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Latin American consensus on hypertension in patients with diabetes type 2 and metabolic syndrome

López-Jaramillo, Patricioa; Sánchez, Ramiro A.b; Diaz, Margaritac; Cobos, Leonardod; Bryce, Alfonsoe; Parra Carrillo, Jose Z.f; Lizcano, Fernandog; Lanas, Fernandoh; Sinay, Isaaci; Sierra, Iván D.j; Peñaherrera, Ernestok; Bendersky, Mariol; Schmid, Helenam; Botero, Rodrigon; Urina, Manuelo; Lara, Joffrep; Foss, Milton C.q; Márquez, Gustavor; Harrap, Stephens; Ramírez, Agustín J.b; Zanchetti, Albertoton behalf of the Latin America Expert Group

doi: 10.1097/HJH.0b013e32835c5444

The present document has been prepared by a group of experts, members of cardiology, endocrinology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of ‘metabolic syndrome’ is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that ‘metabolic syndrome’ is a useful nosographic entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particularly high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations.

aFundación Oftalmológica de Santander FOSCAL, Universidad de Santander UDES, Bucaramanga, Colombia

bArterial Hypertension and Metabolic Unit, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina

cClínica Platinum, Montevideo, Uruguay

dColegio Panamericano del Endotelio, Santiago, Chile

eClínica del Golf, Lima, Peru

fUniversidad de Guadalajara, Guadalajara, Mexico

gAsociación Colombiana de Endocrinología, Universidad de La Sabana, Bogotá, Colombia

hUniversidad de la Frontera, Temuco, Chile

iInstituto Cardiologico de Buenos Aires, Buenos Aires, Argentina

jAsociacion Latinoamericana de Diabetes, Bogota, Colombia

kHospital Luis Vernaza, Guayaquil, Ecuador

lUniversidad de Cordoba, Cordoba, Argentina

mUniversidad Federal do Rio Grande do Sul, Porto Alegre, Brazil

nCentro Medico, Medellin, Colombia

oSociedad Colombiana de Cardiología, Bogotá, Colombia

pSociedad Ecuatoriana de Aterosclerosis, Guayaquil, Ecuador

qUniversidad de Sao Paulo, Ribeirao Preto, Brazil

rFederation Diabetologica Colombiana, Corozal, Colombia

sUniversity of Melbourne, Melbourne, Australia

tIstituto Auxologico Italiano, Milan, Italy

Correspondence to Patricio López-Jaramillo, MD, Clínica de Síndrome Metabólico, Prediabetes y Diabetes, Departamento de Investigación, Fundación Oftalmológica de Santander (FOSCAL), Facultad de Medicina, Universidad de Santander (UDES), Calle 155 A No. 23-09, Floridablanca, Santander, SA, Colombia. E-mail

Abbreviations: ABPM, Twenty-four-hour ambulatory blood pressure monitoring; ACCOMPLISH, Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension; ACCORD, Action to Control Cardiovascular Risk in Diabetes Study; ACEI, angiotensin-converting enzyme inhibitors; ADA, American Diabetes Association; ADVANCE, Action in diabetes and vascular disease# preterax and diamicron mr controlled evalution Study; ALTITUDE, Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints; ARB, angiotensin receptor blockers; ATP III, Adult Treatment Panel III; BP, blood pressure; CCB, calcium channel blockers; CHD, coronary heart disease; CI, confidence interval; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; EMEA, European Medicines Agency; ESH-ESC, European Society of Hypertension-European Society of Cardiology; ESRD, end-stage renal disease; FDAU.S., US Food and Drug Administration; GFR, glomerular filtration rate; Hb A1c, glycosylated haemoglobin; HIC, high-income countries; HOPE, Heart Outcomes Prevention Evaluation; HOT, Hypertension Optimal Treatment Study; IDF, International Diabetes Federation; IFG, impaired fasting glucose; IGTT, impaired glucose tolerance test; LIC, low-income countries; MDRD, Modification of Diet in Renal Disease; OGTT, oral glucose tolerance test; ONTARGET, Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial; PAHO, Pan American Health Organization; PURE, Prospective Urban Rural Epidemiology study; RAAS, renin–angiotensin–aldosterone system; UAE, urinary albumin excretion; UKPDS, United Kingdom Prospective Diabetes Study; UMIC & LMIC, upper middle and low middle income; VO2 max, aerobic capacity; WHO-ISH, WHO-International Society of Hypertension

Received 6 November, 2012

Accepted 6 November, 2012

© 2013 Lippincott Williams & Wilkins, Inc.