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    ABSTRACT: The aim of the study was to investigate the blood pressure variability during 24 h by using ambulatory blood pressure monitoring (ABPM) in a group of obese and non-obese female adolescents with breast development status 4 and 5 of Tanner´s criteria. A cross-sectional study was conducted at the Cardiovascular Research Institute, Mexico. All subjects underwent 24 h non-invasive ABPM recording device. Pubertal status was determined by breast development. Measurements: office systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Height, weight, body mass index (BMI), waist and hip circumferences, arm circumference, waist to hip ratio (W/H), and skinfold thickness measurements: triceps, subscapular, abdominal and supraspinal. Fifty-nine adolescents 13-16 years old; 29 obese (BMI 31.2±4.0), and 30 non- obese (BMI 21.2±2.2). Obese vs. non-obese: Office SBP 116.9 vs. 105.9±9.3 mmHg (p<0.001); ABPM in 24 h: SBP 113.8±6.3 vs. 107.6±5.7 mmHg (p<0.001); diurnal SBP 117.3 mmHg vs. 111.2 mmHg (p<0.001); nocturnal SBP 105.5±8 vs. 99.4 mmHg; absolute variability in 24 h DBP 10.0±1.8 vs. 8.7±1.5 (p<0.003); coefficient of variation 24 h DBP 17.3±3 vs. 15.4±2.6% (p<0.05); systolic non-dipper 16 (55.2%) vs. 9 (30%) (p<0.05); pulse pressure 24 h 49.3±8 vs. 43.5±9 mmHg (p<0.01). Obese adolescents are presenting changes in BP variability during 24-h in comparison with nonobese adolescents; it also includes higher pulse pressure. Thus, these can be early indicators for the development of hypertension or other cardiovascular diseases in the adult life.
    Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral 10/2011; 26(5):1011-7. · 1.31 Impact Factor
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    ABSTRACT: Objective: The aim of the study was to investigate the blood pressure variability during 24 h by using ambulatory blood pressure monitoring (ABPM) in a group of obese and non-obese female adolescents with breast development status 4 and 5 of Tanner´s criteria. Methods: A cross-sectional study was conducted at the Cardiovascular Research Institute, Mexico. All subjects underwent 24 h non-invasive ABPM recording device. Pubertal status was determined by breast development. Measurements: office systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Height, weight, body mass index (BMI), waist and hip circumferences, arm circumference, waist to hip ratio (W/H), and skinfold thickness measurements: triceps, subscapular, abdominal and supraspinal. Results: Fifty-nine adolescents 13-16 years old; 29 obese (BMI 31.2 ± 4.0), and 30 non- obese (BMI 21.2 ± 2.2). Obese vs. non-obese: Office SBP 116.9 vs. 105.9 ± 9.3 mmHg (p < 0.001); ABPM in 24 h: SBP 113.8 ± 6.3 vs. 107.6 ± 5.7 mmHg (p < 0.001); diurnal SBP 117.3 mmHg vs. 111.2 mmHg (p < 0.001); nocturnal SBP 105.5 ± 8 vs. 99.4 mmHg; absolute variability in 24 h DBP 10.0 ± 1.8 vs. 8.7 ± 1.5 (p < 0.003); coefficient of variation 24 h DBP 17.3 ± 3 vs. 15.4 ± 2.6% (p < 0.05); systolic non-dipper 16 (55.2%) vs. 9 (30%) (p < 0.05); pulse pressure 24 h 49.3 ± 8 vs. 43.5 ± 9 mmHg (p < 0.01). Conclusion: Obese adolescents are presenting changes in BP variability during 24-h in comparison with nonobese adolescents; it also includes higher pulse pressure. Thus, these can be early indicators for the development of hypertension or other cardiovascular diseases in the adult life.
    Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral 10/2011; 26(5):1011-1017. · 1.31 Impact Factor
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    ABSTRACT: We compared the Omron 725 CIC device (Omron Healthcare Inc., Vernon Hills, Illinois, USA), which is designed to register the blood pressure on the arm, with a mercury sphygmomanometer. In addition, we evaluated the possible impact that this device might have on the decisions made in a hypertension clinic. Patients (n=183) older than 18 years (range 18-84 years) with a wide range of systolic (87-197 mmHg) and diastolic (48-108 mmHg) blood pressures were included. Some of the standards of the Association for the Advancement of Medical Instrumentation and of the British Hypertension Society were used to evaluate the results of the automated device in clinical practice. Using Bland-Altman analysis, an underestimation of both measures was observed with the automated Omron 725 CIC device; the systolic pressure was 3.6+/-8.8 mmHg too low with a very wide range of -13.7 to 20.9 and the diastolic pressure was also 4.4+/-6.3 mmHg too low with a range of -8.1 to 16.9. Clinical decisions could have been changed in 24 of the 116 hypertensive patients (20.6%) if the readings of the automated device had been used instead of using the readings of a mercury sphygmomanometer. These could have included modifying the dosage or changing the medicine used. The blood pressure measurements by Omron 725 CIC are different from those of blood pressure readings taken with a mercury sphygmomanometer and this could affect clinical decisions in the diagnosis and follow-up of a hypertensive patient in an office environment.
    Blood Pressure Monitoring 11/2007; 12(5):321-7. · 1.80 Impact Factor
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    ABSTRACT: Blood pressure is not adequately controlled in almost 50% of patients with hypertension who are in receipt of antihypertensive therapy. This multicentre, prospective, open-label trial was designed to determine whether or not once-daily telmisartan 80 mg reduced blood pressure during the last 6 h of the 24-h dosing interval in patients with mild-to-moderate hypertension who were unresponsive to previous antihypertensive therapy. The study comprised 100 patients (47 males, 53 females) who had failed to respond satisfactorily to prior treatment given for a minimum of 3 months. At screening, 24-h ambulatory blood pressure monitoring (ABPM) was conducted after the patient had been treated with the currently prescribed antihypertensive medication. Following 5 weeks of telmisartan 80 mg treatment, ABPM was repeated. Telmisartan significantly reduced mean systolic blood pressure, diastolic blood pressure (DBP) and pulse pressure compared with previous antihypertensive therapy over each time interval (24-h, morning, night-time and the last 6 h of the dosing interval [2.00 a.m.-8.00 a.m.]) analysed. In addition, more than 90% of patients responded successfully (clinic DBP <90 mmHg or a >10 mmHg reduction in clinic DBP) at the end of telmisartan treatment. In conclusion, telmisartan provides effective blood pressure control throughout the 24-h dosing interval in patients with mild-to-moderate hypertension who were unresponsive to previous antihypertensive medication.
    International journal of clinical practice. Supplement 01/2005;
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    ABSTRACT: To measure the effect on blood pressure readings when a standard cuff is used on patients with arms of a large circumference, and to determine the frequency of arms of a large circumference. Blood pressures were taken in 120 subjects with an arm circumference greater than 33 cm. Also, the arm circumference was determined in 244 patients from a family health unit, and in 216 patients from a hypertension clinic. A mercury sphygmomanometer and two different cuff sizes were used in a random sequence; therefore, 60 patients' blood pressure were first measured with a large cuff, followed by a standard cuff; the opposite sequence was then applied for another 60 patients. With the obtained values and using a regression analysis, the difference in blood pressure overestimation was calculated. Arm circumference measurement percentages were used to determine the frequency of arms of a large circumference. Both systolic and diastolic blood pressures were significantly greater when the standard cuff was used. For every 5 cm increase in arm circumference, starting at 35 cm, a 2-5 mmHg increase in systolic blood pressure, and a 1-3 mmHg increase in diastolic blood pressure was observed. The prevalence of arms with a large circumference in the family medicine unit and hypertension clinic was 42% and 41.8%, respectively. There is an overestimation of blood pressure when a standard cuff is used in obese subjects. The high prevalence of these individuals in our environment, both in the hypertensive and normotensive population, makes it necessary to have on hand different sizes of cuffs for taking blood pressure in order to avoid incorrect decisions.
    Blood Pressure Monitoring 07/2003; 8(3):101-6. · 1.80 Impact Factor
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    ABSTRACT: White coat hypertension is a frequent phenomenon when hypertension has been recently diagnosed. Its frequency varies between 20% and 50%. White coat hypertension is identified when blood pressure taken with the auscultatory method is high in the office but normal when measured with ambulatory monitoring (AM) in the patient's normal environment. Pharmacological treatment is not indicated in these patients, and there is an on-going controversy about what is their evolution. The purpose of this study was to evaluate the evolution of a group of white coat hypertension patients without pharmacological treatment for a year.Patients with a diagnosis of white coat hypertesion were recruited at a primary attention center. They had presented an average auscultatory blood pressure measured in our hypertension clinic of >140/90 mmHg, and an average AMBP (basal) of
    American Journal of Hypertension - AMER J HYPERTENS. 01/2003; 16(5).
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    ABSTRACT: In people older than 60 years, the increment of the Systolic Blood Pressure (SBP) is accompanied by a decrease in Diastolic Blood Pressure (DBP), which results in a progressive increase of the Pulse Pressure (PP) and consequently increase in cardiovascular risk. Therefore it is convenient to evaluate this phenomenon in Mexican population.To determine the circadian rhythm of Blood Pressure (BP), absolute variability of BP, variation coefficient, PP and dipper phenomenon in adults older than 65 years through Ambulatory Blood Pressure Monitoring (ABPM) at the Cardiovascular Research Institute of the University of Guadalajara.67 ABPM of adults older than 65 years were performed from 1997 to February 2002, 54% (36) women and 46% (31) men, we proceeded to analyze in order to obtain the circadian rhythm, absolute variability of BP, variation coefficient, PP and dipper phenomenon.The mean age was of 71.04 years, range 65-87years. The systolic absolute variability was 14.03 mmHg and for diastolic was 9.63 mmHg, the variation coefficient were 9.88% and 12.24% respectively. In regard to the dipper phenomenon, 43% (29) were systolic nondipper and diastolic nondipper; in 12% (8) night SBP and night DBP was higher than day SBP and DBP; in 12% (8) the night SBP was higher than day SBP and diastolic nondipper ; 10% (7) were systolic nondipper and diastolic dipper; 4% (3) were systolic dipper and diastolic nondipper and finally 18% (12) were systolic dipper and diastolic dipper. The average PP was of 63.23 mmHg for the whole group, but 87% (58) had a PP higher than 50 mmHg.The circadian rhythm in elderly is affected by a deficit in the dipper phenomenon of BP. The PP risen in the old adults represents a cardiovascular risk, 87% (58) had a PP higher than 50 mmHg. The association of the Isolated Systolic Hypertension (ISH), the elevation of the PP and the no dipper phenomenon of BP represent a higher cardiovascular risk in this population.
    American Journal of Hypertension - AMER J HYPERTENS. 01/2003; 16(5).
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    ABSTRACT: Cigarette smoking is an important risk factor for cardiovascular disease. Some studies have shown that smoking produces a acutely increase in Blood Pressure (BP), while other studies related the chronic effect of smoking with lower BP in smokers compared with nonsmokers. In Mexico don’t exist studies that demonstrate the acute effect of smoking in young adults with normal BP.Determine Systolic Blood Pressure (SBP), Diastolic blood Pressure (DBP), Heart Rate (HR), and Pulse Pressure (PP), in smoking subjects before during and after cigarette smoking by Ambulatory Blood Pressure Monitoring (ABPM).We included 56 smokers’ subjects and they were carried out an ABPM. The BP recording was made by 55 minutes, blood pressure readings were performed every five minutes; three blood pressure readings before smoking, one reading while they were smoking (they smoked by 5 minutes) and seven readings after smoking. The basal SBP, DBP, HR and PP refer to the previous registration to the beginning of smoking the cigarette (minute 0).The mean age was 21.5 years (16-44 years). The most prevalent cardiovascular risk family history were Diabetes Mellitus (53%) and Hypertension (52%). Cigarette smoking was related to alcoholism in 64%. Five minutes after smoking SBP increased 8.5 mmHg (maximum peak) (7.5%), 10 minutes after smoking DBP increased 4.5 mmHg (maximum peak) (6%). Ten minutes after smoking HR increased 7.7 beats per minutes (bpm) (maximum peak, 9.8%). Basal PP was 39 mmHg, five minutes after smoking PP increased 4.5 mmHg (11.5%). The previous results were gotten in correlation with basal BP, HR and PP.Cigarette smoking acutely increases BP, SBP is slightly higher than DBP this results in a increased PP. In the present study DBP and HR arisen after smoking was more gradual than SBP increase.
    American Journal of Hypertension - AMER J HYPERTENS. 01/2003; 16(5).
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    ABSTRACT: The adolescents obesity study has been an important topic in medicine over the last several years. The blood pressure (BP) has been related with the sexual maturity during the puberty. The mean BP in obese is higher than non obese adolescents in casual measuremets. The objetive in this study was to compare the BP variability using ambulatory blood pressure monitoring (ABPM) in obese and non obese adolescents group with 4 and 5 breast develop by Tanner criteria.The age range was from 12 to 17 years. The assessment of the breast develop was made by physical exam by Tanner. Obesity: body mass index (BMI) ≥95th percentile and tricipital skinfold thickness (TST)≥95th percentile. Antropometric measurements: weight, height, arm circumference, waist, hip, waist-hip ratio (W/H), subscapular, abdominal and suprailiac skinfold thickness. The casual BP of each subject was measured three times. A SpaceLabs 90207 monitor was used for 24 hours, during a regular school day. The variability analysis included also absolute variability (AV), variation coefficient and pulse pressure (PP). The statistical analysis were made by percentages (%), means, standard deviation (SD), Ji2, student t test and Pearson correlation.We included 29 obese(mean age 13.9±0.84 y), and 30 non obese (mean age 14.9±1.55 y). BMI in obese group 31.2±4.0 and non obese 21.2±2.2; p
    01/2003;
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    ABSTRACT: Several studies had shown that correlationbetween the hypertensive damage and bloodpressure variability as absolute variability orvariation coefficient especially with systolicvariability.We studied 27 hypertensive patients, afterfour weeks on placebo, amlodipine 5mg wasadministrated for four weeks, the patientswhose diastolic blood pressure was not below90mmhg had to increase the dose from 5 mg to10 mg.After amlodipine treatment systolic bloodpressure variability decreased with statisticalsignificance (p=0.001), the same as diastolicvariability (p=0.003), the variation coefficientdecreased also in a significant way for thesystolic blood pressure (p=0.02).Hypertensive loads (systolic and diastolic)during the 24 hrs period, as well as diurnal andnocturnal periods also decreased in a significantway (p≤0.01).Our study results show that amlodipine bydecreasing blood pressure variability (speciallysystolic), presents a positive effect on theantihypertensive treatment.
    Investigación en Salud. 01/2001; III(1):29-33.
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    ABSTRACT: In developing countries, the cost of antihypertensive medications is one of the principal limiting factors when trying to treat patients with high blood pressure. To determine the changes in cost (in US dollars) of these medications and in the percentage of the minimum wage needed to purchase them, two cost studies (1990 and 1996) done in Mexico were compared. The yearly cost of a treatment with hydrochlorothiazide was US $13.80 in 1990; in 1996 it was US $10.92. Both figures represent 1.1% of the minimum wage that was in effect at the time. Propranolol hydrochloride cost US $50.52 for a year's treatment in 1990, and US $66.12 for the same in 1996. These figures represented, respectively, 4.2% and 6.7% of the minimum wage of 1990 and 1996. The annual cost for nifedipine was US $176.76 in 1990 (14.7% of the minimum wage) and US $242.16 in 1996 (24.8% of the minimum wage). The yearly cost of enalapril was US $233.04 in 1990 and US $433.20 in 1996; these costs represented, respectively, 19.4% and 44.2% of the minimum wage. The comparison of these two cost studies (1990 and 1996) shows why Mexico's population is finding it more difficult to purchase antihypertensive medications. Higher costs and reduced purchasing power seem to be the two principal factors causing this. This is probably affecting the population's health, as it is more difficult to control high blood pressure without proper treatment.
    American Journal of Hypertension 05/1998; 11(4 Pt 1):487-93. · 3.67 Impact Factor
  • J. Z. Parra-Carrillo, L. Parra, C. G. Calvo, S. Fonseca
    American Journal of Hypertension - AMER J HYPERTENS. 01/1998; 11(4).
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    ABSTRACT: In developing countries, the cost of antihypertensive medications is one of the principal limiting factors when trying to treat patients with high blood pressure. To determine the changes in cost (in US dollars) of these medications and in the percentage of the minimum wage needed to purchase them, two cost studies (1990 and 1996) done in Mexico were compared.The yearly cost of a treatment with hydrochlorothiazide was US $13.80 in 1990; in 1996 it was US $10.92. Both figures represent 1.1% of the minimum wage that was in effect at the time. Propranolol hydrochloride cost US $50.52 for a year’s treatment in 1990, and US $66.12 for the same in 1996. These figures represented, respectively, 4.2% and 6.7% of the minimum wage of 1990 and 1996.The annual cost for nifedipine was US $176.76 in 1990 (14.7% of the minimum wage) and US $242.16 in 1996 (24.8% of the minimum wage). The yearly cost of enalapril was US $233.04 in 1990 and US $433.20 in 1996; these costs represented, respectively, 19.4% and 44.2% of the minimum wage.The comparison of these two cost studies (1990 and 1996) shows why Mexico’s population is finding it more difficult to purchase antihypertensive medications. Higher costs and reduced purchasing power seem to be the two principal factors causing this. This is probably affecting the population’s health, as it is more difficult to control high blood pressure without proper treatment.
    American Journal of Hypertension - AMER J HYPERTENS. 01/1998; 11(4):487-493.
  • L Baer, J Z Parra-Carrillo, I Radichevich
    Kidney international. Supplement 04/1979;
  • J A Buda, L Baer, S P Arora, J Z Parra-Carrillo, I Radichevich
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    ABSTRACT: The mechanisms involved in residual or recurrent hypertension following operation to correct renal artery stenosis were studied in 10 patients by performing angiotensin II blockade with Saralasin (Sarcosine, alanine, angiotensin II) before and after operation. Peripheral renin and renal vein renin determinations, angiography, and renography were done as well. The limitations of renin determinations are cited and the application of angiotensin II blockade as a specific method of detecting renin-dependent hypertension before and after operation are presented. Saralasin infusion under the controlled conditions of our study proved to be a sensitive method for detection of renin-dependent hypertension. The results of Saralasin infusion correlated closely with peripheral and renal vein renin determinations. Thus angiotensin II blockade before and after operation may supercede more invasive and less specific diagnostic methods.
    Surgery 12/1978; 84(5):664-70. · 3.37 Impact Factor
  • J Z Parra-Carrillo, L Baer, I Radichevich
    Cardiovascular clinics 02/1978; 9(1):183-95.
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    ABSTRACT: One hundred sixteen patients underwent operation for renovascular hypertension from 1962 through 1975; 64% had aortorenal reconstruction and 36% had nephrectomy. Sixty-six percent were cured and 19% were improved. Rapid sequence intravenous pyelography, radioisotope renography, and renal arteriography were equal in ability to detect renovascular hypertension. Bilateral renal biopsy specimens had excellent prognostic value when performed in a graded semiquantitative manner. Plasma renin activity was the most consistently useful criterion for prediction of surgical cure if the following requirements were used: (1) elevated peripheral plasma renin activity, (2) elevated renin from the affected kidney, and (3) suppressed renin secretion from the contralateral kidney. An angiotensin II antagonist, saralasin acetate, used in six patients before operation in an attempt to identify those whose hypertension depended on angiotensin II activity, produced a depressor response correlating well with the surgical result.
    Archives of Surgery 12/1976; 111(11):1243-8. · 4.10 Impact Factor
  • Salud publica de Mexico 23(1):83-92. · 0.94 Impact Factor
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    ABSTRACT: Artículo original Med Int Mex 2006; 22:85-92 RESuMEN Antecedentes: la disfunción diastólica puede preceder a la aparición de la hipertrofia ventricular; sin embargo, no se ha encontrado de manera consistente en los hipertensos de bata blanca. Objetivo: medir la función y la estructura cardiaca en los pacientes con hipertensión de bata blanca. Pacientes y método: se estudiaron de manera prospectiva 104 individuos obesos, no diabéticos, hipertensos leves o que estaban en proceso de dicho diagnóstico. Mediante medición auscultatoria y monitoreo ambulatorio de 24 horas se formaron tres grupos de pacientes: hipertensos sostenidos, hipertensos de bata blanca y no hipertensos. A todos se les realizó un ecocardiograma Doppler para identificar su estructura y función cardiaca. Resultados: la fracción de eyección fue igual en los tres grupos. En los hipertensos de bata blanca la disfunción diastólica (32.2%; p < 0.05) fue mayor que en los no hipertensos, pero menor en relación con los hipertensos sostenidos (50%; p < 0.05). La hipertrofia ventri-cular izquierda en hipertensos sostenidos, hipertensos de bata blanca y no hipertensos fue de 46, 16 y 10%, respectivamente, aunque la diferencia entre los dos últimos grupos no fue significativa. Conclusiones: la hipertensión de bata blanca se asocia con mayor prevalencia de disfunción diastólica, por lo que la identificación tem-prana del daño cardiovascular en estos pacientes podría utilizarse como marcador pronóstico y para prescribir un tratamiento. Palabras clave: hipertensión de bata blanca, disfunción diastólica, daño a órgano blanco. ABSTRACT Background: Diastolic dysfunction can be present in the hypertensive patients, even before the appearance of left ventricular hypertrophy. This change in the ventricular filling has not been found consistently in hypertensive patients with white coat hypertension. Objective: To measure the left ventricle structure and function in white coat hypertension patients and compare the findings in individuals with sustained hypertension. Patients and method: A total of 104 obese individuals (88% female, Quetelet index 30.4 ± 4.2), without diabetes, slightly hypertensive or in study for this diagnosis were studied. Based on auscultatory measurement and 24-hour ambulatory blood pressure monitoring, three groups were formed: sustained hypertensives, white coat hypertensives, and non-hypertensives. A Doppler color echocardiogram was done on each patient to identify cardiac structure and function. Results: Diastolic dysfunction was prevalent in all three groups; white coat hypertensives had greater diastolic dysfunction (32.2%) than non-hypertensives (22.8%) (p < 0.05). Left ventricular hypertrophy was greater in white coat hypertensives than in non-hypertensives, but there was no statistical significance. Ejection fraction was equal in the three groups. Conclusions: White coat hypertension is associated with a high prevalence of diastolic dysfunction, thus the identification of early cardio-vascular damage in these patients could be used as a prognosis marker and to decide the treatment to be used.
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    ABSTRACT: We studied the blood pressure in 1,635 workers in 12 companies of Guadalajara City. We observed direct relationship of age with systolic and diastolic values. The prevalence of high blood pressure for 1,000 workers was: for systolic hypertension 158.71; for sisto-diastolic hypertension 99.42 and for the diastolic hypertension 27.02. We found that for the systo-diastolic hypertensives their life expectancy was 11.5 years shorter and the economic impact was calculated in 2,954.10 million of pesos for each 100 workers.
    Archivos del Instituto de Cardiología de México 60(1):89-98.

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