Patterns of kidney function and risk assessment in a nationwide laboratory database: the Brazilian CHECK-CKD study.

BACKGROUND: Chronic kidney disease (CKD) is a global health problem with rising prevalence, morbidity, mortality, and associated costs. Early identification and risk stratification are key to preventing progression to kidney failure. However, there is a paucity of data on practice patterns of kidney function assessment to guide the development of improvement strategies, particularly in lower-income countries. METHODS: A retrospective observational analysis was conducted in a nationwide laboratory database in Brazil. We included all adult patients with at least one serum creatinine assessment between June 2018 and May 2021. Our primary objective was to determine the proportion of patients with estimated glomerular filtration rate (eGFR) evaluations accompanied by predicted levels of urinary albumin-to-creatinine ratio (pACR) assessments within 12 months. RESULTS: Out of 4,5323,332 serum creatinine measurements, 42% lacked pACR measurements within 12 months. Approximately 10.8% of tests suggested CKD, mostly at stage 3a. The proportion of serum creatinine exams paired with pACR assessment varied according to the CKD stage. Internal Medicine, Cardiology, and Obstetrics/Gynecology were the specialties requesting most of the creatinine tests. Nephrology contributed with only 1.1% of serum creatinine requests for testing. CONCLUSION: Our findings reveal that a significant proportion of individuals with a creatinine test lack an accompanying urinary albuminuria measurement in Brazil, contrary to the recommendations of the international guidelines. Non-Nephrologists perform most kidney function evaluations, even among patients with presumable advanced CKD. This highlights the urge to incorporate in clinical practice the early detection of CKD and to encourage more collaborative multidisciplinary care to improve CKD management.

May Measurement Month 2018: an analysis of blood pressure screening results from Brazil.

Hypertension is a pathology of high prevalence in the world. In Brazil, it is the main risk factor for the major cause of death in the country, coronary heart disease. The May Measurement Month Campaign in 2018 (MMM18) included a population with representation from all Brazilian states and reflects some of the characteristics of hypertension in Brazil. Questionnaire data were collected and three measures of blood pressure (BP) were performed. The sample consisted of 12 413 individuals, 59.1% were white, 51.3% were women. The average age was 54. ± 16.0 years. Diabetes was present in 11.6%, previous myocardial infarction in 5.9%, and previous stroke in 2.7%. Current smokers were 9.3% and 12.4% were regular drinkers. The average body mass index was 27.3 ± 4.5 kg/m2. After multiple imputations, 67.9% were hypertensive (>140/90 mmHg). Of the individuals who were not taking antihypertensive medication, 27.9% were hypertensive and of those taking antihypertensive medication, 40.3% were uncontrolled. Systolic BP increased with age. The MMM18 campaign demonstrated a large number of unknown hypertensives and a high rate of uncontrolled hypertension in Brazil, unfortunately in keeping with 2017 findings.

Whole-body vibration improves the functional parameters of individuals with metabolic syndrome: an exploratory study.

BACKGROUND: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that increases the cardiovascular risk. Regular physical exercise can promote benefits, but the MetS individuals are demotivated to perform it. Thus, new possibilities are important as an alternative intervention. The whole-body vibration can be considered an exercise modality and would be a safe and low-cost strategy to improve functional parameters of individuals in different clinical conditions. The aim of this exploratory study was to assess effects of whole-body vibration on functional parameters of MetS individuals. The hypothesis of this work was that the whole-body vibration could improve the functionality of MetS individuals. METHODS: Twenty-two individuals performed the intervention. The vibration frequency varied from 5 to 14 Hz and the peak-to-peak displacements, from 2.5 to 7.5 mm. Each session consisted of one minute-bout of working time followed by a one minute-bout of passive rest in each peak-to-peak displacement for three-times. The whole-body vibration protocol was applied twice per week for 5 weeks. Data from the trunk flexion, gait speed, sit-to-stand test and handgrip strength were collected. Physiological parameters (blood pressure and heart rate) were also evaluated. The Wilcoxon Rank test and Student t-test were used. RESULTS: No significant changes (p > 0.05) were observed in physiological parameters (arterial blood pressure and heart rate). Significant improvements were found in trunk flexion (p = 0.01), gait speed (p = 0.02), sit-to-stand test (p = 0.005) and handgrip strength (p = 0.04) after the whole-body vibration. CONCLUSIONS: In conclusion, whole-body vibration may induce biological responses that improve functional parameters in participants with MetS without interfering in physiological parameters, comparing before and after a 5-week whole-body vibration protocol. TRIAL REGISTRATION: Register in the Registro Brasileiro de Ensaios Clínicos (ReBEC) with the number RBR 2bghmh (June 6th, 2016) and UTN: U1111-1181-1177. (virgula).

May Measurement Month 2017: Brazilian results-Americas.

Hypertension is a pathology of high prevalence in the world. In Brazil, it is the main risk factor for the major cause of death in the country, coronary heart disease. The May Measurement Month Campaign in 2017 (MMM17) included a population with representation from all Brazilian states and reflects some of the characteristics of hypertension in Brazil. Questionnaire data were collected and three measures of blood pressure (BP) were performed. The sample consisted of 7260 individuals, 40% were white, 56.4% were women. The average age was 52 years. Diabetes was present in 11.9%, previous myocardial infarction in 4.0% and stroke in 2.7%. About 8.4% were smokers and 26.2% were users of alcoholic drinks. The average BMI was 26.9 kg/m2. Considering the means of the last two measures of BP 47.0% were hypertensive (>140/90 mmHg). Of the individuals who did not use medication, 19.5% were hypertensive and of those who used anti-hypertensive medication 40.0% were uncontrolled. Systolic BP increased with age. The use of alcohol was related to higher BP levels, as well as diabetes and obesity. The MMM17 campaign demonstrated a large number of unknown hypertensives and a high rate of uncontrolled hypertension in Brazil.

The First Brazilian Registry of Hypertension.

A systematic, nationwide assessment of care of patients with hypertension in Brazil is needed. The objective of the First National Registry of Patients with Hypertension in Brazil is to evaluate the clinical profile, treatment patterns, and outcomes of diagnosed hypertensive patients in the country.

Heart failure and endothelial nitric oxide synthase G894T gene polymorphism frequency variations within ancestries.

The G894T polymorphism in endothelial nitric oxide synthase enzyme gene plays an important role in heart failure (HF) and its frequency varies among populations. We investigated this association in highly admixed samples in terms of ancestry. The cohort included 210 HF patients and 106 healthy individuals. Self-reported race and NYHA class were analyzed for HF patients. G894T polymorphism was analyzed by polymerase chain reaction (PCR) and by restriction fragment length polymorphism technique. Ancestry was estimated using a PCR reaction containing 46 autosomal ancestry informative markers and an analysis by capillary electrophoresis. The GG homozygous genotype had a higher frequency in HF patients (63.8%) than in healthy individuals (48.1%), showing an increased chance (odds ratio 1.90, 95% confidence interval 1.18-3.05). The ancestry profiles in patients and controls were similar, with a major European contribution (57.1% and 63.2%), followed by African (30.2% and 24.0%) and Native American (12.7% and 12.8%), without a significant difference between both samples (p = 0.28). The GG genotype is associated to HF prognosis, and this association remains present in highly admixed sample groups.

The evaluation of penile microvascular endothelial function using laser speckle contrast imaging in healthy volunteers.

OBJECTIVE: The primary aim of this study was to evaluate the effectiveness of laser speckle contrast imaging (LSCI) coupled with transdermal iontophoretic delivery of acetylcholine (ACh) for the assessment of penile microvascular function. Additionally, we tested systemic microvascular function using both LSCI and ACh iontophoresis on the forearm. METHODS: We assessed cutaneous, endothelium-dependent microvascular reactivity on the penis and forearm of healthy volunteers (aged 56.6 ± 1.0 years, n = 26) at rest and 60 min following the oral administration of the phosphodiesterase type 5 inhibitor (sildenafil: SIL, 100mg). LSCI was coupled with the iontophoresis of ACh using increasing anodal currents of 30, 60, 90, 120, 150 and 180 µA during 10-second intervals spaced 1 min apart. RESULTS: Basal skin microvascular flow in the penis increased significantly following SIL administration. The endothelium-dependent skin microvascular vasodilator responses induced by ACh were also significantly enhanced following SIL administration for each of the following parameters: peak values of cutaneous vascular conductance (CVC); increases in CVC; and the area under the curve for ACh-induced vasodilation. ACh-induced microvascular vasodilation in the forearm was not modified by SIL. Finally, the administration of electric current alone did not affect penile microvascular flow. CONCLUSION: LSCI appears to be a promising non-invasive technique for the evaluation of penile microvascular endothelial function. This methodology may be valuable for the evaluation of penile microvascular reactivity among patients with cardiovascular and metabolic diseases and to test the effectiveness of drugs used to treat vasculogenic erectile dysfunction.

Cutoffs for white-coat and masked blood pressure effects: an ambulatory blood pressure monitoring study.

The values used to define white-coat and masked blood pressure (BP) effects are usually arbitrary. This study aimed at investigating the accuracy of various cutoffs based on the differences (ΔBP) between office BP (OBP) and 24h-ambulatory BP monitoring (ABPM) to identify white-coat (WCH) and masked (MH) hypertension, which are phenotypes coupled with adverse prognosis. This cross-sectional study included 11,350 [Derivation cohort; 45% men, mean age = 55.1 ± 14.1 years, OBP = 132.1 ± 17.6/83.9 ± 12.5 mmHg, 24 h-ABPM = 121.6 ± 11.4/76.1 ± 9.6 mmHg, 25% using antihypertensive medications (AH)] and 7220 (Validation cohort; 46% men, mean age = 58.6 ± 15.1 years, OBP = 136.8 ± 18.7/87.6 ± 13.0 mmHg, 24 h-ABPM = 125.5 ± 12.6/77.7 ± 10.3 mmHg; 32% using AH) unique individuals who underwent 24 h-ABPM. We compared the sensitivity, specificity, positive and negative predictive values and area under the curve (AUC) of diverse ΔBP cutoffs to detect WCH (ΔsystolicBP/ΔdiastolicBP = 28/17, 20/15, 20/10, 16/11, 15/9, 14/9 mmHg and ΔsystolicBP = 13 and 10 mmHg) and MH (ΔsystolicBP/ΔdiastolicBP = -14/-9, -5/-2, -3/-1, -1/-1, 0/0, 2/2 mmHg and ΔsystolicBP = -5 and -3mmHg). The 20/15 mmHg cutoff showed the best AUC (0.804, 95%CI = 0.794-0.814) to detect WCH, while the 2/2 mmHg cutoff showed the highest AUC (0.741, 95%CI = 0.728-0.754) to detect MH in the Derivation cohort. Both cutoffs also had the best accuracy to detect WCH (0.767, 95%CI = 0.754-0.780) and MH (0.767, 95%CI = 0.750-0.784) in the Validation cohort. In secondary analyses, these cutoffs had the best accuracy to detect individuals with higher and lower office-than-ABPM grades in both cohorts. In conclusion, the 20/15 and 2/2 mmHg ΔBP cutoffs had the best accuracy to detect hypertensive patients with WCH and MH, respectively, and can serve as indicators of marked white-coat and masked BP effects derived from 24 h-ABPM.

National Registry of Hypertension Control Evaluated by Office and Home Measurements: The LHAR National Registry. / Registro Nacional do Controle da Hipertensão Arterial Avaliado pela Medida de Consultório e Residencial no Brasil: Registro LHAR.

BACKGROUND: It is known that around 30% of patients have higher blood pressure (BP) values when examined at the office than at home. Worldwide, only 35% of patients with hypertension undergoing treatment have reached their BP targets. OBJECTIVE: To provide epidemiological data on BP control in the offices of a sample of Brazilian cardiologists, considering office and home BP measurement. METHODS: This is a cross-sectional analysis of patients with a hypertension diagnosis and undergoing antihypertensive treatment, with controlled BP or not. BP was assayed in the office by a medical professional and at home using home BP monitoring (HBPM). The association between categorical variables was verified using the chi-square test (p<0.05). RESULTS: The study included 2540 patients, with a mean age of 59.7 ± 15.2 years. Most patients were women (62%; n=1575). Prevalence rates of 15% (n=382) for uncontrolled white coat hypertension and 10% (n=253) for uncontrolled masked hypertension were observed. The rate of BP control in the office was 56.3% and at home, 61%. Meanwhile, 46.4% of the patients had controlled BP in and outside of the office. Greater control was observed in women and in the 49-61 years age group. Considering the new DBHA 2020 threshold for home BP control, the control rate was 42.4%. CONCLUSION: BP control in the offices of a sample of Brazilian cardiologists was 56.3%; this rate was 61% when BP was measured at home and 46.4% when considering both the office and home.

FUNDAMENTO: Sabe-se que em torno de 30% dos pacientes apresentam valores de pressão arterial (PA) mais elevados quando examinados no consultório do que em suas residências. No mundo, admite-se que apenas 35% dos hipertensos já tratados tenham alcançado meta pressórica. OBJETIVO: Fornecer dados epidemiológicos sobre o controle da PA nos consultórios, em uma amostra de cardiologistas brasileiros, avaliado pela medida de consultório e monitorização residencial da pressão arterial (MRPA). MÉTODOS: Análise transversal. Observou-se pacientes com diagnóstico de hipertensão arterial, em tratamento anti-hipertensivo, podendo ou não estar com a PA controlada. A PA foi verificada no consultório por profissional médico, e no domicílio através da MRPA. A associação entre variáveis categóricas se deu por meio do teste do qui-quadrado (p < 0,05). RESULTADOS: Foram incluídos 2.540 pacientes, com idade média 59,7 ± 15,2 anos. A maioria dos pacientes eram mulheres (62%; n = 1.575). O estudo mostrou uma prevalência de 15% (n = 382) de hipertensão do avental branco não controlada, e 10% (n = 253) de hipertensão mascarada não controlada. A taxa de controle da PA no consultório foi 56,3%, e no domicílio, de 61%; 46,4% dos pacientes tiveram PA controlada no consultório e fora dele. Observou-se maior controle no sexo feminino e na faixa etária 49-61 anos. Observando o controle domiciliar com o novo ponto de corte das Diretrizes Brasileiras de Hipertensão Arterial de 2020, a taxa de controle foi de 42,4%. CONCLUSÃO: O controle pressórico nos consultórios em uma amostra de cardiologistas brasileiros foi de 56,3%; 61% quando a PA foi obtida no domicílio, e 46,4% quando o controle foi observado tanto no consultório como no domicílio.

Accuracy of screening strategies for masked hypertension: a large-scale nationwide study based on home blood pressure monitoring.

This study compared the ability of guideline-proposed office blood pressure (OBP) screening thresholds [European Society of Hypertension (ESH) guidelines: 130/85 mmHg for individuals with an OBP < 140/90 mmHg; American College of Cardiology/American Heart Association (ACC/AHA) guidelines: 120/75 mmHg for individuals with an OBP < 130/80 mmHg] and novel screening scores to identify normotensive individuals at high risk of having masked hypertension (MH) in an office setting. We cross-sectionally evaluated untreated participants with an OBP < 140/90 mmHg (n = 22,266) and an OBP < 130/80 mmHg (n = 10,005) who underwent home blood pressure monitoring (HBPM) (derivation cohort) from 686 Brazilian sites. MH was defined according to criteria suggested by the ESH (OBP < 140/90 mmHg; HBPM ≥ 135/85 mmHg), Brazilian Society of Cardiology (BSC) (OBP < 140/90 mmHg; HBPM ≥ 130/80 mmHg) and ACC/AHA (OBP < 130/80 mmHg; HBPM ≥ 130/80 mmHg). Scores were generated from multivariable logistic regression coefficients between MH and clinical variables (OBP, age, sex, and BMI). Considering the ESH, BSC, and ACC/AHA criteria, 17.2%, 38.5%, and 21.2% of the participants had MH, respectively. Guideline-proposed OBP screening thresholds yielded area under curve (AUC) values of 0.640 (for ESH criteria), 0.641 (for BSC criteria), and 0.619 (for ACC/AHA criteria) for predicting MH, while scores presented as continuous variables or quartiles yielded AUC values of 0.700 and 0.688 (for ESH criteria), 0.720 and 0.709 (for BSC criteria), and 0.671 and 0.661 (for ACC/AHA criteria), respectively. Further analyses performed with alternative untreated participants (validation cohort; n = 2807 with an OBP < 140/90 mmHg; n = 1269 with an OBP < 130/80 mmHg) yielded similar AUC values. In conclusion, the accuracy of guideline-proposed OBP screening thresholds in identifying individuals at high risk of having MH in an office setting is limited and is inferior to that yielded by scores derived from simple clinical variables.

Angiotensin Receptor Blockers Evaluated by Office and Home Blood Pressure Measurements. TeleHBPM Study. / Bloqueadores do Receptor de Angiotensina Avaliados por Medida de Consultório e Residencial da Pressão Arterial. Estudo TeleMRPA.

BACKGROUND: Adequate treatment of arterial hypertension and achieving arterial hypertension goals in are important in reducing cardiovascular outcomes. OBJECTIVES: To describe angiotensin receptor blockers in monotherapy or double combination therapy and the rate of arterial hypertension control. METHODS: This cross-sectional study evaluated patients who were using angiotensin receptor blockers between 2017 and 2020. Those using three or more antihypertensive drugs were excluded. The analyzed variables included sex, age, body mass index, valid home blood pressure monitoring (HBPM) measurements, casual and HBPM systolic and diastolic blood pressure measurements, blood pressure variability, and antihypertensive and angiotensin receptor blocker class. Paired t, chi-square, and Fisher's exact tests were used, as well as overlapping 95% confidence intervals and a significance level of 5% (p < 0.05). RESULTS: Of 17,013 patients, 12,813 met the inclusion criteria, 62.1% of whom were female. The mean number of valid measurements was 23.3 (SD, 2.0). The mean HBPM and casual measurements for systolic blood pressure were 126.8 (SD, 15.8) mmHg and 133.5 (SD, 20.1) mmHg (p <0.001), respectively, while those for diastolic blood pressure were 79.1 (SD, 9.7 mmHg) and 83.6 (SD, 11.9) mmHg (p <0.001), respectively. Losartan was the most common angiotensin receptor blocker and resulted in the highest blood pressure values. Combinations of angiotensin receptor blockers with diuretics or calcium channel antagonists resulted in lower blood pressure values. CONCLUSIONS: More than half of the patients used losartan, although it was the least efficient drug for reducing and controlling blood pressure.

FUNDAMENTO: O tratamento adequado e a obtenção das metas na hipertensão arterial são importantes na redução dos desfechos cardiovasculares. OBJETIVOS: Descrever os bloqueadores do receptor de angiotensina (BRA) em monoterapia ou combinação dupla e a taxa de controle da hipertensão arterial. MÉTODOS: Estudo transversal que avaliou pacientes em uso de BRA entre 2017 e 2020. Foram excluídos aqueles em uso de três ou mais anti-hipertensivos. As variáveis analisadas foram: sexo, idade, índice de massa corporal, medidas válidas da medida residencial da pressão arterial (MRPA); pressão arterial sistólica (PAS) e diastólica (PAD) obtidas pela MRPA e de forma casual; variabilidade pressórica; classe dos anti-hipertensivos e dos BRAs. Foram utilizados testes de t pareado, qui-quadrado e Fisher, além de sobreposição dos intervalos de confiança de 95% com nível de significância de 5% (p < 0,05). RESULTADOS: Foram selecionados 17.013 pacientes; destes, 12.813 preencheram os critérios, dos quais 62,1% eram do sexo feminino. O número médio de medidas válidas foi de 23,3 (±2,0), com médias para a PAS de 126,8±15,8 mmHg e 133,5±20,1 mmHg (p < 0,001) e para a PAD de 79,1±9,7 mmHg e 83,6±11,9 mmHg (p < 0,001) pela MRPA e medida casual, respectivamente. Losartana foi o BRA mais utilizado e o que apresentou comportamentos mais elevados da pressão arterial. As combinações de BRA com diuréticos ou com antagonistas de canal de cálcio tiveram menores valores de pressão arterial. CONCLUSÕES: Losartana foi utilizada em mais da metade dos pacientes, apesar de ser a menos eficiente na redução e no controle da pressão arterial.

Impact of the COVID-19 pandemic on blood pressure control: a nationwide home blood pressure monitoring study.

There are concerns that hypertension control may decrease during the COVID-19 pandemic. This study evaluated the impact of the COVID-19 pandemic on office blood pressure (OBP) and home blood pressure monitoring (HBPM) control in a large Brazilian nationwide sample. The results of an adjusted spline analysis evaluating the trajectory of OBP and HBPM control from 01/Jan/2019 to 31/Dec/2020 among independent participants who were untreated (n = 24,227) or treated (n = 27,699) with antihypertensive medications showed a modest and transient improvement in OBP control among treated individuals, which was restricted to the early months following the COVID-19 pandemic outbreak. Furthermore, slight reductions in OBP and HBPM values were detected in the early months following the COVID-19 pandemic outbreak among treated (n = 987) participants for whom blood pressure measurements before and during the pandemic were available, but not among untreated (n = 495) participants. In conclusion, we found no major adverse influence of the COVID-19 pandemic on OBP and HBPM control in a large nationwide sample.

Factors associated with uncontrolled blood pressure in hypertensive Brazilians.

Uncontrolled hypertension has a high prevalence and is related to numerous negative health outcomes. This study aimed to investigate the factors associated with the lack of blood pressure control in hypertensive Brazilians treated in public and private services. This is an analytical, multicentric, and national cross-sectional study, carried out with adult hypertensive patients, monitored in 45 outpatient clinics (September 2013 to October 2015) in a prospective record interview, clinical, and anthropometric assessment. Outcome variables included uncontrolled pressure (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg). Simple and multiple logistic regression analyses were performed. Two thousand six hundred forty-three participants were assessed with a mean age of 61.6 ± 11.9 years, 55.7% of women, and 46.4% with uncontrolled blood pressure (BP). The following were associated with uncontrolled BP: age over 60 years (OR: 1.31 [1.11-1.55]); practice of irregular physical activity (OR: 1.28 [1.06-1.55]); attending the emergency room for hypertensive crises in the last six months (OR: 1.80 [1.46-2.22]); increased body mass index (OR: 1.02 [1.01-1.04]); low adherence to drug treatment (OR: 1.22 [1.04-1.44]) and menopause (OR: 1.36 [1.07-1.72]). The following were negatively associated: fruit consumption (OR: 0.90 [0.85-0.94]); presence of dyslipidemia (OR: 0.75 [0.64-0.89]), acute myocardial infarction (OR: 0.59 [0.46-0.76]), and peripheral arterial disease (OR: 0.52 [0.34-0.78]). Factors associated with difficult-to-control blood pressure are the same that increase the risk for hypertension, while the presence of atherosclerotic disease and its outcomes were associated with better control.

Discrepancies in the diagnosis of hypertension in adolescents according to available office and home high blood pressure criteria.

This study aimed at comparing the prevalence of abnormal blood pressure (BP) phenotypes among 241 adolescents referred for hypertension (15.4 ± 1.4 years, 62% males, 40% obese) according to mostly used or available criteria for hypertension [AAP or ESH criteria for high office BP (OBP); Arsakeion or Goiânia schools' criteria for high home BP monitoring (HBPM)]. High OBP prevalence was greater when defined by AAP compared with ESH criteria (43.5% vs. 24.5%; p < .001), while high HBPM prevalence was similar between Arsakeion and Goiânia criteria (33.5% and 37.5%; p = .34). Fifty-five percent of the sample fulfilled at least one criterion for high BP, but only 31% of this subsample accomplished all four criteria. Regardless of the HBPM criteria, AAP thresholds were associated with lower prevalence of normotension and masked hypertension and greater prevalence of white-coat and sustained hypertension than ESH thresholds. These findings support the need to standardize the definition of hypertension among adolescents.

Twenty-Four-Hour Central (Aortic) Systolic Blood Pressure: Reference Values and Dipping Patterns in Untreated Individuals.

Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18-94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBPMAP/DBPcal), or bSBP/diastolic blood pressure (cSBPSBP/DBPcal), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBPMAP/DBPcal were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBPSBP/DBPcal, respectively. We pragmatically propose as upper normal limit for 24-hour cSBPMAP/DBPcal 135 mm Hg and for 24-hour cSBPSBP/DBPcal 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was -10.6 % in young participants and decreased with increasing age. Central SBPSBP/DBPcal dipping was less pronounced (-8.7% in young participants). In contrast, cSBPMAP/DBPcal dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigation.

Effects of chronic type 5 phosphodiesterase inhibition on penile microvascular reactivity in hypertensive patients with erectile dysfunction: a randomized crossover placebo-controlled trial.

This randomized crossover and placebo-controlled trial evaluated the effects of daily use of sildenafil citrate (SIL, 1-month 50 mg twice daily) on penile and systemic endothelial microvascular function in hypertensive patients presenting with erectile dysfunction. The effects of SIL on arterial pressure were evaluated using ambulatory blood pressure monitoring (ABPM). Fifty patients diagnosed with primary arterial hypertension and erectile dysfunction (aged 57.4 ± 5.6 years), recruited in a tertiary public hospital, were treated with SIL (50 mg twice daily) or placebo (PLA) for two 30-day periods with a 30-day washout between them. Laser speckle contrast imaging coupled with acetylcholine skin iontophoresis was used to evaluate penile and systemic (forearm) cutaneous microvascular reactivity. SIL treatment increased penile basal microvascular flow (P = 0.002) and maximal endothelial-dependent peak response to skin iontophoresis of acetylcholine (ACh, P = 0.006). The area under the curve of microvascular vasodilation induced by ACh was also significantly increased (P = 0.02). Lastly, SIL treatment did not modify systemic microvascular reactivity. Twenty-four-hour ABPM (P = 0.0002) and daytime (P = 0.002) and nighttime (P = 0.001) mean diastolic blood pressure values were significantly reduced after SIL treatment. The scores of the Simplified International Index of Erectile Function (P < 0.0001) and the number of patients with positive responses to Sexual Encounter Profile question 3 (P < 0.0001) also increased after SIL treatment. Penile endothelium-dependent microvascular reactivity improved after continuous use of sildenafil in hypertensive patients with erectile dysfunction; the treatment also reduced blood pressure, suggesting that, in addition to improving erectile function, daily use of sildenafil could improve blood pressure control.

Treated Hypertensive Patients Assessed by Home Blood Pressure Telemonitoring. TeleMRPA Study. / Hipertensos Tratados e Avaliados por Telemonitoramento Residencial da Pressão Arterial. Estudo TeleMRPA.

BACKGROUND: Hypertensive patients undergoing treatment and assessed only by casual blood pressure (BP) measurement may be subject to mistaken decisions. OBJECTIVE: To assess BP behavior by measuring its levels at the office (casual) and at home (HBPM), the behavior of different classes of antihypertensive drugs, and the prevalence of uncontrolled white-coat hypertension (UCWCH) and uncontrolled masked hypertension (UCMH). METHODS: Cross-sectional study assessing patients who underwent BP monitoring in the TeleMRPA platform between 2017 and 2019. The exclusion criteria were: use of no antihypertensive drug; combined use of 3 or more antihypertensive drugs; and use of spironolactone and alpha-2 agonist. The variables analyzed were: age, sex, body mass index (BMI), number of valid BP measurements, means of systolic and diastolic blood pressure (SBP and DBP, respectively) obtained from HBPM and casual measurement, and the classes of antihypertensive drugs. Paired and unpaired t tests, as well as chi-square test, were used. The 5% significance level was adopted. RESULTS: This study selected 22 446 patients, 6731 of whom met the inclusion criteria [61.3%, female sex; mean age, 57.8 (±12.6) years; mean BMI, 29.0 (±5.1) kg/m2]. Mean SBP and DBP were 6.6 mm Hg (p<0.001) and 4.4 mm Hg (p<0.001) higher in casual measurement than in HBPM. The rates of BP control were 57.0% in casual measurement and 61.3% in HBPM (p<0.001), and the prevalence of UCWCH and UCMH was 15.4% and 11.1%, respectively. Renin-angiotensin-aldosterone system blockade was observed in 74.6% of the patients, and 54.8% were on single-drug therapy. CONCLUSIONS: HBPM should be considered for the follow-up of treated hypertensive patients because of the high prevalence of UCWCH and UCMH. Antihypertensive drugs behaved differently in HBPM. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0).

FUNDAMENTO: Hipertensos tratados avaliados apenas com a medida casual da pressão arterial (PA) podem estar sujeitos a decisões equivocadas. OBJETIVOS: Avaliar o comportamento da PA pela medida casual e residencial (MRPA), o comportamento das classes de anti-hipertensivos e as prevalências de hipertensão do avental branco (HABNC) e mascarada não-controladas (HMNC). MÉTODOS: Estudo transversal que avaliou pacientes pela plataforma TeleMRPA entre 2017 e 2019. Foram excluídos aqueles sem medicamentos, com 3 ou mais, em uso de espironolactona e alfa-2 agonistas. As variáveis analisadas foram: idade, sexo, índice de massa corporal (IMC), número de medidas válidas da PA, médias da PA sistólica (PAS) e diastólica (PAD) pela medida casual e MRPA, e as classes de anti-hipertensivos. Utilizados os testes t pareado e não pareado e qui-quadrado. Adotado nível de significância de 5%. RESULTADOS: Selecionados 22.446 pacientes, dos quais 6.731 preencheram os critérios, sendo 61,3% do sexo feminino, com idade média de 57,8 (±12,6) anos e IMC médio de 29,0 (±5,1) kg/m2. Os valores médios de PAS e PAD foram 6,6 mmHg (p<0,001) e 4,4 mmHg (p<0,001) maiores na medida casual que na MRPA. As taxas de controle da PA foram de 57,0% pela medida casual e 61,3% pela MRPA (p<0,001), com prevalência de HABNC e HMNC de 15,4% e 11,1%, respectivamente. O bloqueio do sistema renina-angiotensina-aldosterona ocorreu em 74,6% das vezes e 54,8% estavam em monoterapia. CONCLUSÕES: O uso da MRPA deve ser considerado no acompanhamento de hipertensos tratados em virtude das elevadas prevalências de HABNC e HMNC. Os anti-hipertensivos tiveram comportamentos distintos nas medidas domiciliares. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0).

The impact of changing home blood pressure monitoring cutoff from 135/85 to 130/80 mmHg on hypertension phenotypes.

This study investigated the impact of changing abnormal home blood pressure monitoring (HBPM) cutoff from 135/85 to 130/80 mmHg on the prevalence of hypertension phenotypes, considering an abnormal office blood pressure cutoff of 140/90 mmHg. We evaluated 57 768 individuals (26 876 untreated and 30 892 treated with antihypertensive medications) from 719 Brazilian centers who performed HBPM. Changing the HBPM cutoff was associated with increases in masked (from 10% to 22%) and sustained (from 27% to 35%) hypertension, and decreases in white-coat hypertension (from 16% to 7%) and normotension (from 47% to 36%) among untreated participants, and increases in masked (from 11% to 22%) and sustained (from 29% to 36%) uncontrolled hypertension, and decreases in white-coat uncontrolled hypertension (from 15% to 8%) and controlled hypertension (from 45% to 34%) among treated participants. In conclusion, adoption of an abnormal HBPM cutoff of 130/80 mmHg markedly increased the prevalence of out-of-office hypertension and uncontrolled hypertension phenotypes.

Cardiovascular Risk Factors in Cardiology Specialists from the Brazilian Society of Cardiology. / Fatores de Risco Cardiovascular em Cardiologistas Especialistas pela Sociedade Brasileira de Cardiologia.

BACKGROUND: A major cause of death worldwide, cardiovascular diseases and their prevalence in cardiologists are little known. OBJECTIVES: To describe life habits and cardiovascular risk factors (CVRF) and to investigate the prevalence of diagnosis, awareness, and control of these CVRF among cardiologists members affiliated to and specialists from the Brazilian Society of Cardiology. METHODS: National multicenter cross-sectional study to assess Brazilian cardiologists using a questionnaire on life habits, preexisting diseases, current medications, anthropometric measurements, blood pressure, and levels of glucose and lipids. RESULTS: A total of 555 cardiologists were evaluated, of which 67.9% were male, with a mean age of 47.2±11.7 years. Most were non-smoker (88.7%) and physically active (77.1%), consumed alcohol (78.2%), had normal weight circumference (51.7%), and were overweight (56.1%). The prevalence of systemic arterial hypertension (SAH), diabetes mellitus (DM), and dyslipidemia (DLP) were 32.4%, 5.9%, and 49.7%, respectively, of which only 57.2%, 45.5%, and 49.6%, respectively, were aware of the diseases. CONCLUSIONS: The Brazilian cardiologists participating in the study had a high prevalence of SAH, DM and DLP, but only a half of participants were aware of these conditions and, among these, the rates of controlled disease were low for SAH and DLP, although cardiologists are professionals with great knowledge about these CVRF. These findings represent a warning sign for the approach of CVRF in Brazilian cardiologists and encourage the conduction of future studies.

FUNDAMENTO: Principal causa de morte em todo o mundo, as doenças cardiovasculares (DCV) e sua prevalência nos médicos cardiologistas são pouco conhecidas. OBJETIVOS: Descrever os hábitos de vida e os fatores de risco cardiovascular e verificar a prevalência de diagnóstico, conhecimento e controle dos fatores de risco cardiovasculares (FRCV) de médicos cardiologistas associados e especialistas pela Sociedade Brasileira de Cardiologia. MÉTODOS: Estudo multicêntrico nacional transversal que avaliou cardiologistas brasileiros por meio de questionário sobre hábitos de vida, doenças preexistentes, medicações em uso, medidas antropométricas, pressão arterial e dosagens de glicose e lípideos sanguíneos. RESULTADOS: Foram avaliados 555 cardiologistas, 67,9% do sexo masculino, média de idade de 47,2±11,7 anos. A maioria era não tabagista (88,7%), fisicamente ativa (77,1%), consumia bebida alcóolica (78,2%), com circunferência abdominal normal (51,7%) e excesso de peso (56,1%). As prevalências de hipertensão arterial sistêmica (HAS), diabetes mellitus (DM) e dislipidemia (DLP) foram de 32,4%, 5,9% e 49,7%, respectivamente e, destes, apenas 57,2%, 45,5% e 49,6% sabiam ter as doenças. CONCLUSÕES: Os cardiologistas brasileiros participantes do estudo apresentaram prevalências significativas de HAS, DM e DLP, mas apenas a metade dos participantes sabia ser portador dessas condições e, entre eles, as taxas de controle eram baixas para HAS e DLP, apesar de os cardiologistas serem profissionais detentores de conhecimento diferenciado sobre esses FRCV. Os achados representam um alerta para a abordagem dos FRCV em cardiologistas brasileiros e estimulam a realização de estudos futuros.

Prevalence of masked hypertension evaluated by home blood pressure monitoring in a large sample of patients with office blood pressure <140/90 mmHg.

AIM: Patients with masked hypertension have a higher incidence of target organ damage, including increased left ventricular mass and carotid atherosclerosis and cardiovascular events when compared with normotensive patients. The adverse cardiovascular risks are even greater in patients already taking antihypertensive medication. OBJECTIVE: To identify the prevalence and clinical characteristics of masked hypertension in a large multicenter Brazilian sample that underwent office and home blood pressure monitoring. METHODS: This was an observational cross-sectional analytical study based on secondary data from the teleMRPA online platform, which included 32 cities from 15 states in the five regions of Brazil. The database included 3704 outpatient participants with office blood pressure <140/90 mmHg who performed home blood pressure monitoring for diagnostic investigation (diagnosis group; n = 1819) or treatment (treatment group; n = 1885) of hypertension in 2018. RESULTS: The prevalence of masked hypertension was 18.0% in the whole studied population and 15.4% and 20.4% in the diagnostic and treatment group, respectively. Masked hypertension was more frequently detected in patients with office blood pressure classified as high normal [systolic blood pressure (SBP) = 130-139 mmHg or diastolic blood pressure (DBP) = 85-89 mmHg], followed by those classified as normal (SBP = 120-129 mmHg or DBP = 80-84 mmHg) and optimal (SBP < 120 mmHg and DBP < 80 mmHg), with respective prevalence of 28.3, 13.4 and 4.4% in the diagnostic group and 30.8, 18.8 and 7.1% in the treatment group. CONCLUSION: Masked hypertension has a significant prevalence among individuals with office blood pressure <140/90 mmHg, which is greater with patients with high normal office blood pressure and even higher in patients already using antihypertensive medication.