidad de vida. El presente artículo nos presenta evidencia al respecto, sugiriendo que estos pacientes requieren ser tratados con un esquema de evaluación integral que incluya tanto aspectos médicos como psicológicos.
Today, Mexico has more than 130 million inhabitants; 85 millions of them are adults of 20 or more... more Today, Mexico has more than 130 million inhabitants; 85 millions of them are adults of 20 or more years old. The population pyramid is still one of base wider and this base corresponds to adults younger than 54 years old. Despite predictions made 20 years ago, about a transformation of the population pyramid shape to a mushroom shape as a consequence of more life expected and adult population growth; this change has not been occurred. Hypertension has become the biggest challenge of noncommunicable chronic diseases to public health in Mexico. Around 30% of adult Mexican population has hypertension; 75% of them have less than 54 years old (in productive age); 40% of them are unaware but only 50% of aware hypertensive population takes drugs and, 50% of them are controlled (< 140/90 mmHg). Cardiovascular risk factors including hypertension, dyslipidemia, obesity, and diabetes often cohabit in the same person and are magnifi ed one to another in terms of common pathophysiological pathways. Atherosclerosis, arrhythmias, stroke and heart failure are common and are the fi nal pathologic end-points and explains why cardiovascular diseases occupy fi rst place in mortality in Mexico and worldwide. The costs of care for these diseases are billionaires and if we do not generate appropriate strategies, their global impact can become a high threat to social development of the country. The life style like nutrition, sports habits of the Mexicans must be emphasized; there is poor education about this crucial topic. This position paper is focused on the principal controversies and strategies to be developed by all, government, society, physicians, nurses, patients and all people related with healthcare of hypertension, in order to confront this huge public health problem in Mexico.
El aumento gradual de la presión arterial relacionado con el envejecimiento es un fenómeno consen... more El aumento gradual de la presión arterial relacionado con el envejecimiento es un fenómeno consentido. Además, la aparición de la hipertensión arterial (HTA) se convierte en un importante problema de salud para los adultos mayores, dados los diversos retos que plantea su tratamiento y gestión. Un tratamiento eficaz podría influir sustancialmente en la calidad de vida. En esta revisión describimos las vías fisiopatológicas en las que la presión arterial podría verse influida por los procesos de envejecimiento, cómo podríamos caracterizar mejor la enfermedad y cómo dar un enfoque inicial en el manejo dentro de los adultos mayores. La administración de un tratamiento antihipertensivo adecuado debe centrarse en la disminución de los mmHg, ya que sus propiedades ventajosas son similares en todas las edades; sin embargo, en términos absolutos, los beneficios adquiridos son mayores en los individuos de edad avanzada que en los jóvenes. Los datos actuales sugieren que la medicación antihipertensiva no debe ser rechazada, modificada o interrumpida sólo por la edad avanzada. Aunque esto puede parecer razonable, el edadismo es un determinante social importante para iniciar la antihipertensiva, ya que restringe su acceso sólo por la edad avanzada. Se deben realizar esfuerzos clínicos para optimizar las estrategias para mejorar la presión arterial en los adultos mayores.
Los niveles de presion arterial inadecuados representan para los adultos un problema mayor de sal... more Los niveles de presion arterial inadecuados representan para los adultos un problema mayor de salud, son la fuente principal de perdida de tiempo de vida con calidad, especialmente para los habitantes de paises con ingresos economicos medianos como Mexico. Ademas, representan una carga economica muy importante. El tratamiento y la prevencion de la hipertension arterial han demostrado tener un beneficio claro en reducir las complicaciones de la enfermedad y su aplicacion es costo-util. Estas razones justifican el desarrollo de estrategias para el control del problema. Las estrategias que se proponen son poblacionales, conjuntas para la prevencion del sobrepeso, la dislipidemia y la diabetes, el combate del sedentarismo y el tabaquismo; y estrategias de alto riesgo guiadas por los niveles de presion y el riesgo global, dirigidas a la consecucion de metas de presion arterial, LDLcolesterol, glucosa, peso y cesacion del tabaquismo. La adherencia y constancia en el tratamiento deben ser ...
The recent advances and the potential application of cardiovascular health research have become o... more The recent advances and the potential application of cardiovascular health research have become of great interest for the psychologists, especially in the developing countries. The main contribution of the behavioral medicine has been the behavior modification related to cardiovascular diseases. Behavioral cardiology is an area of the behavioral medicine that studies the psychosocial factors related to the beginning and maintenance of the cardiovascular disease. Its field is the primary and secondary prevention, and the heart patient’s rehabilitation supporting the diagnostic phases, and the multidisciplinary treatment in the control and prevention of cardiovascular diseases.
*Traducción no oficial al español del artículo original en inglés, revisada por los autores. En c... more *Traducción no oficial al español del artículo original en inglés, revisada por los autores. En caso de discrepancia entre ambas versiones, prevalecerá la original (en inglés). Traducido con autorización de Current Problems in Cardiology, Elsevier.
Aims May Measurement Month is a global screening campaign to raise awareness regarding elevated b... more Aims May Measurement Month is a global screening campaign to raise awareness regarding elevated blood pressure (BP). With the growing burden of hypertension, it is imperative to regularly assess the disease’s prevalence, risk factors, and awareness levels in a country. The current prevalence of hypertension in India as per the National Family Health Survey Data stands at 25.3%. May Measurement Month mobilizes healthcare professionals and sensitizes them to regularly measure BP, and impart lifestyle modification advice to the community. It also complements the deficiency in screening programmes at a national and international level. Methods and results May Measurement Month was carried out in May 2019 as an opportunistic screening campaign for adults (≥18 years). It was carried out by over 5000 trained volunteers across approximately 1000 screening sites (hospitals, public places, pharmacies, villages, and malls) in India. A total of 362 708 (57% males and 42.7% females) people were ...
on behalf of the Latin American Society of Hypertension Consensus Expert Group The prevalence of ... more on behalf of the Latin American Society of Hypertension Consensus Expert Group The prevalence of hypertension, type 2 diabetes mellitus (DM2) and the metabolic syndrome continues to increase in Latin America, while the rates of diagnosis, treatment and control of these disorders remain low. The frequency of the risk factors that constitute the metabolic syndrome and are associated with an increased risk of cardiovascular disease has not diminished since the publication of the previous consensus. This document discusses the socioeconomic, demographic, environmental and cultural characteristics of most associated Latin American countries and partially explains the lack of better results in improving clinical and public health actions that allow high morbidity and mortality rates caused by cardiovascular diseases and DM2 to be reduced through programs aligned with the socalled precision medicine, which should be predictive, preventive, personalized and participatory. The Consensus ratifies the diagnostic criteria expressed in the previous consensus to define hypertension and DM2 but, for the metabolic syndrome, and in the absence of evidence, the recommendation is to implement a cohort study that determines the abdominal perimeter value associated with hard outcomes, such as DM2 and CVD. Meanwhile, we recommend modifying the criterion to more than 94 cm in men and more than 84 cm in women according to WHO recommendations. We also recommend the carrying out of a study that identifies the situation of hypertension and DM2 in people of African ancestry who, in Latin America, exceed 75 million and whose epidemiology does not include solid studies. With respect to the proposed therapeutic targets, we recommended maintaining those defined in the previous consensus, but insisting that early pharmacological management of prediabetes with metformin should be introduced, as should the treatment of diabetic hypertensive patients with a combination therapy of two fixed-dose antihypertensive drugs and management with statins. To increase adherence, the use of different drugs combined in a single pill (polypill) is recommended. The simplification of the therapeutic regimen is accompanied by greater control of cardiovascular risk factors, both in primary and secondary prevention, and has been shown to be cost-effective. The consensus recommends the use of the currently available polypill combining an angiotensin-converting enzyme inhibitor, a statin and aspirin for secondary cardiovascular prevention and in patients with a high cardiovascular risk, such as hypertension patients with DM2.
In conclusions both drugs nifedipine GITS and Lecidipine increased significantly cognitive functi... more In conclusions both drugs nifedipine GITS and Lecidipine increased significantly cognitive function in patients with hypertension.
Therapeutic advances in cardiovascular disease, 2009
High blood pressure (BP) is an enormous global problem, and is especially challenging for low- an... more High blood pressure (BP) is an enormous global problem, and is especially challenging for low- and middle-income countries such as those of Latin America. Although developed countries have benefited from significant reductions in cardiovascular and cerebrovascular disease in recent decades, comparable reductions have not been achieved in Latin America. In fact, the prevalence of high BP is increasing in many Latin American countries, and the situation will worsen without definitive efforts to correct it. The growing preponderance of hypertension and chronic diseases, coupled with expected increases in population growth, present a mounting threat to Latin American economies. This report provides a comprehensive overview of the burden of high BP throughout Latin America, and presents recommendations for change. The dismal observations warrant a call to action for improved control of high BP and other cardiovascular risk factors across Latin America. Achieving these ambitious goals wil...
Int. Journal of Clinical Pharmacology and Therapeutics, 2001
The main objective of this study was to evaluate well being and physical activity of two hundred ... more The main objective of this study was to evaluate well being and physical activity of two hundred and forty eight hypertensive patients, of which, one hundred and seventy seven were female, who had previously finished the Latin Amerícan Study on Lacidipine in Hypertension (LASTLHY). This was an open study carried out in twelve clinical centers situated in Argentina, Brazil, Colombia, Mexico and Venezuela, to compare, over a period of sixteen weeks, the antihypertensive actions of fixed-dose once daily oral monopharmacotherapy of 4 rng of lacidipine (n = 120) patients VS. 30 mg of nifedipine (n = 128) patients aged between 40-65 years old, with mild to moderate hypertension beginning at the end of a four weeks placebo run-in (end of week-1). Well being and physical activity were assessed through an experimental single questionnaire, which was administered taking into consíderation the physical and cultural diversities amongst the clinical centers and patients. The questionnaire included thirteen multiplechoice and eight contingent open questions. The score to each question was multiplied by a coefficient according to the importance of each question for each patient (semipersonal ization); the coefficient was evaluated from cultural and socioeconomic information collected at the time of enrollment. The semipersonalization was carried out by a blind psychological study with respect to the medication and had a high repeatability in the assignment of personalized coefficients to the score of each question. The scores of each question were added to obtain an overall weil being and activity scoring. The possible theoretical range for the overall scoring in this study was 10-124.
The aim of this 3-month double-blind study was to assess the antihypertensive effect and acceptab... more The aim of this 3-month double-blind study was to assess the antihypertensive effect and acceptability of perindopril in comparison with enalapril in patients with mild to moderate essential hypertension. After a 4-week placebo run-in period, 161 patients with supine diastolic blood pressure (DBP) between 95 and 115 mmHg were randomized to receive perindopril 4 mg or enalapril 10 mg once daily. If supine DBP was higher than 90 mmHg, treatment was adjusted monthly, first by doubling the dose and then by addition of hydrochlorothiazide 12.5 mg. After 3 months of active treatment the decrease in supine and standing blood pressures was statistically significant within both groups but was not statistically different between groups. The percentage of patients (65%) who achieved supine DBP of &lt; or = 90 mmHg in the perindopril group was not significantly different from the enalapril group (73%). Monotherapy resulted in control of supine DBP in 56% of the perindopril group and 58% of the enalapril group; the addition of hydrochlorothiazide resulted in control of supine DBP in 6% and 15% respectively. The number of withdrawals for adverse events was statistically significant between groups (0 in the perindopril group and 7 in the enalapril group, p = 0.01). During active treatment the most frequently reported complaints were headaches and cough; there was not statistically difference between groups. Changes in laboratory parameters were minor and not significantly different between the two groups except for serum glucose, potassium, and triglyceride levels. In conclusion, there was no significance between perindopril and enalapril in terms of efficacy. Clinical acceptability seems to be better in the perindopril group.(ABSTRACT TRUNCATED AT 250 WORDS)
A. Dalfó Baqué et al.-Validación del cuestionario de calidad de vida en hipertensión arterial (CH... more A. Dalfó Baqué et al.-Validación del cuestionario de calidad de vida en hipertensión arterial (CHAL) para su uso en España. Relación entre variables clínicas y calidad de vida
En la actualidad, la mortalidad por enfermedad coronaria ha disminuido en los países occidentales... more En la actualidad, la mortalidad por enfermedad coronaria ha disminuido en los países occidentales. Sin embargo, la Insuficiencia Cardiaca (IC) permanece como un problema creciente de salud pública, quizá por la mayor supervivencia de la población al mejorar el tratamiento de la enfermedad isquémica. Los pacientes con IC no sólo presentan las mayores tasas de readmisión hospitalaria y por tanto, un alto costo en su tratamiento, también exhiben diversas consecuencias psicosociales durante el proceso y desarrollo de la IC, tales como restricciones conductuales, estrés, depresión, ansiedad comórbida y disminución en la calidad de vida. El presente artículo nos presenta evidencia al respecto, sugiriendo que estos pacientes requieren ser tratados con un esquema de evaluación integral que incluya tanto aspectos médicos como psicológicos.
Today, Mexico has more than 130 million inhabitants; 85 millions of them are adults of 20 or more... more Today, Mexico has more than 130 million inhabitants; 85 millions of them are adults of 20 or more years old. The population pyramid is still one of base wider and this base corresponds to adults younger than 54 years old. Despite predictions made 20 years ago, about a transformation of the population pyramid shape to a mushroom shape as a consequence of more life expected and adult population growth; this change has not been occurred. Hypertension has become the biggest challenge of noncommunicable chronic diseases to public health in Mexico. Around 30% of adult Mexican population has hypertension; 75% of them have less than 54 years old (in productive age); 40% of them are unaware but only 50% of aware hypertensive population takes drugs and, 50% of them are controlled (< 140/90 mmHg). Cardiovascular risk factors including hypertension, dyslipidemia, obesity, and diabetes often cohabit in the same person and are magnifi ed one to another in terms of common pathophysiological pathways. Atherosclerosis, arrhythmias, stroke and heart failure are common and are the fi nal pathologic end-points and explains why cardiovascular diseases occupy fi rst place in mortality in Mexico and worldwide. The costs of care for these diseases are billionaires and if we do not generate appropriate strategies, their global impact can become a high threat to social development of the country. The life style like nutrition, sports habits of the Mexicans must be emphasized; there is poor education about this crucial topic. This position paper is focused on the principal controversies and strategies to be developed by all, government, society, physicians, nurses, patients and all people related with healthcare of hypertension, in order to confront this huge public health problem in Mexico.
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