Latin American Consensus on the management of hypertension in the patient with diabetes and the metabolic syndrome

Abstract

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.

Low levels of awareness, treatment, and control of hypertension in Andean communities of Ecuador

“…The present analysis does not permit to determinate the reason for these differences, but it is possible that it could be related to socio‐economic conditions or to ethnic differences existing between these countries 4 . In the Andean communities included in the present study, several well‐known risk factors are associated with a high prevalence of HTN as older age, quit smoking, low income, low education, overweight, and obesity 9 . With the exception of one community, all were located over 2,400 meters over sea level.…”

May Measurement Month 2018: an analysis of blood pressure screening results from Colombia

“…This highlights the importance of pharmacological treatment in hypertensive subjects, providing evidence to support that antihypertensive treatment is a keystone for controlling high BP. 10 11 …”

Latin American Expert Consensus for Comprehensive Management of Type 2 Diabetes from a Metabolic–Cardio–Renal Perspective for the Primary Care Physician

“…However, patients exhibiting classical symptoms of hyperglycemia can undergo a random plasma glucose test. Similar recommendations are provided by the Latin American consensus published in 2019 for T2D patients with hypertension [19].…”

“…From the renal point of view, the objective is that every patient maintains glomerular filtration within normal limits (90-120 mL/min) without microalbuminuria. A Latin American consensus published in the same year recommends HbA1c of at least 6.5% and classifies hypertension into grade 1 (between 140/90 and 159/99 mmHg), grade 2 (between 160/100 and 179/109 mmHg), and grade 3 (C 180/110 mmHg) [19]. Another Latin American consensus published in 2010 proposed treatment goals for HbA1c as \ 7%, BP B 130/80 mmHg, and LDL-C target as \ 100 mg/dL [31].…”