Different methods for assessing glomerular filtration rate in the elderly.

OBJECTIVE: The objective of this study was to identify the best method to replace cystatin C in the evaluation of glomerular filtration in the elderly. METHODS: Individuals over 60 years of age from a primary care center were studied. Blood was collected to determine creatinine and cystatin C and 24-h urine. Three methods were compared to determine glomerular filtration: Creatinine clearance, Cocroft-Gault, modification of diet in renal disease, and Collaboration Epidemiology of Chronic Kidney Disease based on creatinine, considering as a reference the determination of glomerular filtration using the cystatin-based Chronic Kidney Disease Epidemiology Collaboration equation. The statistical methods used were linear regression, Bland-Altman curve, and receiver operating characteristic. RESULTS: A total of 180 elderly people were evaluated, but 14 patients were lost from the sample, resulting in a total of 166 patients. The average age of patients was 66.9±6.1 years, and 69.8% were females. Regarding the number of patients eligible for the study, there were 12 black, 108 brown, and 46 white, 42.77% hypertensive, and 38.3% diabetic. Glomerular filtration was less than 60 mL/min in 22.28% of patients. Regarding the evaluation of the different equations, the correlation coefficient was lower for creatinine clearance and progressively higher for Cocroft-Gault, modification of diet in renal disease, and Collaboration Epidemiology of Chronic Kidney Disease based on creatinine. The Bland-Altman diagram and the receiver operating characteristic curve showed similar performance to the correlation coefficient for the different equations evaluated. CONCLUSION: Collaboration Epidemiology of Chronic Kidney Disease based on creatinine presented the best performance. Creatinine debug had the worst performance, which reinforces the idea that 24-h urine collection is unnecessary in these patients.

Association between chronic kidney disease stages and changes in ambulatory blood pressure monitoring parameters.

INTRODUCTION: Blood pressure (BP) assessment affects the management of arterial hypertension (AH) in chronic kidney disease (CKD). CKD patients have specific patterns of BP behavior during ambulatory blood pressure monitoring (ABPM). OBJECTIVES: The aim of the current study was to evaluate the associations between progressive stages of CKD and changes in ABPM. METHODOLOGY: This is a cross-sectional study with 851 patients treated in outpatient clinics of a university hospital who underwent ABPM examination from January 2004 to February 2012 in order to assess the presence and control of AH. The outcomes considered were the ABPM parameters. The variable of interest was CKD staging. Confounding factors included age, sex, body mass index, smoking, cause of CKD, and use of antihypertensive drugs. RESULTS: Systolic BP (SBP) was associated with CKD stages 3b and 5, irrespective of confounding variables. Pulse pressure was only associated with stage 5. The SBP coefficient of variation was progressively associated with stages 3a, 4 and 5, while the diastolic blood pressure (DBP) coefficient of variation showed no association. SBP reduction was associated with stages 2, 4 and 5, and the decline in DBP with stages 4 and 5. Other ABPM parameters showed no association with CKD stages after adjustments. CONCLUSION: Advanced stages of CKD were associated with lower nocturnal dipping and greater variability in blood pressure.

Could albumin level explain the higher mortality in hemodialysis patients with pulmonary hypertension?

BACKGROUND: The pathogenesis of pulmonary hypertension (PH) in hemodialysis is still unclear. The aim of this study was to identify the risk factors associated with the presence of PH in chronic hemodialysis patients and to verify whether these factors might explain the highest mortality among them. METHODS: We conducted a retrospective study of hemodialysis patients who started treatment from August 2001 to October 2007 and were followed up until April 2011 in a Brazilian referral medical school. According to the results of echocardiography examination, patients were allocated in two groups: those with PH and those without PH. Clinical parameters, site and type of vascular access, bioimpedance, and laboratorial findings were compared between the groups and a logistic regression model was elaborated. Actuarial survival curves were constructed and hazard risk to death was evaluated by Cox regression analysis. RESULTS: PH > 35 mmHg was found in 23 (30.6%) of the 75 patients studied. The groups differed in extracellular water, ventricular thickness, left atrium diameter, and ventricular filling. In a univariate analysis, extracellular water was associated with PH (relative risk = 1.194; 95% CI of 1.006 - 1.416; p = 0.042); nevertheless, in a multiple model, only left atrium enlargement was independently associated with PH (relative risk =1.172; 95% CI of 1.010 - 1.359; p = 0.036). PH (hazard risk = 3.008; 95% CI of 1.285 - 7.043; p = 0.011) and age (hazard risk of 1.034 per year of age; 95% CI of 1.000 - 7.068; p = 0.047) were significantly associated with mortality in a multiple Cox regression analysis. However, when albumin was taken in account the only statistically significant association was between albumin level and mortality (hazard risk = 0.342 per g/dL; 95% CI of 0.119 - 0.984; p = 0.047) while the presence of PH lost its statistical significance (p = 0.184). Mortality was higher in patients with PH (47.8% vs 25%) who also had a statistically worse survival after the sixth year of follow up. CONCLUSIONS: PH in hemodialysis patients is associated with parameters of volume overload that sheds light on its pathophysiology. Mortality is higher in hemodialysis patients with PH and the low albumin level can explain this association.

Association between statin use and mortality risks during the acute phase of ischemic stroke in patients admitted to an intensive care unit.

Ischemic stroke is a common cause of death. The role of statins in the secondary prevention of the chronic ischemic stroke phase has been established. However, evidence regarding their efficacy in this phase is limited and contradictory. OBJECTIVE: To evaluate the association between statin use and mortality risk during the acute phase of ischemic stroke in patients admitted to an intensive care unit. METHODS: This was an observational and prospective study of ischemic stroke patients aged ≥18, admitted to an intensive care unit. Medications used during the first 7 days after the ictus, as well as medications used previously, were recorded. The primary outcome was all-cause mortality during the first 7 days. RESULTS: We screened 212 patients and included 97 patients with ischemic stroke in the study period. The mortality rate among patients who used statins during the acute IS phase [14% (9/63)] was significantly lower than that among patients who did not use statins [41% (14/34); p=0.007]. This was confirmed in logistical regression with an 0.19 Odds Ratio - OR [p=0.018; 95% confidence interval - 95%CI 0.05-0.75]. Patients who died were older, had a higher incidence of acute myocardial infarction, higher scores on the NIHSS and lower systolic blood pressure. Statins and angiotensin converting enzyme inhibitors were used more frequently among survivors. These associations persisted even after adjustment for confounding variables. CONCLUSION: Statins and angiotensin converting enzyme inhibitors use during hospitalization were independently associated to a lower rate of all-cause mortality in the first 7 days of intensive care unit admission.

Cardiovascular risk factors: differences between ethnic groups.

OBJECTIVES: to compare the metabolic, anthropometric, tobacco and alcohol consumption indicators considered as risk factors for cardiovascular diseases, as well as the demographic and socioeconomic characteristics between indigenous from Rio Negro, Sateré-Mawé, mixed-race/black and white people living in the city of Manaus. METHODS: a cross-sectional observational study guided by the STROBE tool. There was a sample of 191 adults of both sexes. Anthropometric measurements, blood pressure and biochemical analyzes were performed. Statistical test was applied to cross color/race/ethnicity variable with the investigated variables. RESULTS: indigenous had better metabolic and anthropometric indicators related to cardiovascular diseases than mixed-race/black and white, as well as Sateré-Mawé in relation to Rionegrinos (from Rio Negro). CONCLUSIONS: the main differences were obesity, dyslipidemia, pre-systemic arterial hypertension/systemic arterial hypertension, and increased circumferences, with a worse situation for mixed-race/black people. The findings indicate differences in risk factors between race/color and ethnicity groups evaluated.

[Predictors of chronic renal failure in patients in a hypertension center]. / Preditores de insuficiência renal crônica em pacientes de centro de referência em hipertensão arterial.

PURPOSE: To verify which clinical variables can predict the evolution to chronic renal insufficiency in routinely evaluated hypertensives. METHODS: 358 patients from the Hypertension Center of the Botucatu School of Medicine (São Paulo State University) were evaluated. Sequential evaluation of glomerular filtration rate was detected in 210 patients, who were analyzed. Logistic regression was applied to identify clinical variables independently associated with the development of chronic renal insufficiency with a final glomerular filtration rate equal to or below 60 ml/min. RESULTS: In routine urinalysis only proteinuria was independently associated with the outcome. Among 175 patients with initial glomerular filtration rate above 60 ml/min, proteinuria, female gender and age of 50 years or more were predictors of the evolution to a final glomerular filtration rate equal to or below 60 ml/min. CONCLUSION: The presence of proteinuria in simple urinalysis was a risk factor and a reliable predictor associated with the development of chronic renal insufficiency among hypertensives.

Different methods for assessing glomerular filtration rate in the elderly

SUMMARY OBJECTIVE: The objective of this study was to identify the best method to replace cystatin C in the evaluation of glomerular filtration in the elderly. METHODS: Individuals over 60 years of age from a primary care center were studied. Blood was collected to determine creatinine and cystatin C and 24-h urine. Three methods were compared to determine glomerular filtration: Creatinine clearance, Cocroft-Gault, modification of diet in renal disease, and Collaboration Epidemiology of Chronic Kidney Disease based on creatinine, considering as a reference the determination of glomerular filtration using the cystatin-based Chronic Kidney Disease Epidemiology Collaboration equation. The statistical methods used were linear regression, Bland-Altman curve, and receiver operating characteristic. RESULTS: A total of 180 elderly people were evaluated, but 14 patients were lost from the sample, resulting in a total of 166 patients. The average age of patients was 66.9±6.1 years, and 69.8% were females. Regarding the number of patients eligible for the study, there were 12 black, 108 brown, and 46 white, 42.77% hypertensive, and 38.3% diabetic. Glomerular filtration was less than 60 mL/min in 22.28% of patients. Regarding the evaluation of the different equations, the correlation coefficient was lower for creatinine clearance and progressively higher for Cocroft-Gault, modification of diet in renal disease, and Collaboration Epidemiology of Chronic Kidney Disease based on creatinine. The Bland-Altman diagram and the receiver operating characteristic curve showed similar performance to the correlation coefficient for the different equations evaluated. CONCLUSION: Collaboration Epidemiology of Chronic Kidney Disease based on creatinine presented the best performance. Creatinine debug had the worst performance, which reinforces the idea that 24-h urine collection is unnecessary in these patients.

Association between blood pressure and acute phase stroke case fatality rate: a prospective cohort study.

OBJECTIVE: ed to investigate the association between blood pressure and acute phase stroke lethality in a Brazilian intensive care unit. METHODS: This was an observational, prospective cohort study of hemorrhagic and ischemic stroke intensive care patients. The primary outcome was all-cause mortality during the first seven days. RESULTS: There were 146 patients, aged 66 ± 13.4 years, 56% men, 89% Caucasian, 69% had ischemic stroke, and 80% were hypertensive. The median of the National Institutes of Health Stroke Scale score was 16. There were 101 ischemic stroke patients and 45 hemorrhagic stroke patients. In the ischemic stroke patients, logistic regression analysis identified low systolic blood pressure as an independent ominous prognostic factor and the optimal cut off was a mean of systolic blood pressure ≤ 131 mmHg during the first 48 hours from admission for prediction of death. No association was found for hemorrhagic stroke. CONCLUSIONS: There was a negative association between systolic blood pressure and case fatality ratio of acute phase stroke in ischemic stroke intensive care patients.

Spironolactone is secure and reduces left ventricular hypertrophy in hemodialysis patients.

OBJECTIVES: There is recent evidence that aldosterone play a role in the pathogenesis of cardiovascular disease in dialysis patients, which leads to the opportunity to block its actions for the benefit of these patients. In nondialytic chronic kidney disease, spironolactone was safe and effective in reducing left ventricular hypertrophy. However, routine use has been precluded in hemodialysis patients due to the risk of hyperkalemia. The aim of this study is to verify the safety and efficacy in regression of left ventricular hypertrophy with spironolactone in hemodialysis patients undergoing pharmacotherapeutic monitoring. METHODS: We performed a controlled, randomized, double blind study evaluating 17 hemodialysis patients who received spironolactone at a dose of 12.5 mg titrated, in the second week, to 25 mg of spironolactone or placebo. The patients were treated for 6 months. RESULTS: The groups were composed of eight patients (intervention) and nine patients (control). These groups did not differ in their baseline characteristics. The group receiving spironolactone had a left ventricular mass index reduction from 77 ± 14.6 g/m(2.7) to 69 ± 10.5 g/m(2.7), p < 0.04, whereas in placebo group there was an increase from 71 ± 14.2 g/m(2.7) to 74 ± 17.4 g/m(2.7). Systolic or diastolic blood pressure did not change during the study. Potassium did not differ statistically between groups in all instances. CONCLUSION: Spironolactone treatment in hemodialysis patients was secure and effective in regression of left ventricular hypertrophy, a major risk factor for cardiovascular events in these patients. This effect occurred in spite of blood pressure stability. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01128101.

Cardiovascular risk factors: differences between ethnic groups / Factores de riesgo cardiovascular: diferencias entre grupos étnicos / Fatores de risco cardiovascular: diferenças entre grupos étnicos

ABSTRACT Objectives: to compare the metabolic, anthropometric, tobacco and alcohol consumption indicators considered as risk factors for cardiovascular diseases, as well as the demographic and socioeconomic characteristics between indigenous from Rio Negro, Sateré-Mawé, mixed-race/black and white people living in the city of Manaus. Methods: a cross-sectional observational study guided by the STROBE tool. There was a sample of 191 adults of both sexes. Anthropometric measurements, blood pressure and biochemical analyzes were performed. Statistical test was applied to cross color/race/ethnicity variable with the investigated variables. Results: indigenous had better metabolic and anthropometric indicators related to cardiovascular diseases than mixed-race/black and white, as well as Sateré-Mawé in relation to Rionegrinos (from Rio Negro). Conclusions: the main differences were obesity, dyslipidemia, pre-systemic arterial hypertension/systemic arterial hypertension, and increased circumferences, with a worse situation for mixed-race/black people. The findings indicate differences in risk factors between race/color and ethnicity groups evaluated.

RESUMEN Objetivos: comparar los indicadores metabólicos, antropométricos, de consumo de tabaco y alcohol considerados como factores de riesgo para enfermedades cardiovasculares, así como las características demográficas y socioeconómicas entre los indígenas del Rio Negro, Sateré-Mawé, población de raza mixta/negra y blanca que viven en la ciudad de Manaus. Métodos: estudio observacional transversal, guiado por la herramienta STROBE. La muestra consistió en 191 adultos de ambos sexos. Se realizaron mediciones antropométricas, presión sanguínea y análisis bioquímicos. La prueba estadística se aplicó a la variable de color/raza/etnia con las variables investigadas. Resultados: los indígenas tenían mejores indicadores metabólicos y antropométricos relacionados con las enfermedades cardiovasculares que los de raza mixta/negros y blancos, así como los Sateré-Mawé en relación con los rionegrinos (del Rio Negro). Conclusiones: las principales diferencias fueron: obesidad, dislipidemia, pre-hipertensión arterial sistémica/ hipertensión arterial sistémica y aumento de las circunferencias, con una situación peor para los raza mixta/negros. Los resultados indican diferencias en los factores de riesgo entre los grupos de raza/color y etnia evaluados.

RESUMO Objetivos: comparar os indicadores metabólicos, antropométricos, de consumo de tabaco e álcool, considerados como fatores de risco para doenças cardiovasculares, assim como as características demográficas e socioeconômicas entre indígenas do Rio Negro, Sateré-Mawé, Pardos/Negros e Brancos que residem na cidade de Manaus. Métodos: estudo observacional transversal, norteado pela ferramenta STROBE. Amostra de 191 adultos de ambos os sexos. Realizadas medidas antropométricas, pressão arterial e análises bioquímicas. Aplicado teste estatístico no cruzamento da variável cor/raça/etnia com as variáveis investigadas. Resultados: os indígenas apresentaram melhores indicadores metabólicos e antropométricos relacionados às doenças cardiovasculares que os pardos/negros e brancos, assim como os Sateré-Mawé em relação aos rionegrinos. Conclusões: as principais diferenças foram: obesidade, dislipidemia, pré-hipertensão arterial sistêmica/hipertensão arterial sistêmica e circunferências aumentadas, com destaque de pior situação para os pardos/negros. Os achados indicam haver diferenças nos fatores de risco entre os grupos de raça/cor e etnia avaliados.

Association between statin use and mortality risks during the acute phase of ischemic stroke in patients admitted to an intensive care unit / Associação entre o uso de estatina e risco de mortalidade durante a fase aguda do acidente vascular cerebral isquêmico em pacientes admitidos em uma unidade de terapia intensiva

Abstract Ischemic stroke is a common cause of death. The role of statins in the secondary prevention of the chronic ischemic stroke phase has been established. However, evidence regarding their efficacy in this phase is limited and contradictory. Objective: To evaluate the association between statin use and mortality risk during the acute phase of ischemic stroke in patients admitted to an intensive care unit. Methods: This was an observational and prospective study of ischemic stroke patients aged ≥18, admitted to an intensive care unit. Medications used during the first 7 days after the ictus, as well as medications used previously, were recorded. The primary outcome was all-cause mortality during the first 7 days. Results: We screened 212 patients and included 97 patients with ischemic stroke in the study period. The mortality rate among patients who used statins during the acute IS phase [14% (9/63)] was significantly lower than that among patients who did not use statins [41% (14/34); p=0.007]. This was confirmed in logistical regression with an 0.19 Odds Ratio - OR [p=0.018; 95% confidence interval - 95%CI 0.05-0.75]. Patients who died were older, had a higher incidence of acute myocardial infarction, higher scores on the NIHSS and lower systolic blood pressure. Statins and angiotensin converting enzyme inhibitors were used more frequently among survivors. These associations persisted even after adjustment for confounding variables. Conclusion: Statins and angiotensin converting enzyme inhibitors use during hospitalization were independently associated to a lower rate of all-cause mortality in the first 7 days of intensive care unit admission.

Resumo O acidente vascular cerebral (AVC) isquêmico é uma causa comum de morte. O papel das estatinas na prevenção secundária da fase crônica do AVC isquêmico foi estabelecido. No entanto, as evidências sobre a sua eficácia na fase aguda do AVC isquêmico são limitadas e contraditórias. Objetivo: Avaliar a associação entre o uso de estatinas e o risco de mortalidade durante a fase aguda do AVC isquêmico em pacientes internados em uma unidade de terapia intensiva. Métodos: Estudo observacional e prospectivo de pacientes com AVC isquêmico com idade ≥18 anos, internados em uma unidade de terapia intensiva. Os medicamentos utilizados durante os primeiros 7 dias após o ictus, bem como os medicamentos utilizados anteriormente, foram registrados. O desfecho primário foi mortalidade por todas as causas durante os primeiros 7 dias. Resultados: Foram selecionados 212 pacientes e incluídos 97 pacientes com AVC isquêmico no período do estudo. A taxa de mortalidade entre os pacientes que usaram estatinas durante a fase aguda do AVC [14% (9/63)] foi significativamente menor do que a dos pacientes que não usaram estatinas [41% (14/34); p=0,007]. Isso foi confirmado na regressão logística com Odds Ratio - OR 0,19 [p=0,018; intervalo de confiança de 95% - IC95% 0,05-0,75]. Os pacientes que morreram eram mais velhos, apresentavam maior incidência de infarto agudo do miocárdio, escores mais altos na National Institute of Health Stroke Scale (NIHSS) e menor pressão arterial sistólica. Estatinas e inibidores da enzima conversora de angiotensina foram utilizados com maior frequência entre os sobreviventes. Essas associações persistiram mesmo após o ajuste para variáveis de confundimento. Conclusão: O uso de estatinas e inibidores da enzima conversora de angiotensina durante a hospitalização foram associados de forma independente à uma menor taxa de mortalidade por todas as causas nos primeiros 7 dias de internação na unidade de terapia intensiva.

Left ventricular mass behaviour in hemodialysis patients during 17 years.

INTRODUCTION: Ventricular hypertrophy is frequent in dialysis patients and is associated with an ominous prognosis. It is not knowledge if this ventricular change is growing or decreasing in hemodialysis patients. OBJECTIVE: To assess left ventricular hypertrophy behaviour during 17 years in patients of a university dialysis center, as well as to verify the possible causes of this behavior. METHODS: There was performed a retrospective longitudinal study that evaluated the echocardiographic left ventricular mass in hemodialysis patients in our dialysis facility over 17 years. Examinations of 250 patients aged 18 years or more who underwent routine echocardiography were included. RESULTS: There was a progressive reduction of ventricular mass over studied period. This reduction was associated with blood pressure reduction. In multivariate analysis, ventricular mass was associated with blood pressure and hemoglobin. CONCLUSION: Left ventricular hypertrophy underwent significant reduction over 17 years in our hemodialysis patients. The factors associated with this reduction that could be identified in the current study were the progressive reduction of blood pressure and hemoglobin increase.

Aquatic exercise is as effective as dry land training to blood pressure reduction in postmenopausal hypertensive women.

BACKGROUND AND PURPOSE: The evidence of the benefits from regular physical activity to hypertensives is based on dry land training studies. Therefore, the aim of this study is to compare the effect of aquatic exercise with dry land training on hypertensive women. METHODS: This is a randomized controlled study with 52 post-menopausal hypertensive women. The patients were randomly allocated in three groups: water aerobic training group (n = 19), dry land aerobic training group (n = 19) and a non-intervention control group (n = 14). The training protocol was performed by 12 weeks. RESULTS: There were no differences among the three groups concerning basal blood pressure (BP) and biochemical variables. In water group, there was a statistically significant reduction of systolic BP from 136 ± 16 mm Hg at zero week to 124 ± 18 mm Hg at 11th week and 124 ± 15 mm Hg at 12th week. In dry land training group, there was a statistically significant reduction of systolic BP from 138 ± 15 mm Hg at zero week to 125 ± 10 mm Hg at 7th week, 127 ± 10 mm Hg at 10th week and 126 ± 9 mm Hg at 12th week. The control group presented no change in any of the assessed variables. No changes were carried out in any antihypertensive medications during study. DISCUSSION: This is a randomized controlled study that demonstrates the antihypertensive efficacy of aerobic aquatic exercise.

Effect of renal revascularization on the development of renal dysfunction in atherosclerotic ischemic nephropathy.

Chronic kidney disease (CKD) is characterized by a progressive loss of renal function and its main causes are hypertension and diabetes mellitus. Among the causes of hypertension is atherosclerotic renal disease (ARD). The development of CKD in patients with ARD appears to be due not only to the involvement of the main renal arteries, but also of the renal microcirculation, which may explain the fact that the success of the procedure does not guarantee an improvement in the progression of CKD. To date there is no evidence of benefit of angioplasty compared to medical treatment alone in patients with ARD. The present paper analyzes the most significant studies on renal outcomes in patients with ARD undergoing revascularization or medical treatment alone.

Association between blood pressure and acute phase stroke case fatality rate: a prospective cohort study / Associação entre níveis de pressão arterial e letalidade na fase aguda do acidente vascular cerebral: estudo de coorte prospectivo

ABSTRACT Objective ed to investigate the association between blood pressure and acute phase stroke lethality in a Brazilian intensive care unit. Methods This was an observational, prospective cohort study of hemorrhagic and ischemic stroke intensive care patients. The primary outcome was all-cause mortality during the first seven days. Results There were 146 patients, aged 66 ± 13.4 years, 56% men, 89% Caucasian, 69% had ischemic stroke, and 80% were hypertensive. The median of the National Institutes of Health Stroke Scale score was 16. There were 101 ischemic stroke patients and 45 hemorrhagic stroke patients. In the ischemic stroke patients, logistic regression analysis identified low systolic blood pressure as an independent ominous prognostic factor and the optimal cut off was a mean of systolic blood pressure ≤ 131 mmHg during the first 48 hours from admission for prediction of death. No association was found for hemorrhagic stroke. Conclusions There was a negative association between systolic blood pressure and case fatality ratio of acute phase stroke in ischemic stroke intensive care patients.

RESUMO Objetivo Investigar a associação entre pressão arterial e letalidade do acidente vascular cerebral (AVC) em uma unidade de terapia intensiva brasileira. Métodos estudo de coorte prospectivo de pacientes com AVC hemorrágico (AVC-H) ou isquêmico (AVC-I) internados em terapia intensiva. O desfecho primário foi a letalidade por todas as causas nos primeiros sete dias. Resultados Avaliados 146 pacientes, idade: 66 ± 13,4 anos, 56% homens, 89% brancos, 69% AVC-I e 80% hipertensos. A mediana do NIH foi de 16. Os pacientes com AVC-I foram 101 e 45 com AVC-H. Para AVC-I, a análise de regressão logística identificou baixa pressão arterial sistólica como um fator prognóstico negativo e o melhor corte foi uma média da pressão arterial sistólica nas primeiras 48 h de admissão ≤ 131 mmHg para a predição da morte. Para o AVC-H, nenhuma correlação foi encontrada. Conclusões houve associação negativa entre a pressão arterial sistólica e a letalidade do AVC-I em fase aguda em pacientes de terapia intensiva.

Causes of resistant hypertension detected by a standardized algorithm.

Resistant hypertension (RH) is characterized by blood pressure above 140 × 90 mm Hg, despite the use, in appropriate doses, of three antihypertensive drug classes, including a diuretic, or the need of four classes to control blood pressure. Resistant hypertension patients are under a greater risk of presenting secondary causes of hypertension and may be benefited by therapeutical approach for this diagnosis. However, the RH is currently little studied, and more knowledge of this clinical condition is necessary. In addition, few studies had evaluated this issue in emergent countries. Therefore, we proposed the analysis of specific causes of RH by using a standardized protocol in Brazilian patients diagnosed in a center for the evaluation and treatment of hypertension. The management of these patients was conducted with the application of a preformulated protocol which aimed at the identification of the causes of resistant hypertension in each patient through management standardization. The data obtained suggest that among patients with resistant hypertension there is a higher prevalence of secondary hypertension, than that observed in general hypertensive ones and a higher prevalence of sleep apnea as well. But there are a predominance of obesity, noncompliance with diet, and frequent use of hypertensive drugs. These latter factors are likely approachable at primary level health care, since that detailed anamneses directed to the causes of resistant hypertension are applied.

Accuracy of chest radiography plus electrocardiogram in diagnosis of hypertrophy in hypertension.

BACKGROUND: Chest radiography and electrocardiogram have been criticized due to their low sensitivity for Left Ventricular Hypertrophy diagnosis compared to echocardiogram. This one, however, is not available in primary health care centers to all hypertensive population. OBJECTIVE: To evaluate whether the association chest radiography-electrocardiogram provides the accuracy to justify its use in left ventricular hypertrophy detection in hypertensive patients, as well as the usefulness of the cardiothoracic ratio and oblique radiographs in relation to frontal and lateral views in evaluating dimensions of left cardiac chambers. METHODS: This was a prospective study including 177 consecutive hypertensive patients through chest radiography, electrocardiogram and echocardiography. Accuracy test was used to compare these methods using echocardiography as gold standard. RESULTS: The cardiothoracic ratio showed 17% sensitivity for detection of left ventricular hypertrophy, only indicating cardiac alterations at an advanced stage. Frontal plus lateral views showed sensitivity of 52%, which rose to 54% when chest radiography was associated with electrocardiogram. The oblique views did not significantly improve chest radiography accuracy. Chest radiography presented high specificity and elevated sensitivity for detection of aortal enlargement. Interestingly, this alteration was present in half of the hypertensive patients with left ventricular hypertrophy. CONCLUSION: We conclude that the association chest radiography-electrocardiogram is useful for the screening of hypertensive patients for the diagnosis of left ventricular hypertrophy, especially if echocardiogram is unavailable.