Pulse Wave Velocity of 8.2 m/s as a Threshold Associated with Cardiovascular Target Organ Damage Presence. / Velocidade de Onda de Pulso de 8,2m/s como Limiar Associado à Presença de Lesão de Órgão Alvo Cardiovascular.

BACKGROUND: Previous studies have established normal and reference values for Pulse Wave Velocity (PWV). However, the PWV value that has the strongest association with cardiovascular biomarkers remains poorly understood. OBJECTIVE: This study aimed to determine the PWV value more likely to be associated with left ventricular hypertrophy (LVH), increased intima-media thickness (IMT), and presence of carotid plaques in patients with hypertension. METHODS: This cross-sectional study included 119 patients. Analysis of receiver operating characteristic (ROC) curves was performed for each cardiovascular biomarker. Statistical significance was set at p < 0.05. RESULTS: According to the ROC curve analysis, the PWV values were 8.1 m/s, 8.2 m/s, and 8.7 for the LVH, IMT, and presence of carotid plaques, respectively. A PWV value of 8.2 m/s was identified as the best parameter to determine the three TOD biomarkers. PWV above 8.2 m/s was associated with increased CIMT (p = 0.004) and the presence of carotid plaques (p = 0.003) and LVH (p<0.001). PWV above 8.2 showed greater sensitivity for increased CIMT (AUC = 0.678, sensitivity = 62.2), LVH (AUC = 0.717, sensitivity = 87.2), and the presence of plaques (AUC = 0.649, sensitivity = 74.51) in the ROC curve analysis. CONCLUSION: The PWV value 8.2 m/s was more sensitive in early identifying the existence of cardiovascular biomarkers of TOD.

FUNDAMENTO: Estudos prévios estabeleceram valores de normalidade e de referência da Velocidade de Onda de Pulso (VOP). Porém, qual valor de VOP que apresenta a associação mais forte com biomarcadores cardiovasculares ainda é pouco conhecido. OBJETIVO: Identificar o valor de VOP com maior possibilidade de estar associado com hipertrofia ventricular esquerda (HVE), aumento da espessura íntima-média carotídea (EIMC), e presença de placas carotídeas em pacientes hipertensos. MÉTODOS: Este é um estudo transversal de 119 pacientes. Análise de curvas características de operação do receptor (ROC) foi realizada para cada biomarcador cardiovascular. A diferença estatística foi estabelecida em p<0,05. RESULTADOS: Segundo análises das curvas ROC, valores de VOP de 8,1m/s para HVE, 8,2m/s para EMIC aumentada e 8,7m/s para a presença de placa carotídea foram encontrados, respectivamente. O valor de VOP de 8,2m/s foi definido como melhor o parâmetro para encontrar os três biomarcadores de LOA. A VOP acima de 8,2m/s associou-se ao aumento da EMIC (p = 0,004), à presença de placas carotídeas (p = 0,003) e à HVE (p < 0,001). A VOP acima de 8,2m/s apresentou maior sensibilidade para EMIC aumentada (AUC = 0,678, sensibilidade 62,2), HVE (AUC = 0,717, sensibilidade 87,2), e presença de placas (AUC = 0,649, sensibilidade 74,51) na análise das curvas ROC. CONCLUSÃO: O valor de 8,2m/s de VOP foi mais sensível em identificar, precocemente, a existência de biomarcadores cardiovasculares de LOA.

Velocidade de Onda de Pulso de 8,2m/s como Limiar Associado à Presença de Lesão de Órgão Alvo Cardiovascular / Pulse Wave Velocity of 8.2 m/s as a Threshold Associated with Cardiovascular Target Organ Damage Presence

Resumo Fundamento Estudos prévios estabeleceram valores de normalidade e de referência da Velocidade de Onda de Pulso (VOP). Porém, qual valor de VOP que apresenta a associação mais forte com biomarcadores cardiovasculares ainda é pouco conhecido. Objetivo Identificar o valor de VOP com maior possibilidade de estar associado com hipertrofia ventricular esquerda (HVE), aumento da espessura íntima-média carotídea (EIMC), e presença de placas carotídeas em pacientes hipertensos. Métodos Este é um estudo transversal de 119 pacientes. Análise de curvas características de operação do receptor (ROC) foi realizada para cada biomarcador cardiovascular. A diferença estatística foi estabelecida em p<0,05. Resultados Segundo análises das curvas ROC, valores de VOP de 8,1m/s para HVE, 8,2m/s para EMIC aumentada e 8,7m/s para a presença de placa carotídea foram encontrados, respectivamente. O valor de VOP de 8,2m/s foi definido como melhor o parâmetro para encontrar os três biomarcadores de LOA. A VOP acima de 8,2m/s associou-se ao aumento da EMIC (p = 0,004), à presença de placas carotídeas (p = 0,003) e à HVE (p < 0,001). A VOP acima de 8,2m/s apresentou maior sensibilidade para EMIC aumentada (AUC = 0,678, sensibilidade 62,2), HVE (AUC = 0,717, sensibilidade 87,2), e presença de placas (AUC = 0,649, sensibilidade 74,51) na análise das curvas ROC. Conclusão O valor de 8,2m/s de VOP foi mais sensível em identificar, precocemente, a existência de biomarcadores cardiovasculares de LOA.

Abstract Background Previous studies have established normal and reference values for Pulse Wave Velocity (PWV). However, the PWV value that has the strongest association with cardiovascular biomarkers remains poorly understood. Objective This study aimed to determine the PWV value more likely to be associated with left ventricular hypertrophy (LVH), increased intima-media thickness (IMT), and presence of carotid plaques in patients with hypertension. Methods This cross-sectional study included 119 patients. Analysis of receiver operating characteristic (ROC) curves was performed for each cardiovascular biomarker. Statistical significance was set at p < 0.05. Results According to the ROC curve analysis, the PWV values were 8.1 m/s, 8.2 m/s, and 8.7 for the LVH, IMT, and presence of carotid plaques, respectively. A PWV value of 8.2 m/s was identified as the best parameter to determine the three TOD biomarkers. PWV above 8.2 m/s was associated with increased CIMT (p = 0.004) and the presence of carotid plaques (p = 0.003) and LVH (p<0.001). PWV above 8.2 showed greater sensitivity for increased CIMT (AUC = 0.678, sensitivity = 62.2), LVH (AUC = 0.717, sensitivity = 87.2), and the presence of plaques (AUC = 0.649, sensitivity = 74.51) in the ROC curve analysis. Conclusion The PWV value 8.2 m/s was more sensitive in early identifying the existence of cardiovascular biomarkers of TOD.

Antihypertensive effect of Equisetum arvense L.: a double-blind, randomized efficacy and safety clinical trial.

BACKGROUND: Equisetum arvense L. (EA) is a traditional phytomedicine used as a diuretic agent worldwide and regulated strictly by European Medicine Agency (EMA) and Brazilian National Health Surveillance Agency (ANVISA). However, few studies evaluating its efficacy and safety have been published and no clinical trial assessing its antihypertensive effect has been reported to date. PURPOSE: To assess antihypertensive effect, safety and tolerability of EA compared to hydrochlorothiazide (HCTZ). METHODS: This is a double-blind randomized clinical trial, allocating 58 systemic arterial hypertension (SAH) stage I patients (both sexes, 25-65 years old) into two groups (EA and HCTZ). All patients underwent biochemical and cardiologic checkup prior to and during interventions. The EA standardized dry extract (900 mg/day) or HCTZ (25 mg/day) were administered for 3 months and follow-up visits were conducted every 30 days. Efficacy established goals were systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) decreases ≥ 10.0 mmHg and/or casual blood pressure (CBP) < 140/90 mmHg. RESULTS: EA treatment demonstrated a significant antihypertensive effect, promoting a mean decrease of SBP and DBP by 12.6 and 8.1 mmHg, respectively, and resulting a CBP mean of 134.0/84.5 mmHg at the end of intervention on the SAH stage I patients (CBP mean of 148.5/95.7 mmHg). There were no significant statistical differences between EA and HCTZ interventions on blood pressure decrease, and before-after treatments regarding to biochemical tests and signs of acute toxicity, renal, hepatic and hematologic alterations. A slight trend but no significant difference were observed between adverse events from EA (3.58%) and HCTZ (4.68%) groups. CONCLUSION: EA standardized dry extract was successfully applied to the SAH stage I patient treatment, decreasing effectively SBP ad DBP values to the reference normal ranges, and demonstrating a well-tolerability profile similar to HCTZ intervention.

Hypertension Prevalence, Treatment and Control in Older Adults in a Brazilian Capital City.

BACKGROUND: The diagnosis, treatment and control of arterial hypertension are fundamental for a reduction in cardiovascular outcomes, especially in the elderly. In Brazil, there are few studies that specifically identified these rates in the elderly population. OBJECTIVE: To verify rates of prevalence, treatment and control of hypertension in elderly people living in the urban area of a Brazilian capital city. METHODS: A cross-sectional, population-based, randomized, cluster-based study with 912 non-institutionalized elderly individuals (≥ 60 years), living in urban areas in the city of Goiania, Midwest Brazil. Predictor variables were: age, gender, socioeconomic and lifestyle aspects. Blood pressure measurements were performed at home; patients were considered as having arterial hypertension when SBP and/or DBP ≥ 140/90 mmHg or when using antihypertensive drugs (dependent variable). Rates of hypertension treatment and control were evaluated. Variable association analyses were performed by multivariate logistic regression and level of significance was set at 5%. RESULTS: The prevalence of arterial hypertension was 74.9%, being higher (78.6%) in men (OR 1.4, 95% CI: 1.04-1.92); the treatment rate was 72.6%, with higher rates being observed in smokers (OR 2.06, 95% CI: 1.28-3.33). The rate of hypertension control was 50.8%,being higher in women (OR 1.57, 95% CI: 1.19-2.08). CONCLUSION: The prevalence rates were high. Treatment and control rates were low and associated with gender, age and lifestyle, indicating the need for early and individual interventions.

Hypertension Prevalence, Treatment and Control in Older Adults in a Brazilian Capital City / Prevalência, Tratamento e Controle da Hipertensão Arterial em Idosos de uma Capital Brasileira

Abstract Background: The diagnosis, treatment and control of arterial hypertension are fundamental for a reduction in cardiovascular outcomes, especially in the elderly. In Brazil, there are few studies that specifically identified these rates in the elderly population. Objective: To verify rates of prevalence, treatment and control of hypertension in elderly people living in the urban area of a Brazilian capital city. Methods: A cross-sectional, population-based, randomized, cluster-based study with 912 non-institutionalized elderly individuals (≥ 60 years), living in urban areas in the city of Goiania, Midwest Brazil. Predictor variables were: age, gender, socioeconomic and lifestyle aspects. Blood pressure measurements were performed at home; patients were considered as having arterial hypertension when SBP and/or DBP ≥ 140/90 mmHg or when using antihypertensive drugs (dependent variable). Rates of hypertension treatment and control were evaluated. Variable association analyses were performed by multivariate logistic regression and level of significance was set at 5%. Results: The prevalence of arterial hypertension was 74.9%, being higher (78.6%) in men (OR 1.4, 95% CI: 1.04-1.92); the treatment rate was 72.6%, with higher rates being observed in smokers (OR 2.06, 95% CI: 1.28-3.33). The rate of hypertension control was 50.8%,being higher in women (OR 1.57, 95% CI: 1.19-2.08). Conclusion: The prevalence rates were high. Treatment and control rates were low and associated with gender, age and lifestyle, indicating the need for early and individual interventions.

Resumo Fundamento: O diagnóstico, tratamento e controle da hipertensão arterial são fundamentais para a redução de eventos cardiovasculares, especialmente em idosos. No Brasil são escassos os estudos que identificaram essas taxas especificamente na população idosa. Objetivo: Verificar a prevalência, taxas de tratamento e controle da hipertensão arterial entre idosos da zona urbana de uma capital brasileira. Métodos: Estudo transversal de base populacional, com amostragem aleatória por conglomerado, realizado com 912 idosos (maiores de 60 anos), residentes na zona urbana de Goiânia. Variáveis preditoras: idade, sexo, aspectos socioeconômicos e estilo de vida. Medidas da pressão arterial (PA) realizada em domicílio; hipertensão arterial (HA) igual a PA sistólica e/ou diastólica maior ou igual a 140/90mmHg ou usando anti-hipertensivos (variável dependente). Foram avaliadas taxas de tratamento e controle de HA. Análise de associação dos desfechos com regressão logística multivariada e nível de significância de 5%. Resultados: Prevalência de hipertensão arterial total foi de 74,9%, sendo maior entre os homens 78,6% (OR 1,4; IC95%1,04-1,92); A taxa de tratamento foi de 72,6%, com taxas superiores entre os fumantes (OR 2,06; IC 95% 1,28-3,33). A taxa de controle total foi de 50,8%, maior entre as mulheres (OR 1,57; IC 95% 1,19- 2,08). Conclusões: As taxas de prevalência foram elevadas. Taxas de tratamento e controle foram baixas e mostraram associação com sexo, faixa etária e estilo de vida, indicando necessidade de intervenções precoces e individuais.

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.

Hypertensive diabetic patients: incidence of cardiovascular and renal outcomes in a historical cohort over 11 years.

BACKGROUND: Diabetics have increased risks for cardiovascular disease (CVD) and mortality, reducing their life expectancy by up to 15 years. Type 2 diabetes mellitus specifically increases the risk for cardiovascular mortality nearly fivefold. When hypertension is combined with diabetes, the risk of CVD is even greater. OBJECTIVE: Identify non-fatal cardiovascular outcomes and renal function impairment in a cohort of hypertensive patients in regular treatment in a reference treatment center, over 11 years of follow-up. METHODS: Historical cohort of hypertensive patients in regular treatment for at least 11 years in a specialized service for hypertension treatment. The exposed group was hypertensive diabetic patients at the beginning of the cohort, and the non-exposed group had hypertension without diabetes. The cohort began in 2004, with follow-ups in 2009 and 2015. Variables used: gender, race, age, physical activity, alcohol consumption, smoking, blood pressure, body mass index, glycated hemoglobin, diabetes and hypertension diagnosis times, treatment time in specialized service, non-fatal cardiovascular outcomes, and renal impairment assessed by creatinine clearance. RESULTS: 139 patients participated in the study (55 diabetic hypertensive; 84 non-diabetic hypertensive), with an initial (2004) mean hypertension treatment time of 5.8 years. Females were the majority (75.5%) in both groups. Groups were similar regarding socio-demographic variables, but the group of hypertensive diabetic patients had higher frequency of obesity and uncontrolled BP, which persisted in all follow-ups. In 11 years of follow-up (2004-2015), the diabetic group had more cardiovascular events, with increased risk of acute myocardial infarction (RR 95% CI 1.6 12.2-95.0), stroke (RR 95% CI 1.3-6.1 27.7) and complications requiring hospitalization (RR 95% CI 1.6 2.2-3.0). Worsened renal function occurred more often in the non-exposed group, but in the end, the proportion of renal function loss was similar between groups. CONCLUSIONS: Exposure to type 2 diabetes increased the risk of new cardiovascular outcomes over 11 years of follow-up of hypertensive patients. Diabetes by itself increased the risk of cardiovascular outcomes, justifying more intensive actions in this population.