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2.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3): 261-267, jul.-set. 2019. ilus
Article in Portuguese | LILACS (Americas) | ID: biblio-1023048

ABSTRACT

Os três estudos que tiveram importante influência na prática clínica de quem trabalha com hipertensão arterial foram os estudos SIMPLICITY HTN-3, PATHWAY 2 e SPRINT. O estudo SIMPLICITY HTN-3 pôs a dúvida um procedimento que já estava sendo utilizado na prática clínica, qual seja, denervação do nervo simpático renal através de ablação por ondas de radiofrequência. Foi o primeiro estudos com grupo controle que não mostrou diferença entre os desfechos específicos de controle da pressão arterial em pacientes com hipertensão resistente. Portanto, o estudo SIMPLICITY HTN 3 modificou a prática clínica no sentido de que todas as diretrizes de hipertensão são unânimes em afirmar que tal procedimento atualmente deva ser reservado para laboratórios específicos de investigação clínica do método e não deve ser empregado como opção estabelecida de tratamento. O estudo PATHWAY 2 consolida o uso do bloqueador de receptor de mineralocorticoides (espironolactona) como o quarto medicamento no fluxograma de tratamento da hipertensão arterial resistente. Os resultados foram tão impactantes que a diretriz europeia de hipertensão arterial mudou substancialmente a orientação da sequência farmacológica do tratamento. Por fim, o estudo SPRINT demonstrou a necessidade de intervenção em pacientes com hipertensão arterial com valores pressóricos abaixo de 140/90 mmHg na dependência da quantidade de risco adicional dos pacientes. Os resultados do estudo SPRINT motivaram alterações ou inclusões de seus dados em várias diretrizes nacionais e internacionais, tais como Sociedade Brasileira de Cardiologia, American Heart Association e European Society of Cardiology


The three studies that have had an important influence on the clinical practice of who works with arterial hypertension were the SIMPLICITY HTN-3, PATHWAY 2 and SPRINT studies. The SIMPLICITY HTN-3 study raised doubts around a procedure that was already being used in clinical practice, the denervation of the sympathetic renal nerve through radiofrequency wave ablation. It was the first study with a control group that did not show a difference between the specific blood pressure control outcomes in patients with resistant hypertension. Therefore, the Simplicity HTN 3 Study modified clinical practice in the sense that all hypertension guidelines are unanimous in stating that currently such a procedure should be reserved for specific clinical investigation laboratories researching the method and should not be used as an established treatment option. The PATHWAY2 study consolidated the use of the mineralocorticoid receptor blocker (spironolactone) as the fourth drug in the resistant arterial hypertension treatment flowchart. The results were so impactful that the European guideline for arterial hypertension changed its orientation around the pharmacological sequence of resistant hypertension treatment substantially. Finally, the SPRINT study demonstrated the need for intervention in patients with arterial hypertension with pressure values below 140/90 mmHg, depending on the amount of additional cardiovascular risk in those patients. The results of the SPRINT study promoted changes to or inclusions of its data in various national and international guidelines, such as the Brazilian Society of Cardiology, the American Heart Association and the European Society of Cardiology


Subject(s)
Humans , Male , Female , Evidence-Based Practice/methods , Hypertension/therapy , Spironolactone , Guidelines as Topic/standards , Doxazosin , Bisoprolol , Blood Pressure Monitoring, Ambulatory/methods , Evidence-Based Medicine/methods , Arterial Pressure , Antihypertensive Agents
3.
Prensa méd. argent ; 105(4): 235-245, jun 2019. tab
Article in English | LILACS (Americas), BINACIS | ID: biblio-1046188

ABSTRACT

The medical social significance of the arterial hypertension (AH) in the world is determined by its high prevalence, which allows to call it a non-infectious pandemic of today. The AH still remains the most common chronic disease that triggers the cardiovascular continuum, significantly reduces the body's adaptive capacity, worsens the living standards for people of socially minded age, and represents the leading global risk of increased cardiovascular mortality. The purpose of the study was comparison of informative value of various methods for measuring the arterial blood pressure (ABP) (office-based, home-based using electronic apps, and daily) in order to improve the risk assessment of the condition and monitoring the treatment efficiency for the AH patients. The method of qualitative and quantitative analysis of scientific literature and public online sources was used in the study. It has been established that the ABP analysis is an important tool to prevent the negative consequences of the AH. The results of the experimental study have revealed that hourly home-based ABP monitoring using a mobile electronic app is more informative than monitoring at long intervals, and provides information which is close to the average daily indicators obtained in the daily ABP monitoring.


Subject(s)
Humans , Evaluation Studies as Topic/prevention & control , Evaluation Studies as Topic/prevention & control , Chronic Disease/mortality , Epidemiology, Experimental , Treatment Outcome , Blood Pressure Monitoring, Ambulatory/methods , Hypertension/prevention & control , Hypertension/therapy
5.
Arch. argent. pediatr ; 116(5): 328-332, oct. 2018. ilus, tab
Article in English, Spanish | LILACS (Americas), BINACIS | ID: biblio-973663

ABSTRACT

Introducción. La hipertensión enmascarada (HE) en niños se define por registros de presión arterial normal en la consulta y elevados fuera de ella. El monitoreo ambulatorio de presión arterial de 24 horas (MAPA) permite su diagnóstico. Existe poca información sobre su prevalencia en nuestra población. Objetivo. Estimar la prevalencia de HE en niños con factores de riesgo para el desarrollo de hipertensión arterial. Material y método. Estudio prospectivo, observacional, corte transversal. Se incluyeron en forma consecutiva pacientes asistidos en el Hospital General de Niños P. de Elizalde entre 1/7/2015 y 1/12/2016, de 5 a 11 años, con presión arterial normal y, al menos, un factor de riesgo para hipertensión arterial. Se realizó MAPA durante 24 horas (SpaceLabs 90207/90217). Muestra estimada: 110 pacientes. Se contó con las aprobaciones pertinentes. Resultados. Se incluyeron 110 pacientes, edad de 8,7 ± 1,8 años, 60 mujeres. Tiempo de MAPA: 23,18 ± 1,8 horas. Tenían antecedentes neonatales 23 pacientes; todos tenían, al menos, un antecedente personal (los más frecuentes, ingesta aumentada de sal y obesidad); 101 tenían, al menos, un antecedente familiar. El MAPA permitió identificar a 10 pacientes con HE (9,1%; IC 95%: 5,1-15,9); 7 con hipertensión nocturna aislada (6,4%; IC 95%: 3,1-23,5) y 28, prehipertensión (25,4%; IC 95%: 18,2-34,3). Los 10 pacientes con HE fueron 7 varones, 9 obesos y con, al menos, un antecedente familiar. Conclusión. La prevalencia de HE en niños con factores de riesgo de desarrollar hipertensión arterial fue cercana al 10%.


Introduction. Masked hypertension (MH) in children is defined as normal office blood pressure values and high values outside the clinical setting. The 24-hour ambulatory blood pressure monitoring (ABPM) is helpful for diagnosis. There is little information on MH prevalence in our population. Objective. To estimate the prevalence of MH in children with risk factors for arterial hypertension. Material and method. Prospective, observational, cross-sectional study. Patients seen at Hospital General de Niños "P. de Elizalde" between July 1st, 2015 and December 1st, 2016, aged 5-11 years, with normal blood pressure and at least one risk factor for arterial hypertension were included in consecutive order. A 24-hour ABPM was done (SpaceLabs 90207/90217). Estimated sample: 110 patients. All relevant authorizations were obtained. Results. One hundred and ten patients aged 8.7 ± 1.8 years were included; 60 were girls. ABPM duration: 23.18 ± 1.8 hours. Twenty-three patients had neonatal history; all had at least one factor corresponding to personal history (the most common ones were increased salt intake and obesity); 101 had at least one factor corresponding to family history. ABPM helped to identify 10 patients with MH (9.1%; 95% confidence interval --1;CI--3;: 5.1-15.9); 7 had isolated nocturnal hypertension (6.4%; 95% CI: 3.1-23.5) and 28 had prehypertension (25.4%; 95% CI: 18.234.3). Among the 10 patients with MH, 7 were boys, 9 were obese and had at least one factor corresponding to family history. Conclusion. The prevalence of MH in children with risk factors for arterial hypertension was close to 10%.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Sodium Chloride, Dietary/administration & dosage , Blood Pressure Monitoring, Ambulatory/methods , Masked Hypertension/epidemiology , Pediatric Obesity/epidemiology , Blood Pressure , Family Health , Prevalence , Cross-Sectional Studies , Prospective Studies , Risk Factors , Prehypertension/epidemiology , Masked Hypertension/diagnosis
6.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 27(4): f:290-l:293, out.-dez. 2017. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-879466

ABSTRACT

A hipertensão arterial sistêmica (HAS) é uma condição clínica multifatorial caracterizada por elevação sustentada dos níveis pressóricos. No Brasil, a hipertensão arterial atinge 32,5% (36 milhões) de indivíduos adultos, mais de 60% idosos, contribuindo direta ou indiretamente para 50% das mortes por doença cardiovascular. A HAS é uma das comorbidades mais frequentemente observadas em pacientes com câncer. Algumas drogas são diretamente relacionadas ao desenvolvimento ou piora da HAS como os agentes alquilantes e os inibidores do fator de crescimento endotelial. O controle adequado dos níveis de pressão arterial (PA) em pacientes com câncer visa aumentar a tolerância dos doentes à quimioterapia, reduzir a incidência de lesões em órgãos-alvo e, em última análise, reduzir a mortalidade geral. A PA deve ser aferida semanalmente durante o primeiro ciclo e a cada duas a três semanas após. O diagnóstico e tratamento da HAS devem seguir as recomendações atuais da 7aDiretriz Brasileira de Hipertensão e, quando possível, realizados antes do tratamento oncológico. Os IECA e BRA são anti-hipertensivos usados com maior frequência para o tratamento da HAS associada aos inibidores de fator de crescimento endotelial (iVEGF). Os bloqueadores de canal de cálcio não diidropiridínicos, como o verapamil e o diltiazem, são contraindicados com o uso concomitante de iVEGF. A descontinuação definitiva deve ser o último recurso. Os oncologistas e cardiologistas devem desenvolver abordagens em conjunto para manejar a HAS de forma eficaz e segura, com objetivo de manter o benefício do tratamento oncológico e de diminuir a morbidade e mortalidade cardiovascular


Systemic arterial hypertension (SAH) is a multifactorial condition, characterized by a sustained elevation in blood pressure. In Brazil, arterial hypertension affects 32.5% (36 million) adult individuals, more of 60% of whom are elderly, directly or indirectly contributing to 50% of deaths due to cardiovascular disease. SAH is one of the most commonly observed comorbidities in people with cancer. Some drugs are directly related to the development or worsening of SAH, such as alkylating agents and endothelial growth factor inhibitors. Adequate control of blood pressure (BP) in patients with cancer aims to increase patients' tolerance to chemotherapy, reduce the incidence of target organ damage and, ultimately, reduce overall mortality. BP must be measured every week in the first cycle and every two-three weeks after. The diagnosis and treatment of SAH should follow the current recommendations of the VII Brazilian Guideline on Hypertension, and where possible, should be performed before the oncological treatment. ACE inhibitors and ARBs are the most commonly used antihypertensive drugs for the treatment of SAH associated with vascular endothelial growth factor inhibitors (VEGFI). Non-dihydropyridine calcium channel blockers, such as Verapamil and Diltiazem, are contraindicated with the concomitant use of VEGFI. Definitive suspension should be the final resort. Oncologists and cardiologists must develop joint approaches to manage the SAH effectively and safely, with the objective of maintaining the benefit of the oncological treatment and reducing cardiovascular morbidity and mortality


Subject(s)
Humans , Male , Female , Drug Therapy/methods , Hypertension , Neoplasms/therapy , Adrenal Cortex Hormones , Alkylating Agents , Blood Pressure Monitoring, Ambulatory/methods , Calcineurin Inhibitors/therapeutic use , Cardiovascular Diseases/mortality , Diagnosis , Guidelines as Topic/standards , Prognosis , Protein-Tyrosine Kinases
7.
Int. j. cardiovasc. sci. (Impr.) ; 30(4): f:285-l:292, jul.-ago 2017. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-846748

ABSTRACT

Fundamentos: A hipertensão arterial é um importante fator de risco para desfechos cardiovasculares. No entanto, na maioria dos centros de Atenção Primária à Saúde, a pressão arterial permanece com níveis de controle inadequados. A Monitorização Ambulatorial da Pressão Arterial (MAPA) é uma ferramenta útil na predição de morbidade e mortalidade cardiovascular. A implementação da MAPA de 24 horas e a avaliação dos desfechos cardiovasculares na Atenção Primária à Saúde podem ser eficazes para melhorarem estratégias de acompanhamento do paciente hipertenso neste cenário. Objetivo: Avaliar hipertensão não controlada detectada pela MAPA de 24 horas como um preditor de desfechos cardiovasculares em pacientes hipertensos da Atenção Primária à Saúde em um ambiente de baixos recursos. Métodos: Estudo de coorte com base em centros de Atenção Primária à Saúde. O estudo foi conduzido com 143 pacientes hipertensos, que realizaram MAPA de 24 horas no início do estudo. Os alvos terapêuticos foram baseados no Eighth Joint National Committee, na Diretriz Brasileira de Hipertensão e na Diretriz Europeia de Hipertensão. Registros médicos de emergência, admissões hospitalares e atestados de óbitos foram revisados. Resultados: A amostra foi constituída por 143 pacientes que preencheram os critérios de inclusão. Após 4 anos de seguimento foram verificados 17 óbitos, 12 novos casos de fibrilação atrial e 37 internações hospitalares relacionadas a desfechos cardiovasculares. Durante o período de acompanhamento, a MAPA de 24 horas apresentou resultado preditor para novos casos de fibrilação atrial (p = 0,015) e combinação de desfechos cardiovasculares, mortalidade e admissões hospitalares (p = 0,012)


Background: Arterial hypertension is an important risk factor for cardiovascular outcomes. However, in most Primary Health Care centers, blood pressure remains at inadequate control levels. Ambulatory Blood Pressure Monitoring (ABPM) is a useful tool in predicting cardiovascular morbidity and mortality. The implementation of 24-hour ABPM and evaluation of cardiovascular outcomes in Primary Health Care may be effective in improving strategies for monitoring hypertensive patients in this setting. Objective: To evaluate uncontrolled arterial hypertension detected by 24-hour ABPM as a predictor of cardiovascular outcomes in hypertensive patients from Primary Health Care in a low-resource environment. Methods: Cohort study based on primary health care centers. The study was carried out with 143 hypertensive patients, who underwent 24-hour ABPM at baseline. Therapeutic targets were based on the Eighth Joint National Committee, the Brazilian Hypertension Guideline, and the European Hypertension Guideline. Medical records of emergency care, hospital admissions, and death certificates were reviewed. Results: The sample consisted of 143 patients who met the inclusion criteria. After 4 years of follow-up, there were 17 deaths, 12 new cases of atrial fibrillation and 37 hospital admissions related to cardiovascular outcomes. During the follow-up period, the 24-hour ABPM showed a predictive result for new cases of atrial fibrillation (p = 0.015) and a combination of cardiovascular outcomes, mortality, and hospital admissions (p = 0.012). Conclusion: The 24-hour ABPM was an important predictor of cardiovascular outcomes in a hypertensive population that seeks assistance in Primary Health Care centers


Subject(s)
Humans , Male , Female , Middle Aged , Blood Pressure Monitoring, Ambulatory/methods , Hypertension/complications , Primary Health Care/methods , Arterial Pressure , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/physiopathology , Cohort Studies , Predictive Value of Tests , Statistical Analysis , Treatment Outcome
8.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Oliveira Junior, Múcio Tavares de; Kalil Filho, Roberto. Manual da condutas da emergência do InCor: cardiopneumologia / IInCor Emergency Conduct Manual: Cardiopneumology. São Paulo, Manole, 2ª revisada e atualizada; 2017. p.780-787.
Monography in Portuguese | LILACS (Americas) | ID: biblio-848519
9.
Clinics ; 71(9): 494-499, Sept. 2016. tab, graf
Article in English | LILACS (Americas) | ID: lil-794639

ABSTRACT

OBJECTIVES: Post-transplantation hypertension is prevalent and is associated with increased cardiovascular morbidity and subsequent graft dysfunction. The present study aimed to identify the factors associated with arterial stiffness as measured by the ambulatory arterial stiffness index. METHODS: The current study used a prospective, observational, analytical design to evaluate a group of adult heart transplantation patients. Arterial stiffness was obtained by monitoring ambulatory blood pressure and using the ambulatory arterial stiffness index as the surrogate outcome. Multivariate logistic regression analyses were performed to control confounding. RESULTS: In a group of 85 adult heart transplantation patients, hypertension was independently associated with arterial stiffness (OR 4.98, CI 95% 1.06-23.4) as well as systolic and diastolic blood pressure averages and nighttime descent. CONCLUSIONS: Measurement of ambulatory arterial stiffness index is a new, non-invasive method that is easy to perform, may contribute to better defining arterial stiffness prognosis and is associated with hypertension.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Heart Transplantation/adverse effects , Blood Pressure Monitoring, Ambulatory/methods , Vascular Stiffness/physiology , Hypertension/etiology , Hypertension/physiopathology , Prognosis , Time Factors , Logistic Models , Multivariate Analysis , Prospective Studies , Reproducibility of Results , Risk Factors , Statistics, Nonparametric , Risk Assessment/methods
10.
Int. j. cardiovasc. sci. (Impr.) ; 29(4): f:295-l:302, jul.-ago. 2016. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-831827

ABSTRACT

Fundamento: A hipertensão arterial sistêmica (HAS) é uma causa importante de morbidade e mortalidade cardiovascular. Apesar da eficácia do tratamento, um alto número de pacientes não obtém controle de pressão arterial (PA), um fato que implica a necessidade de investigar o papel de outros fatores adicionais, como marcadores de inflamação e microalbuminúria, especialmente em ambientes de saúde. Objetivos: Avaliar a associação entre os níveis de fibrinogênio sérico, Proteína C-reativa ultrassensível (PCR) e microalbuminúria, com medidas de pressão arterial (PA) avaliadas através de monitorização ambulatorial da pressão arterial (MAPA) em pacientes hipertensos, em ambiente de cuidados de saúde primários. Métodos: Foi realizado um estudo transversal com pacientes hipertensos que foram atendidos em centros de cuidados de saúde primários. Uma avaliação de PA foi efetuada pelo médico de cuidados primários, e este procedimento foi seguido por um teste de referência de 24 horas (MAPA), realizado por um profissional independente. Adicionalmente, a coleta de sangue periférico foi realizada para análise futura de marcadores bioquímicos. Resultados: 143 pacientes foram incluídos. Havia uma tendência para associação entre a variável independente (PA alterada por MAPA de 24 horas) e variável dependente (PCR), havia uma associação entre os valores > 3 mg/dL e MAPA alterada de 24 horas. A razão de prevalência (RP) foi de 1,36 (CI 95% 0,90 ­ 2,06); p=0,18. A respeito dos achados de microalbuminúria e fibrinogênio, foi observada RP 1,03 (CI 95% 0,41 ­ 2,57); p=1 e RP 1,19 (CI 95% 0,96 ­ 1,46); p=0,019, respectivamente, e ambas não foram significantes para PA alterada por MAPA de 24 horas. Conclusões: Há uma tendência para a associação entre PCR e a PA avaliada através da MAPA de 24 horas no contexto dos cuidados primários


Background: Systemic arterial hypertension (SAH) is an important cause of cardiovascular morbidity and mortality. In spite of the effectiveness of the treatment, a high number of patients do not obtain blood pressure (BP) control, a fact that implies the need for investigating the role of other additional factors, such as inflammation markers and microalbuminuria, especially in health care environments. Objectives: To evaluate the association between serum fibrinogen levels, ultra-sensitive C-reactive protein (CRP) and microalbuminuria, with blood pressure (BP) averages evaluated by 24-hour ambulatory blood pressure monitoring (ABPM) in hypertensive patients in primary health care setting.Methods: A cross-sectional study with hypertensive patients who were seen in primary health care centers was performed.A BP evaluation was carried out by the primary care doctor, and this procedure was followed by a reference test 24-hour ABPM, performed by an independent professional. Moreover, the peripheral blood collect was performed for future biochemical markers analysis. Results: 143 patients were included. There was a trend for association between the independent variable (altered BP by 24-hour ABPM) and the dependent variable (CRP), there was an association between the values > 3 mg/dL and altered 24-hour ABPM. The prevalence ratio (PR) was of 1.36 (CI 95% 0.90 ­ 2.06); p=0.18. Regarding microalbuminuria and fibrinogen findings, a 1.03 (CI 95% 0.41 ­ 2.57) PR was seen; p=1 and 1.19 (CI 95% 0.96 ­ 1.46) PR; p=0.019, respectively, and both were not significant for altered BP by 24-hour ABPM. Conclusions: It is a trend for association between CRP with BP evaluated by 24-hour ABPM in the primary care setting


Subject(s)
Humans , Male , Female , Adult , Albuminuria/diagnosis , Albuminuria/therapy , Arterial Pressure , Biomarkers/analysis , Blood Pressure Monitoring, Ambulatory/methods , Hypertension/diagnosis , Hypertension/therapy , Inflammation , Brazil , Cardiovascular Diseases/physiopathology , Cardiovascular Diseases/therapy , Cross-Sectional Studies , Primary Health Care/methods , Statistical Analysis
11.
Clinics ; 71(5): 257-263, May 2016. tab, graf
Article in English | LILACS (Americas) | ID: lil-782838

ABSTRACT

OBJECTIVES: The goal of this study was to evaluate the relationship between serum albumin levels and 24-hour ambulatory blood pressure monitoring (24-h ABPM) recordings in non-diabetic essential hypertensive patients. METHODS: A total of 354 patients (mean [SD] age: 55.5 [14.3] years, 50% females) with essential hypertension and 24-h ABPM recordings were included. Patient 24-h nighttime and daytime ABPM values, systolic and diastolic dipping status and average nocturnal dipping were recorded. The correlations between serum albumin levels and nocturnal systolic and diastolic dipping were evaluated, and correlates of average nocturnal systolic dipping were determined via a linear regression model. RESULTS: Overall, 73.2% of patients were determined to be non-dippers. The mean (SD) levels of serum albumin (4.2 [0.3] g/dL vs. 4.4 [0.4] g/dL, p<0.001) and the average nocturnal systolic (15.2 [4.8] mmHg vs. 0.3 [6.6] mmHg, p<0.001) and diastolic dipping (4.2 [8.6] mmHg vs. 18.9 [7.0] mmHg, p<0.001) were significantly lower in non-dippers than in dippers. A significant positive correlation was noted between serum albumin levels and both systolic (r=0.297, p<0.001) and diastolic dipping (r=0.265, p<0.001). The linear regression analysis revealed that for each one-unit increase in serum albumin, the average nocturnal dip in systolic BP increased by 0.17 mmHg (p=0.033). CONCLUSION: Our findings indicate an association between serum albumin levels and the deterioration of circadian BP rhythm among essential hypertensive patients along with the identification of a non-dipper pattern in more than two-thirds of patients. Our findings emphasize the importance of serum albumin levels, rather than urinary albumin excretion, as an independent predictor of nocturnal systolic dipping, at least in non-diabetic essential hypertensive patients with moderate proteinuria.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Blood Pressure Monitoring, Ambulatory/methods , Hypertension/physiopathology , Serum Albumin/analysis , Albuminuria/physiopathology , Blood Pressure/physiology , Circadian Rhythm/physiology , Essential Hypertension , Hypertension/blood , Predictive Value of Tests , Serum Albumin/physiology
12.
Int. j. cardiovasc. sci. (Impr.) ; 28(6): 472-479, nov.-dez. 2015.
Article in Portuguese | LILACS (Americas) | ID: lil-788765

ABSTRACT

Fundamentos: A apneia do sono é fator de risco para várias condições cardiovasculares e, sendo assim, o seudiagnóstico é essencial.Objetivo: Verificar em pacientes portadores de hipertensão arterial sistêmica e apneia do sono, se há associaçãoentre esses diagnósticos.Métodos: Estudo retrospectivo, realizado com pacientes adultos, de ambos os sexos, provenientes do banco dedados da Clínica Paulista de Doenças Cardiovasculares, diagnosticados com hipertensão arterial sistêmica eapneia do sono, no período de janeiro de 2011 a janeiro de 2015. Utilizados dados da monitorização ambulatorialda pressão arterial (MAPA) e da polissonografia associados para verificar a presença de aumento da cargapressórica e ausência de descenso durante o sono e a presença de episódios obstrutivos que diagnosticaram apneiado sono. Os pacientes também foram avaliados em relação aos fatores de risco cardiovascular: sedentarismo,obesidade, tabagismo, nível glicêmico e perfil lipídico.Resultados: Foram avaliados 59 pacientes, sendo que 32 (54,2%) pacientes apresentaram na MAPA manutençãoou aumento da carga pressórica com ausência de descenso durante o sono, quando comparados à vigília. Dessespacientes, 31 (96,9%) apresentaram apneia do sono na polissonografia, mostrando uma associação de 97,0%.Conclusão: Neste estudo, observou-se forte associação entre hipertensão arterial sistêmica e apneia do sono.


Background: Sleep apnea is a risk factor for many cardiovascular conditions, therefore, its diagnosis is essential.Objective: To check in patients with systemic arterial hypertension and sleep apnea whether there is an association between thesediagnoses.Methods: Retrospective study with adult patients of both sexes from the database of Clínica Paulista de Doenças Cardiovascularesdiagnosed with systemic arterial hypertension and sleep apnea from January 2011 to January 2015. Data from ambulatory bloodpressure monitoring (ABPM) and polysomnography associated for the presence of increased pressure load and no pressure decreaseduring sleep and the presence of obstructive episodes that diagnosed sleep apnea. Patients were also evaluated for cardiovascularrisk factors: physical inactivity, obesity, smoking, glucose level and lipid profile.Results: Altogether, 59 patients have been evaluated, 32 of which (54.2%) presented, during ABPM, stable or increased pressureload with no decline during sleep compared to wakefulness. Of these patients, 31 (96.9%) had sleep apnea in polysomnography,showing an association of 97.0%.Conclusion: In this study, we observed a strong association between systemic arterial hypertension and sleep apnea.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Masked Hypertension , Polysomnography , Sleep Apnea Syndromes/diagnosis , Blood Pressure Monitoring, Ambulatory/methods , Retrospective Studies , Risk Factors
13.
Int. j. cardiovasc. sci. (Impr.) ; 28(1): 25-34, jan.-fev. 2015. tab, graf
Article in English, Portuguese | LILACS (Americas) | ID: lil-762186

ABSTRACT

Fundamentos: O efeito do treinamento resistido (TR) no comportamento da pressão arterial (PA), da frequência cardíaca (FC) e do duplo-produto (DP) está fortemente relacionado às características do exercício e apresenta-se inconsistente ao público hipertenso.Objetivos: Comparar a resposta cardiovascular aguda e tardia em sessões de 50% e 75% de uma repetição máxima estimada em hipertensos grau 1. Métodos: Analisou-se no período de 24 horas a pressão arterial sistólica (PAS) e diastólica (PAD) em 14 homens hipertensos leves, treinados (GT) e não treinados (GNT), submetidos a protocolos de 75% e 50% de uma repetição máxima estimada. Concomitantemente, verificou-se o nível de estresse cardiovascular em oito exercícios nas duas intensidades citadas. Resultados: No GT a variável PAS apresentou diferença entre o protocolo de menor intensidade em relação aos demais, 50% com controle (p=0,028) e 50% com 75% (p=0,022); a PAD diferenciou-se apenas nos protocolos de 50% com controle (p=0,024). No GNT a diferença ocorreu em todos os protocolos, tanto na PAS [50% e controle (p=<0,0001); 75% e controle (p=0,039); e 50% e 75% (p=0,001)] quanto na PAD [50% e controle (p=0,002); 75% e controle (p=0,002); e 50% e 75%(p=0,002)]. No estresse cardiovascular, os exercícios seated row e leg press no GT e os exercícios high row, leg curl e abdominal crunch no GNT mostraram diferenças em ambos os protocolos. Conclusão: Percebe-se segurança no TR em hipertensos leves. Ficou evidente que o protocolo de menor intensidade foi mais eficiente na promoção da hipotensão pós-exercício.


Background: The effect of resistance training (RT) on the behavior of blood pressure (BP), heart rate (HR) and double product (DP) is strongly related to the characteristics of exercise and is inconsistent with hypertensive individuals. Objectives: To compare the acute and late cardiovascular response in sessions of 50% and 75% of maximum estimated repetition in grade-1 hypertensive individuals. Methods: For 24 hours, the study analyzed systolic blood pressure (SBP) and diastolic blood pressure (DBP) in 14 mild hypertensive men, trained (TG) and untrained (UG), under protocols of 75% and 50% on maximum estimated repetition. The level of cardiovascular stress in eight exercises for the two intensities mentioned was concomitantly observed. Results: In the TG, the variable SBP showed differences between the protocol of lower intensity compared to the other, 50% with control (p=0.028) and 50% to 75% (p=0.022), and DBP differed only in the protocols of 50% with control (p=0.024). In the UG, the difference occurred in all protocols, as well in SBP [50% and control (p=<0.0001); 75% and control (p=0.039); and 50% and 75% (p=0.001)] as in DBP [50% and control (p=0.002); 75% and control (p=0.002); and 50% and 75% (p=0.002)]. On cardiovascular stress, the exercises seated row, leg press in the TG and high row, leg curl and abdominal crunch in the UG differed in both protocols. Conclusion: The results indicate safety in RT in mild hypertension men. It became evident that the lower intensity protocol showed higher efficiency in promoting post-exercise hypotension.


Subject(s)
Humans , Male , Adult , Arterial Pressure , Exercise , Hypertension/diagnosis , Resistance Training/methods , Analysis of Variance , Body Mass Index , Cross-Sectional Studies , Cardiac Output/physiology , Heart Rate/physiology , Blood Pressure Monitoring, Ambulatory/methods , Stroke Volume/physiology
14.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 25(1): 19-22, jan.-mar.- 2015. tab, graf
Article in Portuguese | LILACS (Americas) | ID: lil-767980

ABSTRACT

O diagnóstico da Hipertensão Arterial Sistêmica (HAS) sofreu mudanças com o advento das medidas de Pressão Arterial (PA) fora do consultório, quer por meio da Monitorização Ambulatorial da Pressão Arterial de 24 horas – MAPA, quer pela Monitorização Residencial da Pressão Arterial – MRPA. Mais recentemente, dois novos tipos de comportamento foram individualizados e representados por: hipertensão do avental branco, quando os valores de PA são sistematicamente elevados nas medidas casuais e normais pela MAPA ou MRPA e normotensão do avental branco ou hipertensão mascarada quando o inverso ocorre qual seja, pressões arteriais sistematicamente normais no consultório com valores indubitavelmente anormais pelos métodos de medidas fora dele (MAPA ou MRPA). Este artigo discute as principais diretrizes de Hipertensão arterial publicadas pelas Sociedades Brasileiras de Cardiologia, Nefrologia e de Hipertensão – DBH VI, Sociedades Europeias de Cardiologia e Hipertensão, 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Eighth Joint National Committee (JNC 8), Sociedades Americana e Internacional de Hipertensão e CHEP – Canadian Hypertension Education Program Recomendations, pela suas relevâncias ao estabelecimento correto do diagnóstico e também para que se objetive o melhor nível de controle da pressão arterial com a finalidade de oferecer maiores benefícios aos pacientes sob tratamento.).


The diagnosis of arterial hypertension has undergone changes, with the advent of blood pressure measurements outside the doctor’s clinic, whether through 24-hour Ambulatory Blood Pressure Monitoring (ABPM) or Home Blood Pressure Monitoring (HBPM).More recently, two types of behavior have been individualized and represented by: White coat Hypertension, where the AP values are systematically elevated in the causal andnormal measurements for MAPA or MRPA, and White coat normotension, or masked ypertension, where the inverse occurs, i.e. systematically normal arterial pressures are recorded in the clinic, with undoubtedly abnormal values by the measurement methods utside the clinic (MAPA or MRPA). This article discusses the main guidelines on arterial Hypertension published by the Brazilian Societies of Cardiology, Nephrology and Hypertension – DBH VI, the European Societies of Cardiology and Hypertension, 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report from the Eighth Joint National Committee (JNC 8), American and International Societies of Hypertension, and the CHEP – Canadian Hypertension Education Program Recommendations, due to their importance for the correct establishment of the diagnosis, and also seeking to obtain the best level of blood pressure control, in order to offer greater benefits for patients undergoing treatment.


Subject(s)
Humans , Male , Female , Middle Aged , Diagnostic Techniques and Procedures , Guidelines as Topic/standards , Arterial Pressure/physiology , Antihypertensive Agents/therapeutic use , Hypertension/diagnosis , Blood Pressure Monitoring, Ambulatory/methods , Risk Factors
15.
Article in English | WPRIM (Western Pacific) | ID: wprim-76677

ABSTRACT

BACKGROUND/AIMS: Ambulatory blood pressure (BP) monitoring has been widely recommended for evaluating the status of BP, but is lacking in practicality. Determination of the specific time points for BP measurement that are representative of 24-hour mean BP could be useful and convenient in hypertensive patients with chronic kidney disease (CKD). METHODS: A total of 1,317 patients for whom 24-hour ambulatory BP monitoring was performed were enrolled in a multicenter study on hypertensive CKD. We analyzed the time points at which systolic blood pressure (SBP) values exhibited the smallest differences from 24-hour mean SBP (mSBP). We included office mSBP and analyzed the relationships between SBPs at the office and the time points with the smallest differences from 24-hour mSBP using several methods. RESULTS: The time points with the smallest differences from 24-hour mSBP were 7:00 AM, 2:00 PM, and 9:30 PM. In regression analysis, SBPs at 7:00 AM and 9:30 PM were better correlated with 24-hour mSBP than SBPs at 2:00 PM and the office. The proportions of patients with SBPs within 30% of 24-hour mSBP were higher at 7:00 AM and 9:30 PM. The best consistency between the uncontrolled hypertensive groups, defined as > or = 135 mmHg of 24-hour mSBP and higher values of SBPs corresponding to 135 mmHg of 24-hour mSBP, were observed at the 7:00 AM and 9:30 PM time points. CONCLUSIONS: The specific time points for SBPs that correlated well with 24-hour mSBP in hypertensive CKD patients were 7:00 AM and 9:30 PM.


Subject(s)
Adult , Aged , Blood Pressure , Blood Pressure Monitoring, Ambulatory/methods , Circadian Rhythm , Cross-Sectional Studies , Female , Humans , Hypertension/diagnosis , Male , Middle Aged , Office Visits , Predictive Value of Tests , Prospective Studies , Renal Insufficiency, Chronic/diagnosis , Republic of Korea , Time Factors , Young Adult
16.
Rio de Janeiro; s.n; 2015. 117 f p.
Thesis in Portuguese | LILACS (Americas) | ID: lil-756241

ABSTRACT

O objetivo deste estudo foi investigar os mecanismos de variabilidade da pressão arterial sistólica batimento-a-batimento através da análise espectral do componente de baixa frequência da variabilidade da pressão arterial sistólica, de medidas de velocidade da onda de pulso e de análise da pressão de incremento em idosos normotensos e hipertensos em tratamento anti-hipertensivo. Adicionalmente, investigamos a associação da variabilidade da pressão arterial com a espessura médio-intimal carotídea. Também investigamos a associação entre variabilidade da pressão arterial batimento-a-batimento e da frequência cardíaca com desempenho cognitivo. A pressão arterial foi medida continuamente através de fotopletismografia em posição supina e semi-ereta passiva. A variabilidade da pressão arterial foi estimada pelo desvio padrão das medidas batimento-a-batimento. Medidas de velocidade de onda de pulso, de pressão de incremento e ultrassonografia das artérias carótidas para medidas da espessura médio-intimal foram realizadas. O componente de baixa frequência da variabilidade da pressão arterial sistólica em posição supina e semi-ereta apresentou uma associação positiva independente coma variabilidade nos modelos de regressão linear múltipla ajustado pela velocidade de onda de pulso ou pela pressão de incremento.O componente de baixa frequência do barorreflexo em posição supina apresentou uma associação negativa independente com a variabilidade da pressão arterial sistólica e nos mesmos modelos. Não foi demonstrada associação entre a variabilidade da pressão arterial sistólica com espessura médio-intimal das artérias carótidas. Não foi demonstrada associação da variabilidade da pressão arterial sistólica batimento-a-batimento ou da frequência cardíaca com desempenho cognitivo global...


The objective of this study was to investigate the mechanisms of variability of the systolic beat-to-beat blood pressure in elderly individuals through spectral analysis of low frequency components of systolic blood pressure variability, measures of pulse wave velocity and augmentation pressure analysis. In addition, we investigated the association of blood pressure variability with carotid intima-media thickness. Also, we investigated the association between beat-to-beat blood pressure and heart rate variability with cognitive performance in the sample. Arterial pressures were measured by photoplethysmography in supine position and during passive semi-upright. The spectra of variability of systolic blood pressure values were subsequently analyzed in the laboratory. Measures of pulse wave velocity, the reflected wave (augmentation pressure) and ultrasonography for carotid intima-media thickness measurements were performed. The low frequency component of systolic blood pressure variability in the supine and semi-upright position was an independent positive predictor of variability in multiple linear regression models with pulse wave velocity and with augmentation pressure; the low frequency component of the baroreflex in supine position was a negative predictor of variability in the same models. It was not demonstrated association of systolic blood pressure variability with intima-media thickness. It was not demonstrated association of beat-to-beat systolic blood pressure variability or heart rate with global cognitive performance in elderly apparently healthy in regular treatment of hypertension. It was demonstrated a positive and independente association of the low-frequency component of the spectrum of blood pressure and heart rate of variability with cognitive domains related to the frontal lobe (matrix reasoning and executive function score)...


Subject(s)
Humans , Aged , Cognition/physiology , Heart Rate/physiology , Hypertension/physiopathology , Arterial Pressure , Hypertension/diagnosis , Blood Pressure Monitoring, Ambulatory/methods
17.
Arq. bras. cardiol ; 103(4): 338-347, 10/2014. tab, graf
Article in English | LILACS (Americas) | ID: lil-725320

ABSTRACT

Background: The importance of measuring blood pressure before morning micturition and in the afternoon, while working, is yet to be established in relation to the accuracy of home blood pressure monitoring (HBPM). Objective: To compare two HBPM protocols, considering 24-hour ambulatory blood pressure monitoring (wakefulness ABPM) as gold-standard and measurements taken before morning micturition (BM) and in the afternoon (AM), for the best diagnosis of systemic arterial hypertension (SAH), and their association with prognostic markers. Methods: After undergoing 24-hour wakefulness ABPM, 158 participants (84 women) were randomized for 3- or 5-day HBPM. Two variations of the 3-day protocol were considered: with measurements taken before morning micturition and in the afternoon (BM+AM); and with post-morning-micturition and evening measurements (PM+EM). All patients underwent echocardiography (for left ventricular hypertrophy - LVH) and urinary albumin measurement (for microalbuminuria - MAU). Result: Kappa statistic for the diagnosis of SAH between wakefulness-ABPM and standard 3-day HBPM, 3-day HBPM (BM+AM) and (PM+EM), and 5-day HBPM were 0.660, 0.638, 0.348 and 0.387, respectively. The values of sensitivity of (BM+AM) versus (PM+EM) were 82.6% × 71%, respectively, and of specificity, 84.8% × 74%, respectively. The positive and negative predictive values were 69.1% × 40% and 92.2% × 91.2%, respectively. The comparisons of intraclass correlations for the diagnosis of LVH and MAU between (BM+AM) and (PM+EM) were 0.782 × 0.474 and 0.511 × 0.276, respectively. Conclusions: The 3 day-HBPM protocol including measurements taken before morning micturition and during work in the afternoon showed the best agreement with SAH diagnosis and the best association with prognostic markers. .


Fundamentos: A importância das medidas da pressão arterial antes do ato miccional matinal e no período da tarde, durante atividades laborativas, na acurácia da monitoração residencial da pressão arterial (MRPA) não foi estabelecida. Objetivo: Comparar dois protocolos de MRPA, tendo como padrão-ouro a monitoração ambulatorial da pressão arterial de 24 horas (MAPA-vigília) e avaliando-se as medidas antes do ato miccional e à tarde, para o melhor diagnóstico de hipertensão arterial (HAS), e sua associação com marcadores prognósticos. Métodos: Após realizarem MAPA de 24 horas, os 158 participantes (84 mulheres) foram randomizados para realizar MRPA de três ou cinco dias com posterior crossover. Analisou-se o protocolo de três dias nas seguintes situações: aferições antes do ato miccional matinal e à tarde (AM+MT); e aferições após o ato miccional matinal e à noite (PM+MN). Todos os pacientes foram submetidos a ecocardiografia (hipertrofia ventricular esquerda - HVE) e a dosagem de albumina urinária (microalbuminúria - MAU). Resultados: A estatística kappa para diagnóstico de HAS entre MAPA-vigília e MRPA de três dias padrão, MRPA de três dias (AM + MT) e (PM + MN), e MRPA de cinco dias foi de 0,660, 0,638, 0,348 e 0,387, respectivamente. Os valores de sensibilidade de AM+MT versus PM+MN foram 82,6% × 71%, respectivamente, e os de especificidade foram 84,8% × 74%, respectivamente. Os valores preditivos positivos e negativos foram 69,1% × 40% e 92,2% × 91,2%, respectivamente. As comparações das correlações intraclasse para diagnósticos de HVE e MAU, entre AM+MT e PM+MN, foram 0,782 × 0,474 e 0,511 × 0,276, respectivamente. Conclusões: O protocolo de MRPA de três dias ...


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Blood Pressure Monitoring, Ambulatory/methods , Hypertension/diagnosis , Urination , Analysis of Variance , Albuminuria/urine , Blood Pressure Monitoring, Ambulatory/standards , Cross-Sectional Studies , Hypertrophy, Left Ventricular , Predictive Value of Tests , Reference Standards , Reproducibility of Results , Time Factors
18.
Rev. bras. cardiol. (Impr.) ; 27(4): 289-292, jul.-ago. 2014. tab, graf
Article in Portuguese | LILACS (Americas) | ID: lil-746699

ABSTRACT

A elevação da pressão arterial (PA) aumenta o risco cardiovascular. A medida da PA obtida no consultóriotem sido o padrão-ouro para o acompanhamento desses pacientes. O advento da monitorização ambulatorialda PA (MAPA) e das medidas domiciliares da PA,entretanto, trouxe novos paradigmas nos conceitos,na classificação e no manejo desses pacientes. A hipertensão mascarada (HM) se caracteriza por PAnormal no consultório acompanhada de elevação da PA na MAPA ou nas medidas domiciliares. Esses pacientes são semelhantes aos hipertensos sustentados em risco cardiovascular. Nesta publicação os autores discutem o diagnóstico e o tratamento da HM.


High blood pressure (BP) steps up cardiovascular risk, with in-office BP measurements long the gold standardfor monitoring these patients. However, the advent of Ambulatory BP Monitoring (ABPM) and in-home BP measurements has ushered in new paradigms forconcepts, classifications and management of these patients. Masked hypertension (MH) is characterizedby normal BP during appointments with rising BP during ABPM or in-home BP measurements. In terms of cardiovascular risk, these patients aresimilar to those with sustained hypertension. In this paper, the authors discuss MH diagnosis and treatment.


Subject(s)
Humans , Masked Hypertension/diagnosis , Masked Hypertension/therapy , Hypertension/complications , Arterial Pressure , Blood Pressure Monitoring, Ambulatory/methods , Risk Factors
19.
Clinics ; 69(4): 219-224, 4/2014. tab
Article in English | LILACS (Americas) | ID: lil-705772

ABSTRACT

OBJECTIVES: Cigarette smoking is an important modifiable cardiovascular risk factor associated with increased stiffness of the large arteries in adulthood. This study aimed to 1) evaluate arterial distensibility and echocardiographic measures in adolescent smokers before and after participation in a successful smoking cessation program and to 2) compare the findings obtained with data from a control population of healthy non-smokers. METHODS: A total of 31 young smoking subjects (58.1% male; range: 11-18 years old; mean: 16.5±1.4 years old; mean tobacco consumption: 2.6±0.6 years) were examined before commencing and after taking part for at least 1 year in a smoking cessation program (mean: 1.4±0.3 years). Arterial stiffness was measured using the previously validated QKd100-60 method. Twenty-four-hour ambulatory blood pressure monitoring and transthoracic echocardiography were also performed. RESULTS: (Smokers before abuse cessation vs. smokers after abuse cessation) systolic blood pressure: p<0.004; diastolic blood pressure: p<0.02; mean blood pressure: p<0.01; QKd100-60 value: 183±5 vs. 196±3 msec, p<0.009; p = ns for all echocardiographic parameters. (Smokers after abuse cessation vs. controls) systolic blood pressure: p<0.01; diastolic blood pressure: p<0.03; mean blood pressure: p<0.02; QKd100-60 value: 196±3 vs. 203±2 msec, p<0.04; p<0.02, p<0.01, and p<0.05 for the interventricular septum, posterior wall, and left ventricular mass, respectively. CONCLUSIONS: Despite successful participation in a smoking cessation program, arterial distensibility improved but did not normalize. This finding underlines the presence of the harmful effect of arterial rigidity in these individuals, despite their having quit smoking and their young ages, thus resulting in the subsequent need for a lengthy follow-up period. .


Subject(s)
Adolescent , Child , Female , Humans , Male , Blood Pressure/physiology , Smoking Cessation , Smoking/physiopathology , Vasodilation/physiology , Age Factors , Arteries/physiopathology , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure/drug effects , Case-Control Studies , Echocardiography , Elasticity , Electrocardiography , Heart Rate/drug effects , Heart Rate/physiology , Reference Values , Risk Assessment , Risk Factors , Statistics, Nonparametric , Smoking/adverse effects , Time Factors
20.
Clinics ; 68(12): 1509-1515, dez. 2013. tab, graf
Article in English | LILACS (Americas) | ID: lil-697705

ABSTRACT

OBJECTIVE: We tested the reproducibility of changes in the ambulatory blood pressure (BP) from the initial values, an indicator of BP reactivity and cardiovascular health outcomes, in young, healthy adults. METHOD: The subjects wore an ambulatory BP monitor attached by the same investigator at the same time of day until the next morning on two different days (day 1 and day 2) separated by a week. We compared the ambulatory BP change from the initial values at hourly intervals over 24 waking and sleeping hours on days 1 and 2 using linear regression and repeated measures analysis of covariance. RESULTS: The subjects comprised 88 men and 57 women (mean age±SE 22.4±0.3 years) with normal BP (118.3±0.9/69.7±0.6 mmHg). For the total sample, the correlation between the ambulatory BP change on day 1 vs. day 2 over 24, waking, and sleeping hours ranged from 0.37-0.61; among women, the correlation was 0.38-0.71, and among men, it was 0.24-0.52. Among women, the ambulatory systolic/diastolic BP change was greater by 3.1±1.0/2.4±0.8 mmHg over 24 hours and by 3.0±1.1/2.4±0.8 mmHg over waking hours on day 1 than on day 2. The diastolic ambulatory BP change during sleeping hours was greater by 2.2±0.9 mmHg on day 1 than on day 2, but the systolic ambulatory BP change during sleeping hours on days 1 and 2 did not differ. Among men, the ambulatory BP change on days 1 and 2 did not differ. CONCLUSION: Our primary findings were that the ambulatory BP change from the initial values was moderately reproducible; however, it was more reproducible in men than in women. These results suggest that women, but not men, may experience an alerting reaction to initially wearing the ambulatory BP monitor. .


Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure/physiology , Body Mass Index , Reference Values , Reproducibility of Results , Sex Factors , Sleep/physiology , Time Factors
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