Mental Health of Elderly Hypertensive Patients in Primary Health Care: An Integrative Review

Introduction: The global context highlights several challenges and manifestations stemming from population aging, among which mental health care for elderly people stands out. Primary health care (PHC), the largest gateway to Brazil's health care network, is strategic in promoting health and care, and in preventing diseases such as systemic arterial hypertension (SAH). It is known that elderly people with SAH present various symptoms of psychological distress and mental disorders that can aggravate cardiac symptoms. This can lead to health, social, and financial impacts on the lives of elderly people and their families. Objective: To identify the evidence on mental health care for hypertensive elderly people in PHC. Materials and methods: This is an integrative literature review; data was collected in January 2023 from the following databases: PubMed, BVS/Bireme, Medline, Lilacs, Cinahl, Scopus, and APA PsycINFO. The studies included were those available in full, in Spanish, English, and Portuguese, and which answered the research question elaborated following the PICo strategy. The article's search and selection processes were performed independently by two trained researchers through peer review. The Prisma guidelines were followed. Results: The studies found were published between 2008 and 2020 and showed two analysis categories: integrated care provided by the multi-professional team and measures that emphasize health-related quality of life. The studies highlighted integrated care management programs, qualification of the bond and territorialization, health measures that have an impact on psychological suffering, and group activities. Conclusions: Mental health care provided in an integrated and shared manner, combined with health activities and groups, is a powerful tool for elderly hypertensive patients in PHC. These strategies still have some challenges in certain contexts, but the review emphasizes the importance of consolidating this form of care, provided in PHC and has outcomes at all levels of care.

Introducción: el contexto mundial destaca diversos desafíos y manifestaciones del envejecimiento de la población, entre ellos la atención a la salud mental de los ancianos. La atención primaria de salud (APS), la mayor puerta de entrada a la red asistencial de Brasil, es estratégica en la promoción de la salud, el cuidado y la prevención de enfermedades como la hipertensión arterial sistémica (HSA). Se sabe que los ancianos con HSA presentan diversos síntomas de angustia psicológica, así como trastornos mentales que pueden agravar los síntomas cardíacos. Esto puede tener repercusiones sanitarias, sociales y económicas en la vida del anciano y su familia. Objetivo: Identificar las evidencias sobre la atención a la salud mental de los ancianos hipertensos en APS. Materiales y método: se trata de una revisión bibliográfica integradora; los datos se recogieron en enero de 2023 de las siguientes bases de datos: PubMed, BVS/Bireme, Medline, Lilacs, Cinahl, Scopus y APA PsycINFO. Se incluyeron estudios disponibles en su totalidad, en español, inglés y portugués, que respondieran a la pregunta de investigación elaborada a la luz de la estrategia PICo. La búsqueda y selección de artículos fue realizada de forma independiente por dos investigadores capacitados mediante revisión por pares. Se siguieron las recomendaciones Prisma. Resultados: los estudios encontrados fueron publicados entre 2008 y 2020, y mostraron dos categorías de análisis: atención integrada por el equipo multiprofesional y acciones que enfatizan la calidad de vida relacionada con la salud. Los estudios encontrados destacaron los programas de gestión integrada de la atención, la cualificación del vínculo y la territorialización, las acciones sanitarias que inciden en el sufrimiento psicológico y las actividades grupales. Conclusiones: la atención a la salud mental realizada de forma integrada y compartida, articulada con actividades y grupos de salud, es poderosa para los pacientes hipertensos ancianos en APS. Estas estrategias aún presentan algunos desafíos en algunos contextos, pero la revisión refuerza la importancia de consolidar esta atención, que se realiza en APS y tiene resultados en todos los niveles de atención.

Introdução: o contexto global evidencia diversos desafios e manifestações do envelhecimento populacional, dos quais destaca-se o cuidado em saúde mental da pessoa idosa. A atenção primária à saúde (APS), maior porta de entrada na rede de atenção à saúde do Brasil, é estratégica na promoção à saúde, ao cuidado e à prevenção de agravos, como a hipertensão arterial sistêmica (HAS). Sabe-se que a pessoa idosa com HAS manifesta diversos sintomas de sofrimento psíquico, bem como transtornos mentais que podem agudizar os sintomas cardíacos. Esse fato pode causar impactos de saúde, sociais e financeiros na vida da pessoa idosa e sua família. Objetivo: identificar as evidências sobre o cuidado em saúde mental ao idoso hipertenso na APS. Materiais e método: trata-se de uma revisão integrativa da literatura; a coleta de dados ocorreu em janeiro de 2023, nas seguintes bases de dados: PubMed, BVS/Bireme, Medline, Lilacs, Cinahl, Scopus e APA PsycINFO. Incluíram-se estudos disponíveis na íntegra, em espanhol, inglês e português, que respondessem à questão de pesquisa elaborada à luz da estratégia PICo. A busca e a seleção dos artigos foram executadas por dois pesquisadores treinados, de modo independente, mediante discussão por pares. As recomendações do Prisma foram seguidas. Resultados: os estudos encontrados foram publicados de 2008 a 2020 e evidenciaram duas categorias de análise: cuidados integrados pela equipe multiprofissional e ações que enfatizam a qualidade de vida relacionada à saúde. Destacaram-se nos estudos encontrados programas de gestão do cuidado integrado, qualificação do vínculo e territorialização, ações de saúde que impactam no sofrimento psíquico e atividades de grupo. Conclusões: o cuidado em saúde mental realizado de maneira integrada e compartilhada articulado com atividades de saúde e grupos são potentes para os idosos hipertensos na APS. Essas estratégias ainda apresentam alguns desafios em alguns contextos, no entanto a condução da revisão reforça a importância da consolidação desse cuidado, que acontece na APS e tem desfechos em todos os níveis de atenção.

Effects of isometric handgrip training on blood pressure among hypertensive patients seen within public primary healthcare: a randomized controlled trial

ABSTRACT BACKGROUND: Meta-analyses have demonstrated that isometric handgrip training (IHT) decreases blood pressure in hypertensive individuals. Nonetheless, most studies were conducted in laboratory settings and its effects in real-world settings remain unclear. OBJECTIVE: To analyze the effects of IHT on office and ambulatory blood pressure in hypertensive patients attended within primary healthcare. DESIGN AND SETTING: Randomized controlled trial conducted in primary healthcare units within the Family Health Program, Petrolina, Pernambuco, Brazil. METHODS: 63 hypertensive patients (30-79 years old; 70% female) were randomly allocated into IHT or control groups. IHT was performed three times per week (4 x 2 minutes at 30% of maximal voluntary contraction, one-minute rest between bouts, alternating the hands). Before and after the 12-week training period, office and ambulatory blood pressure and heart rate variability were obtained. The significance level was set at P < 0.05 (two-tailed testing) for all analyses. RESULTS: IHT significantly decreased office systolic blood pressure (IHT: 129 ± 4 versus 121 ± 3 mmHg, P < 0.05; control: 126 ± 4 versus 126 ± 3 mmHg, P > 0.05), whereas there was no effect on diastolic blood pressure (IHT: 83 ± 3 versus 79 ± 2 mmHg, P > 0.05; control: 81 ± 3 versus 77 ± 3 mmHg, P > 0.05). Heart rate variability and ambulatory blood pressure were not altered by the interventions (P > 0.05 for all). CONCLUSION: IHT reduced office systolic blood pressure in hypertensive patients attended within primary care. However, there were effects regarding diastolic blood pressure, ambulatory blood pressure or heart rate variability. CLINICALTRIALS.GOV IDENTIFIER: NCT03216317.

Does Hypertension Knowledge Influence Levels of Physical Activity in Hypertensive Patients From a Southern Brazilian Community?

Abstract Background: Increased level of physical activity (PA) and health education are known as non-pharmacological treatments of hypertension (HP). There is a lack of studies investigating the influence of HP knowledge on the level of PA among hypertensive patients. Objective: To examine the influence of patient's knowledge about HP on PA level and the relationship between these variables. Methods: A cross-sectional study was conducted in in a primary care center located in a city in the southern Brazil. A total of 199 hypertensive patients (median 61.2 [13] years; body mass index (BMI) 21.9 (7.5) kg/m2; 72.4% women) were included. The level of PA was assessed by measuring the number of steps taken daily. The knowledge about HP was assessed by a standardized questionnaire (HIPER-Q). The Kruskall-Wallis test was used to compare age, BMI and PA level between HP knowledge categories, and the Spearman test was used to assess correlations (p <0.05). Results: The median score of knowledge about HP for patients categorized as insufficient (n=6, 3%), poor (n=24; 12.1%), acceptable (n=101; 50.8%) and good (n=68; 34.2%) was 11.0 (8.0), 20.0 (4.0), 26.0 (5.0) and 38.0 (2.0), respectively. No patient has achieved an "excellent" level of knowledge. There was no significant difference in PA level (p = 0.341), BMI (p = 0.510) or age (p = 0.073) between these categories. Age was negatively correlated with knowledge about HP (p <0.05 and rho = 0.02). Conclusions: Patient's knowledge about HP did not influence the level of PA in hypertensive patients. Age, number of steps per day and BMI were not significantly different between the categories of knowledge. Public policies and organizational strategy should be addressed to improve health education and avoid sedentary behavior in this population. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Análisis de factores de riesgo cardiometabólicos y nutricionales en pacientes diabéticos tipo 2 e hipertensos esenciales usuarios de atención privada y pública / Analysis of cardiometabolic and nutritional risk factors in patients with diabetes type 2 and essential hypertension users of private and public care

La enfermedad cardiovascular es una de las principales causas de morbimortalidad en Chile, según resultados entregados por la Encuesta Nacional de Salud 2017 un 3,3% de la población ha presentado un infarto agudo al miocardio, un 2,6% reporta haber sufrido un ataque cerebrovascular, el 74% de los chilenos presenta obesidad y un 87% sedentarismo, siendo la diabetes mellitus tipo 2 (DM2) con un 12% y la hipertensión arterial con un 28% resultados que preocupan por su importante incremento. La investigación tuvo un diseño observacional de corte transversal. Se realizó en 69 pacientes con DM2 e hipertensos esenciales, entre 40 y 80 años de edad, pertenecientes al Sistema salud municipal (SMS) y privado (SPS) en la ciudad de Iquique. Se realizó encuesta alimentaria, medición antropométrica y exámenes bioquímicos y presión arterial. Al analizar ambos grupos se destaca los siguientes resultados: actividad física 17,24% SPS y 42,5% en SSM, presión arterial controlada 55,2% SPS y 87,5% en SSM, control de hemoglobina glicosilada 26,9% SPS y 52,5% en SSM, colesterol total alterado 17,9% SPS y 45% en SSM, síntomas depresivos 96,5% SPS y 26,3% en SSM. Se evidenció una prevalencia de mal nutrición por exceso de un 89,7% SPS y 95% SSM, riesgo cardiovascular (RCV) según circunferencia de cintura (CC) 96,5% SPS y 92,3% SSM. En relación a la encuesta alimentaria se observó que un 44,8% en usuarios SPS y 52,5% de SSM presentaron consumo alimentario hipercalórico. Los usuarios de atención privada y pública presentaron factores de riesgo cardiovascular, donde destacan la obesidad, sedentarismo y RCV según CC. Al comparar ambos grupos los usuarios SPS presentan menor control metabólico de su enfermedad y factores de riesgo cardiovascular aumentados en relación a los usuarios SSM.

Cardiovascular disease is one of the main causes of morbidity and mortality in Chile, according to the results provided by the 2017 National Health Survey, 3.3% of the population has presented acute myocardial infarction, 2.6% reported have suffered a cerebrovascular accident, 74% of Chileans are obese and 87% have sedentary behavior, belonging to type 2 diabetes mellitus (DM2) into 12% and arterial hypertension into 28%, alarming results due to their significant increase. The research had a cross-sectional observational study design. 69 patients with DM2 and essential hypertensive patients, between 40 and 80 years of age were studied, belonging to the municipal (SSM) and private (SPS) health systems in the city of Iquique. A food intake survey, anthropometric measurements, and biochemical and blood pressure tests were taken. When analyzing both groups, the following results stand out: physical activity 17.24% in SPS and 42.5% in SSM, controlled blood pressure 55.2% in SPS and 87.5% in SSM, controlled glycosylated hemoglobin 26.9% in SPS and 52.5% in SSM, altered values of total cholesterol 17.9% in SPS and 45% in SSM, depression symptoms 96.5% in SPS and 26.3% in SSM. Prevalence of malnutrition due to excess 89.7% in SPS and 95% in SSM, cardiovascular risk (RCV) according to waist circumference (CC) 96.5% in SPS and 92.3% in SSM were evidenced. In relation to the food intake survey, it was observed that 44.8% of SPS users and 52.5% of SSM users consume hypercaloric diet. The users of private and public care presented cardiovascular risk factors, where the obesity, sedentary lifestyle and RCV related to CC stand out. When comparing both groups, SPS users have less control of their disease in relation to SSM users.

Clinical Characteristics and Therapeutic Adherence of Women in a Referral Outpatient Clinic for Severe Hypertension

Abstract Background Cardiovascular disease is the main cause of death worldwide. There is a lack of studies addressing this issue in women and its risk factors, such as hypertension. Objective To evaluate the clinical and therapeutic profile of women with hypertension and to determine which factors are related to treatment adherence and blood pressure control. Methods Cross-sectional study of 181 hypertensive women treated at an outpatient referral clinic. Data were obtained from medical records, face-to-face interviews, and physical examination, using a standardized form. Statistical analysis was performed with prevalence ratio, chi-square and Student's t test. Significance was accepted at p<0.05. Results Most patients were mixed-race or black (91.7%) and the mean age was 66.09 years. Only 44.2% of patients had controlled blood pressure. The prevalence of stroke was 14.9%, whereas the prevalence of coronary artery disease was 19.3%. The mean number of oral antihypertensive drugs prescribed to each individual was 3.41. A history of stroke was more often found in patients with uncontrolled blood pressure (p=0.013) and in those using three or more antihypertensives (p=0.023). Eighty patients (44.2%) had high treatment adherence. Depression was more frequently reported by patients with poorer adherence to treatment (p=0.026). Conclusion Women with hypertension presented a high prevalence of cardiovascular risk factors and cardiovascular events, including a significantly higher prevalence of stroke in those with uncontrolled hypertension. Self-reported depression may help identify patients at risk of nonadherence to treatment.

Relationship between motor-cognitive functions and hemodynamic response of individuals with chronic stroke during and after an acute bout of aerobic exercise / Relação entre as funções motoras cognitivas e a resposta hemodinâmica de indivíduos com AVC crônico durante e após uma sessão aguda de exercícios aeróbicos

BACKGROUNG: Individuals post-stroke commonly presents functional and cardiorespiratory deficits besides a physical inactivity lifestyle in the chronic phase of disease. Considering this, there is a hypothesis that hemodynamic responses could be affected by motor, cognitive and cardiorespiratory deficits during the aerobic exercise. In order to identify functional conditions that can influence the aerobic performance of these individuals, correlations between functional variables and hemodynamic responses during and after the aerobic exercise were studied. As a secondary purpose, the ability of return to hemodynamic resting state were also analyzedMETHODS: In this experimental study, after being evaluated about their motor and cognitive function, balance and prognosis, forty participants underwent a 30-minute aerobic exercise session on a treadmill. Training heart rate, arterial blood pressure, oxygen pulse saturation, heart rate, and respiratory rate were measured before begin the exercise session, every five minutes during the exercise and five minutes after itRESULTS: Cardiorespiratory parameters within normality limits in all phases of the exercise and the capacity of returning to the resting state were observed. Moderate inverse correlations were found between Berg Scale and oxygen pulse saturation (r =-0.401, p = 0.01), between MMSE and diastolic blood pressure (r = -0.406, p = 0.009), age and diastolic blood pressure (r = -0.435, p = 0.005) and between injury time and RR (r = -0.454, p = 0.003). Relationship between the lesion side and the 20 minutes phase of aerobic exercise was also observed (p = 0.042CONCLUSION: Post- stroke individuals present moderate correlation between hemodynamic and respiratory responses during aerobic exercise and balance, muscle strength, injury time, age and side of lesion. They also have the capacity to return to their cardiorespiratory and cardiovascular resting state right after the activity besides their cardiorespiratory deficits

INTRODUÇÃO: Indivíduos pós-AVC comumente apresentam déficits funcionais e cardiorrespiratórios, além de estilo de vida de inatividade física na fase crônica da doença. Diante disso, existe a hipótese de que as respostas hemodinâmicas possam ser afetadas por déficits motores, cognitivos e cardiorrespiratórios durante o exercício aeróbio. Para identificar as condições funcionais que podem influenciar o desempenho aeróbio desses indivíduos, foram estudadas as correlações entre as variáveis funcionais e as respostas hemodinâmicas durante e após o exercício aeróbio. Como objetivo secundário, a capacidade de retorno ao estado de repouso hemodinâmico também foi analisadaMÉTODO: Neste estudo experimental, após serem avaliados quanto à função motora e cognitiva, equilíbrio e prognóstico, quarenta participantes foram submetidos a uma sessão de exercício aeróbio de 30 minutos em esteira. A frequência cardíaca, pressão arterial, saturação periférica de oxigênio, frequência cardíaca e frequência respiratória de treinamento foram medidas antes do início da sessão de exercício, a cada cinco minutos durante o exercício e cinco minutos apósRESULTADOS: Foram observados parâmetros cardiorrespiratórios dentro dos limites da normalidade em todas as fases do exercício e capacidade de retorno ao estado de repouso. Correlações inversas moderadas foram encontradas entre Escala de Berg e saturação do pulso de oxigênio (r = -0,401, p = 0,01), entre MEEM e pressão arterial diastólica (r = -0,406, p = 0,009), idade e pressão arterial diastólica (r = -0,435, p = 0,005) e entre o tempo de lesão e FR (r = -0,454, p = 0,003). Também foi observada relação entre o lado da lesão e a fase de 20 minutos do exercício aeróbio (p = 0,042CONCLUSÃO: Indivíduos pós-AVE apresentam correlação moderada entre as respostas hemodinâmicas e respiratórias durante o exercício aeróbio e equilíbrio, força muscular, tempo de lesão, idade e lado da lesão. Eles também têm a capacidade de retornar ao estado de repouso cardiorrespiratório e cardiovascular logo após a atividade, apesar de seus déficits cardiorrespiratórios

Efeito crônico do treinamento resistido sobre a pressão arterial: uma revisão sistemática e metanálise de ensaios clínicos controlados randomizados / Chronic effect of resistance training on blood pressure: a systematic review and metanalysis of randomized controlled clinical trials

Este estudo tem como objetivo comparar e discutir, a partir de estudos científicos publicados, o efeito crônico do treinamento resistido sobre a pressão arterial. Foi realizada uma revisão sistemática de ensaios clínicos controlados randomizados. A busca dos artigos foi realizada nas bases de dados SciELO, PubMed e Biblioteca Virtual da Saúde. Foram selecionados artigos publicados a partir de 2015, com avaliação da pressão arterial antes e após um período de treinamento resistido e com um grupo controle. Nos 18 estudos selecionados, 551 participantes foram identificados, incluindo idosos, obesos, hipertensos, diabéticos, indivíduos com síndrome metabólica e indivíduos saudáveis, com idade média variando entre 15,4 e 87,7 anos. A maioria dos estudos selecionados realizou uma intervenção de treinamento resistido com exercícios dinâmicos tradicionais para membros inferiores e superiores, com duração de 12 semanas e frequência de 3 vezes por semana. O volume de treinamento apresentado nos estudos variou entre 1 e 5 séries de 3 a 20 repetições por exercício. A intensidade foi apresentada em percentual de uma repetição máxima, percentual de 10 repetições máximas, repetições máximas e percepção subjetiva de esforço. O intervalo de descanso entre os exercícios variou entre 30 e 180 segundos. A metanálise indicou que o treinamento resistido reduziu significativamente a pressão arterial sistólica em -3,38 mmHg ([IC 95% = -5,82; -0,95] p < 0,01; I² = 76%) e a pressão arterial diastólica em -1,95 mmHg ([IC 95% = -3,12; -0,78] p < 0,01; I² = 58%). De acordo com os resultados desta revisão, o treinamento resistido sozinho é mais efetivo em reduzir a pressão arterial de repouso do que o não treinamento, principalmente pressão arterial sistólica; com maior redução em idosos, pré-hipertensos e hipertensos. Sendo assim, o treinamento resistido pode ser um método a ser indicado na prevenção e tratamento da hipertensão arterial sistêmica.(AU)

This study aims to compare and discuss, based on published scientific studies, the chronic effect of resistance training on blood pressure. A systematic review of randomized controlled clinical trials was performed. The search for articles was carried out in the SciELO, PubMed and Biblioteca Virtual da Saúde databases. Articles published from 2015 onwards, with blood pressure assessment before and after a period of resistance training and with a control group, were selected. In the 18 selected studies, 551 participants were identified, including the elderly, obese, hypertensive, diabetics, subjects with metabolic syndrome and healthy subjects, with a mean age ranging between 15,4 and 87,7 years. Most of the selected studies carried out a resistance training intervention with traditional dynamic exercises for lower and upper limbs, lasting 12 weeks and frequency of 3 times a week. The volume of training presented in the studies varied between 1 and 5 sets of 3 to 20 repetitions per exercise. The intensity was presented as a percentage of a maximum repetition, a percentage of 10 maximum repetitions, maximum repetitions and perceived exertion. The rest interval between exercises varied between 30 and 180 seconds. The metaanalysis indicated that resistance training significantly reduced systolic blood pressure by -3,38 mmHg ([95% CI = -5,82; -0,95] p <0,01; I² = 76%) and blood pressure diastolic at -1,95 mmHg ([95% CI = -3,12; -0,78] p <0,01; I² = 58%). According to the results of this review, resistance training alone is more effective in reducing resting blood pressure than non-training, especially systolic blood pressure; with greater reduction in elderly, pre-hypertensive and hypertensive subjects. Therefore, resistance training can be a method to be indicated in the prevention and treatment of systemic arterial hypertension.(AU)

Impact of equine assisted therapy on the cardiovascular parameters of the elderly / Impacto da terapia assistida por equinos nos parâmetros cardiovasculares de idosos

INTRODUCTION: Physical activity programs in the elderly aim to prevent and/or reduce the functional decline resulting from the senescence process. Several studies provide evidence that Equine Assisted Therapy (EAT) is an effective means of improving health. However, studies addressing the effects of EATon the cardiovascular system are scarce. OBJECTIVE: To evaluate the effect of Equine Assisted Therapyon the cardiovascular responses of participants divided into two groups: normotensive and hypertensive. METHODS: Twenty individuals participated, aged between 60 and 79 years, divided into three groups: Normotensive Group (n=14), Hypertensive Group (n=6) and all participants, Total Group (n=20). The Omron® HEM 742 blood pressure monitor was used to measure blood pressure and the Gerathem® portable finger oximeter to measure heart rate and blood oxygen saturation. Ten visits were made once a week, lasting 30 minutes. RESULTS: Between the first and tenth interventions, there was a reduction in blood pressure and heart rate, with statistical significance of systolic blood pressure for the Hypertensive Group (p=0.0478), the Total Group (p=0.0201) and diastolic pressure for the Total Group (p=0.0421). There was also a statistically significant difference in systolic blood pressure and heart rate during some visits. Blood oxygen saturation increased after the intervention, but without statistical significance. CONCLUSION: Equine Assisted Therapy can promote a reduction in blood pressure in the elderly, especially hypertensive individuals.

INTRODUÇÃO: Programas de atividade física em idosos visam prevenir e/ou reduzir o declínio funcional decorrente do processo de senescência. Vários estudos fornecem evidências de que a Terapia Assistida por Equinos (TAE) é um meio eficaz de melhorar a saúde. No entanto, estudos que abordam os efeitos da TAE no sistema cardiovascular são escassos. OBJETIVO: Avaliar o efeito da Terapia Assistida por Eqüinos nas respostas cardiovasculares dos participantes dividos em dois grupos: normotensos e hipertensos. MÉTODOS: Participaram 20 indivíduos, com idade entre 60 a 79 anos, distribuídos em três Grupos: Grupo Normotenso (n=14), Grupo Hipertenso (n=6) e todos os participantes, Grupo Total (n=20). Foi utilizado o monitor de pressão arterial Omron® HEM 742 para aferir a pressão arterial e o oxímetro de dedo portátil Gerathem® para medir a freqüência cardíaca e a saturação de oxigênio no sangue. Foram realizados dez atendimentos uma vez por semana, com duração de 30 minutos. RESULTADOS: Entre a primeira e décima intervenção, houve redução da pressão arterial e da frequência cardíaca, com significância estatística da pressão arterial sistólica para o Grupo Hipertenso (p=0,0478), o Grupo Total (p=0,0201) e da pressão diastólica para o Grupo Total (p=0,0421). Também houve diferença estatisticamente significante da pressão arterial sistólica e da frequência cardíaca durante alguns atendimentos. A saturação de oxigênio no sangue aumentou após a intervenção, porém sem significância estatística. CONCLUSÃO: A Terapia Assistida por Eqüinos pode promover redução da pressão arterial em idosos, principlamente de hipertensos.

Interrelationships between obesity, blood pressure and metabolic profile in climacteric women / Inter-relações entre obesidade, pressão arterial e perfil metabólico em mulheres climatéricas

ABSTRACT Objective This study aimed to evaluate the interrelationships between obesity, blood pressure and metabolic profile in climacteric women. Methods This is a cross-sectional study with a random sample of 874 women, aged 40 to 65 years, assisted in Family Health Strategies units in Montes Claros, Minas Gerais, Brazil. A structural equation model was used to assess the interrelationships between obesity, blood pressure and metabolic profile, adjusted for age. The variables blood pressure, obesity and metabolic profile were treated as constructs, which measurement models were developed using confirmatory factor analysis. Results It was observed that age has a positive and significant effect on blood pressure (β=0.20; p<0.001) and obesity (β=0.10; p=0.004). There was a direct and positive effect of obesity on blood pressure (β=0.26; p<0.001) and on the metabolic profile (β=0.10; p=0.037), adjusted for physical activity. Conclusions The simultaneous analysis of the relationships between age, obesity, blood pressure and metabolic profile in menopausal women suggests that, ageing has an effect on the increase of obesity and blood pressure, just as obesity increases blood pressure and changes the metabolic profile.

RESUMO Objetivo Avaliar as inter-relações entre obesidade, pressão arterial e perfil metabólico em mulheres climatéricas. Métodos Trata-se de estudo transversal com amostra aleatória composta por 874 mulheres com idade entre 40 a 65 anos assistidas em unidades de Estratégias de Saúde da Família em Montes Claros, Minas Gerais, Brasil. Foi utilizado modelo de equação estrutural para avaliar as inter-relações entre obesidade, pressão arterial e perfil metabólico, ajustado pela idade. As variáveis pressão arterial, obesidade e perfil metabólico foram tratadas como construtos, cujos modelos de mensuração foram construídos utilizando-se a análise fatorial confirmatória. Resultados Observou-se que a idade exerce efeito positivo e significativo sobre a pressão arterial (β=0,20; p<0,001) e a obesidade (β=0,10; p=0,004). Houve efeito direto e positivo da obesidade na pressão arterial (β=0,26; p<0,001) e no perfil metabólico (β=0,10; p=0,037), ajustado por atividade física. Conclusão A análise simultânea das relações entre idade, obesidade, pressão arterial e perfil metabólico em mulheres no climatério sugere que o aumento da idade tem efeito sobre o aumento da obesidade e da pressão arterial, assim como a obesidade tem efeito positivo sobre o aumento da pressão arterial e sobre a alteração no perfil metabólico.

Desigualdades étnicas y de género en la prevalencia de presión arterial elevada en población general de Cochabamba: un análisis interseccional de inequidades en salud / Ethnic and gender inequalities in the prevalence of elevated blood pressure in the general population of Cochabamba: an intersectional analysis of health inequities

Las desigualdades en salud comúnmente son evaluadas en una sola dimensión de análisis y poco se conoce sobre el efecto sumativo o multiplicativo cuando se combinan 2 o más dimensiones sociales; representando un desafío para la prevención y control de la Presión Arterial Elevada (PAE). OBJETIVO: analizar los factores involucrados en las desigualdades poblacionales de la prevalencia de PAE en el espacio inter seccional de los procesos de ventaja y desventaja social por referencia étnica y de género. MÉTODOS: estudio observacional, de corte transversal con enfoque interseccional. Participaron sujetos mayores de 18 años con residencia permanente en Cochabamba (n=10595), seleccionados mediante muestreo aleatorio trietápico. Se utilizó la encuesta WHO-STEPS para recopilar información sobre PAE y factores de riesgo asociados. Se construyeron cuatro posiciones interseccionales por la combinación de género y etnicidad. La descomposición de Oaxaca-Blinder se aplicó para estimar las contribuciones de los factores explicativos de las desigualdades. RESULTADOS: la prevalencia de PAE fue mayor en los hombres-mestizos (10,76%); la disparidad por referencia de género fue más importante entre mestizos (3,74%) e indígenas (3,11%); la disparidad interseccional entre grupos extremos (3,53%) fue mayor a la disparidad entre grupos medios (3,32%). La edad, el tipo de trabajo y estilos de vida, contribuyeron más para explicar estas diferencias. CONCLUSIONES: la PAE no se distribuye según los patrones esperados de desventaja social en el espacio interseccional de etnicidad y género. Una alta ventaja social se relacionó con prevalencias más altas de PAE, así como los factores de riesgo de comportamiento asociados.

Health inequalities are commonly evaluated in a single dimension of analysis and little is known about the summative or multiplicative effect when 2 or more social dimensions are combined; representing a challenge for the prevention and control of High Blood Pressure (HBP). OBJECTIVE: analyze the factors involved in the inequalities of the prevalence of HBP in the inter-sectional space of the processes of social advantage and disadvantage by ethnic and gender reference. METHODS: observational, cross-sectional study with an intersectional approach. Subjects over 18 years of age with permanent residence in Cochabamba (n = 10,595), selected by means of three-stage random sampling, participated. The WHO-STEPS survey was used to collect information on HBP and the risk factors associated. Four intersectional positions were constructed by the combination of gender and ethnicity. The Oaxaca-Blinder decomposition was applied to estimate the contributions of the explanatory factors of the inequalities. RESULTS: the prevalence of HBP was higher in mestizos men (10.76%); the disparity by gender reference was more important between mestizos (3.74%) and indigenous people (3.11%); the intersectional disparity between extreme groups (3.53%) was greater than the disparity between middle groups (3.32%). Age, type of work, and lifestyles contributed more to explain these differences. CONCLUSIONS: the HBP is not distributed according to the expected patterns of social disadvantage in the intersectional space of ethnicity and gender. A high social advantage was related to higher prevalence of HBP, as well as associated behavioral risk factors.

Hipertensão na doença renal crônica em tratamento conservador / Hypertension in chronic kidney disease under conservative treatment

A hipertensão arterial sistêmica (HAS) afeta aproximadamente 30% da população geral no mundo industrializado e é uma das principais causas de doença renal crônica (DRC), caracterizada por função renal anormal ou danos estruturais renais com mais de 3 meses de duração. A sua presença classifica o paciente hipertenso como de alto risco cardiovascular (CV). O controle pressórico é fundamental para diminuir a sua progressão e reduzir o risco de morbidade e mortalidade CV. A meta pressórica recomendada deve ser menor que 130x80mmHg para a maioria dos pacientes com DRC. O tratamento não medicamentoso tem como base as mesmas recomendações dos demais pacientes hipertensos. A terapia medicamentosa combinada deve ser iniciada o mais breve possível. Além dos inibidores do sistema renina angiotensina aldosterona, conhecidos por sua eficácia na DRC, os diuréticos e os bloqueadores de canal de cálcio compõem o trio de ouro utilizado no tratamento da HAS, capazes de reduzir o risco cardiovascular e desacelerar a progressão da doença renal. Em conclusão, a DRC é um preditor de risco CV e a presença concomitante de HAS aumenta expressivamente esse risco. A utilização da estratégia terapêutica adequada para manter os níveis pressóricos dentro das metas é fundamental na atenuação da progressão da doença renal e do risco

Systemic arterial hypertension (SAH) affects approximately 30% of the general population in the industrialized world and is a major cause of chronic kidney disease (CKD), characterized by abnormal renal function or structural damage lasting more than 3 months. Its presence classifies the hypertensive as a high cardiovascular (CV) risk patient. Blood pressure (BP) control is essential for slowing the progression and for reducing the risk of CV morbidity and mortality in patients with CKD. BP target <130x80mmHg is recommended for most hypertensives with CKD. Non pharmacological treatment is based on the same recommendations for other hypertensive patients. Combination drug therapy should be started as soon as possible. In addition to the renin angiotensin aldosterone system blockers, known for their effectiveness in CKD, diuretics and calcium channel blockers compose the gold trio used in the treatment of SAH, able to reduce cardiovascular risk and to slow the progression of kidney disease. In conclusion, CKD is a predictor of CV risk and the concomitant presence of SAH significantly increases this risk. The use of an appropriate therapeutic strategy to maintain BP control is crucial to mitigate the progression of kidney disease and CV

Relação entre Velocidade de Onda de Pulso e Biomarcadores Cardiovasculares em Pacientes com Fatores de Risco / Relationship between Pulse Wave Velocity and Cardiovascular Biomarkers in Patients with Risk Factors

Resumo Fundamento A relação entre velocidade de onda de pulso (VOP) e biomarcadores de mudanças estruturais do ventrículo esquerdo e artérias carótidas ainda é pouco elucidada. Objetivo Investigar a relação entre VOP e esses biomarcadores. Métodos Estudo transversal, retrospectivo e analítico. Revisamos prontuários médicos de pacientes com diabetes mellitus, dislipidemia, e pré-hipertensão ou hipertensão, que realizaram medida de pressão arterial central (PAC) utilizando o Mobil-O-Graph®, e doppler de carótida ou ecocardiografia três meses antes ou após a medida da PAC. Análise estatística realizada por correlação de Pearson ou de Spearman, análise de regressão múltipla e de regressão bivariada, e teste t (independente) ou de Mann-Whitney. Um p<0,05 indicou significância estatística. Resultados Prontuários de 355 pacientes foram avaliados, 56,1 ±14,8 anos, 51% homens. A VOP correlacionou-se com espessuras da íntima média (EIM) das carótidas (r=0,310) do septo do ventrículo esquerdo (r=0,191) e da parede posterior do ventrículo esquerdo (r=0.215), e com diâmetro do átrio esquerdo (r=0,181). A EIM associou-se com VOP ajustada por idade e pressão sistólica periférica (p=0,0004); uma EIM maior que 1mm aumentou em 3,94 vezes a chance de se apresentar VOP acima de 10m/s. A VOP foi significativamente maior em indivíduos com hipertrofia do ventrículo esquerdo (p=0,0001), EIM > 1 mm (p=0,006), placa de carótida (p=0,0001), estenose ≥ 50% (p=0,003), e lesões de órgãos-alvo (p=0,0001). Conclusões A VOP correlacionou-se com a EIM e com parâmetros ecocardiográficos, e se associou independentemente com EIM. Essa associação foi mais forte em pacientes com hipertrofia do ventrículo esquerdo, EIM aumentada, placa de carótida, estenose ≥ 50%, e lesões de órgãos-alvo. (Arq Bras Cardiol. 2020; 115(6):1125-1132)

Abstract Background The relationship between pulse wave velocity (PWV) and biomarkers of structural changes of the left ventricle and carotid arteries remains poorly understood. Objective To investigate the relationship between PWV and these biomarkers. Methods This was an analytical, retrospective, cross-sectional study. Medical records of patients with diabetes mellitus, dyslipidemia, and pre-hypertension or hypertension, who underwent central blood pressure (CBP) measurement using Mobil-O-Graph®, and carotid doppler or echocardiography three months before and after the CBPM were analyzed. Statistical analysis was performed using Pearson or Spearman correlation, linear bivariate and multiple regression analysis, and the t test (independent) or Mann-Whitney test. A p <0.05 indicated statistical significance. Results Medical records of 355 patients were analyzed, mean age 56.1 (±14.8) years, 51% male. PWV was correlated with intima-media thickness (IMT) of carotids (r=0.310) and left ventricular septal thickness (r=0.191), left ventricular posterior wall thickness (r=0.215), and left atrial diameter (r=0.181). IMT was associated with PWV adjusted by age and peripheral systolic pressure (p=0.0004); IMT greater than 1 mm increased the chance of having PWV above 10 m/s by 3.94 times. PWV was significantly higher in individuals with left ventricular hypertrophy (p=0.0001), IMT > 1 mm (p=0.006), carotid plaque (p=0.0001), stenosis ≥ 50% (p=0.003), and target-organ damage (p=0.0001). Conclusion PWV was correlated with IMT and echocardiographic parameters, and independently associated with IMT. This association was stronger in individuals with left ventricular hypertrophy, increased IMT, carotid plaque, stenosis ≥ 50%, and target organ damage. (Arq Bras Cardiol. 2020; 115(6):1125-1132)

La enfermedad cerebrovascular y sus factores de riesgo / The cerebrovascular disease and their risk factors

Introducción: Las enfermedades cerebrovasculares son la tercera causa de muerte y la primera de invalidez en el mundo. Objetivo: Medir las asociaciones entre los ictus cerebrovasculares y sus factores de riesgo. Métodos: Se realizó un estudio descriptivo, la serie estuvo conformada por 904 pacientes con diagnóstico al ingreso de enfermedad cerebrovascular, en el período comprendido entre junio 2017 a junio 2018, en el Hospital Militar Central "Dr. Carlos J. Finlay". Se analizaron las formas clínicas de enfermedad cerebrovascular, a partir de las variables edad, sexo, hábito de fumar, alcoholismo, hipertensión arterial, diabetes mellitus, hipercolesterolemia e hipertrigliceridemia. Se utilizaron como medidas de resumen, las frecuencias absolutas y relativas. Resultados: El 54,7 por ciento de los pacientes eran mayores de 70 años y el 58,7 por ciento del sexo masculino. El hábito de fumar se constató en el 87,7 por ciento de pacientes con ictus aterotrombótico y en el 89,2 por ciento de los que tuvieron hemorragias intraparenquimatosas y el alcohol en el 64,6 por ciento de los pacientes con hemorragias intraparenquimatosas. Más del 80 por ciento de los pacientes con ictus isquémicos y hemorrágicos, eran hipertensos. El ictus cardioembólico se asoció en el 91,9 por ciento, con arritmia cardiaca. Conclusiones: La enfermedad cerebrovascular predominó por encima de los 70 años y del sexo masculino. Los ictus isquémicos son más frecuentes que los hemorrágicos. La hipertensión arterial y la diabetes mellitus fueron los factores de riesgo más frecuentes, tanto en los ictus isquémicos como hemorrágicos(AU)

Introduction: Cerebrovascular disease is the third leading cause of death and the first cause of disability in the world. Objective: To measure the associations between cerebrovascular strokes and their risk factors. Methods: A descriptive study was carried out, the series was made up of 904 patients diagnosed upon admission of cerebrovascular disease, in the period from June 2017 to June 2018 at the Hospital Militar Central Dr. Carlos J. Finlay. The different clinical forms of cardiovascular diseases were analyzed based on the variables age, sex, smoking, alcoholism, high blood pressure, diabetes mellitus, hypercholesterolemia and hypertriglyceridemia. Absolute and relative frequencies were used as summary measures. Results: 54.7 percent of patients were older than 70 years and 58.7 percent were male. Smoking was found in 87.7 percent of atherothrombotic stroke and in 89.2 percent of intraparenchymal hemorrhages and alcohol in 64.6 percent of intraparenchymal hemorrhages. More than 80 percent of the patients with ischemic and haemorrhagic stroke were hypertensive, and cardioembolic stroke was associated in 91.9 percent with cardiac arrhythmia. Conclusions: Cerebrovascular disease was predominant over 70 years old and male. Ischemic strokes are more frequent than hemorrhagic ones. High blood pressure and diabetes mellitus were the most frequent risk factors for both ischemic and hemorrhagic strokes(AU)

Controle da Pressão Arterial e Fatores Associados em um Serviço Multidisciplinar de Tratamento da Hipertensão / Blood Pressure Control and Associated Factors in a Real-World Team-Based Care Center

Resumo Fundamento Apesar de se recomendar a intervenção em equipe no tratamento da hipertensão, resultados dessa abordagem em ambientes do mundo real são escassos na literatura. Objetivos Apresentar os resultados de uma estratégia terapêutica baseada em equipe, de longo prazo, de pacientes hipertensos em um serviço de saúde. Métodos Dados de pacientes hipertensos acompanhados em um centro de tratamento multidisciplinar localizado na região centro-oeste do Brasil em junho de 2017 com pelo menos duas visitas de acompanhamento foram avaliados retrospectivamente. Dados antropométricos, pressão arterial (PA), tempo de acompanhamento, tratamento farmacológico, diabetes, estilo de vida foram coletados da última consulta. Valores de PA < 140 x 90 mmHg em não diabéticos e < 130 x 80 mmHg em diabéticos foram considerados PA controlada. Um modelo de regressão logística foi construído para identificar variáveis independentemente associadas com o controle da PA. O nível de significância adotado foi de p<0.05. Resultados Foram incluídos 1548 pacientes, com média de acompanhamento de 7,6 ± 7,1 anos. A maioria dos pacientes eram mulheres (73,6%; n=1139), com idade média de 61,8 anos. As taxas de controle da PA na amostra total, em não diabéticos e nos diabéticos foram 68%, 79%, e 37,9%, respectivamente. Diabetes associou-se inversamente com controle da PA (OR 0,16; IC95% 0,12-0,20; p<0,001), enquanto idade ≥ 60 anos (OR 1,48; IC95% 1,15-1,91; p=0,003) e sexo feminino (OR 1,38; IC95% 1,05-1,82; p=0,020) apresentaram associação direta. Conclusões Uma taxa de controle de cerca de 70% foi encontrada em pacientes atendidos em um serviço multidisciplinar de tratamento da hipertensão. A fim de melhorar esses resultados, atenção deve ser dada a pacientes diabéticos, com idade menor que 60 anos e do sexo masculino. (Arq Bras Cardiol. 2020; 115(2):174-181)

Abstract Background Although team-based care is recommended for patients with hypertension, results of this intervention in a real-world setting are missing in the literature. Objective To report the results of a real-world long-term team-based care for hypertensive patients we conducted this study. Methods Data of hypertensive patients attending a multidisciplinary treatment center located in the Midwest region of Brazil in June 2017 with at least two follow-up visits were retrospectively assessed. Anthropometric, blood pressure (BP), follow-up time, pharmacological treatment, diabetes and lifestyle data were collected from the last visit to the service. BP values < 140 x 90 mmHg in non-diabetics and < 130 x 80 mmHg in diabetics were considered controlled. A logistic regression model was built to identify variables independently associated to BP control. Significance level adopted p < 0.05. Results A total of 1,548 patients were included, with a mean follow-up time of 7.6 ± 7.1 years. Most patients were female (73.6%; n=1,139) with a mean age of 61.8 ±12.8 years. BP control rates in all the sample, and in non-diabetics and diabetics were 68%, 79%, and 37.9%, respectively. Diabetes was inversely associated with BP control (OR 0.16; 95%CI 0.12-0.20; p<0.001) while age ≥ 60 years (OR 1.48; 95%CI 1.15-1.91; p=0.003) and female sex (OR 1.38; 95%CI 1.05-1.82; p=0.020) were directly associated. Conclusions A BP control rate around 70% was found in patients attending a multidisciplinary team care center for hypertension. Focus on patients with diabetes, younger than 60 years and males should be given to further improve these results. (Arq Bras Cardiol. 2020; 115(2):174-181)

The influence of aortic pulse wave velocity on short-term functional capacity in patients with mild paravalvular regurgitation following transcatheter aortic valve implantation

Abstract Introduction: Recently, the clinical significance of mild paravalvular aortic regurgitation (PAR) has been evaluated and suggested that it can be predictor of clinical outcomes. In our study, we aimed to investigate the interaction of aortic pulse wave velocity (PWV) and mild PAR and their effects on the functional status of patients after transcatheter aortic valve implantation (TAVI). Methods: A total of 109 consecutive patients with symptomatic severe aortic stenosis were enrolled prospectively. After TAVI procedure, they were divided in to three groups according to PAR and PWV measurements. Patients without PAR were defined as the NonePAR group (n=60), patients with mild PAR and normal PWV were defined as the MildPAR-nPWV group (n=23), and patients with mild PAR and high PWV were defined as the MildPAR-hPWV group (n=26). Results: Compared with other groups, the MildPAR-hPWV group was older (P<0.001), hypertensive (P=0.015), and had a higher pulse pressure (P=0.018). In addition to PWV, this group had lower aortic regurgitation index (ARI) (P=0.010) and higher rate of New York Heart Association (NYHA) class II (at least) patients (P<0.001) in 30-day follow-up period. On multivariate regression analysis, the MildPARhPWV group (odds ratio=1.364, 95% confidence interval 1.221-1.843; P=0.011) as well as N-terminal-pro-brain natriuretic peptide levels and ARI were independently related with 30-day functional NYHA classification. However, NonePAR or MildPAR-nPWV group was not an independent predictor of early functional status. Conclusion: It was concluded that high PWV may adversely affect early functional status in patients with mild PAR in contrast to normal values following TAVI.

Caracterización de las Crisis Hipertensivas en adultos de la Emergencia del Hospital José Félix Valdivieso, Enero 2016 a Diciembre 2018 / Hypertensive Crisis Characterization in adults in the Emergency Department of Hospital José Felix Valdivieso, Januay 2016- December 2018

INTRODUCCIÓN: La crisis hipertensiva es considerada una complicación aguda de la Hipertensión Arterial Sistémica, y contribuye a las 9.4 millones de muertes anuales estimadas, asociadas a la misma. La morbilidad que ocasionan es otro problema de importancia. Los datos a nivel local son escasos, por lo que conocer las características clínico-epidemiológicas de las crisis hipertensivas reviste gran importancia. El objetivo de este estudio fue caracterizar las Crisis hipertensivas en adultos de la Emergencia del Hospital José Félix Valdivieso Santa Isabel, periodo enero 2016 a diciembre 2018. METODOLOGÍA: Se trató de un estudio descriptivo, transversal, con un universo de 151 pacientes diagnosticados con crisis hipertensiva en el Hospital José Félix Valdivieso entre enero 2016 y diciembre 2018, realizando un muestreo aleatorio simple se obtuvo 122 pacientes. Se recolectó la información mediante revisión de las historias clínicas. Se procesaron los datos mediante Excel 2016, para posteriormente interpretarlos mediante tablas y gráficos. RESULTADOS: El 57% de los pacientes fue de sexo femenino, el grupo de edad de 40 a 65 años que representa el 49% de la muestra, 67% tuvieron un nivel de instrucción primaria, 65% fueron de una procedencia rural. En cuanto a la presencia de factores de riesgo conocidos para crisis hipertensivas, el 50% de la población tuvo sobrepeso, el 70% hipertensión arterial previa. Según el tipo de crisis hipertensiva, el 93% fueron urgencia hipertensivas, en las emergencias hipertensivas el órgano afecto con mayor frecuencia fue el cerebro con 89%. La manifestación clínica más frecuente fue cefalea con un 59%, seguida de sintomatología neurológica.. En cuanto al manejo la terapéutica inicial fue Captopril en el 61%. CONCLUSIÓN: La mayor parte de pacientes afectados fueron del sexo femenino, adultos de edad media. La mayoría de la muestra tuvo antecedentes de sobrepeso u obesidad. El 70% de la población tenia diagnóstico previo de Hipertensión Arterial, y de ellos solamente el 80% tomaba fármacos antihipertensivos. La mayoría de crisis fueron urgencias hipertensivas, en las emergencias hipertensivas el órgano diana más afectado fue el cerebro. El medicamento que se administró con mayor frecuencia en el manejo inicial de la crisis hipertensiva fue captopril. No se registró mortalidad en ese estudio.(au)

BACKGROUND: Hypertensive crisis is considered an acute complication of Hypertension, causing 9.4 million deaths annually. Another important problem is the resulting morbidity. Locally, data is limited, that is the importance of presenting the clinical and epidemiological characteristics of hypertensive crisis. The aim of this study was characterizing hypertensive crisis in adults, in Hospital José Félix Valdivieso, Santa Isabel, from January 2016 to December 2018. METHODS: Descriptive, cross-sectional study, the study universe were 151 patients diagnosed with hypertensive crisis in Hospital José Félix Valdivieso from January 2016 to December 2018, by simple random sampling we picked 122 patients. The information was obtained from the patient's medical chart. The data was processed using Excel 2016, and later interpreted using tables and charts. RESULTS: 57% of the sample were female, 49% had between 40 to 65 years of age, 67% had primary education, 65% came from rural areas. About risk factors; 50% of the population was overweight, 70% had previous diagnosis of hypertension. About the type of hypertensive crisis; 93% were hypertensive urgencies, the most commonly affected organ in hypertensive emergencies was the brain, in 89% of the cases. Headache, was the most frequent symptom(59%), followed by neurological symptoms. Captopril was used as initial treatment in 61% of the cases. CONCLUSION: The majority of affected patients were female, middle aged adults. Most of the sample had overweight or obesity. 70% of the population had previous diagnosis of hypertension, of this patients only 80% had hypertensive treatment. Most of the crisis were hypertensive urgencies, in hypertensive emergencies the most commonly affect organ was the brain. Captopril was used in most of the cases for initial treatment. This study didn't registered any deaths.(au)

Controle pressórico e inércia terapêutica no ambulatório escola da Universidade Iguaçu / Pressure control and therapeutic inertia in the outpatient school of the Iguaçu University

Introdução: Conhecer as taxas de controle da pressão do Ambulatório Escola da Universidade Iguaçu, as estratégias terapêuticas e a taxa de inércia terapêutica frente aos pacientes não controlados, são fundamentais para estabelecer estratégias de alcance de metas pressóricas. Objetivo: Determinar a taxa de pacientes na meta e fora da meta de pressão arterial, a estratégia terapêutica em uso e a taxa de inércia terapêutica frente aos pacientes não controlados. Metodologia: Estudo observacional, prospectivo e analítico através de análise dos prontuários e entrevista com pacientes consecutivos atendidos no ambulatório escola da Universidade Iguaçu, com >18 anos, no período de agosto a dezembro de 2019. Análise de dados demográficos, condições clínicas associadas e presença de outros fatores de risco. Resultados: 202 pacientes estudados na pesquisa, faixa etária de 18 a 85 anos, com 91,08% dos pacientes com hipertensão arterial (40 e 79 anos). Analisando as taxas de controle, 61,38 % encontram-se na meta de pressão arterial de acordo com o risco cardiovascular, segundo a Sociedade Brasileira de Cardiologia, e 38,6%, dos pacientes não se encontram na meta. A adesão terapêutica elevada foi observada em 29,83% dos pacientes na meta vrs 26,92% dos pacientes fora da meta. A taxa de inercia terapêutica foi de 41,03% pacientes com conduta mantida. Conclusão: Dos pacientes atendidos, 38,61% estão fora da meta de pressão arterial, e a inercia terapêutica é um importante problema. Como a maioria dos pacientes hipertensos sem comorbidades são acompanhados nas unidades básicas de saúde por generalistas, a capacitação desses profissionais é de grande importância para um melhor controle da pressão arterial.

Introduction:Knowing the pressure control rates of the outpatient school at the Iguaçu University, therapeutic strategies and the rate of therapeutic inertia in the face of uncontrolled patients are essential to establish strategies to achieve pressure goals. Objective: Determine the rate of patients on and off the blood pressure target, the therapeutic strategy in use and the rate of therapeutic inertia compared to uncontrolled patients. Methodology:Observational, prospective and analytical study through analysis of medical records and interviews with consecutive patients over 18 years old seen at the outpatient school at Universidade Iguaçu, from August to December 2019. Analysis of demographic data, associated clinical conditions and the presence of others risk factors. Results:202 patients studied in the research, age range from 18 to 85 years, with 91.08% of patients with arterial hypertension (40 and 79 years). Analyzing the control rates, 61.38% are on the blood pressure target according to cardiovascular risk, according to the Brazilian Society of Cardiology, and 38.6%, of the patients are not on the target. High therapeutic adherence was observed in 29.83% of patients on target vs. 26.92% of patients off target. The therapeutic inertia rate was 41.3% of patients in the target. Conclusion: Of the patients seen, 38.61% are outside the blood pressure target, and therapeutic inertia is an important problem. As the majority of hypertensive patients without comorbidities are monitored in basic health units by general practitioners, the training of these professionals is of great importance for a better control of blood pressure

A Prevalência da Hipotensão Ortostática e a Distribuição da Variação Pressórica no Estudo Longitudinal da Saúde do Adulto / Prevalence of Orthostatic Hypotension and the Distribution of Pressure Variation in the Longitudinal Study of Adult Health

Resumo Fundamento A hipotensão ortostática (HO) tem sido negligenciada na clínica não havendo estudos sobre sua prevalência na população brasileira. Objetivo Determinar a prevalência de HO e a variação da pressão arterial (PA) após manobra postural no Estudo Longitudinal da Saúde do Adulto. Métodos No presente estudo descritivo da linha de base (N = 14.833 indivíduos, 35-74 anos), os participantes ficavam deitados por 20 minutos e então levantavam ativamente, com a medida da PA em supino e aos 2, 3, e 5 minutos de ortostase. A HO foi definida por queda ≥ 20 mmHg na PA sistólica e/ou queda ≥ 10 mmHg na PA diastólica aos 3 minutos, sendo determinada a sua prevalência com intervalo de confiança de 95% (IC95%). A distribuição da variação da PA após a manobra postural foi determinada numa subamostra (N = 8.011) após remoção de participantes com morbidade cardiovascular e/ou diabetes. Resultados A prevalência de HO foi de 2,0% (IC95%: 1,8 - 2,3), crescente com a idade. Se o critério for a mesma queda pressórica em qualquer das medidas, a prevalência aumenta para 4,3% (IC95%: 4,0 - 4,7). Em presença de HO houve relato de sintomas (tontura, escotomas, náuseas, etc.) em 19,7% dos participantes (IC95%: 15,6 - 24,6) e em apenas 1,4% (IC95%: 1,2 - 1,6) dos sem HO. Os escores-Z −2 das variações da PA antes e após manobra postural na subamostra foram de −14,1 mmHg na PA sistólica e −5,4 mmHg na diastólica. Conclusão A prevalência de HO varia em função do momento da aferição da PA. Os pontos de corte atuais podem subestimar a ocorrência de HO na população. (Arq Bras Cardiol. 2020; 114(6):1040-1048)

Abstract Background Orthostatic hypotension (OH) has been neglected in clinical practice, and there are no studies on its prevalence in the Brazilian population. Objective To determine the prevalence of OH and blood pressure (BP) changes after the postural change maneuver in participants of the Longitudinal Study of Adult Health. Methods In this descriptive study of baseline data (N = 14,833 adults, ages 35 - 74 years), participants remained lying down for 20 minutes and subsequently stood up actively. BP measurements were taken while the participants were supine and at 2, 3, and 5 minutes after standing. OH was defined as a reduction of ≥ 20 mmHg in systolic BP and/or a reduction of ≥ 10 mmHg in diastolic BP at 3 minutes, and its prevalence was determined with a 95% confidence interval (CI). The distribution of BP variation after the postural change maneuver was determined in a subsample (N = 8,011) obtained by removing patients with cardiovascular morbidity and/or diabetes. Results The prevalence of OH was 2.0% (95% CI: 1.8 - 2.3), increasing with age. If the criterion applied were a BP reduction during any measurement, the prevalence would increase to 4.3% (95% CI: 4.0 - 4.7). Symptoms (dizziness, scotoma, nausea, etc.) were reported by 19.7% of participants (95% CI: 15.6 - 24.6) with OH and 1.4% (95% CI: 1.2 - 1.6) of participants without OH. The −2 Z-scores of BP variation before and after the postural change maneuver in the subsample were −14.1 mmHg for systolic BP and −5.4 mmHg for diastolic BP. Conclusion Prevalence of OH varies depending on when BP is measured. Current cutoff points may underestimate the actual occurrence of OH in the population. (Arq Bras Cardiol. 2020; 114(6):1040-1048)

Aortic Arch Calcification on Routine Chest Radiography is Strongly and Independently Associated with Non-Dipper Blood Pressure Pattern / A Calcificação no Arco Aórtico na Radiografia de Tórax de Rotina está Forte e Independentemente Associada ao Padrão Não-Dipper de Pressão Arterial

Abstract Background: Non-dipper blood pressure (NDBP) is one of the important causes of hypertension-related target organ damage and future cardiovascular events. Currently, there is no practical tool to predict NDBP pattern. Objectives: The aim of this study was to investigate the relationship between aortic arch calcification (AAC) on chest radiography and NDBP pattern. Methods: All patients referred for ambulatory BP monitoring test were approached for the study participation. NDBP was defined as the reduction of ≤10% in nighttime systolic BP as compared to the daytime values. AAC was evaluated with chest radiography and inter-observer agreement was analyzed by using kappa statistics. Univariate and multivariate logistic regression analysis was conducted to assess the association of AAC and NDBP pattern. A 2-tailed p-value < 0.05 was considered statistically significant. Results: A total of 406 patients (median age: 51.3) were included. Of these, 261(64%) had NDBP pattern. Overall, the prevalence of AAC was 230 (57%). Non-dipper group had significantly higher prevalence of AAC (70% vs. 33%, p < 0.0001) as compared to the dipper group. Presence of AAC was a strong and independent predictor of NDBP pattern (OR 3.919, 95%CI 2.39 to 6.42) in multivariate analysis. Conclusions: Presence of AAC on plain chest radiography is strongly and independently associated with the presence of NDBP pattern.

Resumo Fundamento: A pressão arterial não-dipper é uma das causas mais importantes de lesão de órgão-alvo da hipertensão e de eventos cardiovasculares futuros. Atualmente, não há uma ferramenta prática para prever o padrão não-dipper de pressão arterial. Objetivos: O objetivo deste estudo foi investigar a relação entre a calcificação no arco aórtico detectada no raio de tórax e o padrão não-dipper de pressão arterial. Métodos: Todos os pacientes encaminhados para monitorização ambulatorial da pressão arterial foram abordados para participação no estudo. A pressão arterial não-dipper foi definida como a redução de ≤10% da pressão arterial sistólica noturna quando comparada com os valores diários. A calcificação no arco aórtico foi avaliada através de radiografia do tórax e a concordância interobservador foi analisada utilizando a estatística kappa. Análises de regressão logística uni e multivariada foram realizadas para avaliar a associação entre a calcificação no AA e o padrão PADV. Valores de p bicaudais < 0,05 foram considerados estatisticamente significativos. Resultados: Ao todo, 406 pacientes (idade mediana: 51,3) foram incluídos. Desses, 261(64%) apresentavam padrão não-dipper de pressão arterial. De modo geral, a prevalência de calcificação no arco aórtico foi de 230 (57%). O grupo não-dipper apresentou prevalência significativamente maior de calcificação no arco aórtico (70% vs. 33%, p < 0,0001) em relação ao grupo dipper. A presença de calcificação no arco aórtico foi um preditor forte e independente de padrão não-dipper de pressão arterial (OR = 3,919; IC: 95% 2,39-6,42) em análise multivariada. Conclusões: A presença de calcificação no arco aórtico em raio-x de tórax simples está forte e independentemente associada à presença de padrão não-dipper de pressão arterial.