[Systemic arterial hypertension and psychiatric morbidity in the outpatient care setting of a tertiary hospital]. / Hipertensão arterial sistêmica e morbidade psiquiátrica em ambulatório de hospital terciário.

Arterial hypertension is one of the most important risk factor for cardiovascular disease, the main cause of death in Brazil. Hypertensive patients that have treated in tertiary care hospitals have shown elevated co-morbidity including psychiatric disturbances. Our objective is to study psychiatric co-morbidity among severe hypertensive patients. This study was performed in an out-patient clinic of tertiary medical care setting. Forty-one patients were enrolled in this research (26 women, 15 men). They were submitted to a clinical interview and answering the PRIME-MD, a specific questionnaire for diagnosis of psychiatric disturbances (by a general practitioner). Frequencies of psychiatric disturbances were different in men and women: 63.4% of the women in this study showed some type of psychiatric disturbance versus 36.6% of men (p = 0.012). The majority of the diagnosis were mood disturbances, mainly depression associated or not with anxious disturbances. Mean age of psychiatric disturbance patients was 47.1 years versus 59.3 years in the patients without psychiatric disturbances (p = 0.0049), showing the presence of psychiatric disturbances in younger patients. Other factors as systolic arterial blood pressure, diastolic arterial blood pressure and body mass index did not show any differences associated with psychiatric disturbance. We conclude that there is a great co-morbidity between high complexity hospitals hypertensive patients and that this type of disturbance is more frequent in women and in younger patients.

[Validation of a questionnaire for the diagnosis of headache in an outpatient clinic at a university hospital]. / Validação de questionário para diagnóstico de cefaléia em ambulatório de hospital universitário.

Headache is a common complaint with a high prevalence in ambulatory settings. The physical and neurological examinations are frequently normal. The use of questionnaires as a screening methods for patients with primary headache could facilitate the diagnosis in non-specialized medical centers. In the present study, we used a questionnaire, based on the IHS criteria and modified by the authors, applied to 204 patients from the outpatient clinic of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Half of the patients were submitted to a clinical interview. We compared the results of the questionnaire with the results of the medical interview (gold standard). Most of the headaches we studied were primary headaches (89.6%). The questionnaire revealed a sensitivity of 90.2% and specificity of 57.9% for migraine detection with a chance corrected agreement (kappa) of 0.47 and a positive predictive (PPV) value of 65.7% and a negative predictive value (NPV) de 86.8%. The sensitivity for tension-type headache detection was 60.8% and the specificity 87.1% with a kappa value of 0.49 and a PPV of 77.8% and a NPV of 75.9%. We conclude that this questionnaire can be used as a screening method for diagnosing headache and that it can be applied by non-medical personnel. This questionnaire could also be used for population studies.

[Antihypertensive treatment. Prescription and cost of drugs. Survey in a tertiary care hospital]. / Tratamento anti-hipertensivo. Prescrição e custo de medicamentos. Pesquisa em hospital terciario.

PURPOSE: To study the most prescribed anti-hypertensive drugs, evaluating their agreement with established guidelines and drug cost. METHODS: One hundred and forty one (101 women, mean age = 53.3 years) hypertensive patients who searched spontaneous attention were interviewed in a tertiary-care hospital. The inclusion criteria were previous diagnosis of hypertension and non cardiovascular complaints. RESULTS: The majority of the 107 (75.9%) patients were on medical treatment. In those receiving monotherapy, thiazides were the most utilized drugs, followed by methyldopa, ACE inhibitors, calcium channel-blockers, and beta-blockers. The association with thiazides (26.3%) followed the same preference. The second most prescribed drug, methyldopa, was the more expensive. Fifty percent of the patients purchased the drugs at their own expense. CONCLUSION: A preference for prescription of expensive drugs for hypertension was detected in this sample in Brazil. This does not agree with major guidelines, mainly the V-JNC, which suggest thiazides and betablockers as first choice drugs for hypertensives with no complications or associated comorbidity.

Tratamento anti-hipertensivo. Prescriçäo e custo de medicamentos. Pesquisa em hospital terciário / Antihypertensive treatment. Prescription and cost of drugs. Survey in a tertiary care hospital

Objetivo - Verificar os medicamentos anti-hipertensivos mais utilizados por pacientes que procuram atendimento em hospital público terciário, avaliando o impacto das diretrizes de atendimento (consensos) e custo de aquisiçäo. Métodos - Foram selecionados 141 pacientes (101 do sexo feminino) de 40 a 72 (média 53,3) anos, que procuraram de forma espontânea, atendimento em hospital terciário, com diagnóstico prévio de hipertensäo arterial feito por médico e ausência de queixas relacionadas ao aparelho cardiovascular. Resultados - Verificou-se que 75,9 "por cento" (n=107) estavam em uso diário de anti-hipertensivos, sendo 60,7 "por cento" (n=86) em monoterapia e os demais em terapia mista. Os medicamentos mais empregados em monoterapia eram: tiazídicos, metildopa, inibidores da ECA, bloqueadores de canal de cálcio e betabloqueadores. A combinaçäo com tiazídicos (26,3 "por cento" do total) seguiu a mesma preferência. O segundo medicamento mais prescrito, metildopa, era o de mair custo. Metade dos pacientes adquiriu os medicamentos por compra direta. Conclusäo - Observou-se maior utilizaçäo de anti-hipertensivos de alto custo, conduta discordante das principais diretrizes das sociedades médicas, sobretudo do V-JNC, que preconizou tiazídicos e betabloqueadores, como anti-hipertensivos de primeira escolha em hipertensos sem complicaçöes ou condiçöes associadas.