Economic evaluation of human albumin use in patients with nephrotic syndrome in four Brazilian public hospitals: pharmacoeconomic study.

CONTEXT AND OBJECTIVE:: In 2004, the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária, ANVISA) published a resolution establishing guidelines for albumin use. Although the published data do not indicate any definitive conclusions about the benefits of albumin use in patients with nephrotic syndrome (NS), the guidelines recommend this procedure only in cases of edema that is refractory to use of diuretics. The aim here was to analyze albumin use among patients with nephrotic syndrome. DESIGN AND SETTING:: Pharmacoeconomic study conducted in four large public referral hospitals for nephrology services in northeastern Brazil. METHOD:: Cost-effectiveness and cost-utility economic evaluations were performed on a concurrent cohort of patients with nephrotic syndrome, who were divided into two groups according to compliance or noncompliance with the guidelines. Quality-of-life data were obtained from the SF36 and CHQ-PF50 questionnaires. RESULTS:: This study enrolled 109 patients (60% adults and 56% women); 41.3% were using albumin in accordance with the guidelines. The weight, diuresis and fluid balance parameters were more cost-effective for patients who adhered to the guidelines. Regarding days of hospitalization avoided, the incremental ratio showed a daily cost of R$ 55.33, and guideline-compliant patients were hospitalized for five days or fewer. The quality of life improved by 8%, and savings of R$ 3,458.13/QALY (quality-adjusted life year) for the healthcare system were generated through guideline compliance. CONCLUSION:: The economic analyses of this study demonstrated that there were greater cost benefits for patients whose treatment followed the guidelines.

Economic evaluation of human albumin use in patients with nephrotic syndrome in four Brazilian public hospitals: pharmacoeconomic study / Avaliação econômica do uso de albumina humana em pacientes com síndrome nefrótica em quatro hospitais públicos brasileiros: estudo de farmacoeconomia

ABSTRACT CONTEXT AND OBJECTIVE: In 2004, the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária, ANVISA) published a resolution establishing guidelines for albumin use. Although the published data do not indicate any definitive conclusions about the benefits of albumin use in patients with nephrotic syndrome (NS), the guidelines recommend this procedure only in cases of edema that is refractory to use of diuretics. The aim here was to analyze albumin use among patients with nephrotic syndrome. DESIGN AND SETTING: Pharmacoeconomic study conducted in four large public referral hospitals for nephrology services in northeastern Brazil. METHOD: Cost-effectiveness and cost-utility economic evaluations were performed on a concurrent cohort of patients with nephrotic syndrome, who were divided into two groups according to compliance or noncompliance with the guidelines. Quality-of-life data were obtained from the SF36 and CHQ-PF50 questionnaires. RESULTS: This study enrolled 109 patients (60% adults and 56% women); 41.3% were using albumin in accordance with the guidelines. The weight, diuresis and fluid balance parameters were more cost-effective for patients who adhered to the guidelines. Regarding days of hospitalization avoided, the incremental ratio showed a daily cost of R$ 55.33, and guideline-compliant patients were hospitalized for five days or fewer. The quality of life improved by 8%, and savings of R$ 3,458.13/QALY (quality-adjusted life year) for the healthcare system were generated through guideline compliance. CONCLUSION: The economic analyses of this study demonstrated that there were greater cost benefits for patients whose treatment followed the guidelines.

RESUMO CONTEXTO E OBJETIVO: Em 2004, a Agência Nacional de Vigilância Sanitária (ANVISA) publicou uma resolução que estabelece diretrizes para o uso de albumina. Embora os dados publicados não indiquem conclusões definitivas sobre os benefícios do uso de albumina em pacientes com síndrome nefrótica (SN), a diretriz recomenda o procedimento apenas em casos de edema refratário ao uso de diuréticos. O objetivo aqui foi analisar o uso de albumina em pacientes com síndrome nefrótica. TIPO DE ESTUDO E LOCAL: Estudo farmacoeconômico realizado em quatro grandes hospitais públicos de referência em serviços de nefrologia no nordeste do Brasil. MÉTODO: Foram realizadas avaliações econômicas do tipo custo-efetividade e custo-utilidade em uma coorte concorrente de pacientes com síndrome nefrótica, divididos em dois grupos de acordo com o cumprimento ou descumprimento das diretrizes. Dados de qualidade de vida foram obtidos a partir dos questionários SF36 e CHQ-PF50. RESULTADOS: Este estudo incluiu 109 pacientes (60% adultos e 56% mulheres); 41,3% estavam usando albumina conforme as diretrizes. Os parâmetros de peso, diurese e balanço hídrico foram mais custo-efetivos para pacientes que aderiram às diretrizes. Quanto a dias de internação evitados, a razão incremental mostrou um custo diário de R$ 55,33, sendo que os pacientes que seguiram as diretrizes ficaram cinco dias a menos internados. A qualidade de vida melhorou 8%, gerando economia de R$ 3,458.13/QALY (quality-adjusted life year) para o sistema de saúde por meio do cumprimento das diretrizes. CONCLUSÃO: As análises econômicas deste estudo demonstraram maiores benefícios em termos de custo para os pacientes cujo tratamento seguiu as diretrizes.

[Prevalence of hospital admission due to adverse drug reaction in Salvador, Bahia]. / Prevalência de admissão hospitalar por reação adversa a medicamentos em Salvador, BA.

OBJECTIVE: To determine the prevalence of hospital admissions due to ADR in Salvador, Bahia and their outcomes. METHODS: All patients admitted in four Sentinel Hospital (ANVISA) in Salvador-Ba were evaluated and followed to determine the prevalence of admissions due to ADR and their outcomes from April to December 2007. Cases were validated by 03 algorithms. The drugs were classified by Anatomical-Therapeutic-Chemical Classification, organs and systems affected by the WHO criteria and severity seconds Pearson et al. Type of ADR was analyzed by Rawlins and Thompson. RESULTS: The prevalence of ADR admission was 0.5% and adjusted for exposed was 2.1%, with 316 cases. Average of hospitalization due to ADR was 12.3 days. Younger and older accounted for 28.8% and 31.1% of patients. Females and blacks were 60% of cases. Main pharmacologic groups were antineoplastics, antibiotics and diuretics, affecting skin, gastrointestinal and hematologic systems. Around 70% of the ADR was validated as defined. ADR of type A was 80% and 90% recovered, and one death (0.5%). CONCLUSION: The prevalence of ADR admission was similar to those described in the literature and only one patient died. As this is the first national study will form the basis for future investigations.

Prevalência de admissão hospitalar por reação adversa a medicamentos em Salvador, BA / Prevalence of hospital admission due to adverse drug reaction in Salvador, Bahia

OBJETIVO: Determinar a prevalência de admissão por RAM em hospitais de Salvador-BA e seus desfechos. MÉTODOS: Todos os pacientes admitidos nos quatro hospitais sentinela da Anvisa em Salvador-BA foram avaliados e seguidos para determinar a prevalência de admissão por RAM e seus desfechos de abril a dezembro de 2007. Os casos foram validados por três algorítmos. Os medicamentos foram classificados pelo Anatomical-Therapeutic-Chemical Classification, órgãos e sistemas afetados pelos critérios da OMS e a gravidade segundo Pearson et al. O tipo seguiu critérios de Rawlins e Thompson. RESULTADOS: A prevalência de admissão por RAM foi 0,56 por cento e corrigida (expostos) de 2,1 por cento, com 316 casos. Tempo médio de hospitalização por RAM foi de 12,3 dias. Jovens e idosos representaram 28,8 por cento e 31,1 por cento dos pacientes. Gênero feminino e raça negra corresponderam a 60 por cento dos casos. Os principais grupos farmacológicos envolvidos foram antineoplásicos, antibióticos e diuréticos, afetando pele, sistema gastrointestinal e hematológico. Reações certas ou provadas corresponderam 70 por cento, 80 por cento dos casos foram do tipo A, com 90 por cento recuperáveis e um óbito. CONCLUSÃO: A prevalência de admissão por RAM foi semelhante às descritas na literatura e somente um paciente foi a óbito. Por tratar-se do primeiro estudo nacional, servirá de base para futuras investigações.

OBJECTIVE: To determine the prevalence of hospital admissions due to ADR in Salvador, Bahia and their outcomes. METHODS: All patients admitted in four Sentinel Hospital (ANVISA) in Salvador-Ba were evaluated and followed to determine the prevalence of admissions due to ADR and their outcomes from April to December 2007. Cases were validated by 03 algorithms. The drugs were classified by Anatomical-Therapeutic-Chemical Classification, organs and systems affected by the WHO criteria and severity seconds Pearson et al. Type of ADR was analyzed by Rawlins and Thompson. RESULTS: The prevalence of ADR admission was 0.5 percent and adjusted for exposed was 2.1 percent, with 316 cases. Average of hospitalization due to ADR was 12.3 days. Younger and older accounted for 28.8 percent and 31.1 percent of patients. Females and blacks were 60 percent of cases. Main pharmacologic groups were antineoplastics, antibiotics and diuretics, affecting skin, gastrointestinal and hematologic systems. Around 70 percent of the ADR was validated as defined. ADR of type A was 80 percent and 90 percent recovered, and one death (0.5 percent). CONCLUSION: The prevalence of ADR admission was similar to those described in the literature and only one patient died. As this is the first national study will form the basis for future investigations.

Preditores da adesão ao tratamento em pacientes com asma grave atendidos em um centro de referência na Bahia / Predictors of adherence to treatment in patients with severe asthma treated at a referral center in Bahia, Brazil

OBJETIVO: Determinar a taxa de adesão ao tratamento padrão com corticóide inalatório em pacientes com asma grave, identificar seus fatores preditores e avaliar a relação entre adesão ao tratamento e os parâmetros de resposta clínica e funcional. MÉTODOS: Coorte prospectiva de pacientes atendidos no Programa de Controle da Asma e da Rinite Alérgica na Bahia, Brasil. O estudo incluiu 160 pacientes com asma grave, acompanhados por um período de 180 dias para medida da adesão (variável dependente) ao corticóide inalatório prescrito. As variáveis independentes foram determinadas na avaliação inicial e durante seis meses através de entrevistas e aplicação de questionário estruturado. Os pacientes registraram em um diário as doses não utilizadas. RESULTADOS: Do total de 160 pacientes, 158 completaram o estudo. A taxa de adesão ao tratamento foi de 83,8 por cento. Dos 158 pacientes, 112 (70,9 por cento) foram considerados aderentes ao tratamento (ponto de corte: 80 por cento de todas as doses administradas). Houve associação significante entre o controle da asma e adesão ao tratamento. Os fatores relacionados a uma baixa adesão foram efeitos adversos, local de residência distante do centro de referência, dificuldade de pagar pelo transporte e regime posológico. Outros fatores, como sintomas depressivos, religião e classe econômica, não tiveram relação com a adesão. CONCLUSÕES: A adesão ao tratamento foi considerada elevada, havendo relação com a resposta clínica ao tratamento em uma amostra de pacientes com asma grave atendidos em um programa público com fornecimento gratuito de medicamentos e atendimento multidisciplinar em unidade de referência.

OBJECTIVE: To determine the rate of adherence to treatment with inhaled corticosteroids in patients with severe asthma, to identify predictive factors for adherence and to evaluate the relationship between adherence to treatment and parameters of clinical and functional response. METHODS: Prospective cohort study of patients enrolled in the Program for the Control of Asthma and Allergic Rhinitis in the state of Bahia, Brazil. The study comprised 160 patients with severe asthma, monitored for 180 days in order to evaluate adherence (dependent variable) to the prescribed inhaled corticosteroid. Independent variables were assessed at baseline and for a six-month follow-up period by means of interviews and the completion of a standardized questionnaire.Patients recorded the missed doses in a diary. RESULTS: Of the 160 patients. 158 completed the study. Adherence rate was 83.8 percent. Of the 158 patients, 112 (70.9 percent) were considered adherent (cut-off point: 80 percent of prescribed doses administered). There was a significant association between asthma control and adherence to treatment.Predictors of poor adherence were adverse effects, living far from the referral center, limited resources to pay for transportation and dose schedule. Other factors, such as depressive symptoms, religion and economic status, were not associated with poor adherence. CONCLUSIONS: Adherence to asthma treatment was high and was associated with the clinical response to treatment, in a sample of patients with severe asthma enrolled in a public program that provides free medication and the assistance of a multiprofessional specialized team in a referral center

Análise da prescrição de captopril em pacientes hospitalizados / Analysis of the prescription of captopril to hospitalized patients

Uma das complicações mais comuns da hipertensão arterial sistêmica é a crise hipertensiva¹ que se caracteriza por uma elevação sintomática da pressão arterial (PA), com ou sem envolvimento de órgãos-alvo, que pode conduzir a um risco imediato ou potencial de vida2-4. A crise hipertensiva pode se manifestar como emergência ou urgência hipertensiva. Na emergência, há a rápida deterioração de órgãos-alvo e risco imediato de vida, situação que não ocorre na urgência hipertensiva2-4. Além disso, as situações em que o paciente apresenta PA elevada diante de algum evento emocional, doloroso ou desconfortável, sem evidências de lesões de órgãos-alvo ou risco imediato de vida, caracterizam a pseudocrise hipertensiva, condição em que não é necessário o uso da terapia anti-hipertensiva de emergência1-3,5. Apesar disso, tem se tornado comum a prática de prescrever anti-hipertensivos precedendo situações em que se identifica algum risco de elevação abrupta da PA, independentemente de sintomas. O presente estudo tem como objetivo avaliar a freqüência de prescrição do captopril precedendo elevação da PA em pacientes internados em um hospital universitário. Pretende também mapear os locais (enfermarias clínicas ou cirúrgicas) onde essa conduta foi mais freqüente.

One of the most common complications of Systemic Arterial Hypertension is the hypertensive crisis¹ characterized by a symptomatic elevation of blood pressure (BP) with or without involvement of target organs, which may lead to immediate or potential risk to life2-4. The hypertensive crisis may manifest itself as hypertensive emergency or urgency. In the emergency there is fast deterioration of target organs and immediate risk to life, a situation that does not occur in hypertensive urgency2-4. On the other hand, situations in which the patient presents elevated BP due to an emotionally charged, painful or uncomfortable event, with no evidence of lesion of target organs or immediate risk to life, characterize the hypertensive pseudo-crisis, a condition that does not require the use of emergency antihypertensive therapy1-3,5. Despite this fact, the practice has become widespread of prescribing antihypertensive medication prior to situations believed to present a risk of abrupt BP elevation, irrespective of the symptoms. This study aims at assessing the frequency of prescription of captopril prior to BP elevation in patients hospitalized in a university hospital. It was also intended to map the places (clinical or surgical wards) where this procedure was more frequent.

Predictors of adherence to treatment in patients with severe asthma treated at a referral center in Bahia, Brazil.

OBJECTIVE: To determine the rate of adherence to treatment with inhaled corticosteroids in patients with severe asthma, to identify predictive factors for adherence and to evaluate the relationship between adherence to treatment and parameters of clinical and functional response. METHODS: Prospective cohort study of patients enrolled in the Program for the Control of Asthma and Allergic Rhinitis in the state of Bahia, Brazil. The study comprised 160 patients with severe asthma, monitored for 180 days in order to evaluate adherence (dependent variable) to the prescribed inhaled corticosteroid. Independent variables were assessed at baseline and for a six-month follow-up period by means of interviews and the completion of a standardized questionnaire.Patients recorded the missed doses in a diary. RESULTS: Of the 160 patients. 158 completed the study. Adherence rate was 83.8%. Of the 158 patients, 112 (70.9%) were considered adherent (cut-off point: 80% of prescribed doses administered). There was a significant association between asthma control and adherence to treatment.Predictors of poor adherence were adverse effects, living far from the referral center, limited resources to pay for transportation and dose schedule. Other factors, such as depressive symptoms, religion and economic status, were not associated with poor adherence. CONCLUSIONS: Adherence to asthma treatment was high and was associated with the clinical response to treatment, in a sample of patients with severe asthma enrolled in a public program that provides free medication and the assistance of a multiprofessional specialized team in a referral center.

Analysis of the prescription of captopril to hospitalized patients.

One of the most common complications of Systemic Arterial Hypertension is the hypertensive crisis(1) characterized by a symptomatic elevation of blood pressure (BP) with or without involvement of target organs, which may lead to immediate or potential risk to life. The hypertensive crisis may manifest itself as hypertensive emergency or urgency. In the emergency there is fast deterioration of target organs and immediate risk to life, a situation that does not occur in hypertensive urgency. On the other hand, situations in which the patient presents elevated BP due to an emotionally charged, painful or uncomfortable event, with no evidence of lesion of target organs or immediate risk to life, characterize the hypertensive pseudo-crisis, a condition that does not require the use of emergency antihypertensive therapy. Despite this fact, the practice has become widespread of prescribing antihypertensive medication prior to situations believed to present a risk of abrupt BP elevation, irrespective of the symptoms. This study aims at assessing the frequency of prescription of captopril prior to BP elevation in patients hospitalized in a university hospital. It was also intended to map the places (clinical or surgical wards) where this procedure was more frequent.

Complications of hypertension in men and women seen in a referral outpatient care unit.

OBJECTIVE: To assess the association between sex and left ventricular hypertrophy, stroke, and renal failure in hypertensive patients in a referral outpatient care unit. METHODS: This study assessed 622 hypertensive patients diagnosed with left ventricular hypertrophy based on electrocardiography, renal failure based on serum creatinine level > or = 1.4 mg/dL, and stroke based on a previous history and physical examination. Logistic regression was used to estimate the odds ratio of the association between sex and target-organ lesions in hypertension adjusted for race, age, and duration of the disease. RESULTS: The mean age of the patients was 48.4 +/- 13.8 years; 74.1% were women, and 84.9% were mulattos or blacks. Almost half of the men and more than 40% of the women had had at least 1 definite event involving a target-organ lesion. The incidence of renal failure was greater among men [adjusted OR (ORa) = 2.73, P= 0.002]. In white patients, the incidence of stroke was significantly (P= 0.017) greater among men (4/33) than among women (0/56), and, in the age group > or = 49 years, the prevalence of left ventricular hypertrophy was significantly greater among men (ORa = 1.99, P= 0.024). CONCLUSION: The data obtained suggest a greater prevalence of renal failure in men than in women, of stroke in white men than in white women, and of left ventricular hypertrophy in men than in women aged 49 years and above.

Complicações da hipertensão arterial em homens e mulheres atendidos em um ambulatório de referência / Complications of hypertension in men and women seen in a referral outpatient care unit

OBJETIVO: Avaliar se o sexo se associa à hipertrofia ventricular esquerda, ao acidente vascular cerebral e à insuficiência renal em hipertensos atendidos em ambulatório de referência. MÉTODOS: Dados de 622 hipertensos, admitidos com diagnóstico de hipertrofia ventricular esquerda baseado no eletrocardiograma, de insuficiência renal, na creatinina > 1,4 mg/dl, e de acidente vascular cerebral em história pregressa e exame físico. Regressão logística foi utilizada para estimar odds ratio da associação entre sexo e lesão de órgãos-alvo da hipertensão, ajustadas para raça, idade e sua duração. RESULTADOS: A média das idades foi 48,4±13,8 anos, 74,1 por cento eram mulheres, 84,9 por cento mulatos ou negros. Quase a metade dos homens e mais de 40 por cento das mulheres apresentavam pelo menos um evento definido com lesão órgão-alvo. Insuficiência renal foi maior nos homens, OR ajustada (ORa) = 2,73; (p=0,002). Nos pacientes brancos, a freqüência de acidente vascular cerebral foi significantemente (p=0,017) maior nos homens (4/33) do que nas mulheres (0/56) e, na análise para idade > 49 anos, a prevalência de hipertrofia ventricular esquerda foi significantemente maior em homens, ORa = 1,99; (p=0,024). CONCLUSAO: Os dados obtidos sugerem maior prevalência de insuficiência renal em homens do que em mulheres, de acidente vascular cerebral em homens brancos do que em mulheres brancas, e de hipertrofia ventricular esquerda em homens do que em mulheres com idade > 49 anos.

Race and hypertensive target-organ damage in patients from an university-affiliated outpatient care referral clinic in the city of Salvador.

OBJECTIVE: To assess whether a patient's race is associated with the presence of left ventricular hypertrophy, stroke, and renal failure in hypertensive patients from an outpatient care referral clinic in the city of Salvador in the state of Bahia. METHODS: We assessed the data of 622 patients collected during their first visit to the hypertension outpatient care clinic between 1982 and 1986, identifying those with a previous history or sequela of stroke, left ventricular hypertrophy, or renal failure (serum creatinine > 1.4 mg/dL). Logistic regression models were used to estimate the odds ratio (OR) of the association between race (mulattos or black vs white individuals) and hypertensive target-organ damage adjusted for sex and age. RESULTS: The mean age of the patients was 53.8+/-14.3 years, and 74.1% were women. In regard to race, 15.1% were white, 65.9% mulatto, and 19.0% black. Stroke was significantly more frequent in blacks or mulattos than in white individuals [adjusted odds ratio (aOR) = 3.44; 95% confidence interval (CI) = (1.23-9.67). In regard to the associations involving race and the events of left ventricular hypertrophy and renal failure, the aORs were not statistically significant but were consistent with a greater prevalence of left ventricular hypertrophy and renal failure in blacks and mulattos. CONCLUSION: Hypertensive mulattos and blacks have a greater risk of target-organ damage than white individuals do, with a greater racial difference for nonfatal stroke. Whether racial differences in mortality related to hypertensive complications influence the associations observed between race and target-organ damage should be assessed.

Raça e lesão de órgãos-alvo da hipertensão arterial em pacientes atendidos em um ambulatório universitário de referência na cidade de Salvador / Race and hypertensive target-organ damage in patients from an university-affiliated outpatient care referral clinic in the city of Salvador

OBJETIVO: Avaliar se a raça do paciente estaria associada à presença de hipertrofia ventricular esquerda, acidente vascular cerebral e insuficiência renal crônica em hipertensos atendidos em ambulatório de referência em Salvador-BA. MÉTODOS: Analisados dados de 622 pacientes com o primeiro atendimento em ambulatório de hipertensão, entre 1982 e 1986, e identificados os com história prévia ou seqüela de acidente vascular cerebral, hipertrofia ventricular esquerda ou insuficiência renal (creatinina sérica > 1,4 mg/dL). Modelos de regressão logística foram utilizados para estimar odds ratio (OR) da associação entre raça (mulatos ou negros vs brancos) e lesão de órgãos-alvo de hipertensão, ajustadas para sexo e idade. RESULTADOS: A média de idade dos pacientes foi 53,8±14,3 anos, 74,1 por cento mulheres. Quanto à raça, 15,1 por cento eram brancos, 65,9 por cento mulatos e 19,0 por cento negros. Acidente vascular cerebral foi significantemente mais freqüente em negros ou mulatos do que em brancos (odds ratio ajustada (ORa)=3,44; intervalo de confiança (IC) 95 por cento=1,23-9,67). Quanto às associações envolvendo raça com os eventos hipertrofia ventricular esquerda e insuficiência renal as ORa não foram estatisticamente significantes, mas foram consistentes com maior prevalência de hipertrofia ventricular esquerda e insuficiência renal em negros e mulatos. CONCLUSAO: Negros e mulatos hipertensos têm maior risco de lesão de órgão alvo do que brancos, com diferença racial maior para acidente vascular cerebral não fatal. Deve ser avaliada se diferenças raciais em mortalidade relacionada a complicações da hipertensão influenciam as associações observadas entre raça e lesão de órgãos-alvo.

Frequência de prescriçäo de anti-hipertensivos por via oral precedendo elevaçäo da pressäo arterial sistêmica em pacientes hospitalizados / Use of oral antihypertensive medication preceding blood pressure elevation in hospitalized patients

OBJECTIVE: To evaluate the frequency of oral antihypertensive medication preceding the increase in blood pressure in patients in a university hospital, the drug of choice, and the maintained use of antihypertensive medication. METHODS: Data from January to June 1997 from the University Hospital Professor Edgard Santos Pharmacy concerning the prescriptions of all inpatients were used. Variables included in the analysis were: antihypertensive medication prescription preceding increase in blood pressure, type of antihypertensive medication, gender, clinical or surgical wards, and the presence of maintained antihypertensive medication. RESULTS: The hospital admitted 2,532 patients, 1,468 in surgical wards and 818 in medical wards. Antihypertensive medication prescription preceding pressure increase was observed in 578 patients (22.8 percent). Nifedipine was used in 553 (95.7 percent) and captopril in 25 (4.3 percent). In 50.7 percent of patients, prescription of antihypertensive medication was not associated with maintained antihypertensive medication. Prescription of antihypertensive drugs preceding elevation of blood pressure was significantly (p<0.001) more frequent on the surgical floor (27.5 percent; 405/1468) than on the medical floor (14.3 percent; 117/818). The frequency of prescription of antihypertensive drugs preceding elevation of blood pressure without maintained antihypertensive drugs and the ratio between the number of prescriptions of nifedipine and captopril were greater in surgical wards. CONCLUSION: The use of antihypertensive medication, preceding elevation of blood pressure (22.8 percent) observed in admitted patients is not supported by scientific evidence. The high frequency of this practice may be even greater in nonuniversity hospitals

Reduçäo da pressäo arterial diastólica e mortalidade cardiovascular em hipertensos näo diabéticos. Uma reanálise do Hot-Study / Reduction in diastolic blood pressure and cardiovascular mortality in nondiabetic hypertensive patients. A reanalysis of the HOT study

OBJECTIVE: To use published Hypertension Optimal Treatment (HOT) Study data to evaluate changes in cardiovascular mortality in nondiabetic hypertensive patients according to the degree of reduction in their diastolic blood pressure. METHODS: In the HOT Study, 18,700 patients from various centers were allocated at random to groups having different objectives of for diastolic blood pressure: <=90 (n=6264); <=85 (n=6264); <=80mmHg (n=6262). Felodipine was the basic drug used. Other antihypertensive drugs were administered in a sequential manner, aiming at the objectives of diastolic blood pressure reduction. RESULTS: The group of nondiabetic hypertensive subjects with diastolic pressure<=80mmHg had a cardiovascular mortality ratio of 4.1/1000 patients/year, 35.5 percent higher than the group with diastolic pressure <=90mmHg (cardiovascular mortality ratio, 3.1/1000 patients/year). In contrast, diabetic patients allocated to the diastolic pressure objective group of <=80mmHg had a 66.7 percent reduction in cardiovascular mortality (3.7/1000 patients/year) when compared with the diastolic pressure group of <=90mmHg (cardiovascular mortality ratio, 11.1/1000 patients/year). CONCLUSION: The results indicate that in hypertensive diabetic patients reduction in diastolic blood pressure to levels <=80mmHg decreases the risk of fatal cardiovascular events. It remains necessary to define the level of diastolic blood pressure <=90mmHg at which maximal reduction in cardiovascular mortality is obtained for nondiabetics

Hipertensäo arterial em adultos de um bairro de Salvador, Bahia / Arterial hypertension in adults from a borough of Salvador city, Bahia, Brazil

Foi realizado estudo para caracterizar a situaçäo da hipertensäo arterial na populaçäo do bairro de Alto das Pombas, em Salvador. Aferiu-se a pressäo aretrial (PA) de 491 indivíduos acima de 20 anos de idade, numa amostra de domicílios do bairro, em agosto de 1996. Foram considerados hipertensos os adultos que apresentaram PA sistólica igual ou superior a 140mmHg e/ou diastólica igual ou superior a 90mmHg, acrescidos daqueles indivíduos que informaram serem portadores dadoença. Obteve-se uma prevalência de hipertensäo de 41,1 porcento, mais elevada no sexo feminino e na faixa de 50 e mais anos. Chamou a atençäo, o alto percentual de indivíduos hipertensos com PA näo controlada, no momento da pesquisa. Os hipertensos foram revisitados após três meses, quando se detectou que 68 porcento continuavam com os níveis pressóricos elevados. Foi referido pelos hipertensos, maior grau de adesäo à reduçäo do sal na dieta e ao tratamento medicamentoso, em relaçäo a outras medidas de controle. O uso de medicamentos näo se mostrou efetivo no controle da doença, sugerindo irregularidades e inadequaçöes no seu uso. Concluiu-se que a hipertensäo arterial constitui-se num problema de saúde pública relevante na área, o qual requer intervençäo através de açöes educativas e organizaçäo da assistência.

Programa experimental de atendimento a pacientes hipertensos: uma abordagem multiprofissional / Program esperimental of atentions the hypertensive patients

Foram acompanhados 678 pacientes matriculados no Ambulatório de Hipertesäo Arterial da Disciplina de Nefrologia da Faculdade de Medicina da Universidade Federal da Bahia durante o período de 1982 a 1986. Os pacientes foram separados aleatoriamente e acompanhados por 2 grupos distintos: o grupo A com atendimento exclusivamente médico e o grupo B com atendimento multiprofissional. Todos os pacientes forma criteriosamente avaliados através de uma anamnese cuidadosa, exame físico, e investigaçäo laboratorial complementar para detectar possíveis complicaçöes da doença. Os indicadores utilizados para avaliaçäo foram comuns aos 2 grupos de pacientes. Constituíram-se das taxas de pacientes ativos, ativos controlados, abandono e perdas. As médias das consultas e de drogas utilizadas, além da média da T.A. período, peso corpóreo, freqüência de pulso e aderência ao tratamento. As complicaçöes eram avaliadas através de alteraçöes de órgäos-alvo. Näo houve diferença entre as características gerais dos 2 grupos. Quando comparados às metas alcançadas, o grupo B foi muito superior em relaçäo ao A, assim como as taxas de pacientes ativos controlados foram maiores no grupo B do que no A. A média de T.A. foi constante para os 2 grupos, bem como a média de drogas utilizadas, e as consultas ligeiramente menor no A do que no B. A aderência ao tratamento foi gradativamente crescente no grupo B. O abandono às consultas foi elevado principalmente no 1§ ano de seguimento e merece melhor avaliaçäo posterior. Após os 3 anos de seguimento, houve a fusäo dos grupos A e B que passou a constituir o grupo C com acompanhamento por 4 anos. Os resultados do grupo C foram coincidentes com os do grupo B. Da avaliaçäo concluímos que a equipe multiprofissional contribuiu para a obtençäo das taxas do grupo B, resultando um melhor controle da T.A. e provavelmente reduzido as suas complicaçöes.

Peritonite por B. subtilis em diálise peritoneal intermitente, crônica / Peritonitis due to B. subtilis in chronic intermittent peritoneal dialysis

Peritonite constitui uma complicaçäo freqüente da diálise peritoneal, sendo importante causa de morbidade e mortalidade. A flora bacteriana mais freqüente envolvida é a de gram-positivos, destacando-se o S. aureus e S. epidermidis, seguidos de estreptococos e de bacilos gram-negativos. Relatamos, no presente, três casos de peritonite em pacientes atendendo programa de diálise peritoneal intemitente, causadas pelo Bacillus subtilis. Habitualmente, o isolamento de Bacillus do líquido de diálise e de secreçöes orgânicas variadas (à exceçäo do B. anthracis) é tido como "contaminaçäo". Nosso relato visa alertar para a importância desse gyenero de bactéria como agente infectante, somando-se áqueles que destacam o papel patogênico dessa bactéria, e chamamos a atençäo para a procura de outros fatores de infecçäo que näo a pele ou aparelho digestivo, nessas situaçöes