Presión de perfusión ocular en sujetos sin enfermedad ocular / Ocular Perfusion Pressure in Subjects Without Ocular Disease

Objetivo: Describir el comportamiento de la presión de perfusión ocular en sujetos sin enfermedad ocular. Métodos: Se realizó un estudio descriptivo transversal con sujetos sin enfermedad ocular de la consulta externa de Oftalmología del Hospital Universitario "General Calixto García", entre enero y diciembre de 2019. Resultados: La mediana de presión intraocular del ojo derecho osciló entre 13,0-16,0 mmHg, y del ojo izquierdo entre 13,0-15,5 mmHg, durante todo el estudio. El valor máximo para ambos ojos se obtuvo a las 6:00 a. m. (madrugada). La mediana de presión arterial sistólica osciló entre 129,0-138,5 mmHg, y de diastólica entre 79,5-81,5 mmHg. El valor mínimo de presión arterial diastólica fue 53 mmHg a las 6:00 a. m. La mediana de presión de perfusión ocular del ojo derecho osciló entre 46,4 mmHg (12:00 a. m.) y 50,8 mmHg; y del ojo izquierdo entre 47,3 mmHg (6:00 a. m.) y 51,9 mmHg. El valor mínimo específico de presión de perfusión ocular fue 35 mmHg para ambos ojos, a las 6:00 a. m. Conclusiones: La hipertensión arterial es el antecedente patológico personal más frecuente en la población estudiada y en ocasiones se producen cifras fuera de la normalidad, tanto elevadas como disminuidas, capaces de afectar la presión de perfusión ocular, sobre todo la diastólica baja. Sin embargo, las presiones de perfusión ocular se mantuvieron normales, probablemente, por mecanismos de autorregulación individuales(AU)

Objective: To describe the behavior of ocular perfusion pressure in subjects without ocular disease. Methods: A cross-sectional descriptive study was performed with subjects without ocular disease from the Ophthalmology outpatient clinic of the University Hospital "General Calixto García", between January and December 2019. Results: The median intraocular pressure of the right eye ranged between 13.0-16.0 mmHg, and of the left eye between 13.0-15.5 mmHg, throughout the study. The maximum value for both eyes was obtained at 6:00 a. m. (early morning). The median systolic blood pressure ranged from 129.0-138.5 mmHg, and diastolic from 79.5-81.5 mmHg. The minimum diastolic blood pressure value was 53 mmHg at 6:00 a.m. The median ocular perfusion pressure of the right eye ranged from 46.4 mmHg (12:00 a.m.) to 50.8 mmHg; and of the left eye from 47.3 mmHg (6:00 a.m.) to 51.9 mmHg. The minimum specific ocular perfusion pressure value was 35 mmHg for both eyes, at 6:00 a.m. Conclusions: Arterial hypertension is the most frequent personal pathologic antecedent in the population studied, and both elevated and decreased out-of-normal figures capable of affecting ocular perfusion pressure, especially low diastolic, occasionally occur. However, ocular perfusion pressures remained normal, probably due to individual autoregulatory mechanisms(AU)

Vinte anos de hipertensão arterial refratária sem diagnóstico: relato de caso / Twenty years of refractory hypertension without diagnosis: case report

JUSTIFICATIVA E OBJETIVOS: A grande maioria dos pacientes portadores de hipertensão arterial sistêmica (HAS) apresenta a forma primária. O diagnóstico de hipertensão arterial (HA) secundário sempre deve ser considerado, correspondendo à prevalência de até 5% dos pacientes hipertensos.O objetivo deste estudo foi ressaltar a importância do reconhecimento clínico precoce da HA secundária, através de anamnese, observação clínica e exame físico minudentes, no exame médico habitual.RELATO DO CASO: Paciente do sexo feminino, 49 anos, portadora de HA refratária a todos os tratamentos farmacológicos instituídos, com diagnóstico tardio de HA secundária. Como sintomas, apresentava cefaleia e precordialgia associada aos esforços. Foi tratada por quase toda vida como HA primária.CONCLUSÃO: Diagnosticar uma causa específica de HA secundária, embora pouco frequente, apenas com um exame físico e anamnese adequados, pode ser necessário para realizar um tratamento definitivo, resolvendo a hipertensão de difícil controle.Ressalta-se também a importância de uma propedêutica qualificada no pré-operatório para evitar complicações cirúrgicas, pós-cirúrgicas e causas secundárias que necessitem correções.

BACKGROUND AND OBJECTIVES: Although the vast majority of patients with secondary systemic blood pressure (SBP) have the primary form, the diagnosis of secondary hypertension should always be evaluated, corresponding to 5% of hypertensive patients. The aim of this study is to highlight the importance of early clinical recognition of secondary hypertension by accurate history, physical examination and clinical observations in theu sual medical examination.CASE REPORT: Female, 49 year-old patient, with hypertension refractory to all drug treatments, with late diagnosis of secondary hypertension. The symptoms were headache and exercise-related chest pain. She has been treated for primary hypertension almost all her life long.CONCLUSION: Making the diagnosis of a specific cause of secondary hypertension, only with physical examination and history, although uncommon, may be necessary in order to givea definitive treatment, solving difficult-to-control hypertension.We also emphasize the importance of a qualified preoperative workup to prevent surgical, post-surgical complications and secondary causes that require corrections.

Perfil epidemiológico da hipertensão arterial sistêmica em pacientes atendidos em uma instituição de ensino superior / Epidemiological profile of arterial hypertension in patients treated in higher education institution

JUSTIFICATIVA E OBJETIVOS: A hipertensão arterial sistólica (HAS) é um dos mais importantes fatores de risco para doenças cardiovasculares (DCV), porém os índices de controle da doença ainda são baixos provavelmente pela baixa adesão ao tratamento. O objetivo deste estudo foi analisar o perfil epidemiológico da HAS em pacientes atendidos em uma Instituição de Ensino Superior (IES). MÉTODO: Trata-se de estudo descritivo, retrospectivo, através da análise de prontuários de pacientes atendidos no período de janeiro de 2007 a agosto de 2008 no Ambulatório de Cardiologia da UniEVANGÉLICA do Centro Universitário de Anápolis. Foi utilizada média e desvio-padrão para planificação dos dados e posteriormente foram tratados estatisticamente utilizando a ANOVA e pós-teste de Tukey para as variáveis paramétricas. RESULTADOS: Foram analisados 137 prontuários de pacientes com média de idade de 59,23 ± 11,08 anos, sendo 67% do sexo feminino. Os principais fatores de risco para DCV foram sedentarismo 57%, idade acima de 60 anos 52%, sobrepeso 69% e história de DCV na família 36%. Observou-se que apenas 1% dos pacientes em estágio 3 de HAS em relação aos pacientes normotensos, estágios1 e 2 de HAS. Verificou-se também aumento da idade conforme o aumento da sua gravidade (p = 0,026).CONCLUSÃO: A HAS revelou-se um importante problema de saúde pública na população estudada. Os níveis de controle e tratamento foram considerados insatisfatórios, principalmente em pacientes mais graves. Faz-se necessário um controle dos fatores de risco principalmente sedentarismo e obesidade para evitar surgimento de DCV associadas à HAS e uma verificação da estratégia utilizada para obter adesão dos pacientes ao tratamento.

BACKGROUND AND OBJECTIVES: Systemic blood pressure (SBP) is one of the most important risk factors for cardiovascular disease (CVD), but the disease control rates are still low probably due to poor adherence to treatment. The aim of this study was to analyze the epidemiology of SBP in patients treated at a Higher Education Institution (HEI). METHOD: This is a descriptive, retrospective study, by examining records of patients treated between January 2007 and August 2008 at the Clinic of Cardiology UniEVANGÉLICA - University Center of Anápolis. We used mean and standard deviation of the data for planning and then were treated statistically using ANOVA and Tukey post-test for parametric variables. RESULTS: We analyzed medical records of 137 patients with mean age 59.23 ± 11.08 years, 67% were female. The main risk factors for CVD 57% were sedentary, age above 60 years 52%, 69% overweight and a history of CVD in the family 36%. It was observed that only 1% of patients with stage 3 SBP compared to normotensive patients, stage 1 and 2 of SBP. It was also increased with increasing age of the severity of the SBP (p = 0.026).CONCLUSION: SBP proved to be an important public health problem in this population. The levels of control and treatment were considered unsatisfactory, especially in more severe patients. It is necessary to control risk factors mainly sedentary lifestyle and obesity to prevent emergence of CVD associated with SBP and a review of the strategy used to obtain patients adherence to treatment.

Systemic blood pressure,intraocular pressure and primary open-glaucoma: A populationbased study in Shaanxi Province of China / 国际眼科杂志(Guoji Yanke Zazhi)

AIM :To investigate the association of primary open-glaucoma (POAG), intraocular pressure (IOP) and systemic blood pressure in a rural population aged 50 years old or above in Shaanxi Province, China.METHODS: In the population-based, cross-sectional study, 1 775 (83.53%) residents, aged 50 years old or above, from 3 counties of Shaanxi Province, China, undertook an interview with a standard questionnaire and a detailed eye examination, including logarithm of the minimum angle of resolution visual acuity, slit-lamp biomicroscopy, applanation tonometry and dilated fundus examination. Two blood pressure reading in the sitting position were taken. Gonioscopy was performed if a narrower peripheral anterior chamber (less than one fourth of the corneal thickness) was indicated. Automated visual field testing was performed by participants assessed to have suspicion of glaucomatous disc damage or if IOP was 22mmHg or higher.RESULTS: IOP significantly correlated with systemic blood pressure, and both IOP and systolic blood pressure increased significantly with increasing age. No association between POAG and hypertension was found. The frequency of POAG increased significantly with lower diastolic perfusion pressure.CONCLUSION: Data in our study are accordance with those reported in other population-based studies, and confirm that lower diastolic perfusion pressure is a significant risk factor for primary open angle glaucoma.

Should ice-bag be applied to the head of a hypertensive patient with cerebral hemorrhage?

1. The blood pressure reaction to cold stimulus applied to the head was studied in 15 cases hypertension2. In practically all these cases, this cold application caused quite sudden though transitory elevation of the systemic blood pressure, both the systolic and the diastolic3. This cold application also caused no symptoms in 1 case, slight headache in 7 cases, moderate headache in 4 cases, and severe headache in 3 cases. The higher the rise in the blood pressure, the more severe is the headache4. Viewed in the light of these results, the application of ice-bag to the head of a hypertensive patient with cerebral hemorrhage was critically appraised. In this appraisal, it was concluded that this therapeutic measure is unnecessary, unphysiological, and perhaps dangerous.(Summary and Conclusion)

Influence of Obstructive Sleep Apnea on Systemic Blood Pressure, Cardiac Rhythm and the Changes of Urinary Catecholamines Concentration / 결핵

BACKGROUND: The existing data indicate that obstructive sleep apnea syndrome contributes to the development of cardiovascular dysfunction such as systemic hypertension and cardiac arrhythmias, and the cardiovascular dysfunction has a major effect on high long-term mortality rate in obstructive sleep apnea syndrome patients. To a large extent the various studies have helped to clarify the pathophysiology of obstructive sleep apnea, but many basic questions still remain unanswered. METHOD: In this study, the influence of obstructive sleep apnea on systemic blood pressure, cardiac rhythm and urinary catecholamines concentration was evaluated. Over-night polysomnography, 24-hour ambulatory blood pressure and EGG monitoring, and measurement of urinary catecholamines, norepinephrine (UNE) and epinephrine (UEP), during waking and sleep were undertaken in obstructive sleep apnea syndrome patients group (OSAS, n=29) and control group (Gontrol, n=25). RESULTS: 1) In OSAS and Control, UNE and UEP concentrations during sleep were significantly lower than during waking (P20 (n=14), there was a significant difference of heart rates before, during and after apneic events (P<0.01), and these changes of heart rates were correlated with the duration of apnea (P<0.01). The difference of heart rates between apneic and postapneic period (deltaHR) was significantly correlated with the difference of arterial oxygen saturation between before and after apneic event (deltaSaO2) (r=0.223, P<0.001). 5) There was no significant difference in the incidence of cardiac arrhythmias between OSAS and Control. In Control, the incidence of ventricular ectopy during sleep was significantly lower than during waking. But in OSAS, there was no difference between during waking and sleep. CONCLUSION: These results suggested that recurrent hypoxia and arousals from sleep in patients with obstructive sleep apnea syndrome may increase sympathetic nervous system activity, and recurrent hypoxia and increased sympathetic nervous system activity could contribute to the development of cardiovascular dysfunction including the changes of systemic blood pressure and cardiac function.