Qual o melhor horário da tomada da medicação anti-hipertensiva? / What is the best time to take antihypertensive medication?

A hipertensão arterial é a principal causa de morte precoce no mundo. Existem diversos fatores que contribuem para sua variação dentro da fisiologia do ritmo circadiano, e que exercem forte impacto sobre o controle da pressão arterial (PA). Os valores da PA sofrem interferência de acordo com o horário da medida. Nas primeiras horas da manhã PAS aumenta rapidamente em 20 a 25 mmHg e a PAD em 10 a 15 mmHg. As drogas anti-hipertensivas, sofrem diversas influências na sua absorção, metabolização e excreção dependentes do ritmo circadiano e de suas propriedades físico-químicas. O ciclo circadiano exerce grande impacto no controle da PA, e apenas modificando o horário das prescrições, seguindo o ritmo circadiano, talvez seja possível obter melhor controle pressórico com menor dose da medicação, reduzindo assim, as possíveis reações adversas

Hypertension is the leading cause of early death worldwide. Several factors contribute to its variation within the physiology of circadian rhythm, and these factors have a strong impact on blood pressure (BP) control. BP values are influenced by the measurement time. In the early hours of the morning, SBP increases rapidly by 20 to 25 mmHg and DBP by 10 to 15 mmHg. Antihypertensive drugs suffer from a variety of influences on their absorption, metabolism and excretion, depending on the circadian rhythm and its physical-chemical properties. The circadian cycle has a great impact on BP control, and only by changing the schedule of prescriptions, following the circadian rhythm, it may be possible to obtain better pressure control with a lower dose of medication, thus reducing potential adverse reactions

Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study.

BACKGROUND: Economic incentives through health insurance may promote healthier behaviors. Little is known about health and economic impacts of incentivizing diet, a leading risk factor for diabetes and cardiovascular disease (CVD), through Medicare and Medicaid. METHODS AND FINDINGS: A validated microsimulation model (CVD-PREDICT) estimated CVD and diabetes cases prevented, quality-adjusted life years (QALYs), health-related costs (formal healthcare, informal healthcare, and lost-productivity costs), and incremental cost-effectiveness ratios (ICERs) of two policy scenarios for adults within Medicare and Medicaid, compared to a base case of no new intervention: (1) 30% subsidy on fruits and vegetables ("F&V incentive") and (2) 30% subsidy on broader healthful foods including F&V, whole grains, nuts/seeds, seafood, and plant oils ("healthy food incentive"). Inputs included national demographic and dietary data from the National Health and Nutrition Examination Survey (NHANES) 2009-2014, policy effects and diet-disease effects from meta-analyses, and policy and health-related costs from established sources. Overall, 82 million adults (35-80 years old) were on Medicare and/or Medicaid. The mean (SD) age was 68.1 (11.4) years, 56.2% were female, and 25.5% were non-whites. Health and cost impacts were simulated over the lifetime of current Medicare and Medicaid participants (average simulated years = 18.3 years). The F&V incentive was estimated to prevent 1.93 million CVD events, gain 4.64 million QALYs, and save $39.7 billion in formal healthcare costs. For the healthy food incentive, corresponding gains were 3.28 million CVD and 0.12 million diabetes cases prevented, 8.40 million QALYs gained, and $100.2 billion in formal healthcare costs saved, respectively. From a healthcare perspective, both scenarios were cost-effective at 5 years and beyond, with lifetime ICERs of $18,184/QALY (F&V incentive) and $13,194/QALY (healthy food incentive). From a societal perspective including informal healthcare costs and lost productivity, respective ICERs were $14,576/QALY and $9,497/QALY. Results were robust in probabilistic sensitivity analyses and a range of one-way sensitivity and subgroup analyses, including by different durations of the intervention (5, 10, and 20 years and lifetime), food subsidy levels (20%, 50%), insurance groups (Medicare, Medicaid, and dual-eligible), and beneficiary characteristics within each insurance group (age, race/ethnicity, education, income, and Supplemental Nutrition Assistant Program [SNAP] status). Simulation studies such as this one provide quantitative estimates of benefits and uncertainty but cannot directly prove health and economic impacts. CONCLUSIONS: Economic incentives for healthier foods through Medicare and Medicaid could generate substantial health gains and be highly cost-effective.

O efeito da musicoterapia na qualidade de vida e na pressão arterial do paciente hipertenso / Music therapy effects on the quality of life and the blood pressure of hypertensive patients / El efecto de la musicoterapia en la calidad de vida y en la presión arterial del paciente hipertenso

FUNDAMENTO: A hipertensão arterial (HA) é uma doença de massa, com conseqüências para o aparelho cardiocirculatório, pois suas complicações elevam as taxas de morbi-mortalidade. Controlar a pressão arterial (PA) diminui complicações e pode preservar a qualidade de vida (QV) dos pacientes. Estudos mostram os efeitos positivos da música como coadjuvante no tratamento de diversas patologias. OBJETIVO: Avaliar o efeito da musicoterapia na QV e no controle da PA de pacientes hipertensos. MÉTODOS: Realizou-se um ensaio clínico controlado que avaliou pacientes de ambos os sexos, maiores que 50 anos, HA estágio 1, em uso de medicação, matriculados em serviço multiprofissional para tratamento da HA. Divididos em grupos experimental (GE) e controle (GC). O GE, além do tratamento convencional, participou de sessões musicoterápicas semanais por doze semanas. O GC permaneceu sob tratamento padrão do serviço. Antes e após a intervenção foi aplicado nos dois grupos o questionário SF-36 e verificada a PA. A voz, importante elemento da comunicação, reflexo do estado físico, psíquico e emocional, foi o principal recurso utilizado. Estatística: testes t-Student e Wilcoxon (significantes p<0,05). RESULTADOS: Os grupos eram inicialmente semelhantes quanto a sexo, idade, escolaridade e QV avaliada. Na comparação inicial e final dos pacientes do GE observamos melhora significativa na QV (p<0,05) e no controle da PA (p<0,05). Sem modificações na adesão. CONCLUSÕES: A musicoterapia contribuiu para a melhora da QV e do controle da PA, sinalizando que essa atividade pode representar um reforço na abordagem terapêutica em programas de atendimento multidisciplinar ao paciente hipertenso.

BACKGROUND: Arterial Hypertension (AH) is a mass disease, with consequences for the cardiocirculatory system, since its complications raise the rates of morbidity and mortality. Controlling blood pressure (BP) reduces complications and may preserve the quality of life (QOL) of patients. Studies show positive effects of music therapy as an adjuvant in the treatment of several diseases. OBJECTIVE: to evaluate the effect of music therapy on the QOL and BP control of hypertensive patients. METHODS: This was a controlled clinical study that evaluated patients of both genders, aged over 50 years, with stage 1 hypertension, in use of medication and enrolled in multidisciplinary service for treatment of hypertension. They were divided into an experimental group (EG) and a control group (CG). The EG, in addition to the conventional treatment, participated in weekly music therapy sessions for twelve weeks. The CG received the standard treatment of the service. Before and after the intervention, the SF-36 questionnaire was applied in both groups, and the BP of each patient was measured. The voice, an important element of communication, reflecting the patient's physical, mental and emotional state, was the main resource used. Statistics: Student T-test and Wilcoxon test were considered significant at p <0.05. RESULSTS: The groups were initially similar in gender, age, education, and the assessed QOL. In the initial and final comparison of EG patients, we observed a significant improvement on the QOL (p <0.05) and BP control (p <0.05), with no change in adhesion. CONCLUSIONS: Music therapy has contributed to an improvement on the QOL and BP control of patients, suggesting that this activity may represent a therapeutic approach to help strengthen the programs of multidisciplinary care of hypertensive patients.

FUNDAMENTO: La hipertensión arterial (HA) es una enfermedad de masa, con consecuencias para el aparato circulatorio, pues sus complicaciones elevan las tasas de morbilidad y mortalidad. Controlar la presión arterial (PA) disminuye complicaciones y puede preservar la calidad de vida (CV) de los pacientes. Estudios muestran los efectos positivos de la música como coadyuvante en el tratamiento de diversas patologías. OBJETIVO: Evaluar el efecto de la musicoterapia en la CV y en el control de la PA de pacientes hipertensos. MÉTODOS: Se realizó un ensayo clínico controlado que evaluó pacientes de ambos sexos, mayores de 50 años, HA estado 1, en uso de medicación, matriculados en servicio multiprofesional para tratamiento de la HA. Se dividieron en grupos experimental (GE) y control (GC). El GE, además del tratamiento convencional, participó en sesiones musicoterápicas semanales por doce semanas. El GC permaneció bajo tratamiento estándar del servicio. Antes y después de la intervención se aplicó en los dos grupos el cuestionario SF-36 y se verificó la PA. La voz, importante elemento de comunicación, reflejo del estado físico, psíquico y emocional, fue el principal recurso utilizado. Estadística: tests t-Student y Wilcoxon (significantes p<0,05). RESULTADOS: Los grupos eran inicialmente similares en cuanto a sexto, edad, escolaridad y CV evaluada. En la comparación inicial y final de los pacientes del GE observamos una mejora significativa en la CV (p<0,05) y en el control de la PA (p<0,05). Sin modificaciones en la adhesión. CONCLUSÕES: La musicoterapia contribuyó para la mejora de la CV y del control de la PA, señalando que esta actividad puede representar un refuerzo en el abordaje terapéutico en programas de atención multidisciplinaria al paciente hipertenso.

Music therapy effects on the quality of life and the blood pressure of hypertensive patients.

BACKGROUND: Arterial Hypertension (AH) is a mass disease, with consequences for the cardiocirculatory system, since its complications raise the rates of morbidity and mortality. Controlling blood pressure (BP) reduces complications and may preserve the quality of life (QOL) of patients. Studies show positive effects of music therapy as an adjuvant in the treatment of several diseases. OBJECTIVE: to evaluate the effect of music therapy on the QOL and BP control of hypertensive patients. METHODS: This was a controlled clinical study that evaluated patients of both genders, aged over 50 years, with stage 1 hypertension, in use of medication and enrolled in multidisciplinary service for treatment of hypertension. They were divided into an experimental group (EG) and a control group (CG). The EG, in addition to the conventional treatment, participated in weekly music therapy sessions for twelve weeks. The CG received the standard treatment of the service. Before and after the intervention, the SF-36 questionnaire was applied in both groups, and the BP of each patient was measured. The voice, an important element of communication, reflecting the patient's physical, mental and emotional state, was the main resource used. STATISTICS: Student T-test and Wilcoxon test were considered significant at p <0.05. RESULTS: The groups were initially similar in gender, age, education, and the assessed QOL. In the initial and final comparison of EG patients, we observed a significant improvement on the QOL (p <0.05) and BP control (p <0.05), with no change in adhesion. CONCLUSIONS: Music therapy has contributed to an improvement on the QOL and BP control of patients, suggesting that this activity may represent a therapeutic approach to help strengthen the programs of multidisciplinary care of hypertensive patients.