Diagnóstico incidental de hipertensión arterial en el primer nivel de salud / Incidental diagnosis of high blood pressure at the first level of health

La hipertensión arterial (HTA) es el principal factor relacionado con la mortalidad en todo el mundo. Según la Organización Mundial de la Salud es un trastorno que causa casi la mitad de todas las defunciones por accidente cerebrovascular o cardiopatía. Se estima que afecta alrededor de 250 millones de personas en Las Américas,(1) mientras que en Cuba se reporta una prevalencia del 30,9 por ciento en personas de 15 o más años de edad.(2) Lo anterior motivó a los autores a realizar, como parte de la tesis de terminación de especialidad en Medicina General Integral, un estudio que permitiese determinar la eficacia del score de riesgo de hipertensión arterial de Framingham en la predicción de la enfermedad a corto plazo (1 año) en pacientes...(AU)

Hipertensión arterial en paciente de raza negra: a propósito de un caso / Hypertension in a black patient: a purpose of a case

Hypertension in black patients is usually more frequent and associated with higher morbidity and mortality. Due to demographic changes in the Chilean population, dealing with this group of patients has become more frequent. The case of a young Haitian patient with severe hypertension and target organ damage is presented.

Riesgos modificables relacionados a la hipertensión arterial / Modifiable risks related to hypertension arterial

La hipertensión arterial (HTA) es una de las causas de muertes a nivel mundial, esta enfermedad incrementa significativamente los riesgos de sufrir cardiopatías, encefalopatías, nefropatías y otras enfermedades. Su prevalencia está asociada a países de bajos y medianos ingresos, y se consideran factores de riesgos al estrés, alcoholismo, obesidad, tabaquismo, drogas, alimentación, genética, raza, y ciertas patologías como diabetes mellitus, algunas de ellas consideradas como factores de riesgo modificables y que pueden ser medidas de prevención y control en su tratamiento. Objetivo: Recopilar información sobre los transcriptores riesgos modificables relacionados a la hipertensión arterial. Materiales y Métodos: El estudio es del tipo descriptivo, La metodología es una revisión narrativa, con recopilación de literatura referente al tema y disponible en la web, se emplearon los descriptores: hipertensión, factores de riesgo. Resultados: Aporte de información relevante sobre los factores de riesgos modificables entre ellos el consumo de tabaco y alcohol, reducción de peso, alimentación, actividades físicas, reducción del consumo de sal, aumento del consumo de hortalizas y frutas, además de la disminución en el consumo de alimentos grasos, sales, y un control periódico de la tensión arterial, bajo la supervisión médica que son considerados para la prevención y control de la HTA, como métodos alternativos para control y prevención de esta enfermedad. Conclusiones: Los factores de riesgo modificables que predominan son el consumo de grasas, ausencia del control del índice de masa corporal y de la presión arterial, así como el consumo excesivo de sal y presencia de estrés. Los factores de riesgo no modificables que predisponen a hipertensión arterial prevalentemente son los antecedentes familiares de HTA y de obesidad. Se ha determinado que los cambios en el estilo de vida, así como una conducta sana para la prevención y control de riesgos que son modificables atenúan la prevalencia de la misma(AU)

Arterial hypertension (AHT) is one of the causes of death at the Worldwide, this disease significantly increases the risk of heart disease, encephalopathies, nephropathies and other diseases. Its prevalence is associated with countries of low and medium income, and are considered risk factors for stress, alcoholism, obesity, smoking, drugs, food, genetics, race, and certain pathologies such as diabetes mellitus, some of them considered as modifiable risk factors and that can be prevention and control measures in their treatment. Objective: Collect information on transcriptionists modifiable risks related to hypertension arterial. Materials and methods: The study is of the descriptive type, the methodology is a narrative review, with a compilation of literature on the subject and available on the web, used the descriptors: hypertension, risk factors. Results: Contribution of relevant information on modifiable risk factors, including the consumption of tobacco and alcohol, weight reduction, nutrition, physical activities, reduction of salt intake, increased consumption of vegetables and fruits, in addition to the decrease in the consumption of fatty foods, salts, and periodic control of blood pressure, under the medical supervision that are considered for the prevention and control of hypertension, such as alternative methods for control and prevention of this disease. Conclusions: The modifiable risk factors that predominate are the consumption of fats, absence of control of body mass index and blood pressure, as well as excessive consumption of salt and presence of stress. Non-modifiable risk factors that predispose to high blood pressure are predominantly a family history of hypertension and obesity. It has been determined that changes in lifestyle, as well as behavior healthy for the prevention and control of risks that are modifiable attenuate the prevalence ofthe same(AU)

Niveles tensionales en niños y adolescentes con esteatosis hepática / Tensional levels in children and adolescents with hepatic steatosis

Introducción: la enfermedad hepática no alcohólica (EHNA) constituye un desorden multifactorial cuyos elementos de riesgo se pueden aludir a la obesidad, el sedentarismo y el componente genético. Objetivo: evaluar los niveles tensionales en niños y adolescentes con esteatosis hepática por sonografía de 5-18 años en el Hospital Regional Universitario Dr. Arturo Gullón. Métodos y técnicas: se realizó un estudio descriptivo de corte transversal y fuente primaria. La muestra estuvo compuesta por de 106 participantes. Se realizó sonografía abdominal para determinar la presencia de esteatosis hepática y se midió la presión arterial sistólica abdominal para determinar la presencia de esteatosis hepática y se midió la presión arterial sistólica y diastólica, IMC, talla y pruebas de laboratorio. Para el análisis estadístico se empleó chi-cuadrado. Resultados: el sexo predominante en la tensión arterial sistólica fue el femenino con un 44.9 % en estadio prehipertensión, mientras que el masculino fue el sexo predominante en presión arterial diastólica con un 49.1 %. Se evidenció que los individuos con IMC del percentil 90 se encontraban en estadio prehipertensión en el percentil. El perfil lipídico (colesterol, HDL, LDL, triglicéridos) y las transaminasas (SGOT y SGPT) mostraron relación con niveles tensionales elevados con predominio en la TAD. Los valores elevados de glicemia presentan relación con las cifras aumentadas de la tensión arterial sistólica. Conclusión: el estudio mostró que existe una relación entre la esteatosis hepática no alcohólica y el riesgo de desarrollar hipertensión arterial. Presentando relación estadísticamente significativa entre los niveles tensionales elevados y el perfil bioquímico estudiado, así como al IMC de los pacientes evaluados en la investigación

Introduction: Nonalcoholic fatty liver disease (NAFLD) is a multifactorial disorder whose risks factors can be attributed to obesity, sedentary lifestyle and a genetic component. Objective: To evaluate blood pressure levels in children and adolescent aged 5-18 years old with hepatic steatosis using ultrasound at the Dr. Arturo Grullón Regional University Hospital. Methods and Techniques: A descriptive cross-sectional study of primary source were carried out. The sample of the study consisted in 106 participants. Abdominal ultrasono-graphy was performed to determine the presence of hepatic steatosis and systolic and diastolic blood pressure, BMI, height and laboratory tests were measured. Chi square was used in the statistical analysis of the data. Results: The predominant sex in systolic blood pressure was female with 44.9% in prehypertension stage, while male was the predominant sex in diastolic blood pressure with 49.1%. It was evidenced that individuals with BMI ≥90thpercentile were in the prehypertensive stage at the percentile. The lipid profile (cholesterol, HDL-C, LDL-C, triglycerides) and transaminases (SGOT ad SGPT) showed a relationship with high blood pressure levels with a predo-minance in DBP. Elevated glucose levels are related to an increase in systolic blood pressure. Conclusion: The study showed that there is a relationship between nonalcoholic fatty liver disease and the risk of developing high blood pressure. Presenting a statistically significant relationship between the elevated blood pres-sure levels and the biochemical profile studied, as well the BMI of the patients evaluated in this research

Aumento de la lipocalina orosomucoide-1 (ORM1) en sujetos con hiperaldosteronismo primario / Increase of lipocalin ORM1 in primary aldosteronism

El hiperaldosteronismo primario (HAP) es la causa más común de hipertensión arterial secundaria. A pesar de la prevalencia del HAP (6-10%) y sus consecuencias, los mecanismos que median los efectos deletéreos renales y extrarenales originados por la aldosterona más allá de la hipertensión arterial (ej. inflamación renal, alteraciones cardiacas y disfunción vascular), siguen siendo poco conocidos. Estudios previos sugieren que el exceso de aldosterona aumentaría proteínas sensibles a la activación del receptor de mineralocorticoides (MR), como las lipocalinas LCN2 (NGAL) y ORM1. OBJETIVO: Determinar la concentración de las lipocalinas ORM1, NGAL y NGAL-MMP9 en sujetos HAP. SUJETOS Y MÉTODOS: Estudio de cohorte transversal en sujetos adultos (similares en sexo, edad e IMC) separados en controles normotensos (CTL), hipertensos esenciales (HE) y con screening positivo de HAP (aldosterona ≥9 ng/dL y ARP < 1 ng/mL*h acorde a las guías internacionales de HAP). Se determinó la presión arterial sistólica (PAS) y diastólica (PAD), aldosterona plasmática, actividad renina plasmática (ARP) y la relación aldosterona / actividad de renina plasmática (ARR). Se determinó la concentración de NGAL, NGAL-MMP9 y ORM1 en suero por ELISA. RESULTADOS: Detectamos mayores niveles de ORM1 en sujetos HAP. No se detectaron diferencias en NGAL ni NGAL-MMP9 entre los grupos. Detectamos una asociación positiva de ORM1 con ARP (rho= -0,407, p=0,012) y con ARR (rho= 0,380 p= 0,021). CONCLUSIÓN: La mayor concentración de ORM1 en sujetos HAP y las asociaciones de ORM1 con aldosterona, ARP y ARR, proponen a esta proteína como un potencial biomarcador de HAP y de utilidad en el desarrollo de algoritmos diagnósticos de HAP.

Primary hyperaldosteronism (PA) is the most common cause of secondary hypertension. Despite the prevalence of PA (6-10%) and its consequences, the mechanisms that mediate the deleterious renal and extrarenal effects caused by aldosterone beyond arterial hypertension (eg renal inflammation, cardiac alterations and vascular dysfunction), remain barely known. Previous studies suggest that excess aldosterone would increase proteins sensitive to activation of the mineralocorticoid receptor (MR), such as lipocalins LCN2 (NGAL) and ORM1. AIM: To determine the concentration of the lipocalins ORM1, NGAL and NGAL-MMP9 in PA subjects. SUBJECTS AND METHODS: Cross-sectional study in adult subjects (similar in sex, age and BMI) grouped as normotensive controls (CTL), essential hypertensive (HE) and subjects with positive PA screening (aldosterone ≥ 9 ng/dL and PRA <1 ng/mL*h, according to international PA guidelines). Systolic (SBP) and diastolic (DBP) blood pressure, plasma aldosterone, plasma renin activity (PRA), and plasma aldosterone renin ratio (ARR) were determined. The concentration of NGAL, NGAL-MMP9 and ORM1 in serum was determined by ELISA. RESULTS: We detected higher levels Recibido: 03-09-2021 of ORM1 in PA subjects. No differences in NGAL or NGAL-MMP9 were detected between the groups. We detected a positive association of ORM1 with ARP (rho = -0.407, p < 0.05) and with ARR (rho = 0.380 p <0.05). CONCLUSION: The high levels of ORM1 in PA subjects and the associations of ORM1 with aldosterone, ARP and ARR, suggest ORM1 is a potential biomarker of PA, and useful in the development of a diagnostic algorithm for PA.

Adequação do cuidado a pessoas com hipertensão arterial no Brasil: Pesquisa Nacional de Saúde, 2013 e 2019 / Adecuación de la atención a personas con hipertensión arterial en Brasil: Encuesta Nacional de Salud, 2013 y 2019 / Adequacy of care for people with arterial hypertension in Brazil: National Health Survey, 2013 and 2019

Objetivo: Analisar a adequação do cuidado recebido por adultos e idosos com hipertensão arterial (HA) e sua associação com macrorregião nacional, características demográficas, socioeconômicas e do sistema de saúde, Brasil, 2013 e 2019. Métodos: Estudo transversal, com dados da Pesquisa Nacional de Saúde. Foram incluídas pessoas na idade de 18 anos ou mais, com diagnóstico de HA e consulta médica por esse motivo nos últimos três anos. Analisou-se a adequação do cuidado, construída a partir de 11 indicadores, por regressão de Poisson. Resultados: Em 2013, 11.129 pessoas com HA (25,3%; IC95% 24,5;26,1) receberam cuidado adequado, e em 2019, 19.107 (18,8%; IC95% 18,2;19,3). Indivíduos do quintil de melhor nível socioeconômico apresentaram prevalência de cuidado adequado 2,54 vezes maior (IC95% 2,03;3,17) em 2013, e 3,53 vezes maior (IC95% 2,94;4,23) em 2019, em relação aos de menor nível socioeconômico. Conclusão: O cuidado adequado diminuiu e as desigualdades econômicas intensificaram-se no período 2013-2019.

Objetivo: Analizar la adecuación de la atención recibida por adultos y ancianos con hipertensión arterial (HA), y su asociación con características regionales, demográficas, socioeconómicas y del sistema de salud, Brasil, 2013 y 2019. Métodos: Estudio transversal con datos de la Encuesta Nacional de Salud. Se incluyeron personas mayores de 18 años con diagnóstico de HA y consulta médica por este motivo en los últimos tres años. Se analizó la adecuación de la atención, construida a partir de 11 indicadores, por la regresión de Poisson. Resultados: En 2013, 11.129 personas con HA (25,3%; IC95% 24,5; 26,1) recibieron atención adecuada y, en 2019, 19.107 (18,8%; IC95% 18,2;19,3). Individuos del quintil con mejor nivel socioeconómico tuvieron una prevalencia de cuidado adecuado de 2,54 (IC95% 2,03;3,17) (2013) y 3,53 (IC95% 2,94;4,23) (2019) veces superior a los del menor nivel socioeconómico. Conclusión: Se identificó que la atención adecuada disminuyó y las desigualdades económicas se intensificaron en el período 2013-2019.

Objective: To analyze adequacy of care received by adults and elderly people with arterial hypertension, and its association with region of the country, demographic, socioeconomic and health system characteristics in Brazil in 2013 and 2019. Methods: This was a cross-sectional study using National Health Survey data. People aged ≥18 years with diagnosis of hypertension and medical consultation for this reason in the last three years were included. Adequacy of care was analyzed based on 11 indicators and using Poisson regression. Results: Adequate care was provided to 11,129 people with hypertension (25.3%; 95%CI 24.5;26.1) in 2013 and to 19,107 (18.8%; 95%CI 18.2;19.3) in 2019. Adequate care prevalence was 2.54 (95%CI 2.03;3.17) times higher in 2013, and 3.53 (95%CI 2.94;4.23) times higher in 2019 among individuals belonging to the highest socioeconomic quintile compared to those belonging to the poorest. Conclusion: We identified that care decreased, and economic inequalities intensified in the period 2013-2019.

Perfil dos pacientes com crise hipertensiva atendidos em uma unidade de pronto atendimento / Perfil de los pacientes con crisis hipertensiva atendidos en una unidad de pronta atención / Profile of patients with hypertensive crisis seen in an emergency care unit

RESUMO Objetivo: descrever o perfil dos pacientes com crise hipertensiva atendidos em uma Unidade de Pronto Atendimento. Método: estudo transversal descritivo, realizado por meio da análise de 80 prontuários de pacientes com quadro de crise hipertensiva, atendidos em uma unidade de pronto atendimento, entre o período de março de 2018 a fevereiro de 2019. Os dados foram coletados por meio de roteiro estruturado e receberam tratamento estatístico descritivo. Resultados: Após a análise dos 80 prontuários, constatou-se que a média de idade entre os pacientes atendidos foi de 58,03, sendo a faixa etária adulta a mais prevalente (53,8%). Constatou-se que a média da pressão arterial sistólica foi significativamente maior em homens em relação às mulheres (p=0,013). Quanto à sintomatologia, a cefaleia foi a mais prevalente, com 35,0%. Verificou-se que durante o atendimento da crise hipertensiva, a maioria dos pacientes fez uso de apenas uma droga para redução da PA, sendo o inibidor adrenérgico de ação central o mais citado. Quanto ao desfecho, grande parte dos pacientes recebeu alta (93,8%) logo após o atendimento, porém, 6,3% permaneceram em internamento de curta permanência até a estabilização do quadro. Considerações finais: Este estudo possibilitou a caracterização da população com crise hipertensiva atendida em um pronto atendimento, a qual evidencia uma possível fragilidade existente entre a articulação dos níveis de atenção à saúde.

RESUMEN Objetivo: describir el perfil de los pacientes con crisis hipertensiva atendidos en una Unidad de Pronta Atención. Método: estudio transversal descriptivo, realizado por medio del análisis de 80 registros médicos de pacientes con cuadro de crisis hipertensiva, atendidos en una unidad de pronta atención, entre el período de marzo de 2018 a febrero de 2019. Los datos fueron recogidos por medio de guion estructurado y recibieron tratamiento estadístico descriptivo. Resultados: después del análisis de los 80 registros médicos, se constató que el promedio de edad entre los pacientes atendidos fue de 58,03, siendo la franja etaria adulta la más prevalente (53,8%). Se constató que el promedio de la presión arterial sistólica fue significativamente mayor en hombres que en las mujeres (p=0,013). En cuanto a la sintomatología, la cefalea fue la más prevalente, con 35,0%. Se verificó que, durante la atención de la crisis hipertensiva, la mayoría de los pacientes hizo uso de solo una droga para reducción de la PA, siendo el inhibidor adrenérgico de acción central el más relatado. Respecto al resultado, gran parte de los pacientes recibió el alta (93,8%) inmediatamente después de la atención, sin embargo, el 6,3% permaneció en internamiento de corta estancia hasta la estabilización del cuadro. Consideraciones finales: este estudio posibilitó la caracterización de la población con crisis hipertensiva atendida en una pronta atención, la cual evidencia una posible fragilidad existente entre la articulación de los niveles de atención a la salud.

ABSTRACT Objective: to describe the profile of patients with hypertensive crisis treated at an Emergency Care Unit. Method: descriptive cross-sectional study carried out through the analysis of 80 medical records of patients with hypertensive crisis, treated at an emergency care unit, between March 2018 and February 2019. Data were collected using a structured script and were subjected to descriptive statistical treatment. Results: after analyzing the 80 medical records, it was found that the mean age of the treated patients was 58.03, with the adult age group being the most prevalent (53.8%). It was found that the mean systolic blood pressure was significantly higher in men than in women (p=0.013). As for symptoms, headache was the most prevalent, with 35.0%. It was found that during the treatment of the hypertensive crisis, most patients used only one drug to reduce BP, with centrally acting antiadrenergic drugs being the most cited. Regarding the outcome, most of the patients were discharged (93.8%) soon after treatment; however, 6.3% remained in short-term hospitalization until their condition stabilized. Final considerations: this study made it possible to characterize the population with hypertensive crisis treated in an emergency room, showing a possible fragility in the articulation between health care levell

Hipertensão mascarada: qual a importância da mrpa neste contexto? / Masked hypertension: how important is hbpm in this context?

A hipertensão arterial (HA) é o principal fator contributivo para as doenças cardiovasculares, as quais constituem a mais importante causa de morte prevenível no mundo. A falta de conhecimento da população acerca da doença, e consequentemente de um diagnóstico adequado, torna baixo o número de pessoas que se tratam. O aspecto silencioso da HA, e a má adesão ao tratamento proposto, dentre outros fatores, contribuem para o elevado risco de complicações. A medida da pressão arterial (PA) neste contexto apresenta grande importância não apenas no diagnóstico, mas também no acompanhamento de portadores de HA, podendo ser realizada de forma casual, em consultório, ou fora do mesmo com a utilização de outros métodos para tal. Dentre as medidas de PA, a monitorização residencial da PA (MRPA) se destaca. É um método destinado a fazer registro da PA fora do ambiente de consultório, obedecendo a um protocolo previamente estabelecido e normatizado. Além disto, a MRPA apresenta custos menores do que a monitorização ambulatorial da PA (MAPA). De acordo com a atual Diretriz Brasileira de HA, são considerados anormais valores de PA consultório ≥ 140/90 mmHg e de MRPA ≥ 130/80 mmHg. Sob esta perspectiva, a MRPA é um exame que permite que se faça o diagnóstico de HA verdadeira (PA elevada no consultório e na MRPA), normotensão verdadeira (PA normal no consultório e na MRPA), HA do avental branco (HAB) (PA elevada no consultório e normal na MRPA) e HA mascarada (HM) (PA normal no consultório e elevada na MRPA). O diagnóstico de HM é bastante relevante na prática clínica, pois em termos prognósticos, a HM apresenta um risco cardiovascular maior que a HAB e a normotensão verdadeira. Além disto, a incidência de eventos cardiovasculares na HM é similar ou até superior à da HA verdadeira.

Hypertension is the main contributing factor to cardiovascular diseases, which are the most important cause of death in the world. The lack of proper diagnosis, mainly due to the silent aspect of hypertension, makes the rate of people undergoing treatment low, contributing to the high risk of complications. The measurement of blood pressure (BP) in this context is important not only in the diagnosis, but also in the follow-up of patients with hypertension, and it can be performed casually, in the office, or outside the office, using other methods for this purpose. Home blood pressure monitoring (HBPM) is a method designed to record BP outside the office environment, following a previously established and standardized protocol and has a lower cost than ambulatory blood pressure monitoring (ABPM) According to the current Brazilian hypertension guideline, office BP values ≥ 140/90 mmHg and HBPM values ≥ 130/80 mmHg are considered abnormal. From this perspective, HBPM is a test that allows the diagnosis of true hypertension (high BP in the office and in HMBP), true normotension (normal BP in the office and in the HBPM), white coat hypertension (high BP in the office and normal BP in HBPM) and masked hypertension (normal BP in the office and high in HBPM). The diagnosis of masked hypertension is quite relevant in clinical practice, because this phenotype has greater cardiovascular risk than true normotension and white coat hypertension. On the other hand, the incidence of cardiovascular events is similar or even greater in masked hypertension in comparison with true hypertension.

O essencial do diagnóstico ao tratamento da hipertensão arterial / The essential from diagnosis to treatment of arterial hypertension

A doença hipertensiva é o principal fator de risco para a mortalidade cardiovascular no mundo. Para tentar melhorar esse cenário, podem-se vislumbrar três ações estratégicas: melhorar o acesso aos cuidados em saúde, aumentar a adesão ao tratamento anti-hipertensivo e quebrar os paradigmas da inércia terapêutica. A hipertensão arterial é doença cujo diagnóstico é rápido, de baixo custo e relativamente fácil. Entretanto, apenas uma em cada cinco pessoas hipertensas está com a pressão arterial controlada. Logo, se as metas pressóricas recomendadas não forem atingidas e mantidas, há maior risco de desfechos cardiovasculares ruins. Estratégias de educação em saúde podem acarretar em maior adesão ao tratamento. Para tanto, deve-se incentivar o esclarecimento da população sobre essa doença, fornecendo-lhe informações pertinentes. Além disso, o profissional médico deve estabelecer estratégias para atingir a meta pressórica, para seus pacientes, por meio do tratamento efetivo. As diretrizes médicas se propõem a oferecer as melhores evidências em diagnóstico e tratamento. No entanto, por vezes, podem ser um tanto confusas e até mesmo complexas para serem utilizadas rotineiramente. A fim de tornar mais simples e objetiva a busca de informações, baseadas em evidências científicas atuais, na conduta dos pacientes hipertensos, propõe-se um fluxograma para consulta rápida. Nele, a hipertensão arterial é conduzida desde o diagnóstico até o tratamento

Hypertensive disease is the main risk factor for cardiovascular mortality worldwide. To improve this scenario, three strategic actions can be envisaged: improving access to health care, increasing adherence to antihypertensive treatment, and breaking the paradigms of therapeutic inertia. Hypertension is a disease whose diagnosis is quick, inexpensive, and relatively easy. However, only one in five people with hypertension has controlled blood pressure. Therefore, if the recommended blood pressure goals are not met and maintained, there is an increased risk of poor cardiovascular outcomes. Health education strategies can lead to greater adherence to treatment. Therefore, the population should be informed about this disease, providing them with pertinent information. In addition, the medical professional must establish strategies to reach the blood pressure goal, for their patients, through effective treatment. Medical guidelines purport to provide the best evidence in diagnosis and treatment. However, sometimes they can be quite confusing and even complex to use routinely. To make the search for information, based on current scientific evidence, in the management of hypertensive patients simpler and more objective, a flowchart for quick consultation is proposed. In it, arterial hypertension is conducted from diagnosis to treatment

Desempenho do eletrocardiograma no diagnóstico da hipertrofia ventricular esquerda em hipertensos idosos e muito idosos / Performance of the electrocardiogram in the diagnosis of left ventricular hypertrophy in older and very older hypertensive patients

Resumo Fundamento: A hipertrofia ventricular esquerda (HVE) é um importante fator de risco cardiovascular, independente da hipertensão arterial. Apesar da evolução dos exames de imagem, o eletrocardiograma (ECG) ainda é o mais utilizado na avaliação inicial, porém, com baixa sensibilidade. Objetivo: Avaliar o desempenho dos principais critérios eletrocardiográficos para HVE em indivíduos hipertensos idosos e muito idosos. Métodos: Em coorte de hipertensos foram realizados ECGs e EcoDopplercardiogramas (ECO), e separados em três grupos etários: <60 anos, Grupo I; 60-79 anos Grupo II; e ≥80 anos, Grupo III. Os critérios eletrocardiográficos mais utilizados foram aplicados para o diagnóstico da HVE: Perúgia; Peguero-Lo Presti; Gubner-Ungerleider; Narita; (Rm+Sm) x duração; Cornell voltagem; Cornell voltagem duração; Sokolow-Lyon voltagem; R de aVL ≥11 mm; RaVL duração. Na avaliação do desempenho desses critérios, além da sensibilidade (Sen) e especificidade (Esp), foram analisadas as "Odds Ratios diagnóstico" (DOR). Consideramos p-valor <0,05 para as análises, com testes bi-caudais. Resultados: Em 2.458 pacientes, a HVE estava presente pelo ECO em 781 (31,7%). Nos Grupos I e II, os melhores desempenhos foram para os critérios de Narita, Perúgia, (Rm+Sm) x duração, sem diferenças estatísticas entre eles. No Grupo III (muito idosos) os critérios de Perúgia e (Rm+Sm) x duração tiveram os melhores desempenhos: Perúgia [44,7/89,3; (Sen/Esp)] e (Rm+Sm) duração [39,4%/91,3%; (Sen/Esp), p<0,05)], com os melhores resultados de DOR:6,8. Isto sugere que nessa população de muito idosos esses critérios têm maior poder discriminatório para separar pacientes com HVE. Conclusão: Nos hipertensos muito idosos os critérios eletrocardiográficos de Perúgia e (Rm+Sm) x duração apresentaram os melhores desempenhos diagnósticos para HVE.

Abstract Background: Left ventricular hypertrophy (LVH) is an important cardiovascular risk factor, regardless of arterial hypertension. Despite the evolution of imaging tests, the electrocardiogram (ECG) is still the most used in the initial evaluation, however, with low sensitivity. Objective: To evaluate the performance of the main electrocardiographic criteria for LVH in elderly and very elderly hypertensive individuals. Methods: In a cohort of hypertensive patients, ECGs and doppler echocardiographies (ECHO) were performed and separated into three age groups: <60 years, Group I; 60-79 years Group II; and ≥80 years, Group III. The most used electrocardiographic criteria were applied for the diagnosis of LVH: Perugia; Pegaro-Lo Presti; Gubner-Ungerleider; Narita; (Rm+Sm) x duration; Cornell voltage; Cornell voltage duration; Sokolow-Lyon voltage; R of aVL ≥11 mm; RaVL duration. In evaluating the performance of these criteria, in addition to sensitivity (Sen) and specificity (Esp), the "Diagnostic Odds Ratios" (DOR) were analyzed. We considered p-value <0.05 for the analyses, with two-tailed tests. Results: In 2,458 patients, LVH was present by ECHO in 781 (31.7%). In Groups I and II, the best performances were for the criteria of Narita, Perugia, (Rm+Sm) x duration, with no statistical differences between them. In Group III (very elderly) the Perugia criteria and (Rm+Sm) x duration had the best performances: Perugia [44,7/89.3; (Sen/Esp)] and (Rm+Sm) duration [39.4%/91.3%; (Sen/Esp), p<0.05)], with the best PAIN results:6.8. This suggests that in this very elderly population, these criteria have greater discriminatory power to separate patients with LVH. Conclusion: In very elderly hypertensive patients, the Perugia electrocardiographic criteria and (Rm+Sm) x duration showed the best diagnostic performance for LVH.

Accuracy of Self-Reported Arterial Hypertension in Brazil: Systematic Review and Meta-Analysis

Abstract Background Self-reported hypertension is a useful method to estimate prevalence in the population. However, it is necessary to evaluate its accuracy, in relation to the gold-standard diagnostic methods of the disease. Objectives To estimate combined measures of sensitivity and specificity for self-reported hypertension, using Brazilian validation studies that included gold standard methods. Methods A systematic review and a meta-analysis were developed. Two independent examiners evaluated 1389 and read 113 potentially eligible articles. Since self-reported morbidity is influenced by the cultural and economic characteristics of a population, as well as by its accessibility to medical care, only studies from one country (Brazil) were included. First, a qualitative analysis was performed, evaluating the relationship between self-reported hypertension and its measurement through gold-standard methods. Subsequently, a meta-analysis estimated the combined sensitivity and specificity for the included studies. Due to a high heterogeneity among studies, the meta-analysis used a random effects model. Bias risks were evaluated by the QUADAS-2 protocol and the standard significance level of 10% was used in all modelling. Results Five studies were included in the qualitative analysis; and four had the necessary information for inclusion in the meta-analysis. Patient selection and Index Test (the question allowing for self-reporting) were the domains with the highest risk of bias. In the meta-analysis, combined sensitivity and specificity were 77%(95%CI:[74.5-79.0%]) and 88%(95%CI:[86.3-88.6%]), respectively. Conclusions The analysed studies allowed for the estimation of more reliable values for combined sensitivity and specificity. These values were higher than those usually found in studies with greater population heterogeneity.

Evaluación médico ocupacional como práctica en la identificación de la hipertensión arterial silenciosa / Medical-Occupational Evaluation as a Practice for the Identification of Silent Arterial Hypertension

Introducción: La hipertensión arterial representa un problema de salud que, si no se identifica a tiempo, puede conducir a enfermedades cardiovasculares graves. Objetivo: Describir la evaluación médico ocupacional como práctica en la identificación de la hipertensión arterial silenciosa. Métodos: Estudio descriptivo transversal, retro-prospectivo, con enfoque cuantitativo, diseño no experimental, realizado en una población de 1245 trabajadores que solicitaron los servicios de evaluación médico ocupacional, en una Institución prestadora de Servicios de Salud. La información se obtuvo de las evaluaciones clínicas, realizadas durante el primer trimestre de 2020 y registros condensados en el software de evaluaciones médico ocupacionales del último trimestre de 2019. La medición de la tensión arterial siguió los parámetros establecidos por la guía de la Sociedad Europea de Hipertensión y Cardiología. El índice de masa corporal siguió las orientaciones de la Organización Mundial de la Salud. El análisis de la información fue hecho en hoja de cálculo Excel y el software PAST, mediante estadísticos descriptivos. Resultados: Durante las evaluaciones médico ocupacionales se identificó 22,26 por ciento de trabajadores con cifras tensionales altas, distribuidas de la siguiente manera: 13,97 por ciento normales altas; 5,22 por ciento hipertensión sistólica aislada, 1,28 por ciento hipertensión grado I, 1,44 por ciento hipertensión grado II y 0,32 por ciento hipertensión grado III; 97,9 por ciento manifestó no percibir sintomatología relacionada con hipertensión. Conclusiones: La evaluación médico ocupacional es una práctica apropiada para la identificación de la hipertensión arterial silenciosa, hallazgos que contribuyen favorablemente al fortalecimiento de intervenciones tempranas conducentes a la prevención de complicaciones cardiovasculares, a corto, mediano o largo plazo(AU)

Introduction: Arterial hypertension represents a health concern that, if not identified on time, can lead to serious cardiovascular diseases. Objective: To describe medical-occupational evaluation as a practice in the identification of silent arterial hypertension. Methods: Descriptive, cross-sectional and retroprospective study with a quantitative approach and nonexperimental design carried out in a population of 1245 workers who requested medical-occupational evaluation services from a healthcare institution. The information was obtained from the clinical evaluations carried out during the first trimester of 2020 and the condensed records of the medical-occupational evaluation software in the last trimester of 2019. Blood pressure measurement followed the parameters established in the guidelines of the European Society of Cardiology/European Society of Hypertension. Body mass index followed the guidelines of the World Health Organization. The information analysis was presented in an Excel spreadsheet and the PAST software, using descriptive statistics. Results: During the medical-occupational evaluations, 22.26 percent of the workers with high blood pressure figures were identified: 13.97 percent was normal high, 5.22 percent had isolated systolic hypertension, 1.28 percent had grade I hypertension, 1.44 percent had grade II hypertension, and 0.32 percent had grade III hypertension; while 97.9 percent stated that they did not perceive symptoms related to hypertension. Conclusions: Medical-occupational evaluation is an appropriate practice for the identification of silent arterial hypertension, findings that contribute favorably to strengthening early interventions leading to the prevention of cardiovascular complications, in the short, medium or long terms(AU)

Hipertensos Tratados e Avaliados por Telemonitoramento Residencial da Pressão Arterial. Estudo TeleMRPA / Treated Hypertensive Patients Assessed by Home Blood Pressure Telemonitoring. TeleMRPA Study

Resumo Fundamento: Hipertensos tratados avaliados apenas com a medida casual da pressão arterial (PA) podem estar sujeitos a decisões equivocadas. Objetivos: Avaliar o comportamento da PA pela medida casual e residencial (MRPA), o comportamento das classes de anti-hipertensivos e as prevalências de hipertensão do avental branco (HABNC) e mascarada não-controladas (HMNC). Métodos: Estudo transversal que avaliou pacientes pela plataforma TeleMRPA entre 2017 e 2019. Foram excluídos aqueles sem medicamentos, com 3 ou mais, em uso de espironolactona e alfa-2 agonistas. As variáveis analisadas foram: idade, sexo, índice de massa corporal (IMC), número de medidas válidas da PA, médias da PA sistólica (PAS) e diastólica (PAD) pela medida casual e MRPA, e as classes de anti-hipertensivos. Utilizados os testes t pareado e não pareado e qui-quadrado. Adotado nível de significância de 5%. Resultados: Selecionados 22.446 pacientes, dos quais 6.731 preencheram os critérios, sendo 61,3% do sexo feminino, com idade média de 57,8 (±12,6) anos e IMC médio de 29,0 (±5,1) kg/m2. Os valores médios de PAS e PAD foram 6,6 mmHg (p<0,001) e 4,4 mmHg (p<0,001) maiores na medida casual que na MRPA. As taxas de controle da PA foram de 57,0% pela medida casual e 61,3% pela MRPA (p<0,001), com prevalência de HABNC e HMNC de 15,4% e 11,1%, respectivamente. O bloqueio do sistema renina-angiotensina-aldosterona ocorreu em 74,6% das vezes e 54,8% estavam em monoterapia. Conclusões: O uso da MRPA deve ser considerado no acompanhamento de hipertensos tratados em virtude das elevadas prevalências de HABNC e HMNC. Os anti-hipertensivos tiveram comportamentos distintos nas medidas domiciliares. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

Abstract Background: Hypertensive patients undergoing treatment and assessed only by casual blood pressure (BP) measurement may be subject to mistaken decisions. Objective: To assess BP behavior by measuring its levels at the office (casual) and at home (HBPM), the behavior of different classes of antihypertensive drugs, and the prevalence of uncontrolled white-coat hypertension (UCWCH) and uncontrolled masked hypertension (UCMH). Methods: Cross-sectional study assessing patients who underwent BP monitoring in the TeleMRPA platform between 2017 and 2019. The exclusion criteria were: use of no antihypertensive drug; combined use of 3 or more antihypertensive drugs; and use of spironolactone and alpha-2 agonist. The variables analyzed were: age, sex, body mass index (BMI), number of valid BP measurements, means of systolic and diastolic blood pressure (SBP and DBP, respectively) obtained from HBPM and casual measurement, and the classes of antihypertensive drugs. Paired and unpaired t tests, as well as chi-square test, were used. The 5% significance level was adopted. Results: This study selected 22 446 patients, 6731 of whom met the inclusion criteria [61.3%, female sex; mean age, 57.8 (±12.6) years; mean BMI, 29.0 (±5.1) kg/m2]. Mean SBP and DBP were 6.6 mm Hg (p<0.001) and 4.4 mm Hg (p<0.001) higher in casual measurement than in HBPM. The rates of BP control were 57.0% in casual measurement and 61.3% in HBPM (p<0.001), and the prevalence of UCWCH and UCMH was 15.4% and 11.1%, respectively. Renin-angiotensin-aldosterone system blockade was observed in 74.6% of the patients, and 54.8% were on single-drug therapy. Conclusions: HBPM should be considered for the follow-up of treated hypertensive patients because of the high prevalence of UCWCH and UCMH. Antihypertensive drugs behaved differently in HBPM. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

Evaluation of blood pressure through home monitoring in brazilian primary care: a feasibility study / Avaliação da pressão arterial através da monitorização residencial na atenção básica brasileira: um estudo de viabilidade

Abstract Blood pressure measurements taken in a clinical setting are subject to errors, therefore there are advantages to monitoring blood pressure at home, especially in in patients diagnosed with hypertension. The study describes the feasibility of home monitoring to assess blood pressure in primary care and compares blood pressure measured at home and during a medical consultation. This cross-sectional study was carried out with patients whose used home blood pressure in the morning and evening, thrice for seven consecutive day sat home. Participants included patients older than 18 years with suspected whitecoat hypertension, taking antihypertensives, or those intolerant of ambulatory blood pressure monitoring, and excluded patients who did not follow the protocol, suffered from an irregular heart rate, and pregnant women. Of the 134 patients who participated in the study, 63.3% had altered blood pressure when measured at health facilities and 48% had higher blood pressure at home. The mean difference between the methods was 10.1 mmHg for systolic and 4.3 mmHg for diastolic. The prevalence of whitecoat hypertension was 19.4%. Blood pressure monitoring at home is a practicable strategy in the Brazilian healthcare system.

Resumo A medição da pressão arterial no consultório está sujeita a erros; assim, a monitorização residencial da pressão arterial é utilizada para o monitoramento e diagnóstico da hipertensão. Descrever a viabilidade da monitorização residencial para avaliar a pressão arterial na atenção primária e comparar os valores da pressão arterial através da monitorização residencial e medida de consultório. Estudo transversal realizado com pacientes que utilizaram a monitorização residencial pela manhã e pela noite, em triplicata por sete dias consecutivos em domicílio. Foram incluídos pacientes maiores de 18 anos, com suspeita de hipertensão do avental branco, utilizando anti-hipertensivos ou intolerantes a monitorização ambulatorial. Foram excluídos pacientes que não seguiram o protocolo, aqueles que apresentavam ritmo cardíaco irregular ou mulheres grávidas. 134 pacientes participaram do estudo, 63,3% apresentaram pressão arterial alteradas em consultório e 48% pela monitorização residencial. A diferença média dos métodos foi de 10,1 mmHg para sistólica e 4,3 mmHg para diastólica. A prevalência de hipertensão do avental branco foi 19,4%. A monitorização residencial da pressão arterial no sistema de saúde brasileiro provou ser uma estratégia viável.

Calidad de vida nomotética en enfermos crónicos / Nomothetic Quality of Life in Chronic Patients

Introducción: La calidad de vida relacionada con la salud, como indicador positivo que evalúa el proceso salud-enfermedad, ha ido ganando en uso, a partir del cambio en los patrones de morbilidad, generado por el envejecimiento demográfico. Objetivo: Caracterizar la calidad de vida relacionada con la salud desde la perspectiva nomotética y su relación con variables de personas y tiempo. Métodos: Se realizó un estudio descriptivo-transversal en 200 adultos con diagnóstico de diabetes mellitus, hipertensión arterial o ambas, atendidos en el centro Daniel Álvarez, de Loja quienes cumplían varios criterios. Se calcularon medias y desviaciones típicas, porcentajes, y pruebas de significación como ANOVA, comparación de medias en muestras independientes y Análisis de Tablas de Contingencia, a través de la Razón de Verosimilitud, con un nivel de significación del 5 por ciento. Resultados: El puntaje promedio de la calidad de vida fue de 2,90, sin asociaciones significativas con las variables investigadas (p > 0,05). Las dimensiones física (3,30) y relaciones sociales (3,09) puntuaron por encima, mientras la psicológica (2,71) y el ambiente (2,70) lo hicieron por debajo. Solo la escolaridad, para la dimensión psicológica (p = 0,03) se asoció de manera significativa al puntaje alcanzado por esta. Conclusiones: La calidad de vida relacionada con la salud global, desde una perspectiva nomotética, en los adultos objeto de estudio, mostró un nivel aceptable, no asociada a ninguna de las variables en estudio. Los dominios psicológico y ambiente obtuvieron el peor puntaje; en tanto el físico y las relaciones sociales exhibieron niveles superiores al global(AU)

Introduction: Health-related quality of life, as a positive indicator that evaluates the health-disease process, has been gaining more use, due to the change in morbidity patterns, generated by demographic aging. Objective: To characterize health-related quality of life from the nomothetic perspective and its relationship with variables of people and time. Methods: A descriptive and cross-sectional study was carried out with 200 adults with a diagnosis of diabetes mellitus, hypertension, or both, cared for at Daniel Álvarez center, in Loja, who met several criteria. Means and standard deviations were calculated, together with percentages. Significance tests such as ANOVA, comparison of means in independent samples, and analysis of contingency tables were carried out, using likelihood ratio, with a significance level of 5 percent. Results: The average score for quality of life was 2.90, without significant associations with the variables investigated (0.05). The physical (3.30) and social relations (3.09) dimensions scored higher, while the psychological (2.71) and the environmental (2.70) scored lower. Only schooling, for the psychological dimension (P=0.03), was significantly associated with its achieved score. Conclusions: The global health-related quality of life in the adults under study, from a nomothetic perspective, showed an acceptable level, not associated with any of the variables analyzed. The psychological and environmental domains obtained the worst scores, while the physical and social relations dimensions exhibited levels higher than the global one(AU)

Potential Impact of the New American High Blood Pressure Guidelines on Hypertension Prevalence in a Primary Health Care Unit in Rio de Janeiro - the LapARC Study

Abstract Background The new American Heart Association guidelines for hypertension (HT) proposed a reduction of the diagnostic cut-off point, leading to a substantial increase in the prevalence of HT. Objectives To assess the prevalence of HT determined by the traditional criteria, the AHA criteria, and home blood pressure monitoring (HBPM) in a population of young adults attending a primary healthcare unit, and its association with cardiovascular risk. Methods A cross-sectional population study on adults aged from 20 to 50 years attending a primary healthcare unit, in Rio de Janeiro, Brazil. Sociodemographic and anthropometric data, cardiovascular risk factors, office blood pressure and HBPM were registered. The diagnosis of HT was defined by traditional criteria (office BP ≥ 140 x 90 mmHg) and by the new (AHA) criteria (office BP ≥ 130 x 80 mmHg). Bivariate analysis was used for comparisons between the two diagnostic criteria, and Kappa coefficient was used to assess the agreement in diagnosis between office BP and HBPM. The level of significance adopted was 5% (p<0.05). Results A total of 472 individuals were evaluated (male: 39%; mean age: 38.5 ± 8.7 years). The prevalence of HT was 23.5% and raised to 41.1% with the new AHA criteria. The prevalence of HT using HBPM was 25.5%, but the diagnostic agreement was low (kappa=0.028) with changes in diagnosis in 18% of the cases. Conclusion The prevalence of HT almost doubled with the new AHA diagnostic criteria for HT. HBPM seemed to be an important instrument in HT diagnosis in this population. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

Associations of circulating irisin with 24-h blood pressure, total and visceral fat, and metabolic parameters in young adult hypertensives

ABSTRACT Objective: Some experimental and clinical studies suggest a possible role of irisin in central and peripheral regulation of blood pressure. The purpose of the study was to assess the associations between serum irisin levels, total and visceral fat, metabolic parameters, and blood pressure pattern during 24-h monitoring (ABPM). Materials and methods: In 206 patients with essential hypertension receiving standard antihypertensive treatments, we assessed anthropometric indices; serum irisin, blood lipids (total cholesterol, LDL-C, HDL-C, and triglycerides), glucose and insulin; body composition including lean mass and total, visceral, android and gynoid fat using a dual-energy x-ray absorptiometry; ABPM; and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR). Results: Baseline irisin levels were within normal reference ranges and comparable between the genders. There were no significant correlations of irisin with age, anthropometric variables, lipids, HOMA-IR, body composition, as well as 24-h blood pressure and dipping status. In univariate analysis, age, fat mass and distribution, lipids and glucose, HOMA-IR, and nocturnal blood pressure fall were poor predictors of irisin levels. These neutral associations were not affected by age, gender, and treatment modality. Conclusions: In young adult hypertensives, serum concentration of irisin was within a normal range and not associated with total and regional fat, blood lipids, insulin resistance, as well as 24-h blood pressure and the magnitude of its nocturnal fall.