Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 1.077
Filter
1.
Arch. argent. pediatr ; 117(6): S205-S242, dic. 2019. tab, graf
Article in Spanish | LILACS (Americas), BINACIS | ID: biblio-1051592

ABSTRACT

La enfermedad cardiovascular secundaria a aterosclerosis es la principal causa de morbimortalidad en la población adulta a nivel mundial. Aunque las manifestaciones clínicas de aterosclerosis (enfermedad coronaria, accidente cerebrovascular y arteriopatía periférica) son excepcionales en la población pediátrica, la presencia de factores de riesgo para enfermedad cardiovascular, así como la adquisición de hábitos que favorecen su desarrollo, se observan ya desde edades tempranas. En el presente documento, se elaboraron recomendaciones, con dos objetivos principales: prevenir la aparición de factores de riesgo para enfermedad cardiovascular (prevención primordial) y detectar y tratar los que favorecen el desarrollo de aterosclerosis clínica (prevención primaria). Si bien las recomendaciones están dirigidas a la población pediátrica, el objetivo del trabajo conjunto de la Sociedad Argentina de Pediatría y la Sociedad Argentina de Cardiología es asegurar un abordaje integral y consensuado de la prevencion cardiovascular a lo largo de toda la vida, incluso, desde antes de la concepción.


Cardiovascular disease secondary to atherosclerosis is the leading cause of morbimortality in the adult population worldwide. Although clinical manifestations of atherosclerosis (coronary heart disease, stroke and peripheral vascular disease) are extremely rare in the pediatric population, the presence of risk factors for cardiovascular disease and the development of health-behavior patterns that promote them are observed since early childhood.In this document, recommendations were developed addressing two main goals: prevention of the risk factors development for cardiovascular disease (primordial prevention) and early detection and treatment of the risk factors to prevent clinical atherosclerosis (primary prevention). Even though the recommendations are addressed to the pediatric population, the aim of the collaborative work between the Sociedad Argentina de Pediatría and the Sociedad Argentina de Cardiología is to ensure a comprehensive and consensual approach of lifetime cardiovascular prevention beginning even before conception.


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Primary Prevention/methods , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Exercise , Tobacco Use Disorder/prevention & control , Risk Factors , Substance-Related Disorders/prevention & control , Alcohol-Related Disorders/prevention & control , Metabolic Syndrome , Diabetes Mellitus, Type 2 , Dyslipidemias/diagnosis , Dyslipidemias/drug therapy , Overweight/prevention & control , Sedentary Behavior , Diet, Food, and Nutrition , Hypertension/diagnosis , Hypertension/prevention & control , Hypertension/therapy , Medical History Taking , Obesity/prevention & control
2.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(4 (Supl)): 383-386, out.-dez. 2019. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-1047316

ABSTRACT

Objetivo: Determinar a prevalência da disfunção erétil (DE) em pacientes com hipertensão arterial (HA) primária em tratamento medicamentoso e sua relação e análise do impacto psicossocial. Métodos: O estudo abordou homens hipertensos em tratamento medicamentoso e idade superior a 40 anos que foram avaliados segundo o Índice Internacional de Função Erétil (IIFE- 5), Escala de Ansiedade e Depressão e um questionário sobre sua opinião quanto à relação da DE com as medicações anti-hipertensivas. A dosagem da testosterona sérica foi usada para exclusão de causas orgânicas da DE. Os dados foram analisados visando identificar o coeficiente de correlação entre as varáveis. Resultados: Foi observada prevalência de DE em 74% dos pacientes e, destes, 43% referiram piora do desempenho sexual após uso crônico da medicação anti-hipertensiva. Não foi possível provar uma correlação direta entre o uso de anti-hipertensivos e a DE, entretanto observou-se aumento do coeficiente de correlação em função da progressão da idade dos pacientes. Os betabloqueadores mostraram maior coeficiente de correlação com a DE (25%), seguido dos inibidores da enzima conversora de angiotensina (19%). Dos pacientes, 43% foram classificados com provável diagnóstico de ansiedade ou depressão e 35% com possível diagnóstico. Conclusão: Foi possível inferir, mas não afirmar uma correlação entre DE, HA e o uso de anti-hipertensivos


Objective: To determine the prevalence of erectile dysfunction (ED) in patients with primary arterial hypertension (AH) undergoing drug treatment and its relationship and analysis of psychosocial impact. Methods: The study addressed hypertensive men on drug treatment and over 40 years of age who were evaluated according to the International Index of Erectile Function (IIFE-5), Anxiety and Depression Scale, and a questionnaire about their opinion regarding the relationship between ED and antihypertensive medications. Serum testosterone dosage was used to rule out the organic causes of ED. Data were analyzed to identify the correlation coefficient between variables. Results: Prevalence of ED was observed in 74% of patients and, of these, 43% reported worsened sexual performance after chronic use of antihypertensive medications. It was not possible to prove any direct correlation between the use of antihypertensive drugs and ED, however an increase in the correlation coefficient was observed as a function of patients' age progression. Beta-blockers showed higher correlation coefficient with ED (25%), followed by angiotensin-converting enzyme inhibitors (19%). 43% of patients were classified with probable diagnosis of anxiety or depression and 35% with possible diagnosis. Conclusion: It was possible to infer but not to affirm a correlation between DE, HA and the use of antihypertensive drugs


Subject(s)
Hypertension/therapy , Erectile Dysfunction , Antihypertensive Agents , Anxiety , Cardiovascular Diseases , Chronic Disease , Prevalence , Prospective Studies , Surveys and Questionnaires , Risk Factors , Depression , Drug Therapy
4.
J. bras. nefrol ; 41(3): 400-411, July-Sept. 2019. tab, graf
Article in English | LILACS (Americas) | 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
5.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(3): 261-267, jul.-set. 2019. ilus
Article in Portuguese | LILACS (Americas) | ID: biblio-1023048

ABSTRACT

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


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


Subject(s)
Humans , Male , Female , Evidence-Based Practice/methods , Hypertension/therapy , Spironolactone , Guidelines as Topic/standards , Doxazosin , Bisoprolol , Blood Pressure Monitoring, Ambulatory/methods , Evidence-Based Medicine/methods , Arterial Pressure , Antihypertensive Agents
6.
Prensa méd. argent ; 105(4): 235-245, jun 2019. tab
Article in English | LILACS (Americas), BINACIS | ID: biblio-1046188

ABSTRACT

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


Subject(s)
Humans , Evaluation Studies as Topic/prevention & control , Evaluation Studies as Topic/prevention & control , Chronic Disease/mortality , Epidemiology, Experimental , Treatment Outcome , Blood Pressure Monitoring, Ambulatory/methods , Hypertension/prevention & control , Hypertension/therapy
7.
Rev. pesqui. cuid. fundam. (Online) ; 11(1): 127-131, jan.-mar. 2019. tabs.
Article in English, Portuguese | LILACS (Americas), BDENF | ID: biblio-968479

ABSTRACT

Objetivo:Analisar a adesão ao tratamento anti-hipertensivo e hábitos de vida de hipertensos. Método: Estudo transversal, realizado com hipertensos da Estratégia Saúde da Família de Lacerdópolis-SC. Utilizou-se entrevista e o BriefMedicationQuestionnaire. Resultados: Participaram 72 hipertensos, 68,1% mulheres, idade média 68,4 anos (±12,1). Quanto à adesão ao tratamento, 6,9% são aderentes, 19,4% tem provável adesão, 70,8% provável baixa adesão e 2,8% baixa adesão. Quem usa múltiplas doses é menos aderente (p=0,00), falhoumais em listar o que usa (p=0,03) e omitiumais (p=0,02). Houve dificuldades para ler o rótulo, abrir a medicação e lembrar de tomar todos os dias, e 19,4% relataram falha de dias ou doses. Conclusão:Houve dificuldade em listar a medicação em uso, ler, abrir e lembrar-se de tomar a medicação, especialmente naqueles acima de 60 anos. A prescrição de múltiplas doses interfere significativamente na adesão ao tratamento e no correto uso da medicação


Objetivo: Analizar la adhesión al tratamiento antihipertensivo y hábitos de vida de hipertensos. Métodos: Estudio transversal, realizado con hipertensos de la Estrategia Salud de la Familia de Lacerdópolis, SC. Se utilizó una entrevista con el BriefMedicationQuestionnaire. Resultados: participaron 72 hipertensos, 68,1% mujeres, edad media 68,4 años (± 12,1). En cuanto a la adhesión al tratamiento, el 6,9% son adherentes, el 19,4% tiene probable adhesión, el 70,8% probable baja adhesión y el 2,8% baja adhesión. El que utiliza múltiples dosis es menos adherente (p = 0,00), fallaron más en listar lo que usan (p = 0,03) y omitieron más (p = 0,02). Hubo dificultades para leer la etiqueta, abrir la medicación y recordar tomar todos los días, y el 19,4% relató un fallo de días o dosis. Conclusión: hubo dificultad en enumerar la medicación en uso, leer, abrir y recordar la toma de la medicación, especialmente en aquellos de más de 60 años. La prescripción de múltiples dosis interfiere significativamente en la adhesión al tratamiento y en el correcto uso de la medicación


Objective: To analyze adherence to antihypertensive treatment and lifestyle of hypertensive patients. Methods: Cross-sectional study with hypertensive patients from the Family Health Strategy of Lacerdópolis, SC. We used interview and the Brief Medication Questionnaire. Results:Participated 72 patients, 68.1% women, mean age 68.4 years (± 12.1). Regarding adherence to treatment, 6.9% are adherents, 19.4% are likely to join, 70.8% are likely to be low adherents and 2.8% are low adherents. Those who used multiple doses were less adherent (p = 0.00), failed to list what they used (p=0.03), and omitted more (p=0.02). There are difficulties for reading, opening and remembering the medication every day, and 19.4% reported failure of days or doses.Conclusion: There are difficulties to list medication in use, read, open and remember to take the medication, especially in those over 60 years. Multi-dose prescription significantly interferes with adherence to treatment and correct use of medication


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Medication Adherence , Treatment Adherence and Compliance , Hypertension/prevention & control , Hypertension/therapy , Primary Health Care , Family Health Strategy
10.
In. Negrão, Carlos Eduardo; Pereira-Barretto, Antônio Carlos; Rondon, Maria Urbana Pinto Brandão. Cardiologia do exercício: do atleta ao cardiopata / Exercise cardiology: from athlete to heart disease. São Paulo, Manole, 4ª; 2019. p.404-421.
Monography in Portuguese | LILACS (Americas) | ID: biblio-1015713
11.
Rev. homeopatia (Säo Paulo) ; 82(3/4): 34-37, 2019.
Article in Portuguese | LILACS (Americas), HomeoIndex | ID: biblio-1049891

ABSTRACT

Os autores realizaram um estudo piloto, na Associação Paulista de Homeopatia, para averiguar os efeitos de placebo e medicação homeopática sobe os níveis pressóricos de pacientes portadores de hipertensão arterial sistêmica idiopática. Foram estudados 19 pacientes em uso concomitante ou não de drogas hipotensoras, sendo 14 do sexo feminino, com idade média de 53 anos, e 5 do sexo masculino, com idade média de 44 anos. Fez-se uso do medicamento homeopático único, escolhido por totalidade sintomática característica, nas dinamizações 6C, 12C, 30C, 200C, em doses repetidas, 2 vezes ao dia, por 4 semanas cada. Todos os pacientes receberam previamente placebo por um período de 4 semanas (fase "washout"). Constatou-se efeito significativo da terapêutica homeopática, porém, dentro de uma dinamização individualizada para cada paciente, além da individualização do medicamento. Os autores finalmente fazem considerações para estudos futuros. (AU)


The authors performed a pilot study at the São Paulo Medical Homeopathic Association to investigate the effects of placebo and homeopathic treatment on the blood pressure of patients with idiopathic hypertension. We analyzed 19 patients concomitantly using or not antihypertensive agents, 14 females, with average age 53 years old, and 5 males, with average age 44 years old. One single homeopathic drug was selected as per the total set of characteristic symptoms, and prescribed in dilutions 6C, 12C, 30C and 200C, in repeated doses, twice per day, over 4 weeks each. All the patients previously received placebo over 4 weeks (washout). We found significant effect of homeopathic treatment, however, only for the best individual dilution, in addition to the individualization of the prescribed drugs. The authors finally make some considerations relative to future studies. (au)


Subject(s)
Humans , Male , Female , Middle Aged , Hypertension/therapy , Antihypertensive Agents/therapeutic use , Placebos/therapeutic use , Homeopathic Therapeutics
12.
Rev. homeopatia (Säo Paulo) ; 82(3/4): 38-41, 2019.
Article in Portuguese | LILACS (Americas), HomeoIndex | ID: biblio-1049903

ABSTRACT

Os autores realizaram um estudo piloto de investigação clínica, no ambulatório da Associação Paulista de Homeopatia, para verificar os efeitos de placebo e de medicamentos homeopáticos, escolhidos por totalidade sintomática característica individual, com um grupo de pacientes portadores de hipertensão arterial. Foi enfocada a capacidade de atuação do placebo e de dinamizações sucessivas de medicamento único, 6C, 12C, 30C e 200C, em doses repetidas, 2 vezes ao dia, na referida totalidade sintomatológica, considerando-se seu desaparecimento ou melhoria. Placebo e homeopatia foram fornecidos em frascos idênticos, a cada 4 semanas, começando pelo placebo, até atingir a 200C. Consultas de controle a cada 2 semanas. Concluise pela significância do medicamento homeopático, que não produziu praticamente agravações ou patogenesias, em doses repetidas. A partir da experiência, os autores sugeres condições melhores para feitura de trabalhos semelhantes, para uma melhor avaliação estatística. (AU)


Nineteen patients with idiopathic high blood pressure were subjected to treatment with placebo and homeopathic medicines. Their effects on the characteristic symptoms used to select the individual medication of each patients were analyzed. Statistically significant effect was found for the homeopathic drugs. No aggravation of pathogenetic symptoms practically occurred with doses taken twice daily. Based on their experience, the authors suggest how to improve studies in this field. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Placebos/therapeutic use , Clinical Evolution , Homeopathic Therapeutics , Hypertension/therapy
13.
Article in English | AIM (Africa) | ID: afr-200291

ABSTRACT

Background: Hypertension is an important worldwide public health challenge because of its high prevalence and concomitant risks of cardiovascular and kidney diseases. The risk factors for hypertension are well known, and screening, diagnosis and treatment of hypertension have been well researched. However, this knowledge has not been translated into community practice as there remains a huge knowledge gap between the academics, health workers and the communities. There is need for community participation in developing and implementation of health interventions among marginalised communities.Aim: The aim of this project was to improve the community’s knowledge about hypertension by positively influencing beliefs and behaviours, leading to improved community hypertension outcomes.Setting: The study was undertaken in Ward 14, a rural area situated south-west of Gwanda District, Matebeleland South Province in Zimbabwe.Methods: We conducted a health services research utilising qualitative methods by using a community-based participatory approach using a cooperative inquiry group.Results: There was improvement in knowledge about awareness and primary prevention of hypertension. Community hypertension care was established through competence training of village health workers (VHWs) and more persons living with hypertension were enrolled into care. Pill pickup rate and treatment compliance improved and the community’s confidence in VHWs was restored. Community hypertension screening, treatment registers and health facility referrals were established.Conclusion: The community was empowered; the VHW was established as a key link between the community and the formal health delivery. This was a sustainable form of improving community hypertension health outcomes.


Subject(s)
Hypertension/prevention & control , Hypertension/epidemiology , Hypertension/diagnosis , Hypertension/therapy , Residence Characteristics , Zimbabwe
14.
Rev. chil. cardiol ; 37(3): 161-169, dic. 2018. tab
Article in Spanish | LILACS (Americas) | ID: biblio-977997

ABSTRACT

Resumen: Objetivo: Describir el perfil de usuarios con diabetes mellitus (DM) e hipertensión arterial (HTA) y su relación con indicadores de resultado clínico. Sujetos y métodos: Estudio transversal, correlacional en usuarios con DM y/o HTA, reclutados desde 4 centros de salud de un Servicio de Salud del centro sur de Chile. Los instrumentos y mediciones incluyeron: cuestionario de variables biodemográficas, "Evaluación de la atención de enfermedades crónicas para pacientes", hemoglobina glicosilada (HbA1c), presión arterial sistólica (PAS) y diastólica (PAD). Resultados: Se evaluaron 222 personas con HTA y/o DM con edad promedio 53,9 (DE 7,5) años, la mayoría mujeres (67,6%). Se encontró un predominio de HTA (53,6%), seguido de DM+HTA (31,1%) y DM (15.3%). El promedio de PAS y de HbA1c fue levemente superior en usuarios con patología mixta (DM+HTA). El promedio de la evaluación de la atención desde la perspectiva del paciente fue 2,61 (DE 1,13), siendo mejor evaluado el "Diseño de un sistema de entrega de cuidados/Apoyo a la decisión". Se encontró relación significativa en usuarios con HTA entre PAS y n° de fármacos (p=0,026); en personas con DM entre HbA1c y años de enfermedad (p=0,002) y en usuarios con multimorbilidad (HTA+ DM) entre años de enfermedad con HbA1c (p=0,01) y con PAS (p=0,01). Conclusión: La evaluación de la atención sugiere la necesidad de mayor esfuerzo en el control de los parámetros terapéuticos, incorporando mejoras en la atención proporcionada. Se necesita más investigación para definir la relación entre el perfil de usuarios con enfermedades crónicas y los resultados clínicos.


Abstracts: Aim: To decribe the profile of users of a health program for chronic diseases (CD), especifically Diabetes Mellitus (DM) and Hypertension (HT), and its relation to indicators of clinical results. Subjects and methods: The subjects had DM and/or HT and were randomly selected form 4 health centers in southern Chile. Questionaires exploring demographic variables, Patient Assessement of Chronic Illness Care (PACIC) measurements of HbA1c, systolic (SBP) and diastolic (DBP) pressures were used as indicators of clinical results. Results: 222 subjects with DM and/or HT were evaluated. Mean age was 53.9 years-old (SD 7.5), 67.6% were females. The prevalence of CD was 53.6% for HT, 31.1% for DM+HT and 15.3% for DM. Mean BP and mean HbA1c were slightly higher in users with DM+HT. As perceived by the patient, the evaluation of care had a mean score 2.61 (SD 1.13). "Design of a method of care delivery / decission support" obtained the highest score. In subjects with HT there was a significant correlation between SBP and the number of drugs being received (p=0.03). Also, a significant correlation between HbA1c and disease duration was found in subjects with DM (p=0.02). In subjects with DM+HT significant correlation (p=0.01) existed between disease duration and both HbA1c and SBP. Conclusion: The evaluation of care suggests the need for a stronger effort in controlling therapeutic measures. Further studies are needed to refine the relation of user profile and clinical results.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Diabetes Mellitus, Type 2/therapy , Health Services/statistics & numerical data , Hypertension/therapy , Health Profile , Chile/epidemiology , Cross-Sectional Studies , Surveys and Questionnaires , Outcome Assessment, Health Care , Diabetes Mellitus/epidemiology , Hypertension/epidemiology
16.
Rev. salud pública ; 20(4): 465-471, jul.-ago. 2018. tab
Article in Spanish | LILACS (Americas) | ID: biblio-979008

ABSTRACT

RESUMEN Objetivo Determinar el costo de la atención de la hipertensión arterial, su impacto en el estadio de la enfermedad en un grupo de pacientes de una IPS en Tunja Boyacá Colombia. Materiales y Métodos Estudio transversal de costo-efectividad. Se estudiaron 172 historias clínicas de pacientes con HTA de Tunja Colombia. Resultados El costo de atención promedio en primer nivel fue de $184 631 pesos mes/ paciente, el 61% es gasto en talento humano, 20% en laboratorios y 10% en medicamentos. El cumplimiento frente a lo programado fue de 72.1%. Conclusiones El talento humano consume más del 50% de los recursos en el manejo de la HTA pero repercute en su control y manejo positivamente. Las cifras tensionales demuestran un manejo controlado de los pacientes del programa, el 61% de los mismos tenían cifras normales y 53% demuestran una clasificación en los estadios normales. La hipertensión arterial consume gran cantidad de recursos, por lo que deberá ser objeto de estudio por equipos multidisciplinarios de salud, en la búsqueda de alternativas de manejo más eficientes.(AU)


ABSTRACT Objective To determine the cost of care related to high blood pressure management and its impact on the stage of the disease in a group of patients from Tunja, Boyacá, Colombia. Materials and Methods Cost-effectiveness, cross-sectional study. 172 clinical histories of patients with high blood pressure from Tunja, Colombia, were included. Results The average cost of care in the primary care service was $184 631 pesos per month/patient; 61% of this amount is spent on human resources, 20% on laboratory tests and 10% on medication. Compliance with the program was 72.1%. Conclusions The expenditure on human talent is more than 50% of the resources allocated for the management of high blood pressure, but this has positive repercussions on the control and management of this condition. High blood pressure figures show controlled management of the patients included in the program: 61% of them had normal figures and 53% were classified in the normal stages. High blood pressure requires a large amount of resources, so it should be studied by multidisciplinary health teams in order to find more efficient management alternatives..(AU)


Subject(s)
Humans , Primary Health Care/economics , Health Care Costs , Health Management , Hypertension/therapy , Cross-Sectional Studies/instrumentation , Colombia , Costs and Cost Analysis/methods
18.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3)jul.-ago. 2018. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-916417

ABSTRACT

As situações clínicas de aumento súbito da pressão arterial (PA) que caracterizam as crises hipertensivas são comuns na prática clínica, principalmente nas consultas realiza-das no pronto atendimento, portanto, o diagnóstico adequado é essencial para o melhor tratamento e desfecho clínico. A crise hipertensiva é definida pelo aumento súbito na PA (≥180 /120 mmHg) e a necessidade da redução agressiva da PA depende da gravidade da situação clinica associada. A presença de lesões novas ou progressivas em órgãos-alvo e risco iminente de morte definem as emergências hipertensivas que requerem tratamento imediato visando a rápida redução da pressão arterial, porém, não, necessariamente, a níveis normais. Na maioria dos casos, a velocidade do aumento da PA é mais importante que o nível real da PA, portanto, é fundamental que haja avaliação clínica para o diagnóstico preciso dessas condições clínicas, as quais incluem encefalopatia hipertensiva, síndromes coronarianas agudas, edema agudo dos pulmões, acidente vascular cerebral, dissecção de aorta e eclampsia. As metas para diminuição da PA para as emergências hipertensivas, de acordo com o órgão-alvo envolvido, são revisadas pelas atuais diretrizes brasileiras e ame-ricanas de hipertensão. O tratamento das emergências hipertensivas inclui vasodilatadores de ação direta e bloqueadores adrenérgicos já consagrados, entretanto, evidências recentes mostram o benefício do uso de novos fármacos ainda não disponíveis em nosso meio


The clinical conditions of an acute rise in blood pressure (BP) that characterize hyperten-sive crises are common in clinical practice, particularly in consultations that take place in the emergency room. Therefore the correct diagnosis is important for the best treatment and clinical outcome. Hypertensive crisis is defined as a sudden rise in BP (≥ 180/120 mmHg), and the need for aggressive reduction of BP depends on the severity of the associated clinical situation. The presence of new or progressive target organ injury and imminent risk of death define hypertensive emergencies requiring immediate treatment aimed at rapid reduction of blood pressure, not ne-cessarily to normal levels. In most cases, the speed of the rise in BP is more important than the actual level of BP, and clinical evaluation is essential for the accurate diagnosis of these clinical conditions, which include hypertensive encephalopathy, acute coronary syndromes, pulmonary edema, stroke, aortic dissection, and eclampsia. The goals of BP reduction for hypertensive emergencies, according to the target organ involved, have been reviewed by the current Brazi-lian and American guidelines on hypertension. Treatment of hypertensive emergencies includes direct action vasodilators and adrenergic blockers, which are already well established, but recent evidence shows the benefit of the use of new drugs, not yet available in Brazil


Subject(s)
Humans , Male , Female , Hypertension/diagnosis , Hypertension/therapy , Risk Factors , Acute Coronary Syndrome/complications , Antihypertensive Agents/therapeutic use , Aorta , Cardiovascular Diseases/physiopathology , Clonidine/therapeutic use , Dissection/methods , Echocardiography/methods , Electrocardiography/methods , Guidelines as Topic/standards , Nitroprusside/therapeutic use , Stroke , Target Organs , Vasodilator Agents/therapeutic use
19.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3)jul.-ago. 2018. ilus
Article in Portuguese | LILACS (Americas) | ID: biblio-916420

ABSTRACT

A dissecção da aorta é uma condição grave cujo diagnóstico preciso precoce é fun-damental para a sobrevida dos pacientes. Dentro do contexto da dor torácica aguda no setor de emergência, seu diagnóstico pode passar despercebido, o que exige um alto índice de suspeição para ser realizado em tempo hábil. A disponibilidade dos métodos de imagem têm contribuído para a prontidão desse diagnóstico. Os objetivos iniciais do tratamento consistem no controle da dor e da pressão arterial através, principalmente, do uso de betabloqueadores endovenosos. Tais medidas diminuem o stress na parede da aorta, minimizando a propagação da delaminação. A identificação da localização do segmento de aorta dissecado é crucial, pois impacta no tratamento e no prognóstico. Pacientes com dissecção tipo B de Stanford e sem complicações podem receber trata-mento medicamentoso exclusivo, enquanto que a dissecção aguda tipo A de Stanford é uma emergência cirúrgica. Em relação à cirurgia, têm-se discutido o benefício da técnica do Frozen Elephant Trunk, a qual corrige uma maior extensão de aorta comprometida, po-dendo beneficiar pacientes com isquemia distal, apesar de apresentar maior complexidade e aumentar o risco de complicações neurológicas. Para as dissecções tipo B, o reparo endovascular tem sido amplamente utilizado e vários especialistas têm sugerido essa abordagem também para os casos não complicados, pois estudos recentes descrevem a influência do tratamento no remodelamento aórtico e, consequentemente, na sobrevida


Aortic dissection is a dramatic condition whose early accurate diagnosis is fundamen-tal for patient survival. Within the context of acute chest pain in the emergency room, its diagnosis can be overlooked, requiring a high level of suspicion to be performed in a timely manner. The availability of imaging methods has contributed to a faster diagnosis. The initial management goal is to control pain and blood pressure, mainly through the use of intra-venous beta-blockers. This strategy decreases shear stress on the aortic wall, minimizing the progression of delamination. Identifying the location of the dissected aortic segment is crucial, as this will impact on the treatment and prognosis. Patients with uncomplicated Stanford type B dissection may receive pharmaceutical treatment alone, while acute type A dissection is a surgical emergency. In relation to surgery, the benefit of the "Frozen Ele-phant Trunk" technique has been discussed, which corrects a greater area of compromised aorta and may benefit patients with distal ischemia, despite adding greater complexity and increasing the risk of neurological complications. For type B dissections, endovascular repair has been widely used, and several experts have also suggested this approach for uncomplicated cases, as recent studies have described the influence of the treatment on aortic remodeling and consequently, on survival


Subject(s)
Humans , Male , Female , Aneurysm, Dissecting/diagnosis , Aneurysm, Dissecting/physiopathology , Aorta , Dissection/methods , Aortic Diseases , Chest Pain/complications , Diagnostic Imaging/methods , Echocardiography, Transesophageal/methods , Endovascular Procedures/methods , Hypertension/therapy , Obesity , Prognosis , Risk Factors , Tomography/methods
20.
Rev. méd. hondur ; 86(1/2): 18-21, ene-. jul. 2018. graf.
Article in Spanish | LILACS (Americas) | ID: biblio-1007078

ABSTRACT

Antecedentes: La hipertensión arterial es una enfermedad crónica no transmisible altamente prevalente en Honduras. Es un factor de riesgo para enfermedades cardiovasculares, cerebrovasculares y renales. La mortalidad por enfermedades cardiovasculares es del 27% en el país, según la Organización Mundial de la Salud. Objetivo: Determinar el nivel de adherencia al tratamiento farmacológico y no farmacológico, en los pacientes hipertensos que acudieron al centro de salud San Juan de Ojojona, en el primer trimestre del año 2017. Pacientes y métodos: Se utilizó el cuestionario Martin-Bayarre-Grau para estudio del nivel de adherencia al tratamiento antihipertensivo, aplicado mediante entrevistas personales a 66 pacientes seleccionados por muestreo aleatorio simple. Resultados: La mayoría de las personas estudiadas (60%) estaban parcialmente adheridas al tratamiento, el 36.4% totalmente adherido y 3% tenía adherencia nula al tratamiento. Conclusión: La escasa actividad física y no seguir las indicaciones dietéticas inluyen grandemente en la adherencia parcial que tiene la mayoría de la población estudiada...(AU)


Subject(s)
Humans , Male , Female , Cardiovascular Diseases/complications , Treatment Adherence and Compliance , Hypertension/therapy , Antihypertensive Agents/therapeutic use
SELECTION OF CITATIONS
SEARCH DETAIL