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1.
Medicine (Baltimore) ; 100(5): e24127, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592863

RESUMO

BACKGROUND: It is well known that morning blood pressure surge increases the risk of myocardial events in the first several hours post-awakening. This meta-analysis was performed to compare the antihypertensive efficacy of morning and bedtime dosing on decreasing morning blood pressure surge. METHODS: Articles in 4 databases about clinical trials of ingestion time of antihypertensive drugs were searched and performed a meta-analysis to evaluate the different effects on morning blood pressure and absolute blood pressure (BP) reduction from baseline of between bedtime administration (experimental group) and morning awaking administration (control group). RESULTS: The aim of this study is to compare the antihypertensive efficacy of morning and bedtime dosing on decreasing morning blood pressure surge. CONCLUSIONS: The bedtime will provide evidence support for clinicians and patients for reducing morning blood pressure surge. ETHICS AND DISSEMINATION: This study does not require ethical approval.


Assuntos
Anti-Hipertensivos , Cronoterapia Farmacológica , Hipertensão , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/farmacocinética , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial/métodos , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Metanálise como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
2.
BMJ ; 372: m4858, 2021 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468518

RESUMO

OBJECTIVE: The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. DESIGN: Unmasked randomised controlled trial with automated ascertainment of primary endpoint. SETTING: 76 general practices in the United Kingdom. PARTICIPANTS: 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. INTERVENTIONS: Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. MAIN OUTCOME MEASURES: The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. RESULTS: After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of -3.4 mm Hg (95% confidence interval -6.1 to -0.8 mm Hg) and a mean difference in diastolic blood pressure of -0.5 mm Hg (-1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. CONCLUSIONS: The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. TRIAL REGISTRATION: ISRCTN13790648.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/métodos , Pressão Sanguínea/fisiologia , Hipertensão/terapia , Autogestão , Telemedicina/métodos , Idoso , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Monitorização Ambulatorial da Pressão Arterial/economia , Monitorização Ambulatorial da Pressão Arterial/normas , Feminino , Medicina Geral/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Reino Unido
3.
Lancet Neurol ; 19(11): 899-907, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33098800

RESUMO

BACKGROUND: Results from the Systolic Blood Pressure Intervention Trial (SPRINT) showed that intensive control of systolic blood pressure significantly reduced the occurrence of mild cognitive impairment, but not probable dementia. We investigated the effects of intensive lowering of systolic blood pressure on specific cognitive functions in a preplanned substudy of participants from SPRINT. METHODS: SPRINT was an open-label, multicentre, randomised controlled trial undertaken at 102 sites, including academic medical centres, Veterans Affairs medical centres, hospitals, and independent clinics, in the USA and Puerto Rico. Participants were adults aged 50 years or older with systolic blood pressure higher than 130 mm Hg, but without diabetes, history of stroke, or dementia. Participants were randomly assigned (1:1) to a systolic blood pressure goal of less than 120 mm Hg (intensive treatment) versus less than 140 mm Hg (standard treatment). All major classes of antihypertensive agents were included. A subgroup of randomly assigned participants including, but not limited to, participants enrolled in an MRI substudy was then selected for a concurrent substudy of cognitive function (target 2800 participants). Each individual was assessed with a screening cognitive test battery and an extended cognitive test battery at baseline and biennially during the planned 4-year follow-up. The primary outcomes for this substudy were standardised composite scores for memory (Logical Memory I and II, Modified Rey-Osterrieth Complex Figure [immediate recall], and Hopkins Verbal Learning Test-Revised [delayed recall]) and processing speed (Trail Making Test and Digit Symbol Coding). SPRINT was registered with ClinicalTrials.gov, NCT01206062. FINDINGS: From Nov 23, 2010, to Dec 28, 2012, 2921 participants (mean age 68·4 years [SD 8·6], 1080 [37%] women) who had been randomly assigned in SPRINT were enrolled in the substudy (1448 received intensive treatment and 1473 received standard treatment). SPRINT was terminated early due to benefit observed in the primary outcome (composite of cardiovascular events). After a median follow-up of 4·1 years (IQR 3·7-5·8), there was no between-group difference in memory, with an annual decline in mean standardised domain score of -0·005 (95% CI -0·010 to 0·001) in the intensive treatment group and -0·001 (-0·006 to 0·005) in the standard treatment group (between-group difference -0·004, 95% CI -0·012 to 0·004; p=0·33). Mean standardised processing speed domain scores declined more in the intensive treatment group (between-group difference -0·010, 95% CI -0·017 to -0·002; p=0·02), with an annual decline of -0·025 (-0·030 to -0·019) for the intensive treatment group and -0·015 (-0·021 to 0·009) for the standard treatment group. INTERPRETATION: Intensive treatment to lower systolic blood pressure did not result in a clinically relevant difference compared with standard treatment in memory or processing speed in a subgroup of participants from SPRINT. The effect of blood pressure lowering might not be evident in specific domains of cognitive function, but instead distributed across multiple domains. FUNDING: National Heart, Lung, and Blood Institute, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute on Aging, National Institute of Neurological Disorders and Stroke, and the Alzheimer's Association.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Cognição/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Testes de Estado Mental e Demência , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/farmacologia , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial/tendências , Cognição/fisiologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/prevenção & controle , Disfunção Cognitiva/psicologia , Feminino , Seguimentos , Humanos , Hipertensão/psicologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Estados Unidos/epidemiologia , United States Department of Veterans Affairs/tendências
4.
Rev. cuba. med ; 59(3): e1368, tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1139058

RESUMO

Introducción: El incremento matutino de la presión arterial detectado por monitoreo ambulatorio se asocia a daño de órgano blanco y a una mayor incidencia de eventos cardiovasculares. Objetivo: Determinar la adherencia terapéutica en hipertensos con incremento matutino de la presión arterial. Métodos: Se realizó un estudio transversal en 195 pacientes hipertensos ingresados en el servicio de medicina interna del Hospital Universitario Calixto García en el año 2018. Estos mostraron incremento matutino de la presión arterial y se valoró la adherencia terapéutica mediante el test de cumplimiento autocomunicado de Morisky-Green-Levine. Las variables identificadas como predictores relevantes de no adherencia fueron introducidas en un modelo multivariado de regresión logística. Resultados: 63,6 por ciento de los pacientes con incremento matutino de la presión fueron no adherentes, predominaron los pacientes del sexo masculino, 71,6 por ciento. El 84,0 por ciento (p=0,00) de los no adherentes ingerían de 3 a 4 fármacos antihipertensivos, 90,2 por ciento (p=0,00) tomaban 3 o más dosis. 50,5 por ciento de los pacientes tenía un diagnóstico de más de 5 años. Conclusiones: Los pacientes con incremento matutino de presión arterial se caracterizaron por ser no adherentes a la terapéutica antihipertensiva(AU)


Introduction: The morning hypertension detected by ambulatory monitoring is associated with target organ damage and a higher incidence of cardiovascular events. Objective: To determine the therapeutic adherence in hypertensive patients with a morning hypertension. Methods: A cross-sectional study was carried out in 195 hypertensive patients admitted to the internal medicine service at Calixto García University Hospital in 2018. They showed a morning increase of blood pressure and therapeutic adherence was assessed using the self-reported compliance test by Morisky-Green-Levine. The variables identified as relevant predictors of non-adherence were entered in a multivariate logistic regression model. Results: 63.6 percent of the patients with morning hypertension were non-adherent. Male patients predominated. 71.6 percent 84.0 percent (p = 0.00) of the non-adherents had 3 to 4 antihypertensive drugs, 90.2 percent(p = 0.00) took 3 or more doses. 50.5 percent of the patients were diagnosed for more than 5 years. Conclusions: Patients with morning hypertension were described as non-adherent to antihypertensive therapy(AU)


Assuntos
Humanos , Masculino , Feminino , Monitorização Ambulatorial da Pressão Arterial/métodos , Exacerbação dos Sintomas , Cooperação e Adesão ao Tratamento , Estudos Transversais
5.
Cochrane Database Syst Rev ; 8: CD012739, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32748394

RESUMO

BACKGROUND: Regular blood pressure (BP) measurement is crucial for the diagnosis and management of hypertensive disorders in pregnancy, such as pre-eclampsia. BP can be measured in various settings, such as conventional clinics or self-measurement at home, and with different techniques, such as using auscultatory or automated BP devices. It is important to understand the impact of different settings and techniques of BP measurement on important outcomes for pregnant women. OBJECTIVES: To assess the effects of setting and technique of BP measurement for diagnosing hypertensive disorders in pregnancy on subsequent maternal and perinatal outcomes, women's quality of life, or use of health service resources. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) on 22 April 2020, and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) involving pregnant women, using validated BP devices in different settings or using different techniques. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data, assessed risk of bias, and used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS: Of the 21 identified studies, we included three, and excluded 11; seven were ongoing. Of the three included RCTs (536,607 women), one was a cluster-RCT, with a substantially higher number of participants (536,233 deliveries) than the other two trials, but did not provide data for most of our outcomes. We generally judged the included studies at low risk of bias, however, the certainty of the evidence was low, due to indirectness and imprecision. Meta-analysis was not possible because each study investigated a different comparison. None of the included studies reported our primary outcome of systolic BP greater than or equal to 150 mmHg. None of the studies reported any of these important secondary outcomes: antenatal hospital admissions, neonatal unit length of stay, or neonatal endotracheal intubation and use of mechanical ventilation. Setting of BP measurement: self-measurement versus conventional clinic measurement (one study, 154 women) There were no maternal deaths in either the self-monitoring group or the usual care group. The study did not report perinatal mortality. Self-monitoring may lead to slightly more diagnoses of pre-eclampsia compared with usual care (risk ratio (RR) 1.49, 95% confidence interval (CI) 0.87 to 2.54; 154 women; 1 study; low-certainty evidence) but the wide 95% CI is consistent with possible benefit and possible harm. Self-monitoring may have little to no effect on the likelihood of induction of labour compared with usual care (RR 1.09, 95% CI 0.82 to 1.45; 154 women; 1 study; low-certainty evidence). We are uncertain if self-monitoring BP has any effect on maternal admission to intensive care (RR 1.54, 95% CI 0.06 to 37.25; 154 women; 1 study; low-certainty evidence), stillbirth (RR 2.57, 95% CI 0.13 to 52.63; 154 women; 1 study; low-certainty evidence), neonatal death (RR 1.54, 95% CI 0.06 to 37.25; 154 women; 1 study; low-certainty evidence) or preterm birth (RR 1.15, 95% CI 0.37 to 3.55; 154 women; 1 study; low-certainty evidence), compared with usual care because the certainty of evidence is low and the 95% CI is consistent with appreciable harms and appreciable benefits. Self-monitoring may lead to slightly more neonatal unit admissions compared with usual care (RR 1.53, 95% CI 0.65 to 3.62; 154 women; 1 study; low-certainty evidence) but the wide 95% CI includes the possibility of slightly fewer admissions with self-monitoring. Technique of BP measurement: Korotkoff phase IV (K4, muffling sound) versus Korotkoff phase V (K5, disappearance of sound) to represent diastolic BP (one study, 220 women) There were no maternal deaths in either the K4 or K5 group. There may be little to no difference in the diagnosis of pre-eclampsia between using K4 or K5 for diastolic BP (RR 1.16; 95% CI 0.89 to 1.49; 1 study; 220 women; low-certainty evidence), since the wide 95% CI includes the possibility of more diagnoses with K4. We are uncertain if there is a difference in perinatal mortality between the groups because the quality of evidence is low and the 95% CI is consistent with appreciable harm and appreciable benefit (RR 1.14, 95% CI 0.16 to 7.92; 1 study, 220 women; low-certainty evidence). The trial did not report data on maternal admission to intensive care, induction of labour, stillbirth, neonatal death, preterm birth, or neonatal unit admissions. Technique of BP measurement: CRADLE intervention (CRADLE device, a semi-automated BP monitor with additional features, and an education package) versus usual care (one study, 536,233 deliveries) There may be little to no difference between the use of the CRADLE device and usual care in the number of maternal deaths (adjusted RR 0.80, 95% CI 0.30 to 2.11; 536,233 women; 1 study; low-certainty evidence), but the 95% CI is consistent with appreciable harm and appreciable benefit. The trial did not report pre-eclampsia, induction of labour, perinatal mortality, preterm birth, or neonatal unit admissions. Maternal admission to intensive care and perinatal outcomes (stillbirths and neonatal deaths) were only collected for a small proportion of the women, identified by an outcome not by baseline characteristics, thereby breaking the random allocation. Therefore, any differences between the groups could not be attributed to the intervention, and we did not extract data for these outcomes. AUTHORS' CONCLUSIONS: The benefit, if any, of self-monitoring BP in hypertensive pregnancies remains uncertain, as the evidence is limited to one feasibility study. Current practice of using K5 to measure diastolic BP is supported for women with pregnancy hypertension. The benefit, if any, of using the CRADLE device to measure BP in pregnancy remains uncertain, due to the limitations and instability of the trial study design.


Assuntos
Determinação da Pressão Arterial/métodos , Complicações Cardiovasculares na Gravidez/diagnóstico , Monitorização Ambulatorial da Pressão Arterial/métodos , Feminino , Humanos , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Autocuidado/métodos
6.
Rev. esp. cardiol. (Ed. impr.) ; 73(8): 615-622, ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-ET1-6252

RESUMO

INTRODUCCIÓN Y OBJETIVOS: La denervación renal es una intervención percutánea para el tratamiento de la hipertensión arterial resistente. Estudios aleatorizados han mostrado resultados contradictorios sobre su eficacia. Se presentan los resultados de un registro de denervación en pacientes con hipertensión resistente según práctica clínica en España. MÉTODOS: Registro multicéntrico de pacientes consecutivos con hipertensión arterial resistente tratados con denervación renal en España en el periodo 2009-2018. RESULTADOS: Se ha incluido a 125 pacientes (media de edad, 56±años; el 41% mujeres; media de 14±9 años de evolución de la hipertensión). La presión arterial sistólica y diastólica en la consulta y ambulatoria de 24 h disminuyeron a los 6 meses de la intervención (de 166±20/95±16 a 149±22/87±16mmHg y de 151±14/89±12 a 143±15/84±11; ambas, p < 0,0001). A los 12 meses se mantenía la reducción en la presión arterial con una disminución en el número de fármacos antihipertensivos de 4,9±1,2 a 4,4±1,5 (p = 0,0001). No hubo complicaciones importantes relacionadas con el procedimiento. La tasa de respuesta a la denervación al año fue del 80%, si bien con una amplia variabilidad entre centros. CONCLUSIONES: La denervación renal en pacientes con hipertensión resistente se relacionó con una disminución de las cifras de presión arterial en la consulta y, lo que es más importante, en la monitorización ambulatoria de presión arterial, con una disminución significativa del tratamiento farmacológico


INTRODUCTION AND OBJECTIVES: Renal denervation is a percutaneous intervention for the treatment of resistant hypertension. Randomized studies have shown contradictory results on its efficacy. We present the results of a renal denervation registry for the treatment of resistant hypertension in real-life patients in Spain. METHODS: Multicenter registry of consecutive patients with resistant hypertension treated with renal denervation in Spain between 2009 and 2018. RESULTS: We included 125 patients (mean age, 56 years; 41% female; mean onset of hypertension 14±9 years previously). Office systolic and diastolic blood pressure and ambulatory blood pressure monitoring decreased 6 months after the intervention (166±20/95±16 to 149±22/87±16 mmHg and 151±14/89±12 to 143±15/84±11, both P <.0001). At 12 months, the blood pressure reduction was maintained and the number of antihypertensive drugs decreased from 4.9±1.2 to 4.4±1.5 (P=.0001). There were no significant procedure-related complications. The response rate to denervation at 1 year was 80%, but there were wide differences between centers. CONCLUSIONS: In patients with resistant hypertension, treatment with renal denervation was related to a decrease in office blood pressure and, more importantly, in ambulatory blood pressure monitoring, with a significant reduction in pharmacological treatment


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Simpatectomia/métodos , Hipertensão/terapia , Hipertensão Maligna/cirurgia , Monitorização Ambulatorial da Pressão Arterial/métodos , Denervação/métodos , Prática Clínica Baseada em Evidências/tendências , Resultado do Tratamento , Resistência a Múltiplos Medicamentos , Registros de Doenças/estatística & dados numéricos , Estudos Retrospectivos , Determinação da Pressão Arterial/métodos
8.
Clin Exp Hypertens ; 42(8): 681-684, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-32476487

RESUMO

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a common disorder with important clinical consequences. Many studies have proven that hypertension is one of the most important comorbid disorders in PCOS. Masked hypertension is defined as a presence of normal office blood pressure together with abnormal results in 24-h ambulatory blood pressure monitoring (ABPM). The prevalence of this condition in patients with PCOS is not well defined. The aim of this study was to evaluate the prevalence of masked hypertension in PCOS compared to control subjects. METHODS: Sixty patients with PCOS and 60 control subjects were enrolled in the study. All patients with PCOS and controls without a history of hypertension underwent physical examination including office blood pressure measurement, ABPM, and measurement of laboratory and anthropometric parameters. RESULTS: Mean age was 30.5 ± 6.6 in control group and 26.4 ± 7.1 year in patients with PCOS (p = .001). Twenty-four patients (40%) had masked hypertension in PCOS group whereas 11 patients (18.3%) in the control group (p = .009). Twenty-four-hour diastolic blood pressure (p = .03), daytime systolic (p < .001), and daytime diastolic blood pressure (p = .01) and nighttime systolic blood pressure (p = .01) were significantly higher in patients with PCOS compared with control group. CONCLUSIONS: This study demonstrates increased masked hypertension prevalence in patients with PCOS. We suggest that all patients with PCOS should undergo ambulatory blood pressure monitoring for detecting masked hypertension.


Assuntos
Hipertensão Mascarada/epidemiologia , Síndrome do Ovário Policístico/complicações , Adulto , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial , Monitorização Ambulatorial da Pressão Arterial/métodos , Feminino , Humanos , Hipertensão Mascarada/complicações , Hipertensão Mascarada/diagnóstico , Hipertensão Mascarada/fisiopatologia , Prevalência , Adulto Jovem
9.
PLoS Med ; 17(6): e1003124, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32555625

RESUMO

BACKGROUND: While evidence from randomised controlled trials shows that telemonitoring for hypertension is associated with improved blood pressure (BP) control, healthcare systems have been slow to implement it, partly because of inadequate integration with existing clinical practices and electronic records. Neither is it clear if trial findings will be replicated in routine clinical practice at scale. We aimed to explore the feasibility and impact of implementing an integrated telemonitoring system for hypertension into routine primary care. METHODS AND FINDINGS: This was a quasi-experimental implementation study with embedded qualitative process evaluation set in primary care in Lothian, Scotland. We described the overall uptake of telemonitoring and uptake in a subgroup of representative practices, used routinely acquired data for a records-based controlled before-and-after study, and collected qualitative data from staff and patient interviews and practice observation. The main outcome measures were intervention uptake, change in BP, change in clinician appointment use, and participants' views on features that facilitated or impeded uptake of the intervention. Seventy-five primary care practices enrolled 3,200 patients with established hypertension. In an evaluation subgroup of 8 practices (905 patients of whom 427 [47%] were female and with median age of 64 years [IQR 56-70, range 22-89] and median Scottish Index of Multiple Deprivation 2012 decile of 8 [IQR 6-10]), mean systolic BP fell by 6.55 mm Hg (SD 15.17), and mean diastolic BP by 4.23 mm Hg (SD 8.68). Compared with the previous year, participating patients made 19% fewer face-to-face appointments, compared with 11% fewer in patients with hypertension who were not telemonitoring. Total consultation time for participants fell by 15.4 minutes (SD 68.4), compared with 5.5 minutes (SD 84.4) in non-telemonitored patients. The convenience of remote collection of BP readings and integration of these readings into routine clinical care was crucial to the success of the implementation. Limitations include the fact that practices and patient participants were self-selected, and younger and more affluent than non-participating patients, and the possibility that regression to the mean may have contributed to the reduction in BP. Routinely acquired data are limited in terms of completeness and accuracy. CONCLUSIONS: Telemonitoring for hypertension can be implemented into routine primary care at scale with little impact on clinician workload and results in reductions in BP similar to those in large UK trials. Integrating the telemonitoring readings into routine data handling was crucial to the success of this initiative.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/métodos , Hipertensão/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Participação do Paciente , Atenção Primária à Saúde/métodos , Desenvolvimento de Programas , Adulto Jovem
11.
Hipertens. riesgo vasc ; 37(1): 4-10, ene.-mar. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-188667

RESUMO

Objetivo: Describir los hallazgos de la implementación de la iniciativa Mayo Mes de la Medición 2017 aplicada a población colombiana adulta con el objetivo de crear conciencia sobre la importancia de la medición, conocimiento y control de la presión arterial. Materiales y métodos: Mayo Mes de la Medición es una encuesta transversal que sigue las directrices de la Sociedad Internacional de Hipertensión y la Liga Mundial de Hipertensión, que recoge información de factores de riesgo cardiovascular y mediciones de presión arterial. En Colombia su implementación fue liderada por la Fundación Oftalmológica de Santander (FOSCAL) y la Sociedad Latinoamericana de Hipertensión (LASH) con el apoyo de la Red Colombiana para la Prevención de las Enfermedades Cardiovasculares y Diabetes (RECARDI). Resultados: Se recolectaron datos en 11 departamentos de 21.797 personas, siendo el 58,7% mujeres, la edad promedio fue de 40,5±17,7 años. La prevalencia global de hipertensión arterial (HTA) fue del 20,8% (autorreporte de tratamiento antihipertensivo o toma de presión arterial sistólica [≥140mmHg]). El 46,5% del total de hipertensos tuvieron cifras de presión arterial sistólica que les clasifica como no controlados (presión arterial sistólica<140mmHg) y el 26,4% no conocían su condición de hipertensos, los cuales en el presente reporte son considerados como los casos nuevos de HTA. Conclusión: La prevalencia de presión arterial es alta en esta población adulta joven, en la cual el desconocimiento de la condición de HTA es también alta, y en aquellos que conocen su condición existe un porcentaje bajo de control de la HTA, resultados que demuestran la necesidad de implementar programas eficaces de detección de pacientes hipertensos y de establecer tratamientos estandarizados para mejorar el control de la HTA como una estrategia para la reducción de eventos cardiovasculares


Aim: To describe the findings of implementing May Measurement Month 2017 in the adult Colombian population to raise awareness of the importance of blood pressure measuring, monitoring, and awareness. Materials and methods: May Measurement Month is a cross-sectional survey that follows the directives of the International Society of Hypertension and the World Hypertension League, which gathers information on cardiovascular risk factors and blood pressure readings. Its implementation in Colombia was lead by the Santander Ophthalmological Foundation (FOSCAL) and the Latin American Society of Hypertension (LASH) with the support of the Colombian Network for the Prevention of Cardiovascular Diseases and Diabetes (RECARDI). Results: Data was collected from 11 departments on 21,797 people, 58.7% of whom were female, with an average age of 40.5±17.7 years. The overall prevalence of high blood pressure (HBP) was 20.8% (self-reported antihypertensive treatment or systolic blood pressure reading [systolic blood pressure≥140mmHg]). Of the total number of hypertensives, 46.5% had systolic blood pressure readings classified as uncontrolled (systolic blood pressure<140mmHg), and 26.4% were unaware that they were hypertensive who, in this report, we consider to be new cases of HBP. Conclusion: The prevalence of (elevated) blood pressure is high in this young adult population, whose lack of awareness of HBP is also high, and HBP in those aware of their condition is poorly controlled. These results highlight the need to implement effective detection programmes for hypertensive patients and to establish standardised treatments to improve HBP control as a strategy to reduce cardiovascular events


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Conhecimentos, Atitudes e Prática em Saúde , Determinação da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial/métodos , Pressão Arterial , Doenças Cardiovasculares/prevenção & controle , Hipertensão/prevenção & controle , Colômbia , Estudos Transversais , Inquéritos e Questionários , Sociedades Médicas/normas , Fatores de Risco , Promoção da Saúde , Antropometria
12.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 46(2): 81-89, mar. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195626

RESUMO

OBJETIVO: Determinar los valores de punto de corte óptimos para la determinación de la presión arterial en consulta (PAC) como prueba de seguimiento en la consulta de Atención Primaria (AP). MATERIAL Y MÉTODO: A 153 hipertensos menores de 80años que cumplieran con criterios de inclusión y exclusión se les realizó una monitorización ambulatoria de su presión arterial durante 24h (MAPA), tras lo cual se obtuvieron dos medidas de PAC. Con los registros obtenidos de PAC, y tomándose la MAPA como referencia, se procedió a realizar la curva ROC para elegir el punto de corte óptimo. El acuerdo entre ambas mediciones fue determinado por el coeficiente de correlación intraclase y el método de Bland-Altman, tras lo cual se realizó un estudio de validación con el objetivo de diagnosticar el control o no del hipertenso. RESULTADOS: Los valores óptimos de corte fueron 137mmHg para la PA sistólica (sensibilidad: 89,3%; especificidad: 72,2%) y de 84mmHg para la diastólica (sensibilidad: 79,4%; especificidad: 72,3%). El acuerdo en el diagnóstico de control entre PAC y MAPA fue de 58,9% (kappa: 0,418). CONCLUSIÓN: El valor de corte óptimo de la PA diastólica para el seguimiento es menor a las cifras establecidas en la actualidad


AIM: This study seeks to determine the optimal cut-off values for the determination of the blood pressure in the clinic as a follow-up test in Primary Care practice. DESIGN: A total of 153 hypertensive patients under 80years of age who met inclusion and exclusion criteria for the study, were subjected to ambulatory monitoring of their blood pressure for 24hours (ABPM). After which two clinic-based measurements were obtained. With the results obtained from the clinic, and taking the ABMP as a reference, the ROC curve was calculated choose the optimal cut-off point. The agreement between both measurements was determined by the intraclass correlation coefficient and the Bland-Altman equation. A validation study was then carried out with the objective of diagnosing whether or not the hypertensive patient was in control. RESULTS: The optimal cut-off values were 137mmHg for systolic BP (sensitivity: 89.3%; specificity: 72.2%) and 84mmHg for diastolic blood pressure (sensitivity: 79.4%; specificity: 72.3%). The agreement in the diagnosis of control between clinic-based measurement and ABPM was 58.9% (Kappa: 0.418). CONCLUSION: The optimal cut-off value of the diastolic BP for follow-up is lower than the values currently established


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pressão Arterial/fisiologia , Monitorização Ambulatorial da Pressão Arterial/métodos , Hipertensão/diagnóstico , Atenção Primária à Saúde/métodos , Estudos Transversais , Sensibilidade e Especificidade
13.
Clin Exp Hypertens ; 42(6): 527-530, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31933376

RESUMO

PURPOSE: In this study, we evaluated the electromechanical properties of atriums in patients with masked hypertension by using tissue Doppler echocardiographic technique to predict the predisposition to atrial arrhythmias. METHODS: A total of 118 subjects were included in the study. Twenty-four-hour blood pressure monitorization (ABPM) was used to determinate the masked hypertension in the study group. Tissue Doppler imaging was used to find intra-left and -right atrial electromechanical delay (AEMD) and inter-atrial electromechanical delay. The results compared between patients with masked hypertension and without. RESULTS: There were 55 (%46.6) patients with masked hypertension and 63 (%53.4) patients without masked hypertension without any difference regarding age sex heart rate. No statistically significant difference was found in intra-right AEMD between the groups. Left ventricular end-diastolic and systolic diameters (p <0.01 vs p=0.034), left ventricular posterior and septal wall thickness (p < .01 vs p < .01), left ventricular mass index (p <0.01), left atrium volume (p = 0.02), and indexed left atrial volume (p <0 .01) were high in patients with masked hypertension Inter-AEMD (48.07 ± 11.49 ms vs 43.73 ± 8.61 p=0.02) and intra-left AEMD (24.8 ± 6.35 ms vs 21.42 ± 7.99 ms p=0.013) were significantly higher in masked hypertensive patients. CONCLUSIONS: Masked hypertension shares the same clinical outcomes like overt hypertension. Any effort must be given to prevent unwanted events in masked hypertensive patients. According to our findings we suggesting that masked hypertensive patients must be evaluated for atrial arrhythmia.


Assuntos
Fibrilação Atrial , Ecocardiografia Doppler/métodos , Átrios do Coração , Hipertensão Mascarada , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Monitorização Ambulatorial da Pressão Arterial/métodos , Fenômenos Eletrofisiológicos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Masculino , Hipertensão Mascarada/diagnóstico , Hipertensão Mascarada/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico
14.
Sci Rep ; 10(1): 1410, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996723

RESUMO

Availability of daily continuous blood pressure (DCBP) has a strong impact to realization of healthy society. However, existing methods to obtain blood pressure of cuff type and cuff-less types utilizing correlation with pulse waveform, pulse transit time or pulse rate; or computation of circulation model are not suitable to obtain DCBP. Here we implemented a method based on a simple circulatory system model using pulse rate measurement to overcome the limitations, and showed that it provides appropriate estimation of DCBP. The present model consists of a circulatory dynamic system model and an inverse model of a circulatory control system with input of pulse rate and six model parameters representing standard pulse rate, elasticity of systemic arteries, peripheral vascular resistance, and characteristics of resistance and stroke volume control. Validity of the DCBP estimation method was examined by preliminary experiment for one subject in four days and that for four subjects in one day. DCBP estimation was performed with 24-hour pulse rate measurement by a wearable device and sphygmomanometer measurement for parameter determination and verification. Mean absolute errors in systolic/diastolic pressures were appropriate ones for preliminary experiments with 9.4/6.4 mmHg in four days and 7.3/5.9 mmHg in five subjects.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/métodos , Pressão Sanguínea/fisiologia , Frequência Cardíaca/fisiologia , Modelos Cardiovasculares , Adulto , Monitorização Ambulatorial da Pressão Arterial/instrumentação , Monitores de Pressão Arterial , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico/fisiologia , Resistência Vascular/fisiologia , Dispositivos Eletrônicos Vestíveis , Adulto Jovem
15.
Clin Exp Hypertens ; 42(3): 244-249, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31122073

RESUMO

Objective: Circadian blood pressure (CBP) abnormalities are well-known risk factors for many diseases such as cardiovascular, cerebrovascular, and chronic kidney disease. The object of this study was to evaluate the relationship between abnormalities in CBP rhythm and target organ damage (TOD) in normotensive non-dipper (non-DP) subjects.Methods: The 24-h ambulatory BP monitoring (ABPM) and echocardiography were performed and urinary albumin excretion (UAE) was measured in 127 normotensive dipper (DP) (42 males, 85 females) and 337 (89 males, 248 females) normotensive non-DP subjects.Results: When we compared DP and non-DP subjects; Pulse wave velocity (PWV) (7.12 ± 1.72 vs 7.57 ± 1.87 m/s, p = 0.02), the percentile of corrected PWV (cPWV) (7.1 vs. 20.2, p= 0.001) and the percentile of corrected augmentation index (cAIx) (23.5 vs. 33.9, p = 0.03), left ventricle mass index (LVMI) (78.00 ± 23.27 vs. 95.59 ± 18.29 g/m2, p = 0.01), relative wall thickness (RWT)(0.36 ± 0.13 vs 0.46 ± 0.09, p = 0.01), percentile of proteinuria (8.6 vs 29.2%, p = 0.00) were higher in non-DP group. In the correlation analyses, the PWV, LVMI, RWT were negatively correlated with the rate of systolic fall in nighttime (%)(-0.15, p = 0.01 vs. -0.23, p = 0.02 vs. -0.27, p = 0.00). It was observed that cPWV, cAIx, and UAE were independently associated with age and non-DP status (NDS), in logistic regression analysis.Conclusions: Our results suggested that normotensive persons with CBP abnormalities had TOD. In light of the data of this article, non-dipper status is detected in the early period and if the provision of diurnal blood pressure rhythm may reduce the incidence of future adverse events in nondipper normotensive subjects.


Assuntos
Transtornos Cronobiológicos , Ritmo Circadiano/fisiologia , Hipertensão , Proteinúria , Disfunção Ventricular Esquerda , Adulto , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial/métodos , Transtornos Cronobiológicos/diagnóstico , Transtornos Cronobiológicos/fisiopatologia , Transtornos Cronobiológicos/terapia , Ecocardiografia/métodos , Feminino , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Proteinúria/diagnóstico , Proteinúria/etiologia , Proteinúria/prevenção & controle , Análise de Onda de Pulso/métodos , Fatores de Risco , Fatores de Tempo , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/prevenção & controle
16.
Clin Pharmacol Ther ; 107(1): 147-153, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31625600

RESUMO

According to models developed from large epidemiological studies, mean increases in systolic blood pressure of 2-3 mmHg can increase the risk of cardiovascular (CV) adverse events, especially in patients with a high risk for CV disease. There are new regulatory recommendations for the use of a safety ambulatory blood pressure monitoring (ABPM) study to assess the blood pressure (BP) effects of drugs used chronically. The ABPM study collects BP measurements over 24 hours at baseline and during treatment in patients with underlying CV risk. Our evaluation of ABPM studies submitted to the US Food and Drug Administration (FDA) shows these studies can provide precise estimates of BP changes and lack a pronounced placebo response. With the assessment of BP effects in development programs, opportunities exist for developing quantitative safety models to predict CV risk, support dose selection, identify patients with increased BP response, and provide insight into underlying mechanisms.


Assuntos
Anti-Hipertensivos/administração & dosagem , Monitorização Ambulatorial da Pressão Arterial/métodos , Hipertensão/tratamento farmacológico , Anti-Hipertensivos/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial/métodos , Doenças Cardiovasculares/prevenção & controle , Humanos , Hipertensão/fisiopatologia
17.
Br J Ophthalmol ; 104(1): 81-86, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31055450

RESUMO

BACKGROUND/AIMS: To investigate the risk factors for disease progression of normal-tension glaucoma (NTG) with pretreatment intraocular pressure (IOP) in the low-teens. METHODS: One-hundred and two (102) eyes of 102 patients with NTG with pretreatment IOP≤12 mm Hg who had been followed up for more than 60 months were retrospectively enrolled. Patients were divided into progressor and non-progressor groups according to visual field (VF) progression as correlated with change of optic disc or retinal nerve fibre layer defect. Baseline demographic and clinical characteristics including diurnal IOP and 24 hours blood pressure (BP) were compared between the two groups. The Cox proportional hazards model was used to identify the risk factors for disease progression. RESULTS: Thirty-six patients (35.3%) were classified as progressors and 66 (64.7%) as non-progressors. Between the two groups, no significant differences were found in the follow-up periods (8.7±3.4 vs 7.7±3.2 years; p=0.138), baseline VF mean deviation (-4.50±5.65 vs -3.56±4.30 dB; p=0.348) or pretreatment IOP (11.34±1.21 vs 11.17±1.06 mm Hg; p=0.121). The multivariate Cox proportional hazards model indicated that greater diurnal IOP at baseline (HR=1.609; p=0.004), greater fluctuation of diastolic BP (DBP; HR=1.058; p=0.002) and presence of optic disc haemorrhage during follow-up (DH; HR=3.664; p=0.001) were risk factors for glaucoma progression. CONCLUSION: In the low-teens NTG eyes, 35.3% showed glaucoma progression during the average 8.7 years of follow-up. Fluctuation of DBP and diurnal IOP as well as DH were significantly associated with greater probability of disease progression.


Assuntos
Glaucoma de Baixa Tensão/fisiopatologia , Hemorragia Retiniana/complicações , Adulto , Idoso , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial/métodos , Ritmo Circadiano/fisiologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Pressão Intraocular/fisiologia , Glaucoma de Baixa Tensão/complicações , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Óptico/complicações , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Campos Visuais/fisiologia , Adulto Jovem
18.
Clin Exp Hypertens ; 42(3): 266-270, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31204518

RESUMO

Objective: Although neurotensin is found throughout the body including cardiovascular structures, the correlation of plasma neurotensin levels with resistant hypertension (RH) has never been examined. Therefore, we aimed to compare plasma neurotensin concentration, between patients with RH and those with controlled hypertension (CH).Methods: Forty-one patients with RH and 45 patients with CH who had undergone outpatient ambulatory blood pressure measurements were prospectively recruited. RH was defined as uncontrolled blood pressure despite using three antihypertensive agents including a diuretic or need of four or more drugs to control blood pressure. The demographic properties, medications, laboratory parameters including neurotensin levels, and echocardiographic parameters were recorded.Results: There was no significant difference among groups in terms of age, sex, smoking or body mass index. Office and ambulatory blood pressures and mean number of antihypertensive drugs used were significantly higher in patients with RH compared to patients with CH. Plasma neurotensin levels were significantly lower in patients with RH (median: 0.380 ng/ml; interquartile range: 0.292-0.471) than in the patients with controlled blood pressure (median: 0.638 ng/ml; interquartile range: 0.483-0.783). Multivariate and receiver-operating characteristics curve analyses showed that neurotensin is an independent predictor for RH and the optimal cut-off value of neurotensin for RH was lower than 0.509 ng/ml, with a sensitivity of 85.4% and a specificity of 73.3% (area under the curve = 0.793, 95% CI: 0.691-0.894, p < .001)Conclusion: This study is the first to show a correlation between lower neurotensin levels and RH.


Assuntos
Resistência a Medicamentos/fisiologia , Hipertensão , Neurotensina/sangue , Anti-Hipertensivos/uso terapêutico , Biomarcadores/sangue , Pressão Sanguínea/efeitos dos fármacos , Monitorização Ambulatorial da Pressão Arterial/métodos , Diuréticos/uso terapêutico , Feminino , Humanos , Hipertensão/sangue , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
19.
J Pediatr ; 216: 37-43.e2, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31685228

RESUMO

OBJECTIVE: To determine the stability of ambulatory blood pressure monitoring (ABPM) over time in children referred for evaluation of elevated BPs and assess for factors predicting change. STUDY DESIGN: This retrospective chart review conducted at Seattle Children's Hospital and University of Pittsburgh Medical Center Children's Hospital of Pittsburgh identified 124 children referred for elevated BPs with 2 ABPM studies at least 6 months apart. All subjects received lifestyle counseling. Subjects with secondary hypertension (HTN) or on antihypertensive medication were excluded. ABPM phenotype was classified using American Heart Association guidelines as showing normal BP, prehypertension, and HTN. Generalized linear mixed effect regression models were used to regress stable, improving, or worsening HTN outcomes at study follow-up on baseline BP index and load variables. RESULTS: The median age of patients was 14.1 years (73% males) and the median interval between studies was 18 months. ABPM phenotype changed in 58 of 124 children, with 16% worsening and 31% improving. Older age was associated with persistence of HTN. Although not significant, decrease in body mass index z-score tracked with sustained normal ambulatory BPs. CONCLUSIONS: Although the sample size is small, our study suggests ABPM phenotype shows variability over time. Further study is required to identify factors supporting risk for progression of ABPM phenotype over time.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/métodos , Pressão Sanguínea , Hipertensão/diagnóstico , Pré-Hipertensão/diagnóstico , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Masculino , Fenótipo , Estudos Retrospectivos
20.
Clin Exp Hypertens ; 42(5): 438-448, 2020 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31756122

RESUMO

Background: This study investigated whether a combination drug containing an angiotensin II receptor blocker (ARB) and a calcium channel blocker (CCB) could provide effective antihypertensive therapy.Methods: A multicenter, prospective, open-label study was conducted at the clinics of Clinical Research Network. The subjects had uncontrolled blood pressure (BP) despite ARB or CCB monotherapy. The effect on both office and home BP was examined after patients switched to a combination drug (REZ: containing 20 mg of olmesartan [OL] and 16 mg of azelnidipine [AZ]).Results: A total of 78 patients were enrolled. After switching to REZ, a significant and sustained reduction of office BP was observed. The proportion of patients who achieved the target for both office and home BP was an increase from 0% to 55%. Switching from amlodipine to REZ resulted in a significant and sustained decrease of office and home BP. There was also a significant decrease of home pulse rate (PR), but office PR was unchanged. To determine the accuracy of the BP and PR values reported by patients, the frequency of each number as the first digit was determined. The frequency of "0" was extremely high for both office and home BP values, and the same was noted for home PR values.Conclusion: The results of this study suggested that switching from a single drug to combination therapy with REZ could achieve a stronger antihypertensive effect. However, concern was raised regarding the methods of BP and PR measurement and recording in this clinical trial involving general practitioners.


Assuntos
Anlodipino , Ácido Azetidinocarboxílico/análogos & derivados , Pressão Sanguínea/efeitos dos fármacos , Di-Hidropiridinas , Substituição de Medicamentos/métodos , Hipertensão , Imidazóis , Tetrazóis , Anlodipino/administração & dosagem , Anlodipino/efeitos adversos , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Ácido Azetidinocarboxílico/administração & dosagem , Ácido Azetidinocarboxílico/efeitos adversos , Monitorização Ambulatorial da Pressão Arterial/métodos , Di-Hidropiridinas/administração & dosagem , Di-Hidropiridinas/efeitos adversos , Combinação de Medicamentos , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Imidazóis/administração & dosagem , Imidazóis/efeitos adversos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tetrazóis/administração & dosagem , Tetrazóis/efeitos adversos , Resultado do Tratamento
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