Changes in blood pressure according to stature in Mexican adults / Cambios en la presión arterial de acuerdo con la estatura en adultos mexicanos

ABSTRACT OBJECTIVE: To determine the possible existence of differences in blood pressure change over time according to stature in Mexican adults. METHODS: We analyzed the National Household Living Standards Survey databases following household members between 2005 and 2009. We selected participants who were between 20 and 40 years old (n = 7,130). We estimated multilevel models with random intercept to analyze differences in blood pressure changes according to stature. We adjusted the models for age, locality size, geographic region, per capita family income, waist-to-height ratio, physical activity, alcohol consumption, smoking, and use of antihypertensive drugs. RESULTS: In both sexes, baseline blood pressure tended to be lower as stature decreased. The differences were maintained in both the crude and adjusted models. In men, the increases in systolic pressure over time tended to be higher as stature increased. CONCLUSIONS: Contrary to what studies observed in high-income countries, in Mexico blood pressure was positively associated with stature.

RESUMEN OBJETIVO: Determinar si existen diferencias en el cambio de la presión arterial a lo largo del tiempo de acuerdo con la estatura en adultos mexicanos. MÉTODOS: Se analizaron las bases de datos de la Encuesta Nacional de Niveles de Vida de los Hogares en la que se siguieron a los miembros de los hogares entre el 2005 y 2009. Se seleccionaron a los participantes que tenían entre 20 y 40 años (n = 7,130). Se estimaron modelos multinivel con intercepto aleatorio para analizar diferencias en los cambios de la presión arterial de acuerdo con la estatura. Los modelos fueron ajustados por edad, tamaño de localidad, región geográfica, ingreso familiar per cápita, índice cintura-estatura, actividad física, consumo de alcohol, tabaquismo y uso de antihipertensivos. RESULTADOS: En ambos sexos, la presión arterial inicial tendió a ser menor conforme la estatura fuese menor. Las diferencias se mantuvieron tanto en los modelos crudos como en los modelos ajustados. En los varones los incrementos de la presión sistólica a lo largo del tiempo tendieron a ser mayores conforme la estatura era más alta. CONCLUSIONES: Contrario a lo observado en países de altos ingresos, en México la presión arterial se asoció positivamente con la estatura.

Analysis of the interrelationships between factors influencing blood pressure in adults / Análise das inter-relações entre os fatores que influenciam a pressão arterial em adultos

ABSTRACT OBJECTIVE To investigate the interrelationships between sociodemographic, behavioral and clinical factors associated with high blood pressure in a population of Brazilian adults. METHODS Data from a cross-sectional population-based study conducted with adults were used. In the hypothetical model developed socioeconomic status, fruit and vegetable intake, adiposity and blood pressure were treated as latent variables and age, gender, glycemia, physical activity, smoking, alcohol consumption and control of arterial hypertension were considered observed variables. Confirmatory factorial analysis was used to construct the latent variables measurement models and the structural equation modeling was used to adjust the final model. RESULTS The study included 808 individuals, with mean age of 44.2 years (± 17.8), 52.7% being female. It verified that age exerted a positive direct effect on blood pressure (β = 0.39), adiposity (β = 0.44), glycemia (β = 0.26) and smoking (β = 0.30). Age had a negative direct effect on physical activity (β=-0.17) and alcohol consumption (β = -0.10). Males were positively associated with blood pressure (β = 0.13), smoking (β = 0.28; p < 0.001) and alcohol consumption (β = 0.18). Adiposity had a positive direct effect on blood pressure (β = 0.23) and glycemia (β = 0.16) and alcohol consumption produced a positive effect (β = 0.09) on adiposity. Fruit and vegetable intake had a negative direct effect on blood pressure (β = -0.11), while socioeconomic status had a positive direct effect on fruit and vegetable consumption (β = 0.47). We adjusted the structural model according to the variable medical control of arterial hypertension, which had a negative direct effect on blood pressure (β = -0.10). CONCLUSIONS Results suggest that increasing age is associated with increased blood pressure, adiposity, glycemia and smoking, as well as with reduced physical activity and alcohol consumption. Males were associated with increased blood pressure and greater use of alcohol and cigarettes. Higher adiposity indicators were correlated with increased blood pressure and glycemic levels; higher alcohol consumption was associated with increased adiposity. Higher consumption of fruits and vegetables, as well as active control of hypertension were associated with reduced blood pressure. Better socioeconomic status was associated with higher consumption of fruits and vegetables.

RESUMO OBJETIVO Investigar as inter-relações entre fatores sociodemográficos, comportamentais e clínicos associados à elevação da pressão arterial em adultos. MÉTODOS Utilizaram-se dados de um estudo transversal de base populacional. Foi desenvolvido um modelo hipotético em que condição socioeconômica, consumo de frutas e vegetais, adiposidade e pressão arterial foram tratadas como variáveis latentes, e idade, sexo, glicemia, atividade física, tabagismo, consumo de álcool e controle da hipertensão arterial (HA) foram tratadas como variáveis observadas. Utilizou-se a modelagem de equação estrutural para ajustar o modelo final. RESULTADOS Participaram do estudo 808 indivíduos, com idade média de 44,2 anos (DP = 17,8), sendo 52,7% do sexo feminino. Verificou-se que a idade exerceu efeito positivo sobre pressão arterial (β = 0,39), adiposidade (β = 0,44), glicemia (β = 0,26) e tabagismo (β = 0,30), e efeito negativo sobre atividade física (β = -0,17) e consumo de álcool (β = -0,09). O sexo masculino mostrou-se associado positivamente com a pressão arterial (β = 0,13), com o tabagismo (β = 0,28) e com o consumo de bebida alcoólica (β = 0,18). A adiposidade teve efeito positivo sobre a pressão arterial (β = 0,23) e a glicemia (β = 0,16), o consumo de álcool produziu efeito positivo sobre a adiposidade (β = 0,09), o consumo de frutas e vegetais exerceu efeito negativo sobre a pressão arterial (β = -0,11), e a condição socioeconômica teve efeito positivo sobre o consumo de frutas e vegetais (β = 0,47). O modelo estrutural foi ajustado pela variável controle médico da hipertensão, que apresentou efeito negativo sobre a pressão arterial (β = -0,10). CONCLUSÕES Os resultados sugerem que o aumento da idade se associa ao aumento da pressão arterial, adiposidade, glicemia e tabagismo, assim como com a redução da atividade física e consumo de álcool. O sexo masculino associou-se com aumento da pressão arterial e maior uso de bebida alcoólica e cigarros. A adiposidade correlaciona-se ao aumento da pressão arterial e da glicemia, enquanto maior consumo de álcool associa-se com aumento da adiposidade e maior consumo de frutas e vegetais, assim como o controle ativo da hipertensão, correlaciona-se com redução da pressão arterial. A melhor condição socioeconômica mostrou-se associada com maior consumo de frutas e vegetais.

Losartan improves alveolar bone dynamics in normotensive rats but not in hypertensive rats

Abstract Hypertension is one of the main causes of premature death in the world; also, it is associated with several bone alterations. Preclinical studies have demonstrated delayed alveolar bone healing in hypertensive rats. However, losartan has been favorable for consolidation of bone grafts and reduction in active periodontitis. Therefore, losartan is suggested to be effective in bone formation stages, as well as in the synthesis of matrix proteins and mineralization. Objectives: To evaluate the alveolar bone dynamics in hypertensive rats treated with losartan by laser confocal microscopy and histological analysis. Methodology: Thirty-two rats, 16 spontaneously hypertensive rats (SHR) and 16 Wistar albinus rats, treated or not with losartan (30 mg/kg/day) were used. Calcein fluorochrome at 21 days and alizarin red fluorochrome at 49 days were injected in rats (both 20 mg/kg). The animals were submitted to euthanasia 67 days after treatment, and then the right maxilla was removed for laser confocal microscopy analysis and the left maxilla for histological analysis. Results: This study showed a greater calcium marking in normotensive animals treated with losartan in relation to the other groups. Laser confocal microscopy parameters showed higher values of bone volume formed, mineralized surface, active surface of mineralization and bone formation rate in normotensive animals treated with losartan. However, a smaller mineralized surface was observed in all hypertensive animals. Conclusion: Losartan can improve bone mineralization parameters under normal physiological conditions, but the same anabolic effect does not occur under hypertension.

Assessment of patient's anxiety and expectation associated with hemodynamic changes during surgical procedure under local anesthesia / Avaliação da ansiedade e da expectativa do paciente associadas às alterações hemodinâmicas durante procedimento cirúrgico sob anestesia local

Introduction: The dental patient's anxiety and expectation may significantly alter their vital signs. The use of local anesthetics associated with a vasoconstrictor may also alter the vital signs of these patients, promoting hemodynamic changes that may result in emergency situations. Objective: To evaluate the influence of anxiety of patients submitted to third molar extraction and the use of different anesthetic substances with adrenaline on their vital signs (oxygen saturation, heart rate, and systolic and diastolic blood pressure) in different moments. Material and method: Forty patients answered the questionnaire of the Dental Anxiety Scale (Corah's Scale) and fear (KleinKnecht's Scale) and were submitted to third molar extraction in two surgical times for the use of articaine or mepivacaine, both associated with adrenaline. The results were analyzed by ANOVA followed by Tukey post hoc test, Student's t test, and Pearson's correlation coefficients (α=0.05). Result: There was no significant differences in saturation or heart rate. The blood pressure showed significant variations during time for both anesthetics, however mepivacaine resulted in a longer postoperative time to restore blood pressure. Patients with high or moderate anxiety and high fear index were those who had positive correlations with the highest blood pressure values. Conclusion: Anxiety and fear positively influence the increase in blood pressure. Mepivacaine promoted a greater resistance to the return of normal vital signs, especially blood pressure levels.

Introdução: A ansiedade e a expectativa do paciente odontológico podem alterar de forma significativa seus sinais vitais. Da mesma forma, o uso de anestésico local associado a um vasoconstrictor também alteram os sinais vitais desses pacientes, promovendo alterações hemodinâmicas que podem resultar em situações de emergência. Objetivo: Avaliar a influência da ansiedade de pacientes submetidos à exodontia de terceiros molares e do uso de diferentes substâncias anestésicas com adrenalina sobre seus sinais vitais (saturação de oxigênio, pulsação e pressão arterial sistólica e diastólica) em diferentes momentos operatórios. Material e método: Quarenta pacientes responderam os questionários da Escala de Ansiedade Dentária (Escala de Corah) e de medo (Escala de Kleinknecht) e foram submetidos à exodontia dos terceiros molares em dois tempos cirúrgicos para utilização de articaína ou mepivacaína, ambos associados com adrenalina. Os resultados obtidos foram analisados por ANOVA seguido do teste post hoc de Tukey, t de Student e coeficientes de correlação de Pearson (α=0,05). Resultado: Não houve alteração significativa na saturação nem na frequência cardíaca. A pressão arterial apresentou variações significantes nos tempos aferidos para os dois anestésicos, entretanto a mepivacaína resultou em maior tempo de pós-operatório para o restabelecimento da pressão arterial. Os pacientes com muita ou moderada ansiedade e alto índice de medo foram os que tiveram correlações positivas com os maiores números pressóricos aferidos. Conclusão: A ansiedade e medo influenciam positivamente no aumento da pressão arterial. A mepivacaína promoveu uma maior resistência ao retorno da normalidade dos sinais vitais, especialmente dos níveis pressóricos.

Does Third Molar Surgery Alter Cardiac Parameters? A Retrospective Study

Objective: To investigate perioperative changes in the cardiac parameters of anxiety, which are blood pressure and heart rate, in patients undergoing surgical extraction of third molars. Material and Methods: Patients who reported anxiety before scheduled procedures were monitored for cardiac parameters before, during and after the surgery. The obtained data were analyzed to determine if there is a certain pattern of change within these values in systemically healthy patients. Alterations in selected parameters with regard to duration and difficulty of operation were also studied. IBM SPSS Statistics was used for data analysis. Repeated-measures of analysis of variance (ANOVA), paired samples t-test and Kruskal-Wallis tests were applied and a significance level of 5% was assessed. Results: Difficulty was categorized as minimally, moderately or very difficult in 9, 28 and 3 patients respectively. Mean operation time was 36.18 minutes with a range of 8 to 91 minutes. Operation time showed no variations with different levels of difficulty (p = 0.268). No statistical differences in any of the parameters listed above could be identified. Conclusion: Despite the common belief that dental procedures initiate anxiety, this study reveals that physiological parameters of anxiety show no significant changes over the course of third molar surgery, likewise difficulty and duration of surgery do not cause noteworthy changes in these parameters.

Análise da variabilidade da frequência cardíaca (VFC) em cirurgias de exodontia de terceiros molares inferiores / Analysis of heart rate variability (HRV) in lower third molar surgeries

Embora amplamente utilizados no monitoramento durante o tratamento odontológico, pesquisas questionam a sensibilidade de medidas como da Pressão Arterial e Frequência Cardíaca na detecção precoce de anormalidades cardiocirculatórias iniciais e, sobretudo, das respostas autonômicas ao estresse mental e às drogas administradas durante procedimentos cirúrgicos. A Variabilidade da Frequência Cardíaca (VFC), isto é, a variação do intervalo RR batimento-a-batimento, é reconhecida como uma sensível preditora de eventos cardiovasculares graves como arritmias, isquemia miocárdica e morte súbita, além de trazer informações sobre a atividade do sistema nervoso autônomo. O objetivo deste estudo foi avaliar a aplicabilidade da análise da VFC (obtida a partir da utilização de frequencímetro portátil) na mensuração de respostas fisiológicas durante cirurgias odontológicas. 33 pacientes, ASA 1, com indicação de extração de terceiros molares inferiores foram avaliados em 3 momentos: entrevista, cirurgia e pós-operatório, com intervalos de uma semana. Também foi avaliada a ansiedade ao tratamento odontológico e relato de evento traumático prévio. A VFC foi obtida após processamento dos intervalos RR registrados com o frequencímetro Polar RS800. Foram analisadas as variáveis do domínio tempo (SDNN e rMSSD) e frequência (razão LF/HF). Concomitantemente foram medidas Pressão Arterial Sistólica (PAS), Diastólica (PAD), Média (PAM), Frequência Cardíaca (FC) e variáveis eletrocardiográficas. Nesta amostra de voluntários saudáveis, a ansiedade ao tratamento odontológico e o antecedente de experiências traumáticas não se mostraram correlacionados à maior intensidade de dor pós-operatória. Não foram observadas alterações da PAS, PAD, PAM, FC, tampouco alterações eletrocardiográficas relevantes ao longo das fases cirúrgicas. Com relação à VFC, houve redução do SDNN entre a fase basal e a fase anestesia. Gênero, idade, ansiedade e tabagismo passivo não determinaram comportamentos diferentes nas variáveis estudadas. O presente estudo demonstrou viabilidade da inclusão do estudo da VFC em protocolos clínicos de avaliação do comportamento do aparelho cardiovascular em procedimentos odontológicos. O estudo da VFC através de frequencímetros de pulso, instrumentos de baixo custo, ampla disponibilidade e fácil manuseio, pode prestar-se como uma ferramenta útil em estudos de segurança cardiovascular de novos fármacos e procedimentos.

Although widely used in monitoring during dental treatment, researches question the sensitivity measures such as Blood Pressure and Heart Rate (HR) in the early detection of cardiovascular abnormalities early and especially of autonomic responses to mental stress and drugs administered during surgical procedures. The Heart Rate Variability (HRV), the variation of the RR interval beat-to-beat, is recognized as a significant predictor of serious cardiovascular events such as arrhythmias, myocardial ischemia and sudden death, in addition to providing information about the activity of autonomic nervous system. The aim of this study was to evaluate the applicability of HRV analysis (obtained from the use of portable frequency meter) in measuring physiological responses during dental surgery. 33 patients, ASA 1, indicating the extraction of third molars were evaluated in three stages: interview, surgery and postoperatively at intervals of a week. Was also assessed anxiety during dental treatment and reported prior traumatic event. HRV was obtained after processing of RR intervals recorded with the frequency meter Polar RS800. The variables analyzed were in the time domain (SDNN and rMSSD) and frequency (LF / HF ratio). Concomitantly were measured systolic blood pressure (SBP), diastolic (DBP), Medium (PAM), HR and electrocardiographic variables. In this sample of healthy volunteers, anxiety during dental treatment and previous traumatic experiences were not correlated to the intensity of postoperative pain. No changes were observed in SBP, DBP, MAP, HR, nor relevant electrocardiographic changes along the surgical stages. Regarding to HRV, the SDNN decreased between the baseline phase and phase anesthesia. Gender, age, anxiety, and passive smoking didnt determine different behaviors in studied variables. The present study demonstrated feasibility of including the study of HRV in clinical protocols for assessing the behavior of the cardiovascular system in dental procedures. The study of HRV by pulse frequency meters, instruments low cost, wide availability and easy handling, it may lend itself as a useful tool in studies of cardiovascular safety of new drugs and procedures.