ABSTRACT
Abstract Background The early detection of vascular damage in subclinical stages of hypertensive disease may be the key point in the prevention of cardiovascular outcomes. Objectives to correlate parameters of structural vascular damage (measurement of the carotid intima-media thickness) with parameters of functional vascular damage (central hemodynamic measurements) in pre-hypertensive and hypertensive patients taking up to two classes of anti-hypertensive drugs. Methods This was a cross-sectional descriptive study conducted with a convenience sample of patients attending the Liga de Hipertensão Arterial , a multidisciplinary program for the diagnosis and treatment of systemic hypertension, of the Federal university of Goias. Patients with arrythmia, diabetes, previous cardiovascular or cerebrovascular diseases, and end-stage diseases were excluded. Carotid Doppler test, measurements of peripheral and central blood pressure by applanation tonometry (Sphygmocor®) and oscillometry (Mobil-O-Graph®) were performed. The t-test was used for comparisons and the Pearson correlation test for correlations, considering a p<0.05 statistically significant. Results twenty patients (12 women) were evaluated, mean age 53.8 ± 14.3 years. Higher values of central pulse pressure (42.9±13.9 vs. 34.7±9.6, p=0.01) and pulse wave velocity (PWV) (9.0±1.9 vs. 7.9±1.5, p=0.01) were obtained by applanation tonometry compared with oscillometry. No difference between the methods was observed for the other measures. A significant correlation was found between carotid artery intima-media thickness (CA-IMT) and PWV (r=0.659; p=0.002) by the oscillometric test, but not with applanation tonometry. No correlation was found between central hemodynamic variables and the presence of carotid artery plaques. Conclusion PWV, estimated by oscillometry, was the only central hemodynamic parameter that correlated significantly with CA-IMT in pre-hypertensive and hypertensive patients at low cardiovascular risk. International Journal of Cardiovascular Sciences. 2020; [online].ahead print, PP.0-0
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Oscillometry , Carotid Artery Injuries/diagnosis , Carotid Intima-Media Thickness/instrumentation , Manometry , Reference Standards , Epidemiology, Descriptive , Cross-Sectional Studies , Heart Disease Risk Factors , Hypertension/complicationsABSTRACT
Abstract Objective: Blood pressure (BP) references for Brazilian adolescents are lacking in the literature. This study aims to investigate the normal range of office BP in a healthy, non-overweight Brazilian population of adolescents. Method: The Brazilian Study of Cardiovascular Risks in Adolescents (Portuguese acronym "ERICA") is a national school-based study that included adolescents (aged 12 through 17 years), enrolled in public and private schools, in cities with over 100,000 inhabitants, from all five Brazilian macro-regions. Adolescents' height and body mass index (BMI) were classified in percentiles according to age and gender, and reference curves from the World Health Organization were adopted. Three consecutive office BP measurements were taken with a validated oscillometric device using the appropriate cuff size. The mean values of the last two readings were used for analysis. Polynomial regression models relating BP, age, and height were applied. Results: Among 73,999 adolescents, non-overweight individuals represented 74.5% (95% CI: 73.3-75.6) of the total, with similar distribution across ages. The majority of the non-overweight sample was from public schools 84.2% (95% CI: 79.9-87.7) and sedentary 54.8% (95% CI: 53.7-55.8). Adolescents reporting their skin color as brown (48.8% [95% CI: 47.4-50.1]) or white (37.8% [95% CI: 36.1-39.5]) were most frequently represented. BP increased by both age and height percentile. Systolic BP growth patterns were more marked in males when compared to females, along all height percentiles. The same pattern was not observed for diastolic BP. Conclusions: Blood pressure references by sex, age, and height percentiles for Brazilian adolescents are provided.
Resumo Objetivo Referências de pressão arterial (PA) para adolescentes brasileiros estão ausentes na literatura. Este estudo tem como objetivo investigar a variação normal da pressão arterial no consultório em uma população brasileira saudável de adolescentes sem sobrepeso. Método O Estudo dos Riscos Cardiovasculares em Adolescentes (ERICA) é um estudo brasileiro, de âmbito nacional e de base escolar, que incluiu adolescentes (12 a 17 anos) matriculados em escolas públicas e privadas, em cidades com mais de 100.000 habitantes, de todas as cinco macrorregiões brasileiras. A altura e o índice de massa corporal (IMC) dos adolescentes foram classificados em percentis de acordo com a idade e o sexo, sendo adotadas as curvas de referência da Organização Mundial de Saúde. Foram realizadas três medidas consecutivas de PA no consultório com um dispositivo oscilométrico validado, utilizando o manguito de tamanho apropriado. Os valores médios das duas últimas leituras foram utilizados nas análises. Modelos de regressão polinomial relacionando PA, idade e estatura foram aplicados. Resultados Entre os 73.999 adolescentes, os indivíduos sem sobrepeso representaram 74,5% (IC95%: 73,3-75,6) do total, com distribuição similar entre as idades. A maior parte da amostra sem sobrepeso originava-se das escolas públicas, com 84,2% (IC95%: 79,9-87,7), e os sedentários 54,8% (IC95%: 53,7-55,8). Os adolescentes que relataram sua cor de pele como parda (48,8% [IC95%: 47,4-50,1]) e branca (37,8%: [IC 95% 36,1-39,5]) foram os mais representados. A PA aumentou tanto com a idade, quanto com o percentil de altura. Os padrões de aumento sistólico da PA foram mais acentuados no sexo masculino quando comparados ao sexo feminino, em todos os percentis de altura. O mesmo padrão não foi observado para a PA diastólica. Conclusões São fornecidas referências de pressão arterial por sexo, idade e percentil de altura para adolescentes brasileiros.
Subject(s)
Humans , Male , Female , Child , Adolescent , Cardiovascular Diseases , Reference Values , Blood Pressure , Brazil , Body Mass Index , Cross-Sectional Studies , Risk FactorsABSTRACT
ABSTRACT OBJECTIVE: To investigate the association of physical inactivity in leisure and school time with common mental disorders during adolescence. METHODS: The sample consisted of 73,399 adolescents (12-17 years old), participants in the Estudo de Riscos Cardiovasculares em Adolescentes (Erica — Study of Cardiovascular Risks in Adolescents). This cross-sectional, national and school-based study was conducted in 2013 and 2014 in Brazilian municipalities with more than 100,000 inhabitants. Leisure time physical activity was categorized according to weekly practice volume, and adolescents were classified as active (≥ 300 minutes/week), inactive (0 minute/week) and insufficiently active (1-299 minutes/week). Sports practice and participation in physical education classes at school were also analyzed. The presence of common mental disorders was assessed based on the general health questionnaire, with a cutoff point greater than or equal to 3. Odds ratios (OR) were estimated using multiple logistic regression. RESULTS: The chance of common mental disorders was 16% higher in the group that reported being inactive (0 minute/week) at leisure time (OR = 1.16; 95%CI 1.06 (1.27). The prevalence of common mental disorders was higher among young people who did not practice sports (37.2% vs. 25.9%; OR = 1.14; 95%CI 1.04-1.25) and did not participate in physical education classes at school (39.5% vs. 29.6%; OR = 1.25; 95%CI 1.15-1.36). Insufficient physical activity (1-299 minutes/week) did not increase the OR of common mental disorders. Practicing physical activity during leisure time, regardless of duration and weekly frequency, reduced the chances of common mental disorders in this population by 26%. CONCLUSIONS: Physical inactivity during leisure and school time is associated with the presence of common mental disorders in adolescence. The results suggest that sports practice, school physical education and physical activity during leisure time, even without reaching the current recommendation, are related to the mental health of young people.
RESUMO OBJETIVO: Investigar a associação da inatividade física no lazer e na escola com os transtornos mentais comuns durante a adolescência. MÉTODOS: A amostra foi composta por 73.399 adolescentes (12-17 anos), participantes do Estudo de Riscos Cardiovasculares em Adolescentes (Erica). Esse estudo transversal, nacional e de base escolar foi realizado em 2013 e 2014, nos municípios brasileiros com mais de 100 mil habitantes. A atividade física no lazer foi categorizada de acordo com o volume de prática semanal, e os adolescentes foram classificados em ativos (≥ 300 minutos/semana), inativos (0 minuto/semana) e insuficientemente ativos (1-299 minutos/semana). A prática esportiva e a participação em aulas de educação física na escola também foram analisadas. A presença de transtornos mentais comuns foi avaliada a partir do general health questionnaire, com ponto de corte maior ou igual a 3. Odds ratios (OR) foram estimados utilizando regressão logística múltipla. RESULTADOS: A chance de transtornos mentais comuns foi 16% maior no grupo que relatou ser inativo (0 minuto/semana) no lazer (OR = 1,16; IC95% 1,06-1,27). A prevalência de transtornos mentais comuns foi maior entre jovens que não praticaram esportes (37,2% vs. 25,9%; OR = 1,14; IC95% 1,04-1,25) e não participaram das aulas de educação física na escola (39,5% vs. 29,6%; OR = 1,25; IC95% 1,15-1,36). Atividade física insuficiente (1-299 minutos/semana) não aumentou a razão de chances de transtornos mentais comuns. Praticar atividade física no lazer, independentemente da duração e frequência semanal, reduziu em 26% as chances de transtornos mentais comuns nessa população. CONCLUSÕES: A inatividade física no lazer e na escola foi associada à presença de transtornos mentais comuns na adolescência. Os resultados sugerem que prática esportiva, educação física escolar e atividade física durante o lazer, mesmo sem atingir a recomendação atual, têm relação com a saúde mental dos jovens.
Subject(s)
Humans , Male , Female , Child , Adolescent , Schools , Sedentary Behavior , Leisure Activities , Mental Disorders/epidemiology , Brazil/epidemiology , Cross-Sectional StudiesABSTRACT
Background: Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Knowledge about cardiovascular risk factors (CVRFs) in young adults and their modification over time are measures that change the risks and prevent CVDs. Objectives: To determine the presence of CVRFs and their changes in different health care professionals over a period of 20 years. Methods: All students of medicine, nursing, nutrition, odontology, and pharmacy departments of Federal University of Goiás who agreed to participate in this study were evaluated when they started their degree courses and 20 years afterward. Questionnaires on CVRFs [systemic arterial hypertension (SAH), diabetes mellitus, dyslipidemia, and family history of early CVD, smoking, alcohol consumption, and sedentarism] were administered. Cholesterol levels, blood sugar levels, blood pressure, weight, height, and body mass index were determined. The Kolmogorov-Smirnov test was used to evaluate distribution, the chi-square test was used to compare different courses and sexes, and the McNemar test was used for comparing CVRFs. The significance level was set at a p value of < 0.05. Results: The first stage of the study included 281 individuals (91% of all the students), of which 62.9% were women; the mean age was 19.7 years. In the second stage, 215 subjects were reassessed (76% of the initial sample), of which 59.07% were women; the mean age was 39.8 years. The sample mostly consisted of medical students (with a predominance of men), followed by nursing, nutrition, and pharmacy students, with a predominance of women (p < 0.05). Excessive weight gain, SAH, and dyslipidemia were observed among physicians and dentists (p < 0.05). Excessive weight gain and SAH and a reduction in sedentarism (p < 0.05) were observed among pharmacists. Among nurses there was an increase in excessive weight and alcohol consumption (p < 0.05). Finally, nutritionists showed an increase ...
Fundamento: As doenças cardiovasculares (DCVs) são as principais causas de morte no mundo. O conhecimento sobre os fatores de risco cardiovasculares (FRCV) em jovens e suas alterações ao longo do tempo, podem contribuir para ações que modifiquem estes riscos e previnam o aparecimento das DCVs. Objetivos: Verificar, em diferentes profissionais da área da saúde, a presença e alterações nos fatores de risco cardiovasculares (FRCV) num intervalo de vinte anos. Métodos: Avaliados comparativamente ao ingressar na faculdade e vinte anos após, todos os alunos de medicina, enfermagem, nutrição, odontologia e farmácia de uma Universidade Federal que aceitaram participar. Utilizados questionários sobre FRCV (HAS, DM, dislipidemia e história familiar de DCV precoce, tabagismo, etilismo e sedentarismo). Determinados colesterol, glicemia, PA, peso, altura e IMC. Utilizados teste de Kolmogorov-Smirnov para avaliar distribuição, Qui-Quadrado para comparação entre cursos e sexos e McNemar para FRCV. Significante p < 0,05. Resultados: Inicialmente estudados 281 indivíduos (91% do total de alunos), sendo 62,9% mulheres, idade média 19,7 anos e reavaliados 215 (76% da amostra inicial), 59,07% mulheres, idade média 39,8 anos. Maior representatividade por estudantes de medicina, predomínio do sexo masculino entre eles, e predomínio do sexo feminino nos estudantes de enfermagem, nutrição e farmácia (p < 0,05). Entre os médicos e odontólogos houve aumento de excesso de peso, HAS e dislipidemia (p < 0,05). Entre os farmacêuticos, aumento de excesso de peso e HAS e redução do sedentarismo (p < 0,05). Entre os enfermeiros, elevou-se excesso de peso e etilismo (p < 0,05). Na nutrição, houve elevação da dislipidemia (p < 0,05). Conclusão: Encontrada ...
Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Cardiovascular Diseases/etiology , Delivery of Health Care/statistics & numerical data , Alcohol Drinking/adverse effects , Brazil/epidemiology , Cardiovascular Diseases/prevention & control , Dyslipidemias/complications , Dyslipidemias/epidemiology , Hypertension/complications , Hypertension/epidemiology , Longitudinal Studies , Overweight/complications , Overweight/epidemiology , Risk Assessment , Risk Factors , Sedentary Behavior , Sex Distribution , Statistics, Nonparametric , Time FactorsSubject(s)
Humans , Antihypertensive Agents/administration & dosage , Hypertension/drug therapy , Practice Guidelines as Topic , Societies, Medical , Brazil , Blood Pressure/drug effects , Cerebrovascular Disorders/complications , Coronary Disease/complications , Drug Therapy, Combination/methods , Risk Factors , Renal Insufficiency, Chronic/drug therapy , Treatment OutcomeSubject(s)
Humans , Diabetes Mellitus , Hypertension/complications , Blood Glucose , Blood Pressure , Brain Diseases/etiology , Brazil , Diabetes Complications/therapy , Diabetes Mellitus/therapy , Dyslipidemias/drug therapy , Heart Diseases/etiology , Hypertension/therapy , Kidney Diseases/etiology , Peripheral Arterial Disease/etiology , Risk Factors , Societies, MedicalABSTRACT
Comparamos a eficácia antihipertensiva e a tolerabilidade da Felodipina com o Captopril. Estudamos pacientes que após quatro semanas de placebo (PAD entre 95 e 110mmHg), receberam por quatro semanas de maneira duplo cega Felodipina 5mg/dia (n=43) ou Captopril 50mg/dia (n=39). Nos dois grupos houve queda progressiva da pressäo (diferenças significativas em relaçäo ao placebo). Näo houve diferenças entre as duas drogas quanto a pressäo e a freqüência cardíaca. Os efeitos adversos foram discretos. Concluimos que Felodipina (5mg/dia) e Captopril (50mg/dia) säo regimes terapêuticos igualmente eficazes como monoterapia no controle da hipertensäo leve/moderada, tendo poucos efeitos colaterais e com a vantagem da Felodipina poder ser administrada em dose única diária.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Captopril/therapeutic use , Felodipine/therapeutic use , Antihypertensive Agents/therapeutic use , Hypertension/drug therapy , Drug ToleranceABSTRACT
A utilizaçäo dos produtos denominados alimentos dietéticos vem aumentando em proporçäo vertiginosa, tanto por parte da indústria alimentícia, quanto pelo próprio usuário. A falta de uma legislaçäo clara, que estabeleça procedimentos mais apropriados, causa uma confusäo conceitual e, conseqüentemente, dificulta o uso adequado dos próprios alimentos, tidos como "diet", "light" ou baixa caloria. Na tentativa de sistematizar (escassas) referências bibliográficas sobre o assunto, procedeu-se a um estudo de revisäo cujo objetivo foi tornar mais acessível a utilizaçäo de tais produtos, possibilitando ao profissional de saúde melhores condições de orientar os pacientes que necessitam, por algum motivo, fazer uso dos mesmos
Subject(s)
Humans , Male , Female , Sweetening Agents , Food, Formulated , Food AnalysisABSTRACT
PURPOSE--To evaluate clinical efficacy and tolerability of isradipine SRO (I.SRO), 5 mg O.D. in essential hypertensives. METHODS--Eighty-three of 87 selected outpatients with a mean age of 51.3 years (ranging from 25 to 65), 33 male, 48 white, 29 black and others of different races, who had clinical supine and orthostatic diastolic blood pressure (DBP) > or = 95 mmHg and < or = 115 mmHg underwent the study. After a three-week wash-out period, patients received I.SRO 5 mg O.D. at 8:00 am for a six-week period (phase I). After this phase, patients received I.SRO 5 mg O.D. at 8:00 pm for a six-week period (phase II). The patients had a follow-up with an interval of three weeks and the ambulatorial blood pressure monitoring (ABPM) for 24 hours was performed with a SpaceLabs 90207 or Del Mar Avionics devices after the wash-out period and at the end of phases I and II. Measurements were performed at 15-min intervals during the day (6 am to 10 pm) and at 30-min intervals during the night (10 pm to 6 am). RESULTS--a) Heart rate did not show significant changes during the treatment period (phases I and II) when compared with the wash-out period; b) causal blood pressure: at the end of both treatment periods (phases I and II) there were statistically significant decreases (p < 0.001) in supine SBP and DBP compared with wash-out values. The mean SBP decreased from 161.6 +/- 14 to 144.3 +/- 13 mmHg (phase I) and to 141.8 +/- 13 mmHg (phase II). The mean DBP decreased from 103.4 +/- 6 to 91.2 +/- 7 (phase I) and to 89.1 +/- 8 (phase II); c) ABPM: the mean systolic 24-h ambulatory blood pressure was significantly reduced (p < 0.001) from 148.8 +/- 17 to 137.2 +/- 15 mmHg (phase I) and to 133.4 +/- 13 mmHg (phase II). The mean diastolic 24-h ambulatory blood pressure was significantly decreased (p < 0.001) from 94.3 +/- 9 to 87.0 +/- 9 (phase I) and to 85.8 +/- 8 mmHg (phase II). The mean daytime and nighttime, systolic and diastolic 24-h ambulatory blood pressure were: wash-out--152.3 +/- 17, 140.2 +/- 21, 97.4 +/- 9, 86.8 +/- 13; phase I--139.9 +/- 15, 130.0 +/- 17, 89.3 +/- 9, 81.3 +/- 10; phase II--136.7 +/- 13, 125.3 +/- 15, 88.5 +/- 8, 79.1 +/- 10, respectively. Blood pressure load (percentage of systolic blood pressure values > 140 mmHg or of diastolic blood pressure values > 90 mmHg) was significantly reduced from 62.2/62 per cent (SBP/DBP), on the was-out, to 37.9/39.9 per cent (SBP/DBP) on phase I and to 32.3/34.3 per cent (SBP/DBP) on phase II; d) side effects: most frequently related were palpitations (2.3 per cent ), headache (1.1 per cent ), flush (1 per cent ) and ankle oedema (1 per cent ). They were in general, mild-to-moderate and disappeared after the first 3 weeks of treatment. Only two patients were withdrawn because of headache (one of them with previous diagnosis of migraine). CONCLUSION--I.SRO, given by oral route, in the dosage of 5 mg O.D. as monotherapy, was effective and well tolerated, promoted significant reduction on 24-h ambulatory blood pressure attenuating the early morning rise and did not interfere with the circadian rhythm of blood pressure. No significant differences were detected in the BP lowering effect when I.SRO was given during the morning or evening. These results may indicate that the drug is as suitable as one of the first choice for treating mild and moderate hypertensive patients
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Isradipine/administration & dosage , Hypertension/drug therapy , Blood Pressure Determination , Hypertension/physiopathology , Monitoring, Physiologic , Arterial PressureABSTRACT
Foram estudados 18 pacientes portadores de hipertensäo arterial leve e moderada e/ou insuficiência cardíaca. Os pacientes foram divididos aleatoriamente em dois grupos, cada um com 9 indivíduos. Os pacientes do grupo A receberam furosemide na dose de 1 comprimido de 40 mg por dia, com sua dieta habitual. Os os grupo B receberam a mesma dose de furosemide e tiveram suplementaçäo de potássio através de comprimido efervecente de cloreto de potássio na dose de 2 comprimidos por dia (940 mg de K). Foram avaliados clinicamente, sendo realizados ECG, dosagens de Na, Cl, K sérico e K salivar e reavaliados após 7 dias 15 em 15 dias até os 3 meses e a cada 30 dias até os 6 meses quando foi encerrada a observaçäo. Näo houve diferença entre os dois grupos com relaçäo aos níveis sérico e salivar de potásio (nível de significância 5%). Näo observadas diferenças eletrocardiográficas, nem referidas queixas clínicas sugestivas de hipocalemia. Conclui-se que em pacientes submetidos a terapêutica diurêtica com furosemide, nestas doses, näo se justifica a reposiçäo artificial de potássio