Objective:To analyze the efficacy of multiple pharmacological therapy on blood pressure control and therapeutics goals in a group of high-risk patients.Design and method:Blood pressure levels were analyzed in a group of 156 hypertensive patients with diabetes mellitus under pharmacological treatment, reviewed in the outpatient cardiology office. Blood pressure levels were classified according to the AHA and ESC classifications. Sociodemographic data, cardiovascular risk factors, number of drugs and therapeutic goals were recorded. Blood pressure measurement was performed using an digital manometer according to AHA and ESC guidelines. Results are shown in terms of measures of central tendency.Results:Average age was 55 ± 16 [20–93], 40% (62) were women. Smoking was the most common cardiovascular risk factor with 40% (62), followed by obesity 20% (31), CKD 10% (15), 25% (39) of the women were postmenopausal. The mean systolic blood pressure (SBP) obtained in the measurements was 124.27 mmHg (240–10 mmHg) and 74.7 mmHg (110–30 mmHg) of diastolic blood pressure (DBP), both in men and women (p = 0.06). Antihypertensive drug treatment was: 37% monotherapy, 42% dual,19% triple and 2% quadruple. Only 67% (104) were in therapeutics goals according to the ESC guidelines and 33% (52) according AHA guidelines respectively.Conclusions:Goal achievement is poor in this group of high-risk patients. Even though 63% of the patients had multiple pharmacological treatments, more than a third of patients were not reaching therapeutics goals in blood pressure control. This percentage doubles when more stringent goals are used, following the AHA guidelines.

To describe the presentation of a pulmonary artery dissection to the Emergency Unit, the sequence of events, and a literature review. Case report: A 59-year-old female patient with known Chagas heart disease presented at the Emergency Unit with an event of sudden, stabbing chest pain and progressive dyspnea, evolving rapidly to cardiogenic shock. A chest radiograph reported severe widening of the mediastinum and cardiomegaly; therefore, a thoracic angiotomography was performed to rule out acute aortic syndrome, in which a dissecting pulmonary artery aneurysm was diagnosed. Transthoracic echocardiogram showed an intimal flap at the pulmonary artery and severe dilatation. The patient died in less than four hours after arrival at the emergency room without being able to access surgical treatment due to the rapid evolution. Conclusion: Pulmonary artery dissection is a rare disease, with a high rate of mortality. Optimal management requires a rapid diagnosis with multiple imaging techniques. There is a lack of information about this topic.