Hipertensão arterial resistente (HAR) / Resistant arterial hypertension (RAH)

A hipertensão arterial resistente (HAR) é definida quando a pressão arterial (PA) permanece acima das metas recomendadas com o uso de três anti-hipertensivos de diferentes classes, incluindo um bloqueador do sistema renina- angiotensina (inibidor da enzima conversora da angiotensina [IECA] ou bloqueador do receptor de angiotensina [BRA]), um bloqueador dos canais de cálcio (BCC) de ação prolongada e um diurético tiazídico (DT) de longa ação em doses máximas preconizadas e toleradas, administradas com frequência, dosagem apropriada e comprovada adesão. Nesta definição está incluído o subgrupo de pacientes hipertensos resistentes, cuja PA é controlada com quatro ou mais medicamentos anti-hipertensivos, chamada de HAR controlada (HAR-C). A classificação da doença em HAR-C e HAR não controlada (HAR-NC), incluindo a HAR refratária (HAR-Ref), um fenótipo extremo de HAR-NC em uso de cinco ou mais anti-hipertensivos, é uma proposta que ganha espaço na literatura. Diante da suspeita clínica de HAR, é necessário verificar a confirmação diagnóstica, e a primeira etapa na investigação é a exclusão das causas de pseudorresistência, tais como falta de adesão ao tratamento (farmacológico e não farmacológico), posologia inadequada, técnica imprópria de aferição da PA e efeito do avental branco. O MAPA e o monitoramento residencial da pressão arterial (MRPA) são os exames para confirmação do controle inadequado da PA. Uma vez afastada a pseudorresistência, confirma-se a existência da HAR e inicia-se uma investigação diagnóstica com exames específicos, conforme a orientação das Diretrizes de Hipertensão em relação ao comprometimento de lesões em órgãos-alvo e hipertensão secundária. A ocorrência de comorbidades associadas deve ser detectada com exames especializados de acordo com a suspeita clínica. O objetivo do tratamento medicamentoso na HAR é detectar as causas do não controle e encontrar a melhor combinação de fármacos, visando o alcance das metas pressóricas com menor ocorrência de efeitos adversos e maior adesão. Em geral, busca-se otimizar o tratamento tríplice com os fármacos preferenciais, que são: IECA ou BRA, BCC di-hidropiridínico e DT.

Resistant hypertension (RHTN) is defined as blood pressure (BP) persistently above the recommended target values despite the use of three antihypertensive agents of different classes, including one blocker of the renin- angiotensin system (angiotensin-converting enzyme inhibitor [ACEI] or angiotensin receptor blocker [ARB]), one long- acting calcium channel blocker (CCB), and one long-acting thiazide diuretic (TD) at maximum recommended and tolerated doses, administered with appropriate frequency and doses and with proven adherence. The definition above includes a subgroup of patients with RHTN whose BP is controlled with four or more antihypertensive medications, known as controlled RHTN (C-RHTN). On clinical suspicion of RHTN, diagnostic confirmation is required, and the first step in the investigation is the exclusion of causes of pseudoresistance, such as lack of treatment adherence (pharmacological and non-pharmacological), inadequate dosing, improper BP measurement technique, and white-coat effect. Lack of BP control should be confirmed by ABPM and home blood pressure monitoring (HBPM). Secondary hypertension (SecH) is defined as increased BP due to an identifiable cause. Patients with RH should be investigated for the most prevalent causes of "non-endocrine" and "endocrine" SecH after exclusion of use of medications that may interfere with BP values: antiinflammatory drugs, glucocorticoids, nasal decongestants, appetite suppressants, antidepressants, immunosuppressants, erythropoietin, contraceptives, and illicit drugs. The objective of pharmacological treatment in RHTN is to identify the causes of lack of control and find the best combination of drugs, aiming at achieving the target BP with few adverse effects and greater adherence. In general, triple treatment optimization is attempted with preferred drugs, namely, ACEIs or ARBs, dihydropyridine CCBs, and TDs

El efecto anti-hipertensivo de angiotensina-(1-9) es mediado por aumento temprano de la diuresis y natriuresis / Cardiac arrest associated to intramural hematoma of the anterior descending coronary artery

Introducción: Angiotensina (Ang)-(1-9) posee propiedades anti-hipertensivas y efecto protector a nivel cardiovascular en ratas hipertensas. Sin embargo, se desconoce si estos efectos están asociados a un mecanismo de desbalance de sodio a nivel renal. Objetivo: Determinar si el efecto anti-hipertensivo de Ang-(1-9) está asociado a un mecanismo diurético-na-triurético. Método: Ratas macho Sprague Dawley (200 ± 10g) fueron aleatorizadas para recibir Ang II (400 ng/kgmin) vía bomba osmótica. Como control se utilizaron ratas con operación sham (n=18). Después de 2 semanas desde la instalación de bomba, las ratas Sham e hipertensas fueron randomizadas para recibir vehículo (n=10), Ang-(1-9) (602 ng/kg/min, n=17) o una co-administración de Ang-(1-9) y A779 (100 ng kg-1min-1, n=7 bloqueador del receptor MAS) por 2 semanas. Resultados: Se determinó la presión arterial sistólica (PAS), masa ventricular relativa (MVR), área y perímetro de los cardiomiocitos (AC y PC) y la fracción volumétrica de colágeno total (FVCT). Para evaluar la diuresis y natriuresis se utilizaron ratas normotensas que fueron randomizadas para recibir vehículo (n=8) o Ang-(1-9) (600 ngKg-1min-1, n=8) por 6 días. Se observó un incremento significativo(p<0.05) de PAS (33%), MVR (17%), AC (64%), PC (20%), FVCT (46%). La administración crónica de Ang-(1-9) disminuyó PAS (20%), MVR (13 %), AC (35%), PC (20%) y FVCT (20%). Estos efectos no fueron mediados por el receptor MAS. Al comparar las ratas normotensas tratadas con vehículo o Ang-(1-9), se observó un aumento significativo de la diuresis y natriuresis en los días 2 y 3 en los animales con infusión de Ang-(1-9). Conclusión: Ang-(1-9) reduce la hipertensión y el remodelamiento cardíaco en ratas hipertensas. En animales normotensos se demostró que el tratamiento con Ang-(1-9)-induce diuresis y natriuresis. Este es el primer reporte que señala que el efecto de Ang-(1-9) está asociado a una regulación del sodio a nivel renal.

Background: Angiotensin-(1-9) has anti-hypertensive properties and protective cardiovascular effect in hypertensive rats. However, it is unknown whether its effects are related to a kidney mechanism to balance sodium. Aim: To determine if the anti-hypertensive effect of Ang-(1-9) is associated to a diuretic-natriuretic mechanism. Method: Sprague Dawley male rats (200±10 grs) were randomized to receive Angiotensin II by osmotic pump (400 ng/kg/min). Sham operated rats were utilized as control (n=18). Two weeks after pump setting, Sham rats with hypertension were randomized to receive placebo (n=10), Ang-(1-9)(602 ng/kg/min, n=17) or Ang-(1-9) plus A779 (Ang-(1-7) Receptor Mas blocker, 100ng/kg-1min-1, n=7) co-administration for two weeks. Arterial systolic pressure (PAS), ventricular relative mass (MVR), cardiomyocytes area and perimeter (AC and PC) and total collagen volume fraction (FVCT) were measured. Normotensive rats were utilized to evaluate diuresis and natriuresis which were randomized to receive placebo (n=8) or Ang-(1-9) (600ng/kg-1/min-1, n=8) for six days. Results: It was observed a significant rise (p<0.05) of PAS (33%), MVR (17%), AC (64%), PC (26%), FVCT (46%) was observed. Chronic administration of Ang-(1-9) reduced PAS (20%), MVR (13%), AC (35%), PC (20%) and FCVT (20%). All those effects were not mediated by Mas receptor. A significant raise was observed of diuresis and natriuresis at the second and third day of treatment in rats receiving Ang-(1-9) in comparison with normotensive rats treated with placebo. Conclusion: Ang-(1-9) reduces hypertension and cardiac remodeling in hypertensive rats. Ang-(1-9) induces natriuresis and diuresis in normotensive rats. This is the first report showing that Ang-(1-9) is associated to sodium balance in the kidney.

Percepción de la calidad de vida en personas con situación de enfermedad crónica en una institución prestadora de servicios de salud Barranquilla / Perception of quality of life in people with a chronic disease situation in an institution providing health services in Barranquilla

Objetivo: Describir la percepción de la calidad de vida de personas en situación de enfermedad crónica: Diabetes e Hipertensión Arterial. Metodología: Estudio de abordaje cualitativo, descriptivo, con empleo de técnica de análisis de contenido. La muestra se determinó por muestreo teórico por saturación de datos, lo cual se alcanzó cuando los participantes coincidieron en sus apreciaciones y la información resultó repetitiva. Los informantes fueron en total 6 personas, conformados por 2 hombres con diagnóstico de Diabetes Mellitus y 4 mujeres, 2 de ellas con HTA y 2 con Diabetes Mellitus, inscritos ellos en el programa de Promoción de la Salud y Prevención de la Enfermedad, en la Institución Prestadora de Salud, Hospital Nazareth de la ciudad de Barranquilla. La participación de los informantes fue voluntaria, previa firma del consentimiento informado y por escrito. Asimismo, se les aclaró que cuando lo consideraran pertinente podían retirarse del estudio. Se les garantizó la privacidad y anonimato de la información. Durante el análisis de la información se tuvieron en cuenta los siguientes pasos: transcripción de las entrevistas, lectura y relectura, identificación de códigos y construcción de las categorías derivadas de los códigos, contrastación de los resultados para su validación con los participantes y el asesor de la investigación. Dichos datos fueron sistematizados y procesados a través del Atlas T. Finalmente, se procedió a establecer los patrones de relación entre las categorías. Resultados: En relación con la percepción que tienen los participantes en el estudio, con Enfermedades Crónicas No Transmisibles (ECNT), el estudio reportó que estos perciben que su calidad de vida se encuentra afectada negativamente en las dimensiones física, psicológica, social, y en menor grado en la dimensión espiritual, lo cual redunda en su bienestar. Discusión: Las investigaciones consultadas y los resultados del estudio coinciden en que la ECN, puede alterar la percepción que tienen las personas frente a su calidad de vida, debido al impacto que causa en las diferentes dimensiones. Conclusión: Los resultados del estudio demuestran la necesidad de que el cuidado que se brinda a las personas con ECNT, sea abordado no solo desde la dimensión física, sino de manera integral. Este abordaje permitirá identificar oportunamente los factores que influyen en una percepción negativa de la calidad de vida. Recomendaciones: Los resultados del estudio permiten desde la disciplina de enfermería fortalecer los Programas de Promoción de la salud y Prevención de la enfermedad, mediante el diseño de protocolos de atención que concuerden con las necesidades de las personas en situación de ECNT, para minimizar el impacto de la enfermedad en la calidad de vida.

Objective: describe the perceived quality of life of people living in chronic disease: diabetes and hypertension. Methodology: a qualitative approach, descriptive, using content analysis technique. The sample size was determined using theoretical sampling saturation of data, which was reached when the participants agreed in their assessments and the information was repetitive. The informants were a total of 6 persons, made up of 2 men with a diagnosis of Diabetes Mellitus and 4 women, 2 with hypertension and 2 Diabetes Mellitus, enrolled them in the program, Health Promotion and Disease Prevention at the Lending institution of Health, Nazareth Hospital in the city of Barranquilla. During the data analysis took into account the following steps, transcription of interviews, reading and rereading, identifying and building codes derived categories of codes, contrasting the results for validation with the participants and the consultant research. These data were systematized and processed through the Atlas T. Finally, we proceeded to establish the patterns of relationships between categories. Results: Regarding the perception of people with chronic diseases in the study, the study reported that participants perceive their quality of life is negatively affected the physical, psychological, social, and less so in the spiritual dimension, which results in their welfare. Discussion: The research consulted and results of the study agree that the ECNT, you can switch perception versus quality of life due to the impact has on the different dimensions. Conclusions: The results of the study demonstrate the need for the care provided to people with ECNT, is addressed not only from the physical dimension, but holistically. This approach will quickly identify the factors that influence a negative perception of the. Recommendations: The results of the study permits from the nursing programs to strengthen the health promotion and disease prevention through the design of protocols of care that is consistent with the needs of people in situations of chronic diseases to minimize the impact of disease on quality of life.

Correlation between Arterial Compliance and Insulin Resistance in Prehypertensive People / 中国康复理论与实践

@#Objective To investigate the correlation between the arterial compliance and insulin resistance in the prehypertensive people.Methods 30 healthy persons,36 prehypertensive persons and 46 hypertensive patients were measured Cl and C2 using CVProfilor DO-2020 and determined insulin sensitivity with HOMA-IR.Results Adjusted for the age and the course of disease,C1 and C2 decreased in hypertensive patients compared with that of the healthy and prehypertensive people(P<0.05);C2 decreased in prehypertensive people compared with the healthy groups(P<0.05).HOMA-IR increased in hypertensive patients and prehypertensive people compared with the healthy groups(P<0.05).There was significant correlation between HOMA-IR and C2 in prehypertensive people.Conclusion Small arterial compliance decrease and insulin resistance can be found with negatively correlation in prehypertensive people.