Síndrome metabólica em motoristas profissionais de transporte de cargas da rodovia BR-116 no trecho Paulista-Régis Bittencourt / Metabolic Syndrome in professional truck drivers who work on Highway BR-116 within the area of São Paulo City - Régis Bittencourt

O objetivo deste estudo foi determinar a prevalência da síndrome metabólica e identificar variáveis relacionadas a motoristas profissionais em trânsito na Rodovia BR-116. Foram avaliados 258 motoristas com medida do índice de massa corporal (IMC), circunferência abdominal, pressão arterial, triglicérides, colesterol total e frações e proteína C reativa. Avaliou-se a síndrome metabólica de acordo com a I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome Metabólica. O nível de significância adotado foi p < 0,05. Foram utilizadas as análises uni e multivariadas. Verificou-se que a idade dos motoristas foi de 37,5 ± 10,1 anos, 82 por cento tinham IMC > 25 kg/m², 58 por cento circunferência abdominal > 94 cm, 9 por cento colesterol total > 240 mg/dL, 10 por cento LDL-c > 160 mg/dL; 23 por cento HDL-c < 40 mg/dL, 22 por cento triglicérides > de 200 mg/dL, 7 por cento glicemia > 110 mg/dL e 19 por cento proteína C reativa > 0,5 mg/dL. A prevalência da hipertensão arterial foi de 37 por cento, 9 por cento apresentaram médio/alto escore de risco de Framingham e 24 por cento com síndrome metabólica. A análise de regressão logística indicou a associação independente da síndrome metabólica para as variáveis: IMC (OR = 1,4007 IC 95 por cento 1,192-1,661), hábito de verificar o colesterol (OR = 0,1020 IC 0,017-0,589) e escore de risco de Framingham (OR = 26,3 IC 2,520-276,374). Verificou-se presença expressiva de fatores de risco cardiovasculares e da síndrome metabólica na população estudada.

The objective of this study was to determine the Metabolic Syndrome prevalence as well as identify variables related in truck drivers who work on Highway BR-116 (São Paulo, Brazil). A total of 258 truck drivers were assessed and the variables studied were: body mass index, waist circumference, blood pressure, triglycerides, total and fraction cholesterol, glycemia and C reactive protein. Cardiovascular disease risk was evaluated by Framingham's risk score whereas the Metabolic Syndrome based on the First Brazilian Guideline for Diagnosis and Treatment of the Metabolic Syndrome. The significance level adopted was p< 0.05 and univariate and multivariate analysis were applied. The average age was of 37.5±10.1. According to the anthropometric data, it was observed body mass index >25 kg/m² in 82 percent, waist circumference >94 cm in 58 percent, total cholesterol >240mg/dL in 9 percent, LDL-c >160mg/dL in 10 percent; HDL-c <40mg/dL in 20 percent, triglycerides >200mg/dL in 22 percent, glycemia >110mg/dL in 7 percent, and C reactive protein >0.5 mg/dL in 19 percent. Hypertension prevalence was 37 percent, 9 percent were identified at the highest/medium Framingham's risk score and 24 percent showed Metabolic Syndrome. The logistical regression analysis indicated independent association of the Metabolic Syndrome for the following variables (OD odds ratio, CI confidence interval at 95 percent): body mass index (OR = 1.4007 CI 95 percent 1.192-1.661), use to check cholesterol (OR = 0.1020 CI 0.017-0.589) and Framingham's risk score (OR = 26.389 CI 2.520-276.374). As a conclusion, it was observed a quite expressive prevalence of cardiovascular risk factors as well as Metabolic Syndrome in truck drivers.

Blood pressure measurements taken by patients are similar to home and ambulatory blood pressure measurements

OBJECTIVE: To compare blood pressure measurements taken at home by physicians, nurses, and patients with office blood pressure measurement , ambulatory blood pressure monitoring and home blood pressure measurement. METHODS: A total of 44 patients seen by a home care program were studied. Protocol 1 a) blood pressure was measured by the patient, a physician and a nurse during a regular home visit (Home1); b) home blood pressure measurement was measured for 4 days (HBPM1); c) office blood pressure measurement was measured by a physician, a nurse, and the patient; and by 24-hour ambulatory blood pressure monitoring. Protocol 2 blood pressure was measured by the patient, a physician, and a nurse during a special home visit in the presence of a physician and a nurse only (Home2); and b) home blood pressure measurement was taken for the second time (HBPM2). Echocardiography, guided by a two-dimensional echocardiograph, was performed. RESULTS: Protocol 1: a) office blood pressure measurement and Home1 were significantly higher than ambulatory blood pressure monitoring, except for systolic and diastolic office blood pressure measurement taken by the patient or a family member, systolic blood pressure taken by a nurse, and diastolic blood pressure taken by a physician. b) ambulatory blood pressure monitoring and HBPM1 were similar. Protocol 2: a) HBPM2 and Home2 were similar. b) Home2 was significantly lower than Home1, except for diastolic blood pressure taken by a nurse or the patient. There were significant relationships between: a) diastolic blood pressure measured by the patient and the thickness of the interventricular septum, posterior wall, and left ventricular mass; and b) ambulatory and HBPM2 diastolic and systolic blood pressure taken by a physician (home2) and left ventricular mass. Therefore, the data indicate that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic values relative to "office...

Hypertension in employees of a University General Hospital

OBJETIVO: Conhecer a prevalência de hipertensão arterial em funcionários de um complexo hospitalar e relacionar com variáveis sócio demográficas. MÉTODOS: Foi medida a pressão arterial com aparelho de coluna de mercúrio e manguito adequado à circunferência do braço, o peso e a altura em amostra de 864 dos 9.905 funcionários do Hospital Universitário estratificada de acordo com sexo, idade e ocupação. RESULTADOS: A prevalência de hipertensão foi de 26% (hipertensão referida = 62% ou pressão sistólica > 140 e/ou > 90 mm Hg no momento da medida = 38%). Dos que referiram 51% estavam hipertensos no momento da medida. A prevalência foi 17, 23 e 29% (p < 0,05) nos médicos, enfermagem e "outros". Análise univariada mostrou "odds ratio" significante para o sexo masculino, idade > 50 anos, unidade de trabalho para o Instituto de Radiologia e Prédio da Administração, escolaridade 10 anos e índice de massa corporal (IMC) maior ou igual a 30 kg/m2. O modelo de regressão logística com procedimento "stepwise" mostrou associação estatisticamente significante com hipertensão arterial para as variáveis: sexo, idade, cor da pele, renda familiar e IMC. CONCLUSÃO: A prevalência de hipertensão foi alta em funcionários do Complexo Hospital das Clínicas, principalmente nos de ocupação diferente de médico e enfermagem. Os grupos de maior risco (homens, cor preta, baixa renda familiar, obesos) precisam ser orientados quanto a prevenção e diagnóstico precoce da doença através de programas especiais.

A influência do conhecimento sobre a doença e a atitude frente à tomada dos remédios no controle da hipertensäo arterial / The influence of patient's consciousness regarding high blood pressure and patient's attitude in face of disease controlling medicine intake

OBJECTIVE: To assess the relation between blood pressure control and the following: the Morisky-Green test, the patient's consciousness regarding high blood pressure, the patient's attitude in face of medicine intake, the patient's attendance at medical consultations, and the subjective physician's judgment. METHODS: We studied 130 hypertensive patients with the following characteristics: 73 percent females, 60±11 years, 58 percent married, 70 percent white, 45 percent retired, 45 percent with incomplete elementary schooling, 64 percent had a familial income of 1 to 3 minimum wages, body mass index of 30±7 kg/m², consciousness regarding the disease for a mean period of 11±9.5 years, and mean treatment duration of 8 ±7 years. RESULTS: Only 35 percent of the hypertensive individuals had blood pressure under control and a longer duration of treatment (10±7 vs 7±6.5 years; P<0.05). The retiree predominated. The result of the Morisky-Green test did not relate to blood pressure control. In evaluating the attitude in face of medicine intake, the controlled patients achieved significantly higher scores than did the noncontrolled patients (8±1.9 vs 7 ±2, P<0.05). The hypertensive patients had higher levels of consciousness regarding their disease and its treatment, and most (70 percent) patients attended 3 or 4 medical consultations, which did not influence blood pressure control. The physicians attributed significantly higher scores regarding adherence to treatment to controlled patients (6±0.8 vs 5±1.2; P<0.05). CONCLUSION: Consciousness regarding the disease, the Morisky-Green test, and attendance to medical consultations did not influence blood pressure control

Efeito hipertensäo e normotensäo do avental branco na liga de hipertensäo do Hospital das Clínicas, FMUSP. Prevalência, características clínicas e demográficas / White-coat hypertension and normotension in the league of hypertension of the Hospital das Clínicas, FMUSP. Prevalence, clinical and demographic characteristics

OBJECTIVE: To assess the prevalence of white-coat normortension, white-coat hypertension, and white-coat effect. METHODS: We assessed 670 medical records of patients from the League of Hypertension of the Hospital das Clínicas of the Medical School of the University of Säo Paulo. White-coat hypertension (blood pressure at the medical office: mean of 3 measurements with the oscillometric device ³140 or ³90 mmHg, or both, and ambulatory blood pressure monitoring mean during wakefulness < 135/85) and white-coat normotension (office blood pressure < 140/90 and blood pressure during wakefulness on ambulatory blood pressure monitoring ³ 135/85) were analyzed in 183 patients taking no medication. The white-coat effect (difference between office and ambulatory blood pressure > 20 mmHg for systolic and 10 mmHg for diastolic) was analyzed in 487 patients on treatment, 374 of whom underwent multivariate analysis to identify the variables that better explain the white-coat effect. RESULTS: Prevalence of white-coat normotension was 12 percent, prevalence of white-coat hypertension was 20 percent, and prevalence of the white-coat effect was 27 percent. A significant correlation (p<0.05) was observed between white-coat hypertension and familial history of hypertension, and between the white-coat effect and sex, severity of the office diastolic blood pressure, and thickness of left ventricular posterior wall. CONCLUSION: White-coat hypertension, white-coat normotension, and white-coat effect should be considered in the diagnosis of hypertension

Avaliação do aparelho automático oscilométrico de medida de pressão arterial DIXTAL DX-2710 pelos protocolos de validação da British Hypertension Society (BHS) e Association for de Advancement of Medical Instrumentation (AAMI) / Assessment of the DIXTAL DX-2710 automated oscillometric device for blood pressure measurement with the validation protocols of the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI)

OBJECTIVE: To assess the Dixtal DX2710 automated oscillometric device used for blood pressure measurement according to the protocols of the BHS and the AAMI. METHODS: Three blood pressure measurements were taken in 94 patients (53 females 15 to 80 years). The measurements were taken randomly by 2 observers trained to measure blood pressure with a mercury column device connected with an automated device. The device was classified according to the protocols of the BHS and AAMI. RESULT: The mean of blood pressure levels obtained by the observers was 148±38/93±25 mmHg and that obtained with the device was 148±37/89±26 mmHg. Considering the differences between the measurements obtained by the observer and those obtained with the automated device according to the criteria of the BHS, the following classification was adopted: "A" for systolic pressure (69 percent of the differences < 5; 90 percent < 10; and 97 percent < 15 mmHg); and "B" for diastolic pressure (63 percent of the differences < 5; 83 percent < 10; and 93 percent < 15 mmHg). The mean and standard deviation of the differences were 0±6.27 mmHg for systolic pressure and 3.82±6.21 mmHg for diastolic pressure. CONCLUSION: The Dixtal DX2710 device was approved according to the international recommendations

O impacto das descobertas de Riva-Rocci e Korotkoff / The impact of Riva-Rocci's and Korokoff's findings

A medida da pressäo arterial é o recurso mais utilizado para o diagnóstico e o tratamento da hipertensäo arterial. Scipione Riva-Rocci é o responsável pelo marco, na era moderna, da medida da pressäo arterial. Em 1896, Riva-Rocci idealizou o esfigmomanômetro de coluna de mercúrio, que difere do utilizado em nossos dias apenas pelo manguito, que possuía 4,4 cm de largura. Em 1905, Nicolai Sergievic Korotkoff sugeriu a possibilidade de auscultar os sons com a utilizaçäo do estetoscópio, identificando as pressões sistólica e diastólica e determinando o método indireto com técnica auscultatória usado nos dias atuais. Em 1970, surgiram os primeiros aparelhos, automáticos ou semi-automáticos, de medida da pressäo arterial. Entretanto, eles só podem ser utilizados se forem precisos e devidamente aprovados de acordo com a legislaçäo internacional. A medida indireta da pressäo arterial com técnica auscultatória pode apresentar erros ligados ao observador, ao paciente, ao equipamento e à técnica, apesar de ser um procedimento simples e fácil de ser realizado. Portanto, os profissionais da área da saúde que medem a pressäo arterial devem ter conhecimento adequado para evitar possíveis erros

O perfil de um grupo de pessoas hipertensas de acordo com conhecimento e gravidade da doença / The profile of hypertensive patients related to awareness and level of hypertension

Foram entrevistados 205 hipertensos em tratamento ambulatorial para avaliar o papel do perfil bio-social no conhecimento e grau de gravidade da doença. As características da população foram: 72% mulheres, 63% brancos, 78% com mais de 40 anos, 60% casados, 68% com baixa escolaridade, 41% com renda de 1 a 3 salários, 75% com peso elevado, 76% não fumantes, 89% sem atividade física regular, e das mulheres 48% já tinham usado hormônios anticoncepcionais. A análise evidenciou que a ausência de conhecimento se associou com sexo masculino, idade entre 20 e 40 anos, viúvo, não branco e peso normal. Pressão arterial mais elevada (diastólica> 110 mm Hg) se associou com mais de 60 anos, não casado, acima do peso, baixa escolaridade, baixa renda, com mais de 5 anos de hipertensão e já ter feito tratamento anterior

We interviewed 205 hypertensives to characterize social demographic data, life style, history and awareness of hypertension. Most patients were female (72%), white (63%), over 40 years old (78%), married (60%), and had low level of education (68%). Their family income was lower than US$ 3000 a year (41%). In terms of weight, 75% were classified as overweight, 76% were non smoker, and 89% did not do any regular physical activity. The profile of the hypertensives who were unaware of the disease was: male, 20-40 years old, widow, not white, and non-obese. The profile of the hypertensives who had high level of hypertension (diastólic> 110 mm Hg) was older than 60 years old, not married, overweight, low level of education, low income, with more than 5 years of hypertension, and previously treated

Papel da sesta nos parâmetros estruturais cardíacos e na interpretaçäo da monitorizaçäo ambulatorial da pressäo arterial / The effect of siesta in parameters of cardiac structure and in interpretation of ambulatory arterial blood pressure monitoring

OBJECTIVE: To evaluate the influence of the siesta in ambulatory blood pressure (BP) monitoring and in cardiac structure parameters. METHODS: 1940 ambulatory arterial blood pressure monitoring tests were analyzed (Spacelabs 90207, 15/15 minutes from 7:00 to 22:00 hours and 20/20 minutes from 22:01 to 6.59hours) and 21 percent of the records indicated that the person had taken a siesta (263 woman, 52ñ14 years). The average duration of the siesta was 118ñ58 minutes. RESULTS: (average ñ standard deviation) The average of systolic/diastolic pressures during wakefulness, including the napping period, was less than the average for the period not including the siesta (138ñ16/85ñ11 vs 139ñ16/86ñ11 mmHg, p<0.05); 2) pressure loads during wakefulness including the siesta, were less than those observed without the siesta); 3) the averages of nocturnal sleep blood pressures were similar to those of the siesta, 4) nocturnal sleep pressure drops were similar to those in the siesta including wakefulness with and without the siesta; 5) the averages of BP in men were higher (p<0.05) during wakefulness with and without the siesta, during the siesta and nocturnal sleep in relation to the average obtained in women; 6) patients with a reduction of 0- 5 percent during the siesta had thickening of the interventricular septum and a larger posterior wall than those with a reduction during the siesta >5 percent. CONCLUSION: The siesta influenced the heart structure parameters and from a statistical point of view the average of systolic and diastolic pressures and the respective pressure loads of the wakeful period.

A medida da pressão arterial no idoso / Blood pressure measurement in the elderly

O estudo teve como objetivo investigar os fatores intervenientes na medida da pressão arterial em idosos. Foram estudados 71 pacientes (homens, 61 por cento; média de idade, 66 mais ou menos 7 anos; baixa escolaridade; casados, 63 por cento; ativos profissionalmente, 62 por cento; hipertensos, 72 por cento) encaminhados para cateterismo cardíaco em um hospital governamental de Cardiologia do município de São Paulo. Foram realizados: a) medida da pressão arterial pelo método indireto com técnica auscultatória e oscilométrica; b) medida direta da pressão arterial; c) realização da manobra de Osler; d) verificação da presença de hiato auscultatório; e e) avaliação da hipotensão postural. Os resultados mostraram que: 1) não houve diferença significativa (p > 0,05) na medida da pressão arterial nas diferentes posições; 2) a medida da pressão arterial pelo método oscilométrico foi significativamente maior (p < 0,05) que a realizada pelo método auscultatório; 3) a prevalência da manobra de Osler positiva foi de 27 por cento, hiato auscultatório de 23 por cento e hipotensão postural de 8 por cento; 4) os pacientes Osler positivos e negativos não se diferenciaram em relação a idade, sexo, doença cardiovascular e hipertensão arterial; 5) a pressão sistólica avaliada com aparelho oscilométrico nos pacientes Osler negativos, hipertensos e não hipertensos, foi significativamente maior (p < 0,05) que a medida com técnica auscultatória; 6) não houve diferença significativa (p > 0,05) nas médias das pressões sistólica e diastólica, tanto no método direto como no método indireto, entre os grupos de pacientes Osler positivo e negativo; 7) as diferenças entre os valores da pressão arterial sistólica e diastólica verificadas pelos métodos indireto e direto não foram significativas (p > 0,05) entre os grupos de pacientes Osler positivos e negativos; e 8) a medida direta da pressão arterial foi significativamente menor (p < 0,05) que a medida indireta.

Resultado da campanha de avaliaçäo da calibraçäo e condiçäo de esfignomanômetros / The results of the campaing for evaluating sphygmomanometers accuracy and their physical conditions

OBJECTIVE: To evaluate the sphygmomanometers calibration accuracy and the physical conditions of the cuff-bladder, bulb, pump, and valve. METHODS: Sixty hundred and forty five aneroid phygmomanometers were evaluated, 521 used in private practice and 124 used in hospitals. Aneroid manometers were tested against a properly calibrated mercury manometer and were considered calibrated when the error was £3mm Hg. The physical conditions of the cuffs-bladder, bulb, pump, and valve were also evaluated. RESULTS: Of the aneroid sphygmomanometers tested, 51 per cent of those used in private practice and 56 per cent of those used in hospitals were found to be not accurately calibrated. Of these, the magnitude of inaccuracy ranged from 4 to 8mm Hg in 70 per cent and 51 per cent of the devices, respectively. The problems found in the cuffs - bladders, bulbs, pumps, and valves of the private practice and hospital devices were bladder damage (34 per cent vs. 21 per cent, respectively), holes/leaks in the bulbs (22 per cent vs. 4 per cent, respectively), and rubber aging (15 per cent vs. 12 per cent, respectively). Of the devices tested, 72 per cent revealed at least one problem interfering with blood pressure measurement accuracy. CONCLUSION: Most of the manometers evaluated, whether used in private practice or in hospitals, were found to be inaccurate and unreliable, and their use may jeopardize the diagnosis and treatment of arterial hypertension.

Monitorizaçäo residencial da pressäo arterial e monitorizaçäo ambulatorial da pressäo arterial versus medida de pressäo arterial no consultório / Home blood pressure measurement and ambulatory blood pressure measurement versus office blood pressure measurement

Objetivos - Comparar a monitorização residencial da pressão arterial (MRPA) e monitorização ambulatorial da pressão arterial (MAPA) com os registros de consultório e correlacionar o índice de massa de ventrículo esquerdo (IMVE) com a MRPA e medida de consultório. Métodos - Protocolo 1 - Sessenta e oito hipertensos (58+12 anos, 37 mulheres) realizaram: a) MRPA durante 7 dias; b) MAPA de 24h; e c) medida da pressão arterial no consultório, pelo médico. Protocolo 2 - 41 hipertensos (48+14 anos, 25 mulheres) além de MRPA e medida no consultório, realizaram ecocardiograma bi-dimensional. Resultados - Protocolo 1 - a medida de consultório (153+24/96+13mmHg) foi maior (p<0,05) do que a obtida pela MRPA (133+18/84+12mmHg). Protocolo 2 - o IMVE mostrou correlação com as médias de pressão sistólica/diastólica da MRPA (r=0,02/0,22, p>0,05). Conclusão - A MRPA apresentou menores do que a medida de consultório e semelhantes aos da MAPA, além de melhor correlação com IMVE do que a medida de consultório.

Medida da pressão arterial. Critérios empregados em artigos científicos de periódicos Brasileiros / Blood Pressure Measurement. Criteria Employed in Scientific Articles Published in Brazilian Journals

PURPOSE: To evaluate the criteria used for the technique of blood pressure measurement in scientific articles published in Brazilian journals. METHODS: Two hundred twenty three scientific articles from 18 medical journals, published between 1989 and 1994 were evaluated, in order to identify the type of sphygmomanometer used; the state of calibration; the cuff size; the position of the patient during the measurement; whether the blood pressure measurement was obtained after a resting period; the phase used to identify the systolic and diastolic pressures; and the number of readings taken. RESULTS: There was no reference in the articles about the following data: the type of sphygmomanometer in 51, the accuracy of calibration in 82, the cuff size in 64, the position of the patient in 25, the rest period before measurement in 60, the systolic and diastolic phases in 49, and the number of measurements in 52. CONCLUSION: Most of the papers analyzed did not follow or omitted important aspects cited in national and international recommendations for the correct blood pressure measurement.

Perspectivas da pesquisa qualitativa para a enfermagem / Perspectives of qualitative research for nursing

Este trabalho analisa a pesquisa qualitativa, caracterizando as abordagens fenomenológica, etnográfica e da teoria fundamentada em dados. Salienta as perspectivas que ela abre para a pesquisa na Enfermagem