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.

Coronary emergency and diabetes as manifestations of pheochromocytoma.

We report on a woman with refractory hypertension and diabetes suffering from hypertensive crises, one with chest pain suggesting acute coronary syndrome, and another with an abdominal pain, after which a para-aortic abdominal mass was diagnosed, by ultrasound, as pheochromocytoma, later confirmed by an adrenal scintigraphic study with (131)I-labeled metaiodobenzylguanidine. The patient was successfully treated with complete reversal of hypertension and diabetes. Our case illustrates the importance of maintaining a high index of suspicion in patients simultaneously presenting with an acute myocardial event and hypertensive crises.

Pharmacologic treatment for prehypertension: to treat or not to treat?

The Seventh Joint National Committee on the Prevention, Detection, Evaluation and Treatment of Hypertension (VII JNC) introduced the term "prehypertension" to designate individuals whose systolic blood pressure (BP) levels are in the range of 120 to 139 mm Hg and diastolic BP between 80 and 89 mm Hg. The decision to establish this new BP category was based on a rate of progression to hypertension, its prevalence and association with other cardiovascular disease (CVD) risk factors, its relationship to the development of CVD, and its therapy. So, the prehypertension term was established to focus attention on a segment of the population who is at higher-than-normal CVD risk and in whom therapeutic approaches to prevent or delay the onset of hypertension would be of value. The VII JNC report has recommended the adoption of healthy lifestyles to achieve BP goals except in prehypertensive subjects with diabetes or chronic renal disease in whom drug treatment is also advocated. The treatment with antihypertensive drugs to prehypertension has been the subject of recent debate. The decision to use antihypertensive drug treatment should be based on global CVD risk rather than on specific levels of BP alone. This review article discusses the background, risk factors, treatment options and some recent patents related to hypertension.

Crise hipertensiva: atualização clínico-terapêutica / Hypertensive crisis: clinical-therapeutic updating

Crise hipertensiva é uma situação clínica comum caracterizada por elevação sintomática da pressão arterialque apresenta alta taxa de morbidade e mortalidade e é classificada em emergência e urgência hipertensiva. Oquadro clínico de emergência hipertensiva difere do quadro de urgência por apresentar risco de morte iminentedecorrente de lesão em órgãos-alvo instalada ou em evolução, em particular coração, cérebro e rins. Essa condição requer uma abordagem clínica criteriosa que permita o diagnóstico rápido e correto do comprometimentode órgão-alvo. A intervenção terapêutica deve ser imediata, eficiente e individualizada para cada sistema comprometido, em geral com uso de anti-hipertensivos por via endovenosa em uma unidade de terapia intensiva. Por outro lado, o paciente com urgência hipertensiva não apresenta envolvimento de órgãos-alvo e nem se encontra com risco de morte maior, por isso o tratamento pode ser feito com anti-hipertensivos por via oral na própria sala de urgência. Este artigo revisa as principais causas de crise hipertensiva, a sua fisiopatogênese e a epidemiologia, bem como a sua abordagem clínica e terapêutica com os anti-hipertensivos utilizados e suas indicações.