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#30 De: Jorge Did Nunez <jdid@infomed.sld.cu>
Enviado: Lunes, 31 de Enero de 2000 07:32
Asunto: Estratificacion de Riesgo/Risk stratification
Sponsored by: Laboratorios Gador
Estimados colegas:
Qusiera aprovechar la publicacion en el congreso del documento del Profesor John Chalmers titulado "The 1999 WHO-ISH hypertension
guidelines stratifiying the risk to treat the patient", basado en los postulados de las "1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension", para formular tres interrogantes que me surgieron luego de estudiar detenidamente el documento de referencia.
a). En el grupo de BAJO RIESGO, dado que el riesgo se cuantifica en menos del 15%, ¿que valores corresponden a la ¨hipertertension borderline¨ de acuerdo a la expresion ¨riesgo particularmente bajo? (pagina 162).
b). En los grupos de MEDIANO RIESGO y ALTO RIESGO, cuyos rangos terminan y comienzan en un valor de 20%, como se puede eliminar el
solapamiento entre los grupos (paginas 162-53).
c). ¿Puede ser usada la metodologia de Estratificacion de Riesgo para la Cuantificacion Pronostica presentada en la Tabla 3 para todos los pacientes con hipertension arterial, o esta es solamente aplicable a los pacientes entre los rangos de edad seguidos en el estudio Framingham, de acuerdo a lo expresado en la parte final del primer parrafo del titulo Stratification of patients with hypertension by absolute level of cardiovascular risk?
Cordialmente

Dear colleagues:
I would like to take advantage of the publication in the congress of the document by Professor John Chalmers titled "The 1999 WHO-ISH hypertension guidelines stratifying the risk to treat the patient", based on the postulates by the "1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension", to ask three questions that I wondered about after studying at length the mentioned document.
a) In the LOW RISK group, given that risk is quantified in less than a 15%: what values correspond to "borderline hypertension" according to the expression "particularly low risk"? (page 162)
b) In the MEDIUM and HIGH RISK groups, the ranges of which end and begin in a 20% value, how can you eliminate the superposition between the groups (pages 162-53).
c) Can the methodology of Risk Stratification be used for Prognosis Quantification presented on Table 3 for all patients with hypertension, or this is applicable only to the patients between the age ranges followed in the Framingham study, according to what has been expressed in the final part of the first paragraph under the title Stratification of patients with hypertension by absolute level of cardiovascular risk?
Cordially,
Dr. Jorge P. Did
jdid@infomed.sld.cu
La Habana. Cuba

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#31 De: Moderador del Foro ,edgardo@schapachnik.com.ar
Enviado: Domingo 06 de Febrero de 2000 20:45
Asunto: Epistaxis, ¿sí o no?/Epistaxis, yes or not?
Sponsored by: IntraMed
Queridos colegas:
Mientras ansiosamente esperamos opiniones acerca del caso que enviara el Dr. Gomez Llambi y acerca de la consulta del Dr. Did Nunez sobre la Conferencia del Dr. Chalmers referente a Estratificacion del Riesgo, introduzco un nuevo elemento:
¿Que opinan los colegas acerca de la tan mentada epistaxis como consecuencia de Hipertension Arterial?
La Hipertension, ¿produce epistaxis, como es afirmado por la sabiduria popular? ¿Esto es así? Si lo es, ¿por que?
En el sitio de Medscape's Cardiology MedPulse(R)
<http://cardiology.medscape.com>
se encuentra una referencia al numero de febrero de la Revista Annals of Emergency Medicine, donde hay un articulo referente al tema.
Los invito a opinar.
Cordialmente
Edgardo

Dear colleagues:
While we wait anxiously for the opinions about the case sent by Dr. Gomez Llambi, and about the consult by Dr. Did Nunez about the Lecture by Dr. Chalmers regarding Risk Stratification, I present a new element:
What do colleagues think about the much-trumpeted epistaxis as a consequence of Hypertension?
Does hypertension produce epistaxis, as it is stated by popular knowledge? Is this so? If so, why?
At the Medscape's Cardiology MedPulse(R) site
<http://cardiology.medscape.com>
there is a reference about February's issue of the Journal Annals of Emergency Medicine, where there is an article about the topic.
I invite you to express your opinion.
Cordially,
Edgardo

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#32 De: Jose Antonio Carbonell <ccarbone@caracas.c-com.net>
Enviado: Martes, 8 de Febrero de 2000 11:25
Asunto: Epistaxis
Sponsored by: Agilent Technologies
Estimados amigos:
En lo personal no creia en la Epistaxis como manifestacion de una crisis hipertensiva, hasta que hace un mes aproximadamente me encontraba en mi puesto de emergencia y tuve la oportunidad de atender a un paciente de raza negra, de aproximadamente 50 años de edad con una importante epistaxis anterior....su presion arterial era de 230/130 mmHg (la mas elevada que he visto en mi vida). Se inicio tratamiento con Nifedipina, sin ningun exito, segui con Catapressan (R) IV, tampoco tuve exito....lo referi para hospitalizacion y me imagino que alla habran insistido con el Cata pressan (R) o le habran puesto Nitroprusiato...
Lo que quiero decir con todo esto es que desde que vi este caso si creo que la espitaxis pueda ser una manifestacion de una crisis hipertensiva, aunque no estaria seguro si es por la ruptura de los pequeños elementos vasculares del area anterior de las fosas nasales.
Aprovecho la oportunidad para introducir una nueva pregunta al Foro:
Yo he leido y tengo fotocopia de trabajos de investigacion publicados en The Lancet y Postgraduate Medicine (PM) donde se asegura que la nifedipina sublingual no se absorbe, y que solamente es asi por via oral. Que lo que ocurre es que a la persona que se le coloca la nifedipina sublingual la termina tragando y de ahi su efecto....mi pregunat es: Que opinan Ustedes al respecto ?
Saludos desde Caracas (Venezuela)

Dear friends:
Personally, I did not believe in Epistaxis as manifestation of a hypertensive crisis, until a month ago more or less, I was in my emergency work, and I had the chance of treating a patient, black race, approximately 50 years old, with an important anterior epistaxis... his blood pressure was 230/130mmHg (the highest I have seen in my life). We begun treatment with Nifedipine, without success, and I went on with Catapressan (R) IV, I was not successful either... I send him to be admitted in the hospital, and I imagined that there they may have insisted with the Catapressan (R), or they may have used Nitroprusside...
What I mean with all this, is that since I saw this case I do believe that epistaxis may be a manifestation of a hypertensive crisis, though I am not so sure if it is due to the break of small vascular elements in the anterior area of the nasal cavities.
I take advantage of this opportunity to introduce a new question to the Forum:
I have read, and I have photocopies of works of research published in The Lancet and Postgraduate Medicine (PM) where it is stated that sublingual nifedipine is not absorbed, and that it is only absorbed orally. What would happen is that the individual in whom sublingual nifedipine is placed, ends swallowing it, and that is the reason of its effect... my question is: What do you think about it?
Greetings from Caracas (Venezuela)
Dr. Jose Antonio Carbonell

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