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1.
Rev. bras. med. esporte ; 28(3): 183-185, May-June 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1365709

ABSTRACT

ABSTRACT Introduction: Hypertension is one of the most common cardiovascular and cerebrovascular diseases and a major public health problem. Although, through the rational use of drugs, the blood pressure of hypertensive patients can be better controlled, a series of side effects of drugs and expensive medical expenses limit the ability of patients to comply with the demands of hypertension. Objective: To explore the effect of long-term exercise training on the rehabilitation of hypertensive patients. Methods: The patients were divided into a control group and an exercise group, and we used multiple measurements of blood pressure, a questionnaire, and registered the situation of each patient, after what results were compared and analyzed. Results: After 12 weeks of training, the subject's blood pressure has dropped significantly. The systolic blood pressure dropped by an average of 15.5mmHg compared to before the exercise prescription was implemented, diastolic blood pressure dropped by an average of 10.6mmHg. Conclusions: Continuous physical exercise in hypertensive patients has medium- and long-term effect on blood pressure control. Level of evidence II; Therapeutic studies - investigation of treatment results.


RESUMO Introdução: A hipertensão é uma das doenças cardiovasculares e cerebrovasculares mais comuns e um importante problema de saúde. Embora a pressão de pacientes hipertensos possa ser melhor controlada através do uso racional de medicamentos, seus efeitos colaterais e os elevados custos médicos limitam a habilidade dos pacientes de atender às demandas da hipertensão. Objetivo: Explorar o efeito a longo prazo de exercícios na reabilitação de pacientes hipertensos. Métodos: Dividiram-se os pacientes em um grupo controle e um grupo de exercícios e realizaram-se múltiplas avaliações de sua pressão sanguínea. Além disso, foi aplicado um questionário e a situação de cada paciente foi registrada. Em seguida, os resultados foram comparados e analisados. Resultados: Depois de 12 dias de treino, a pressão sanguínea dos pacientes caiu significativamente. A pressão sanguínea sistólica após a implementação dos exercícios caiu em média 15.5mmHg, e a pressão diastólica caiu em média 10.6mmHg. Conclusões: Atividade física continua em pacientes hipertensos tem efeitos de médio e longo prazo no controle da pressão sanguínea. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.


RESUMEN Introducción: La hipertensión es una de las enfermedades cardiovasculares y cerebrovasculares más comunes y un importante problema de salud. Aunque la presión de pacientes hipertensos pueda ser mejor controlada a través del uso racional de medicamentos, sus efectos colaterales y los elevados costos médicos limitan la habilidad de los pacientes de atender a las demandas de la hipertensión. Objetivo: Explorar el efecto a largo plazo de ejercicios en la rehabilitación de pacientes hipertensos. Métodos: Los pacientes fueron divididos en un grupo control y un grupo de ejercicios y realizaron múltiples evaluaciones de su presión sanguínea. Además, fue aplicado un cuestionario y la situación de cada paciente fue registrada. Luego, los resultados fueron comparados y analizados. Resultados: Después de 12 días de entrenamiento, la presión sanguínea de los pacientes disminuyó significativamente. La presión sanguínea sistólica, después de la implementación de los ejercicios, descendió en promedio 15.5mmHg, y la presión diastólica descendió en promedio 10.6mmHg. Conclusiones: La actividad física continua en pacientes hipertensos tiene efectos de medio y largo plazo en el control de la presión sanguínea. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

2.
Rev. bras. med. esporte ; 28(2): 126-129, Mar-Apr. 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1365682

ABSTRACT

ABSTRACT Introduction: Studies have shown that different forms of aerobic exercise can lower blood pressure in patients with essential hypertension. Appropriate resistance exercises can also effectively lower blood pressure. Objective: To study the impact of sports on hypertension in colleges and universities. Methods: Several hypertension patients in colleges and universities were selected and randomly divided into two groups. One group (drug-only group) used conventional antihypertensive drugs (nifedipine), while the other (physical exercise group) supplemented drug therapy with physical exercise. There was a comparative analysis of the blood pressure of the two groups of patients. Results: The was a clear effect of sports on the hypertensive patients, with significant differences in the blood pressure reduction of the two groups. Conclusion: Sports can help treat high blood pressure. This method is viable for clinical application. Level of evidence II; Therapeutic studies - investigation of treatment results.


RESUMO Introdução: Estudos mostram que diferentes tipos de exercício aeróbico podem diminuir a pressão sanguínea de pacientes com hipertensão essencial; o mesmo é verdade para exercícios de resistência adequados. Objetivo: Estudar o impacto dos esportes na hipertensão em escolas secundárias e universidades. Métodos: Selecionou-se diversos pacientes com hipertensão em escolas secundárias e universidades, que foram aleatoriamente divididos em dois grupos. Um grupo (grupo terapia medicamentosa exclusiva) usou medicamentos anti-hipertensivos convencionais (nifedipino), enquanto o outro (grupo atividade física) utilizou atividades físicas como complemento à medicação. Realizou-se uma análise comparativa da pressão dos dois grupos de pacientes. Resultados: O esporte teve efeito evidente sobre os pacientes hipertensos, gerando diferenças significativas na pressão sanguínea entre os dois grupos. Conclusão: O esporte pode ajudar a tratar a hipertensão. O método utilizado é viável para aplicação clínica. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.


RESUMEN Introducción: Estudios muestran que diferentes tipos de ejercicio aeróbico pueden disminuir la presión sanguínea de pacientes con hipertensión esencial; lo mismo es verdad para ejercicios de resistencia adecuados. Objetivo: Estudiar el impacto de los deportes en la hipertensión en escuelas secundarias y universidades. Métodos: Se seleccionaron diversos pacientes con hipertensión en escuelas secundarias y universidades, que fueron aleatoriamente dividididos en dos grupos. Un grupo (grupo de terapia medicamentosa exclusiva) usó medicamentos anti-hipertensivos convencionales (nifedipino), mientras que el otro (grupo actividad física) utilizó actividades físicas como complemento a la medicación. Se realizó un análisis comparativo de la presión de los dos grupos de pacientes. Resultados: El deporte tuvo efecto evidente sobre los pacientes hipertensos, generando diferencias significativas en la presión sanguínea entre los dos grupos. Conclusión: El deporte puede ayudar a tratar la hipertensión. El método utilizado es viable para aplicación clínica. Nivel de evidencia II; Estudiantes terapéuticos - investigación de resultados de tratamiento.

3.
Univ. salud ; 24(1): 95-101, ene.-abr. 2022. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1361190

ABSTRACT

Resumen Introducción: La enfermedad arterial hipertensiva no controlada (EAHNC), se asoció en 2008 con alta mortalidad por enfermedad cardiovascular que genera 9,4 millones de fallecimientos y 7% de la carga de enfermedad expresada en Años de Vida Ajustados por Discapacidad (AVAD). Un 50% de los pacientes no se adhieren al tratamiento EAH y se desconoce sobre las causas en el nivel básico de atención en Colombia. Objetivo: Identificar factores asociados con la adherencia al tratamiento de EAH en una Empresa Social del Estado (E.S.E), pública de un municipio colombiano. Materiales y métodos: Estudio de casos y controles, 75 casos y 75 controles seleccionados aleatoriamente a partir de una base de pacientes del programa de control de hipertensión arterial. Resultados: La edad mayor a 50 años fue el único factor asociado con falta de adherencia al tratamiento, sujetos entre 50-59 años con un OR=3,18 (Intervalo al 95% de confianza) IC95% 1,01-10,00; y entre 60-69 años OR=3,70 IC95% 1,17-11,60 tienen mayor probabilidad de no adherirse al tratamiento. Conclusiones: Los mayores de 50 a 69 años de edad presentaron la más alta probabilidad de no adherencia al tratamiento de la EAH. Se requieren reforzar medidas de seguimiento para mejorar su adherencia al tratamiento.


Abstract Introduction: In 2008, uncontrolled hypertensive arterial disease (UHAD) was associated with a high cardiovascular mortality that caused 9.4 million deaths and 7% of the disease burden expressed as Disability-Adjusted Life Years (DALYs). The reasons why 50% of the patients treated in primary care facilities in Colombia do not adhere to UHAD treatment are unknown. Objective: To identify factors associated with UHAD treatment adherence in a Public Health Care institution from a Colombian city. Materials and methods: A case-control study with 75 cases and 75 controls randomly selected from a patient database of the arterial hypertension control program. Results: Being older than 50 years was the only factor associated with lack of adherence to treatment. Participants who were 50-59 (OR=3.18; IC95% 1.01-10.00) and 60-69 (OR=3.70; IC95% 1.17-11.60) are less likely to adhere to treatment. Conclusions: Patients who are 50-69 years old had the highest probability of non-adherence to UHAD treatment. Follow-up measures are necessary to improve this figure.

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5.
Int. j. cardiovasc. sci. (Impr.) ; 35(2): 253-264, Mar.-Apr. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1364973

ABSTRACT

Abstract The regular practice of physical exercise as a non-pharmacological treatment of arterial hypertension (AH) has been encouraged due to causing a series of physiological responses in the cardiovascular system, such as the production of vasoactive substances, including nitric oxide (NO). NO is a relaxation factor released by the endothelium, and the decrease in its bioavailability is related to coronary and arterial diseases, such as AH. This study aimed to perform an integrative literature review to elucidate the effect of physical training on NO levels in patients with AH and to establish a relationship between these levels and blood pressure (BP) control. A literature review was was performed by searching PubMed / MEDLINE, Lilacs, Scielo, Cinahl and Embase databases. The search string used was ("arterial hypertension" OR hypertension) AND (exercise OR "physical exercise" OR "aerobic exercise" OR "exercise training" or "physical activity") AND ("nitric oxide"). We included fully available controlled and uncontrolled clinical trials published in English and Portuguese languages in the last 10 years. The review consisted of 16 articles, of which 13 reported an increase in NO production after the physical training intervention, and three studies found no change. In addition, 15 studies observed a reduction in BP after the intervention. In conclusion, regular practice of physical exercises, advocating moderate intensity, can improve NO bioavailability in pre-hypertensive and hypertensive individuals, which seems to be one of the mechanisms responsible for BP reduction.

6.
Int. j. cardiovasc. sci. (Impr.) ; 35(2): 161-171, Mar.-Apr. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1364975

ABSTRACT

Abstract Background: There are divergences in the literature regarding the experimental model (Wistar-WIS or Wistar Kyoto-WKY) to be used as a Spontaneously Hypertensive Rat (SHR) control. The characterization of these models in terms of cardiovascular parameters provides researchers with important tools at the time of selection and application in scientific research. Objective: The aim of this study was to evaluate the use of WIS and WKY as a Spontaneously Hypertensive Rat (SHR) control by assessing the long-term behavior of blood pressure and cardiac structure and function in these strains. Methods: To this end, WIS, WKY, and SHR underwent longitudinal experiments. Blood pressure and body mass were measured every two weeks from the 8th to the 72nd. Echocardiographic analysis was performed in all groups with 16, 48, and 72 weeks of life. After having applied the normality test, the Two-Way ANOVA of repeated measures followed by the Tukey post hoc test was used. A significance level of 5% was established. Results: The WIS group showed higher body mass (p<0.05), while the WKY and SHR presented higher body mass variation over time (p<0.05). SHR exhibited increased values of systolic, diastolic, and mean blood pressure when compared to WKY and WIS, whereas the WKY generally showed higher values than WIS (p<0.05). Regarding the cardiac function, SHR showed reduced values, while the WKY presented an early decrease when compared to WIS with aging (p<0.05). Conclusion: WIS is a more suitable normotensive control for SHR than WKY in experiments to test blood pressure and cardiac structure and function.

8.
Rev Bras Hipertens ; 29(1): 6-9, 20220310.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1367446

ABSTRACT

Homem de 53 anos, hipertenso e portador de bronquite, admitido em um serviço de urgência no dia 15 de dezembro de 2020 devido sintomas gripais, febre e cefaleia iniciados há oito dias. Após constatação de acometimento pulmonar importante mediante tomografia computadorizada (TC) de tórax, sugestivo de infecção pelo vírus SARS-CoV2, o paciente foi internado em unidade de terapia intensiva. Foi intubado no décimo dia de internação, e, dois dias após, evoluiu com labilidade pressórica importante, recorrendo ao uso de noradrenalina e nitroprussiato, além de outros anti-hipertensivos, conforme a necessidade. O quadro predominante foi a hipertensão arterial sistêmica, manifestada principalmente com a mudança de decúbito, sendo o maior valor pressórico registrado de 240x90 mmHg. A disautonomia também se manifestou por ausência de dejeções, sudorese excessiva e espasmos musculares. A frequência cardíaca se manteve estável e dentro dos parâmetros de normalidade.A partir do trigésimo dia de internação, observou-se melhora progressiva do quadro e reestabelecimento da homeostase. Obteve alta após 59 dias de internação, sem sequelas significativas. A explicação mais razoável para o caso é o aumento da resistência vascular periférica, por ação da angiotensina II, associada à supressão do sistema parassimpático, o que explica, também, a incompetência do barorreflexo para compensação da frequência cardíaca. Adicionalmente, o paciente estava em uso de carvedilol. Este caso enfatiza o desafio diagnóstico precoce da disautonomia em pacientes críticos, devido a carência de ferramentas adequadas para uso na prática cotidiana. A estimulação vagal pode constituir opção terapêutica eficaz, mas carece de mais estudos


A 53-year-old male, hypertensive and with bronchitis, was admitted to the emergency department on December 15, 2020 due to flu-like symptoms, fever and headache that started eight days ago. After finding significant lung involvement by chest computed tomography (CT) suggestive of SARS-CoV2 virus infection, the patient was admitted to the intensive care unit. He was intubated on the tenth day of hospitalization, and, 2 days later, he evolved with significant pressure lability, using norepinephrine and nitroprusside, in addition to other antihypertensive drugs, as needed. The predominant state was hypertension, expressed mainly when there is interference from the patient's position in bed. The highest pressure value recorded was 240x90 mmHg. Dysautonomy was also manifested by the absence of stools, excessive sweating and muscle spasms. Heart rate remains stable and within normal limits. From the thirtieth day of hospitalization onwards, there was an evolution with progressive improvement and restoration of homeostasis. He was discharged after 59 days of hospitalization, without sequelae. The most reasonable explanation for the case is the increase in peripheral vascular resistance, due to the action of angiotensin II, associated with the suppression of the parasympathetic system, which also explains the incompetence of the baroreflex to compensate the heart rate. Additionally, the patient was using carvedilol. This case emphasizes the importance of tools that early identify dysautonomy, prepare the team. Vagal stimulation can be an effective therapeutic option, but further studies are needed

9.
Rev Bras Hipertens ; 29(1): 14-18, 20220310.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1367456

ABSTRACT

Caso clínico de uma paciente do sexo feminino, encaminhada a nossa Instituição aos sete anos de idade por provável Hipertensão Arterial Sistêmica. A paciente apresentava obesidade grave desde os quatro anos e há alguns meses foram detectadas medidas de pressão arterial elevadas em várias consultas médicas. Tem antecedentes de rematuridade, sedentarismo e dieta inadequada, além de história familiar também de obesidade e hipertensão arterial. Discutimos as condutas quanto a investigação da etiologia, da presença de lesões de órgãos alvo e do tratamento. Na evolução, houve controle adequado da pressão arterial após início de inibidores da enzima de conversão da angiotensina, mas grande dificuldade na redução do peso. Ao longo do seguimento, mesmo sob orientações nutricionais e reforço quanto a modificações do estilo de vida, a paciente apresentou ganho ponderal de 25 quilos. Relatamos este caso atendendo a necessidade de discussão do tema frente ao aumento significativo da prevalência de HAS em crianças e adolescente. Existem aspectos multifatoriais para o desenvolvimento da hipertensão arterial na infância, em grande parte associada a um estilo de vida inadequado. As dificuldades relacionadas ao seu manejo a presença de comorbidades, em especial da obesidade, ressaltam a necessidade de uma abordagem multiprofissional para que a evolução do quadro da paciente venha a ser o desejado


Clinical case of a female patient referred to our Institution at the age of seven years old with Systemic Arterial Hypertension. The patient had been severely obese since she was 4 years old and high blood pressure levels were detected in several medical consultations a few months ago. She has a history of prematurity, a sedentary lifestyle, and an inadequate diet, in addition to a family history of obesity and high blood pressure. We discussed the investigation of the etiology, the presence of target organ lesions, and the treatment of arterial blood pressure in youth. In the follow-up, there was adequate control of blood pressure after initiation of angiotensin-converting enzyme inhibitor, with great difficulty in weight reduction. Even under nutritional guidelines and reinforcement regarding lifestyle changes, the patient had a weight gain of 25 kilos. We report this case in view of the significant increase in the prevalence of Systemic Arterial Hypertension in children and adolescents. There are multifactorial aspects to the development of this scenario, largely associated with an inadequate lifestyle. The difficulties related to its management and the presence of comorbidities, especially obesity, highlight the need for a ultidisciplinary approach so that the evolution of the patient's condition becomes as desired

11.
Arq. bras. cardiol ; 118(3): 614-622, mar. 2022. tab
Article in English, Portuguese | LILACS | ID: biblio-1364355

ABSTRACT

Resumo Fundamento Aparentemente, a pior resposta a algumas classes de anti-hipertensivos, especialmente inibidores da enzima conversora da angiotensina e bloqueadores de receptor de angiotensina, pela população negra, explicaria, pelo menos parcialmente, o pior controle da hipertensão entre esses indivíduos. Entretanto, a maioria das evidências vêm de estudos norte-americanos. Objetivos Este estudo tem o objetivo de investigar a associação entre raça/cor da pele autorrelatadas e controle de PA em participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) utilizando várias classes de anti-hipertensivos em monoterapia. Métodos O estudo envolveu uma análise transversal, realizada com participantes da linha de base do ELSA-Brasil. O controle de pressão arterial foi a variável de resposta, participantes com valores de PA ≥140/90 mmHg foram considerados descontrolados em relação aos níveis de pressão arterial. A raça/cor da pele foi autorrelatada (branco, pardo, negro). Todos os participantes tiveram que responder perguntas sobre uso contínuo de medicamentos. A associação entre o controle de PA e raça/cor da pele foi estimada por regressão logística. O nível de significância adotado nesse estudo foi de 5%. Resultados Do total de 1.795 usuários de anti-hipertensivos em monoterapia na linha de base, 55,5% se declararam brancos, 27,9%, pardos e 16,7%, negros. Mesmo depois de padronizar em relação a variáveis de confusão, negros em uso de inibidores da enzima conversora de angiotensina (IECA), bloqueadores de receptor de angiotensina (BRA), diuréticos tiazídicos (DIU tiazídicos) e betabloqueadores (BB) in monoterapia tinham controle de pressão arterial pior em comparação a brancos. Conclusões Os resultados deste estudo sugerem que, nesta amostra de brasileiros adultos utilizando anti-hipertensivos em monoterapia, as diferenças de controle de pressão arterial entre os vários grupos raciais não são explicadas pela possível eficácia mais baixa dos IECA e BRA em indivíduos negros.


Abstract Background It seems that the worst response to some classes of antihypertensive drugs, especially angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, on the part of the Black population, would at least partially explain the worse control of hypertension among these individuals. However, most of the evidence comes from American studies. Objectives This study aims to investigate the association between self-reported race/skin color and BP control in participants of the Longitudinal Study of Adult Health (ELSA-Brasil), using different classes of antihypertensive drugs in monotherapy. Methods The study involved a cross-sectional analysis, carried out with participants from the baseline of ELSA-Brasil. Blood pressure control was the response variable, participants with BP values ≥140/90 mmHg were considered out of control in relation to blood pressure levels. Race/skin color was self-reported (White, Brown, Black). All participants were asked about the continuous use of medication. Association between BP control and race/skin color was estimated through logistic regression. The level of significance adopted in this study was of 5%. Results Of the total of 1,795 users of antihypertensive drugs in monotherapy at baseline, 55.5% declared themselves White, 27.9% Brown, and 16.7% Black. Even after adjusting for confounding variables, Blacks using angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blocker (ARB), thiazide diuretics (thiazide DIU), and beta-blockers (BB) in monotherapy had worse blood pressure control compared to Whites. Conclusions Our results suggest that in this sample of Brazilian adults using antihypertensive drugs in monotherapy, the differences in blood pressure control between different racial groups are not explained by the possible lower effectiveness of ACEIs and ARBs in Black individuals.


Subject(s)
Humans , Adult , Hypertension/drug therapy , Hypertension/epidemiology , Antihypertensive Agents/therapeutic use , Antihypertensive Agents/pharmacology , United States , Blood Pressure , Brazil , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Calcium Channel Blockers/therapeutic use , Cross-Sectional Studies , Longitudinal Studies , Angiotensin Receptor Antagonists/therapeutic use , Race Factors
13.
Arq. bras. cardiol ; 118(3): 565-575, mar. 2022. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1364343

ABSTRACT

Resumo Fundamento Pacientes com anemia falciforme (AF) têm risco aumentado de complicações cardiovasculares. O teste ergométrico é usado como marcador de prognóstico em uma série de doenças cardiovasculares. Entretanto, há uma escassez de evidências sobre exercícios em pacientes com AF, especialmente em relação à sua segurança, viabilidade e possível função prognóstica. Objetivos Usamos o teste em esteira máximo para determinar a segurança e a viabilidade do teste ergométrico em pacientes com AF. Além disso, os fatores associados à duração do exercício, bem como o impacto das alterações causadas pelo exercício em resultados clínicos, também foram avaliados. Métodos 113 pacientes com AF que passaram pelo teste ergométrico e por uma avaliação cardiovascular abrangente incluindo um ecocardiograma e os níveis do peptídeo natriurético do tipo B (BNP). O desfecho de longo prazo foi uma combinação de eventos incluindo morte, crises álgicas graves, síndrome torácica aguda ou internações hospitalares por outras complicações associadas â doença falciforme. A análise de regressão de Cox foi realizada para identificar as variáveis associadas ao resultado. Um p valor <0,05 foi considerado estatisticamente significativo. Resultados A média de idade foi de 36 ± 12 anos (intervalo, 18-65 anos), e 62 pacientes eram do sexo feminino (52%). A presença de alterações isquêmicas ao esforço e resposta pressórica anormal ao exercício foram detectadas em 17% e 9 % da´população estudada respectivamente. Dois pacientes apresentaram crise álgica com necessidade de internação hospitalar no período de 48 horas da realização do exame. Fatores associados à duração do exercício foram idade, sexo, velocidade máxima de regurgitação tricúspide (RT), e relação E/e', após a padronização quanto aos marcadores da gravidade da doença. Durante o período médio de acompanhamento de 10,1 meses (variando de 1,2 a 26), 27 pacientes (23%) apresentaram desfechos clínicos adversos. Preditores independentes de eventos adversos foram a concentração de hemoglobina, velocidade do fluxo transmitral tardio (onda A), e a resposta da PA ao exercício. Conclusões A realização de testes ergométricos em pacientes com AF, clinicamente estáveis, é viável. A duração do exercício estava associada à função diastólica e a pressão arterial pulmonar. A resposta anormal da PA foi um preditor independente de eventos adversos.


Abstract Background Patients with sickle cell disease (SCD) are at increased risk for cardiovascular complications. Exercise testing is used as a prognostic marker in a variety of cardiovascular diseases. However, there is a lack of evidence on exercise in SCD patients, particularly regarding its safety, feasibility, and possible prognostic role. Objectives We used the maximal treadmill test to determine safety and feasibility of the exercise testing in SCD patients. Additionally, the factors associated with exercise duration, as well as the impact of exercise-induced changes on clinical outcome, were also assessed. Methods One-hundred thirteen patients with SCD, who underwent exercise testing, were prospectively enrolled. A comprehensive cardiovascular evaluation, including echocardiography and B-type natriuretic peptide (BNP) levels, were obtained. The long-term outcome was a composite endpoint of death, severe acute painful episodes, acute chest syndrome, or hospitalization for other SCD-related complications. Cox regression analysis was performed to identify the variables associated with the outcome. A p-value<0.05 was considered to be statistically significant. Results The mean age was 36 ± 12 years (range, 18-65 years), and 62 patients were women (52%). Ischemic electrocardiogram and abnormal blood pressure (BP) response to exercise were detected in 17% and 9%, respectively. Two patients experienced pain crises within 48 hours that required hospitalization. Factors associated with exercise duration were age, sex, tricuspid regurgitation (TR) maximal velocity, and E/e' ratio, after adjustment for markers of disease severity. During the mean follow-up of 10.1 months (ranging from 1.2 to 26), the endpoint was reached in 27 patients (23%). Independent predictors of adverse events were hemoglobin concentration, late transmitral flow velocity (A wave), and BP response to exercise. Conclusions Exercise testing in SCD patients who were clinically stable is feasible. Exercise duration was associated with diastolic function and pulmonary artery pressure. Abnormal BP response was an independent predictor of adverse events.


Subject(s)
Humans , Female , Adult , Young Adult , Exercise Test , Anemia, Sickle Cell/complications , Prognosis , Echocardiography , Feasibility Studies , Middle Aged
14.
Arq. bras. cardiol ; 118(3): 607-613, mar. 2022. tab
Article in English, Portuguese | LILACS | ID: biblio-1364344

ABSTRACT

Resumo Fundamento A ventriculografia esquerda é um método invasivo para avaliar a função sistólica do ventrículo esquerdo. Depois do advento de métodos não invasivos, o seu uso tem sido questionado por resultar em algum risco para o paciente. Objetivos Avaliar quais fatores associam-se independentemente com a decisão de realizar ventriculografia em pacientes com doença arterial coronariana. Métodos Tratou-se de um estudo analítico, retrospectivo, avaliando prontuários eletrônicos e banco de dados e comparando 21 variáveis de interesse pré-definidas entre pacientes submetidos a cineangiocoronariografia. Foi considerado significante p < 0,05. Resultados Avaliamos 600 pacientes consecutivos, e a ventriculografia esquerda foi realizada na maioria dos pacientes submetidos a uma cineangiocoronariografia (54%). Depois da análise multivariada, os pacientes com síndromes coronarianas crônicas ( odds ratio [OR] 1,72; intervalo de confiança de 95% [IC 95%]: 1,20-2,46; p < 0,01) tiveram maior chance de serem submetidos ao procedimento. Os pacientes com função ventricular conhecida (OR = 0,58; IC 95%: 0,40-0,85; p < 0,01), os revascularizados (OR 0,31; IC 95% 0,14-0,69; p < 0,01), os hipertensos (OR 0,58; IC 95%: 0,36-0,94; p = 0,02) e aqueles com maiores valores de creatinina (OR 0,42; IC 95% 0,26-0,69; p < 0,01) tiveram maior chance de não realizar ventriculografia. Conclusões Nos pacientes submetidos a cineangiocoronariografia, o diagnóstico de síndrome coronariana crônica associou-se de modo independente com uma maior realização da técnica, enquanto ter a função ventricular previamente conhecida, ser hipertenso, ter sido submetido a revascularização cirúrgica prévia e ter valores de creatinina mais elevados associaram-se a uma maior chance de não realizar o método.


Abstract Background Left ventriculography is an invasive method for assessment of left ventricular systolic function. Since the advent of noninvasive methods, its use has been questioned, as it carries some risk to the patient. Objective To assess which factors are independently associated with the decision to perform ventriculography in patients with coronary artery disease. Methods Analytical, retrospective, database review study of electronic medical records comparing 21 predefined variables of interest among patients undergoing coronary angiography. P-values <0.05 were considered significant. Results We evaluated 600 consecutive patients undergoing coronary angiography. Left ventriculography was performed in the majority of cases (54%). After multivariate analysis, patients with chronic coronary syndrome (OR 1.72; 95% CI: 1.20-2.46; p < 0.01) were more likely to undergo the procedure. Patients with known ventricular function (OR 0.58; 95% CI: 0.40-0.85; p < 0.01); those with a history of CABG (OR 0.31; 95% CI: 0.14-0.69; p < 0.01) or hypertension (OR 0.58; 95% CI: 0.36-0.94; p = 0.02); and those with higher creatinine levels (OR 0.42; 95% CI: 0.26-0.69; p < 0.01) had greater odds of not undergoing ventriculography. Conclusions In patients undergoing coronary angiography, a diagnosis of chronic coronary syndrome was independently associated with greater likelihood of left ventriculography, while having previously determined ventricular function, a history of hypertension or CABG, and higher creatinine levels were associated with a decreased likelihood of undergoing this procedure.


Subject(s)
Humans , Coronary Artery Disease/complications , Coronary Artery Disease/diagnostic imaging , Retrospective Studies , Ventricular Function, Left , Coronary Angiography , Heart
15.
J. pediatr. (Rio J.) ; 98(1): 53-59, Jan.-Feb. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1360559

ABSTRACT

Abstract Objective: To investigate the association between oral contraceptive use and cardiovascular risks, including metabolic syndrome and their components in Brazilian adolescents. Method: This study used data from the Study of Cardiovascular Risks in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes - ERICA), a nationwide, cross-sectional, school-based study with individuals aged 12-17 years. Sociodemographic variables and OC use were assessed by a self-administered questionnaire. International Diabetes Federation criteria were used to define metabolic syndrome. Descriptive statistics were reported as prevalence and their respective confidence interval of 95% of oral contraceptives according to variables. Logistic regression was performed. Crude and adjusted odds ratios were calculated. Results: This subsample was composed of 22,682 female adolescents, of which 12.65% reported using oral contraceptives and their use was associated with hypertension and hypertriglyceridemia. These associations remained statistically significant after adjusting for age, school region, race, and tobacco use with an increase of 2.68 (1.66 - 4.32) and 3.45 (2.56 - 4.65) times, respectively. Conclusion: The present study was the first to examine the association between the use of oral contraceptives and cardiovascular risk factors among the largest number of female Brazilian adolescents. This method was significantly associated with hypertension, hypertriglyceridemia. Teenagers using oral contraceptives should be monitored for side effects, including blood pressure measurements and advised to avoid smoking.

17.
Rev. bras. cir. cardiovasc ; 37(1): 29-34, Jan.-Feb. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1365545

ABSTRACT

Abstract Introduction: In this study, we aimed to retrospectively evaluate the results of type A intramural hematoma (TA-IMH) cases that underwent ascending aortic surgery. Methods: One hundred ninety-four patients who underwent aortic surgery between 2010 and 2018 were included in this study. TA-IMH was differentiated according to tomography angiographic images. Demographic data, operation type, hypothermic circulatory arrest times, echocardiographic findings, wall thickness of IMH, complications, and prognosis were retrospectively analyzed. Results: TA-IMH (n=14) or type A aortic dissection (AD) (n=35) data were collected from patients' files and 49 cases were enrolled into the study. Bentall operation was performed in eight patients (type A AD = six [17.1%], TA-IMH = two [14.3%]); 41 patients underwent tubular graft interposition of ascending aorta (AD = 29 [82.9%], TA-IMH = 12 [85.7%]). There was no significant difference in terms of age, gender distribution, aortic dimensions, cardiopulmonary bypass times, hypothermic circulatory arrest times, hospital ward stay, and intensive care unit stay between the two groups. The mortality rate of AD group was 34.4% and of TA-IMH group was 14.3%. There was no significant difference in terms of mortality between the groups. In our study, 45.7% of patients had hypertension and that rate was lower than the one found in the literature. In addition, bicuspid aorta was not observed in both groups. Connective tissue disease was not detected in any group. Conclusion: Surgical treatment of aorta is beneficial for TA-IMH. Our aortic surgical indications comply with the European aortic surgical guidelines. Hypertension control should be provided aggressively.

18.
Saude e pesqui. (Impr.) ; 15(1): e9934, abr./jun. 2022.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1368166

ABSTRACT

O objetivo deste estudo foi avaliar o autocuidado e o risco cardiometabólico em pessoas com hipertensão arterial (HA) em seguimento clínico regular na atenção primária à saúde. Estudo analítico e transversal conduzido entre 86 pessoas com HA no interior do Estado de São Paulo, por meio da aplicação das versões brasileiras da Escala de Autocuidado de Hipertensão e do Escore de Risco Cardiometabólico de Framingham. Os participantes demonstraram níveis satisfatórios de confiança (71,3(14,7)), níveis insatisfatórios para manutenção (59,2(14,5)) e manejo (55,1(20,3)) do autocuidado na Escala de Autocuidado e 34,6% de chance de desenvolver infarto agudo do miocárdio nos próximos dez anos. Os indivíduos com menor idade apresentaram níveis de confiança satisfatórios em relação ao manejo do autocuidado, e observou-se maior risco cardiometabólico entre pessoas com diabetes e angina. Os indivíduos possuem confiança, mas demonstram inadequados manejo e manutenção do comportamento de autocuidado, e quanto menor a idade, melhor o manejo do autocuidado.


This study aimed evaluate self-care and cardiometabolic risk in people with arterial hypertension undergoing regular clinical follow-up in primary health care. Exploratory study conducted among people with hypertension in the interior of the State of São Paulo, through the application of the Brazilian versions of the Hypertension Self-Care Scale and the Framingham Cardiometabolic Risk Score. Participants demonstrated satisfactory levels of confidence (71.3 (14.7)) and unsatisfactory levels for Self-Care maintenance (59.2 (14.5)) and management (55.1 (20.3)), domains of the Scale Self-care; and a 34.6% chance of developing acute myocardial infarction in the next 10 years. The youngest individuals had satisfactory levels of confidence in relation to the management of self-care; and higher cardiometabolic risk was observed among people with diabetes and angina. No significant associations were found between the other variables. Individuals have confidence, but demonstrate inadequate Self-Care management and maintenance and the younger the better self-care management.

19.
Saude e pesqui. (Impr.) ; 15(1): e9741, abr./jun. 2022.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1368164

ABSTRACT

Este trabalho objetivou propor e verificar evidências de validação de um instrumento de avaliação do apoio social ao hipertenso na perspectiva de profissionais prestadores de serviço na Atenção Básica. Para o percurso metodológico, realizaram-se as etapas: consulta a especialistas, imputação de dados e análise fatorial confirmatória (AFC). O instrumento proposto foi adaptado do Primary Care Assessment Tool versão profissionais, sendo validados seis itens agregados nas dimensões conceituais "Enfoque na família" e "Orientação para a comunidade", que foram confirmados pela AFC com base no ajuste do modelo (CNIN/DF = 2,256; RFI = 0,924; NFI = 0,959; IFI = 0,977; TLI = 0,956; e CFI =0,977). Evidenciou-se uma correlação significativa (p-valor = 0,000) e positiva entre as dimensões. A adequada consistência interna e confiabilidade no ajuste do modelo permitiu a reprodução dele respeitando-se as limitações. Assim, disponibiliza-se aos gestores e pesquisadores um instrumento estatisticamente validado para avaliar o apoio social aos hipertensos.


Current study verifies validation evidences of an instrument for the evaluation of social support for hypertensive patients from the perspective of professionals in primary care. Methodology followed stages below: consultation with specialists, imputation of data and confirmatory factor analysis (CFA). The proposed instrument was adapted from the Primary Care Assessment Tool, professional version, with the validation of six items aggregated within the conceptual dimensions "Focus on the family" and "Community Orientation", confirmed by CFA, based on the adjustment of the model (CNIN/DF = 2.256; RFI = 0.924; NFI = 0.959; IFI = 0.977; TLI = 0.956; and CFI =0.977). Significant correlation (p-value=0.000) and positive correlation between the dimensions were evidenced. Adequate internal consistency and reliability in the model´s adjustment allowed its reproduction and limitations. Managers and researchers are provided with a statistically validated instrument to evaluate social support for hypertensive patients.

20.
Arch. argent. pediatr ; 120(1): e8-e16, feb 2022. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1353524

ABSTRACT

La hipertensión arterial (HTA) es un factor de riesgo modificable de enfermedad cardiovascular (ECV) y debe incluirse dentro del estudio de los orígenes del desarrollo de la salud y enfermedad (DOHaD). Durante el desarrollo intrauterino y perinatal, diferentes factores ambientales impactan en la programación temprana de las enfermedades crónicas no transmisibles (ECNT). En esta revisión se resume la evidencia que vincula los cambios adaptativos y la plasticidad del feto a factores ambientales desfavorables alterando el fenotipo adulto en el desarrollo de HTA. Estos cambios adaptativos responden a cambios epigenéticos que favorecen el desarrollo de HTA y ECV en la edad adulta con implicancias intergeneracionales. Por último, se mencionan estrategias preventivas para limitar o revertir algunas de las variables que pueden producir alteraciones en la programación del desarrollo que conducen a HTA en etapas más tardías de la vida.


Hypertension (HTN) is a modifiable risk factor for cardiovascular disease (CVD) and should be included in the study of developmental origins of health and disease (DOHaD). During intrauterine and perinatal development, different environmental factors have an impact on the early programming of noncommunicable diseases (NCDs). This review provides a summary of the evidence that connects the fetus' plasticity and adaptive changes to unfavorable environmental factors that alter the adult phenotype in the development of HTN. Such adaptive changes result from epigenetic changes that favor the development of HTN and CVD in adulthood with intergenerational implications. Lastly, we mention preventive strategies to limit or reverse any variable that may alter developmental programming leading to HTN later in life.


Subject(s)
Humans , Female , Pregnancy , Cardiovascular Diseases , Noncommunicable Diseases , Hypertension/etiology , Risk Factors , Epigenesis, Genetic
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