Acute effects of high-intensity resistance training on central blood pressure parameters of elderly hypertensive women: a crossover clinical trial.

OBJECTIVE: Assess the acute effects of a high-intensity resistance training session on central blood pressure (CBP) parameters of elderly hypertensive women. METHODS: Forty physically active hypertensive women were included in resistance training and control protocols. Resistance training exercises were bench press, leg press and lat pull-down. The resistance training protocol consisted of three sets of 10 repetitions to volitional failure with 90 s of rest between sets. No exercise was performed in the control protocol. CBP parameters were measured in four moments: before (PRE), immediately after (T0), 30 min (T30) and 60 min (T60) following both protocols. RESULTS: Resistance training significantly increased central SBP (cSBP) 107.4 ±â€Š16.3 vs. 117.5 ±â€Š16.7), augmentation index ((24.9 ±â€Š12.7 vs. 33.1 ±â€Š12.0), pulse wave velocity (PWV 9.7 ±â€Š1.0 vs. 10.3 ±â€Š1.1), peripheral pulse pressure (pPP 48.5 ±â€Š11.7 vs. 58.9 ±â€Š13.1), central pulse pressure (cPP 38.3 ±â€Š11.6 vs. 46.5 ±â€Š13.1) and amplified pulse pressure (ampPP 10.2 ±â€Š4.2 vs. 12.4 ±â€Š5.6) immediately after exercises. The comparison between groups showed higher values of cSBP (117.5 ±â€Š16.7 vs. 106.3 ±â€Š14.6), augmentation index (20.9 ±â€Š11.0 vs. 33.1 ±â€Š12.0), pPP (46.6 ±â€Š11.0 vs. 58.9 ±â€Š13.1) and cPP (36 ±â€Š10.2 vs. 46.5 ±â€Š13.1) at T0. After 30 min, all variables returned to the baseline values. CONCLUSION: High-intensity resistance training session increased CBP parameters immediately after exercises, but those changes were not sustained after 30 min.

Use of low volume, high effort resistance training to manage blood pressure in hypertensive patients inside a public hospital: a proof of concept study.

Physical exercise has been shown to have an important role in the prevention and treatment of arterial hypertension. However, the general exercise recommendations are time consuming, which might be detrimental to exercise adoption. Based on this, minimal doses of exercise have been suggested as an alternative approach and this report investigates the feasibility and effects of low volume and high effort resistance training for hypertensive patients in a hospital setting. This is a pilot non-randomized prospective study where 15 sedentary hypertensive patients (11 women and 4 men) performed 24 resistance training sessions over 12 weeks at a public hospital. The resistance training sessions consisted of two sets of four exercises, with a rest interval of two minutes between sets. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured 10 minutes before and 10 minutes after each training. No injuries or intercurrence were reported during the study. SBP decreased significantly when compared the first and last sessions, when the measures were performed at rest (152 ± 16 mmHg vs. 122 ± 9 mmHg vs, p<0.05), and after (137 ± 13 mmHg vs. 115 ± 5 mmHg, p<0.05) the resistance training session. Similarly, DBP also decreased significantly when the values from the last session were compared with the first session, when measured at rest (83 ± 14 mmHg vs 73 ± 9 mmHg, p<0.05). Low volume and high effort resistance training seems to be a feasible non-pharmacological strategy to help controlling blood pressure in hypertensive patients within a hospital.

Carotid Intima and Media Thickness Correlation with Central Blood Pressure Measurements by Tonometric and Oscillometric Methods: A Proof of Concept

Abstract Background The early detection of vascular damage in subclinical stages of hypertensive disease may be the key point in the prevention of cardiovascular outcomes. Objectives to correlate parameters of structural vascular damage (measurement of the carotid intima-media thickness) with parameters of functional vascular damage (central hemodynamic measurements) in pre-hypertensive and hypertensive patients taking up to two classes of anti-hypertensive drugs. Methods This was a cross-sectional descriptive study conducted with a convenience sample of patients attending the Liga de Hipertensão Arterial , a multidisciplinary program for the diagnosis and treatment of systemic hypertension, of the Federal university of Goias. Patients with arrythmia, diabetes, previous cardiovascular or cerebrovascular diseases, and end-stage diseases were excluded. Carotid Doppler test, measurements of peripheral and central blood pressure by applanation tonometry (Sphygmocor®) and oscillometry (Mobil-O-Graph®) were performed. The t-test was used for comparisons and the Pearson correlation test for correlations, considering a p<0.05 statistically significant. Results twenty patients (12 women) were evaluated, mean age 53.8 ± 14.3 years. Higher values of central pulse pressure (42.9±13.9 vs. 34.7±9.6, p=0.01) and pulse wave velocity (PWV) (9.0±1.9 vs. 7.9±1.5, p=0.01) were obtained by applanation tonometry compared with oscillometry. No difference between the methods was observed for the other measures. A significant correlation was found between carotid artery intima-media thickness (CA-IMT) and PWV (r=0.659; p=0.002) by the oscillometric test, but not with applanation tonometry. No correlation was found between central hemodynamic variables and the presence of carotid artery plaques. Conclusion PWV, estimated by oscillometry, was the only central hemodynamic parameter that correlated significantly with CA-IMT in pre-hypertensive and hypertensive patients at low cardiovascular risk. International Journal of Cardiovascular Sciences. 2020; [online].ahead print, PP.0-0

Physical inactivity during leisure and school time is associated with the presence of common mental disorders in adolescence.

OBJECTIVE: To investigate the association of physical inactivity in leisure and school time with common mental disorders during adolescence. METHODS: The sample consisted of 73,399 adolescents (12-17 years old), participants in the Estudo de Riscos Cardiovasculares em Adolescentes (Erica - Study of Cardiovascular Risks in Adolescents). This cross-sectional, national and school-based study was conducted in 2013 and 2014 in Brazilian municipalities with more than 100,000 inhabitants. Leisure time physical activity was categorized according to weekly practice volume, and adolescents were classified as active (≥ 300 minutes/week), inactive (0 minute/week) and insufficiently active (1-299 minutes/week). Sports practice and participation in physical education classes at school were also analyzed. The presence of common mental disorders was assessed based on the general health questionnaire, with a cutoff point greater than or equal to 3. Odds ratios (OR) were estimated using multiple logistic regression. RESULTS: The chance of common mental disorders was 16% higher in the group that reported being inactive (0 minute/week) at leisure time (OR = 1.16; 95%CI 1.06 (1.27). The prevalence of common mental disorders was higher among young people who did not practice sports (37.2% vs. 25.9%; OR = 1.14; 95%CI 1.04-1.25) and did not participate in physical education classes at school (39.5% vs. 29.6%; OR = 1.25; 95%CI 1.15-1.36). Insufficient physical activity (1-299 minutes/week) did not increase the OR of common mental disorders. Practicing physical activity during leisure time, regardless of duration and weekly frequency, reduced the chances of common mental disorders in this population by 26%. CONCLUSIONS: Physical inactivity during leisure and school time is associated with the presence of common mental disorders in adolescence. The results suggest that sports practice, school physical education and physical activity during leisure time, even without reaching the current recommendation, are related to the mental health of young people.

Blood pressure reference values for Brazilian adolescents: data from the Study of Cardiovascular Risk in Adolescents (ERICA Study) / Valores de referência para pressão arterial em adolescentes brasileiros: dados do Estudo dos Riscos Cardiovasculares em Adolescentes (Estudo ERICA)

Abstract Objective: Blood pressure (BP) references for Brazilian adolescents are lacking in the literature. This study aims to investigate the normal range of office BP in a healthy, non-overweight Brazilian population of adolescents. Method: The Brazilian Study of Cardiovascular Risks in Adolescents (Portuguese acronym "ERICA") is a national school-based study that included adolescents (aged 12 through 17 years), enrolled in public and private schools, in cities with over 100,000 inhabitants, from all five Brazilian macro-regions. Adolescents' height and body mass index (BMI) were classified in percentiles according to age and gender, and reference curves from the World Health Organization were adopted. Three consecutive office BP measurements were taken with a validated oscillometric device using the appropriate cuff size. The mean values of the last two readings were used for analysis. Polynomial regression models relating BP, age, and height were applied. Results: Among 73,999 adolescents, non-overweight individuals represented 74.5% (95% CI: 73.3-75.6) of the total, with similar distribution across ages. The majority of the non-overweight sample was from public schools 84.2% (95% CI: 79.9-87.7) and sedentary 54.8% (95% CI: 53.7-55.8). Adolescents reporting their skin color as brown (48.8% [95% CI: 47.4-50.1]) or white (37.8% [95% CI: 36.1-39.5]) were most frequently represented. BP increased by both age and height percentile. Systolic BP growth patterns were more marked in males when compared to females, along all height percentiles. The same pattern was not observed for diastolic BP. Conclusions: Blood pressure references by sex, age, and height percentiles for Brazilian adolescents are provided.

Resumo Objetivo Referências de pressão arterial (PA) para adolescentes brasileiros estão ausentes na literatura. Este estudo tem como objetivo investigar a variação normal da pressão arterial no consultório em uma população brasileira saudável de adolescentes sem sobrepeso. Método O Estudo dos Riscos Cardiovasculares em Adolescentes (ERICA) é um estudo brasileiro, de âmbito nacional e de base escolar, que incluiu adolescentes (12 a 17 anos) matriculados em escolas públicas e privadas, em cidades com mais de 100.000 habitantes, de todas as cinco macrorregiões brasileiras. A altura e o índice de massa corporal (IMC) dos adolescentes foram classificados em percentis de acordo com a idade e o sexo, sendo adotadas as curvas de referência da Organização Mundial de Saúde. Foram realizadas três medidas consecutivas de PA no consultório com um dispositivo oscilométrico validado, utilizando o manguito de tamanho apropriado. Os valores médios das duas últimas leituras foram utilizados nas análises. Modelos de regressão polinomial relacionando PA, idade e estatura foram aplicados. Resultados Entre os 73.999 adolescentes, os indivíduos sem sobrepeso representaram 74,5% (IC95%: 73,3-75,6) do total, com distribuição similar entre as idades. A maior parte da amostra sem sobrepeso originava-se das escolas públicas, com 84,2% (IC95%: 79,9-87,7), e os sedentários 54,8% (IC95%: 53,7-55,8). Os adolescentes que relataram sua cor de pele como parda (48,8% [IC95%: 47,4-50,1]) e branca (37,8%: [IC 95% 36,1-39,5]) foram os mais representados. A PA aumentou tanto com a idade, quanto com o percentil de altura. Os padrões de aumento sistólico da PA foram mais acentuados no sexo masculino quando comparados ao sexo feminino, em todos os percentis de altura. O mesmo padrão não foi observado para a PA diastólica. Conclusões São fornecidas referências de pressão arterial por sexo, idade e percentil de altura para adolescentes brasileiros.

Posicionamento Luso-Brasileiro de Emergências Hipertensivas ­ 2020 / Luso-Brazilian Position Statement on Hypertensive Emergencies - 2020

A emergência hipertensiva (EH) está integrada em um quadro nosológico mais geral denominado crise hipertensiva (CH). A CH representa situações clínicas que cursam com elevação aguda da pressão arterial (PA), geralmente níveis de PA sistólica (PAS) ≥ 180 mmHg e diastólica (PAD) ≥ 120 mmHg, que podem resultar ou não em lesões de órgãos-alvo (LOA) (coração, cérebro, rins e artérias).1-5 A CH pode se apresentar sob duas formas distintas em relação à gravidade e ao prognóstico: a urgência hipertensiva (UH) e a EH. Casos de EH cursam com elevação acentuada da PA associada a LOA e risco imediato de morte, fato que requer redução rápida e gradual dos níveis tensionais em minutos a horas, com monitoramento intensivo e uso de fármacos por via endovenosa (EV).1-5 Ela pode se manifestar como um evento cardiovascular, cerebrovascular, renal ou na gestação, na forma de pré-eclâmpsia ou eclâmpsia. Embora a definição clássica das duas apresentações da CH a descreva com valores acima dos 180/120 mmHg, atualmente o maior consenso se estabelece no conceito de que mais do que os valores é o dano ou o risco iminente de acometimento de órgãos-alvo que distingue a EH da UH. Assim, a UH caracteriza-se por elevações da PA, sem LOA e sem risco de morte iminente, fato que permite redução mais lenta dos níveis de PA em período de 24 a 48 horas. Atualmente, existe uma ampla discussão sobre a real existência do diagnóstico "urgência hipertensiva".6 Muitos preconizam que esta classificação necessita ser atualizada (se não abandonada) e que a maior importância diagnóstica é a observação dos sinais/sintomas e da disfunção aguda dos órgãos-alvo, mais do que no valor da PA. Outros acreditam que o termo correto deveria ser "elevação da PA sem LOA em evolução".5,7 Como visto, embora o nível de PA seja frequentemente muito elevado (≥ 180/120 mmHg), não é isso que define EH, mas o comprometimento dos órgãos-alvo. Portanto, o padrão numérico que define a CH é conceitual e serve como parâmetro de conduta, mas não deve ser usado como critério absoluto. Se a definição de CH hoje está mais universalmente aceita, a epidemiologia e prevalência desta condição são ainda questões de baixo conhecimento da comunidade científica. Na literatura, existem poucos estudos sobre o tema e todos eles com número limitado de participantes. Atualmente, discute-se a hipótese de a não adesão ao tratamento ser um dos fatores mais prevalentes na etiologia da CH, sem especificações quanto à separação entre UH e EH. Nos EUA, nos maiores estudos seriados a incidência de CH é de cerca de 4,8%, sendo 0,8% atribuída às EH.8,9 Outros centros mostram que a CH responde por uma taxa variável de 0,45 a 0,59% de todos os atendimentos de emergência hospitalar e 1,7% das emergências clínicas, sendo a UH mais comum do que a EH.10-12 Acidente vascular cerebral (AVC) isquêmico e edema agudo de pulmão (EAP) são as situações clínicas mais encontradas nas EH.10,11 Estima-se que cerca de 1% dos indivíduos hipertensos possa vir a apresentar uma CH ao longo da sua vida.1,2 As situações clínicas envolvidas em uma EH, de acordo com as LOA, são mostradas na Tabela 1. A Tabela 2 mostra as principais situações relacionadas à UH.

Blood pressure reference values for Brazilian adolescents: data from the Study of Cardiovascular Risk in Adolescents (ERICA Study).

OBJECTIVE: Blood pressure (BP) references for Brazilian adolescents are lacking in the literature. This study aims to investigate the normal range of office BP in a healthy, non-overweight Brazilian population of adolescents. METHOD: The Brazilian Study of Cardiovascular Risks in Adolescents (Portuguese acronym "ERICA") is a national school-based study that included adolescents (aged 12 through 17 years), enrolled in public and private schools, in cities with over 100,000 inhabitants, from all five Brazilian macro-regions. Adolescents' height and body mass index (BMI) were classified in percentiles according to age and gender, and reference curves from the World Health Organization were adopted. Three consecutive office BP measurements were taken with a validated oscillometric device using the appropriate cuff size. The mean values of the last two readings were used for analysis. Polynomial regression models relating BP, age, and height were applied. RESULTS: Among 73,999 adolescents, non-overweight individuals represented 74.5% (95% CI: 73.3-75.6) of the total, with similar distribution across ages. The majority of the non-overweight sample was from public schools 84.2% (95% CI: 79.9-87.7) and sedentary 54.8% (95% CI: 53.7-55.8). Adolescents reporting their skin color as brown (48.8% [95% CI: 47.4-50.1]) or white (37.8% [95% CI: 36.1-39.5]) were most frequently represented. BP increased by both age and height percentile. Systolic BP growth patterns were more marked in males when compared to females, along all height percentiles. The same pattern was not observed for diastolic BP. CONCLUSIONS: Blood pressure references by sex, age, and height percentiles for Brazilian adolescents are provided.

Physical inactivity during leisure and school time is associated with the presence of common mental disorders in adolescence / Inatividade física no lazer e na escola está associada à presença de transtornos mentais comuns na adolescência

ABSTRACT OBJECTIVE: To investigate the association of physical inactivity in leisure and school time with common mental disorders during adolescence. METHODS: The sample consisted of 73,399 adolescents (12-17 years old), participants in the Estudo de Riscos Cardiovasculares em Adolescentes (Erica — Study of Cardiovascular Risks in Adolescents). This cross-sectional, national and school-based study was conducted in 2013 and 2014 in Brazilian municipalities with more than 100,000 inhabitants. Leisure time physical activity was categorized according to weekly practice volume, and adolescents were classified as active (≥ 300 minutes/week), inactive (0 minute/week) and insufficiently active (1-299 minutes/week). Sports practice and participation in physical education classes at school were also analyzed. The presence of common mental disorders was assessed based on the general health questionnaire, with a cutoff point greater than or equal to 3. Odds ratios (OR) were estimated using multiple logistic regression. RESULTS: The chance of common mental disorders was 16% higher in the group that reported being inactive (0 minute/week) at leisure time (OR = 1.16; 95%CI 1.06 (1.27). The prevalence of common mental disorders was higher among young people who did not practice sports (37.2% vs. 25.9%; OR = 1.14; 95%CI 1.04-1.25) and did not participate in physical education classes at school (39.5% vs. 29.6%; OR = 1.25; 95%CI 1.15-1.36). Insufficient physical activity (1-299 minutes/week) did not increase the OR of common mental disorders. Practicing physical activity during leisure time, regardless of duration and weekly frequency, reduced the chances of common mental disorders in this population by 26%. CONCLUSIONS: Physical inactivity during leisure and school time is associated with the presence of common mental disorders in adolescence. The results suggest that sports practice, school physical education and physical activity during leisure time, even without reaching the current recommendation, are related to the mental health of young people.

RESUMO OBJETIVO: Investigar a associação da inatividade física no lazer e na escola com os transtornos mentais comuns durante a adolescência. MÉTODOS: A amostra foi composta por 73.399 adolescentes (12-17 anos), participantes do Estudo de Riscos Cardiovasculares em Adolescentes (Erica). Esse estudo transversal, nacional e de base escolar foi realizado em 2013 e 2014, nos municípios brasileiros com mais de 100 mil habitantes. A atividade física no lazer foi categorizada de acordo com o volume de prática semanal, e os adolescentes foram classificados em ativos (≥ 300 minutos/semana), inativos (0 minuto/semana) e insuficientemente ativos (1-299 minutos/semana). A prática esportiva e a participação em aulas de educação física na escola também foram analisadas. A presença de transtornos mentais comuns foi avaliada a partir do general health questionnaire, com ponto de corte maior ou igual a 3. Odds ratios (OR) foram estimados utilizando regressão logística múltipla. RESULTADOS: A chance de transtornos mentais comuns foi 16% maior no grupo que relatou ser inativo (0 minuto/semana) no lazer (OR = 1,16; IC95% 1,06-1,27). A prevalência de transtornos mentais comuns foi maior entre jovens que não praticaram esportes (37,2% vs. 25,9%; OR = 1,14; IC95% 1,04-1,25) e não participaram das aulas de educação física na escola (39,5% vs. 29,6%; OR = 1,25; IC95% 1,15-1,36). Atividade física insuficiente (1-299 minutos/semana) não aumentou a razão de chances de transtornos mentais comuns. Praticar atividade física no lazer, independentemente da duração e frequência semanal, reduziu em 26% as chances de transtornos mentais comuns nessa população. CONCLUSÕES: A inatividade física no lazer e na escola foi associada à presença de transtornos mentais comuns na adolescência. Os resultados sugerem que prática esportiva, educação física escolar e atividade física durante o lazer, mesmo sem atingir a recomendação atual, têm relação com a saúde mental dos jovens.

Smoking, alcohol consumption and mental health: Data from the Brazilian study of Cardiovascular Risks in Adolescents (ERICA).

INTRODUCTION: Previous researches have indicated a strong association of alcohol and tobacco use with psychiatric disorders, but the relationship with depression and anxiety symptoms is still uncertain. We investigated the association of psychological distress and alcohol consumption, tobacco use and exposure to secondhand smoke (SHS) among adolescents in a developing country. METHODS: The authors evaluated 73,399 individuals (12-17 years) who participated in the Cardiovascular Risks Study in Adolescents (ERICA), a cross-sectional, national and school-based study, carried out in 124 Brazilian municipalities. The variables considered were alcoholic beverages (experimentation, consumption in the previous month and frequency of use) and smoking (experimentation, current smoking habits, frequent smoking and SHS exposure). Psychological distress was defined as a score ≥ 3 points in GHQ-12. Analyses included multiple logistic regression modeling. RESULTS: The frequency of individuals with psychological distress was higher in the group who smoked for at least 7 consecutive days (53.3% vs 31.2%; OR: 2.17; 95%CI: 1.65-2.86), were exposed to SHS indoors (37.8% vs 29.8%; OR:1.30; 95%CI: 1.14-1.48), and outdoors (37.7% vs 26.6%; OR: 1.49; 95%CI: 1.28-1.74), and among young people who consumed at least 1 drink of alcohol in the previous 30 days (42.4% vs 28.6%; OR: 1.70; 95%CI: 1.46-1.97), when compared to adolescents not exposed. CONCLUSIONS: Smoking (passively and actively) and the consumption of alcoholic beverages are associated to psychological distress in the adolescent population. Avoiding smoking and the use of alcohol may have beneficial effects on the mental health. Our data reinforce the urgent necessity to prevent effectively underage access to legal drugs in Brazil.

Hormonal assessment of participants in a long distance walk.

BACKGROUND: Exercise can disrupt homeostasis and trigger many adaptive responses in different hormonal axes. The study of hormonal interactions with physical activity is highly complex due to the number of variables, such as exercise duration, exercise intensity, individual level of training, circadian rhythm, nutritional status, and environmental conditions. METHODS: This study was performed to assess daily variations of thyroid hormones, cortisol, testosterone, insulin and glucose during moderate to high intensity aerobic physical activity for 5 consecutive days. Sample collection was performed at baseline in the morning and in the evening, immediately after finishing the activity, on the 4 initial days of the activity. Statistical analysis was performed using software STATA V14. Continuous variables are presented as means and standard deviations, while categorical variables are presented as absolute and percentage values. We used Shapiro-Wilk, Wilcoxon Sign, Mann-Whitney and Student's T test, according the needs. RESULTS: The adrenocorticotropic axis showed an initial increase in the evening cortisol level compared to the baseline level in the morning (17.46 µg/dL and 15.97 µg/dL, respectively) and then exhibited a significant reduction between the 1st and 4th day of activity (17.46 µg/dL and 8.39 µg/dL, respectively; P = 0.001). The same pattern was observed for free thyroxine (T4) between the 1st and 4th day (1.31 and 1.14, respectively; P < 0.001). CONCLUSIONS: Moderate to intense long duration physical activity resulted in little variation in the hormones assessed, with a trend toward reduced levels of cortisol and free T4. These findings highlight an adaptive hormonal mechanism in response to stress that is repeated daily, as shown by cortisol and thyroid function in our study.

Self-rated health status and illiteracy as death predictors in a Brazilian cohort.

Cohort studies assessing predictive values of self-rated health (SRH) and illiteracy on mortality in low-to-middle income countries are missing in the literature. Aiming to determine if these two variables were death predictors, an observational prospective population-based cohort study was conducted in a Brazilian small city. The cohort was established in 2002 with a representative sample of adults living in the city, and re-assessed in 2015. Sociodemographic (including illiteracy), anthropometric, lifestyle, previous CVD, and SRH data were collected. Cox proportional hazard models were designed to assess SRH and illiteracy in 2002 as death (all causes, CVD and non-CVD) predictors in 2015. From a total of 1066 individuals included in this study, 95(9%) died of non-CVD causes and 53(5%) from CVD causes. Mortality rates were higher among those with worse SRH in comparison to better health status categories for all causes of death, CVD and non-CVD deaths (p<0.001 for all outcomes). Similarly, illiterate individuals had higher mortality rates in comparison to non-illiterate for all causes of death (p<0.001), CVD (p = 0.004) and non-CVD death (p<0.001). Higher SRH negatively predicted CVD death (HR 0.44; 95%CI 0.44-0.95; p = 0.027) and all causes of death (OR 0.40; 95%CI 0.20-0.78; p = 0.008) while illiteracy positively predicted Non-CVD death (OR 1.59; 95%CI 1.03-2.54; p = 0.046). In conclusion, we found in this large Brazilian cohort followed for 13 years that better health perception was a negative predictor of death from all causes and CVD deaths, while illiteracy was a positive predictor of non-CVD deaths.

White-coat, masked and sustained hypertension detected by home blood pressure monitoring in adolescents: prevalence and associated factors.

PURPOSE: Population-based studies estimating prevalence's of white-coat, masked and sustained hypertension in non-European adolescents are needed, particularly in developing countries. Aiming to determine these estimates and, additionally identify factors associated to these conditions this study was conducted. MATERIALS AND METHODS: Cross-sectional study with a representative sample of secondary school students from a Brazilian state capital. Office measurements were performed with validated semi-automatic devices. Home BP (blood pressure) monitoring protocol included two day-time and two evening-time measurements over 6 days. Adolescents' were classified as: normotensives (office and home BP <95th percentile); sustained hypertensives (office and home BP ≥95th percentile); white-coat hypertensives (office BP ≥95th percentile and home BP <95th percentile) and masked hypertensives (office BP <95th percentile and home BP ≥95th percentile). Logistic regression models were built to identify if sex, age, BMI and family history of HTN were independently associated with white-coat, masked and sustained hypertension. RESULTS: In a sample of 1024 adolescents, prevalence of white-coat, masked and sustained hypertension was 7.5%, 2.2% and 1.7%, respectively. Male sex was positively associated with white-coat hypertension (OR 2.68; 95%CI 1.58-4.54; p < 0.001). BMI was positively associated with both white-coat (OR 1.23; 95%CI 1.16-1.30; p < 0.001) and sustained hypertension (OR 1.19; 95%CI 1.11-1.29; p < 0.001). None of the independent variables were associated with masked hypertension in this population. CONCLUSION: The estimated prevalence of white-coat hypertension, masked and sustained hypertension in a population of non-European adolescents assessed by home BP monitoring was 7.5%, 2.2% and 1.7% respectively. Male sex was positively associated with white-coat hypertension in these adolescents while BMI was positively associated with both white-coat and sustained hypertension.

Multidisciplinary treatment of patients with diabetes and hypertension: experience of a Brazilian center.

BACKGROUND: Although multidisciplinary treatment is recommended for type 2 diabetes mellitus and hypertension (HTN), there is a lack of scientific literature supporting the hypothesis of extending this treatment strategy to patients with both diabetes and HTN. Aiming to report results of long-term multidisciplinary treatment for these patients and identify strategies to improve their management, we conducted this study. METHODS: Data of patients with diabetes and HTN with regular follow-up visits in a multidisciplinary HTN treatment center from Brazil's Midwest were retrospectively assessed. Patients ≥ 18 years enrolled in the service by June 2017 with a minimum of three visits were included. Anthropometric, blood pressure (BP), laboratory, pharmacological treatment, lifestyle, and cardiovascular events data were collected from first (V1), intermediate (V2) and most recent (V3) visits to the service. BP < 130 × 80 mmHg, LDL-cholesterol (LDL-C) < 70 mg/dL and HbA1C < 7.0% were defined as treatment targets. Wilcoxon signed-rank test was used to compare variables along study visits. A linear regression model was built to identify variables associated with better overall patient control. RESULTS: A total of 162 patients were included (mean age of 56.5 ± 10.8 years). Median follow-up time was 60 (IQR 40-109) months, 80.2% of the sample was female and 83.3% had no cardiovascular event history. BP, total cholesterol, LDL-C, triglycerides and HbA1C values showed a significant trend to improve along the study visits (p < 0.001). Growing trend in aspirin (p = 0.045) and statins (p < 0.001) use was found, in addition to treatment compliance increase (p < 0.001). Significant improvement trends in BP (p < 0.001), LDL-C (p = 0.004) and HbA1C (p = 0.002) control were also found across visits. Control rates of BP, LDL-C and HbA1C in combination were low in V1, V2 and V3 (1.2, 1.9 and 6.8%, respectively), but showed significant improvement trend (p < 0.001). Treatment compliance (ß-coefficient = 1.20; 95% CI 1.07-1.34; p < 0.001) was positively associated with better overall patients control. CONCLUSIONS: Multidisciplinary treatment of patients with diabetes and HTN significantly improved clinical and laboratory parameters, despite ageing of population evaluated. Although combined control of HbA1C, BP and LDL-cholesterol increased along follow-up, management of all these three conditions needs to improve, and focus on treatment compliance should be given to attain this goal.

Office blood pressure measurements with oscillometric devices in adolescents: a comparison with home blood pressure.

PURPOSE: Compare multiple in office BP measurements in adolescents using an oscillometric device with out-of-office blood pressure measurements (home blood pressure monitoring - HBPM). MATERIALS AND METHODS: Office measurements were performed with validated semi-automatic devices twice (3 minutes interval) in two different moments (1 week apart), with a total of four readings. These BP readings were named R1, R2, R3 and R4 (following the sequence they were performed), FDM (mean of two readings on first day) and SDM (mean of two readings on second day) and SRM (R2-R4 means). The HBPM protocol included two day-time and two evening-time measurements over 6 days. RESULTS: A total of 1024 students between 12 and 17 years were included (mean age 14.68 years; 52.4% females). The mean systolic blood pressure (SBP) values of R2, SDM and SRM were similar to HBPM values. Regarding diastolic blood pressure (DBP) HBPM value was different than R4. High SBP and DBP correlation coefficients with HBPM values were found for R2, SDM and SRM values. CONCLUSION: The second office BP measurement performed with an oscilometric device in adolescents was comparable to HBPM values, suggesting that two office readings might be suitable to rule out hypertension in this age group.

Comparison of Cardiovascular Risk Factors in Different Areas of Health Care Over a 20-Year Period / Comparação entre Fatores de Risco Cardiovascular em Diferentes Áreas da Saúde num Intervalo de Vinte Anos

Background: Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Knowledge about cardiovascular risk factors (CVRFs) in young adults and their modification over time are measures that change the risks and prevent CVDs. Objectives: To determine the presence of CVRFs and their changes in different health care professionals over a period of 20 years. Methods: All students of medicine, nursing, nutrition, odontology, and pharmacy departments of Federal University of Goiás who agreed to participate in this study were evaluated when they started their degree courses and 20 years afterward. Questionnaires on CVRFs [systemic arterial hypertension (SAH), diabetes mellitus, dyslipidemia, and family history of early CVD, smoking, alcohol consumption, and sedentarism] were administered. Cholesterol levels, blood sugar levels, blood pressure, weight, height, and body mass index were determined. The Kolmogorov-Smirnov test was used to evaluate distribution, the chi-square test was used to compare different courses and sexes, and the McNemar test was used for comparing CVRFs. The significance level was set at a p value of < 0.05. Results: The first stage of the study included 281 individuals (91% of all the students), of which 62.9% were women; the mean age was 19.7 years. In the second stage, 215 subjects were reassessed (76% of the initial sample), of which 59.07% were women; the mean age was 39.8 years. The sample mostly consisted of medical students (with a predominance of men), followed by nursing, nutrition, and pharmacy students, with a predominance of women (p < 0.05). Excessive weight gain, SAH, and dyslipidemia were observed among physicians and dentists (p < 0.05). Excessive weight gain and SAH and a reduction in sedentarism (p < 0.05) were observed among pharmacists. Among nurses there was an increase in excessive weight and alcohol consumption (p < 0.05). Finally, nutritionists showed an increase ...

Fundamento: As doenças cardiovasculares (DCVs) são as principais causas de morte no mundo. O conhecimento sobre os fatores de risco cardiovasculares (FRCV) em jovens e suas alterações ao longo do tempo, podem contribuir para ações que modifiquem estes riscos e previnam o aparecimento das DCVs. Objetivos: Verificar, em diferentes profissionais da área da saúde, a presença e alterações nos fatores de risco cardiovasculares (FRCV) num intervalo de vinte anos. Métodos: Avaliados comparativamente ao ingressar na faculdade e vinte anos após, todos os alunos de medicina, enfermagem, nutrição, odontologia e farmácia de uma Universidade Federal que aceitaram participar. Utilizados questionários sobre FRCV (HAS, DM, dislipidemia e história familiar de DCV precoce, tabagismo, etilismo e sedentarismo). Determinados colesterol, glicemia, PA, peso, altura e IMC. Utilizados teste de Kolmogorov-Smirnov para avaliar distribuição, Qui-Quadrado para comparação entre cursos e sexos e McNemar para FRCV. Significante p < 0,05. Resultados: Inicialmente estudados 281 indivíduos (91% do total de alunos), sendo 62,9% mulheres, idade média 19,7 anos e reavaliados 215 (76% da amostra inicial), 59,07% mulheres, idade média 39,8 anos. Maior representatividade por estudantes de medicina, predomínio do sexo masculino entre eles, e predomínio do sexo feminino nos estudantes de enfermagem, nutrição e farmácia (p < 0,05). Entre os médicos e odontólogos houve aumento de excesso de peso, HAS e dislipidemia (p < 0,05). Entre os farmacêuticos, aumento de excesso de peso e HAS e redução do sedentarismo (p < 0,05). Entre os enfermeiros, elevou-se excesso de peso e etilismo (p < 0,05). Na nutrição, houve elevação da dislipidemia (p < 0,05). Conclusão: Encontrada ...

Comparison of cardiovascular risk factors in different areas of health care over a 20-year period.

BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Knowledge about cardiovascular risk factors (CVRFs) in young adults and their modification over time are measures that change the risks and prevent CVDs. OBJECTIVES: To determine the presence of CVRFs and their changes in different health care professionals over a period of 20 years. METHODS: All students of medicine, nursing, nutrition, odontology, and pharmacy departments of Federal University of Goiás who agreed to participate in this study were evaluated when they started their degree courses and 20 years afterward. Questionnaires on CVRFs [systemic arterial hypertension (SAH), diabetes mellitus, dyslipidemia, and family history of early CVD, smoking, alcohol consumption, and sedentarism] were administered. Cholesterol levels, blood sugar levels, blood pressure, weight, height, and body mass index were determined. The Kolmogorov-Smirnov test was used to evaluate distribution, the chi-square test was used to compare different courses and sexes, and the McNemar test was used for comparing CVRFs. The significance level was set at a p value of < 0.05. RESULTS: The first stage of the study included 281 individuals (91% of all the students), of which 62.9% were women; the mean age was 19.7 years. In the second stage, 215 subjects were reassessed (76% of the initial sample), of which 59.07% were women; the mean age was 39.8 years. The sample mostly consisted of medical students (with a predominance of men), followed by nursing, nutrition, and pharmacy students, with a predominance of women (p < 0.05). Excessive weight gain, SAH, and dyslipidemia were observed among physicians and dentists (p < 0.05). Excessive weight gain and SAH and a reduction in sedentarism (p < 0.05) were observed among pharmacists. Among nurses there was an increase in excessive weight and alcohol consumption (p < 0.05). Finally, nutritionists showed an increase in dyslipidemia (p < 0.05). CONCLUSION: In general, there was an unfavorable progression of CVRFs in the population under study, despite it having adequate specialized knowledge about these risk factors.