RESUMO
RESUMEN Introducción: Nuestro objetivo fue determinar si la hipertensión arterial nocturna (HTAN) se asocia a eventos cardiovasculares o mortalidad en el seguimiento. Material y métodos: Estudio de cohorte retrospectiva que incluyó pacientes adultos que se realizaron una presurometría ambulatoria en un hospital de la ciudad de Buenos Aires, incorporados a un registro propio entre marzo de 2017 y julio de 2020, con seguimiento de hasta 36 meses de la presurometría índice. Se realizaron análisis uni y multivariados para identificar factores asociados. Resultados: De 522 sujetos, se incluyeron 494 en el análisis final. El 48% eran de sexo masculino y la edad promedio fue de 58,9 años. El 62% (n = 308) presentó HTAN. Se halló una mayor incidencia del punto final compuesto cardiovascular en este grupo en comparación con quienes no la presentaban, 10,4% vs 3,8% (p = 0,013). El análisis final por regresión de Cox multivariada demostró que la HTAN fue un predictor independiente de eventos cardiovasculares (HR = 3,9; IC 95% 1,56-9,81; p = 0,001), incluso independientemente de la HTA diurna y de los diferentes patrones circadianos de presión. Conclusión: En una cohorte contemporánea y de la ciudad de Buenos Aires, el patrón de HTAN se asoció con la aparición de desenlaces cardiovasculares. En base a estos hallazgos, se deben implementar medidas para incrementar su diagnóstico en nuestro medio.
ABSTRACT Background: Nocturnal Hypertension (NHT) has an impact on cardiovascular morbidity and mortality. Our aim was to evaluate the association between NHT and cardiovascular events. Methods: We carried out a retrospective cohort study including adults which had an ambulatory blood pressure monitoring test between March 2017 and July 2020 at a hospital in Buenos Aires City Argentina, with up to 36 months follow-up. Univariate and multivariate analyzes were performed to identify associated factors. Results: Four hundred and ninety four patients were included in the final analysis, 48% male, average age 58.9 years. Sixty two percent (n=308) presented NHT. A higher incidence of the cardiovascular composite endpoint was found in this group compared to those who did not present it, 10.4% vs 3.8% (p=0.013). In the final multivariate Cox regression analysis NHT was an independent predictor of cardiovascular events (HR=3.9; 95% CI 1.56-9.81; p=0.001), even independently of daytime HTN and the different circadian patterns of pressure. Conclusions: In this contemporary cohort from Buenos Aires, NHT was related to cardiovascular events incidence. Different measures should be taken to increase NHT awareness and diagnosis.
RESUMO
Resumen Las enfermedades tropicales desatendidas (ETD) constituyen un conjunto de afecciones altamente prevalentes en regiones tropicales y subtropicales, asociadas a pobreza y subdesarrollo. Constituyen una verdadera crisis sanitaria, incapacitando y llevando a la muerte a millones de personas anualmente. Esto se ve potenciado por las dificultades socioeconómicas que cursan estos países, mayormente en vías de desa rrollo, lo cual repercute en la calidad de la asistencia sanitaria que pueden proveer a la población. La morbilidad de estas enfermedades se explica por la amplia afectación orgánica que generan. El aparato cardiovascular resulta particularmente afectado, lo que explica en gran medida la morbimortalidad de las ETD. En el presente artículo se revisan los aspectos fundamentales de un proyecto llevado a cabo por los Líderes Emergentes de la Sociedad Interamericana de Cardiología (SIAC), cubriendo diferentes aspectos del impacto sobre el aparato cardiovascular de las ETD: el Proyecto NET-Heart (del inglés, Neglected Tropical Diseases and other Infectious Diseases Affecting the Heart).
Abstract Neglected tropical diseases (NTD) are a group of diseases with high prevalence in tropical and subtropi cal countries. They are associated to poverty and underdevelopment. Due to its high morbimortality, these conditions are considered a health crisis. The impact of these diseases can be worsened by the poor socioeconomic status of the affected countries, most of them under-developed, which affects the health care provided to patients. The morbidity of these diseases is explained by the wide organic impairment that they produce. The cardiovascular system is par ticularly affected, which explains the high morbimortality of NTD. In this article, we review the key issues of a project elaborated by Emerging Leaders of the Interamerican Society of Cardiology (SIAC), about the cardiovascular impact of NTD: the NET-Heart Project (Neglected Tropical Diseases and other Infectious Diseases affecting the Heart).
Assuntos
Humanos , Medicina Tropical , Sistema Cardiovascular , Doenças Negligenciadas/epidemiologiaRESUMO
Background: SARS-CoV-2 pandemic has modified the cardiovascular care of ambulatory patients. The aim of this survey was to study changes in lifestyle habits, treatment adherence, and mental health status in patients with cardiometabolic disease, but no clinical evidence of COVID-19. Methods: A cross-sectional survey was conducted in ambulatory patients with cardiometabolic disease using paper/digital surveys. Variables investigated included socioeconomic status, physical activity, diet, tobacco use, alcohol intake, treatment discontinuation, and psychological symptoms. Results: A total of 4,216 patients (50.9% males, mean age 60.3 ± 15.3 years old) from 13 Spanish-speaking Latin American countries were enrolled. Among the study population, 46.4% of patients did not have contact with a healthcare provider, 31.5% reported access barriers to treatments and 17% discontinued some medication. Multivariate analysis showed that non-adherence to treatment was more prevalent in the secondary prevention group: peripheral vascular disease (OR 1.55, CI 1.08-2.24; p = 0.018), heart failure (OR 1.36, CI 1.05-1.75; p = 0.017), and coronary artery disease (OR 1.29 CI 1.04-1.60; p = 0.018). No physical activity was reported by 38% of patients. Only 15% of patients met minimum recommendations of physical activity (more than 150 minutes/week) and vegetable and fruit intake. Low/very low income (45.5%) was associated with a lower level of physical activity (p < 0.0001), less fruit and vegetables intake (p < 0.0001), more tobacco use (p < 0.001) and perception of depression (p < 0.001). Low educational level was also associated with the perception of depression (OR 1.46, CI 1.26-1.70; p < 0.01). Conclusions: Patients with cardiometabolic disease but without clinical evidence of COVID-19 showed significant medication non-adherence, especially in secondary prevention patients. Deterioration in lifestyle habits and appearance of depressive symptoms during the pandemic were frequent and related to socioeconomic status.
Assuntos
COVID-19 , Doenças Cardiovasculares/terapia , Depressão/psicologia , Diabetes Mellitus/terapia , Dieta , Dislipidemias/terapia , Exercício Físico , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Arritmias Cardíacas/terapia , Fatores de Risco Cardiometabólico , Fumar Cigarros/epidemiologia , Doença da Artéria Coronariana/terapia , Escolaridade , Feminino , Acessibilidade aos Serviços de Saúde , Insuficiência Cardíaca/terapia , Humanos , Hipertensão/terapia , América Latina/epidemiologia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Doenças Vasculares Periféricas/terapia , SARS-CoV-2 , Prevenção Secundária , Classe Social , Inquéritos e QuestionáriosRESUMO
Alcoholic beverages, specifically wine, have been consumed for many years. Wine is postulated to play an important role in the improvement of cardiovascular risk factors. Most epidemiological studies have found sustained consumption at light-to-moderate amounts to increase HDL cholesterol, reduce platelet aggregation, and promote fibrinolysis. Wine consumption has been inversely associated with ischemic heart disease, and the alcohol-blood pressure association, in most studies, follows a J-shaped curve. These outcomes have been attributed to the molecular constituents of wine, namely ethanol and polyphenols. Due to the continued interest in wine as a biological beverage, we review the chemistry of wine as clinicians, including its chemical composition, viticulture and enological practices, and other chemical factors that influence the bioactive components of wine. We also outline the biological effects of wine components and directions for future research.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Valor Nutritivo , Vinho/análise , Consumo de Bebidas Alcoólicas/efeitos adversos , Animais , Doenças Cardiovasculares/diagnóstico , Humanos , Prognóstico , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Vinho/efeitos adversosRESUMO
El objetivo del presente estudio fue valorar la utilidad del tilt test en pacientes con síncope de origen desconocido. Entre enero de 1994 y setiembre de 1995 se realizó tilt test a 93 pacientes, edad promedio 59 años, 46 por ciento de sexo masculino, con diagnóstico de síncope de origen desconocido y a 30 sujeitos control, edad promedio 53 años, 50 por ciento de sexo masculino. El estudio consistió en una primera etapa de reposo en decúbito dorsal de 15 minutos para obtener parámetros basalaes y una segunda etapa de inclinación a 80 grados durante 30 minutos. La tensión arterial (TA) y la frecuencia cardíaca fueron monitoreadas cada minuto durante el procedimento. El test se consideró positivo cuando el paciente presentaba caída de la TA sistólica > 30 mmHg. (vasodepresor), bradiasistolia (cardioinhibidor), o respuesta mixta, acompañada de síntomas. El tilt test fue positivo en 31 de 93 pacientes. (33 por ciento). Diecisiete pacientes (55 por ciento) presentaron respuesta vasodepresora, 3 pacientes (9 por ciento) cardioinhibitoria y 11 pacientes (36 por ciento) respuesta mixta. Los síntomas fueron presíncope en el 62 por ciento, síncope en el 19 por ciento y en los restantes pacientes. (19 por ciento), mareos, disnea o pérdida del equilibrio. Todos los pacientes se recuperaron en forma espontánea al retornar a la posición supina. Ningún sujeto del grupo control desarrolló respuesta anormal o síntomas durante el estudio (sensibilidad: 33 por ciento y Especificidad: 100 por ciento). Se concluye due el tilt test es un método diagnóstico seguro y efectivo para identificar el sustrato neurocardiogénico en pacientes con diagnóstico de síncope de origen desconocido.