Prevalence of physical inactivity and its effects on blood pressure and metabolic parameters in a Brazilian Urban Population / Prevalência de inatividade física e seus efeitos na pressão arterial e parâmetros metabólicos em uma população urbana brasileira

Background: Cardiovascular disease is the leading cause of mortality in the world and physical inactivity represents an important risk factor. Objective: This study aimed to evaluate the prevalence of physical inactivity in the adult population and its effects on blood pressure, blood glucose and lipid profile. Methods: A population-based cross-sectional study with stratified simple random sampling was conducted in 1,717 adults divided by age groups: 18-39, 40-49, 50-59, 60-69 and ≥ 70 years. The participants answered the physical activity questionnaire and were classified as physically active or inactive. The bootstrap statistical method was used to assess physical activity, associated with lipid profile and blood glucose levels. The level of significance was 5%. Results:The prevalence of physical inactivity in the general population was 65.8%. There was a significant difference in the group older than 70 years. There was a significant decrease in physical activity in the group with lower educational level, with a significant difference between social classes AB and C. The prevalence of hypertension was 27.5% among physically inactive and 21.4% among active individuals (p = 0.04). The prevalence of metabolic syndrome was 26.1% in inactive and 16.7% in the active individuals (p = 0.007). Total cholesterol, low-density lipoprotein and triglycerides levels were more elevated in the physically inactive group, which was not observed with high-density lipoprotein levels. Blood glucose was also higher in the inactive group. Conclusion: This study shows a high prevalence of physical inactivity and a positive correlation between risk factors for cardiovascular disease, mainly blood pressure, glucose and lipids profiles

Effects of transcutaneous electrical nerve stimulation (TENS) on arterial stiffness and blood pressure in resistant hypertensive individuals: study protocol for a randomized controlled trial.

BACKGROUND: Resistant hypertension (RH) treatment requires an adequate and intense therapeutic approach. However, the results are not always satisfactory despite intensive treatment. Of the different pathophysiological mechanisms involved in the pathogenesis of RH, sympathetic overstimulation and therapies that block the sympathetic system have been widely studied. These approaches, however, are invasive and expensive. Another possible approach is by transcutaneous electrical nerve stimulation (TENS), a noninvasive method that modulates activity by using low-frequency transcutaneous electrical stimulation to inhibit primary afferent pathways. Thus, the current study will evaluate the effect of applying TENS in the cervicothoracic region of subjects with RH and will seek to develop a new low-cost and readily available therapy to treat this group of hypertensive individuals. METHODS/DESIGN: This is a randomized, single blind (subject), parallel-assignment study controlled with a sham group and including participants aged 40 to 70 years with resistant hypertension. The trial has two arms: the treatment and control (sham group). The treatment group will be submitted to the stimulation procedure (TENS). The sham group will not be submitted to stimulation. The primary outcomes will be a reduction in the peripheral blood pressure and adverse events. The secondary outcomes will be a reduction the central blood pressure. The study will last 30 days. The sample size was calculated assuming an alpha error of 5 % to reject the null hypothesis with a statistical power of 80 %, thereby resulting in 28 participants per group (intervention versus sham). DISCUSSION: In recent decades, RH has become very common and costly. Adequate control requires several drugs, and in many cases, treatment is not successful. Sympathetic nervous system inhibition by renal denervation and central inhibition have significant effects in reducing BP; however, these treatments are costly and invasive. Another type of sympathetic nervous system inhibition can also be noninvasively achieved by electric current. Therefore, the application of TENS may be a new therapeutic option for treating resistant hypertensive individuals. TRIAL REGISTRATION: Clinical Trials NCT02365974.

Angiotensin-converting enzyme insertion/deletion polymorphism, 24-h blood pressure profile and left ventricular hypertrophy in hypertensive individuals: a cross-sectional study.

BACKGROUND: The absence of nocturnal blood pressure dipping (ND) identified by 24-h ambulatory blood pressure monitoring (ABPM) correlates with a worse cardiovascular prognosis. The renin-angiotensin system influences blood pressure levels and the occurrence of target organ damage (TOD). Thus, the aim of this study was to correlate the angiotensin-converting enzyme gene (ACE) insertion/deletion (I/D) polymorphism with the 24-h blood pressure profile and TOD in hypertensive individuals. METHODS: 155 non-diabetic hypertensive individuals on antihypertensive treatment underwent ABPM. Peripheral blood samples were drawn for biochemistry and genetic analysis of the ACE I/D polymorphism by polymerase chain reaction. ND was defined as ≥10 % differences in the mean systolic blood pressure (BP) during wakefulness and sleep. RESULTS: There were no differences in clinical or biochemical variables or TOD in respect to ND status, except for higher BP levels during sleep (p < 0.001) in non-dippers. There was significant difference in the prevalence of left ventricular hypertrophy (LVH) between ACE genotypes (II: 13.0 %; ID: 34.1 %; DD: 46.5 %; p value = 0.024) with an increased risk in carriers of the DD genotype (OR = 5.80; IC 95 % 1.50-22.44; p value = 0.011). Carriers of the D allele had higher systolic BP during wakefulness and by ABPM (p < 0.05), higher left ventricular mass (117.3 ± 50.0 vs. 100.3 ± 25.7; p value = 0.017) and higher prevalence of LVH (37.4 vs. 12.5 %; OR = 4.14; 95 % IC: 1.17-14.65; p value = 0.028), compared to the II genotype. CONCLUSIONS: The DD genotype is associated with a higher prevalence of LVH. The presence of the D allele appears to be associated with higher mean 24-h and wake systolic BP measured by ABPM in hypertensive patients under antihypertensive treatment.

Twelve-week randomized study to compare the effect of vildagliptin vs. glibenclamide both added-on to metformin on endothelium function in patients with type 2 diabetes and hypertension.

BACKGROUND: Vildagliptin, a DPP-4 inhibitor widely used for the treatment of type 2 diabetes mellitus (T2DM), shows beneficial effects on endothelial function. This study aims to evaluate the effect of vildagliptin on endothelial function and arterial stiffness in patients with T2DM and hypertension. METHODS: Fifty over 35-year-old patients with T2DM and hypertension, without cardiovascular disease, will be randomly allocated to two groups: group 1 will receive vildagliptin added-on to metformin and group 2, glibenclamide added-on to metformin. Biochemical tests (glycemia, glycated hemoglobin, total cholesterol, high-density lipoprotein cholesterol, triglycerides, creatinine, alanine aminotransferase, ultrasensitive C-reactive protein, and microalbuminuria), 24-h non-invasive ambulatory blood pressure monitoring, and assessment of endothelial function and arterial stiffness will be performed in both groups before and after 12 weeks of treatment. The endothelial function will be assessed by peripheral arterial tonometry, which measures the reactive hyperemia index (vasodilation), and arterial stiffness will be evaluated by applanation tonometry. All analysis will be performed using SPSS Statistical Software. For all analysis, a 2-sided P < 0.05 will be considered statistically significant. RESULTS: The study started in December 2013 and patient recruitment is programed until October 2015. The expected results are that vildagliptin will improve the endothelial function in patients with T2DM and hypertension compared to glibenclamide treatment, independently of glycemic control. CONCLUSIONS: It is expected that this DPP-4 inhibitor will improve endothelial function in patients with T2 DM. TRIAL REGISTRATION: Clinical Trials NCT02145611, registered on 11 Jun 2013.

Prevalence of metabolic syndrome: association with risk factors and cardiovascular complications in an urban population.

INTRODUCTION: Metabolic syndrome (MS) is a set of cardiovascular risk factors and type 2 diabetes, responsible for a 2.5-fold increased cardiovascular mortality and a 5-fold higher risk of developing diabetes. OBJECTIVES: 1-to evaluate the prevalence of MS in individuals over 18 years associated with age, gender, socioeconomic status, educational levels, body mass index (BMI), HOMA index and physical activity; moreover, to compare it to other studies; 2-to compare the prevalence of elevated blood pressure (BP), high triglycerides and plasma glucose levels, low HDL cholesterol and high waist circumference among individuals with MS also according to gender; 3-to determine the number of risk factors in subjects with MS and prevalence of complications in individuals with and without MS aged over 40 years. METHODS: A cross-sectional study of 1369 Individuals, 667 males (48.7%) and 702 females (51.3%) was considered to evaluate the prevalence of MS and associated factors in the population. RESULTS: The study showed that 22.7% (95% CI: 19.4% to 26.0%) of the population has MS, which increases with age, higher BMI and sedentary lifestyle. There was no significant difference between genders until age ≥70 years and social classes. Higher prevalence of MS was observed in lower educational levels and higher prevalence of HOMA positive among individuals with MS. The most prevalent risk factors were elevated blood pressure (85%), low HDL cholesterol (83.1%) and increased waist circumference (82.5%). The prevalence of elevated BP, low HDL cholesterol and plasma glucose levels did not show significant difference between genders. Individuals with MS had higher risk of cardiovascular complications over 40 years. CONCLUSION: The prevalence of MS found is similar to that in developed countries, being influenced by age, body mass index, educational levels, physical activity, and leading to a higher prevalence of cardiovascular complications after the 4th decade of life.

Nebivolol reduces central blood pressure in stage I hypertensive patients: experimental single cohort study / Nebivolol reduz pressão arterial central em pacientes hipertensos estágio I: estudo experimental de coorte única

CONTEXT AND OBJECTIVES: Assessment of central blood pressure (BP) has grown substantially over recent years because evidence has shown that central BP is more relevant to cardiovascular outcomes than peripheral BP. Thus, different classes of antihypertensive drugs have different effects on central BP despite similar reductions in brachial BP. The aim of this study was to investigate the effect of nebivolol, a β-blocker with vasodilator properties, on the biochemical and hemodynamic parameters of hypertensive patients. DESIGN AND SETTING: Experimental single cohort study conducted in the outpatient clinic of a university hospital. METHODS: Twenty-six patients were recruited. All of them underwent biochemical and hemodynamic evaluation (BP, heart rate (HR), central BP and augmentation index) before and after 3 months of using nebivolol. RESULTS: 88.5% of the patients were male; their mean age was 49.7 ± 9.3 years and most of them were overweight (29.6 ± 3.1 kg/m2) with large abdominal waist (102.1 ± 7.2 cm). There were significant decreases in peripheral systolic BP (P = 0.0020), diastolic BP (P = 0.0049), HR (P < 0.0001) and central BP (129.9 ± 12.3 versus 122.3 ± 10.3 mmHg; P = 0.0083) after treatment, in comparison with the baseline values. There was no statistical difference in the augmentation index or in the biochemical parameters, from before to after the treatment. CONCLUSIONS: Nebivolol use seems to be associated with significant reduction of central BP in stage I hypertensive patients, in addition to reductions in brachial systolic and diastolic BP. .

CONTEXTO E OBJETIVOS: A avaliação da pressão arterial central (PAc) tem crescido substancialmente nos últimos anos porque as evidências mostraram que PAc central é mais relevante para os desfechos cardiovasculares do que pressão arterial (PA) periférica. Assim, diferentes classes de anti-hipertensivos têm efeitos diferentes sobre PAc apesar de reduções semelhantes na PA braquial. O objetivo foi investigar o efeito do nebivolol, β-bloqueador com propriedades vasodilatadoras, nos parâmetros bioquímicos e hemodinâmicos de pacientes hipertensos. TIPO DE ESTUDO E LOCAL: Estudo de coorte única experimental realizado em ambulatório de hospital universitário. MÉTODOS: Todos os 26 pacientes recrutados foram submetidos à avaliação bioquímica e hemodinâmica (PA, frequência cardíaca, FC, PAc, augmentation index) antes e após três meses usando nebivolol. RESULTADOS: 88,5% dos indivíduos eram do sexo masculino, com média de idade de 49,7 ± 9,3 anos, predominância de sobrepeso (29,6 ± 3,1 kg/m2) e aumento da cintura abdominal (102,1 ± 7,2 cm). Houve diminuição significativa da PA sistólica periférica (P = 0,0020) e diastólica (P = 0,0049), da FC (P < 0,0001) e da PAc (129,9 ± 12,3 x 122,3 ± 10,3 mmHg, P = 0,0083) após o tratamento em comparação aos valores basais. Não houve diferença no augmentation index, nem nos parâmetros bioquímicos antes e após o período de tratamento. CONCLUSÕES: O uso de nebivolol parece estar associado à redução significativa da PAc em hipertensos estágio 1, além da redução da pressão sistólica e diastólica braquial. .

Nebivolol reduces central blood pressure in stage I hypertensive patients: experimental single cohort study.

CONTEXT AND OBJECTIVES: Assessment of central blood pressure (BP) has grown substantially over recent years because evidence has shown that central BP is more relevant to cardiovascular outcomes than peripheral BP. Thus, different classes of antihypertensive drugs have different effects on central BP despite similar reductions in brachial BP. The aim of this study was to investigate the effect of nebivolol, a ß-blocker with vasodilator properties, on the biochemical and hemodynamic parameters of hypertensive patients. DESIGN AND SETTING: Experimental single cohort study conducted in the outpatient clinic of a university hospital. METHODS: Twenty-six patients were recruited. All of them underwent biochemical and hemodynamic evaluation (BP, heart rate (HR), central BP and augmentation index) before and after 3 months of using nebivolol. RESULTS: 88.5% of the patients were male; their mean age was 49.7 ± 9.3 years and most of them were overweight (29.6 ± 3.1 kg/m2) with large abdominal waist (102.1 ± 7.2 cm). There were significant decreases in peripheral systolic BP (P = 0.0020), diastolic BP (P = 0.0049), HR (P < 0.0001) and central BP (129.9 ± 12.3 versus 122.3 ± 10.3 mmHg; P = 0.0083) after treatment, in comparison with the baseline values. There was no statistical difference in the augmentation index or in the biochemical parameters, from before to after the treatment. CONCLUSIONS: Nebivolol use seems to be associated with significant reduction of central BP in stage I hypertensive patients, in addition to reductions in brachial systolic and diastolic BP.

Existem diferenças entre os diversos diuréticos? / Are there differences among the several diuretics?

Esse artigo faz uma breve revisão sobre as principais classes dos diuréticos e suas indicações. Aborda com detalhes os diuréticos tiazídicos, principal classe utilizada no tratamento da hipertensão arterial, abordando as diferenças entre eles em relação à estrutura, farmacodinâmica e farmacocinética. Posteriormente, avalia criteriosamente os principais trials clínicos, discutindo os efeitos dos tiazídicos na redução da pressão arterial, nos eventos cardiovasculares, incluindo acidente vascular encefálico, insuficiência cardíaca congestiva e doença arterial coronariana; além de abordar os efeitos sobre a glicemia. Finalmente, compara os principais diuréticos tiazídicos em relação à potência e efetividade na redução da pressão arterial.

This article is a brief review on the main classes of diuretics and indications. It discusses in detail the thiazide diuretics, the principal class used in the treatment of hypertension, addressing the differences between them in relation to structure, pharmacokinetics and pharmacodynamics. Afterwards, carefully assesses the key clinical trials, discussing the effects of thiazides in reducing blood pressure, cardiovascular events, including stroke, heart failure and coronary artery disease; in addition to addressing the effects on blood glucose. Finally, it compares the main thiazide diuretics in relation to the potency and effectiveness in lowering blood pressure.

Hipocalemia persistente: relato de caso / Persistent hypokalemia: case report

JUSTIFICATIVA E OBJETIVOS: Os distúrbios do metabolismo do potássio são comuns e tanto a reposição como o diagnóstico etiológico da hipocalemia grave e refratária em pacientes internados são um grande desafio na prática clínica. A diminuição do potássio plasmático leva a um grande prejuízo na função de nervos e músculos, podendo resultar em arritmias graves, em que o paciente na maioria das vezes apresenta-se assintomático, ou com queixas inespecíficas, como fraqueza muscular. O objetivo deste estudo foi mostrar a dificuldade no diagnóstico etiológico da hipocalemia e trazer alternativas para simplificá-lo. RELATO DO CASO: Paciente do sexo masculino, 34 anos, técnico em enfermagem, que evoluiu com hipocalemia persistentee grave. No período de dois meses evoluiu com quadro de hipertensão arterial, e, posteriormente, acne, confusão mental e diabetes com baixos valores plasmáticos de potássio apesar da reposição vigorosa, por via oral e venosa, de cloreto de potássio. Após descartar o hiperaldosteronismo, investigou-se hipercortisolismo,apesar de discretos achados fenotípicos de síndrome de Cushing. Com a confirmação do diagnóstico de doença de Cushing, o mesmo foi submetido à adrenalectomia bilateral com rápida correção dos valores pressóricos, glicêmicos e de potássio sérico. CONCLUSÃO: Diante de um caso de hipocalemia grave e refratária à reposição, torna-se indispensável o estabelecimento do diagnóstico etiológico para a correção deste grave distúrbio metabólico.

BACKGROUND AND OBJECTIVES: Metabolic disorders of potassium are common and both the replacement and the etiology of severe and refractory hypokalemia in hospitalized patients are a major challenge in clinical practice. The decrease in plasma potassium leads to a large impairment of nerves and muscles function and can result in life-threatening arrhythmias, in which the patient is most often asymptomatic or presents with nonspecific complaints, such as muscle weakness. This study aims to show the difficulty in diagnosing the etiology of hypokalemia and bring alternatives to simplify it. CASE REPORT: Male patient, 34 years-old, technical nursing has developed severe and persistent hypokalemia. In a two-month period he progressed with hypertension, and later, acne, diabetes, mental confusion and low plasma levels of potassium despite vigorous oral and intravenous potassium chloride replacement. After discarding hyperaldosteronism, hypercortisolism was investigated, although discrete phenotypic findings of Cushing's syndrome were present. Just after confirmation of Cushing's disease, the patient has undergone bilateral adrenalectomy with rapid correction of blood pressure values serum glucose and potassium. CONCLUSION: Facing a case of severe hypokalemia refractory to potassium replacement, it is essential to establish an etiological diagnosis for the correction of this serious metabolic disorder.

Fatores associados ao aumento no índice de incremento de pressão radial em indivíduos hipertensos / Factors associated with increased radial augmentation index in hypertensive individuals

FUNDAMENTO: A rigidez arterial é uma variável preditora de morbimortalidade e um possível marcador de lesão vascular. Sua avaliação não invasiva por tonometria radial e análise do índice de incremento (r-AI) permite identificar os pacientes expostos a um maior risco cardiovascular. OBJETIVO: Analisar a influência do r-AI em variáveis clínico-bioquímicas e sua influência na prevalência de dano em órgão-alvo em pacientes hipertensos. MÉTODOS: Cento e quarenta pacientes hipertensos consecutivos, em seguimento clínico ambulatorial, foram submetidos à análise transversal. Os níveis de pressão arterial (PA) e o r-AI foram obtidos por tonometria de aplanação da artéria radial (HEM-9000AI, Onrom). Os pacientes foram alocados em tercis r-AI (r-AI < 85 por cento; 85 < r-AI < 97 por cento; r-AI > 97 por cento). RESULTADOS: A amostra era predominantemente composta por mulheres (56,4 por cento), com idade média de 61,7 ± 11,7 anos e índice de massa corporal de 29,6 ± 6,1 Kg/m². O maior tercil apresentou uma proporção maior de mulheres (p = 0,001), maior PA sistólica (p = 0,001) e pressão de pulso (p = 0,014), e menor peso (p = 0,044), altura (p < 0,001) e frequência cardíaca (p < 0,001). A análise multivariada demonstrou que o peso (β = -0,001, p = 0,017), frequência cardíaca (β = -0,001, p = 0,007) e pressão central (β = 0,015, p < 0,001) se correlacionam com o r-AI de maneira independente. Em análises de regressão logística, o 3º tercil r-AI foi associado a uma diminuição do diabete (DM) (OR = 0,41; 95 por cento CI 0,17-0,97; p = 0,042). CONCLUSÃO: Este estudo demonstrou que peso, frequência cardíaca e PA central se relacionam com o r-AI de maneira independente.

BACKGROUND: Arterial stiffness is a variable predictor of morbidity and mortality and a possible marker of vascular injury. Its non-invasive assessment by radial tonometry and analysis of the augmentation index (r-AI) allows identifying patients exposed to higher cardiovascular risk. OBJECTIVE: To analyze the influence of r-AI on clinical-biochemical variables and its influence on the prevalence of target-organ damage in hypertensive patients. METHODS: 140 consecutive hypertensive patients, followed-up in an outpatient clinic, were analyzed in a cross-sectional study. Blood pressure (BP) levels and r-AI were obtained by applanation tonometry of the radial artery (HEM-9000AI, Onrom). The patients were allocated into r-AI tertiles (r-AI < 85 percent; 85< r-AI < 97 percent; r-AI > 97 percent). RESULTS: The sample was predominantly composed of women (56.4 percent), mean age of 61.7 ± 11.7 years and body mass index 29.6 ± 6.1 Kg/m². The highest tertile showed higher proportion of women (p = 0.001), higher systolic BP (p = 0.001) and pulse pressure (p = 0.014), and lower weight (p = 0.044), height (p < 0.001) and heart rate (p < 0.001). Multivariate analysis demonstrated that weight (β = -0.001, p = 0.017), heart rate (β = -0.001, p = 0.007) and central pressure (β = 0.015, p < 0.001) correlated independently with r-AI. In logistic regression analyses, the 3rd r-AI tertile was associated to lower levels of diabetes (DM) (OR = 0.41; 95 percent CI 0.17-0.97; p = 0.042). CONCLUSION: This study demonstrated that weight, heart rate and central BP were independently related to r-AI.

Factors associated with increased radial augmentation index in hypertensive individuals.

BACKGROUND: Arterial stiffness is a variable predictor of morbidity and mortality and a possible marker of vascular injury. Its non-invasive assessment by radial tonometry and analysis of the augmentation index (r-AI) allows identifying patients exposed to higher cardiovascular risk. OBJECTIVE: To analyze the influence of r-AI on clinical-biochemical variables and its influence on the prevalence of target-organ damage in hypertensive patients. METHODS: 140 consecutive hypertensive patients, followed-up in an outpatient clinic, were analyzed in a cross-sectional study. Blood pressure (BP) levels and r-AI were obtained by applanation tonometry of the radial artery (HEM-9000AI, Onrom). The patients were allocated into r-AI tertiles (r-AI < 85%; 85< r-AI < 97%; r-AI > 97%). RESULTS: The sample was predominantly composed of women (56.4%), mean age of 61.7 ± 11.7 years and body mass index 29.6 ± 6.1 Kg/m². The highest tertile showed higher proportion of women (p = 0.001), higher systolic BP (p = 0.001) and pulse pressure (p = 0.014), and lower weight (p = 0.044), height (p < 0.001) and heart rate (p < 0.001). Multivariate analysis demonstrated that weight (ß = -0.001, p = 0.017), heart rate (ß = -0.001, p = 0.007) and central pressure (ß = 0.015, p < 0.001) correlated independently with r-AI. In logistic regression analyses, the 3rd r-AI tertile was associated to lower levels of diabetes (DM) (OR = 0.41; 95% CI 0.17-0.97; p = 0.042). CONCLUSION: This study demonstrated that weight, heart rate and central BP were independently related to r-AI.

Medical students' knowledge about end-of-life decision-making / Conhecimento de Estudantes de Medicina sobre Tomada de Decisão no Fim da Vida

The influence of medical students' knowledge concerning end-of-life care, considering ethical theories and clinical practice, remains controversial. We aimed to investigate medical students' knowledge of bioethical concepts related to moral kinds of death (euthanasia, disthanasia, and orthothanasia) and to analyze the influence of their clinical experience on practicing such approaches in a tertiary hospital in the state of São Paulo, Brazil. We interviewed 180 medical students [distributed in Group 1 (G1) - first to third- year students, and Group 2 (G2) - fourth to sixth-year students] to evaluate the influence of the course on "medical ethics" on ethical theories and clinical practice, using a closed questionnaire. The course on "medical ethics" did not distinguish the groups (P=0.704) in relation to bioethical concepts. Neologisms such as "cacothanasia" and "idiothanasia" were incorrectly viewed as bioethical concepts by 28 percent of the interviewees. Moreover, 45.3 percent of the sample considered health care professionals incapable of managing terminally ill patients, especially G2 (29 percent) as compared to G1 (16.5 percent, P=0.031). The concept of euthanasia was accepted by 41 percent of sample, as compared to 98.2 percent for orthothanasia. Among medical students that accepted ways to abbreviate life (22.9 percent), 30.1 percent belonged to G1, and only 16.1 percent to G2 (P=0.049). These medical students were unfamiliar with common bioethical concepts. Moreover, they considered healthcare professionals incapable of managing terminally ill patients. The ethical ideal of the "good death" reflects better acceptance of orthothanasia by medical students, suggesting a tendency to apply it in their future clinical practice.

A influência do conhecimento de estudantes de medicina sobre o manejo com o fim da vida, considerando teorias éticas e aplicabilidade clínica, permanece controversa. Objetivamos investigar o conhecimento de estudantes de medicina sobre conceitos bioéticos a respeito dos tipos morais de morte (Eutanásia, Distanásia e Ortotanásia) e analisar a influência de suas experiências clínicas para praticá-los, em um hospital terciário do estado de São Paulo, Brasil. Nós entrevistamos 180 estudantes de medicina [distribuídos em Grupo 1 (G1) - estudantes do primeiro ao terceiro ano de graduação em medicina e Grupo 2 (G2) - estudantes do quarto ao sexto ano] para avaliar a influência do "curso de ética médica" em teorias éticas e prática clínica, utilizando um questionário fechado. O "curso de ética médica" não diferiu os grupos (P=0.704) sobre os conceitos bioéticos. Neologismos como Cacotanásia e Idiotanásia foram erroneamente considerados como conceitos bioéticos por 28 por cento dos indivíduos. Além disso, 45.3 por cento da amostra consideraram os profissionais de saúde inaptos ao manejo de pacientes terminais, principalmente G2 (29 por cento) comparado a G1 (16.5 por cento, P=0.031). O conceito de Eutanásia foi aceito por 41 por cento da amostra, enquanto Ortotanásia por 98.2 por cento. Dentre os estudantes de medicina que aceitaram maneiras para abreviar a vida (22.9 por cento), 30.1 por cento deles pertenciam a G1 enquanto somente 16.1 por cento a G2 (P=0.049). Estudantes de medicina mostram desconhecimento sobre conceitos clássicos em Bioética. Além disso, consideram os profissionais de saúde inaptos ao manejo de pacientes terminais. O ideal ético considerando a "boa morte" reflete melhor aceitação dos estudantes de medicina pela Ortotanásia, sugerindo tendência em aplicá-la em sua futura prática clínica.

[Absence of nocturnal dipping is associated with stroke and myocardium infarction]. / Ausência de descenso noturno se associa a acidente vascular cerebral e infarto do miocárdio.

BACKGROUND: The arterial hypertension varies in according to the circadian cycle, presenting physiologic fall of blood pressure (BP) during sleep (dipping). The absence of this fall or its increase associates to higher incidence of target-organ damages. OBJECTIVE: To analyze the prevalence of dipping in hypertensive individuals, to correlate dipping to the blood pressure levels, clinic, and socio-demographic factors, and biochemical characteristics and to associate it cardiovascular events (stroke and myocardial infarction). METHODS: Hypertensive individuals were submitted to the ambulatory blood pressure monitoring. Presence of dipper was defined as fall >10% of the systolic BP of the day for sleep. RESULTS: 163 evaluated patients were divided in dippers (D, n=53) and nondippers (ND, n=110). Between the groups there was not significant difference to the age, sex, race, time of hypertension, glycemia, LDL-cholesterol, total cholesterol, triglycerides, schooling, smoking, and history of diabetes. D presented BP higher than the ND during the day and lower during sleep. ND had higher body mass index (BMI) (p=0.0377), lower level of HDL-cholesterol (p=0.0189), and higher pulse pressure during sleep (p=0.0025). History of stroke alone (p=0,046) and combined with myocardial infarction (p=0.032) were more frequent in nondippers individuals. In the logistic regression, only ND was associated independently with stroke or myocardial infarction. CONCLUSION: ND was associated in an independent way with the target-organ damages analyzed, what demonstrates its importance and strengthens the necessity of more aggressive treatment with objective to reach BP goals e, consequently, to prevent the development of new cardiologic and cerebrovascular events.

Prevalência e fatores de risco para hipertensão em uma população urbana brasileira / Hypertension prevalence and risk factors in a Brazilian urban population

FUNDAMENTO: Os estudos disponíveis não analisaram de modo abrangente os vários fatores envolvidos na gênese da hipertensão (HT), especialmente a associação entre pressão arterial, excreção urinária de sódio e disfunção renal. OBJETIVO: Avaliar a prevalência dos fatores de risco para HT em diferentes grupos etários em uma amostra representativa da uma população urbana brasileira. MÉTODOS: A população estudada (1.717 indivíduos adultos) foi avaliada por grupos etários: 18 a 39 anos; 40 a 49; 50 a 59; 60 a 69 e > 70 anos. As médias das variáveis quantitativas e as variáveis categóricas dos grupos normotenso e hipertenso foram comparadas. RESULTADOS: A prevalência geral ajustada para HT foi de 25,23 por cento. A prevalência aumentou com a idade e era mais alta em indivíduos com baixo nível educacional. Índice de massa corporal e circunferência abdominal aumentados estavam positivamente associados com uma maior prevalência de HT. Havia uma associação positiva significante entre HT e excreção urinaria de sódio. Os indivíduos hipertensos apresentavam maior frequência de disfunção renal, definida como clearance de creatinina <60 ml/min/m². A prevalência de diabetes mellitus na população geral era de 5,6 por cento e 14,5 por cento nos indivíduos hipertensos. A hipertensão era uma condição conhecida por 74,4 por cento dos indivíduos hipertensos. Entre os indivíduos hipertensos tratados, 52,4 por cento tinham a hipertensão controlada e apenas 34,3 por cento dos pacientes hipertensos no geral (tratados ou não) tinham a pressão arterial controlada. CONCLUSÃO: Esse estudo de base populacional é especial devido ao fato de agregar diferentes fatores demográficos, epidemiológicos e de risco envolvidos na gênese da hipertensão na avaliação de uma única amostra com um cálculo populacional que pode ser extrapolado para outras populações hipertensas.

BACKGROUND: The available studies have not fully analyzed the several factors involved in the genesis of hypertension (HT), especially the association among blood pressure, urinary sodium excretion and renal dysfunction. OBJECTIVE: To assess the HT prevalence and risk factors in different age groups in a representative sample of an urban Brazilian population. METHODS: The studied population (1717 adult individuals) was evaluated by age groups: 18 to 39 years; 40 to 49; 50 to 59; 60 to 69 and > 70 years. Quantitative variable means and categorical variables of the hypertensive and normotensive groups were compared. RESULTS: The adjusted overall prevalence of HT was 25.23 percent. The prevalence increased with age and was higher in individuals with low educational level. Increased body mass index and abdominal waist were positively related to a higher prevalence of HT. There was a significant positive association between HT and urinary sodium excretion. Hypertensive individuals presented higher frequency of renal dysfunction, defined as measured creatinine clearance <60 ml/min/m². The prevalence of diabetes mellitus was 5.6 percent in the overall population and 14.5 percent in hypertensive individuals. Hypertension was a known condition to 74.4 percent of the hypertensive individuals. Among treated hypertensive individuals, 52.4 percent achieved controlled blood pressure and only 34.3 percent of the overall hypertensive patients (treated or not) had blood pressure controlled. CONCLUSION: This population-based is unique by gathering different demographic, epidemiologic and risk factors involved in the genesis of hypertension in a single sample assessment with a population calculation, which might be extrapolated to other hypertensive populations.

[Hypertension prevalence and risk factors in a Brazilian urban population]. / Prevalência e fatores de risco para hipertensão em uma população urbana brasileira.

BACKGROUND: The available studies have not fully analyzed the several factors involved in the genesis of hypertension (HT), especially the association among blood pressure, urinary sodium excretion and renal dysfunction. OBJECTIVE: To assess the HT prevalence and risk factors in different age groups in a representative sample of an urban Brazilian population. METHODS: The studied population (1717 adult individuals) was evaluated by age groups: 18 to 39 years; 40 to 49; 50 to 59; 60 to 69 and > 70 years. Quantitative variable means and categorical variables of the hypertensive and normotensive groups were compared. RESULTS: The adjusted overall prevalence of HT was 25.23%. The prevalence increased with age and was higher in individuals with low educational level. Increased body mass index and abdominal waist were positively related to a higher prevalence of HT. There was a significant positive association between HT and urinary sodium excretion. Hypertensive individuals presented higher frequency of renal dysfunction, defined as measured creatinine clearance <60 ml/min/m(2). The prevalence of diabetes mellitus was 5.6% in the overall population and 14.5% in hypertensive individuals. Hypertension was a known condition to 74.4% of the hypertensive individuals. Among treated hypertensive individuals, 52.4% achieved controlled blood pressure and only 34.3% of the overall hypertensive patients (treated or not) had blood pressure controlled. CONCLUSION: This population-based is unique by gathering different demographic, epidemiologic and risk factors involved in the genesis of hypertension in a single sample assessment with a population calculation, which might be extrapolated to other hypertensive populations.

Ausência de descenso noturno se associa a acidente vascular cerebral e infarto do miocárdio / Absence of nocturnal dipping is associated with stroke and myocardium infarction / La ausencia de descenso nocturno de la presión arterial se asocia a accidente cerebrovascular e infarto de miocardio

Fundamento: A pressão arterial (PA) varia de acordo com o ciclo circadiano, apresentando quedas fisiológicas durante o sono (descenso noturno - DN). A ausência dessa queda se associa a maior incidência de lesões em órgãos-alvo. Objetivo: Analisar a prevalência de DN em indivíduos hipertensos, correlacionar DN aos níveis pressóricos, variáveis clínicas, fatores sociodemográficos e bioquímicos e associá-lo a eventos cardiovasculares (acidente vascular cerebral - AVC e infarto agudo do miocárdio - IAM). Métodos: Foram avaliados 163 hipertensos, submetidos a monitorização ambulatorial da pressão arterial. DN foi definido como queda >10 por cento da PA sistólica do período da vigília para o de sono. Resultados: Os pacientes foram divididos em grupos dipper (D) e não dipper (ND). Não houve diferença significante entre os grupos quanto a idade, sexo, raça, tempo de hipertensão, glicemia, LDL-colesterol, colesterol total, triglicérides, escolaridade, tabagismo, história de diabetes. Grupo dipper apresentou PA superior a ND durante a vigília e inferior durante o sono. Grupo ND cursou com maior índice de massa corpórea (IMC) (p=0,0377), menor HDL-colesterol (p=0,0189) e maior pressão de pulso durante o sono (p=0,0025). História de AVC ou IAM foram mais frequentes em ND. À regressão logística, apenas a ausência de descenso noturno associou-se independentemente a AVC ou IAM. Conclusão: A ausência de DN associou-se de maneira independente às lesões em órgãos-alvo analisadas, o que demonstra a sua importância e reforça a necessidade de tratamento mais agressivo com objetivo de se atingir as metas pressóricas e, consequentemente, evitar o desenvolvimento de novos eventos cardiocerebrovasculares.

Background: The arterial hypertension varies in according to the circadian cycle, presenting physiologic fall of blood pressure (BP) during sleep (dipping). The absence of this fall or its increase associates to higher incidence of target-organ damages. Objective: To analyze the prevalence of dipping in hypertensive individuals, to correlate dipping to the blood pressure levels, clinic, and socio-demographic factors, and biochemical characteristics and to associate it cardiovascular events (stroke and myocardial infarction). Methods: Hypertensive individuals were submitted to the ambulatory blood pressure monitoring. Presence of dipper was defined as fall >10 percent of the systolic BP of the day for sleep. Results: 163 evaluated patients were divided in dippers (D, n=53) and nondippers (ND, n=110). Between the groups there was not significant difference to the age, sex, race, time of hypertension, glycemia, LDL-cholesterol, total cholesterol, triglycerides, schooling, smoking, and history of diabetes. D presented BP higher than the ND during the day and lower during sleep. ND had higher body mass index (BMI) (p=0.0377), lower level of HDL-cholesterol (p=0.0189), and higher pulse pressure during sleep (p=0.0025). History of stroke alone (p=0,046) and combined with myocardial infarction (p=0.032) were more frequent in nondippers individuals. In the logistic regression, only ND was associated independently with stroke or myocardial infarction. Conclusion: ND was associated in an independent way with the target-organ damages analyzed, what demonstrates its importance and strengthens the necessity of more aggressive treatment with objective to reach BP goals e, consequently, to prevent the development of new cardiologic and cerebrovascular events.

Fundamento: La presión arterial (PA) varía de acuerdo al ciclo circadiano, presentando descensos fisiológicos durante el sueño (descenso nocturno - DN). La ausencia de ese descenso se asocia a mayor incidencia de lesiones en órganos blanco. Objetivo: Analizar la prevalencia de DN en individuos hipertensos, correlacionar DN a los niveles de presión, variables clínicas, factores sociodemográficos y bioquímicos y asociarlos a eventos cardiovasculares (accidente cerebrovascular - ACV e infarto agudo de miocardio - IAM). Métodos: Fueron evaluados 163 hipertensos, sometidos a monitoreo ambulatorio de la presión arterial. El DN fue definido como descenso > 10 por ciento de la PA sistólica del período de vigilia al de sueño. Resultados: Los pacientes fueron divididos en grupos dipper (D) y no dipper (ND). No existió diferencia significativa entre los grupos en cuanto a edad, sexo, raza, tiempo de hipertensión, glucemia, LDL-colesterol, colesterol total, triglicéridos, escolaridad, tabaquismo, historia de diabetes. El Grupo dipper presentó PA superior al ND durante la vigilia e inferior durante el sueño. El Grupo ND cursó con mayor índice de masa corporal (IMC) (p=0,0377), menor HDL-colesterol (p=0,0189) y mayor presión de pulso durante el sueño (p=0,0025). Historia de ACV o IAM fueron más frecuentes en ND. En la regresión logística, sólo la falta de descenso nocturno se asoció independientemente del ACV o del IAM. Conclusión: La ausencia de DN se asoció de manera independiente a las lesiones en órganos blanco analizadas, lo que demuestra su importancia y refuerza la necesidad de tratamiento más agresivo con el objetivo de alcanzar las metas tensionales y, en consecuencia, evitar el desarrollo de nuevos eventos cardio y cerebrovasculares.

Prevalence and sociodemographic factors in a hypertensive population in São José do Rio Preto, São Paulo, Brazil.

BACKGROUND: Systemic arterial hypertension (SAH) is one of the greatest problems of public health in Brazil. Its detection and early treatment should be a priority to reduce the morbimortality of the cardiovascular diseases. OBJECTIVE: This study aimed at assessing the prevalence of SAH and the sociodemographic factors in a population of hypertensive individuals from São José do Rio Preto, São Paulo, Brazil. METHODS: A cross-sectional study was carried out in a stratified sample of 1,717 people, representative of the urban adult population from the city of São José do Rio Preto, between 2004 and 2005. RESULTS: The sample consisted of 1,717 people, with 762 of them (25.2%) being characterized as hypertensive. The following results were observed: 54.6% were women; 78.4% were caucasian; 66.1% were illiterate or had not finished Elementary School; 63.9% were married, 40.9% belonged to social classes D and E; 37.9% were self-employed or wage earners. CONCLUSION: The results of study on SAH in the city of São José do Rio Preto shows the need for early-onset continuous educational interventions.

Prevalência e fatores sociodemográficos em hipertensos de São José do Rio Preto - SP / Prevalence and sociodemographic factors in a hypertensive population in São José do Rio Preto, São Paulo, Brazil

FUNDAMENTO: A hipertensão arterial sistêmica (HAS) constitui um dos maiores problemas de saúde pública no Brasil. Sua detecção e tratamento precoce devem ser prioridades para reduzir a morbidade e mortalidade das doenças cardiovasculares. OBJETIVO: Neste estudo objetivou-se estimar a prevalência de hipertensão arterial sistêmica na população e identificar os fatores sociodemográficos dos hipertensos de São José do Rio Preto - SP/Brasil. MÉTODOS: Em 2004/2005, realizou-se um estudo transversal, em amostra de 1.717 indivíduos estratificada por faixa etária, representativa da população adulta e urbana da cidade de São José do Rio Preto - SP/Brasil. RESULTADOS: A amostra foi constituída por 1.717 indivíduos, dos quais 762 (25,2 por cento) eram hipertensos: 54,6 por cento eram mulheres; 78,4 por cento, brancos; 66,1 por cento, analfabetos/Ensino Fundamental incompleto; 63,9 por cento, casados; 40,9 por cento, classes sociais D e E; 37,9 por cento, inseridos no mercado de trabalho como profissionais liberais ou assalariados. CONCLUSÃO: Os resultados do estudo da HAS em São José do Rio Preto indicam a necessidade de intervenções educacionais contínuas de início precoce.

BACKGROUND: Systemic arterial hypertension (SAH) is one of the greatest problems of public health in Brazil. Its detection and early treatment should be a priority to reduce the morbimortality of the cardiovascular diseases. OBJECTIVE: This study aimed at assessing the prevalence of SAH and the sociodemographic factors in a population of hypertensive individuals from São José do Rio Preto, São Paulo, Brazil. METHODS: A cross-sectional study was carried out in a stratified sample of 1,717 people, representative of the urban adult population from the city of São José do Rio Preto, between 2004 and 2005. RESULTS: The sample consisted of 1,717 people, with 762 of them (25.2 percent) being characterized as hypertensive. The following results were observed: 54.6 percent were women; 78.4 percent were caucasian; 66.1 percent were illiterate or had not finished Elementary School; 63.9 percent were married, 40.9 percent belonged to social classes D and E; 37.9 percent were self-employed or wage earners. CONCLUSION: The results of study on SAH in the city of São José do Rio Preto shows the need for early-onset continuous educational interventions.

Hipertensão arterial: aspectos farmacológicos e terapêuticos / Arterial Hypertension: pharmacological and therapeutics aspects

A hipertensão arterial sistêmica (HAS) é uma doença poli­gênica, multifatorial, caracterizada por aumento da resistência vascular, associada a alterações metabólicas e hormonais com repercussão em órgãos-alvo, sendo responsável por cerca de 40% de incapacitação e alta frequência de internações A prevalência da hipertensão arterial varia de 22% a 44% em diferentes países e regiões. Em estudo realizado em São José do Rio Preto (SP), na população adulta (maior e igual a 18 anos) a prevalência (populacional) de hipertensão arterial foi de 26% com a seguinte distribuição por faixas etárias: 18 a 39: 11%; 40-49: 24%; 50 a 59: 45%; 60 a 69: 66% e maior e igual a 70: 69%3. Sir George Pickering admitia a não existência de valores li­mítrofes entre a normotensão e hipertensão, mas, ao contrário, a relação entre pressão arterial e mortalidade é quantitativa, significando que quanto maior o nível pressórico, pior será o prognóstico, sendo qualquer valor divisório, arbitrário...