Mission 70/26 Project: improving blood pressure control in Portugal.

PURPOSE: As reported in most European countries, the percentage of treated hypertensive patients achieving a well-controlled blood pressure (e.g. < 140/90 mmHg) is insufficient. This represents a major health concern particularly in countries with a high prevalence of cardiovascular events such as stroke. Therefore, there is a need to develop national programs to increase not only the awareness regarding elevated blood pressure but also the percentage of treated patients achieving recommended blood pressure targets. The present paper describes the new initiative of the Portuguese Society of Hypertension (PSH) to achieveat least 70% of controlled hypertensive patients, followed in primary care, in 2026. MATERIALS AND METHODS: The strategies used to improve blood pressure control are aimed at healthcare professionals and general population and include governmental and organizational interventions. To be able to analyze the control rate of HTN patients, and using BI-CSP reports (the Primary Care health unit platform), every six months, we will be addressing the proportion of HTN patients (age: 18-65 years) with BP < 140/90 mmHg and the proportion of HTN patients with at least one blood pressure recorded in the last semester. CONCLUSION: With Mission 70/26, the PHS aims to improve awareness among all health professionals and community alike about the problem of uncontrolled HTN and its role in the consequent disability and high mortality rate from cardiovascular causes.

Hypertension is the most prevalent cardiovascular risk factor worldwide, affecting 42,6% of adult portuguese population.Only 52,8% of hypertensive patients followed in primary public care had their HTN controlled.Mission 70/26 project was designed by the Portuguese Society of Hypertension with the purpose of achieving 70% control of hypertensive patients under Primary Healthcare by 2026.The strategies used to improve blood pressure control are aimed at healthcare professionals and general population and include governmental and organizational interventions.

The OXIMAPA Study: Hypertension Control by ABPM and Association with Sleep Apnea Syndrome by Pulse Oximetry.

INTRODUCTION: Ambulatory blood pressure monitoring by automatic device is the best blood pressure evaluation method and sleep apnea syndrome is the leading cause of poor control. Oximetry allows screening these individuals but its usefulness has been poorly explored in Primary Health Care. The aim was to evaluate the blood pressure control at the office and with ambulatory blood pressure monitoring by automatic device and to relate it to sleep apnea syndrome. MATERIAL AND METHODS: We selected a sample of 50 participants, representative of 3036 hypertensive patients. The variables were: blood pressure value at the office and blood pressure with ambulatory blood pressure monitoring by automatic device; presence of criteria of sleep apnea syndrome in oximetry. RESULTS: The prevalence of uncontrolled blood pressure was 56% on office evaluation and 68% on ambulatory blood pressure monitoring by automatic device. It was found: 36% of daytime hypertension, 52% nocturnal hypertension, 40% non-dipper profile, 16% of white coat hypertension and 28% masked hypertension. The prevalence of sleep apnea syndrome was 16%. Blood pressure in ambulatory blood pressure monitoring by automatic device and blood pressure in office showed no statistically significant association (p = 0.761). We found a statistically significant association between sleep apnea syndrome and daytime hypertension (p = 0.019) and non-dipper profile (p = 0.005). DISCUSSION AND CONCLUSION: Ambulatory blood pressure monitoring by automatic device detected more 12% of uncontrolled hypertension than office blood pressure. Sleep apnea syndrome is strongly associated with uncontrolled hypertension and oximetry may be a good screening method, but should be studied further.

Introdução: A monitorização ambulatorial da pressão arterial é o melhor método de avaliação da pressão arterial e a síndrome da apneia do sono é a principal causa de mau controlo. A oximetria permite rastrear estes indivíduos mas a sua utilidade tem sido pouco explorada em Cuidados de Saúde Primários. O objectivo foi avaliar o controlo da pressão arterial no consultório e na monitorização ambulatorial da pressão arterial, e relacioná-la com a síndrome da apneia do sono. Material e Métodos: Selecionou-se uma amostra de 50 participantes, representativa de 3036 doentes hipertensos. As variáveis avaliadas foram: valor de pressão arterial no consultório e na monitorização ambulatorial da pressão arterial; presença de critérios de síndrome da apneia do sono na oximetria. Resultados: A prevalência de pressão arterial não controlada foi de 56% no consultório e 68% na monitorização ambulatorial da pressão arterial. Encontrou-se: 36% de hipertensão diurna, 52% de hipertensão nocturna, 40% de perfil não-dipper, 16% de hipertensão da bata-branca e 28% de hipertensão mascarada. A prevalência de síndrome da apneia do sono foi 16%. A pressão arterial no consultório e na monitorização ambulatorial da pressão arterial não mostrou associação estatisticamente significativa (p = 0,761). Encontrou-se uma associação estatisticamente significativa entre síndrome de apneia do sono e hipertensão diurna (p = 0,019) e perfil não-dipper (p = 0,005). Discussão e Conclusão: A monitorização ambulatorial da pressão arterial detetou mais 12% de casos de hipertensão não controlada do que o consultório. A síndrome da apneia do sono está fortemente associada a hipertensão não controlada e a oximetria pode ser um bom método de rastreio, mas deve ser mais estudada.

Psychomotor and anxiolytic effects of mexazolam in patients with generalised anxiety disorder.

OBJECTIVE: The primary aim of this study was to evaluate the psychomotor effects of mexazolam versus placebo in patients with generalised anxiety disorder (GAD). PATIENTS AND METHODS: This was a multicentre, randomised, double-blind, parallel-group clinical trial in 60 outpatients with GAD (Diagnostic and Statistical Manual of Mental Disorders-4(th) edition [DSM-IV] criteria). After a placebo run-in period, patients were assigned to mexazolam 1mg three times daily (n = 32) or placebo (n = 28) for 21 days. Effects on psychomotor performance were evaluated with the Leeds Psychomotor Test Battery (critical flicker fusion threshold, recognition, motor and total reaction time). The Hamilton Anxiety Rating Scale (HAM-A) and the Clinical Global Impression (CGI) were used to evaluate the patients' clinical status (secondary objective). RESULTS: At neither assessment were any statistically significant differences detected between mexazolam and placebo for CGI, critical flicker fusion, and the different reaction times. The HAM-A total and the HAM-A somatic scores indicated a statistically significant therapeutic effect for mexazolam vs placebo after 1 week of treatment but not after 3 weeks. The most prominent adverse event with mexazolam was mild drowsiness. CONCLUSIONS: Mexazolam in a therapeutically effective dosage regimen does not impair psychomotor performance to a clinically relevant extent.