Avaliação dos efeitos a curto prazo de programas de conscientiização e de terapia com pravastatina em indivíduos de alto risco para doença cardiovascular provenientes de consultórios particulares / The evaluation of short term effects of awareness programs and pravastatin therapy on subjects from private clinics at high risk for cardivascular disease

OBJETIVO - Avaliar a eficácia de programas de conscientização (PC) sobre o controle de fatores de risco (FR) para doença cardiovascular (DCV). MÉTODOS - Pacientes hipercolesterolêmicos de alto risco para DCV foram divididos em 2 frupos durante 16 semanas. O grupo A(n=180, 54,4ñ10,0 anos, 55 'por cento' homens) recebeu orientação verbal e escrita sobre controle de FR, e o grupo B (n=180, 54,4ñ10,9 anos, 45 'por cento' homens) apenas orientação verbal. Todos os participantes receberam 10mg/dia de pravastatina por 12 semanas. Avaliaram-se o peso, pressão arterial, o colesterol total (CT) e fraçöes, triglicérides, índices I e II de Castelli (CT/HDL-C e LDL-C/HDL-C) e escores de Framingham. RESULTADOS - No basal, A diferiu de B no HDL-C (40,0ñ11,0 vs 43,0ñ11,0mg/dl, p=0,013) e no índice I (8,2ñ3,0 vs 7,6ñ2,3, p=0,008). Após 16 semanas as variaçöes 'porcentagem' foram maiores em A do que B no CT (-28,0 vs -25,0, p<0,05), LDL-C (-29,0 vs -27,6, p<0,05), HDL-C (+13,7 vs +10,8, p<0,05) e índice I (-39,0 vs -33,0; p<0,05). A pravastatina potencializou os efeitos da dieta sobre os lípides. CONCLUSÄO - O PC parece ser mais eficaz a curto prazo, em reduzir os FR para DCV do que a orientação apenas verbal.

[Assessment of short-term effects of awareness programs and pravastatin therapy on subjects from private clinics at high risk for cardiovascular disease]. / Avaliação dos efeitos a curto prazo de programas de conscientização e de terapia com pravastatina em indivíduos de alto risco para doença cardiovascular provenientes de consultórios particulares.

PURPOSE: To evaluate short-term efficacy of awareness programs (AP) in reducing coronary heart disease risk factors (CHDRF). METHODS: High risk hypercholesterolemic patients were divided in 2 groups during 16 weeks. Group A (n = 417, 54.3 +/- 10.0 years, 55% males) received verbal and written orientation on CHDRF control, and group B (n = 180, 54.4 +/- 10.9 years, 45% males) received only verbal orientation. All participants received pravastatin 10 mg q.d. for 12 weeks. The evolution of body weight, arterial pressure, lipid profile, Castelli's I and II indexes (TC/HDL and LDL/HDL), and Framingham scores were evaluated. RESULTS: At baseline, A had a lower HDL-C (40.0 +/- 11.0 vs 43.0 +/- 11.0 mg/dl, p = 0.013) and a higher index I (8.2 +/- 3.0 vs 7.6 +/- 2.3, p = 0.008) than B. After 16 weeks, A had greater change than B in TC (-28.0 vs -25.0, p < 0.05), LDL-C (-29.0 vs -27.6, p < 0.05), HDL-C levels (+13.7 vs +10.8, p < 0.05) and in the Castelli's Index (-39.0 vs -33.0; p < 0.05). In both groups pravastatin use potentialized the effects of diet on the lipid profile. CONCLUSION: The AP seemed to be more effective than verbal orientation alone in CHDRF reduction at short-term.

[Captopril in the treatment of patients with congestive heart failure. Its bicycle ergometry evaluation]. / Captopril no tratamento de pacientes com insuficiência cardíaca congestiva. Avaliação cicloergométrica.

PURPOSE: To analyze the physical performance of the patients with congestive heart failure (CHF), grades I and II of the New York Heart Association (NYHA), submitted to ergometric test: 1) under conventional treatment with digitalis and diuretic; 2) with an angiotensin converting enzyme inhibitor, captopril, associate with conventional treatment; 3) using captopril associated with digitalis or diuretic. METHODS: A randomized double blind study was performed in 20 patients with CHF (I and II-NYHA) submitted to ergometric test in different therapeutic phases. The initial workload was 5 watts and load was increased until the appearance of limiting symptoms. RESULTS: The introduction of captopril to the conventional treatment for CHF or associated with digitalis or diuretic promotes significant increase in the duration of the physical exercise, in the oxygen consumption and in the total workload during the ergometric test. CONCLUSION: In the initial forms of CHF, captopril provides better physical performance when compared with conventional treatment and the diuretic treatment can be changed for the angiotensin converting enzyme inhibitor with equal efficacy.

[Treatment of mild and moderate cardiac failure with captopril. A multicenter study]. / Tratamento da insuficiência cardíaca leve e moderada com captopril. Estudo multicêntrico.

PURPOSE: Evaluation of the clinical effects of captopril addition to the conventional therapy of functional class II and III (NYHA) congestive heart failure (CHF). METHODS: One hundred and fifteen patients with CHF, 46 (40%) class II and 69 (60%) class III, on conventional treatment (digitalis and diuretic) were the subject of this study. The age ranged from 22 to 75 years (mean 56.6 +/- 11); 67 were male and 66 were caucasians. The etiologies of the heart failure were: hypertensive heart disease 47 (40.9%), ischemic heart disease 27 (23.5%), Chagas cardiomyopathy 20 (17.4%), idiopathic cardiomyopathy 15 (13.0%), and other causes 6 (5.2%). Diuretic and digitalis were maintained in the same dosage during all the treatment. Captopril therapy was started with 6.25 mg b.i.d. or t.i.d., and the dosage was increased gradually to 25 mg b.i.d. or t.i.d. The duration of the study was 12 weeks. Clinical visits occurred every four weeks and laboratory tests were performed in the beginning and at the end of the study. RESULTS: The dosage of captopril ranged from 12.5 to 75 mg (mean 28.5 +/- 13.1 mg/day). The addition of captopril to the conventional therapy of CHF was associated with significant reduction (p < 0.01) of heart rate, systolic and diastolic blood pressure. In the end of the study 13 patients (11.3%) were in functional class III, 50 (43.5%) in class II and 52 (45.2%) in class I. Globally, functional class was improved in 98 (85.2%) patients and remained unchanged in 17 (14.8%) (p < 0.01). The side effects (dizziness, cough, hypotension and headache) were moderate and uncommon and did not need interruption of the treatment. CONCLUSION: The addition of captopril to the conventional therapy of class II and III CHF was associated with significant improvement of functional class and with good tolerability.

[Acute lethal intoxication caused by mercury vapor]. / Intoxicação aguda letal por vapor de mercúrio.

Nowadays mercury poisoning usually results from the oral ingestion of methylmercury or from inhalation of mercury vapor. Mercury intoxication in a gold prospector after inhalation of mercury vapor is described. The patient presented a history of fever, tachypnea and headache. Despite the treatment with dimercaprol, penicillamine and intensive supportive care the patient died with symptoms of acute respiratory distress.

[Lethal mercury poisoning due to ingestion of merthiolate]. / Intoxicação letal por mercúrio através da ingestão de "merthiolate".

A case of mercurial poisoning caused by ingestion of an organic mercurial compound, thimerosal, found in local antiseptic solutions. The clinical picture consisted of grave neurological symptoms which were not reversed by penicillamine and resin administration despite rapid plasma level reduction of mercury. We call attention to this case because of the widespread availability of antiseptic solutions containing mercurial compounds and alcohol.

[Efficacy of captopril in the treatment of mild and moderate hypertension in patients over 60 years of age]. / Eficácia do captopril no tratamento da hipertensão arterial leve e moderada de pacientes com idade superior a 60 anos.

The response to the use of converting enzyme inhibitor (captopril) either alone or associated to hydrochlorothiazide was evaluated during three months in 128 patients over 60 years old, with mild (79.7%) and moderate (20.3%) hypertension. Seventy (55%) were female and 58 (45%) male, being 64.8% white, 33.6% non-white and 1.6% asiatic. All patients received initially either a single dose of 25 mg of captopril or twice 12.5 mg, and after 1 month those in which hypertension was maintained 25 mg of hydrochlorothiazide was associated. During this period the analysis of the results showed a significant reduction of systolic and diastolic blood pressure (DP), however, there was a marked reduction during the first month. Thus, DP decreased from 101 +/- 8.8 (control) to 93 +/- 8.7 in the first month, to 89.6 +/- 8.2 in the second and 86 +/- 8.2 in the third, all significant at p less than 0.001. Similar distinction with previous treatment were observed when ranges on DP were analysed in patients receiving isolated or associated captopril. There was a small but significant weight and heart rate fall in patients receiving only captopril. Reduction of side effects was observed in 79% of the patients, as compared to previous treatment there being distinct improvement, while 21% showed no alterations and none showed complications. Therefore, we may conclude that use of captopril in elderly hypertensive patients was efficacious in the control of arterial blood without influence on quality of life.

[Treatment of mild and moderate hypertension with the use of captopril alone or combined with hydrochlorothiazide. A multicenter study]. / Tratamento da hipertensão arterial leve e moderada com o uso de captopril isolado ou associado à hidroclorotiazida. Estudo multicêntrico.

The efficacy of captopril 25 mg/day as monotherapy or when necessary, in association with hydrochlorothiazide 25 mg/day, was studied during three months in 472 patients, average age 45 (17-59) years, 51% males with mild (73%) 95 less than PAD less than 104 mmHg, and moderate (27%) arterial hypertension 104 less than PAD less than 114 mmHg. Were included in the study hypertensive patients with previous antihypertensive therapy or when in the course of any previous antihypertensive treatment (52.4%) blood pressure control were not observed and side effects compromised patient's compliance. Captopril 25 mg/day was used once a day as single dose or subdivided in two daily doses (12.5 mg b.i.d.), during 30 days. If blood pressure was not normalized or dyastolic blood pressure drop was not equal or bigger than 10% after this period, it was added hydrochlorothiazide 25 mg/day. After three months under treatment, 411 (87%) patients normalized their dyastolic blood pressure DBP (less than 90 mmHg), from them, 273 (57.6%) had received only captopril and the others 138 (29.4%) with the addition of hydrochlorothiazide. The drop of mean arterial pressure, MAP = 2 DBP + 1 SBP was in average, 17.3 mmHg, in the 3 patients whose blood pressure normalized with captopril alone, and in average of 18.5 mmHg in those patients requiring addition of hydrochlorothiazide (difference without statistical significance). A small decrease of body weight, but with statistical significance (p less than 0.001) were observed during the use of captopril as monotherapy. Expressive reduction of side effects were observed during the period under captopril related to the period with previous antihypertensive therapy.