Dietary counseling on long-term weight loss in overweight hypertensive patients

OBJECTIVE: This study aimed to evaluate long-term weight loss in overweight hypertensive patients receiving dietary counseling. METHODS: Longitudinal study included overweight hypertensive patients who had an initial individual consultation with a nutritionist between January 2002 and December 2005 and were followed for four years in a hypertension clinic. Patients who had at least four consultations during the follow-up period were included in the dietary counseling group. Those who scheduled their first consultation but missed that appointment or had fewer than four consultations during the follow-up period were allocated to the control group. Target Energy intake was calculated at 20-25 kcal/kg actual body weight/day. RESULTS: The study included 102 patients aged 55 + 1 years old (58 in the dietary counseling group). As compared with the control group, patients in the dietary counseling group showed a significantly greater reduction in body weight (-3.6 + 0.8 vs. 0.8 + 0.7 kg), which remained significant after controlling for age, gender, baseline body mass index, and the use of different antihypertensive and antidiabetic drugs. Weight loss between 5.0 percent and 9.9 percent was observed in a significantly higher percentage of patients in the dietary counseling group (28 percent vs. 11 percent). A weight loss of at least 10 percent was only observed in dietary counseling group patients, who had a significantly lower odds ratio for increasing the number and/or dosage of antihypertensive agents, even after controlling for age, gender, and baseline body mass index. CONCLUSIONS: Dietary counseling may be associated with long-term weight loss in overweight hypertensive patients.

Curva-J: conceito, considerações fisiopatológicas e efeito da terapia anti-hipertensiva: [revisão] / J-Curve: concept, pathophysiologic aspects and effects of anti-hypertensivetherapy: [review]

O controle adequado da pressão arterial (PA) traz benefícios incontestáveis em reduzir a mortalidade e a morbidade cardiovascular. Contudo, recentemente, diversas diretrizes vêm preconizando valores cada vez mais baixos não somente para a PA, como também para outros fatores de risco. Contudo, o comportamento dos pacientes hipertensos não tem sido homogêneo. Para o subgrupo de hipertensos com doença arterial coronária (DAC) prévia, vem se observando que a redução dos níveis de pressão arterial diastólica (PAD) abaixo de 80 mmHg traz aumento na ocorrência eventos coronarianos. Por outro lado, não se tem observado o fenômeno da curva J para a pressão arterial sistólica (PAS), tampouco a deterioração da função renal, nem aumento no número de acidentes vasculares cerebrais. Há três prováveis mecanismos propostos para explicar a existência da curva J: 1) a PAD baixa poderia ser um epifenômeno coexistindo ou caracterizando um pobre estado de saúde ou doença crônica (causalidade reversa); 2) a baixa PAD poderia ser causada por um aumento na PA de pulso refletindo doença vascular avançada e rigidez da parede arterial; 3) um agressivo tratamento anti-hipertensivo poderia levar a uma baixa PAD e, assim, à hipoperfusão das coronárias, resultando em eventos coronarianos. Dessa forma, o fenômeno curva J traz duas mensagens clínicas importantes: a primeira é que o médico deve individualizar o melhor tratamento para cada paciente, observando riscos e benefícios para cada intervenção; e a segunda é que esse fato não deve desestimular em perseguir agressivamente um melhor controle da PA, uma vez que menos de um terço dos hipertensos está com a PA controlada.

The rigorous control of arterial blood pressure reduces significantly the morbidity and mortality consequences of arterial hypertension. However, in the presence of coronary artery disease (limited coronary flow reserve) there is aJ-curve relation ship between treated DBP and myocardial infarction, but not for stroke. In such high-risk (ischemic heart disease) cases it would be prudent to avoid lowering DBP to below the low 80s mmHg. Three pathophysiologic mechanisms have been proposed to explain the existence of a J-curve: 1) low DBP could be an epiphenomenon to coexisting or underlying poor health or chronic illness leading to increasing morbidity and mortality (reverse causality); 2)low DBP could be caused by an increased pulse pressure reflecting advanced vascular disease and stiffened large arteries; and 3) over-aggressive antihypertensive treatment could lead to too-low DBP and thus hypoperfusion of the coronaries resulting in coronary events. However, these considerations should not deter practicing physicians from pursuing more aggressive control in treating hypertension, because currently, at best, only approximately one-third o four patients are at goal BPs of < 140/90 mmHg...