O exercício físico como uma alternativa para o controle da pressão arterial em hipertensos: uma revisão integrativa da literatura / Physical exercise as an alternative for blood pressure control in hypertensive individuals: an integrative literature review / El ejercicio físico como alternativa para el control de la presión arterial en hipertensos: una revisión bibliográfica integradora

Introdução: A Hipertensão Arterial Sistêmica (HAS) é uma doença crônica de alta prevalência que pode provocar consequências desastrosas em indivíduos não tratados. Por isso, a comunidade científica busca encontrar formas para mitigar os efeitos danosos da hipertensão. Nesse sentido, a prática de exercícios físicos (EF) surge como uma medida não farmacológica interessante para o controle da pressão arterial (PA). Objetivo: Evidenciar os potencias benefícios do exercício físico no controle da PA. Métodos: Trata-se de uma revisão bibliográfica integrativa da literatura, elaborada a partir de trabalhos científicos acerca dos benefícios da prática de exercícios físicos no controle da pressão arterial. Foram considerados artigos originais e completos publicados em português, espanhol e inglês nos últimos dez anos, de 2013 até 2023, obtidos nas plataformas SCIELO, PUBMED e LILACS. Resultados: Os estudos atuais disponíveis sobre o tema mostram grande eficácia da realização de atividades físicas na prevenção e no tratamento da HAS. Algumas evidências sugerem que a prática regular de EF possui muitos benefícios para diversos órgãos e sistemas do corpo humano, principalmente para o coração e o sistema cardiovascular. Conclusão: A partir dos estudos analisados, evidencia-se que a prática regular de atividades físicas resulta em uma série de benefícios para a saúde no geral, como melhora na capacidade cognitiva, diminuição da gordura visceral e controle dos níveis pressóricos. O EF possui relação significativa com a HAS, sendo comprovadamente benéfica. A prática prolongada de atividades físicas teve um efeito protetor na incidência de doenças cardiovasculares e na mortalidade em comparação aos indivíduos sedentários. É importante que comunidade científica busque formas de realizar mais estudos, a fim de informar e influenciar pessoas a praticarem atividades físicas.

Introduction: Systemic Arterial Hypertension (SAH) is a chronic disease of high prevalence that can cause disastrous consequences in untreated individuals. Therefore, the scientific community seeks to find ways to mitigate the harmful effects of hypertension. In this sense, the practice of physical exercises (PE) emerges as an interesting non-pharmacological measure for the control of blood pressure (BP). Objective: To highlight the potential benefits of physical exercise in BP control. Methods: This is an integrative literature review, based on scientific papers about the benefits of physical exercise in blood pressure control. Original and complete articles published in Portuguese, Spanish and English in the last ten years, from 2013 to 2023, obtained from SCIELO, PUBMED and LILACS platforms were considered.Results: The current studies available on the subject show great effectiveness of performing physical activities in the prevention and treatment of SAH. Some evidence suggests that the regular practice of PE has many benefits for various organs and systems of the human body, especially for the heart and cardiovascular system. Conclusion: From the studies analyzed, it is evident that regular physical activity results in a series of benefits for overall health, such as improved cognitive ability, decreased visceral fat, and control of blood pressure levels. PE has a significant relation with SAH, being proven beneficial. Long-term physical activity had a protective effect on the incidence of cardiovascular disease and mortality compared to sedentary individuals. It is important that the scientific community seek ways to conduct further studies in order to inform and influence people to practice physical activities.

Introducción: La hipertensión arterial sistémica (HSA) es una enfermedad crónica de alta prevalencia que puede causar consecuencias desastrosas en individuos no tratados. Por isso, a comunidade científica procura encontrar formas de mitigar os efeitos nocivos da hipertensão. En este sentido, la práctica de ejercicios físicos (EF) surge como una medida no farmacológica interesante para el control de la presión arterial (PA). Objetivo: Demostrar los beneficios del ejercicio físico en el control de la PA. Métodos: Se trata de una revisión bibliográfica integradora de la literatura, elaborada a partir de trabajos científicos acerca de los beneficios de la práctica de ejercicios físicos en el control de la presión arterial. Fueron considerados artículos originales y completos publicados en portugués, español e inglés en los últimos diez años, de 2013 a 2023, obtenidos de las plataformas SCIELO, PUBMED y LILACS. Resultados: Los estudios actuales disponibles sobre el tema muestran gran eficacia de la realización de actividades físicas en la prevención y tratamiento de la HSA. Algunas evidencias sugieren que la práctica regular de EF tiene muchos beneficios para diversos órganos y sistemas del cuerpo humano, especialmente para el corazón y el sistema cardiovascular. Conclusión: De los estudios analizados se desprende que la práctica regular de actividades físicas conlleva una serie de beneficios para la salud en general, como la mejora de la capacidad cognitiva, la disminución de la grasa visceral y el control de los niveles de presión arterial. La PE tiene una relación significativa con la HSA, demostrándose beneficiosa. La práctica prolongada de actividades físicas tuvo un efecto protector sobre la incidencia de enfermedades cardiovasculares y la mortalidad en comparación con los individuos sedentarios. Es importante que la comunidad científica busque la forma de realizar más estudios para informar e influenciar a las personas para que practiquen actividades físicas.

Indications for echocardiography and confirmation rates of cardiovascular diseases: experience of a specialist cardiac outpatient clinic in Kumasi, Ghana

Background: Transthoracic echocardiography is a very helpful noninvasive cardiovascular imaging technique for the diagnosis and risk stratification in the management of patients with cardiovascular diseases. We aimed to review the clinical indications for transthoracic echocardiography and the confirmation rate of cardiovascular diseases by echocardiography at a specialist cardiac clinic in Ghana. Methods: Using a cross sectional study design, the echocardiography reports of all patients above the age of 15 who were assessed at the clinic were analyzed. Data on patient demographics, clinical history, clinical indication for echocardiography, and the echocardiographic findings were analyzed using version 25.0 of the Statistical Package for Social Sciences (SPSS). Results: A total of 594 participants were studied. The age range of participants was 15­96 years, with a mean (± standard deviation) age of 53.72 (± 17.25) years. There were more females (50.17%) than males (49.83%). Most (54.21%) of the participants had echocardiography for cardiac evaluation. Other indications included hypertension/hypertensive heart disease (HHD) (n = 131; 22.06%), heart failure (n = 69; 11.62%), chest pains (n = 12; 2.02%), and valvular heart disease (VHD) (n = 11; 1.85%). Three hundred and eight nine (70.30%) of the participants had their clinical diagnoses confirmed by echocardiography; echocardiographic confirmation rates for heart failure, VHD, and HHD were 92.75%, 90.91%, and 88.54%, respectively. Conclusion: Echocardiography showed high confirmation rates for our patients with heart failure, VHD, and HHD. Prompt usage of this noninvasive cardiovascular imaging for the initial evaluation of patients with cardiovascular diseases is highly recommended.

Blood pressure trend of lowlanders during first 6 days of acclimatisation to high altitude

Objectives: The present study was planned to delineate the blood pressure (BP) response of the lowlanders during initial 6 days of acclimatisation to high altitude. Materials and Methods: 398 normotensive sojourners at sea level ascended to HA (3,500 m). Blood pressure response of these subjects were analysed for 6 consecutive days at HA. Based on the BP response of these subjects on the 6th day at HA they were divided into two groups: HBP-high BP group and NBP- normal BP group. Results: It showed that on 6th day at HA, 51 out of 398 subjects presented with BP?140/90 mmHg (HBP) while others remained normotensive (NBP). Comparative systolic BP of HBP and NBP groups during successive days at HA were as follows: HA day 1 (146.8 ± 13.7 mmHg vs 146.3 ± 8.8 mmHg, p>0.05), HA day 4 (144.5 ± 8.7 mmHg vs 135.0 ± 7.0 mmHg, p<0.05) and HA day 6 (148.1 ± 7.9 mmHg vs 131.7 ± 5.3 mmHg, p<0.05). Whereas, diastolic BP of HBP and NBP groups were: HA day 1 (94.0 ± 8.1 mmHg vs 93.2 ± 6.6 mmHg, p>0.05), HA day 4 (88.9 ± 6.0 mmHg vs 85.3 ± 5.1 mmHg, p<0.05) and HA day 6 (93.8 ± 6.3 mmHg vs 83.7 ± 3.8 mmHg, p<0.05). Conclusion: It was found that NBP had initially raised BP which returned to normal levels after acclimatisation period of 6 days, but in HBP, it started rising after 4th day. It can be concluded that those individuals whose BP on 6th day at HA does not return to normal after acclimatisation period needs regular follow up as these individuals can have a delayed acclimatisation normalising BP later on or can become hypertensive subsequently

Prevalencia de hipertensión arterial en Colombia según información del Sistema Integral de Información de la Protección Social (SISPRO) / Prevalence of arterial hypertension in Colombia according to data from the Comprehensive Social Protection Information System (SISPRO)

Resumen Introducción: La hipertensión arterial es el principal factor de riesgo cardiovascular modificable y aumenta la probabilidad de mortalidad de causa cardiovascular. Las mediciones de prevalencia en Colombia han incluido ciudades principales y pequeñas regiones, pero no se dispone de información en el país. Objetivo: Describir la prevalencia de hipertensión arterial a partir de los reportes a los sistemas oficiales de información en Colombia. Método: Mediante la extracción y el análisis de datos de la herramienta SISPRO del Ministerio de Salud y Protección Social de Colombia, se calculó la prevalencia de hipertensión arterial, estandarizada por edad y para las diferentes regiones geográficas del país, entre los años 2013 y 2017. Resultados: Durante los 5 años evaluados hubo 12,386,343 registros con diagnóstico principal de hipertensión arterial; en 2013 se observó la menor prevalencia (4.65%) y en 2017 la mayor (5.83%). El promedio de prevalencia nacional en los mayores de 60 años durante los 5 años fue del 28.14%. La prevalencia es mayor en las mujeres, con una relación mujer: hombre de 1.78:1. El grupo de mayor prevalencia durante el estudio fueron las mujeres mayores de 80 años en 2017, con una prevalencia ajustada del 54.4%. Las regiones con prevalencia mayor al 10% fueron Risaralda, Caldas, Boyacá, Antioquia y Sucre. Conclusiones: La prevalencia nacional de los registros de consultas por hipertensión arterial a las fuentes oficiales de información es menor que la reportada en estudios realizados en poblaciones similares y sugiere que existe un subregistro del reporte a dichas fuentes de información.

Abstract Introduction: Systemic hypertension is the main modifiable cardiovascular risk factor, leading to increased probability of mortality due to cardiovascular causes. Studies assessing the prevalence of systemic hypertension in Colombia have included main cities and small regions. However, there is no available data regarding the country as a whole. Objective: To describe the prevalence of systemic hypertension according to reports made to the official information systems in Colombia. Method: The prevalence of systemic hypertension was calculated through the extraction and analysis of data contained within the SISPRO tool, the official information system for the Colombian Ministry of Health and Social Protection. The prevalence was then standardized by age, and for the different geographical regions of the country in the period comprised between years 2013 and 2017. Results: During the five years of follow-up, we located 12,386,343 registries reporting systemic hypertension as a main diagnosis. The lowest prevalence (4.65%) was found in year 2013, and the highest prevalence (5.83%) was found in 2017. The mean national prevalence for patients above the age of 60, during the aforementioned 5-year period, was 28.14%. The prevalence was higher in women, with a women-to-men ratio of 1.78:1. The group with the higher adjusted prevalence during the study period was composed of women above the age of 80 in year 2017, with an adjusted prevalence of 54.4%. The regions with a prevalence over 10% were Risaralda, Caldas, Boyacá. Antioquia and Sucre. Conclusions: The national prevalence of registered consultations due to systemic hypertension to the official information sources is lower than that reported in previous studies conducted on similar populations, suggesting the existence of underreport to said information sources.

Padrão prescritivo de medicamentos para hipertensão arterial sistêmica na atenção primária em saúde: revisão sistemática e meta-análise / Pattern prescription drugs for systemic hypertension in primary health care: systematic review and meta-analysis

Investigamos publicações científicas sobre o padrão prescritivo de medicamentos para hipertensão arterial sistêmica e uso de diretrizes na atenção primária em saúde por revisão sistemática e meta-análise. Os artigos foram selecionados nas bases de dados PubMed, Web of Science e LILACS, de acordo com as declarações PRISMA, de 2004 a 2020. A revisão sistemática mostrou um padrão de prescrição superior para terapia combinada (52,9%). A metanálise confirmou a superioridade para a terapia combinada (OR 1,76; IC 1,29 - 2,41). Foi observada maior prevalência de monoterapia no estudo Sueco (98%) e terapia combinada no Nigeriano (98%). Maior frequência prescritiva de inibidores da enzima de conversão da angiotensina em Trinidade (64%); diuréticos (64%), betabloqueadores (63%) e bloqueadores dos canais de cálcio (53%) na Nigéria; e bloqueadores dos receptores da angiotensina (43%) em Portugal. Quanto ao uso das diretrizes, 53% dos estudos relataram a sua utilização na prescrição de anti-hipertensivos na atenção primária em saúde.

We investigated scientific publications on the prescription pattern of systemic hypertension drugs and use of guidelines in primary health care by systematic review and meta-analysis. Articles were selected in the PubMed, Web of Science and LILACS databases, according to the PRISMA statements, from 2004 to 2020. The systematic review showed a higher prescription pattern for combination therapy (52,9%). The meta-analysis confirmed the superiority of prescription for combination therapy (OR 1.76, CI 1.29 - 2.41). Was observed higher monotherapy prevalence in the Swedish study (98%) and combined therapy in Nigerian (98%). Higher frequency prescriptive of angiotensin-converting enzyme inhibitors in Trinidad (64%); diuretics (64%), beta blockers (63%), and calcium channel blockers (53%) in Nigeria; and angiotensin-receptor blockers (43%) in Portugal. Regarding the use of guidelines, 50% the studies reported their use for the prescription of antihypertensive in primary health care.

Prevalence pattern precipitating factors and presenting features of congestive heart failure patients in GDMCH Dharmapuri

Introduction: Heart failure is the end stage of all diseases of the heart and is a major cause of morbidity and mortality. Since 1970s the treatment of CHF has been transformed, resulting in major benefit to patients. This advance has been the consequence of better understanding of the pathophysiology, investigations, the introduction of newer drugs and cardiac transplantation. Aim of the study: To find out the prevalence of congestive heart failure among the patients admitted in the hospital and to analyse their presenting features and precipitating factors. Materials and methods: A total of 196 cases that satisfied the inclusion and exclusion criteria stated above were taken up for subsequent study. Results: During the study period, 6072 patients were admitted in the medical wards. Out of them 196 satisfied the inclusion criteria. So the prevalence was 3.2 % (196/6072). Among the 196, 7 were expired, thus case fatality rate was 3.5% (7/196). Conclusion: The prevalence of congestive heart failure among hospitalized was 3.2 %Congestive heart failure was common among the age group of 45 – 65 years. Drug intake mainly Non-steroidal anti-inflammatory drugs, anaemia and infections were the most common precipitating factors

A study of waist hip ratio in identifying cardiovascular risk factors at Government Dharmapuri College Hospital

Introduction: Rising incidence of Diabetes mellitus, Systemic hypertension and Dyslipidemia, the well-known risk factor for cardiovascular disease is the leading cause for increased incidence of cardiovascular diseases1. Till today, body mass index and waist circumference are the two popular parameters used to assess the cardiovascular risk factors. Though Asian people are not overtly obese, they are still at an increased risk of cardiovascular disease and this may be due to presence of visceral obesity, but the cut off value for waist circumference. Aim of the Study: To assess the effectiveness of the newer anthropometric index, Waist/Height ratio in identifying cardiovascular risk factors. To compare the effectiveness of various anthropometric indices Body mass index, Waist Circumference and Waist/Height ratio in identifying Cardiovascular risk factors. Materials and Methods: 135 patients were included in our study. Careful history taking was first taken in these patients regarding pre-existing diabetes mellitus, systemic hypertension and dyslipidemia and about the treatment for these illnesses. In all these patients the following anthropometric measurements are done: Height, weight, waist Circumference were measured using standard methods. Results: In our study, 135 patients was selected randomly. The cut off values of anthropometric indices which was taken as abnormal were Body mass index > 25kg/m2 , Waist Circumference Males > 90 cm Females > 85 cm, Waist/Height ratio > 0.5. Conclusion: Waist/Height ratio with cut off > 0.5 was found to be an effective, newer and cheaper anthropometric index in identifying cardiovascular disease.

Aspectos clínicos actuales del monitoreo ambulatorio de presión arterial / Current clinical aspects of ambulatory blood pressure monitoring

Resumen La hipertensión arterial sistémica es la enfermedad de mayor prevalencia a nivel mundial que incrementa de forma importante el riesgo cardiovascular. Un diagnóstico temprano, junto al logro de metas, disminuye de forma importante el riesgo de complicaciones. Recientemente se han actualizado los criterios diagnósticos para la hipertensión, así como la introducción del monitoreo ambulatorio de presión arterial. La introducción en la práctica clínica del monitoreo ambulatorio de presión arterial fue para ayudar al diagnóstico de la "hipertensión de bata blanca" y la "hipertensión enmascarada". En la actualidad también se ha demostrado que el monitoreo ambulatorio de presión arterial es superior al método tradicional de registro de presión arterial en el consultorio, tanto para el diagnóstico como para el adecuado control y ajuste del tratamiento farmacológico. Además se han introducido nuevos conceptos de suma importancia como la hipertensión arterial nocturna aislada, la elevación matutina alterada de la presión arterial y los patrones alterados de descenso nocturno de la presión arterial; los cuales se han asociado a un incremento de riesgo cardiovascular. Varios estudios han mostrado relevante valor pronóstico en algunas poblaciones. Aún existen otros conceptos en los cuales hace falta un mayor estudio para establecer adecuadamente su introducción en la práctica clínica como la carga hipertensiva, la variabilidad, la presión de pulso y la rigidez arterial; además de establecer valores de acuerdo a más estudios clínicos en poblaciones como pacientes geriátricos y niños.

Abstract Systemic arterial hypertension is the prevalentest disease worldwide that significantly increases cardiovascular risk. An early diagnosis together to achieve goals decreases the risk of complications significatly. Recently have been updated the diagnostic criteria for hypertension and the introduction of ambulatory blood pressure monitoring. The introduction into clinical practice of ambulatory blood pressure monitoring was to assist the diagnosis of "white coat hypertension" and "masked hypertension". Today has also shown that ambulatory blood pressure monitoring is better than the traditional method of recording blood pressure in the office, to the diagnosis and to adequate control and adjustment of drug treatment. Also there have been introduced important new concepts such as isloted nocturnal hypertension, morning blood pressure elevation altered and altered patterns of nocturnal dip in blood pressure; which have been associated with increased cardiovascular risk. Several studies have shown significant prognostic value in some stocks. There are still other concepts on which further study is needed to properly establish their introduction to clinical practice as hypertensive load variability, pulse pressure and arterial stiffness. In addition to setting values according to further clinical studies in populations such as elderly and children.

Direct, spontaneous carotid‑cavernous fistula with a contracted kidney: A rare association.

We report a case of a 20‑year‑old female having systemic hypertension who presented with right‑sided proptosis, chemosis, and diminished vision, preceded by an acute episode of unilateral throbbing headache. Imaging studies revealed a right‑sided direct, spontaneous carotid‑cavernous fistula (CCF), aneurysm of internal carotid artery, bleed in the parieto‑frontal lobe, and swelling of extraocular muscles. Abdominal ultrasound revealed a small contracted right kidney measuring 64 mm × 27 mm. A direct spontaneous CCF can occur spontaneously following rupture of intracranial aneurysm without any history of trauma or connective tissue disorder. Prompt diagnosis of intravascular malformations at initial presentation can prevent neurological complications and vision loss. A team approach including emergency physicians, neurosurgeons, and ophthalmologists is needed for the proper management of such patients.

Ocular Perfusion Pressure and Pulsatile Ocular Blood Flow in Normal and Systemic Hypertensive Patients.

Purpose: The purpose was to compare the ocular perfusion pressure (OPP) and the pulsatile ocular blood flow (POBF) in normal and systemic hypertensive patients. Materials and Methods: Totally, 121 individuals (normal n = 60, systemic hypertension patients n = 61) were enrolled in this prospective age-matched comparative study. Intraocular pressure (IOP) and systemic arterial pressure were measured in seated position with 2 min interval between the measurements using Goldmann applanation tonometer (GAT) and tycos sphygmomanometer, respectively. The OPP was calculated as 2/3 of mean arterial pressure (MAP) minus IOP. After 5 min in the seated position POBF measurements were taken with the ocular blood flow (OBF) tonograph. Results: Mean age was 57.5 years (range 35-72 years) in the normal group and 59.6 years (range 36-78 years) in the hypertensive group; majority of the patients were female (68.5% and 71% respectively in each group). Measured parameters in both the groups showed, systolic blood pressure (BP) (143.6 ± 20.5 mmHg vs. 121.9 ± 17.5 mmHg), diastolic BP (90.7 ± 13.5 mmHg vs. 80.1 ± 9.9 mmHg), MAP (108.4 ± 14.2 mmHg vs. 94.2 ± 11.2 mmHg), and OPP (57.6 ± 14.6 vs. 48.7 ± 10.6 mmHg) were significantly greater (P = 0.001) in systemic hypertensive patients in comparison to normals. However, there was no difference in OBF tonograph values in both groups. The IOP measured by the OBF tonograph was higher than GAT in both groups, but the difference was not statistically significant (P = 0.41). Conclusion: Systemic hypertensive patients have a higher OPP in comparison to normal patients, but they do not have higher POBF. More studies are required to evaluate the role of the OPP in different ocular pathologies affecting the POBF.

Red eyes in the necropsy floor: twenty cases of hyphema in dogs and cats / Olhos vermelhos na sala de necropsia: vinte casos de hifema em cães e gatos

Hyphema (hemorrhage within the anterior chamber of the eye) can be caused by several mechanisms and can easily be detected in routine ophthalmic or necroscopic examination as discolored red eye(s). The purpose of this study is to report the cause of hyphema diagnosed as a postmortem finding in dogs and cats. Twenty cases, 14 dogs and six cats of several ages and breeds and of both sexes were included in the study. Hyphema presented as a unilateral (14 cases out of 20) or bilateral (6/20) disorder in dogs and cats and extension of hemorrhage varied from minimal to diffuse. Hyphema was secondary to systemic disease (15/20) or occurred as a primary ocular lesion (5/20) in four dogs and one cat. Primary hyphema was always unilateral. In four of these cases, the cause of hyphema was trauma and remaining case was caused by phacoclastic uveitis in a dog with bilateral hypermature cataract. Various causes of bleeding disorders were found related to secondary hyphema: in decreasing order of frequency, they included vasculitis (8/15), systemic hypertension (5/15), and acquired coagulopathies (2/15). Vasculitis due to feline infectious peritonitis accounted for half of the cases (n=3) of systemic hyphema in cats. The various pathological aspects and pathogenesis of hyphema in dogs and cats are described and discussed...

Hifema, hemorragia na câmara anterior do olho, pode ser causada por vários mecanismos e pode facilmente ser detectada no exame oftálmico de rotina ou na necropsia como olho(s) vermelhos(s). O objetivo deste trabalho é relatar as causas de hifema diagnosticado como um achado postmortem em cães e gatos. Vinte casos, 14 cães e seis gatos de várias idades e raças, e de ambos os sexos foram incluídos no estudo. O hifema em cães e gatos teve uma apresentação unilateral (14 casos dos 20) ou bilateral (6/20), e a extensão da hemorragia variou de mínima a difusa. O hifema era secundário à doença sistêmica (15/20) ou ocorreu como lesão ocular primária em cinco dos 20 casos (quatro cães e um gato). O hifema primário foi sempre unilateral; em quatro desses casos, a causa foi traumatismo e o caso restante foi causado por uveíte facoclástica em um cão com catarata hipermadura bilateral. Várias causas de distúrbios hemorrágicos foram encontradas em relação ao hifema secundário: em ordem decrescente de frequência foram: vasculite (8/15), hipertensão sistêmica (5/15) e coagulopatias adquiridas (2/15). Os vários aspectos patológicos e a patogênese do hifema são descritos e discutidos...

Relationship between systemic hypertension, perfusion pressure and glaucoma: A comparative study in an adult Indian population.

Aims: To study the relationship between blood pressure (BP), intraocular pressure (IOP), mean ocular perfusion pressure (MOPP) and primary open angle glaucoma (POAG) in patients with hypertension and compare it to a control group of normotensives. Design: Cross‑sectional observational study. Materials and Methods: A total of 108 subjects with primary hypertension and 100 age‑matched controls without hypertension were enrolled for the study. IOP measurement using Noncontact Tonometer and dilated fundus evaluation using + 90 D lens were done for all cases. Single recording of BP was taken. Gonioscopy, Humphrey’s central visual fields, optical coherence tomography and pachymetry were done for all subjects with IOP > 21 mm Hg or C: D ratio ≥ 0.5 or asymmetry of > 0.2. Statistical Analysis: Univariate and multivariate multinomial regression models were used to determine the association between covariates and risk of glaucoma or glaucoma suspect. Results: There was no difference in the glaucoma status between subjects with and without hypertension. Subjects on antihypertensive medications were 1½ times more likely to have suspicious glaucoma (odds ratio [OR] =1.56] and nearly twice as likely to have POAG (OR = 1.85). In addition, we found a 31% and 12% reduction in risk of having POAG (95% confidence interval [CI] =13–45%, P = 0.001) and glaucoma suspect (95% CI = 2–21%, P = 0.03) respectively with every 1 mm Hg increment in MOPP. Conclusion: Subjects on antihypertensive medications are more likely to have either glaucoma or glaucoma suspect, and higher ocular perfusion pressure offers relative protection from glaucomatous damage.

Avaliação dos níveis pressóricos em pacientes submetidos a tratamento cirúrgico ambulatorial / Evaluation of blood pressure in patients undergoing ambulatory surgery

O objetivo foi investigar e comparar as alterações da pressão arterial em pacientes hipertensos e normotensos submetidos à cirurgia odontológica em âmbito ambulatorial. A amostra foi constituída por dois grupos: Grupo Normotenso e Grupo Hipertenso (com 8 indivíduos em cada grupo). Pacientes foram avaliados pela Monitorizarão Ambulatorial da Pressão Arterial (MAPA) durante 24 horas. As aferições constadas no exame foram divididas para análise dos dados em 5 momentos: sono, pré-cirúrgico, transcirúrgico, pós-cirúrgico e vigília. Houve aumento significativo da pressão arterial no momento transcirúrgico do Grupo Normotenso (p = 0,02) e do Grupo Hipertenso (p = 0,04). No momento transcirúrgico notou-se o aumento significativo da pressão arterial nos dois grupos, todavia o grupo hipertenso manteve seus índices pressóricos elevados por maior fração de tempo.

The objective was investigated and compare the blood pressure variances in hypertensive and regular blood pressure patients who went thru dental surgery at ambulatory environment. The sample was made of two different groups: Regular Blood Pressure Group and Hypertensive Group (with 8 individuals on each group). Patients were evaluated by Blood Pressure Ambulatory Monitoring for 24 hours. The readings observed at the exam were divided in 5 moments: sleep, Pre-Operatory, Trans-Operatory, Post-Operatory and Follow Up. There was a significant increase observed at the Blood Pressure reading at the Trans-operatory of the Regular Blood Pressure group (p = 0,02) and the Hypertensive Group (p = 0,04). During the trans- -operatory it was observed a significant increase of the Blood Pressure on both groups, but the Hypertensive Group kept their numbers elevated for a longer time.

Estudo da pressão arterial pelo método indireto oscilométrico (petmap®) em cães domésticos não anestesiados / Study of blood pressure by the indirect oscillometric method (petmap®) in domestic unanesthetized dogs

O estudo das pressões arteriais sistólica, média, diastólica e da frequência cardíaca, pelo método indireto oscilométrico (petmap®), foi realizado em 150 cães atendidos pelo Serviço de Clínica Médica de Pequenos Animais da FMVZ - Unesp/Botucatu. Investigou-se a influência de fatores como presença do proprietário, estado de saúde, diagnóstico de doença renal, raça, idade, sexo, decúbito, contenção, fluidoterapia, condição corpórea, temperamento, atividade física, dieta e atitude associados ou não à elevação da pressão arterial. Dos 150 cães, 34% encontravam-se sob a categoria de risco mínimo para o desenvolvimento de lesões hipertensivas, 14,6% com hipertensão branda, 22,6% com hipertensão moderada e 28,66%, com hipertensão grave. Houve influência, dos fatores analisados, na elevação da pressão arterial de acordo com a categoria de risco.

The study of systolic, mean, diastolic and heart rate by the oscillometric indirect method (PetMapTM) was performed in 150 dogs attended by the Small Animal Service of Medicine of FMVZ - Unesp/Botucatu. The influence of factors such as presence of the owner, health status, diagnosis of kidney disease, race, age, sex, recumbency, containment, fluid, body condition, temperament, physical activity, diet and attitude associated or not with elevated blood pressure was investigated. Of the 150 dogs, 34% were under the category of minimal risk for the development of hypertensive lesions, 14.6% with mild hypertension, 22.6% with moderate hypertension and 28.66% with severe hypertension. The analyzed factors influenced the elevation of blood pressure according to risk category.

Síndrome metabólica em crianças e adolescentes: dúvidas na terminologia, mas não nos riscos cardiometabólicos / Metabolic syndrome in children and adolescents: doubts about terminology but not about cardiometabolic risks

A síndrome metabólica (SM) tem gerado enormes controvérsias, a iniciar-se pela terminologia. O próprio autor que sugeriu o termo, Gerald Reaven, recomenda que não o utilizemos, porque, como a síndrome é um apanhado de alterações metabólicas e três dessas alterações podem defini-la, fica sempre difícil saber-se a que conjunto de alterações estamos nos referindo quando conotamos o termo SM. Em crianças, a complicação é ainda maior, já que se fazem diferentes adaptações aos critérios propostos para adultos. De qualquer forma, independentemente da terminologia, os riscos cardiovasculares são bem estabelecidos e fica cada vez mais claro que as crianças, já em tenra idade, podem começar a ter alterações metabólicas preditivas de problemas mais sérios futuramente. Assim, o papel do endocrinologista pediátrico e do pediatra geral é de investigar essas crianças, especialmente se portadoras de sobrepeso ou obesidade, para detectar precocemente e intervir em condições que podem ser prevenidas na vida adulta. Essa é uma nova visão de uma abordagem pediátrica preventiva de problemas que, usualmente, só são diagnosticados em vida adulta. Nesta revisão, abordamos os aspectos de definição, epidemiologia, fisiopatologia e de complicações da SM em crianças e adolescentes.

Metabolic syndrome (MS) has been a condition involved in considerable controversy, starting with the terminology. Gerald Reaven himself, the author who proposed the term MS, advised against the use of this terminology because the definition implies in at least three metabolic alterations, and it is never clear to which group of alterations we are referring to when we say that a patient has MS. In children, the problem is even more complicated, since there are many different adaptations to the criteria used in adults. On the other hand, independent of the terminology, cardiovascular risks are well-established and it is very clear that even children may present metabolic disturbances which predict future metabolic problems. The role of the pediatric endocrinologist or the general pediatrician is to investigate, especially in overweight/obese children, conditions that if treated early, may prevent future complications that today, unfortunately, are being diagnosed only in adult life. In this review, we discuss problems on the definition, epidemiology, pathophysiology, and complications of MS in children and adolescents.

Avaliação de um modelo de parâmetros distribuídos aplicado à estimação da geometria arterial na hipertensão / Evaluation of a distributed parameter model applied to arterial geometry estimation in hypertension

A hipertensão arterial provoca adaptações estruturais nas artérias, principalmente pelos processos de hipertrofia e remodelagem, as quais antecedem lesões de órgãos-alvo. A determinação de variáveis mecânicas e geométricas associadas ao sistema arterial possibilita ao clínico identificar precocemente as adaptações que decorrem da hipertensão arterial sistêmica no paciente, permitindo a intervenção terapêutica mais adequada. Este trabalho apresenta a avaliação de um modelo eletro-hidráulico e seu método associado para a determinaçãodos parâmetros geométricos do segmento arterial do antebraço. O método proposto requer somente a aquisição não-invasiva de ondas de pulso em dois sítios distintos. Séries de ondas de pulso da artéria radial foram simuladas a partir de ondas de pulso reais da artéria braquial, empregandoum modelo de parâmetros distribuídos simplificado das artérias do antebraço. O modelo é composto por três seções,representando os segmentos arteriais braquial, radial e a mão. As artérias braquial e radial foram representadas por componentes resistivos (atrito local), indutivos (massa do sangue) e capacitivos (complacência arterial), enquanto a mão foi representada por elementos resistivos (resistências de pequenos vasos da mão e periféricos) e capacitivos (complacência de pequenos vasos). Os resultados mostram um erro médio de estimação que pode ser considerado pequeno (3,7%) quando comparado aos valores de adaptação arterial in vivo (alterações de até 15%), indicando a utilização deste procedimento para estimar o processo de remodelagem das artérias de médio calibre observado na hipertensão arterial sistêmica.

Arterial hypertension leads to structural adaptation of arteries, mainly hypertrophy or remodeling, which precedes target-organ injuries. Determination of both mechanical and geometrical variables related to arterial system allows physicians to identify early arterial adaptation derived from systemic hypertension and to propose therapeutics. This work presents the evaluation of an electric-hydraulic model, and associated method, for determination of geometrical and mechanical parameters of forearm arteries. The proposed method requires only noninvasive acquisition of two pressure pulses at distinct sites. Series of pressure pulses from radial artery were simulated using acquired brachial artery pulses and a simplified distributed-model of the forearm arteries. The model presents three sections, representing brachial, radial, and hand vasculature. Brachial and radial arteries were represented with resistive (friction), inductive (blood mass), and capacitive (arterial compliance) elements. The hand was modeled with resistive (small vessels and capillaries) and capacitive elements (small vessels compliance). The results show that an average estimation error of 3.7% is small compared to “in vivo” findings (changes up to 15%), indicatingthat the procedure can be used to assess the remodeling of medium-sized arteries on primary systemic arterial hypertension.

Clinical study of minimally traumatic puncture drainage of hematoma combined with Salviae Miltiorrhizae injection(丹参注射液) in treatment of hypertensive cerebral hemorrhage / 中国中西医结合急救杂志

Objective To observe the effects of minimally traumatic puncture drainage of hematoma combined with Salviae Miltiorrhizae injection(丹参注射液) on the edematous volume around the lesion and neural functional defect in patients with hypertensive cerebral hemorrhage.Methods Eighty-nine patients with hypertensive cerebral hemorrhage were randomly divided into two groups: treatment group(n=45) and control group(n=44).All the patients had received minimally traumatic puncture drainage of hematoma,dehydration therapy,hemostatics,anti-inflammatory and anti-hypertensive agents, etc.In addition,Salviae Miltiorrhizae injection was continuously injected intravenously in the patients in the treatment group for three weeks.Cranial CT was performed to measure the volume of edema around the lesion at 7,14 and 21 days before and after operation,neurologic impairment degree scores(NDS) were assessed by National Institutes of Health Stroke Scale(NIHSS),and at the same time the fatality rate and re-hemorrhagic situation were observed at 14 and 30 days before and after initiating the operation.Results The areas of perilesional edema in both groups were conspicuously diminished at 7,14 and 21 days after initiating the operation,the area of perilesional edema diminished gradually,and significantly smaller in the therapeutic group than that in the control group at 14 and 21 days(P

La caminata: ¿Importante en el tratamiento de pacientes hipertensos? / The walking exercise: Is it important in the patient with high blood pressure?

Introducción: la hipertensión arterial esencial es un problema de salud pública con tendencia ascendente, multifactorial, de etiología desconocida en 90% de bs casos y en 10% restante obedece a una causa orgánica identificable. Las estrategias de control de la hipertensión establecen el uso de fármacos, ejercicio aeróbico, alimentación balanceada y disminución de hábitos en el consumo de alcohol y tabaco. El Comité Nacional para la prevención, detección, evaluación y tratamiento de la presión sanguínea alta, recomienda la caminata como parte de la estrategia general de manejo. El objetivo del estudio es evaluar el efecto de un programa de caminata. Material y métodos: se seleccionaron pacientes hipertensos con deficiente adherencia al tratamiento farmacológico, un grupo estuvo expuesto al programa de caminata. La observación de los grupos se realizó durante 20 días; a cada paciente se le aplicó un cuestionario estructurado con 20 preguntas, medición de peso y talla, monitoreo de la presión arterial (PA) e información sobre caminata para el grupo expuesto. Resultados: en el grupo de pacientes expuestos al programa de caminata se observó una disminución gradual de las presiones sistólica y diastólica inversamente proporcional al tiempo de caminata, obteniéndose mayor beneficio en la presión diastólica. Discusión: los pacientes sometidos al ejercicio de caminata presentaron beneficios manifestados en el transcurso de ésta principalmente a partir de los 15 días. Posiblemente se obtengan mejores resultados de PA sistólica y diastólica al incrementarse los días de ejercicio y el tiempo de caminata.

Introduction: systemic hypertension is a Health Public problem with a tendency to growth with a multiple risk factors and unknown etiology in mostof90% of patients and ¡nabout10% the etiology is a consecuence of an organic origen. Strategies to treat hypertension stablish the drugs use, aerobic exercise, a health and balance nutrition and withdrawal from alcohol and tobacco habits. The National Joint Committe for prevention, identification, evaluation and treatment of high blood pressure recommends walking exercise with in the general plan of treatment. Objective: to study and evaluate the effect of a walking program in systemic hypertension. Material and methods: we studied hypertensive patients with a lack of adherence to drugs treatment divided in two groups, one group with a special walking program during 20 days. All patients answered a questionnaire with 20 items. We measured weight, height, arterial pressure and asking about exercise. Results: in the walking program group there was a progressive down of systolic and diastolic pressure proportionally to walking time. It was more benefit in diastolic pressure. Discussion: hypertensive patient within a walking program were beneficed since 15 days in practicing. It could be better with more time and more distance of exercise.

The Changes of Plasma Catecholamines Concentration during Waking and Sleep in Obstructive Sleep Apnea Syndrome Patients with Systemic Hypertension / 결핵

BACKGROUND: Recent studies reported that untreated patients with obstructive sleep apnea syndrome had high long-term mortality rates, and cardiovascular complications of these patients had a major effect on mortality. Several data indicates that obstructive sleep apnea syndrome contributes to the development of diurnal systemic hypertension. But the pathophysiological mechanism of the development of systemic hypertension in these patients is still uncertain. This study was performed to evaluate the possible role of sympathetic nervous system activity for the development of systemic hypertension in patients with obstructive sleep apnea syndrome. METHOD: 35 patients with obstructive sleep apnea syndrome(OSAS) and 13 control subjects (Control) were included in this study. 21 patients of OSAS were normotensives(OSAS-NBP), and 14 patients of OSAS were hypertensives(OSAS-HBP). Full night polysomnography was undertaken to all subjects. We measured plasma norepinephrine(NE) and epinephrine(EP) concentrations during waking and sleep, using high performance liquid chromatography, in all patients and control subjects. RESULTS: In OSAS, OSAS-NBP and Control, plasma NE and EP concentrations during sleep were lower than during waking(p<0.01). But, in OSAS-HBP, there was no difference between during waking and sleep. Plasma NE concentrations during sleep of OSAS, OSAS-NBP and OSAS-HBP were higher than Control(p<0.05). In OSAS-HBP, daytime systolic blood pressure correlated with plasma NE concentration during sleep(r=0.7415, p<0.01), and correlated inversely with mean arterial oxygen saturation(r=-0.6465, p<0.05) or arterial oxygen saturation nadir(r=-0.6114, p<0.05) during sleep. CONCLUSION: The sympathetic activity during sleep of obstructive sleep apnea syndrome patients was higher than control subjects. In obstructive sleep apnea syndrome patients with systemic hypertension, there was no diurnal variation of sympathetic activity, and there was correlation between daytime systolic blood pressure and sympathetic activity during sleep. These data suggests that chronic hyperactivity of sympathetic nervous system may contribute to the development of diurnal systemic hypertension in patients with obstructive sleep apnea syndrome.