Conicity index in people with hypertension followed in the Brazil's Family Health Strategy / Índice de conicidad en personas con hipertensión en seguimiento con la Estrategia de Salud Familiar / Índice de conicidade em pessoas com hipertensão arterial acompanhadas pela Estratégia Saúde da Família

ABSTRACT Objectives: to analyze the conicity index in people with hypertension followed in the Brazil's Family Health Strategy. Methods: cross-sectional study conducted in a medium-sized municipality located in the state of Paraná. Data collection took place in the first semester of 2016. using an adapted and validated instrument. which addresses attributes of Primary Health Care. Sociodemographic and anthropometric variables and blood pressure were used in the study. The analysis of variance and linear regression was used to analyze the variables. Results: a total of 417 people participated in the study. most were women. elderly. married. with less than eight years of education and retired. Conicity index was prevalent in most of the study population. being significantly associated with the group of people with inadequate blood pressure control and high anthropometric parameters. Conclusions: most of the study participants had altered conicity index. especially those with inadequate blood pressure control.

RESUMEN Objetivos: analizar el índice de conicidad en personas con hipertensión en tratamiento de seguimiento con la Estrategia de Salud Familiar. Métodos: estudio transversal realizado en un municipio de tamaño medio ubicado en el estado de Paraná. Los datos se recopilaron en el primer semestre de 2016. utilizando un instrumento adaptado y validado. que aborda los atributos de la Atención Primaria de Salud. En este estudio. se utilizaron las variables sociodemográficas. antropométricas y las mediciones de la presión arterial. El análisis de varianza y regresión lineal se utilizó para tratar las variables. Resultados: participación de 417 personas en el estudio. la mayoría mujeres. ancianos. casados. con menos de ocho años de estudio y jubilados. El índice de conicidad prevaleció en la mayoría de la población de estudio. con una asociación significativa con el grupo de personas con control inadecuado de la presión arterial y parámetros antropométricos altos. Conclusiones: la mayoría de los participantes en el estudio tenían un índice de variación alterado. especialmente aquellos con un control inadecuado de la presión arterial.

RESUMO Objetivos: analisar o índice de conicidade em pessoas com hipertensão arterial acompanhadas pela Estratégia Saúde da Família. Métodos: estudo transversal, realizado em um município de médio porte localizado no estado do Paraná. Os dados foram coletados no primeiro semestre de 2016, utilizando instrumento adaptado e validado, que aborda atributos da Atenção Primária à Saúde. Neste estudo, foram utilizadas variáveis sociodemográficas, antropométricas e medidas de pressão arterial. Empregou-se a análise de variância e regressão linear para o tratamento das variáveis. Resultados: participação de 417 pessoas, a maioria mulheres, idosas, casadas, com menos de oito anos de estudo e aposentadas. O índice de conicidade foi prevalente na maior parte da população estudada, com significativa associação ao grupo de pessoas com controle pressórico inadequado e parâmetros antropométricos elevados. Conclusões: a maioria dos participantes do estudo apresentou índice de conicidade alterado, principalmente as pessoas com controle pressórico inadequado.

Matriz de recomendações para farmacoterapia da Hipertensão Arterial Sistêmica: recurso para subsidiar a adaptação de guias de prática clínica / Matrix of recommendations for pharmacotherapy of arterial hypertension: resource to subsidize the adaptation of clinical practice guidelines

A hipertensão arterial sistêmica (HAS) é uma doença crônica altamente prevalente, que pode ser controlada com tratamento farmacológico. Para tal, recomenda-se aplicar as melhores evidências clínicas por meio da utilização de guias de prática clínica (GPC) de alta qualidade. No entanto, o processo de desenvolvimento de GPC requer recursos humanos e tempo, sendo a adaptação uma opção para reduzir a duplicação de esforços e adequar o GPC para uso local. O objetivo deste trabalho foi sintetizar as recomendações de GPC para o tratamento farmacológico da HAS. Aplicou-se o método de adaptação ADAPTE, realizando as duas primeiras fases: Configuração e Adaptação. Na fase de Configuração, o Grupo CHRONIDE realizou o planejamento e registrou a pesquisa no Próspero. Na fase de Adaptação, realizou-se uma revisão sistemática. Os critérios de eligibilidade foram: GPC que continham recomendações para o tratamento farmacológico da HAS em atenção primária, publicados em inglês, português ou espanhol, no período de 01/01/2011 a 31/12/2016. Em 31/11/2017 atualizou-se GPC incluídos. Para a determinação da qualidade destes GPC, três avaliadores, de forma independente, aplicaram o Appraisal of Guidelines for Research & Evaluation II (AGREE II). Dos 37 GPC avaliados, 6 foram considerados de alta qualidade (escore 60% ou mais no domínio Rigor de desenvolvimento do AGREE II). As recomendações destes foram extraídas e incluídas nas matrizes. Os GPC apresentaram divergências em suas recomendações. As divergências mais relevantes foram as recomendações mais rigorosas do GPC de 2017 da American College of Cardiology e American Heart Association (ACC/AHA), que trouxe metas terapêuticas e níveis pressóricos para indicação de farmacoterapia mais baixos que os demais. A maioria dos GPC recomendou o uso de diuréticos tiazídicos como farmacoterapia de primeira linha para tratamento da HAS e contraindicou o uso combinado de inibidores da enzima conversora de angiotensina e bloqueadores dos receptores de angiotensina II. Portanto, em uma discussão para adaptação local de recomendações, um dos pontos principais, além da questão do acesso aos medicamentos, seria adotar ou não os paramêtros mais rigorosos do GPC 2017 ACC/AHA

Arterial hypertension is a high prevalent chronic disease that can be controlled with pharmacologic treatment. For such, is recommended the use of the high clinical evidences presented in high quality clinical practice guidelines (CPG). However, the guideline development process requires time and capable human resources, which transform the adaptation to an option to reduce a duplication of efforts and to adapt the CPG to local use. The objective of this work was to synthesize the recommendations of CPG for the pharmacological treatment of arterial hypertension. The ADAPTE method was applied, using 2 steps: Configuration and Adaptation. In the Configuration step, the CHRONIDE group carried out the planning and the method was registered in Prospero. In the Adaptation step a systematic review was performed. The eligibility criteria were: CPG containing recommendations for the pharmacological treatment of arterial hypertension in primary care, published in English, Portuguese or Spanish, from 01/01/2011 to 12/31/2016. On 11/31/2017 it was updated the GPC included. To determine the CPG quality, 3 independent reviewers, assessed the CPG using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. Of the 37 evaluated CPG, 6 were considered to being as high quality (score 60% or higher in the domain " Rigour of Development "). The recommendations were extracted and included in the matrix of recommendations. The CPG has presentes differences in their recommendations. The most relevant divergences were the further rigorous recommendations described on CPG 2017 of the American College of Cardiology and American Heart Association (ACC/AHA), which brought therapeutic goals and blood pressure levels lower for pharmacotherapy than the others recommendations. The majority of CPG has recommended the use of thiazide diuretics as first-line pharmacotherapy for the treatment of arterial hypertension and has contraindicated the combined use of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. Therefore, in a discussion for local adaptation of recommendations, one of the main points, apart from the issue of access to medicines, would be to adopt or would not be adopt the futher rigorous parameters of GPC 2017 ACC/AHA

Consideraciones en torno a las Guías USA 2017 de hipertensión arterial / A word of caution about the 2017 hypertension management guidelines

The 2017 Guidelines on hypertension of the American College of Cardiology and American Heart Association, which proposed values of 130/80 mmHg as the cutoff points for the onset of hypertension, aroused great interest. This recommendation is based in the SPRINT study (The Systolic Pressure Intervention Trial), which included hypertensive patients over 50 years of age, non-diabetic, without a history of stroke and with a low representation of subjects with a history of coronary artery disease (16%). A group with intensive anti-hypertensive therapy (pressure achieved 121.5 mmHg) achieved a significantly lower cardiovascular risk as compared with a group with standard therapy (pressure achieved 134.6 mmHg). The Guide proposes immediate pharmacological therapy in diabetic hypertensive patients, in those with stage 3 chronic kidney disease or with persistent albuminuria, and in patients with atherosclerotic disease. The Guideline does not include the management of isolated systolic hypertension of the elderly and did not consider studies that show an increased risk when pressure is reduced below 130/80 mmHg in patients with coronary disease, peripheral vascular disease, diabetes mellitus or chronic renal failure. The new classification of hypertension would increase the number of hypertensive patients in our country by more than one million, would increase the risk associated with diastolic pressure reductions in older adults and ignores the evidence indicating a risk associated with reductions below 130/80 mmHg in patients with diabetes, with chronic renal failure or with atherosclerotic disease. Therefore, it is advisable to maintain a threshold of 140/90 mmHg and perform a careful and gradual management of blood pressure in the latter group of hypertensive patients.

¿Podemos comenzar a cambiar nuestra "mirada" ante la urgencia hipertensiva? / Can we start changing our viewpoint towards hypertensive urgency?

La urgencia hipertensiva (UH) es una situación muy frecuente que asusta tanto a los pacientes como a sus familiares y al personal de salud y representa aproximadamente el 30% de las consultas no programadas (o de urgencia). En el presente artículo, los autores se hacen eco de publicaciones recientes y proponen dejar de utilizar el término urgencia hipertensiva para describir las situaciones de elevación de la presión arterial por encima de una tensión arterial sistólica ≥ 180 mmHg y/o una tensión arterial diastólica (TAD) ≥ 110 mmHg, sin asociación con daño de órgano blanco (con o sin sintomatología inespecífica concurrente), ya que los pacientes con este cuadro no corren riesgo inminente, no requieren atención médica de urgencia y, por lo tanto, deberían enmarcarse dentro de los cuidados habituales de los pacientes con factores de riesgo cardiovascular y riesgo cardiovascular global elevado. Esto implica no solo un cambio semántico, sino un desafío en el abordaje y manejo de estas situaciones tan frecuentes. (AU)

Hypertensive urgency (UH) is a very frequent clinical situation that scares patients, their families as well as health care provid-ers and represents approximately 30% of the non-scheduled (or urgent) visits. In the present article, taking into account recent publications, the authors propose to stop using the term hypertensive urgency to describe situations of elevated blood pressure above systolic blood pressure ≥ 180 mmHg and / or diastolic blood pressure ( TAD) ≥ 110 mmHg, without end organ dam-age (with or without concurrent non-specific symptomatology), since patients with this condition are not at imminent risk, do not require urgent medical attention and should therefore be framed within usual care of patients with cardiovascular risk factors and high overall cardiovascular risk. This implies not only a semantic change, but a challenge in the approach and management of these frequent situations. (AU)

Comparative study of the antihypertensive effects of hexane, chloroform and methanol fractions of essential oil of Alpinia zerumbet in rats Wistar / Estudo comparativo do efeito anti-hipertensivo das frações hexânixa, clorofórmica e metanólica do óleo essencial da Alpinia zerumbet

ABSTRACT The aim of this study was to characterize components of the EOAz and its hexane (HFEOAz), chloroform (CFEOAz) and methanol (MFEOAz) fractions, and its antihypertensive effect. EOAz was extracted from leaves by hydrodistillation. Aliquot was subjected to selective desorption with silica gel column and eluted with hexane, chloroform and methanol. The components of the EOAz and fractions were analyzed by gas chromatography coupled with mass spectrometry and nuclear magnetic resonance spectroscopy of hydrogen. Experiments of vascular reactivity were performed with isolated aortic rings of male Wistar rats. Antihypertensive effect was evaluated in hypertensive rats submitted to the inhibition of synthesis of nitric oxide. Blood pressure was measured indirectly by tail plethysmography. MFEOAz showed the lowest EC50 (150.45 µg/mL), 1,8-cineole (27.81%) and terpinen-4-ol (57.35%) as main components. Single administration by nasogastric tube of EOAz, fractions and captopril significantly reduced the blood pressure of hypertensive rats, when compared to animals of the negative control group with distilled water. In conclusion, the potency of the MFEOAz was higher than that of EOAz and other fractions. The antihypertensive effect of EOAz and fractions was similar, higher than the negative control and lower than that of captopril.

RESUMO O objetivo deste estudo foi caracterizar os componentes do óleo essencial das folhas de Alpinia zerumbet (OEAz) e suas frações hexânica (FHOEAz), clorofórmica (FCOEAz) e metanólica (FMOEAz), e seu efeito anti-hipertensivo. OEAz foi extraído das folhas por hidrodestilação. Uma alíquota foi submetida à desadsorção seletiva com coluna de gel de sílica e eluída com hexano, clorofórmio e metanol. Os componentes do OEAz e fracções foram analisadas por cromatografia gasosa acoplada à detector de massa e por espectros de ressonância magnética nuclear de hidrogênio. Experimentos de reatividade vascular foram realizados com anéis aórticos isolados de ratos Wistar machos. Efeito anti-hipertensivo foi avaliado em ratos hipertensos submetidos à inibição da síntese de óxido nítrico. A pressão arterial foi medida indiretamente por pletismografia de cauda. FMOEAz mostrou a menor CE50 (150,45 μg/mL), 1,8-cineol (27,81%) e terpinen-4-ol (57,35%) como componentes principais. A administração em dose única por sonda nasogástrica de OEAz, frações e captopril reduziu significativamente a pressão arterial de ratos hipertensos, quando comparados aos animais do grupo controle negativo com água destilada. Em conclusão, a potência da FMOEAz foi maior que a do OEAz e outras frações. O efeito anti-hipertensivo de OEAz e frações foi semelhante, maior do que o controle negativo e menor do que o captopril.

Quality of Life on Arterial Hypertension: Validity of Known Groups of MINICHAL / Qualidade de Vida na Hipertensão Arterial: Validade de Grupos Conhecidos do MINICHAL

Introductions: In the care of hypertension, it is important that health professionals possess available tools that allow evaluating the impairment of the health-related quality of life, according to the severity of hypertension and the risk for cardiovascular events. Among the instruments developed for the assessment of health-related quality of life, there is the Mini-Cuestionario of Calidad de Vida en la Hipertensión Arterial (MINICHAL) recently adapted to the Brazilian culture. Objective: To estimate the validity of known groups of the Brazilian version of the MINICHAL regarding the classification of risk for cardiovascular events, symptoms, severity of dyspnea and target-organ damage. Methods: Data of 200 hypertensive outpatients concerning sociodemographic and clinical information and health-related quality of life were gathered by consulting the medical charts and the application of the Brazilian version of MINICHAL. The Mann-Whitney test was used to compare health-related quality of life in relation to symptoms and target-organ damage. The Kruskal-Wallis test and ANOVA with ranks transformation were used to compare health-related quality of life in relation to the classification of risk for cardiovascular events and intensity of dyspnea, respectively. Results: The MINICHAL was able to discriminate health-related quality of life in relation to symptoms and kidney damage, but did not discriminate health-related quality of life in relation to the classification of risk for cardiovascular events. Conclusion: The Brazilian version of the MINICHAL is a questionnaire capable of discriminating differences on the health‑related quality of life regarding dyspnea, chest pain, palpitation, lipothymy, cephalea and renal damage. .

Fundamento: No cuidado ao hipertenso, é importante que o profissional de saúde disponha de ferramentas que possibilitem avaliar o comprometimento da qualidade de vida relacionada à saúde, de acordo com a gravidade da hipertensão e o risco para eventos cardiovasculares. Dentre os instrumentos criados para avaliação da qualidade de vida relacionada à saúde, destaca-se o Mini-Cuestionario de Calidad de Vida en la Hipertensión Arterial (MINICHAL), recentemente adaptado para a cultura brasileira. Objetivo: Estimar a validade de grupos conhecidos da versão brasileira do MINICHAL em relação à classificação de risco para eventos cardiovasculares, sintomas, intensidade da dispneia e lesões de órgãos-alvo. Métodos: Foram investigados 200 hipertensos em seguimento ambulatorial, cujos dados sociodemográficos, clínicos e de qualidade de vida relacionada à saúde foram obtidos por meio de consulta ao prontuário e da aplicação da versão brasileira do MINICHAL. O teste de Mann-Whitney foi utilizado para comparar qualidade de vida relacionada à saúde em relação aos sintomas e às lesões de órgãos-alvo. Teste de Kruskal-Wallis e ANOVA com transformação nos ranks foram empregados para comparar qualidade de vida relacionada à saúde em relação à classificação de risco para eventos cardiovasculares e intensidade da dispneia, respectivamente. Resultados: O MINICHAL discriminou qualidade de vida relacionada à saúde em relação aos sintomas e dano renal (lesões de órgãos-alvo), porém não discriminou qualidade de vida relacionada à saúde em relação à classificação de risco para eventos cardiovasculares. Conclusão: A versão brasileira do MINICHAL é um instrumento capaz de discriminar diferenças na qualidade de vida relacionada à saúde em relação aos sintomas de dispneia, precordialgia, palpitação, lipotímia, cefaleia e presença de dano renal. .

El apoyo familiar y la adherencia en el tratamiento de hipertensión arterial / Family support and adherence in the treatment of hypertension

Introducción: La hipertensión arterial es un factor de riesgo para las enfermedades cardiovasculares; es un problema de salud que se incrementa cuando el paciente no cuenta con apoyo familiar. Objetivo: Conocer cómo influye el apoyo familiar en el cumplimiento o adherencia del tratamiento de hipertensión arterial. Metodología: Se realizó un estudio transversal en pacientes hipertensos que acudieron al Instituto Nacional de Cardiología (INCICh) de la ciudad de México, la recolección de la información fue a través de un cuestionario ex profeso que contempló dos secciones una para los pacientes y otro para los familiares de los pacientes. Resultados: Se estudiaron 234 pacientes hipertensos del INCICh de más 20 años de edad, el 64% son casados, el 47.7% cohabita con su cónyuge y el 33% con su hija(o); el 88% tiene una familia nuclear; 131 (56%) son pacientes descontrolados (47% del género femenino y 57% masculino) 103 (44%) controlados (54% del género femenino y 46% masculino). Con respeto al apoyo familiar el 84% vive con un familiar y sólo el 79% está en contacto diario con el paciente, en cuanto al apego farmacológico, el 56% le recuerda que debe tomar el medicamento, el 82% de la administración del medicamento la realiza el paciente mismo y el 76% le ayuda a su familiar a entender las indicaciones del médico. Las variables de apoyo familiar en las que se encontró una asociación estadísticamente significativa fue que el hipertenso debe medirse la tensión arterial en la casa y debe llevar su dieta y cuando el enfermo no la sigue lo amenaza de los riesgos que implica. Discusión: El apego al tratamiento se vincula de forma directa con el apoyo que los familiares le otorguen al enfermo. Conclusiones: El éxito del tratamiento depende fundamentalmente del apego, sin embargo el apoyo familiar juega un papel importante.

Introduction: Hypertension is a risk factor for cardiovascular disease, is a health problem that increases when the patient has no family support. Objective: To examine the influence of family support in the compliance or adherence of the treatment of Hypertension. Methodology: A cross-sectional study was conducted in hypertensive patients who attended the National Institute of Cardiology (INCICh) in Mexico City, gathering information was through a questionnaire that expressly included two sections one for patients and one for relatives of patients. Results: 234 hypertensive patients INCICh over 20 years old were studied, 64% were married, 47.7% cohabiting with their spouse and 33% with his daughter(o) , 88 % have a nuclear family, 131 (56%) are uncontrolled patients (47 % female and 57% male ) 103 (44%) controlled (54% female and 46% male) . With respect to family support, 84 % live with a family and only 79% is in daily contact with the patient, in terms of drug addiction, 56% reminds you to take medication, 82% of the drug is performed by the patient and 76% helps your family understand the doctor’s instructions. Family support variables in which a statistically significant association was that hypertension should measure blood pressure at home and you must take your diet and when the patient does not follow the threat of the risks found. Discussion: Adherence to treatment is linked directly with the support that you grant the family sick. Conclusions: The success of treatment depends mainly on the attachment, but the family support plays an important role.

Hipertensión arterial secundaria en el adulto: evaluación diagnóstica y manejo / Secondary arterial hypertension in adults: diagnostic assesment and management

La Hipertensión arterial (HTA) es un grave problema de salud pública mundial. En efecto, sus complicaciones causan anualmente 9,4 millones de muertes. La HTA también es un problema de salud de alto impacto en Chile. De hecho, la Encuesta Nacional de Salud (ENS) 2009-2010 del Ministerio de Salud, reportó una prevalencia del 26,9%. La HTA se define como una Presión arterial sistólica (PAS) 140mmHg y/o una Presión arterial diastólica (PAD) 90mmHg. Tradicionalmente, se ha clasificado la HTA en primaria o esencial, que agrupa a más del 90% de los hipertensos adultos; y en secundaria, que reúne a menos del 10% de los hipertensos. En la evaluación inicial de un paciente con HTA, se debe: Confirmar el diagnóstico; 2) Detectar causas de HTA secundaria, y 3) Evaluar riesgo cardiovascular (CV), daño orgánico y comorbilidades. Para ello, se necesita determinar la Presión Arterial (PA) y la historia clínica, que incluya antecedentes familiares, examen físico, pruebas de laboratorio y pruebas diagnósticas adicionales. En un pequeño porcentaje de adultos con HTA, se puede identificar una causa específica y potencialmente reversible; no obstante, debido a su elevada prevalencia, las formas secundarias pueden afectar a millones de pacientes en todo el mundo. Se puede sospechar una forma secundaria de HTA por un alza marcada de la PA, la aparición o empeoramiento repentinos de una HTA, una mala respuesta de la PA al tratamiento farmacológico y por un daño orgánico desproporcionado para la duración de la HTA. Si la evaluación inicial hace pensar que el paciente tiene una HTA secundaria, entonces se debe tener en consideración las causas más relevantes, que se describen en este artículo.

Arterial hypertension is a serious public health problem worldwide. Indeed, its complications cause 9.4 million deaths annually. Hypertension is also a health problem with high impact in Chile. In fact, the National Health Survey 2009-2010, conducted by the Ministry of Health, showed a prevalence of 26.9%. Arterial hypertension is defined as systolic blood pressure (SBP) 140mmHg and/or diastolic blood pressure (DBP) 90mmHg. Traditionally, hypertension has been classified into primary or essential, which represents over 90% of adults with hypertension; and secondary, which includes less than 10% of hypertensive patients. The initial evaluation of a patient with hypertension should: 1) Confirm the diagnosis of hypertension; 2) Detect causes of secondary hypertension; and 3) Assess cardiovascular risk, organ damage (OD) and concomitant clinical conditions. This calls for blood pressure (BP) measurement, medical history including family history, physical examination, laboratory investigations and further diagnostic tests. A specific, potentially reversible cause of BP elevation can be identified in a relatively small proportion of adult patients with hypertension. However, because of the overall high prevalence of hypertension, secondary forms can affect millions of patients worldwide. A secondary form of hypertension can be indicated by a severe elevation in BP, sudden onset or worsening of hypertension, poor BP response to drug therapy and OD disproportionate to the duration of hypertension. If the initial assessment suggests that the patient has a secondary hypertension, then you should take into consideration the relevant causes, which are described in this article.

Pharmaceutical Care for hypertensive patients provided within the Family Health Strategy in Goiânia, Goiás, Brazil

The aim of Pharmaceutical Care programs is to improve patients' quality of life, and such programs are particularly effective in the case of chronic diseases such as hypertension. The objective of this longitudinal study was to analyze a Pharmaceutical Care model for hypertensive patients receiving care within the Family Health Strategy (FHS). All patients were being seen by an FHS team affiliated to a primary healthcare unit in Goiânia, Goiás, Brazil. Fourteen patients participated in the study, with each patient receiving six home visits during the Pharmaceutical Care. Overall, 142 drug-related problems were reported, the most common concerning the ineffectiveness of treatment (33.8%). A total of 135 pharmaceutical interventions were performed, 92.6% of which involved pharmacist-patient communication, with 48.8% of these interventions being implemented. Cardiovascular risk decreased in three patients and remained unchanged in nine. In hypertensive patients with diabetes, fasting glucose levels were reduced in six out of nine cases. The Pharmaceutical Care model proposed here was effective in detecting drug-related problems and in proposing interventions to resolve or prevent these problems. Consequently, this may have contributed towards improving clinical parameters, such as fasting glucose levels and cardiovascular risk in hypertensive patients receiving care within the FHS.

A Atenção Farmacêutica tem como objetivo conseguir resultados concretos que melhorem a qualidade de vida do paciente, contribuindo especialmente em doenças crônicas, como a Hipertensão Arterial. O objetivo deste estudo foi analisar um modelo de Atenção Farmacêutica a pacientes com Hipertensão Arterial assistidos pela Estratégia Saúde da Família (ESF). Trata-se de um estudo longitudinal realizado com pacientes assistidos pela ESF de uma Unidade Básica de Saúde de Goiânia-GO. Participaram do estudo, 14 pacientes que receberam seis visitas domiciliares para Atenção Farmacêutica. Registraram-se 142 Problemas Relacionados a Medicamentos (PRM) sendo mais frequente a falta de efetividade do tratamento (33,8%). Realizaram-se 135 intervenções farmacêuticas, das quais 92,6% foram com a comunicação farmacêutico-paciente, em que 48,8% das intervenções foram implementadas. Observou-se redução do risco cardiovascular em três pacientes e nove pacientes não apresentaram alteração no nível de risco cardiovascular. Entre os pacientes hipertensos e diabéticos observou-se redução da glicemia de jejum em seis. O modelo de Atenção Farmacêutica proposto foi capaz de detectar PRM propondo intervenções para resolvê-los e preveni-los e, consequentemente, pode ter contribuído na melhora de parâmetros clínicos como glicemia de jejum e risco cardiovascular em pacientes hipertensos assistidos pela ESF.

Croton schiedeanus Schltd prevents experimental hypertension in rats induced by nitric oxide deficit

Croton schiedeanus Schltd (N.V.: "almizclillo") is a plant used in traditional medicine as an antihypertensive in Colombia. It contains flavonoid, diterpenoid and fenilbutanoid metabolites that have vasodilatation effects linked to the NO/cGMP pathway. This work aimed to assess the capacity of a 96% EtOH extract to prevent the hypertension induced by nitric oxide (NO) deficiency in rats. The NO synthase inhibitor L-NAME (10 mg/kg/d, i.p) was administered during five weeks to three groups of rats (6-7 animals): C. Schiedeanus (200 mg/kg/d, p.o), enalapril (reference, 10 mg/kg/d, p.o) and vehicle (control: olive oil 1 ml/kg/d, p.o). In addition, the blank group received only vehicle. The arterial blood pressure (BP) and heart rate (HR) were measured daily for six weeks. After sacrificing the animals, the aortic rings were isolated, contraction was triggered with phenylephrine (PE 10-6 M) and relaxant responses were achieved with cumulative concentrations of acetylcholine (ACh, 10-10 - 10-4 M). L-NAME increased the systolic arterial pressure in the control group, attaining mean values of 131 mm Hg at week 5, whereas the C. schiedeanus, enalapril and blank groups maintained blood pressure under 100 mm Hg. The capacity of PE to contract aortic rings was greater in the C. schiedeanus, enalapril and blank groups than in the control group (2157, 2005, 1910 and 1646 mg, respectively). The pEC50 values for ACh were as follows: C. Schiedeanus (6.89) >enalapril (6.39) > blank (5.68) > control (5.09). These results give support to C. Schiedeanus as a natural antihypertensive source.

Croton schiedeanus Schltd (NV: "almizclillo") é utilizado na medicina tradicional da Colômbia para o tratamento da hipertensão arterial. Outras pesquisas demonstraram que a planta tem metabólitos como os flavonoides, os diterpenoides e os fenilbutanoides, os quais têm comprovados efeitos vasodilatadores vinculados com a via NO/GMPc. O objetivo deste estudo foi avaliar a capacidade do extrato de Croton schiedeanus Schltd em EtOH a 96% na prevenção da hipertensão induzida pela deficiência de óxido nítrico (NO), em ratos. O inibidor da NO sintetase L-NAME (10 mg/kg/d, ip) foi administrado durante cinco semanas em três grupos de ratos (6-7 animais): C. schiedeanus (200 mg/kg/d, v.o.), enalapril (referência, 10 mg/kg/d, v.o.) e o veículo (controle: azeite de oliva 1 mL/kg/d, v.o.). O grupo branco recebeu somente o veículo. A pressão sanguínea (BP) e a frequência cardíaca (FC) foram medidas diariamente em um período de seis semanas. Após o sacrifício, os anéis aórticos foram isolados e contraídos, utilizando fenilefrina (PE 10-6 M) e as respostas para a relaxação foram obtidas com doses acumulativas de acetilcolina (ACh, 10-10-10-4 M). Os resultados demonstraram que o L-NAME provocou incremento significativo da pressão nos ratos do grupo controle, obtendo-se valores médios de 131 mm Hg na quinta semana. No entanto, os grupos C. schiedeanus, enalapril e branco mantiveram a pressão arterial aos níveis médios iniciais 100 mm Hg. A capacidade da PE para fazer a contração dos anéis da aorta foi maior nos grupos C. schiedeanus, enalapril e branco do que no grupo controle (2157, 2005, 1910 and 1646 mg, respectivamente). Os valores de pCE50 de ACh foram os seguintes: C. schiedeanus (6,89) > enalapril (6,39) > branco (5,68) > controle (5,09). Pode-se afirmar que estes resultados dão suporte à C. schiedeanus como fonte natural anti-hipertensiva.

Adesão ao tratamento: estudo entre portadores de hipertensão arterial cadastrados em uma Unidade Básica de Saúde / Adherence to treatment: study among people with hypertension registered on a Basic Health Unit

Objetivo - Identificar as causas da não adesão do paciente portador de hipertensão arterial sistêmica (HAS) ao tratamento. A hipertensão arterial é uma das doenças cardiovasculares mais comum, silenciosa e assintomática onde exerce grande influência nas complicações de patologias importantes como o acidente vascular cerebral (AVC) e o infarto agudo do miocárdio (IAM). É o maior problema de saúde pública no país. Os familiares são de grande importância para o sucesso do tratamento, atuam no auxilio direto ao controle dos níveis pressóricos, incentivando o usuário à adesão, promovendo assim a prevenção de possíveis complicações. Métodos - Foi utilizado um questionário estruturado e adaptado de Morisky-Green, e aplicado a pacientes hipertensos atendidos em uma cidade do interior do Estado de São Paulo na Rede Pública de Saúde. Resultados - Fatores como baixo nível de escolaridade, problemas socioeconômicos, sobrecarga de trabalho, raça, alimentação, predisposição genética, as dificuldades que os pacientes encontram com o não conhecimento da doença e suas complicações, o acesso a medicamentos, são considerados como determinantes para o aparecimento da HAS ou suas complicações. Conclusão - Evidencia-se maior necessidade de orientação quanto o que pode ocasionar em médio prazo o esquecimento ou o descuido ao utilizar os medicamentos prescritos, tendo um equilíbrio entre saber e não saber, consciência, conhecimento e satisfação sobre a HAS. Deste modo, o Ministério da Saúde vem constantemente atualizando os processos de educação em saúde, com cartilhas, programas educativos, comprometimento de uma equipe multiprofissional, com o objetivo de reduzir o número de letalidade com referência a essa patologia.

Objective - To identify causes of non-adherence of patients with systemic arterial hypertension (SAH). Hypertension is the most common cardiovascular disease and asymptomatic silent which exerts great influence on complications of important pathologies such as stroke and myocardial infarction. It is biggest public health problem in the country, considered one of the greatest challenges of the professionals working in this area. The family are very important for the success of treatment, act in direct aid to the control of blood pressure levels, encouraging the user membership, thus promoting the prevention of possible complications. Methods - We used a structured questionnaire adapted from Morisky-Green, and applied to hypertensive patients treated in an inland city of São Paulo State, in Public Health System. Results - Factors such as low educational level, socioeconomic problems, work overload, race, diet, genetic predisposition, the difficulties that patients are not aware of the disease and its complications, access to medicines, are considered crucial to the emergence hypertension or its complications. Conclusion - This study highlights a need for greater guidance on what can cause medium-term forgetfulness or carelessness when using prescribed medications, having a balance between knowing and not knowing, awareness, knowledge and satisfaction of the systemic arterial hypertension. Thus the Ministry of Health is constantly upgrading processes of health education with brochures, educational programs, involvement of a multidisciplinary team, with the goal of reducing the number of lethality with reference to this condition.

Tratamiento de la hipertensión arterial en la nefropatía diabética avanzada / Hypertension treatment in advanced diabetic nephropathy

La diabetes afecta aproximadamente al 10% de la población adulta, por lo que constituye la etiología más frecuente de enfermedad renal entre los pacientes que requieren hemodiálisis. La hipertensión está frecuentemente asociada con la diabetes tipo 2, en la que se presenta como diagnóstico previo, concomitante o posterior, y a la diabetes tipo 1, como consecuencia de la nefropatía. La hipertensión incrementa el riesgo cardiovascular y acelera la progresión de la nefropatía, en tanto que su tratamiento retrasa los eventos cardiovasculares y renales. Los mecanismos principalmente involucrados en la hipertensión y progresión de la nefropatía son la expansión secundaria a la reabsorción incrementada de sodio y la sobreestimulación del sistema renina-angiotensina-aldosterona, y la vasoconstricción por desregulación de los moduladores de la resistencia vascular. Los objetivos generales del tratamiento antihipertensivo en el paciente con diabetes son lograr una presión arterial sistólica < 130 mm Hg y diastólica < 80 mm Hg, y menores en el paciente proteinúrico (< 125/75 mm Hg). Para alcanzar estos objetivos debe restringirse la ingesta de sodio a < 2 000 mg/día, considerándose los inhibidores del sistema renina-angiotensina como las drogas de elección inicial para retrasar la disminución del filtrado glomerular. El algoritmo del tratamiento antihipertensivo sugiere la modificación de los hábitos de vida y asociaciones farmacológicas orientadas fisiopatológicamente para alcanzar los objetivos

D-α -tocopherol reduces renal damage in hypertensive rats

This study investigated the beneficial effects of D-α-tocopherol supplementation in protecting against the renal morphological and functional changes caused by hypertension. Spontaneously hypertensive (SHR) and normotensive control (WKY) rats received D-α-tocopherol (80 mg/kg by gavage) or vehicle (mineral oil) every other day for 60 days, from the age of 2 months. After this treatment period, all animals were assessed for renal morphological and functional parameters. The glomerular hypertrophy, increased interlobular wall thickness and enlarged renal vascular resistance found in SHR were reduced by D-α-tocopherol treatment. Sodium and volume retention observed in SHR were also decreased by D-α-tocopherol treatment. Moreover, D-α-tocopherol supplementation significantly reduced arterial pressure in SHR but not in WKY. D-α-tocopherol also reduced the excretion of thiobarbituric acid-reactive substances (TBARS), a marker of oxidative stress, in SHR. These results suggest that D-α-tocopherol supplementation can reduce kidney damage induced by hypertension.

O presente estudo avaliou os efeitos benéficos da suplementação com D-α-tocopherol sobre as alterações morfológicas e funcionais renais causadas pela hipertensão arterial. A partir de dois meses de idade, ratos espontaneamente hipertensos (SHR) e controles normotensos (WKY) receberam D-α-tocoferol (80 mg/kg por gavagem) ou veículo (óleo mineral) em dias alternados, por 60 dias. Após este período foram avaliados os parâmetros morfofuncionais dos rins. Os animais SHR apresentaram: hipertrofia glomerular, aumento da espessura da parede das arterias interlobulares e elevação da resistência vascular renal. Estas alterações foram menores nos animais SHR suplementados com D-α-tocoferol. A retenção de sódio e de volume encontrada nos SHR também foi reduzida com o tratamento com D-α-tocoferol. Além disso, a suplementação com D-α-tocoferol reduziu significativamente a pressão arterial em SHR, mas não em WKY. Houve, também, redução da excreção de ácido tiobarbitúrico (TBARS), um marcador de estresse oxidativo, nos animais SHR tratados com D-α-tocoferol. Os resultados sugerem que suplementação com D-α-tocoferol é capaz de reduzir importantes alterações renais causadas pela hipertensão arterial.

An economic evaluation of antihypertensive therapies based on clinical trials

OBJECTIVE: Hypertension is a major issue in public health, and the financial costs associated with hypertension continue to increase. Cost-effectiveness studies focusing on antihypertensive drug combinations, however, have been scarce. The cost-effectiveness ratios of the traditional treatment (hydrochlorothiazide and atenolol) and the current treatment (losartan and amlodipine) were evaluated in patients with grade 1 or 2 hypertension (HT1-2). For patients with grade 3 hypertension (HT3), a third drug was added to the treatment combinations: enalapril was added to the traditional treatment, and hydrochlorothiazide was added to the current treatment. METHODS: Hypertension treatment costs were estimated on the basis of the purchase prices of the antihypertensive medications, and effectiveness was measured as the reduction in systolic blood pressure and diastolic blood pressure (in mm Hg) at the end of a 12-month study period. RESULTS: When the purchase price of the brand-name medication was used to calculate the cost, the traditional treatment presented a lower cost-effectiveness ratio [US$/mm Hg] than the current treatment in the HT1-2 group. In the HT3 group, however, there was no difference in cost-effectiveness ratio between the traditional treatment and the current treatment. The cost-effectiveness ratio differences between the treatment regimens maintained the same pattern when the purchase price of the lower-cost medication was used. CONCLUSIONS: We conclude that the traditional treatment is more cost-effective (US$/mm Hg) than the current treatment in the HT1-2 group. There was no difference in cost-effectiveness between the traditional treatment and the current treatment for the HT3 group.

comparative study of the management of stage 2 hypertension by combined therapy with losartan, amlodipine and hydrochlorothiazide

The most effective and accurate treatment of hypertensive patients reduces cardiovascular events and improves the quality of life. This study compared the efficacy and safety of combined [combination therapy] with an angiotensin-receptor blocker [ARB] a calcium-channel blocker [CCB] [Losartan / Amloidipine 50/10mg] vs maximal combination doses of ARB with hydrochlorothiazide [Losartan /HCTZ 100/25 mg] and maximal combination doses of CCB with HCTZ [Amlodipine /HCTZ 10/25 mg] in the management of stage 2 hypertension. This randomized clinical trial [RTC] comprised 478 hypertensive patients with mean age 50.5 +/- 5.21 years, and took place between January 2010 and December 2011 in Vasei Hospital clinic in Sabzevar. Antihypertensive drugs were washed out after 5 days of discontinuation of drugs and the patients with mean blood pressure in sitting position >/= 160 and <200 mmHg in systole and >/= 100 and <110 mmHg in diastole were randomized into three groups: Losartan / Amlodipine 50/10 mg [n =164], Losartan / HCTZ 100/25 mg [n =155] and Amlodipine / HCTZ 10/25 mg [n =159]. The end point was reaching the blood pressure below 140/90 within 56 days of treatment in each group. There was a significant difference in systolic blood pressure reductions between treatment groups [P<0.001] and also there was a significant difference between groups in reducing diastolic blood pressure [P<0.01]. The highest systolic and diastolic blood pressure reduction respectively was found in Amlodipine/losartane and losartane/HTCZ group. The ANCOVA analysis revealed that only treatment regimen had a significant effect [P=0.01] and other factor including Age, Gender, Diabetes Mellitus, Smoking and High serum cholesterol didn't have significant effect on blood pressure reduction. ARB/CCB combination therapy reduced blood pressure more effectively than the maximal doses of ARB or CCB with HCTZ in stage 2 hypertensive patients within this period of study