Left Ventricular Remodeling Patterns in Primary Healthcare / Padrões de Remodelamento Ventricular Esquerdo na Atenção Primária à Saúde

Abstract Background: Left ventricular remodeling (LVR) is related to both non-fatal and fatal outcomes. Objective: To describe the geometric patterns of the LV and their associations. Methods: A total of 636 individuals between the ages of 45 and 99 years in Rio de Janeiro, Brazil, were submitted to clinical evaluation, laboratory tests, electrocardiogram, and tissue Doppler echocardiography (TDE). The difference between categories was tested with Kruskall-Wallis with post hoc tests, once all variables studied are non-normally distributed and Pearson's Qui-square (categorical variables). Gross and adjusted ORs were estimated by logistic regression. The level of significance was 5% for all tests. Subjects had LVR characterized as: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Results: The prevalence of altered patterns was 33%. Subjects presented NG (n = 423; 67%); EH (n = 186; 29%); CH (n = 14; 2%); and CR (n = 13; 2%). The variables of gender, age, level of education and albumin/creatinine ratio (A/C), showed a relationship with the chance of EH even after adjustment. Conclusion: Approximately one third of the studied individuals had LVR and were at risk for developing heart failure. Altered A/C in urine was associated with EH, indicating an early relationship between cardiac and renal dysfunction.

Resumo Fundamento: O remodelamento ventricular esquerdo (RVE) está relacionado a desfechos não fatais e fatais. Objetivo: Descrever os padrões geométricos do VE e suas associações. Métodos: Um total de 636 indivíduos entre 45 e 99 anos no Rio de Janeiro, Brasil, foi submetido a avaliação clínica, exames laboratoriais, eletrocardiograma e ecocardiograma com Doppler tecidual (EDT). A diferença entre as categorias foi testada com Kruskall-Wallis com testes post hoc, uma vez que todas as variáveis estudadas não são normalmente distribuídas e o qui-quadrado de Pearson (variáveis categóricas). As ORs brutas e ajustadas foram estimadas por regressão logística. O nível de significância foi de 5% para todos os testes. Os indivíduos tinham RVE caracterizada como: geometria normal (GN), remodelamento concêntrico (RC), hipertrofia concêntrica (HC) e hipertrofia excêntrica (HE). Resultados: A prevalência de padrões alterados foi de 33%. Os sujeitos apresentaram GN (n = 423; 67%); HE (n = 186; 29%); HC (n = 14; 2%); e RC (n = 13; 2%). As variáveis sexo, idade, escolaridade e razão albumina/creatinina (A/C) mostraram relação com a chance de HE, mesmo após o ajuste. Conclusão: Aproximadamente um terço dos indivíduos estudados apresentavam RVE e corriam risco de desenvolver insuficiência cardíaca. A/C alterada na urina foi associada à HE, indicando uma relação precoce entre disfunção cardíaca e renal.

Análisis de la no adherencia al tratamiento en el paciente hipertenso / Analysis of no adherence to treatment in hypertensive patients

Introducción: los pacientes hipertensos necesitan estar seguros de que el control de la tensión arterial reducirá las complicaciones de la enfermedad, mientras los médicos quieren una guía basada en la evidencia para poder controlar a estos enfermos, por lo que esto constituye un grave problema de salud a nivel mundial, la problemática sobre el control y el daño de órgano diana justificó este estudio. Objetivo: conocer el impacto del descontrol de la hipertensión arterial en la atención primaria de salud. Materiales y métodos: se realizó un estudio descriptivo transversal, sobre la prevalencia de la hipertensión arterial descontrolada, en un grupo de pacientes en un consultorio. Resultados: existió un incremento de la hipertensión paralelo a la edad, predominó el sexo femenino y la raza blanca, con una elevada presencia de factores de riesgo, lo que unido al descontrol empeora el pronóstico de este grupo, siendo la principal causa de abandono el tratamiento la aparición de efectos secundarios y la baja estima en que se tuvieron las medicaciones y la dieta para el control de la hipertensión arterial. Conclusiones: una adecuada fracción de la población hipertensa se encontraba controlada, aunque se encontró un elevado por ciento de la población con factores de riesgo, un descontrol casi total sobre la dieta, siendo la principal causa de abandono el tratamiento la aparición de efectos secundarios y la baja estima en que se tuvieron las medicaciones, lo que ocasionó una elevada frecuencia de complicaciones (AU).

Introduction: hypertensive patients should be sure of that controlling arterial pressure will reduce the disease´s complications, while physicians want an evidence based guideline to control these patients, so this is a serious health problem around the world. The problem of control and target organ damage justified this study. Objetive: to know the impact of arterial hypertension lack of control in primary health care. Materials and methods: a cross-sectional, descriptive study was carried out on the uncontrolled arterial hypertension in a group of patients of a medical consultation. Results: there it was an increase of hypertension in parallel to age; female sex and white race predominated, with a high presence of risk factors; all of that, together with lack of control, makes prognosis worse in this group. The main causes of treatment desertion were the appearance of secondary effects and the low estimation for the medication and diet to control the arterial hypertension. Conclusions: an adequate fraction of the hypertensive population was controlled, although a high percent of the population was found with risk factors, with a lack of control on their diet; the appearance of secondary effects and the low estimation for the medication were the main cause of treatment desertion, inducing a high frequency of complications (AU).

Análisis de la no adherencia al tratamiento en el paciente hipertenso / Analysis of no adherence to treatment in hypertensive patients

Introducción: los pacientes hipertensos necesitan estar seguros de que el control de la tensión arterial reducirá las complicaciones de la enfermedad, mientras los médicos quieren una guía basada en la evidencia para poder controlar a estos enfermos, por lo que esto constituye un grave problema de salud a nivel mundial, la problemática sobre el control y el daño de órgano diana justificó este estudio. Objetivo: conocer el impacto del descontrol de la hipertensión arterial en la atención primaria de salud. Materiales y métodos: se realizó un estudio descriptivo transversal, sobre la prevalencia de la hipertensión arterial descontrolada, en un grupo de pacientes en un consultorio. Resultados: existió un incremento de la hipertensión paralelo a la edad, predominó el sexo femenino y la raza blanca, con una elevada presencia de factores de riesgo, lo que unido al descontrol empeora el pronóstico de este grupo, siendo la principal causa de abandono el tratamiento la aparición de efectos secundarios y la baja estima en que se tuvieron las medicaciones y la dieta para el control de la hipertensión arterial. Conclusiones: una adecuada fracción de la población hipertensa se encontraba controlada, aunque se encontró un elevado por ciento de la población con factores de riesgo, un descontrol casi total sobre la dieta, siendo la principal causa de abandono el tratamiento la aparición de efectos secundarios y la baja estima en que se tuvieron las medicaciones, lo que ocasionó una elevada frecuencia de complicaciones (AU).

Introduction: hypertensive patients should be sure of that controlling arterial pressure will reduce the disease´s complications, while physicians want an evidence based guideline to control these patients, so this is a serious health problem around the world. The problem of control and target organ damage justified this study. Objetive: to know the impact of arterial hypertension lack of control in primary health care. Materials and methods: a cross-sectional, descriptive study was carried out on the uncontrolled arterial hypertension in a group of patients of a medical consultation. Results: there it was an increase of hypertension in parallel to age; female sex and white race predominated, with a high presence of risk factors; all of that, together with lack of control, makes prognosis worse in this group. The main causes of treatment desertion were the appearance of secondary effects and the low estimation for the medication and diet to control the arterial hypertension. Conclusions: an adequate fraction of the hypertensive population was controlled, although a high percent of the population was found with risk factors, with a lack of control on their diet; the appearance of secondary effects and the low estimation for the medication were the main cause of treatment desertion, inducing a high frequency of complications (AU).