Subject(s)
Humans , Antihypertensive Agents/administration & dosage , Hypertension/drug therapy , Practice Guidelines as Topic , Societies, Medical , Brazil , Blood Pressure/drug effects , Cerebrovascular Disorders/complications , Coronary Disease/complications , Drug Therapy, Combination/methods , Risk Factors , Renal Insufficiency, Chronic/drug therapy , Treatment OutcomeABSTRACT
Dietary intervention is an important approach in the prevention of cardiovascular disease. Over the last decade, some studies have suggested that a calcium-rich diet could help to control body weight, with anti-obesity effects. The potential mechanism underlying the impact of calcium on body fat has been investigated, but it is not fully understood. Recent evidence has also suggested that a calcium-rich diet could have beneficial effects on other cardiovascular risk factors, such as insulin resistance, dyslipidemia, hypertension and inflammatory states. In a series of studies, it was observed that a high intake of milk and/or dairy products (the main sources of dietary calcium) is associated with a reduction in the relative risk of cardiovascular disease. However, a few studies suggest that supplemental calcium (mainly calcium carbonate or citrate) may be associated with an increased risk of cardiovascular events. This review will discuss the available evidence regarding the relationship between calcium intake (dietary and supplemental) and different cardiovascular risk factors and/or events.
Subject(s)
Humans , Calcium, Dietary/administration & dosage , Cardiovascular Diseases/prevention & control , Dairy Products , Calcium, Dietary/adverse effects , Risk FactorsABSTRACT
OBJECTIVE: This study aimed to evaluate long-term weight loss in overweight hypertensive patients receiving dietary counseling. METHODS: Longitudinal study included overweight hypertensive patients who had an initial individual consultation with a nutritionist between January 2002 and December 2005 and were followed for four years in a hypertension clinic. Patients who had at least four consultations during the follow-up period were included in the dietary counseling group. Those who scheduled their first consultation but missed that appointment or had fewer than four consultations during the follow-up period were allocated to the control group. Target Energy intake was calculated at 20-25 kcal/kg actual body weight/day. RESULTS: The study included 102 patients aged 55 + 1 years old (58 in the dietary counseling group). As compared with the control group, patients in the dietary counseling group showed a significantly greater reduction in body weight (-3.6 + 0.8 vs. 0.8 + 0.7 kg), which remained significant after controlling for age, gender, baseline body mass index, and the use of different antihypertensive and antidiabetic drugs. Weight loss between 5.0 percent and 9.9 percent was observed in a significantly higher percentage of patients in the dietary counseling group (28 percent vs. 11 percent). A weight loss of at least 10 percent was only observed in dietary counseling group patients, who had a significantly lower odds ratio for increasing the number and/or dosage of antihypertensive agents, even after controlling for age, gender, and baseline body mass index. CONCLUSIONS: Dietary counseling may be associated with long-term weight loss in overweight hypertensive patients.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Diet, Reducing , Directive Counseling , Hypertension/diet therapy , Overweight/diet therapy , Weight Loss , Analysis of Variance , Body Mass Index , Energy Intake/physiology , Follow-Up Studies , Life Style , Odds Ratio , Risk Factors , Time FactorsABSTRACT
O controle adequado da pressão arterial (PA) traz benefícios incontestáveis em reduzir a mortalidade e a morbidade cardiovascular. Contudo, recentemente, diversas diretrizes vêm preconizando valores cada vez mais baixos não somente para a PA, como também para outros fatores de risco. Contudo, o comportamento dos pacientes hipertensos não tem sido homogêneo. Para o subgrupo de hipertensos com doença arterial coronária (DAC) prévia, vem se observando que a redução dos níveis de pressão arterial diastólica (PAD) abaixo de 80 mmHg traz aumento na ocorrência eventos coronarianos. Por outro lado, não se tem observado o fenômeno da curva J para a pressão arterial sistólica (PAS), tampouco a deterioração da função renal, nem aumento no número de acidentes vasculares cerebrais. Há três prováveis mecanismos propostos para explicar a existência da curva J: 1) a PAD baixa poderia ser um epifenômeno coexistindo ou caracterizando um pobre estado de saúde ou doença crônica (causalidade reversa); 2) a baixa PAD poderia ser causada por um aumento na PA de pulso refletindo doença vascular avançada e rigidez da parede arterial; 3) um agressivo tratamento anti-hipertensivo poderia levar a uma baixa PAD e, assim, à hipoperfusão das coronárias, resultando em eventos coronarianos. Dessa forma, o fenômeno curva J traz duas mensagens clínicas importantes: a primeira é que o médico deve individualizar o melhor tratamento para cada paciente, observando riscos e benefícios para cada intervenção; e a segunda é que esse fato não deve desestimular em perseguir agressivamente um melhor controle da PA, uma vez que menos de um terço dos hipertensos está com a PA controlada.
The rigorous control of arterial blood pressure reduces significantly the morbidity and mortality consequences of arterial hypertension. However, in the presence of coronary artery disease (limited coronary flow reserve) there is aJ-curve relation ship between treated DBP and myocardial infarction, but not for stroke. In such high-risk (ischemic heart disease) cases it would be prudent to avoid lowering DBP to below the low 80s mmHg. Three pathophysiologic mechanisms have been proposed to explain the existence of a J-curve: 1) low DBP could be an epiphenomenon to coexisting or underlying poor health or chronic illness leading to increasing morbidity and mortality (reverse causality); 2)low DBP could be caused by an increased pulse pressure reflecting advanced vascular disease and stiffened large arteries; and 3) over-aggressive antihypertensive treatment could lead to too-low DBP and thus hypoperfusion of the coronaries resulting in coronary events. However, these considerations should not deter practicing physicians from pursuing more aggressive control in treating hypertension, because currently, at best, only approximately one-third o four patients are at goal BPs of < 140/90 mmHg...
Subject(s)
Humans , Antihypertensive Agents , HypertensionABSTRACT
A pré-hipertensão e a pressão arterial normal-alta fazem parte de uma categoria de pressão arterial que é a precursora da hipertensão arterial e estão associadas com o aumento da morbidade e da mortalidade por doenças cardiovasculares. Essas associações são mais fortes nos indivíduos portadores de diabetes mellitus. É interessante notar que essa categoria de pressão arterial parece estar mais relacionada como aumento do risco de infarto do miocárdio e de doenças coronarianas que com o do risco de acidente vascular encefálico. Também tem sido registrado que os outros fatores de risco para as doenças cardiovasculares e as doenças cardiovasculares anatômicas e subclínicas (aumento do índice de massa e do diâmetro interno do ventrículo esquerdo e espessamento da camada íntima-média da carótida) são mais prevalentes na presença da pré-hipertensão. Alguns estudos mostraram, recentemente, que em indivíduos com pressão arterial normal-alta, quando comparados aos normotensos, predominam os fatores de risco metabólico e da síndrome metabólica. Mesmo nos indivíduos saudáveis, aqueles compressão normal-alta apresentaram concentrações plasmáticas reduzidas de adiponectina e sinais precoces de disfunção endotelial e de estresse oxidativo.
The prehypertension and the high-normal blood pressure are a precursor of hypertension and are associated with excess morbidity and deaths from cardiovascular disease. This association is pronounced among individuals with diabetes mellitus. Interestingly, prehypertension appears to be associated with an increase risk of myocardial infarction and coronary artery disease but not stroke. Also have been demonstrated that cardiovascular risk factors and subclinical anatomic cardiovascular disease (leftventricular mass index, left ventricular internal diameter, and carotid artery intima-media thickness), increasea cross blood pressure categories from normotension to hypertension. Recently, some studies have found that individuals with high-normal blood pressure had higher prevalence of cardiovascular and metabolic risk factors and metabolic syndrome than those with normal blood pressure, even if healthy, they showed reduced adiponectin values, early signs of endothelial dysfunction, andoxidative stress.
Subject(s)
Humans , Cardiovascular Diseases/etiology , Hypertension , Arterial Pressure/physiology , Risk FactorsABSTRACT
Among the main etiologies of secondary arterial hypertension figure out the tumorous affections of adrenal gland, located on cortex - primary aldosteronism (Conns syndrome) and Cushings syndrome - or at glandular medulla - pheocromocytoma. Although these tumors are at most benign the surgical resection is needed in order to eliminate the disturbances provided by them and to limit the mass growth, being curative in about 80-90 percent of the cases. In this paper some particularities above surgical treatment of these diseases will be focused emphasizing the pre-operative prepare of the patients and the currently preconized approach.
ABSTRACT
Com o objetivo de avaliar a resposta sobre a resistência vascular periférica (RVP), 29 pacientes, portadores de hipertensäo arterial leve e moderada, foram tratados durante 12 semanas, com dose fixa de clortalidona 50 mg em dias alternados. O controle da pressäo arterial foi realizado previamente à administraçäo da droga e nas 2ª, 5ª, 8ª, 11ª e 14ª semanas. A RVP foi calculada através de medidas ecocardiográficas realizadas nas 2ª, 8ª e 14ª semanas (torr x 1**-1 x min). A pressäo arterial diastólica supina (PAD) reduziu-se significantemente de 103,4 + ou - 66 mmHg para 87,1 + ou - 8,8 mmHG entre a 2ª e 14ª semanas de tratamento (p <0,001). Todos os valores da PAD medidos nas outras semanas também mostraram diferenças significativas em relaçäo ao valor inicial. A RVP apresentou reduçäo significativa (p < 0,001) após seis semanas do início do tratamento ativo, variando de 17,96 + ou - 4,04 torr x 1**-1 min para 15,21 + ou - 3,76 torr x 1**-1 x min. Entre a 8ª e 14ª semanas a RVP manteve-se inalterada (15,21 + ou - 3,76 torr x 1**-1 min e 15,11 + ou - 3,67 torr x 1**-1 x min, respectivamente). Estes resultados sugerem fortemente que um dos mecanismos de açäo anti-hipertensiva dos diuréticos é, a médio prazo, a reduçäo da resistência periférica, o que explica a manutençäo de sua eficácia após a estabilizaçäo da volemia, que se reduz, principalmente, no início da terapêutica