Device and nondevice-guided slow breathing to reduce blood pressure in hypertensive patients: A systematic review and meta-analysis.

Backgroud and Aims: Hypertension (HTN) is a multifactorial chronic disease. Considering the high prevalence rates of this disease, treatment of HTN is necessary, not only to reduce blood pressure (BP) levels but also to prevent the development of cardiovascular, cerebrovascular, and kidney diseases. This treatment can be through medication, which will be determined according to the BP values, obtained either in medical consultations or at home; presence of cardiovascular risk factors, and the presence of target organ damage identified during anamnesis. The aim of this systematic review and meta-analysis is to summarize the effects of device-guided slow breathing (DGSB) and nondevice-guided slow breathing (NDGSB) on BP levels of patients with HTN. Methods: This study is a systematic review and meta-analysis of randomized clinical trials, pertaining to hypertensive patients, with or without comorbidity, over 18 years old, of both sexes, and with or without hypertensive medication. The selected studies showed comparisons between groups that performed DGSB and/or NDGSB with control conditions. The primary outcome was the value of systolic blood pressure (SBP) and diastolic blood pressure (DBP) after the interventions. Results: Twenty-two studies involving 17,214 participants were included in the quantitative analysis. Considerable heterogeneity was revealed between studies. Using random effect model, it was found that DGSB did not significantly reduce SBP and DBP compared to usual care, both in terms BP values and in relation to their variations (SBP, mean difference [MD]: -2.13 mmHg, (95% confidence interval [CI]: -12.71 to 8.44), 288 individuals; I 2 = 93%, high heterogenity: DBP, MD: -0.90, 95% CI: -3.97 to 2.11, 288 individuals; I 2 = 63%, substantial heterogenity. SBP variations MD: -2.42, 95% CI: -7.24 to 2.40, 443 individuals; I 2 = 85% high heterogenity/DBP variations MD: -1.67, 95% CI: -4.57 to 1.24, 443 individuals; I 2 = 80%, high heterogenity). Conclusion: Based on these results it appears that DGSB did not reduce BP in hypertensive patients and NDGSB is a new path for the future.

Knowledge and practice outcomes after home blood pressure measurement education programs.

OBJECTIVES: We investigated the outcomes of three home blood pressure measurement (HBPM) education programs on adult knowledge and practice. METHODS: We chose a pretest/post-test design and randomly divided 95 adults into three groups: individual training (group A), group training (group B), and self-learning (group C), for education regarding HBPM in accordance with the Canadian Hypertension Education Program. Participants involved in groups A and B received interactive education led by a nurse. Participants in group C learned by themselves using an instruction booklet and a HBPM device lent to them for 7 days. Knowledge was assessed pretest and post-test by questionnaire. Skills were evaluated postintervention by direct observation. RESULTS: Analysis of the 60 participants indicated significant knowledge improvement. Pretest scores of 38 (group A), 54 (group B), and 45% (group C) rose significantly to 97, 99, and 90%, respectively (pretest vs. post-test; P<0.0001). Individual and group training sessions were significantly more effective compared with the self-learning program, which was confirmed by differences between groups in post-test practice. Assessment scores: 74 (group A), 79 (group B), and 53% (group C; group A vs. group C; P=0.001, group B vs. group C; P=0.001). CONCLUSION: Our findings indicate that adults attending an individual or group training program for HBPM retained its theoretical and practical principles better than those engaged in self-learning. Their success may be attributed to interaction with the nurse.

Perfil de hipertensos em um núcleo de saúde da família / Hypertensives profile in a family health center

O estudo caracteriza o perfil de hipertensos em um Núcleo de Saúde da Família do interior paulista. As variáveis sexo, idade, escolaridade, doenças associadas e tratamento foram obtidas da ficha A do SIAB(Sistema de Informação da Atenção Básica); do prontuário médico e analisadas pelo programa Epi-Info. A população foi de 343 hipertensos. Destes, 188 são usuários do serviço, sendo 70% mulheres e 30% homens;74,80% idosas, 66,66% idosos; 7,44% analfabetos, 65,42% com 1º grau de escolaridade, 15,95% com 2º graue 5,31% com ensino superior. As doenças mais referidas foram as cardiovasculares que se destacam com os percentuais mais elevados atingindo 25,53%, o diabetes aparece em 22,34%; seguido da dislipidemia (20,74%), obesidade (17,02%), tabagismo (5,31%), doença cérebro vascular (4,78%) e doença renal (1,59%). Os fármacos mais utilizados foram os Inibidores da Enzima Conversora de Angiotensina, Diréticos Tiazídicos, Anti-agregantes plaquetários e os Hipoglicemiantes orais. Tais resultados poderão subsidiar o desenvolvimentode estratégias para prevenção de complicações e retardo de agravos.

This study characterizes the hypertensives´ profile in a Family Health Care Center from the interior of SãoPaulo. The variables such as the age, sex, years of study and treatment were taken from the registered cardA from the BHIS (Basic Health Information System), and the medical record; these were analyzed by the EpiInfo program. A total of 343 hypertensives comprised the population. Out of these, 188 were users of this service: 70% women and 30% men, 74.8% elderly women, 66.6% elderly men, 7.44% were illiterate, 65.42% had primary school, 15.95% had high school and 5.31% had university level. Cardiovascular disease was theleading reported disease, the highest percentual (25.53%), diabetes (22.34%), following dislipidemy (20.74%),obesity (17.02%), tobacco (5.31%), brain disease (4.78%) and kidney disease (1.59%). The drugs most used were Angiotensina converting enzyme inhibition, Diuretics, Aspirin, and Hipoglicemiants. These results canprovide the development of strategies for prevention of short and long-term complications.

Caracteristicas e resultados do atendimento de pacientes na Unidade de Hipertensäo do Hospital das Clínicas da Faculdade de Medicina de Ribeiräo Preto da Universidade de Säo Paulo / Characteristics and results of attendences of hypertensives patients in the hypertension unit of Clinical Hospital of Medicine School of Ribeiräo Preto, Säo Paulo University

Objetivo- Avaliar as características e os resultados do atendimento de pacientes hipertensos em serviços especializados. Métodos-Estudo prospectivo de avaliaçäo de pacientes submetidos a diagnóstico, a tratamento e a seguimento em serviço especializado de hipertensäo. Objetivou-se analisar o comportamento de uma populaçäo com vistas a alguns parâmetros bem definidos, tais como: atraso, faltas, abandono aos retornos marcados e observância à terapêutica proposta, em períodos de um ano e no total de tempo compreendido entre janeiro de 1995 e maio de 1998. Resultados-A observanciâ aos esquemas prescritos e às orientaçöes oferecidas aos pacientes, neste grupo estudado, considerando as condiçöes específicas de atendimento implementadas foi similar àquelas descritas na literatura. Entretanto, a implementaçäo de esquemas de orientaçöes e programas educacionais peculiares mostraram maior observância ao tratamento sem, no entanto, modificar os percentuais de controle da pressäo arterial, fator que, sabidamente, depende de outros aspectos. Conclusäo-A constituíçäo de serviços multidisciplinares com programas específicos de atendimento e orientaçäo aos pacientes leva, através de um melhor conhecimento da doença, à maior observancia às orientaçöes terapêuticas sem, entretanto, haver modificaçäo dos percentuais de pacientes controlados.(au)