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1.
Más Vita ; 3(1): 18-31, mar. 2021. tab, graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1253305

ABSTRACT

La hipertensión arterial es la enfermedad crónica más frecuente, la importancia de controlar esta enfermedad radica en que no presenta síntomas y generalmente es diagnosticada cuando aparecen complicaciones que repercuten negativamente en la esperanza y calidad de vida de quien la padece. Siendo la adherencia terapéutica un elemento clave en el control de la enfermedad y, también, de los principales factores para de esta manera prevenir el riesgo cardiovascular y una muerte prematura. Objetivo: Desarrollar y validar un instrumento para determinar los factores que influyen en la adherencia terapéutica del paciente hipertenso. Materiales y métodos: Se realizó un estudio cuantitativo-cualitativo, de cohorte transversal, tipo exploratoria, descriptivo, de diseño no experimental. Utilizando una encuesta y una entrevista de saturación o a profundidad. La validación del instrumento se realizó mediante juicio de expertos y un plan piloto de 20 individuos para la cuantitativa y dos personas hipertensas en la cualitativa, escogidas por conveniencia. Resultados: Según juicio de expertos el instrumento cuantitativo con 19 ítems tiene 97.2 % de confiabilidad y el 96.6% de confiabilidad en el instrumento cualitativo constituido con tres categorías. El alfa de Cronbach es 0.811 lo cual indica un buen nivel de fiabilidad y correlación entre los ítems del cuestionario. Conclusiones: Se pone a disposición de los profesionales de la salud un instrumento válido y confiable, con 7 dimensiones y 19 ítems, siendo prometedor para determinar los factores que influyen en la adherencia terapéutica y medir el grado de adherencia terapéutica en pacientes con hipertensión arterial(AU)


Arterial hypertension is the most common chronic disease, the importance of controlling this disease lies in the fact that it has no symptoms and is generally diagnosed when complications appear that have a negative impact on the life expectancy and quality of life of the sufferer. Adherence to treatment is a key element in the control of the disease and also one of the main factors in preventing cardiovascular risk and premature death. Objective: To develop and validate an instrument to determine the factors that influence therapeutic adherence in hypertensive patients. Materials and methods: A quantitative-qualitative, cross-sectional cohort, exploratory, descriptive, non-experimental design study was carried out. A survey and a saturation or in-depth interview were used. The validation of the instrument was carried out by means of expert judgment and a pilot plan of 20 individuals for the quantitative and two hypertensive persons in the qualitative, chosen by convenience. The Results: According to expert judgment, the quantitative instrument with 19 items has 97.2% reliability and 96.6% reliability in the qualitative instrument with three categories. Cronbach's alpha is 0.811 which indicates a good level of reliability and correlation between the items of the questionnaire. Conclusions: A valid and reliable instrument, with 7 dimensions and 19 items, is made available to health professionals, being promising for determining the factors that influence therapeutic adherence and measuring the degree of therapeutic adherence in patients with arterial hypertension(AU)


Subject(s)
Humans , Male , Female , Chronic Disease , Patient Compliance , Hypertension/physiopathology , Hypertension/drug therapy , Cardiovascular Diseases , Surveys and Questionnaires , Hospitalization
2.
Article in English | WPRIM | ID: wpr-880338

ABSTRACT

Recent studies have revealed an inverse association between height and cardiovascular disease. However, the background mechanism of this association has not yet been clarified. Height has also been reported to be positively associated with cancer. Therefore, well-known cardiovascular risk factors, such as increased oxidative stress and chronic inflammation, are not the best explanations for this inverse association because these risk factors are also related to cancer. However, impaired blood flow is the main pathological problem in cardiovascular disease, while glowing feeding vessels (angiogenesis) are the main characteristic of cancer pathologies. Therefore, endothelial maintenance activity, especially for the productivity of hematopoietic stem cells such as CD34-positive cells, could be associated with the height of an individual because this cell contributes not only to the progression of atherosclerosis but also to the development of angiogenesis. In addition, recent studies have also revealed a close connection between bone marrow activity and endothelial maintenance; bone marrow-derived hematopoietic stem cells contribute towards endothelial maintenance. Since the absolute volume of bone marrow is positively associated with height, height could influence endothelial maintenance activity. Based on these hypotheses, we performed several studies. The aim of this review is not only to discuss the association between height and bone marrow activity, but also to describe the potential mechanism underlying endothelial maintenance. In addition, this review also aims to explain some of the reasons that implicate hypertension as a major risk factor for stroke among the Japanese population. The review also aims to clarify the anthropological reasons behind the high risk of atherosclerosis progression in Japanese individuals with acquired genetic characteristics.


Subject(s)
Aged , Atherosclerosis/physiopathology , Body Height/physiology , Bone Marrow/physiology , Disease Progression , Endothelium/physiology , Humans , Hypertension/physiopathology , Japan/epidemiology , Male , Middle Aged , Risk Factors , Stroke/physiopathology
3.
Arq. neuropsiquiatr ; 78(7): 412-418, July 2020. tab
Article in English | LILACS | ID: biblio-1131724

ABSTRACT

ABSTRACT Background: Central nervous system changes associated to systemic arterial hypertension (SAH) are progressive and may cause negative effects on cognitive performance. The objective of this study was to investigate the relation between SAH and the components of executive functions (EF), inhibitory control (IC), updating and shifting, comparing a control group (without SAH) to patients with SAH, in two levels of severity. Methods: The protocol included the following tests to evaluate EF components: T.O.V.A. Test (IC), Backward Digit Span from Wechsler Adults Intelligence Scale (WAIS-III), Phonemic and Semantic Verbal Fluency (updating), and Trail Making Test Part B (shifting). Results: A total of 204 participants was included: 56 from the Control Group (CG), 87 SAH stage 1, and 61 SAH stage 2. The groups were not different for age (52.37±12.29) and education (10.98±4.06). As to controlled blood pressure (BP), duration of hypertension treatment and number of drugs, the SAH 2 group had a worse BP control, longer duration of hypertension treatment and use of more drugs when compared to the SAH 1. The findings revealed that patients with more severe hypertension presented worse performance in updating (Backward Digit Span, phonemic and semantics VF) and shifting (Trail Making Test Part B). Conclusion: The results suggest that patients with SAH have a significant impairment in EF, more specifically in updating and shifting. Besides that, such damage may be directly proportional to the severity of SAH. It is suggested that future studies include neuroimaging exams to exclude possible cerebrovascular diseases.


RESUMO Introdução: As alterações do sistema nervoso central associadas à hipertensão arterial sistêmica (HAS) são progressivas e podem ocasionar efeitos negativos no desempenho cognitivo. O objetivo deste estudo foi investigar a relação entre a HAS e os componentes das funções executivas (FE), controle inibitório (CI), atualização e alternância, comparando um grupo controle (sem HAS) a pacientes com HAS, em dois níveis de gravidade. Métodos: O protocolo incluiu os seguintes testes para avaliar os componentes das FE: T.O.V.A. Test (CI), Dígitos Ordem Indireta da Escala de Inteligência Wechsler para Adultos (Wechsler Adults Intelligence Scale - WAIS-III), Fluência Verbal fonêmica e semântica (atualização) e Teste de Trilhas parte B (alternância). Resultados: Foram incluídos 204 participantes, sendo 56 do Grupo Controle (GC), 87 HAS estágio 1 (HAS 1) e 61 de HAS estágio 2 (HAS 2). Os grupos não foram diferentes em relação à idade (52,37±12,29) e escolaridade (10,98±4,06). Em relação à pressão arterial (PA) controlada, tempo de tratamento da HAS e número de medicações, o grupo HAS 2 apresentou pior controle de PA, mais tempo de tratamento da HAS e uso de maior número de medicações quando comparado ao grupo HAS 1. Os achados revelaram que os pacientes com HAS em estágio mais grave apresentaram pior desempenho nos testes de alternância (Teste de Trilhas parte B) e atualização (Dígitos Ordem Indireta, FV fonêmica e semântica). Conclusão: Esses resultados sugerem que pacientes com a HAS possuem prejuízo significativo em FE, especificamente em alternância e atualização, e que esse prejuízo pode ser diretamente proporcional à gravidade da HAS. Sugere-se que, em estudos futuros, incluam-se exames de neuroimagem com o objetivo de excluir possíveis doenças cerebrovasculares.


Subject(s)
Humans , Adult , Cognition/physiology , Cognition Disorders/complications , Executive Function/physiology , Hypertension/physiopathology , Trail Making Test , Neuropsychological Tests
4.
Rev. chil. pediatr ; 91(3): 324-329, jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1126168

ABSTRACT

Resumen: El recién nacido prematuro se enfrenta a las condiciones extrauterinas con sistemas aún inmaduros, tanto anatómica como fisiológicamente. El riñón termina de desarrollarse a finales del tercer trimes tre del embarazo, por lo que está especialmente expuesto a alterar su desarrollo normal en caso de nacer en forma prematura. Esta situación puede condicionar, entre otras consecuencias, una menor masa renal funcional y cambios microvasculares que representan un riesgo elevado de hipertensión arterial y daño renal crónico en el largo plazo. En el presente artículo se analiza la evidencia existente actual sobre estos riesgos en los prematuros y se ofrece un esquema de seguimiento de estos niños desde el punto de vista nefrológico.


Abstract: The premature newborn faces extrauterine conditions with some systems still immature, both ana tomically and physiologically. The kidney finishes developing at the end of the third trimester of pregnancy, so it is especially exposed to alter its normal development if preterm birth occurs. This si tuation may condition, among other consequences, a lower functional renal mass and microvascular changes comprising a high risk of chronic kidney disease in the long term and arterial hypertension. This article analyzes the current evidence on these risks in premature infants and offers a nephrology follow-up scheme of these children.


Subject(s)
Humans , Infant, Newborn , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/etiology , Renal Insufficiency, Chronic/physiopathology , Renal Insufficiency, Chronic/therapy , Hypertension/diagnosis , Hypertension/etiology , Hypertension/physiopathology , Hypertension/therapy , Infant, Premature, Diseases/diagnosis , Infant, Premature, Diseases/etiology , Infant, Premature, Diseases/physiopathology , Infant, Premature, Diseases/therapy , Risk , Aftercare/methods , Kidney/growth & development , Kidney/embryology , Kidney/physiopathology , Nephrology/methods
5.
Rev. méd. Chile ; 148(5): 611-617, mayo 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1139345

ABSTRACT

Background: Moderate isometric handgrip exercise is an effective tool in the management of systemic hypertension. Aim: To evaluate the effectiveness of a high intensity isometric handgrip exercise protocol for the reduction of blood pressure in older people with pre or stage-1 hypertension. Material and Methods: Twenty-three participants aged 73.8 ± 6.6 years (range 61-90) completed eight weeks of high intensity isometric handgrip training 2 times per week, performing 32 contractions maintained for 5 seconds, with breaks of 5 seconds. Blood pressure (BP) was measured at baseline and at the end of the intervention. Results: Systolic blood pressure decreased from 141 ± 11 to 127 ± 10 mmHg (p < 0.01). The decrease in diastolic blood pressure was from 79 ± 7 to 74 ± 6 mmHg (p < 0.01). Conclusions: A blood pressure reduction was recorded in these participants after a period of high intensity isometric handgrip exercise.


Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Hand Strength/physiology , High-Intensity Interval Training , Hypertension/physiopathology , Hypertension/therapy , Blood Pressure/physiology , Treatment Outcome , Isometric Contraction/physiology
6.
Medicina (B.Aires) ; 80(2): 157-161, abr. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1125057

ABSTRACT

Un tercio de la población mundial tiene niveles anormalmente altos de presión arterial, hipertensión, responsable de casi el 50% de las muertes por accidente cerebrovascular y enfermedad coronaria. La sensibilidad a la sal es un factor de riesgo para la morbilidad y mortalidad cardiovascular y también para otras enfermedades. En estudios previos describimos un modelo de hipertensión sal sensible (HSS) en ratas Wistar ovariectomizadas (oVx) adultas. Las ratas oVx son normotensas con ingesta normal de sal (NS, 0.24% de NaCl), pero desarrollan un perfil de HSS con una ingesta elevada de sal (HS, 1% de NaCl). En los estudios en riñón encontramos que el circuito receptor D1 de dopamina, citocromo P450 4A y Na+, K+-ATPasa está alterado por la ausencia de hormonas ováricas, lo que se asocia a menor excreción de sodio e hipertensión arterial. La ingesta HS en ratas oVx también promueve cambios en la expresión de proteínas relacionadas con el transporte de sodio en células mononucleares de sangre periférica, principalmente linfocitos periféricos. Por lo tanto, el transporte de sodio se modifica en varios niveles de la fisiología normal. En estudios recientes observamos que el estradiol aumenta la proliferación y diferenciación de células epiteliales en cultivos de corteza renal humana. Sensibilidad a la sal, inmunidad adaptativa, presión arterial y proliferación de células epiteliales en riñón son fenómenos de gran importancia biológica regulados por estradiol.


Female sex hormones participate in the regulation of blood pressure and renal epithelial proliferation, effects not related to their reproductive function. About one-third of the world's population has abnormally high levels of blood pressure, hypertension, which is responsible for almost 50% of deaths from stroke and coronary heart disease. Salt sensitivity is a risk factor for cardiovascular morbidity and mortality and other diseases as well. We reported a model of salt sensitive hypertension in adult ovariectomized (oVx) Wistar rats. oVx rats are normotensive under normal salt intake (NS, 0.24% NaCl), but upon a high salt intake (HS, 1% NaCl) oVx rats developed a blood pressure profile of salt-sensitive hypertension. Our studies on kidney molecules related to sodium balance found that the circuit dopamine D1-like receptor, cytochrome P450 4A and Na+, K+-ATPase is altered by the absence of ovary hormones which is accompanied by a reduced ability to excrete sodium. In oVx rats HS intake also promotes changes in the expression of proteins related to sodium transport in peripheral blood mononuclear cells, mainly peripheral lymphocytes. Therefore, sodium transport is modified at several levels of normal physiology. Lately, we described that estradiol increases the rate of renal epithelial cell proliferation in primary cultures developed from human renal cortex. Thus, salt sensitivity, adaptive immunity, blood pressure and renal cell proliferation are complex biological responses regulated by female sex hormones.


Subject(s)
Humans , Animals , Female , Rats , Sodium Chloride/metabolism , Estradiol/metabolism , Hypertension/metabolism , Kidney/metabolism , Blood Pressure , Sodium Chloride/adverse effects , Rats, Wistar , Sodium-Potassium-Exchanging ATPase , Cell Proliferation , Hypertension/physiopathology
7.
Article in English | LILACS, BBO | ID: biblio-1101870

ABSTRACT

ABSTRACT The coronavirus disease 2019 (covid-19) pandemic has caused a public health emergency worldwide. Risk, severity and mortality of the disease have been associated with non-communicable chronic diseases, such as diabetes mellitus. Accumulated evidence has caused great concern in countries with high prevalence of this morbidity, such as Brazil. This text shows the picture of diabetes in Brazil, followed by epidemiological data and explanatory hypothesis for the association between diabetes and covid-19. We emphasized how the burden of these two morbidities in a middle-income country has aggravated this pandemic scenario. The comprehension of this association and biological plausibility may help face this pandemic and future challenges.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Pneumonia, Viral/epidemiology , Coronavirus Infections/epidemiology , Diabetes Complications/epidemiology , Diabetes Mellitus/epidemiology , Betacoronavirus , Pneumonia, Viral/physiopathology , Severity of Illness Index , Brazil/epidemiology , Cardiovascular Diseases/complications , Cardiovascular Diseases/physiopathology , Cardiovascular Diseases/epidemiology , Comorbidity , Prevalence , Risk Factors , Age Factors , Coronavirus Infections/physiopathology , Diabetes Complications/physiopathology , Diabetes Mellitus/physiopathology , Pandemics , SARS-CoV-2 , COVID-19 , Hypertension/complications , Hypertension/physiopathology , Hypertension/epidemiology , Middle Aged , Obesity/complications , Obesity/physiopathology , Obesity/epidemiology
8.
Einstein (Säo Paulo) ; 18: eAO5227, 2020. tab, graf
Article in English | LILACS | ID: biblio-1056054

ABSTRACT

ABSTRACT Objective To investigate the efficacy of a behavior change program named Vida Ativa Melhorando a Saúde on cardiovascular parameters in hypertensive patients. Methods Ninety hypertensive patients aged over 40 years were randomly allocated to one of two groups: Vida Ativa Melhorando a Saúde or Control (n=45 respectively). Patients in the Vida Ativa Melhorando a Saúde group took part in a behavior change program aimed to encourage changes in physical activity levels and eating habits, according to the Social Cognitive Theory. The program consisted of 90-minute weekly group meetings conducted by a physical therapist and a dietitian. One chapter of the educational material (workbook) provided was discussed per meeting. Participants in the Control Group attended a single educative lecture on lifestyle changes. Brachial and central blood pressure, arterial stiffness and endothelial function parameters were measured pre- and post-intervention. Results Vida Ativa Melhorando a Saúde led to reduction of brachial (131.3±15.8mmHg to 125.1±17.3mmHg; p<0.01) and central (123.6±16.3mmHg to 119.0±20.6mmHg; p=0.02) systolic and brachial diastolic (123.6±16.3mmHg to 119.0±20.6mmHg; p<0.01) blood pressure values, and improvement of post-occlusive reactive hyperemia (from 5.7±2.5mL·100mL−1 to 6.5±2.1mL·100mL−1 tissue·min−1; p=0.04). No changes in body composition, heart rate and arterial stiffness parameters were detected in both groups (p>0.05). Conclusion Vida Ativa Melhorando a Saúde program improved blood pressure and microvascular reactivity in hypertensive patients. Trial registration: ClinicalTrials.gov: NCT02257268


RESUMO Objetivo Analisar a eficácia do programa de mudança de comportamento Vida Ativa Melhorando a Saúde sobre parâmetros cardiovasculares em pacientes hipertensos. Métodos Noventa pacientes hipertensos ≥40 anos foram aleatoriamente randomizados em dois grupos: Vida Ativa Melhorando a Saúde (n=45) e Controle (n=45). O Grupo Vida Ativa Melhorando a Saúde participou de um programa de mudança de comportamento que objetiva motivar mudanças na atividade física e nos hábitos alimentares, de acordo com a teoria sociocognitiva. O programa foi conduzido em grupos, durante 12 semanas consecutivas, em encontros semanais (~90 minutos), conduzidos por um profissional de edução física e um nutricionista. Um capítulo do material didático era discutido em cada um desses encontros. O Grupo Controle participou de uma única palestra educativa sobre mudanças de estilo de vida. Medidas de pressão arterial braquial e central, rigidez arterial, e de função endotelial foram realizadas nos momentos pré e pós-intervenção. Resultados O Grupo Vida Ativa Melhorando a Saúde reduziu a pressão arterial sistólica braquial (de 131,3±15,8mmHg a 125,1±17,3mmHg; p<0,01) e central (de 123,6±16,3mmHg a 119,0±20,6mmHg; p=0,02) e a pressão arterial diastólica braquial (123,6±16,3mmHg a 119,0±20,6mmHg; p<0,01) e apresentou melhora na hiperemia reativa pós-oclusão (de 5,7±2,5mL·100mL−1a 6,5±2,1mL·100mL−1tecido·min−1; p=0,04). Não houve modificação na composição corporal, na frequência cardíaca e nem nos parâmetros de rigidez arterial em ambos os grupos (p>0,05). Conclusão O Programa Vida Ativa Melhorando a Saúde melhorou a pressão arterial e a reatividade microvascular em pacientes hipertensos. Registro do estudo: ClinicalTrials.gov: NCT02257268


Subject(s)
Humans , Male , Female , Aged , Health Behavior/physiology , Hypertension/physiopathology , Blood Pressure/physiology , Body Composition , Exercise/physiology , Program Evaluation , Treatment Outcome , Feeding Behavior/physiology , Vascular Stiffness/physiology , Heart Rate/physiology , Hyperemia/physiopathology , Hypertension/psychology , Life Style , Middle Aged
9.
Arq. neuropsiquiatr ; 77(12): 848-854, Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055204

ABSTRACT

ABSTRACT Vitamin D is a pleiotropic steroid hormone that modulates the autonomic balance. Its deficiency has been described as an environmental risk factor for multiple sclerosis (MS). The aim of this study was to investigate the serum levels of vitamin D, vitamin D binding protein (VDBP) and vitamin D receptors (VDR) and to evaluate cardiac dysautonomia in MS patients due to bidirectional interaction between vitamin D and the autonomic nervous system. Methods: The current cross-sectional study was conducted on 26 patients with relapsing-remitting MS and on 24 healthy controls. Twenty-four-hour ambulatory blood pressure variability (BPV) was calculated and the participants were evaluated for orthostatic hypotension and supine hypertension. Serum levels of vitamin D, VDBP and VDR were measured. Results: The mean serum vitamin D level was significantly lower in MS patients than in controls (p = 0.044); however there was no significant difference in terms of VDR and VDBP levels between the groups. Supine hypertension and orthostatic hypotension were significant and the 24-hour systolic BPV was significantly decreased in patients with MS (p < 0.05) compared to controls. No correlation was found between vitamin D, VDBP and VDR with supine hypertension, orthostatic hypotension and systolic BPV values (p > 0.05). Also, there was a negative correlation between VDBP and the EDSS (p = 0.039, r = −0.406). Conclusion: There was no correlation between orthostatic hypotension, supine hypertension and systolic BPV values and serum vitamin D, VDBP and VDR in MS patients. Future prospective studies with large number of patients may help us to better understand the relationship between vitamin D and the autonomic nervous system.


RESUMO A vitamina D é um hormônio esteroide pleiotrópico que modula o equilíbrio autonômico. Sua deficiência tem sido descrita como fator de risco ambiental para esclerose múltipla (EM). O objetivo deste estudo foi investigar os níveis séricos de vitamina D, proteína de ligação à vitamina D (VDBP) e receptor de vitamina D (VDR) e avaliar a disautonomia cardíaca em pacientes com EM devida à interação bidirecional entre vitamina D e sistema nervoso autônomo. Métodos: O presente estudo transversal foi realizado em 26 pacientes com EM remitente-recorrente e em 24 controles saudáveis. A variabilidade da pressão arterial ambulatorial (BPV) por 24 horas foi calculada e os participantes foram avaliados quanto à hipotensão ortostática e hipertensão supina. Os níveis séricos de vitamina D, VDBP e VDR foram medidos. Resultados: O nível sérico médio de vitamina D foi significativamente menor nos pacientes com EM do que nos controles (p = 0,044); no entanto, não houve diferença significativa em termos de níveis de VDR e VDBP entre os grupos. Hipertensão supina e hipotensão ortostática foram significativas e a BPV sistólica de 24 horas diminuiu significativamente em pacientes com EM (p < 0,05) em comparação aos controles. Não foi encontrada correlação entre vitamina D, VDBP e VDR com hipertensão supina, hipotensão ortostática e BPV sistólica (p > 0,05). Também houve correlação negativa entre VDBP e EDSS (p = 0,039, r = −0,406). Conclusão: Não houve correlação entre hipotensão ortostática, hipertensão supina e valores de BPV sistólica e vitamina D sérica, VDBP e VDR em pacientes com EM. Futuros estudos prospectivos com grande número de pacientes podem nos ajudar a entender melhor a relação entre vitamina D e sistema nervoso autônomo.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Autonomic Nervous System Diseases/blood , Vitamin D/blood , Vitamin D-Binding Protein/blood , Receptors, Calcitriol/blood , Multiple Sclerosis, Relapsing-Remitting/blood , Primary Dysautonomias/blood , Reference Values , Autonomic Nervous System Diseases/physiopathology , Vitamin D Deficiency/complications , Vitamin D Deficiency/blood , Blood Pressure/physiology , Enzyme-Linked Immunosorbent Assay , Case-Control Studies , Cross-Sectional Studies , Risk Factors , Supine Position/physiology , Statistics, Nonparametric , Multiple Sclerosis, Relapsing-Remitting/physiopathology , Primary Dysautonomias/etiology , Primary Dysautonomias/physiopathology , Heart Rate/physiology , Hypertension/physiopathology , Hypertension/blood , Hypotension, Orthostatic/physiopathology , Hypotension, Orthostatic/blood
10.
J. bras. nefrol ; 41(4): 451-461, Out.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056616

ABSTRACT

ABSTRACT Hypertension and Diabetes mellitus are the two main causes of chronic kidney disease that culminate in the final stage of kidney disease. Since these two risk factors are common and can overlap, new approaches to prevent or treat them are needed. Macitentan (MAC) is a new non-selective antagonist of the endothelin-1 (ET-1) receptor. This study aimed to evaluate the effect of chronic blockade of ET-1 receptor with MAC on the alteration of renal function observed in hypertensive and hyperglycemic animals. Genetically hypertensive rats were divided into control hypertensive (HT-CTL) group, hypertensive and hyperglycemic (HT+DIAB) group, and hypertensive and hyperglycemic group that received 25 mg/kg macitentan (HT-DIAB+MAC25) via gavage for 60 days. Kidney function and parameters associated with oxidative and nitrosative stress were evaluated. Immunohistochemistry for neutrophil gelatinase-associated lipocalin (NGAL), ET-1, and catalase in the renal cortex was performed. The HT+DIAB group showed a decrease in kidney function and an increase in NGAL expression in the renal cortex, as well as an increase in oxidative stress. MAC treatment was associated with attenuated ET-1 and NGAL production and increases in antioxidant defense (catalase expression) and nitric oxide production. In addition, MAC prevented an increase in oxidant injury (as measured by urinary hydroperoxide and lipid peroxidation), thus improving renal function. Our results suggest that the antioxidant effect of the ET-1 receptor antagonist MAC is involved in the improvement of kidney function observed in hypertensive and hyperglycemic rats.


RESUMO Hipertensão e Diabetes Mellitus figuram como as duas principais causas de doença renal crônica que culmina em doença renal terminal. Uma vez que os dois fatores de risco são comuns e podem se sobrepor, novas abordagens preventivas e terapêuticas se fazem necessárias. O macitentan (MAC) é um novo antagonista não-seletivo dos receptores da endotelina-1 (ET-1). O presente estudo teve como objetivo avaliar os efeitos do bloqueio crônico dos receptores da ET-1 com MAC sobre a alteração da função renal em animais hipertensos e hiperglicêmicos. Ratos geneticamente hipertensos foram divididos em grupos com animais hipertensos de controle (HT-CTL), hipertensos e hiperglicêmicos (HT+DIAB) e hipertensos e hiperglicêmicos tratados com 25 mg/kg de macitentan (HT-DIAB+MAC25) via gavagem por 60 dias. Foram avaliados função renal e parâmetros associados ao estresse oxidativo e nitrosativo. Exames de imunoistoquímica foram realizados para lipocalina associada à gelatinase neutrofílica (NGAL), ET-1 e catalase no córtex renal. O grupo HT+DIAB exibiu diminuição da função renal e aumento na expressão de NGAL no córtex renal, bem como estresse oxidativo aumentado. O tratamento com MAC foi associado a atenuação da produção de ET-1 e NGAL e maior ativação das defesas antioxidantes (expressão de catalase) e elevação da produção de óxido nítrico. Além disso, o MAC evitou exacerbação da lesão oxidante (medida por hidroperóxidos urinários e peroxidação lipídica), melhorando assim a função renal. Nossos resultados sugerem que o efeito antioxidante do antagonista dos receptores da ET-1 MAC esteja imbricado no aprimoramento da função renal observada em ratos hipertensos e hiperglicêmicos.


Subject(s)
Humans , Animals , Male , Hyperglycemia/complications , Kidney/drug effects , Antioxidants/pharmacology , Rats/genetics , Risk Factors , Endothelin-1/metabolism , Administration, Intravenous , Endothelin Receptor Antagonists/administration & dosage , Endothelin Receptor Antagonists/therapeutic use , Hyperglycemia/chemically induced , Hypertension/complications , Hypertension/physiopathology , Kidney/physiopathology , Kidney/injuries , Antibiotics, Antineoplastic/administration & dosage
11.
J. pediatr. (Rio J.) ; 95(6): 696-704, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056663

ABSTRACT

ABSTRACT Objective: To assess the carotid intima-media thickness and factors associated with cardiovascular disease in children and adolescents with chronic kidney disease. Material and methods: Observational, cross-sectional study carried out at the Universidade Federal de São Paulo (chronic kidney disease outpatient clinics) with 55 patients (60% males) with a median age of 11.9 years (I25-I75: 9.2-14.8 years). Of the 55 patients, 43 were on conservative treatment and 12 were on dialysis. Serum laboratory parameters (creatinine, uric acid, C-reactive protein, total cholesterol and fractions, and triglycerides), nutritional status (z-score of body mass index, z-score of height/age), body fat (fat percentage and waist circumference), and blood pressure levels were evaluated. The carotid intima-media thickness measure was evaluated by a single ultrasonographer and compared with percentiles established according to gender and height. Data collection was performed between May 2015 and March 2016. Results: Of the children and adolescents with chronic kidney disease, 74.5% (95% CI: 61.0; 85.3) showed an increase (>P95) in carotid intima-media thickness. In patients with stages I and II hypertension, 90.9% had increased carotid intima-media thickness. Nutritional status, body fat and laboratory tests were not associated with increased carotid intima-media thickness. After multivariate adjustment, only puberty (PR = 1.30, p = 0.037) and stages I and II arterial hypertension (PR = 1.42, p = 0.011) were independently associated with carotid intima-media thickness alterations. Conclusion: The prevalence of increased carotid thickness was high in children and adolescents with chronic kidney disease. Puberty and arterial hypertension were independently associated with increased carotid intima-media thickness.


RESUMO Objetivo: Avaliar a espessura médio-intimal da carótida e os fatores associados à doença cardiovascular em crianças e adolescentes com doença renal crônica. Material e métodos: Estudo observacional transversal feito na Universidade Federal de São Paulo (ambulatórios de doença renal crônica) com 55 pacientes (60% do sexo masculino) com mediana de 11,9 anos (I25-I75: 9,2-14,8). Dos 55 pacientes, 43 estavam em tratamento conservador e 12 em terapia dialítica. Foram avaliados os parâmetros laboratoriais séricos (creatinina, ácido úrico, proteína C-reativa, colesterol total e frações e triglicérides), estado nutricional (escore z de índice de massa corpórea, escore z de estatura/idade), gordura corporal (percentual de gordura e circunferência abdominal) e pressão arterial. A medida da espessura médio-intimal da carótida foi avaliada por um único ultrassonografista e comparada com percentis estabelecidos de acordo com o sexo e a estatura. A coleta de dados foi feita entre maio de 2015 e março de 2016. Resultados: Das crianças e adolescentes com doença renal crônica, 74,5% (IC 95%: 61,0; 85,3) apresentaram aumento (> P95) da espessura médio-intimal da carótida. Nos pacientes com hipertensão arterial estágios I e II, 90,9% apresentaram aumento da espessura médio-intimal da carótida. O estado nutricional, a gordura corporal e os exames laboratoriais não apresentaram associação com o aumento da espessura médio-intimal da carótida. Após ajuste multivariado, apenas a puberdade (RP = 1,30; p = 0,037) e a hipertensão arterial estágios I e II (RP = 1,42; p = 0,011) mostraram-se independentemente associados à alteração da espessura médio-intimal da carótida. Conclusão: A prevalência do aumento da espessura da carótida foi elevada em crianças e adolescentes com doença renal crônica. A puberdade e a hipertensão arterial mostraram-se independentemente associadas ao aumento da espessura médio-intimal da carótida.


Subject(s)
Humans , Male , Female , Child , Adolescent , Cardiovascular Diseases/complications , Carotid Arteries/physiopathology , Renal Insufficiency, Chronic/complications , Carotid Intima-Media Thickness , Sexual Maturation , Blood Pressure , Cross-Sectional Studies , Risk Factors , Puberty , Hypertension/complications , Hypertension/physiopathology
12.
Int. braz. j. urol ; 45(6): 1227-1237, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056325

ABSTRACT

ABSTRACT Introduction: Children with a solitary post-nephrectomy kidney (SNK) are at potential risk of developing kidney disease later in life. In response to the global decline in the number of nephrons, adaptive mechanisms lead to renal injury. The aim of this study was to determine the prevalence and time of onset of high blood pressure (HBP), proteinuria, glomerular filtration rate (GFR) disruption and renal tubular acidosis (RTA) in children with SNK. Materials and methods: After obtaining the approval from our institution's ethics committee, we reviewed the medical records of patients under 18 years of age who underwent unilateral nephrectomy between January 2005 and December 2015 in three university hospitals. Results: We identified 43 patients, 35 (81.4%) cases of unilateral nephrectomy (UNP) were due to a non-oncologic pathology and Wilm's tumor was identified in 8 (18.6%) cases. In patients with non-oncologic disease, 9.3% developed de novo hypertension, with an average time of onset of 7.1 years, 25% developed proteinuria de novo, with an average time of onset of 2.2 years. For GFR, 21.8% presented deterioration of the GFR in an average time of 3.4 years. Ten (43.5%) patients developed some type of de novo renal injury after UNP. Patients with oncologic disease developed the conditions slowly and none of them developed proteinuria. Conclusions: Taking into account the high rate of long term postoperative renal injury, it can be considered that nephrectomy does not prevent this disease. The follow-up of children with SNK requires a multidisciplinary approach and long-term surveillance to detect renal injury.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Solitary Kidney/physiopathology , Solitary Kidney/epidemiology , Nephrectomy/adverse effects , Postoperative Period , Prognosis , Proteinuria/physiopathology , Proteinuria/epidemiology , Acidosis, Renal Tubular/physiopathology , Acidosis, Renal Tubular/epidemiology , Prevalence , Retrospective Studies , Risk Factors , Follow-Up Studies , Colombia/epidemiology , Age of Onset , Renal Insufficiency, Chronic/physiopathology , Renal Insufficiency, Chronic/epidemiology , Glomerular Filtration Rate/physiology , Hypertension/physiopathology , Hypertension/epidemiology
13.
Int. braz. j. urol ; 45(6): 1204-1208, Nov.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1056338

ABSTRACT

ABSTRACT Purpose: This study aims to assess the association between CHA2DS2-VASc score and erectile dysfunction in patients who were admitted to cardiology outpatient clinics. Materials and methods: One hundred and two male patients who were admitted to the cardiology outpatient clinic were included to the study. Erectile dysfunction was evaluated in the urology outpatient clinic in the same hospital and scored using Turkish Version of The International Index of Erectile Function. CHA2DS2-VASc score was calculated for every patient using the current associated guidelines. Results: There was a negative correlation between The International Index of Erectile Function score and CHA2DS2-VASc score, age, hypertension, heart failure, diabetes mellitus, stroke respectively. Smoking and dislipidemia were not correlated with The International Index of Erectile Function score (p>0.05). Conclusion: CHA2DS2-VASc score can be used to detect Erectile dysfunction in patients who are admitted to the cardiology outpatient clinics.


Subject(s)
Humans , Male , Adult , Aged , Risk Assessment/methods , Erectile Dysfunction/diagnosis , Erectile Dysfunction/physiopathology , Reference Values , Anthropometry , Cross-Sectional Studies , Reproducibility of Results , Risk Factors , Age Factors , Statistics, Nonparametric , Stroke/physiopathology , Diabetes Mellitus/physiopathology , Heart Failure/physiopathology , Hypertension/physiopathology , Middle Aged
14.
Säo Paulo med. j ; 137(5): 446-453, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1059096

ABSTRACT

ABSTRACT BACKGROUND: Lower urinary tract symptoms significantly worsen quality of life. The hypothesis that they might lead to serious systolic blood pressure alterations through inducing sympathetic nervous activity has not been studied so far. OBJECTIVES: To investigate the relationship between benign prostate enlargement-related storage and voiding symptoms and systolic blood pressure. DESIGN AND SETTING: Cross-sectional single-center study on data from a hospital patient record system. METHODS: We evaluated the medical records of all consecutive patients with benign prostate enlargement-related lower urinary tract symptoms admitted between January 2012 and December 2017. Storage and voiding symptoms were assessed separately. International Prostate Symptom Score, uroflowmetry, postvoiding residual urine volume and systolic blood pressure were recorded. Pearson correlation and linear regression analysis were used. RESULTS: Positive correlations were found between systolic blood pressure and all of the storage symptoms. Among these, urgency had the most significant effect. There were 166 patients (41.4%) with urgency for urination, which increased mean systolic blood pressure from 124.88 mmHg (average value in elevated blood pressure group) to 132.28 mmHg (average value in stage-1 hypertension group). Hesitancy in urinating and feeling of incomplete bladder emptying had weak positive correlations with systolic blood pressure. There was a negative correlation between systolic blood pressure and intermittency of urination. CONCLUSIONS: With increasing numbers of urine storage symptoms, systolic blood pressure also increases, while the opposite occurs for voiding symptoms in patients with benign prostate enlargement. We conjecture that storage symptoms may lead to this increase through inducing sympathetic hyperactivity. Further prospective studies with larger groups are needed to confirm these findings.


Subject(s)
Male , Middle Aged , Aged , Prostatic Hyperplasia/complications , Urination/physiology , Blood Pressure/physiology , Lower Urinary Tract Symptoms/complications , Hypertension/complications , Organ Size , Prostate/physiopathology , Severity of Illness Index , Cross-Sectional Studies , Lower Urinary Tract Symptoms/physiopathology , Hypertension/physiopathology
15.
Arq. bras. cardiol ; 113(4): 677-684, Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038580

ABSTRACT

Abstract Background: Hypertrophic cardiomyopathy (HCM) is the most common heart disease of genetic origin in the world population, with a prevalence of at least 1/500. The association with systemic arterial hypertension (SAH) is not uncommon, as it affects approximately 25% of the world population. Most studies aim at the differential diagnosis between these diseases, but little is known about the magnitude of this association. Objective: To compare left ventricular global longitudinal strain (GLS) in HCM patients with and without associated SAH. Methods: Retrospective cross-sectional study that included 45 patients with HCM and preserved ejection fraction, with diagnosis confirmed by magnetic resonance imaging, including 14 hypertensive patients. Transthoracic echocardiography was performed, with emphasis on left ventricular myocardial strain analysis using GLS. In this study, p < 0.05 was considered statistically significant. Results: Left ventricular strain was significantly lower in hypertensive individuals compared to normotensive individuals (-10.29 ± 2.46 vs. -12.35% ± 3.55%, p = 0.0303), indicating greater impairment of ventricular function in that group. Mean age was also significantly higher in hypertensive patients (56.1 ± 13.9 vs. 40.2 ± 12.7 years, p = 0.0001). Diastolic dysfunction was better characterized in hypertensive patients (p = 0.0242). Conclusion: Myocardial strain was significantly lower in the group of patients with HCM and SAH, suggesting greater impairment of ventricular function. This finding may be related to a worse prognosis with early evolution to heart failure. Prospective studies are required to confirm this hypothesis.


Resumo Fundamentos: A cardiomiopatia hipertrófica (CMH) é a doença cardíaca de origem genética mais frequente na população mundial, com prevalência de, pelo menos, 1/500. A associação com hipertensão arterial sistêmica (HAS) não é incomum, uma vez que esta acomete aproximadamente 25% da população mundial. A maioria dos estudos objetiva o diagnóstico diferencial entre essas doenças, mas pouco se sabe sobre a magnitude dessa associação. Objetivo: Comparar o strain longitudinal global (SLG) do ventrículo esquerdo em pacientes portadores de CMH com e sem HAS associada. Métodos: Estudo transversal retrospectivo que incluiu 45 pacientes portadores de CMH e fração de ejeção preservada, com diagnóstico confirmado por ressonância magnética, sendo 14 hipertensos. Realizada avaliação ecocardiográfica transtorácica com ênfase na análise da deformação miocárdica do ventrículo esquerdo por meio do SLG. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: A deformação do ventrículo esquerdo foi significativamente menor nos hipertensos quando comparada aos normotensos (-10,29 ± 2,46 vs. -12,35% ± 3,55%, p = 0,0303), indicando maior comprometimento da função ventricular naquele grupo. A média de idade também foi significativamente maior nos hipertensos (56,1 ± 13,9 vs. 40,2 ± 12,7 anos, p = 0,0001). A disfunção diastólica foi melhor caracterizada nos pacientes hipertensos (p = 0,0242). Conclusão: A deformação miocárdica foi significativamente menor no grupo de pacientes com CMH e HAS, sugerindo maior comprometimento da função ventricular. Esse achado pode estar relacionado a um pior prognóstico com evolução precoce para insuficiência cardíaca. Estudos prospectivos são necessários para confirmar essa hipótese.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Cardiomyopathy, Hypertrophic/physiopathology , Ventricular Function, Left/physiology , Ventricular Dysfunction, Left/physiopathology , Hypertension/physiopathology , Prognosis , Reference Values , Stroke Volume/physiology , Cardiomyopathy, Hypertrophic/diagnostic imaging , Echocardiography , Cross-Sectional Studies , Retrospective Studies , Ventricular Dysfunction, Left/diagnostic imaging , Statistics, Nonparametric
16.
J. bras. nefrol ; 41(3): 400-411, July-Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1040253

ABSTRACT

Abstract Hypertension (blood pressure > 140/90 mm Hg) is very common in patients undergoing regular dialysis, with a prevalence of 70-80%, and only the minority has adequate blood pressure (BP) control. In contrast to the unclear association of predialytic BP recordings with cardiovascular mortality, prospective studies showed that interdialytic BP, recorded as home BP or by ambulatory blood pressure monitoring in hemodialysis patients, associates more closely with mortality and cardiovascular events. Although BP is measured frequently in the dialysis treatment environment, aspects related to the measurement technique traditionally employed may be unsatisfactory. Several other tools are now available and being used in clinical trials and in clinical practice to evaluate and treat elevated BP in chronic kidney disease (CKD) patients. While we wait for the ongoing review of the CKD Blood Pressure KIDGO guidelines, there is no guideline for the dialysis population addressing this important issue. Thus, the objective of this review is to provide a critical analysis of the information available on the epidemiology, pathogenic mechanisms, and the main pillars involved in the management of blood pressure in stage 5-D CKD, based on current knowledge.


Resumo A hipertensão (pressão arterial > 140/90 mmHg) é muito comum em pacientes submetidos à diálise regular, com uma prevalência de 70-80%, e apenas a minoria tem controle adequado da pressão arterial (PA). Em contraste com a associação incerta entre de PA pré-dialítica com mortalidade cardiovascular, estudos prospectivos mostraram que a PA interdialítica, registrada como PA domiciliar ou pela monitorização ambulatorial da pressão arterial em pacientes em hemodiálise, está mais relacionada à mortalidade e eventos cardiovasculares. Embora a PA seja medida com frequência no ambiente de tratamento de diálise, aspectos relacionados à técnica de medição tradicionalmente empregada podem ser insatisfatórios. Várias outras ferramentas estão agora disponíveis, e estão sendo usadas em ensaios clínicos e na prática clínica para avaliar e tratar a PA elevada em pacientes com doença renal crônica (DRC). Enquanto esperamos pela revisão das diretrizes do KIDGO para a pressão sanguíneana DRC, não há nenhuma diretriz para a população em diálise abordando essa importante questão. Assim, o objetivo desta revisão é fornecer uma análise crítica das informações disponíveis sobre a epidemiologia, os mecanismos patogênicos e os principais pilares sustentadores do manejo da pressão arterial no estágio 5-D da DRC, com base no conhecimento atual.


Subject(s)
Humans , Peritoneal Dialysis , Hypertension/therapy , Hypertension/epidemiology , Prevalence , Risk Factors , Blood Pressure Monitoring, Ambulatory , Diet, Sodium-Restricted , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/therapy , Hypertension/diagnosis , Hypertension/physiopathology , Antihypertensive Agents/therapeutic use
17.
Arq. bras. cardiol ; 113(2): 218-228, Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019401

ABSTRACT

Abstract Background: Studies have persuasively demonstrated that citrulline has a key role in the arginine-nitric oxide system, increasing nitric oxide bioavailability, an important mediator of peripheral vasodilation. Objective: To analyze the inter-individual post-exercise hypotension responsiveness following acute citrulline supplementation in hypertensives. Methods: Forty hypertensives were randomly assigned to one of the four experimental groups (control-placebo, control-citrulline, exercise-placebo, and exercise-citrulline). They ingested placebo or citrulline malate [CM] (6 grams). During the exercise session, individuals performed 40 minutes of walking/running on a treadmill at 60-70% of HR reserve. For the control session, the individuals remained seated at rest for 40 minutes. Office blood pressure (BP) was taken every 10 minutes until completing 60 minutes after the experimental session. The ambulatory BP device was programmed to take the readings every 20 minutes (awake time) and every 30 minutes (sleep time) over the course of 24 hours of monitoring. Statistical significance was defined as p < 0.05. Results: Unlike the other experimental groups, there were no "non-responders" in the exercise/citrulline (EC) for "awake" (systolic and diastolic BP) and "24 hours" (diastolic BP). The effect sizes were more consistent in the EC for systolic and diastolic ambulatorial BP response. The effects were "large" (> 0.8) for "awake", "asleep", and "24 hours" only in the EC for diastolic BP. Conclusion: CM supplementation can increase the post-exercise hypotensive effects in hypertensives. In addition, the prevalence of non-responders is lower when associated with aerobic exercise and CM supplementation.


Resumo Fundamento: Estudos demonstraram de maneira persuasiva que a citrulina tem um papel fundamental no sistema arginina-óxido nítrico, aumentando a biodisponibilidade do óxido nítrico, um importante mediador da vasodilatação periférica. Objetivo: Analisar a responsividade interindividual da hipotensão pós-exercício após suplementação aguda com citrulina em hipertensos. Métodos: Quarenta hipertensos foram aleatoriamente designados para um dos quatro grupos experimentais (controle-placebo, controle-citrulina, exercício-placebo e exercício-citrulina). Eles ingeriram placebo ou citrulina malato [CM] (6 gramas). Durante a sessão de exercício, os indivíduos realizaram 40 minutos de caminhada/corrida em esteira a 60-70% da FC de reserva. Para a sessão de controle, os indivíduos permaneceram sentados em repouso por 40 minutos. A medida da pressão arterial (PA) no consultório foi realizada a cada 10 minutos até completar 60 minutos após a sessão experimental. O dispositivo ambulatorial de PA foi programado para fazer as leituras a cada 20 minutos (tempo de vigília) e a cada 30 minutos (tempo de sono) ao longo de 24 horas de monitoramento. A significância estatística foi definida como p < 0,05. Resultados: Diferentemente de outros grupos experimentais, não houve "não respondedores" no exercício/citrulina (EC) para "acordado" (PA sistólica e diastólica) e "24 horas" (PA diastólica). Os tamanhos de efeito foram mais consistentes no EC para a resposta sistólica e diastólica da PA ambulatorial. Os efeitos foram "grandes" (> 0,8) para "acordado", "dormindo", e para "24 horas" apenas no EC para a PA diastólica. Conclusão: A suplementação com CM pode aumentar os efeitos hipotensivos pós-exercício em hipertensos. Além disso, a prevalência de "não respondedores" é menor quando associada ao exercício aeróbico e à suplementação com CM.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Vasodilator Agents/pharmacology , Blood Pressure/drug effects , Exercise/physiology , Citrulline/analogs & derivatives , Post-Exercise Hypotension/physiopathology , Hypertension/physiopathology , Malates/pharmacology , Arginine/metabolism , Reference Values , Time Factors , Placebo Effect , Anthropometry , Double-Blind Method , Analysis of Variance , Treatment Outcome , Citrulline/pharmacology , Statistics, Nonparametric , Exercise Test , Hypertension/therapy , Nitric Oxide/metabolism
18.
J. bras. nefrol ; 41(2): 266-274, Apr.-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1012534

ABSTRACT

Abstract Refractory hypertension (RfH) is an extreme phenotype of resistant hypertension (RH), being considered an uncontrolled blood pressure besides the use of 5 or more antihypertensive medications, including a long-acting thiazide diuretic and a mineralocorticoid antagonist. RH is common, with 10-20% of the general hypertensives, and its associated with renin angiotensin aldosterone system hyperactivity and excess fluid retention. RfH comprises 5-8% of the RH and seems to be influenced by increased sympathetic activity. RH patients are older and more obese than general hypertensives. It is strongly associated with diabetes, obstructive sleep apnea, and hyperaldosteronism status. RfH is more frequent in women, younger patients and Afro-americans compared to RFs. Both are associated with increased albuminuria, left ventricular hypertrophy, chronic kidney diseases, stroke, and cardiovascular diseases. The magnitude of the white-coat effect seems to be higher among RH patients. Intensification of diuretic therapy is indicated in RH, while in RfH, therapy failure imposes new treatment alternatives such as the use of sympatholytic therapies. In conclusion, both RH and RfH constitute challenges in clinical practice and should be addressed as distinct clinical entities by trained professionals who are capable to identify comorbidities and provide specific, diversified, and individualized treatment.


Resumo A Hipertensão Arterial Refratária (HARf) representa um fenótipo extremo da hipertensão arterial resistente (HAR), sendo considerada a falência ao tratamento apesar do uso de 5 ou mais classes de anti-hipertensivos, incluindo um diurético tiazídico de longa ação e um antagonista mineralocorticoide. A HAR é comum (10-20%) entre os hipertensos em geral, sendo decorrente de hiperatividade do Sistema Renina Angiotensina Aldosterona e retenção hidrossalina. Aqueles com HARf correspondem a 5-8% dos resistentes e parecem sofrer maior influência catecolaminérgica. Os resistentes tendem a ter maior idade, ao sobrepeso e à obesidade. Comorbidades incluem diabetes, apneia obstrutiva do sono e status de hiperaldosteronismo. Refratários são afro-americanos em maior proporção, mais jovens e, predominantemente, mulheres. Ambos são fortemente associados à elevada albuminúria, HVE, doenças cardio e cerebrovasculares, além da doença renal crônica. O fenômeno do jaleco branco parece ser mais evidente nos resistentes. Quanto ao tratamento, a intensificação da terapia diurética está indicada nos resistentes, enquanto na HARf, a falência à terapia impôs novas alternativas de tratamento ("simpaticolíticas"). Em conclusão, tanto a HAR quanto a HARf constituem-se desafios na prática clínica e devem ser abordadas como entidades clínicas distintas por profissionais especialistas que identifiquem comorbidades e venham a prover um tratamento específico, diversificado e individualizado.


Subject(s)
Humans , Drug Resistance , Hypertension/drug therapy , Hypertension/epidemiology , Phenotype , Sympatholytics/therapeutic use , Blood Pressure/drug effects , Complementary Therapies , Alcohol Drinking/adverse effects , Exercise , Smoking/adverse effects , Prevalence , Blood Pressure Monitoring, Ambulatory , Diet, Sodium-Restricted , Diuretics/pharmacology , Dietary Approaches To Stop Hypertension , Hypertension/diagnosis , Hypertension/physiopathology , Antihypertensive Agents/pharmacology
19.
Rev. bras. enferm ; 72(3): 646-653, May.-Jun. 2019. tab
Article in English | LILACS, BDENF | ID: biblio-1013537

ABSTRACT

ABSTRACT Objective: Assess the level of health literacy of adults, with and without hypertension, treated in three basic health units (UBS) in Picos, Piauí. Methods: Cross-sectional study conducted with 357 adults. Data were collected using a questionnaire with sociodemographic variables, and literacy was assessed by the Test of Functional Literacy in Adults. Descriptive analysis was performed followed by the association between literacy and exposure variables with Pearson's chi-squared (X2) test and Mann-Whitney U test. Results: Inadequate or marginal health literacy was found in three units investigated (71.5%; 77.8% and 85.2%);. Age and the years of schooling were factors associated with inadequate literacy in adults with hypertension (p<0.0001). Conclusion: Inadequate literacy was found in more than 70% of the hypertensive patients investigated. This finding reinforces the need to improve the self-care skills of hypertensive patients, especially the older ones and those with few years of schooling.


RESUMEN Objetivo: evaluar el nivel de alfabetización en salud de adultos, con y sin hipertensión, tratados en tres unidades básicas de salud (UBS) en Picos, Piauí. Método: Estudio transversal realizado con 357 adultos. Los datos se recopilaron mediante un cuestionario con variables sociodemográficas, y la alfabetización se evaluó mediante la Prueba de Alfabetización Funcional en adultos. Se realizó un análisis descriptivo seguido de la asociación entre las variables de alfabetización y exposición con la prueba de chi-cuadrado de Pearson (X2) y la prueba U de Mann-Whitney. Resultados: En las tres unidades investigadas (71,5%; 77,8% y 85,2%) se encontró una alfabetización de salud inadecuada o marginal. La edad y los años de escolaridad fueron factores asociados con una alfabetización inadecuada en adultos con hipertensión (p<0,0001). Conclusión: se encontró una alfabetización inadecuada en más del 70% de los pacientes hipertensos investigados. Este hallazgo refuerza la necesidad de mejorar las habilidades de autocuidado de los pacientes hipertensos, especialmente los de mayor edad y aquellos con pocos años de escolaridad.


RESUMO Objetivo: Avaliar o nível de letramento em saúde de adultos, com e sem hipertensão, acompanhados em três Unidades Básicas de Saúde (UBS) de Picos, Piauí. Método: Estudo transversal realizado com 357 adultos. Para coleta de dados utilizou-se questionário com variáveis sociodemográficas, e o instrumento Test of Funcional Literacy in Adults para avaliar o letramento. Realizou-se análise descritiva seguida da associação entre letramento e variáveis de exposição com os testes X2 de Pearson e Mann-Whitney. Resultados: Letramento inadequado ou marginal foi encontrado nas três unidades investigadas (71,5%; 77,8% e 85,2%). Foram fatores associados ao letramento inadequado a idade e os anos de estudo nos adultos com hipertensão (p<0,0001). Conclusão: O letramento inadequado foi encontrado em mais de 70% dos hipertensos investigados. Esse achado reforça a necessidade de melhorar as habilidades para o autocuidado dos hipertensos, principalmente naqueles com maior idade e menos anos de estudo.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Health Literacy/standards , Hypertension/psychology , Chi-Square Distribution , Cross-Sectional Studies , Surveys and Questionnaires , Statistics, Nonparametric , Hypertension/physiopathology , Middle Aged
20.
Arq. bras. cardiol ; 112(5): 534-542, May 2019. tab, graf
Article in English | LILACS | ID: biblio-1011189

ABSTRACT

Abstract Background: Spontaneously hypertensive rats (SHR) show deficit in thermal balance during physical exercise. Objective: To assess the effects of low-intensity physical exercise training on thermal balance of hypertensive rats undergoing an acute exercise protocol. Methods: Sixteen-week-old male Wistar rats and SHR were allocated into four groups: control Wistar rats (C-WIS), trained Wistar (T-WIS), control SHR (C-SHR) and trained SHR (T-SHR). Treadmill exercise training was performed for 12 weeks. Blood pressure, resting heart rate and total exercise time was measured before and after the physical exercise program. After the exercise program, a temperature sensor was implanted in the abdominal cavity, and the animals subjected to an acute exercise protocol, during which internal body temperature, tail skin temperature and oxygen consumption until fatigue were continuously recorded. Mechanical efficiency (ME), work, heat dissipation threshold and sensitivity were calculated. Statistical significance was set at 5%. Results: Physical training and hypertension had no effect on thermal balance during physical exercise. Compared with C-WIS, the T-WIS group showed higher heat production, which was counterbalanced by higher heat dissipation. Hypertensive rats showed lower ME than normotensive rats, which was not reversed by the physical training. Conclusion: Low-intensity physical training did not affect thermal balance in SHR subjected to acute exercise.


Resumo Fundamento: Ratos espontaneamente hipertensos (SHR) apresentam déficits no balanço térmico durante o exercício físico. Objetivo: Avaliar os efeitos do treinamento físico de baixa intensidade sobre o balanço térmico de ratos hipertensos submetidos a um protocolo de exercício físico agudo. Métodos: Ratos machos Wistar e SHR, com 16 semanas de idade, foram divididos em quatro grupos experimentais: Wistar controle (WIS-C), Wistar treinado (WIS-T), SHR controle (SHR-C) e SHR treinado (SHR-T). O treinamento físico em esteira rolante foi realizado durante 12 semanas. A pressão arterial, a frequência cardíaca de repouso e o tempo de exercício foram medidos previamente e após o programa de treinamento físico. Após o programa de treinamento físico, um sensor de temperatura foi implantado na região intraperitoneal e os ratos foram submetidos a um protocolo de exercício físico agudo com registros contínuos da temperatura corporal interna, temperatura da pele da cauda e do consumo de oxigênio até a fadiga. A eficiência mecânica (EM), o trabalho, o limiar e a sensibilidade para dissipação de calor foram calculados. Para as análises estatísticas o nível de significância adotado foi de 5%. Resultados: O treinamento físico e a hipertensão arterial não alteraram o balanço térmico durante o exercício físico. O grupo WIS-T quando comparado ao WIS-C, apresentou maior produção de calor, que foi contrabalanceado por uma maior dissipação de calor. Os animais hipertensos apresentaram menor EM em comparação aos animais normotensos, e o treinamento físico não foi capaz de reverter esta alteração. Conclusão: O treinamento físico de baixa intensidade não provocou alterações no balanço térmico de ratos hipertensos submetidos a um protocolo de exercício físico agudo.


Subject(s)
Animals , Male , Rats , Physical Conditioning, Animal/physiology , Body Temperature Regulation/physiology , Hypertension/physiopathology , Oxygen Consumption/physiology , Rats, Inbred SHR , Blood Pressure/physiology , Rats, Wistar , Heart Rate/physiology
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