ABSTRACT
El feocromocitoma y el paraganglioma son tumores neuroendocrinos secretores de catecolaminas. Los feocromocitomas se originan en la médula suprarrenal, mientras que los paragangliomas son extraadrenales. Se describe una serie de casos de niños con diagnóstico anatomopatológico de feocromocitoma o paraganglioma que consultaron en un hospital pediátrico de alta complejidad de Argentina. Se incluyeron 21 pacientes, 14 varones, con una mediana de edad de 11,4 años; 8 casos con feocromocitoma y 13 casos con paraganglioma. Se presentaron con hipertensión arterial 14/21. La mayoría de los paragangliomas tuvieron localización paraaórtica (9/13). Debido a que representan una causa potencialmente curable de hipertensión arterial, la sospecha clínica es muy importante. El diagnóstico temprano y la instauración de un tratamiento antihipertensivo adecuado, que permita afrontar la cirugía con normotensión arterial, aseguran la curación en la mayoría de los casos si la resección tumoral es completa.
Pheochromocytomas and paragangliomas are neuroendocrine tumors producing catecholamines. Pheochromocytomas occur in the adrenal medulla, while paragangliomas are those that occur outside the adrenal gland. Here we describe a case series of children with a pathological diagnosis of pheochromocytoma or paraganglioma who consulted at a tertiary care children's hospital in Argentina. A total of 21 patients (14 males) were included; their median age was 11.4 years; 8 children had pheochromocytoma and 13, paraganglioma. Arterial hypertension was observed in 14/21. Most paragangliomas were para-aortic (9/13). Since they are a potentially curable cause of hypertension, clinical suspicion is very important. An early diagnosis and the initiation of an adequate antihypertensive treatment, which allows the patient to undergo surgery with normal blood pressure, ensure a cure in most cases if tumor resection is complete.
Subject(s)
Humans , Child , Paraganglioma/complications , Paraganglioma/diagnosis , Pheochromocytoma/complications , Pheochromocytoma/diagnosis , Adrenal Gland Neoplasms/diagnosis , Adrenal Gland Neoplasms/therapy , Hypertension/diagnosis , Argentina , HospitalsABSTRACT
Objetivo: Caracterizar o perfil clínico e epidemiológico de gestantes com hiper- tensão, diabetes e obesidade no serviço de pré-natal de alto risco de uma ma- ternidade no norte de Santa Catarina, onde foi realizado este estudo. Métodos: Estudo transversal acerca das características epidemiológicas e clínicas de 174 gestantes maiores de 18 anos em atendimento no pré-natal de alto risco. Resul- tados: As gestantes eram, na maioria (80%), jovens (18 a 35 anos), pardas (24,1%), com ensino médio completo (40,5%) e renda per capita de até um salário míni- mo (58,1%). Os percentuais de hipertensão e diabetes foram mais elevados acima dos 35 anos. Foi elevado o percentual de mulheres obesas (17%) e com diabetes (≈24%), com histórico elevado dessas doenças na família (≈63%). Correlação es- tatisticamente significativa de diabetes com a idade foi encontrada. Verificou- -se também tendência de associação de hipertensão com a idade gestacional e transtornos do sono. Conclusão: Essas condições estão intimamente ligadas com a saúde pré-concepcional, sendo, muitas vezes, modificáveis. O incremento de ações de melhoria da qualidade de vida da mulher em idade reprodutiva é um recurso para a redução desses agravos. Ainda, a precoce identificação deles pelos profissionais que realizam acompanhamento pré-natal pode reduzir a incidência de gestações de alto risco sem acompanhamento especializado.
Objective: This study was conducted to characterize the clinical and epidemiological profile of pregnant women with hypertension, diabetes, and obesity in the high-risk prenatal service of a maternity hospital in northern Santa Catarina. Methods: The present was a cross-sectional study that involved 174 pregnant women over 18 years of age and in high-risk prenatal care. Results: The women were mostly (80%) young (18 to 35 years), brown (24.1%), with complete high school education (40.5%), and per capita income up to a minimum wage (58.1%). The percentages of hypertension and diabetes were higher above 35 years of age. High percentage of obese (17%) and diabetic (≈24%) women were found, most with family history to these diseases (≈63%). Statistically significant correlation was found between dia- betes and age. Hypertension tended to associate with gesta- tional age and sleep disorders. Conclusion: These conditions are intricately linked with preconception health and are, fre- quently, modifiable. The increase of actions to improve the quality of life of women in reproductive age is a strategy to reduce these diseases. Furthermore, the early identification of these by prenatal follow-up professionals may reduce the incidence of high-risk pregnancies without specialized follow-up.
Subject(s)
Humans , Female , Pregnancy , Health Profile , Pregnant Women , Diabetes Mellitus/diagnosis , Hypertension/diagnosis , Obesity/diagnosis , Prenatal Care/methods , Sleep Wake Disorders , Cross-Sectional Studies , Women's Health/statistics & numerical data , Pregnancy, High-RiskABSTRACT
Introduction: Primary hyperaldosteronism is a leading cause of secondary arterial hypertension, affecting approximately 10% to 20% of the hypertensive population worldwide and in Brazil. This condition involves excessive aldosterone production due to factors such as adrenal adenoma, hyperplasia, or, less commonly, adrenal carcinoma and familial hyperaldosteronism. This study reports a case of resistant hypertension secondary to aldosterone-producing adenoma.Clinical Case: A 70-year-old male patient presented with episodes of dizziness, syncope, cramps, and asthenia. His medical history included resistant hypertension for over 30 years, despite treatment with five classes of antihypertensive medications. Additionally, he had a history of dyslipidemia, type 2 diabetes mellitus, non-dialysis chronic renal failure, and obstructive coronary artery disease. Physical examination showed a BMI of 29 kg/m² (overweight), mean blood pressure of 140/90 mmHg (right arm) and 150/100 mmHg (left arm), and palpable nodules in both thyroid lobes, classified as Bethesda V based on aspiration cytopathology. Subsequently, he underwent total thyroidectomy and lymph node dissection. Laboratory tests revealed high plasma aldosterone levels with suppressed renin and an elevated aldosterone-renin ratio, raising suspicion of primary hyperaldosteronism. This diagnosis was confirmed by a computed tomography scan, which identified a 1.2 cm nodule in the right adrenal gland consistent with an adenoma. The patient underwent unilateral laparoscopic adrenalectomy. Two years post-surgery, the patient's blood pressure was well-controlled with three antihypertensive medications, and his blood sugar, aldosterone, and renin levels were normal.Discussion and Conclusion: Most patients undergoing unilateral adrenalectomy for aldosterone-producing adenomas experience significant clinical improvement. Early screening and diag-nosis of primary hyperaldosteronism are crucial for effective management, reducing the risk of complications in the cardiovascular and renal systems (AU)
Introdução: O hiperaldosteronismo primário é a principal causa de hipertensão arterial secundária, com prevalência estimada entre 10% e 20% da população hipertensa mundial e no Brasil. Trata-se de uma condição caracterizada pela produção excessiva de aldosterona, que pode ser causada por adenoma, hiperplasia adrenal ou, mais raramente, carcinoma adrenal e condições hereditárias de hiperaldosteronismo familiar. O objetivo deste estudo é relatar um caso de hipetensão arterial resistente secundária a um adenoma produtor de aldosterona.Caso Clínico: Um paciente do sexo masculino, de 70 anos, apresentou episódios de tontura, síncope, câimbras e astenia. Sua história médica inclui hipertensão arterial resistente por mais de 30 anos, apesar do tratamento com cinco classes de antihipertensivos. O paciente também possui histórico de dislipidemia, diabetes mellitus tipo 2, insuficiência renal crônica não dialítica e coronariopatia obstrutiva. O exame físico revelou um IMC de 29 kg/m² (sobrepeso), pressão arterial média de 140/90 mmHg (braço direito) e 150/100 mmHg (braço esquerdo), além de nódulos palpáveis nos lobos direito e esquerdo da tireoide, classificados como Bethesda V em citopatologia aspirativa. Foi realizada, então, tireoidectomia total e esvaziamento ganglionar.Os exames laboratoriais mostraram níveis elevados de aldosterona plasmática, com renina suprimida e uma elevada relação aldosterona-renina, o que levantou a suspeita de hiperaldoste-ronismo primário. Esta suspeita foi confirmada por tomografia computadorizada, que revelou um nódulo de 1,2 cm na glândula suprarrenal direita, compatível com adenoma. O paciente foi submetido a uma suprarrenalectomia unilateral por laparoscopia. Dois anos após a cirurgia da adrenal esquerda, o paciente apresentava níveis pressóricos controlados com o uso de três clas-ses de anti-hipertensivos, e houve normalização dos níveis de potássio, aldosterona e renina.Discussão e Conclusão: A maioria dos pacientes submetidos a adrenalectomia unilateral por adenoma produtor de aldosterona experimenta uma melhora clínica significativa. O rastreamento e diagnóstico precoce são essenciais para o manejo eficaz do hiperaldosteronismo primário, ajudando a reduzir complicações cardiovasculares e renais (AU)
Subject(s)
Humans , Male , Aged , Delayed Diagnosis , Hyperaldosteronism/diagnosis , Hypertension/diagnosis , Antihypertensive AgentsABSTRACT
Objetivo: evaluar el efecto de la intervención educativa que realizan los enfermeros para controlar la presión arterial en personas con hipertensión arterial, en comparación con los cuidados habituales. Método: revisión sistemática con metaanálisis de ensayos clínicos aleatorizados realizada en seis bases de datos. Se incluyeron estudios en los cuales el enfermero llevó a cabo la intervención educativa en la persona con hipertensión arterial. El riesgo de sesgo se evaluó mediante la herramienta Risk of Bias Tool, el metaanálisis se hizo utilizando el software Review Manager y la certeza de la evidencia se calculó usando el sistema Grading of Recommendations Assessment, Development and Evaluation. Resultados: se encontraron 1692 estudios revisados por pares y se incluyeron ocho artículos en el metaanálisis. El metaanálisis se calculó para el resultado presión arterial sistólica y presión arterial diastólica, subagrupados por tiempo y tipo de implementación de la intervención. Para la intervención educativa presencial, realizada d forma individual combinada con actividad grupal, la estimativa del efecto fue -12,41 mmHg (Intervalo de Confianza 95%, -16,91 a -7,91, p<0,00001) para la presión sistólica y -5,40 mmHg (Intervalo 95% Confianza, -7,98 a -2,82, p<0,0001) para la presión diastólica, con certeza de evidencia alta. Conclusión: a intervención educativa realizada por el enfermero, de forma individual combinada con la actividad grupal, tiene efecto clínico y estadísticamente significativo. Registro PROSPERO: CRD42021282707.
Objetivo: to assess the effect of an educational intervention performed by nurses for blood pressure control in people with arterial hypertension, when compared to usual care. Método: a systematic review with meta-analysis of randomized clinical trials, conducted in six databases. The studies included were those in which an educational intervention was performed by nurses on people with arterial hypertension. The risk of bias was assessed by means of the Risk of Bias Tool, the meta-analysis was performed in the Review Manager software and certainty of the evidence was calculated in the Grading of Recommendations Assessment, Development and Evaluation system. Resultados: a total of 1,692 studies were found, which were peer-reviewed, including eight of them in the meta-analysis. The meta-analysis was calculated for the "systolic blood pressure" and diastolic blood pressure" outcomes, in subgroups by time and by intervention performance type. For the in-person educational intervention, performed individually combined with a group activity, the effect estimate was -12.41 mmHg (95% Confidence Interval: from -16.91 to -7.91, p<0,00001) for systolic pressure and -5.40 mmHg (95% Confidence Interval: from -7.98 to -2.82, p<0,00001) for diastolic pressure, with high certainty of evidence. Conclusión: the educational intervention performed by nurses, individually and combined with a group activity, presents a statistically significant clinical effect. PROSPERO registration No.: CRD42021282707.
Objetivo: avaliar o efeito da intervenção educativa realizada por enfermeiros para controle da pressão arterial em pessoas com hipertensão arterial, comparada com cuidado habitual. Método: revisão sistemática com metanálise de ensaios clínicos randomizados realizada em seis bases de dados. Foram incluídos estudos em que a intervenção educativa foi realizada pelo enfermeiro à pessoa com hipertensão arterial. O risco de viés foi avaliado pela Risk of Bias Tool, a metanálise no software Review Manager e a certeza da evidência no sistema Grading of Recommendations Assessment, Development and Evaluation. Resultados: foram encontrados 1692 estudos, revisados por pares, e oito artigos foram incluídos na metanálise. A metanálise foi calculada para o desfecho pressão arterial sistólica e pressão arterial diastólica, em subgrupo por tempo e por tipo de execução da intervenção. Para a intervenção educativa presencial, realizada de modo individual combinada com atividade de grupo, a estimativa de efeito foi de -12.41 mmHg (Intervalo de Confiança 95%, -16.91 a -7.91, p<0.00001) para pressão arterial sistólica e -5.40 mmHg (Intervalo de Confiança 95%, -7.98 a -2.82, p<0.0001) para pressão arterial diastólica, com certeza da evidência alta. Conclusão: a intervenção educativa realizada pelo enfermeiro, de modo individual combinada com atividade de grupo, apresenta efeito clínico e estatisticamente significativo. Registro PROSPERO: CRD42021282707.
Subject(s)
Blood Pressure/physiology , Health Education , Hypertension/diagnosis , NursesABSTRACT
La hipertensión arterial es un problema frecuente de salud pública, puede ser de etiología primaria o secundaria. La hipertensión arterial secundaria debida a una causa se puede tratar con intervenciones específicas. Con el propósito de identificar las causas y mecanismos más frecuentes, se realizó una búsqueda de artículos en Google Académico y Pubmed. Se encontró que podemos sospecharla en pacientes menores de 30 años debutando con hipertensión arterial sin factores de riesgo evidentes, datos clínicos, laboratoriales y estudios de imagen compatibles con causas renales o endocrinas de hipertensión secundaria, datos sugestivos de apnea del sueño. Debemos obtener una historia clínica y realizar un examen físico buscando pistas clínicas que nos orienten, para realizar estudios necesarios y llegar a un diagnóstico oportuno...(AU)
Subject(s)
Humans , Databases, Bibliographic , Hypertension/diagnosis , Public Health , PeriodicalABSTRACT
El hiperaldosteronismo primario es una condición caracterizada por una producción excesiva de aldosterona, que no depende del sistema renina-angiotensina-aldosterona. Una de las manifestaciones clínicas más frecuentes es la hipertensión arterial resistente al tratamiento convencional. Se estima que aproximadamente el 10% de los casos de hipertensión secundaria están asociados con el hiperaldosteronismo primario, siendo aproximadamente el 50% de estos casos causados por un adenoma suprarrenal. Los tumores de las glándulas suprarrenales presentan desafíos para el anestesiólogo, requiriendo una evaluación preoperatoria minuciosa, un adecuado control hemodinámico durante el perioperatorio. El objetivo del presente caso clínico es reportar la utilización de la anestesia total intravenosa en una cirugía laparoscópica de tumor suprarrenal en un paciente con hiperaldosteronismo primario. Se busca describir la técnica anestésica empleada, evaluar la respuesta hemodinámica del paciente durante el procedimiento y analizar los resultados obtenidos en términos de estabilidad cardiovascular, control del dolor y prevención de complicaciones postoperatorias. Se presenta el caso de una paciente de 28 años con hipertensión arterial sistémica de 4 años de evolución, que ha sido difícil de controlar. Debido a la sospecha de hiperaldosteronismo primario, se llevó a cabo la prueba de cociente aldosterona/actividad de renina plasmática, la cual mostró niveles elevados. Como parte del manejo, se realizó una adrenalectomía izquierda laparoscópica bajo anestesia total intravenosa...(AU)
Subject(s)
Humans , Female , Hypertension/diagnosis , Anesthesia, Intravenous/methods , Renin , Hyperaldosteronism/diagnosisABSTRACT
Introdução: O diabete mellitus (DM) e a hipertensão arterial sistêmica (HAS) são doenças crônicas não-transmissíveis que se associam a alto risco de mortalidade. Objetivo: Analisar o perfil laboratorial de pessoas com DM e HAS acompanhados na atenção primária à saúde. Método: Estudo descritivo e transversal, com a amostra de 345 pessoas em acompanhamento pelas estratégias de saúde da família pertencentes a duas Unidades Básicas de Saúde da zona urbana do município de Santarém, Pará, Brasil. Os participantes foram divididos em quatro grupos conforme diagnóstico: HAS; DM; ambas (DM-HAS); ou nenhuma (SEM). Foram coletadas informações socioeconômicas e clínicas dos participantes, com posterior coleta de sangue para as variáveis bioquímicas. Para a análise de dados foi realizada a estatística descritiva e inferencial, adotando-se significância de p<0,05. Resultados: Em todos os grupos predominaram participantes do sexo feminino, casados, pardos, com renda até dois salários, com 4-7 anos de estudo, não tabagistas e não estilistas. Em relação ao SEM, o DM se associou com valores alterados para glicose (p<0,0001), HDL-c (p=0,0481), ureia (p=0,0252), creatinina (p=0,0006) e hemoglobina (p=0,0024). Já o DM-HAS se associou com a presença de alteração para glicose (p<0,0001), ureia (p=0,0009), creatinina (p=0,0059) e taxa de filtração glomerular (p=0,0048). Conclusão: Conclui-se, conforme o método proposto, que a presença da DM e/ou HAS são capazes de modificar o perfil bioquímico de maneira negativa, bem como se ressalta a importância do acompanhamento desta pessoa pela atenção primária à saúde, visto que algumas pessoas apresentaram alterações bioquímicas que chamam atenção e não estão em acompanhamento (AU).
Introduction:Diabetes mellitus (DM) and systemic arterial hypertension (SAH) are chronic non-communicable diseases that are associated with a high risk of mortality. Objective: To analyze the laboratory profile of people with DM and SAH followed up in primary health care. Methods: Descriptive and cross-sectional study, with a sample of 345 people being monitored by family health strategies belonging to two Basic Health Units in the urban area of the city of Santarém, Pará, Brazil. Participants were divided into four groups according to their diagnosis: SAH; DM; both (DM-SAH); or neither (NO). Socioeconomic and clinical information was collected from the participants, with subsequent blood collection for biochemical variables. Descriptive and inferential statistics were used for data analysis, adopting a significance of p<0.05. Results: In all groups, female participants, married, brown, with an income of up to two salaries, 4-7 years of schooling, non-smokers, and non-alcoholics predominated. Compared to NO, DM was associated with altered values for glucose (p<0.001), HDL-c (p=0.048), urea (p=0.025), creatinine (p<0.001), and hemoglobin (p=0.002). DM-SAH was associated with the presence of alterations in glucose (p<0.001), urea (p<0.001), creatinine (p=0.005), and glomerular filtration rate (p=0.004). Conclusion: In conclusion, the results using the proposed method indicate that the presence of DM and/or SAH is able to negatively modify the biochemical profile. In addition, the importance of monitoring this population in primary health care was demonstrated, since some people presented potentially worrying biochemical alterations that are not being followed up (AU).
Subject(s)
Humans , Primary Health Care , Biochemical Phenomena , Health Status Indicators , Diabetes Mellitus/diagnosis , Hypertension/diagnosisABSTRACT
O objetivo deste estudo foi analisar as características clínicas e a qualidade de vida (QV) de pessoas com hipertensão e/ou diabetes acompanhadas pela Atenção Primária à Saúde em três municípios do Ceará. Estudo transversal, realizado com 384 pessoas com hipertensão e/ou diabetes. Na coleta de dados, realizou-se levantamento de dados clínicos e aplicação do questionário de avaliação da QV, Short Form-36. Procedeu-se análise descritiva e inferencial pelo Software R, realizados os testes de Kruskall-Wallis e de Mann-Whitney. Houve predomínio do sexo feminino com ≥ 60 anos. Houve diferença significativa entre pressão arterial sistólica (p<0,005) e glicemia pós-prandial (p<0,001) por grupos de diagnósticos. Na QV houve diferença entre os sexos. Obtiveram maiores escores os domínios aspectos sociais (87,5) e saúde mental (72); e menores escores: limitação por aspectos físicos (25) e emocionais (33,3). Pessoas com os diagnósticos em associação apresentam prejuízo, nos domínios capacidade física (p<0,01), limitações por aspectos físicos (p<0,01) e emocionais (p<0,001). Concluiu-se que as características clínicas, diagnósticos em associação e seus níveis glicêmicos e pressóricos, impactam na QV.
The objective was to analyze the clinical characteristics and quality of life (QoL) of people with hypertension and/or diabetes monitored by Primary Health Care in three municipalities in Ceará. A cross-sectional study, carried out with 384 people with hypertension and/or diabetes. During data collection, clinical data were collected and the QoLassessment questionnaire, Short Form-36, was applied. A descriptive and inferential analysis was performed using the R Software, using the Kruskal-Wallis and Mann-Whitney tests. There was a predominance of females aged ≥ 60 years. There was a significant difference between systolic blood pressure (p<0.005) and postprandial glucose (p<0.001) by diagnostic groups. In QoL, there was a difference between the sexes. The domains social aspects (87.5) and mental health (72) obtained higher scores; and lower scores: limitation due to physical (25) and emotional (33.3) aspects. People with the diagnoses in association present impairment in the physical capacity (p<0.01), role physical (p<0.01) role emotional (p<0.001). It was concluded that the clinical characteristics, diagnoses in association and their glycemic and blood pressure levels, impact QoL
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Primary Health Care , Diabetes Mellitus , Hypertension , Quality of Life , Health Strategies , Diabetes Mellitus/diagnosis , Hypertension/diagnosisABSTRACT
Hypertension is the primary disease that endangers human health. A convenient and accurate blood pressure measurement method can help to prevent the hypertension. This paper proposed a continuous blood pressure measurement method based on facial video signal. Firstly, color distortion filtering and independent component analysis were used to extract the video pulse wave of the region of interest in the facial video signal, and the multi-dimensional feature extraction of the pulse wave was preformed based on the time-frequency domain and physiological principles; Secondly, an integrated feature selection method was designed to extract the universal optimal feature subset; After that, we compared the single person blood pressure measurement models established by Elman neural network based on particle swarm optimization, support vector machine (SVM) and deep belief network; Finally, we used SVM algorithm to build a general blood pressure prediction model, which was compared and evaluated with the real blood pressure value. The experimental results showed that the blood pressure measurement results based on facial video were in good agreement with the standard blood pressure values. Comparing the estimated blood pressure from the video with standard blood pressure value, the mean absolute error (MAE) of systolic blood pressure was 4.9 mm Hg with a standard deviation (STD) of 5.9 mm Hg, and the MAE of diastolic blood pressure was 4.6 mm Hg with a STD of 5.0 mm Hg, which met the AAMI standards. The non-contact blood pressure measurement method based on video stream proposed in this paper can be used for blood pressure measurement.
Subject(s)
Humans , Blood Pressure/physiology , Blood Pressure Determination/methods , Algorithms , Hypertension/diagnosis , Sexually Transmitted DiseasesABSTRACT
Objective: To explore the percentage of in-use electronic sphygmomanometers independently validated clinically in China. Methods: We conducted a cross-sectional survey and Beijing, Shenzhen, Shijiazhuang, Datong, and Shihezi were selected according to the geographical location and economic level. In each site, one tertiary hospital, two community health centers, and 20 families with electronic sphygmomanometers in use were chosen. The information of electronic sphygmomanometers including brand, model, manufacturer and production date were obtained by the trained staff. Ten electronic sphygmomanometers from each hospital, five electronic sphygmomanometers from each community health center, and one electronic sphygmomanometer from each family were surveyed, and the user's subjective judgment results and judgment basis on the accuracy of the electronic sphygmomanometer measurement were collected. We searched six registration websites (Medaval, Stride BP, dabl Educational Trust, British and Irish Hypertension Society, American Medical Association and Hypertension Canada) and two research databases (PubMed and CNKI) for the clinical validation status of each electronic sphygmomanometer. Results: A total of 200 electronic sphygmomanometers were investigated in this study, of which only 29.0% (58/200) passed independent clinical validation. When stratified by users, the percentage of being clinical validated was 46.0% (23/50) for electronic sphygmomanometers in hospitals, 42.0% (21/50) for those in community health centers and 14.0% (14/100) for those in home use, respectively, and the proportions between the three groups were significantly difference (P<0.001). Doctors in tertiary hospitals and community health service centers judged the accuracy of electronic sphygmomanometers mainly on the basis of "regular correction" (41.0% (41/100)) and "comparison with other electronic sphygmomanometers" (20.0% (20/100)), while among home users, 41.0% (41/100) were not clear about the accuracy of electronic sphygmomanometers, and 40.0% (40/100) made the judgment by "comparison with the devices in hospitals". Conclusion: The clinical validation of in-use electronic sphygmomanometers in China is low. Most of users, including healthcare professionals, are not aware of clinical validation of electronic sphygmomanometers.
Subject(s)
Humans , Blood Pressure Determination , Cross-Sectional Studies , Sphygmomanometers , Hypertension/diagnosis , China , Electronics , Blood PressureABSTRACT
Objective: To assess the clinical features and relative factors of left ventricular hypertrophy (LVH) in children with primary hypertension. Methods: In this retrospective cohort study, 430 children diagnosed with primary hypertension in Children's Hospital, Capital Institute of Pediatrics from January 2019 to September 2022 were enrolled. Their clinical data was analyzed and LVH was assessed by echocardiography. According to left ventricular geometry, these children were assigned to the LVH group and normal geometry group. General conditions, laboratory indicators and ambulatory blood pressure parameters between two groups were compared by independent sample t-test or Mann-Whitney U test. Spearman correlation coefficient was used to analyze the correlation between LVH and clinical indicators including blood pressure, biochemical and metabolic indicators. The independent risk factors of LVH were analyzed by multivariable logistic regression. The receiver operating characteristic (ROC) curve was used to explore the value of risk factors in the diagnosis of LVH. Results: Among the 430 children with primary hypertension, 342 (79.5%) were males and 88 (20.5%) females. Their age was (12.6±2.3) years, and 123 children (28.6%) of them had LVH. Body mass index (BMI) ((30.0±5.2) vs. (26.2±4.3) kg/m2), ratio of stage 2 hypertension (75.6% (93/123) vs. 59.6% (183/307)), 24-hour systolic blood pressure (24 h SBP)((131±10) vs. (128±10) mmHg,1 mmHg=0.133 kPa), daytime systolic blood pressure (SBP) ((135±11) vs. (131±11) mmHg), nighttime SBP ((128±11) vs. (123±10) mmHg), cholesterol level ((4.0±0.7) vs. (3.9±0.7) mmol/L), serum uric acid level ((447±81) vs. (426±91) μmol/L) and incidence of hyperinsulinemia (69.9% (86/123) vs.59.0% (181/307)) were significantly elevated in the LVH group compared with those in the normal geometry group (all P<0.05). There were more patients with a disease course over 5 years in the LVH group than in the normal geometry group, with a statistically significant difference (χ2=8.90,P=0.031). Spearman correlation analysis showed that BMI, 24 h SBP, daytime SBP, nighttime SBP, triglyceride, uric acid, and serum sodium level were positively correlated with LVMI (r=0.43, 0.20, 0.18, 0.18, 0.18, 0.16, and 0.12, all P<0.05). BMI, hyperinsulinemia, and cholesterol level were positively correlated with relative wall thickness (RWT) (r=0.22, 0.12, and 0.16, all P<0.05). The multivariate logistic regression analysis showed that BMI (OR=1.17, 95%CI 1.10-1.25) and 24 h SBP (OR=1.04, 95%CI 1.01-1.08) were the independent risk factors for LVH (both P<0.05). The area under the receiver operator characteristic curve, combined with BMI and 24 h SBP, was 0.72 (95%CI 0.67-0.77, P<0.05), with a sensitivity and specificity of 71.5% and 64.8%, respectively. Conclusions: BMI and 24 h SBP are the independent risk factors for LVH in children with primary hypertension, and the combination of BMI and 24 h SBP has an acceptable diagnostic value for LVH. Early monitoring of these indexes is necessary to predict preclinical cardiac damage.
Subject(s)
Male , Female , Humans , Child , Adolescent , Hypertension/diagnosis , Hypertrophy, Left Ventricular/etiology , Uric Acid , Blood Pressure Monitoring, Ambulatory , Retrospective Studies , Blood Pressure/physiology , Risk Factors , Essential Hypertension , Hyperinsulinism , CholesterolABSTRACT
Introducción: la presión arterial elevada es el principal factor de riesgo de enfermedad global. En la República Dominicana el 31 % de la población padece de hipertensión arterial (HTA) y de este, un 60 % lleva tratamiento médico. Objetivo: determinar los niveles tensionales en individuos no hipertensos entre 18-65 años en la comunidad de Pizarrete Abajo, durante el período agosto-septiembre 2018. Metodología: estudio prospectivo, descriptivo y de corte longitudinal, en el que se analizaron 85 individuos que residen en la comunidad de Pizarrete Abajo, de los cuales 44 resultaron con niveles tensionales alterados. Resultados: el 51.7 % de los encuestados presentó niveles de tensión arterial alterados, sin haber sido anteriormente diagnosticado con hipertensión arterial. Un 24 % de las personas mostró niveles alterados una semana después de la primera toma de presión arterial. Conclusiones: en una muestra de 85 personas se encontraron niveles tensionales alterados en 44 individuos. Se procedió a una segunda toma de presión arterial una semana después de la primera y se observó que un 56.8 % correspondió a valores tensionales elevados, un 20.4 % a valores de HTA estadio 1 y un 18.1 % a valores de HTA estadio 2.
Introduction: High blood pressure is the main risk factor for global disease. In the Dominican Republic, 31% of the population suffers from arterial hypertension (HTN) and of these, 60% have medical treatment. Objective: To determine blood pressure levels in non-hypertensive individuals between 18-65 years of age in the community of Pizarrete Abajo during the period of August - September 2018. Methodology: Prospective, descriptive, and longitudinal study in which 85 individuals residing in the community of Pizarrete Abajo were analyzed, of which 44 resulted in altered blood pressure levels. Results: 51.7% of the individuals presented altered blood pressure levels without previously being diagnosed with hypertension. 24% of people showed altered levels one week after the first blood pressure measurement. Conclusions: In a sample of 85 people, altered blood pressure levels were found in 44 individuals. A second blood pressure measurement was carried out one week after the first measurement and it was observed that 56.8% corresponded to high blood pressure values, 20.4% corresponded to stage 1 HTN levels, and 18.1% corresponded to stage 2 HTN levels.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Mass Screening , Hypertension/diagnosis , Risk Factors , Dominican Republic , Sedentary BehaviorABSTRACT
Resumo Introdução O monitoramento da hipertensão arterial sistêmica (HAS) é realizado no Brasil, fundamentado no autorrelato, por meio do sistema VIGITEL. Tendo em vista lacunas acerca desse agravo em populações de trabalhadores, estas devem ser alvo da ação ampliada para o seu diagnóstico epidemiológico. Objetivo Testar a validade de critério do autorrelato de HAS, comparando-o com medidas aferidas de pressão arterial (PA). Método Realizou-se estudo de corte transversal com amostra aleatória do universo de 1.561 trabalhadores de um serviço judiciário na Bahia. Calcularam-se sensibilidade, especificidade, valores preditivos e razões de probabilidade para o autorrelato de HAS, comparando-os com a aferição direta da PA, medida de referência. O diagnóstico de HAS foi a média de duas aferições com PA sistólica ≥ 140 mmHg, e/ou PA diastólica ≥ 90 mmHg, e/ou uso regular de anti-hipertensivos. Resultados Em amostra de 391 trabalhadores, verificou-se sensibilidade de 66,4% (57,1-74,6%), especificidade de 87,9% (83,2-91,4%), valor preditivo positivo de 70,5% (61,1-78,6%), valor preditivo negativo de 85,7% (80,9-89,4%), razões de probabilidade positiva e negativa de 5,5 (3,88-7,72) e de 0,4 (0,30-0,49), respectivamente. Conclusão Este estudo evidenciou o autorrelato como medida válida para o diagnóstico epidemiológico da HAS entre trabalhadores, recomendando seu uso. No entanto, esta validade depende do diagnóstico prévio do agravo.
Abstract Background Monitoring of hypertension, based on self-report, has been performed in Brazil through VIGITEL. In view of the gaps about this problem in worker populations, these should be the targets of the expanded action of epidemiological diagnosis of hypertension. Objective To test the validity of hypertension self-report in comparison to blood pressure (BP) measurements. Method A cross-sectional study was conducted on a random sample of 1561 workers from a Judicial Service in Bahia. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for the hypertension self-report in comparison with direct BP measurement (reference). Hypertensive cases presented the mean of two BP measurements, with systolic BP ≥ 140 mmHg, and/or diastolic BP ≥ 90 mmHg and/or regular use of antihypertensive drugs. Results In a sample of 391 workers, there was a sensitivity of 66.4% (57.1-74.6%), a specificity of 87.9% (83.2-91.4%), a positive predictive value of 70.5% (61.1- 78.6%), a negative predictive value of 85.7% (80.9-89.4%), a positive and negative likelihood ratio of 5.5 (3.88-7.72) and 0.4 (0.30-0.49) respectively. Conclusion This study showed self-report as a valid measure to implement the epidemiological diagnosis of hypertension among workers, recommending its use. However, its validity depends on the previous diagnosis.
Subject(s)
Self Report , Hypertension/diagnosis , Hypertension/epidemiologyABSTRACT
A cada nova edição de diretrizes, algumas recomendações se consolidam e outras surgem, à luz de novas evidências, mudando comportamentos, entendimentos e trazendo novas possibilidades e desafios. A nova Diretriz da Sociedade Europeia de Hipertensão (ESH) de 2023 apresenta-se coerente com outras que foram publicados na última década. Ao mesmo tempo em que se mostra conservadora em alguns tópicos, avança de maneira inovadora em outros pontos sensíveis. Embora ampla e abrangente, percebe-se que o foco principal converge para alguns poucos e importantes objetivos. A Diretriz da ESH 2023 propõe como objetivos centrais: 1. Determinação incansável para que se atinja a meta pressórica recomendada; 2. Atenção máxima contra a inércia terapêutica; 3. Usar de múltiplas estratégias para o melhor engajamento do paciente ao tratamento. Além disso, traz recomendações importantes nas áreas de mecanismos fisiopatológicos, diagnóstico, tratamento, acompanhamento e destaques em situações especiais. Logo abaixo, destaco alguns aspectos que considero relevante (AU).
With each new edition of guidelines, some recommendations are consolidated, and others emerge in the light of new evidence, changing behaviors and understandings and bringing new possibilities and challenges. The new 2023 European Society of Hypertension (ESH) Guidelines are consistent with others published in the last decade. While being conservative on some topics, it advances in an innovative way on other sensitive points. Although broad and comprehensive, the focus converges on a few important objectives. The ESH 2023 Guideline proposes as central objectives: 1. Tireless determination to reach the recommended blood pressure goal. 2. Maximum attention against therapeutic inertia. 3. Using multiple strategies for better patient engagement with treatment. In addition, it brings important recommendations in the areas of pathophysiological mechanisms, diagnosis, treatment, follow-up, and highlights in special situations. Below, I highlight some aspects that I consider relevant
Subject(s)
Humans , Hypertension/diagnosis , Hypertension/drug therapyABSTRACT
RESUMO O objetivo deste estudo foi compreender as concepções de qualidade de vida de idosos portadores de hipertensão arterial sistêmica e diabetes mellitus tipo II. Trata-se de um estudo exploratório-descritivo de abordagem qualitativa, e a estratégia de coleta de dados foi a técnica de Grupo Focal. Os dados foram analisados usando o programa de análise qualitativa - QDA miner e interpretados através da análise de conteúdo, proposta por Bardin. Os dados revelaram duas categorias: 'Concepções de Qualidade de Vida', que aponta para os elementos que atravessam a compreensão que os idosos têm da qualidade de vida e 'Relação entre Qualidade de vida e doença crônica', como a vivência da doença crônica está associada à qualidade de vida. Os dados indicam que as concepções de qualidade de vida de idosos com hipertensão arterial e diabetes mellitus passam pelo processo de convivência com a doença crônica, enfatizando a importância de fatores subjetivos, especialmente os recursos psicológicos e sociais dos idosos, que auxiliam no enfrentamento dos efeitos negativos das condições crônicas que interferem na qualidade de vida.
RESUMEN El objetivo de este estudio fue comprender las concepciones de cualidad de vida de ancianos con hipertensión arterial y diabetes mellitus. Se trata de un estudio exploratorio-descriptivo de enfoque cual itativo y la estrategia para la recolección de datos fue la técnica de Grupo Focal. Los datos se analizaron usando el programa de análisis cualitativo-QDA miner e interpretados a través del análisis de contenidos propuesta por Bardin. Los datos revelaron dos categorías: "'concepciones de calidad de vida", ', que señala los elementos que pasan por la comprensión que los ancianos tienen de calidad de vida y "'la relación calidad de vida y enfermedad crónica" ' - cómo la experiencia de la enfermedad crónicas se asocia con la calidad de vida. Los datos indicaron que las concepciones de cualidad de vida de ancianos con hipertensión arterial y diabetes mellitus pasan por el proceso de convivencia con la enfermedad crónica enfatizando la importancia de factores subjetivos especialmente los recursos psicológicos y sociales de los ancianos que ayudan en el enfrentamiento de los efectos negativos de las condiciones crónicas que interfieren en la cualidad de vida.
ABSTRACT The aim of this study was to understand the quality of life concepts in elderly people who suffers from arterial hypertension and diabetes mellitus. It is a descriptive and exploratory study with qualitative approach, the data collection strategy was Focus Group Interviews. The software QDA Miner was used for qualitative data analysis and the Content Analysis Method proposed by Bardin was used for data interpretation. The data had disclosed two categories: 'concepts of quality of life', pointing to the elements that go through the understanding that the elderly have of the quality of life, and 'relation between quality of life andchronic illness' - how the experience of chronic disease is associated with quality of life. Data had indicated that the quality of life concepts in this population are related to the way they live with the chronic illness. The subjective factors are very important concerning the elderly people life with the chronic illness, mainly their psychological and social resources, that help them to fight the negative effects of chronic illness conditions in the quality of life.
Subject(s)
Humans , Male , Female , Aged , Quality of Life/psychology , Aged/psychology , Diabetes Mellitus/diagnosis , Hypertension/diagnosis , Aging/physiology , Chronic Disease , Focus Groups/methods , Resilience, PsychologicalSubject(s)
Humans , Male , Female , Aged , Masked Hypertension , Hypertension/diagnosis , Hypertension/drug therapy , Prognosis , Blood Pressure , Blood Pressure Monitoring, AmbulatoryABSTRACT
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)
Subject(s)
Risk Factors , Hypertension/diagnosis , Life Style , Tobacco Use Disorder , Brain Diseases , Prevalence , Alcoholism , Heart Diseases , Kidney Diseases , ObesityABSTRACT
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.
Subject(s)
Humans , Male , Adult , Cardiovascular Diseases/diagnosis , Hypertension/diagnosis , Hypertension/drug therapy , Blood Pressure Determination , Prevalence , Black People , Hypertension/complications , Hypertension/physiopathology , Hypertension/epidemiology , Antihypertensive AgentsABSTRACT
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)