Clinical Study on Zhuanyaotang Granules for the Treatment of Degenerative Lumbar Spinal Stenosis / 中国中医药信息杂志

Objective To observe the clinical efficacy of Zhuanyaotang Granules for the treatment of degenerative lumbar spinal stenosis(DLSS).Methods Using a randomized double blind controlled design,104 DLSS patients were divided into an experimental group and a control group using a random number table method,with 52 patients in each group.The treatment group took oral Zhuanyaotang Granules,methylcobalamin tablets and celecoxib capsule simulants.The control group used Zhuanyaotang Granules simulants,methylcobalamin tablets and celecoxib capsules.The course of treatment was 3 weeks for both groups.The follow-ups were conducted at 1 month and 3 months after treatment.The intermittent claudication distance,visual analogue scale(VAS)score and JOA efficacy rating criteria for low back pain score were observed in both groups before treatment,1,2,3 weeks of treatment and 1 month after treatment and 3 months after treatment.Adverse reactions during treatment were recorded.Results There were 5 cases of detachment and 2 cases of exclusion in the experimental group,and 5 cases of detachment and 1 case of exclusion in the control group.Compared with before treatment,there were statistically significant differences in intermittent claudication distance,VAS score,and JOA score between the two groups of patients at various time points during treatment and follow-up(P<0.05);there was no statistically significant difference in intermittent claudication distance,VAS score,and JOA score between the experimental group and the control group before treatment and 1 and 2 weeks of treatment(P>0.05);compared with the two groups at 3 weeks of treatment and 1 and 3 months after treatment,the intermittent claudication distance and JOA score in the experimental group were lower than those in the control group(P<0.05);There was no significant difference in VAS score between the two groups and the control group after 3 weeks of treatment(P>0.05).There were 2 adverse reactions(4.4%)in the experimental group and 5 adverse reactions(10.8%)in the control group,without statistical significance(P>0.05).Conclusion Zhuanyaotang Granules can effectively relieve pain and improve lumbar function in patients with DLSS,which is more effective and safer than oral celecoxib capsules and methylcobalamin tablets.

Health and lifestyle parameters in peripheral artery disease at two periods of the COVID-19 pandemic: comparison between men and women

ABSTRACT Objective: This study analyzed the impact of sex on self-reported health and lifestyle parameters in peripheral artery disease patients at two periods of the COVID-19 pandemic. Methods: In this longitudinal study, 99 patients with peripheral artery disease (53 men and 46 women) were evaluated during two periods of the COVID-19 pandemic ( i.e ., at onset: May to August 2020, and on follow-up: May to August 2021). Patients were interviewed via telephone, and information regarding lifestyle and health parameters was obtained. Results: At the onset of the COVID-19 pandemic, health and habit parameters were similar between women and men, with 63.0% and 45.3% indicating frequent fatigue, 73.9% and 84.9% reporting increased sitting time, and 23.9% and 39.6% practicing physical activity, respectively. At follow-up, difficulties in physical mobility (women: from 26.1% to 73.9%, p<0.001; men: from 39.6% to 71.7%, p=0.001) and the frequency of hospitalization for reasons other than COVID-19 increased similarly in women and men (women: from 4.3% to 21.7%, p=0.013; men: from 9.4% to 24.5%, p=0.038). The other parameters were similar between the periods. Conclusion: Self-reported physical mobility difficulties and hospitalization frequency increased in women and men with peripheral artery disease.

Effects of aerobic and combined training on pain-free walking distance and health-related quality of life in patients with peripheral artery disease: a randomized clinical trial / Efeitos do treinamento aeróbico e combinado na distância percorrida sem dor e na qualidade de vida relacionada à saúde em pacientes com doença arterial periférica: um ensaio clínico randomizado

Abstract Background Decreased walking ability in patients with peripheral arterial disease is often a clinical problem and limits the quality of life and daily activities of these subjects. physical exercise is important in this scenario, as it improves both the daily walking distance and the ability to withstand intermittent claudication related to the limitations of the peripheral disease. Objectives Our aim was to compare the effects of two types of exercise training (aerobic training and aerobic training combined with resistance exercises) on pain-free walking distance (PFWD) and health-related quality of life (HRQoL) in a sample composed of patients with peripheral artery disease (PAD). Methods Twenty patients with claudication symptoms were randomized to either aerobic control (AC) N= 9, or combined training (CT) N= 8, (24 sixty-minute sessions, twice a week). The total walking distance until onset of pain due to claudication was assessed using the 6-minute walk test and HRQoL was measured using the WHOQOL-bref questionnaire (general and specific domains) at baseline and after training. We used generalized estimating equations (GEE) to assess the differences between groups for the PFWD and HRQoL domains, testing the main group and time effects and their respective interaction effects. P values < 0.05 were considered statistically significant. Results Seventeen patients (mean age 63±9 years; 53% male) completed the study. Both groups experienced improvement in claudication, as reflected by a significant increase in PFWD: AC, 149 m to 299 m (P<0.001); CT, 156 m to 253 m (P<0.001). HRQoL domains also improved similarly in both groups (physical capacity, psychological aspects, and self-reported quality of life; P=0.001, P=0.003, and P=0.011 respectively). Conclusions Both aerobic and combined training similarly improved PFWD and HRQoL in PAD patients. There are no advantages in adding strength training to conventional aerobic training. This study does not support the conclusion that combined training is a good strategy for these patients when compared with classic training.

Resumo Contexto A diminuição da capacidade de marcha em pacientes com doença arterial periférica é frequentemente um problema clínico e limita a qualidade de vida e as atividades diárias desses indivíduos. O exercício físico é importante nesse cenário, pois melhora tanto a distância caminhada diária quanto a capacidade de suportar a claudicação intermitente relacionada às limitações da doença periférica. Objetivos Comparar os efeitos do treinamento aeróbico (TA) e do treinamento aeróbico combinado com exercícios de resistência (TC) na distância percorrida livre de dor (DPLD) e na qualidade de vida relacionada à saúde (QVRS) em pacientes com doença arterial periférica (DAP). Métodos Vinte pacientes com sintomas de claudicação foram randomizados para TA ou TC. Os treinamentos foram realizados em 24 sessões, duas vezes por semana. A DPLD foi avaliada por meio do teste de caminhada de 6 minutos, e a QVRS foi medida pelo instrumento da avaliação de qualidade de vida da Organização Mundial da Saúde (WHOQOL-BREF), no início e após o treinamento. Para avaliar as diferenças entre os grupos para DPLD e os domínios da QVRS, foi utilizado o modelo de equações de estimativa generalizada, testando os efeitos principais do grupo e tempo, bem como os respectivos efeitos de interação. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados Dezessete pacientes (idade média: 63±9 anos; 53% do sexo masculino) completaram o estudo. Ambos os grupos apresentaram melhora na claudicação, refletida por um aumento significativo na DPLD: grupo controle aeróbico - de 149 m para 299 m (P < 0,001); grupo de treinamento combinado - de 156 m para 253 m (P < 0,001). Os domínios da QVRS também melhoraram de forma semelhante em ambos os grupos (capacidade física, aspectos psicológicos e qualidade de vida autorreferida; P = 0,001, P = 0,003 e P = 0,011, respectivamente). Conclusões Ambos os treinamentos melhoraram de forma semelhante a DPLD e a QVRS em pacientes com DAP. Não há vantagens em associar o treinamento de força ao treinamento aeróbico convencional. O estudo não permite concluir que o TC é uma boa estratégia para esses pacientes quando comparado ao treinamento clássico.

Perfusión 2D por angiografía en oclusión arterial periférica. Método de evaluación inmediato posproceder / 2D perfusion by angiography in peripheral arterial occlusion. Post-procedural immediate evaluation method

La enfermedad arterial periférica se considera la mayor causa de hospitalización, con riesgo de amputación de la extremidad afectada y muerte debido a la enfermedad per se o sus complicaciones. Se reporta la experiencia del tratamiento a un paciente con macroangiopatía diabética, estenosis del 64 por ciento de la arteria ilíaca izquierda y afectación de los segmentos fémoro-poplíteos bilaterales, al cual, a través de un acceso percutáneo vía arteria braquial izquierda, se le realizó revascularización mediante la implantación de stent de cromo-cobalto liberado por balón catéter. El objetivo de este estudio fue describir la utilidad del 2D-ASD y su valor como herramienta para determinar el transproceder y la repercusión en el flujo sanguíneo de la revascularización realizada, y establecer un pronóstico funcional para el paciente. Se utilizó la angiografía por perfusión bidimensional como herramienta para evaluar el éxito técnico del proceder y la repercusión inmediata en la perfusión distal de la extremidad afecta, y describir la utilidad de la escala paramétrica de colores y las curvas de densidad en función del tiempo obtenidos en el estudio(AU)

Peripheral artery disease is considered the leading cause of hospitalization, with risk of amputation of the affected limb and death due to the disease per se or its complications. It is reported the experience of treatment in a patient with diabetic macroangiopathy, stenosis of 64 precent of the left iliac artery and involvement of the bilateral femoro-popliteal segments, to which, through a percutaneous access via the left brachial artery, revascularization was performed through the implantation of cobalt-chromium stent released by balloon catheter. The objective of this study was to describe the usefulness of 2D-ASD and its value as a tool to determine the trans-procedure and the impact on blood flow of the revascularization performed, and to establish a functional prognosis for the patient. Two-dimensional perfusion angiography was used as a tool to evaluate the technical success of the procedure and the immediate impact on distal perfusion of the affected limb, and to describe the usefulness of the parametric color scale and density curves as a function of the time obtained in the study(AU)

Perfusión 2D por angiografía en oclusión arterial periférica. Método de evaluación inmediato posproceder / 2D perfusion by angiography in peripheral arterial occlusion. Post-procedural immediate evaluation method

La enfermedad arterial periférica se considera la mayor causa de hospitalización, con riesgo de amputación de la extremidad afectada y muerte debido a la enfermedad per se o sus complicaciones. Se reporta la experiencia del tratamiento a un paciente con macroangiopatía diabética, estenosis del 64 por ciento de la arteria ilíaca izquierda y afectación de los segmentos fémoro-poplíteos bilaterales, al cual, a través de un acceso percutáneo vía arteria braquial izquierda, se le realizó revascularización mediante la implantación de stent de cromo-cobalto liberado por balón catéter. El objetivo de este estudio fue describir la utilidad del 2D-ASD y su valor como herramienta para determinar el transproceder y la repercusión en el flujo sanguíneo de la revascularización realizada, y establecer un pronóstico funcional para el paciente. Se utilizó la angiografía por perfusión bidimensional como herramienta para evaluar el éxito técnico del proceder y la repercusión inmediata en la perfusión distal de la extremidad afecta, y describir la utilidad de la escala paramétrica de colores y las curvas de densidad en función del tiempo obtenidos en el estudio(AU)

Peripheral artery disease is considered the leading cause of hospitalization, with risk of amputation of the affected limb and death due to the disease per se or its complications. It is reported the experience of treatment in a patient with diabetic macroangiopathy, stenosis of 64 percent of the left iliac artery and involvement of the bilateral femoro-popliteal segments, to which, through a percutaneous access via the left brachial artery, revascularization was performed through the implantation of cobalt-chromium stent released by balloon catheter. The objective of this study was to describe the usefulness of 2D-ASD and its value as a tool to determine the trans-procedure and the impact on blood flow of the revascularization performed, and to establish a functional prognosis for the patient. Two-dimensional perfusion angiography was used as a tool to evaluate the technical success of the procedure and the immediate impact on distal perfusion of the affected limb, and to describe the usefulness of the parametric color scale and density curves as a function of the time obtained in the study(AU)

Impacto do câncer em pacientes com doença arterial periférica / Impact of cancer in patients with peripheral artery disease

Introdução e Objetivo: O impacto do câncer em pacientes com DAP sobre nível de atividade física diária, capacidade funcional, função cardiovascular e qualidade de vida ainda não é conhecido, sendo, portanto, o objetivo deste presente estudo. Métodos: Estudo transversal com 299 pacientes. Nível de Atividade física (acelerômetro), capacidade funcional (teste de caminhada de 6 minutos, Handgrip, Short Physical Performance Battery, Walking Impairment Questionnaire-WIQ e o Walking Estimated-Limitation Calculated by History), função cardiovascular (pressão arterial braquial, variabilidade da frequência cardíaca e rigidez arterial) e qualidade de vida (WHOQOL-bref) foram comparados entre os pacientes com DAP com e sem histórico de câncer. Resultados: Pacientes com DAP e câncer (N=27) apresentaram melhor desempenho no domínio da distância e da velocidade do WIQ (21±37 vs 14±26, p=0.036; 29±18 vs 22±15, p=0.022, respectivamente) comparado aos pacientes com DP sem câncer. Os outros parâmetros foram similares entre os grupos. Conclusão: Os pacientes com DAP e câncer apresentaram

Introduction and Objective: The impact of cancer in patients with PAD on the level of daily physical activity, functional capacity, cardiovascular function and quality of life is not yet known, thus being the objective of this present study. Methods: Cross-sectional study with 299 patients. Physical activity level (accelerometer), functional capacity (6-minute walk test, Handgrip, Short Physical Performance Battery, Walking Impairment Questionnaire-WIQ and the Walking Estimated-Limitation Calculated by History), cardiovascular function (brachial blood pressure, variability of heart rate and arterial stiffness) and quality of life (WHOQOL-bref) were compared between patients with PAD with and without a history of cancer. Results: Patients with PAD and cancer (N=27) performed better in the distance and speed domains of the WIQ (21±37 vs 14±26, p=0.036; 29±18 vs 22±15, p=0.022, respectively) compared to PD patients without cancer. The other parameters were similar between groups. Conclusion: Patients with PAD and cancer had better results for subjectively assessed functional capacity.

Plasma thrombin-antithrombin complex evaluates hypercoagulable states and predicts revasenosis after revascularization in patients of atherosclerosis obliterans / 中华检验医学杂志

Objective:To study the changing characteristics of the levels of plasma thrombin-antithrombin complex (TAT) in atherosclerosis obliterans (ASO) patients with different conditions and the clinical value of predicting luminal restenosis after revascularization.Methods:A total of 386 ASO patients were collected, including 209 males and 177 females, aged 70 (44-97) years old, including 196 patients with intermittent claudication and 190 patients with critical limb ischemia. There were 172 patients with intermittent claudication and 185 patients with critical limb ischemia who received revascularization therapy. During the 30-day follow-up period, 23 patients with intermittent claudication and 49 patients with critical limb ischemia developed restenosis after surgery. Venous blood samples were collected before surgery, on the 3rd day after surgery, and on the 7th day after surgery. Plasma TAT levels were determined by Shine i2900-automatic chemiluminescence immunoassay analyzer; Kruskal-Wallis H test was used for comparison among multiple groups; Mann-Whitney U test was used for data comparison between the two groups; continuous comparison of patient data in the same group was done by using Friedman rank test; multivariate correlation analysis by Logistic regression was conducted to obtain odds ratio( OR). The diagnostic performance of TAT was evaluated by ROC analysis. Kaplan-Meier curve was used to analyze the survival curve, and the hazard ratio (HR) was obtained by Cox proportional hazard regression model. Results:Compared with the healthy control group, the level of plasma TAT in patients with intermittent claudication was significantly higher ( P<0.001); the level of plasma TAT in patients with critical limb ischemia was significantly higher than that in patients with intermittent claudication ( P<0.001). The plasma TAT of patients with Rutherford grade 3 >grade2, grade4 >grade3, and grade6 >grade5 ( P values were 0.038, <0.001, and 0.013, respectively).In the intermittent claudication group, the plasma TAT levels of the patients with restenosis on the 3rd and the 7th day after revascularization were both higher than that of the patients with unobstructed blood flow ( P values were 0.004 and <0.001, respectively); The plasma TAT level of patients with unobstructed blood flow on the 7th day after surgery was lower than that on the 3rd day after surgery and before surgery (both P values <0.001); the plasma TAT level of patients with restenosis on the 7th day after surgery was lower than that on the 3rd day after surgery and higher than before surgery (both P values < 0.001). In the critical limb ischemia group, before surgery, on the 3rd and the 7th day after surgery,the plasma TAT levels of the patients with restenosis were higher than that of the patients with unobstructed blood flow ( P values were 0.001, 0.013, and <0.001, respectively); The plasma TAT level of patients with unobstructed blood flow on the 7th day after surgery was lower than that on the 3rd day after surgery and before surgery (both P values <0.001); the plasma TAT level of patients with restenosis on the 7th day after surgery was lower than that on the 3rd day after surgery ( P<0.001), but was not significantly difference from that before surgery. The ROC analysis showed that the areas under the curve (AUC) of plasma TAT on the 7th day after surgery to predict postoperative restenosis in all the patients, patients with intermittent claudication and those with critical limb ischemia were 0.839, 0.783 and 0.853, respectively. Survival analysis indicated that in the critical limb ischemia group, patients with plasma TAT levels higher than the critical value (≥7.66 ng/ml) on the 7th day after surgery showed significantly higher cumulative risk of restenosis events within 30 days after surgery (Log-rank χ 2=93.674, P<0.001). Cox regression analysis showed that the plasma TAT level on the 7th day after the surgery could be used as an independent indicator to predict the occurrence of restenosis within 30 days after surgery in the critical limb ischemia group ( HR=2.259, P<0.001). Conclusion:Plasma TAT can reflect the hypercoagulable state of ASO patients in different conditions, which is helpful for stratification of disease severity. In addition, TAT is highly sensitive for luminal restenosis after revascularization and can be used as an independent marker for evaluating postoperative restenosis events in patients with critical limb ischemia.

El Síndrome de Leriche: Subdiagnóstico en la Enfermedad Arterial Periférica

Resumen La enfermedad oclusiva aorto-ilíaca, denominada también como Síndrome de Leriche, es la oclusión de la aorta abdominal en su segmento infrarrenal, siendo la aterosclerosis la causa principal. Los factores de riesgo más frecuentes, son: la hipertensión, la diabetes mellitus, la dislipidemia y el tabaquismo. Se describe el caso de un paciente con factores de riesgo para enfermedad ateroesclerótica quien ingresó por dolor en miembros inferiores, claudicación intermitente, cambios de coloración en pie y ausencia de pulsos en miembros inferiores. Clínicamente, esta entidad se caracteriza por la tríada clásica: Claudicación, disfunción eréctil y pulsos distales disminuidos. Debido a su cronicidad, muchos suelen ser asintomáticos debido a la circulación colateral que desarrollan, lo que conlleva a un subregistro. Los estudios vasculares como: la ecografía doppler, la angiotomografía computarizada y la angiografía aórtica pueden ayudar a confirmar el diagnóstico y la ubicación de la estenosis, siempre teniendo como pilar fundamental la sospecha clínica.

Abstract Aortoiliac occlusive disease, also known as Leriche´s Syndrome, is the occlusion of the abdominal aorta in its infrarenal segment, with atherosclerosis being the main cause. The most frequent risk factors are: hypertension, diabetes mellitus, dyslipidemia and smoking. The case of a patient with risk factors for atherosclerotic disease who was admitted due to pain in the lower limbs, intermittent claudication, discoloration of the foot and absence of pulses in the lower limbs is described. Clinically, is characterized by the classic triad: Claudication, erectile dysfunction and decreased distal pulses. Due to their chronicity, many are usually asymptomatic due to the collateral circulation they develop, which leads to underreporting. Vascular studies such as: Doppler ultrasound, computed tomography angiography and aortic angiography can help confirm the diagnosis and location of stenosis, always having clinical suspicion as a fundamental pillar.

Respostas fisiológicas à caminhada máxima e submáxima em pacientes com doença arterial periférica sintomática / Physiological responses to maximal and submaximal walking in patients with symptomatic peripheral artery disease

Resumo Fundamento: Embora a caminhada máxima e submáxima sejam recomendadas para pacientes com doença arterial periférica (DAP), a realização desses exercícios pode induzir diferentes respostas fisiológicas. Objetivos: Comparar os efeitos agudos de caminhada máxima e submáxima na função cardiovascular, a regulação e os processos fisiopatológicos associados pós-exercício em pacientes com DAP sintomática. Métodos: Trinta pacientes do sexo masculino foram submetidos a 2 sessões: caminhada máxima (protocolo de Gardner) e caminhada submáxima (15 períodos de 2 minutos de caminhada separados por 2 minutos de repouso ereto). Em cada sessão, foram medidos a pressão arterial (PA), a frequência cardíaca (FC), a modulação autonômica cardíaca (variabilidade da FC), os fluxos sanguíneos (FS) do antebraço e da panturrilha, a capacidade vasodilatadora (hiperemia reativa), o óxido nítrico (ON), o estresse oxidativo (a peroxidação lipídica) e a inflamação (quatro marcadores), pré e pós-caminhada. ANOVAs foram empregadas e p < 0,05 foi considerado significativo. Resultados: A PA sistólica e a PA média diminuíram após a sessão submáxima, mas aumentaram após a sessão máxima (interações, p < 0,001 para ambas). A PA diastólica não foi alterada após a sessão submáxima (p > 0,05), mas aumentou após a caminhada máxima (interação, p < 0,001). A FC, o equilíbrio simpatovagal e os FS aumentaram de forma semelhante após as duas sessões (momento, p < 0,001, p = 0,04 e p < 0,001, respectivamente), enquanto a capacidade vasodilatadora, o ON e o estresse oxidativo permaneceram inalterados (p > 0,05). As moléculas de adesão vascular e intercelular aumentaram de forma semelhante após as sessões de caminhada máxima e submáxima (momento, p = 0,001). Conclusões: Nos pacientes com a DAP sintomática, a caminhada submáxima, mas não a máxima, reduziu a PA pós-exercício, enquanto a caminhada máxima manteve a sobrecarga cardíaca elevada durante o período de recuperação. Por outro lado, as sessões de caminhada máxima e submáxima aumentaram a FC, o equilíbrio simpatovagal cardíaco e a inflamação pós-exercício de forma semelhante, enquanto não alteraram a biodisponibilidade de ON e o estresse oxidativo pós-exercício.

Abstract Background: Although maximal and submaximal walking are recommended for patients with peripheral artery disease (PAD), performing these exercises may induce different physiological responses. Objectives: To compare the acute effects of maximal and submaximal walking on post-exercise cardiovascular function, regulation, and associated pathophysiological processes in patients with symptomatic PAD. Methods: Thirty male patients underwent 2 sessions: maximal walking (Gardner's protocol) and submaximal walking (15 bouts of 2 minutes of walking separated by 2 minutes of upright rest). In each session, blood pressure (BP), heart rate (HR), cardiac autonomic modulation (HR variability), forearm and calf blood flows (BF), vasodilatory capacity (reactive hyperemia), nitric oxide (NO), oxidative stress (lipid peroxidation), and inflammation (four markers) were measured pre- and post-walking. ANOVAs were employed, and p < 0.05 was considered significant. Results: Systolic and mean BP decreased after the submaximal session, but they increased after the maximal session (interactions, p < 0.001 for both). Diastolic BP did not change after the submaximal session (p > 0.05), and it increased after maximal walking (interaction, p < 0.001). HR, sympathovagal balance, and BF increased similarly after both sessions (moment, p < 0.001, p = 0.04, and p < 0.001, respectively), while vasodilatory capacity, NO, and oxidative stress remained unchanged (p > 0.05). Vascular and intercellular adhesion molecules increased similarly after both maximal and submaximal walking sessions (moment, p = 0.001). Conclusions: In patients with symptomatic PAD, submaximal, but not maximal walking reduced post-exercise BP, while maximal walking maintained elevated cardiac overload during the recovery period. On the other hand, maximal and submaximal walking sessions similarly increased post-exercise HR, cardiac sympathovagal balance, and inflammation, while they did not change post-exercise NO bioavailability and oxidative stress.

Distancia de claudicación e índice tobillo-brazo en pacientes con insuficiencia arterial tratados con células madre / Claudication distance and ankle-arm index in patients with arterial insufficiency treated with stem cells

Introducción: La enfermedad arterial periférica de miembros inferiores constituye un problema de salud por ser responsable de más del 40 % de las amputaciones no traumáticas en diabéticos y no diabético. Las células madre pudieran contribuir positivamente a su tratamiento, al participar en el proceso angiogénico. Objetivo: Describir la distancia de claudicación y el índice de presiones tobillo-brazo en pacientes con insuficiencia arterial tratados con células madre. Métodos: Se realizó un estudio cuasi experimental, prospectivo y analítico en 36 pacientes con el diagnóstico de insuficiencia arterial, atendidos en el servicio de Angiología del Hospital Militar Central "Dr. Carlos J. Finlay". Los pacientes fueron tratados con células mononucleares autólogas obtenidas de sangre periférica, aplicadas por vía intramuscular. Las variables estudiadas resultaron: edad, sexo, factores de riesgo, patrón oclusivo, distancia de claudicación e índice de presiones tobillo-brazo. Resultados: Predominaron el sexo masculino (63,9 por ciento), el grupo de edades de 65 y más años (44,4 percent), y el color de piel blanco (61,1 percent)). Los factores de riesgo más frecuentes fueron el tabaquismo (72,2 percent)) y la hipertensión arterial (69,4 percent)). En el 77,7 percent) desapareció el dolor a la marcha (p < 0,01). La distancia de claudicación aumentó (p < 0) al concluir el sexto mes (397,2 ± 118,8 metros: IC 95 percent): 357; 437,4). Hubo un incremento altamente significativo (p < 0) del índice de presiones tobillo-brazo de la arteria pedia. Conclusiones: Las células mononucleares autólogas resultan eficaces en el tratamiento de la insuficiencia arterial, por eliminar el dolor ante el ejercicio, aumentar la distancia a la marcha y elevar los índices de presiones tobillo-brazo(AU)

ABSTRACT Introduction: Lower limb´s peripheral artery disease is a health problem as being the cause of more than 40% of non-traumatic amputations in diabetic and non-diabetic patients. Stem cells could contribute positively to their treatment by participating in the angiogenic process. Objective: Describe claudication distance and ankle-arm´s pressure index in patients with arterial insufficiency treated with stem cells. Methods: A quasi-experimental, prospective and analytical study was carried out in 36 patients diagnosed with arterial insufficiency, attended in the Angiology service of "Dr. Carlos J. Finlay" Central Military Hospital. Patients were treated with autologous mononuclear cells obtained from peripheral blood, and they were used intramuscularly. The studied variables were: age, sex, risk factors, occlusive pattern, claudication distance and ankle-arm´s pressure index. Results: Male sex (63.9%), age group of 65 years and older (44.4%), and white skin (61.1%) predominated. The most common risk factors were: smoking habit (72.2%), and high blood pressure (69.4%). In 77.7% of the cases, the pain while walking disappeared (p < 0.01). The claudication distance increased (p< 0) at the end of the sixth month (397.2 ± 118.8 meters: IC 95 %: 357; 437.4). There was a highly significant increase (p< 0) of the ankle-arm´s pressure index of the dorsalis pedis artery. Conclusions: Autologous mononuclear cells are effective in treating arterial insufficiency as they eliminate pain during exercise, increase distance while walking, and increase ankle-arm´s pressure rates.

Enfermedad arterial periférica en pacientes trasplantados renales. Validez del cuestionario de Edimburgo para el diagnóstico de enfermedad / Peripheral arterial disease in renal transplant patients. Validity of the Edinburgh questionnaire for disease diagnosis

RESUMEN Objetivos: Determinar en pacientes trasplantados renales la prevalencia de enfermedad arterial periférica y la validez de las manifestaciones clínicas de claudicación intermitente para su diagnóstico. Material y métodos: Ámbito y período: Servicio de Nefrología del Complejo Hospitalario Universitario A Coruña, 2013-2017. Criterios inclusión: pacientes trasplantados renales con injerto funcionante que consientan participar en el estudio. Justificación del tamaño muestral: n=371 pacientes (seguridad= 95% y precisión= ± 4,25%). Mediciones: edad, edad al trasplante, sexo, dislipemia, índice de masa corporal, tabaquismo, diabetes, signo de Godet, edema perimaleolar, índice tobillo-brazo y cuestionario Edimburgo. El riesgo cardiovascular se midió mediante los scores Framingham-Wilson, Regicor, SCORE y Dorica. Resultados: La edad media al trasplante fue de 47,86 ± 12,62 años, 65,5% hombres. El 8,7% de los pacientes presentan un índice tobillo-brazo <0,90. El 16,2% de los pacientes manifiestan claudicación intermitente según el cuestionario Edimburgo. La concordancia entre ambas pruebas diagnósticas es débil (índice de Kappa=0,34). El cuestionario de Edimburgo mostró sensibilidad del 59,38% para predecir índice tobillo-brazo <0,90 y especificidad del 88,10%. Las variables asociadas a la presencia de arteriopatía son la edad al trasplante (OR=1,07) y el tabaquismo (OR=6,17), encontrándose la dislipemia en el límite de la significación estadística. Conclusiones: Una décima parte de los pacientes presentan arteriopatía periférica. La concordancia entre el cuestionario Edimburgo y el índice tobillo-brazo es débil. Por lo que debería usarse el índice tobillo-brazo como método diagnóstico. Las manifestaciones clínicas infraestiman la prevalencia de arteriopatía. La edad, el tabaquismo y la dislipemia incrementan su riesgo. Los pacientes con arteriopatía presentan riesgo cardiovascular más elevado.

ABSTRACT Objectives: To assess the prevalence of peripheral artery disease in kidney transplant patients and the validity of intermittent claudication for its diagnosis. Methods: Setting and period: Nephrology Department of the University Hospital A. Coruña, 2013-2017. Inclusion criteria: transplant patients with functioning grafts who gave their consent to participate in the study. Sample size rationale: n=371 patients (confidence interval= 95%; precision= ± 4.25%). Measurements: age, age at the time of transplant, sex, dyslipemia, body mass index, smoking, diabetes, sign of Godet, perimalleolar edema, ankle-brachial index and the Edinburgh Questionnaire. Cardiovascular risk was measured with these scores: Framingham-Wilson, Regicore, SCORE and Dorica. Results: The mean age at the time of transplant was 47.86±12.62; 65.5% of patients were men and 8.7% of them had an ankle-brachial index of <0.90. When answering the Edinburgh Questionnaire, 16.2% of subjects reported suffering from intermittent claudication. Concordance between these two diagnostic tests is poor (kappa index= 0.34). The Edinburgh Questionnaire showed a sensitivity of 59.38% in predicting the ankle-brachial index (<0.90) and specificity (88.10%). The variables associated with the presence of artery disease are age at the time of transplant (OR=1.07) and smoking (OR=6.17), dyslipidemia being at the limit of statistical significance. Conclusions: A tenth part of the patients have peripheral artery disease. Concordance between the Edinburgh Questionnaire and the ankle-brachial index is poor; therefore, the latter should be used as diagnostic method. Clinical signs and symptoms underestimate the prevalence of artery disease. Age, smoking and dyslipidemia increase the risk of this disease. Artery disease patients have a higher cardiovascular risk.

Nível de atividade física, qualidade do sono e de vida em pacientes com doença arterial periférica / Level of physical activity, quality of sleep and life in patients with peripheral arterial disease

Introdução: a Doença Arterial Periférica (DAP) decorre do estreitamento ou oclusão arterial, que interfere no aporte sanguíneo das extremidades inferiores. A DAP pode levar a um repouso prolongado, causando prejuízos à qualidade de vida e do sono dos pacientes, devido à dor e receio de lesão. Objetivo: descrever o nível de atividade física, a qualidade de vida e do sono em pacientes com DAP. Metodologia: trata-se de um estudo observacional, epidemiológico e transversal, realizado no Hospital Geral de Camaçari-BA. Foram incluídos pacientes com diagnóstico de DAP, ambos os sexos, com idade superior a 18 anos, internados no referido hospital. Foram excluídos os pacientes com distúrbios psiquiátricos e dificuldade de compreensão dos questionários. Para a avaliação do nível de atividade física foi utilizado o Questionário Internacional de Atividade física, para Qualidade de Vida o questionário Short Form Health Survey 36, para qualidade do sono Índice de Qualidade do Sono de Pittsburgh e para Claudicação Intermitente o Questionário de Edimburgo. Resultados: dos 27 pacientes analisados, 55,6% (15/27) eram do sexo feminino e 44,4% (12/27) masculino, 37% (10/27) de cor/raça preta. A média de idade foi de 62,6±8,3 anos, peso 71,8±16,2kg, altura 164,8±8,3cm e IMC 26,3±5. A maioria relatou ser ativo, 33,3% (9/27). Segundo a SF-36 o domínio mais limitante foi "dor" (28,6), o escore global do PSQI foi de 10,4 e a maioria (81,5%) não apresentava claudicação intermitente. Conclusão: a presença de DAP foi mais frequente nos idosos e foram identificados a presença de distúrbios do sono e diminuição da qualidade de vida.

Introduction: peripheral Arterial Disease (PAD) is due to narrowing or arterial occlusion, which interferes with the blood supply of the lower extremities. PAD can lead to prolonged rest, causing damage to the quality of life and sleep of patients, due to pain and fear of injury. Objective: to describe the level of physical activity, quality of life and sleep in patients with PAD. Methodology: this is an observational, epidemiological and cross-sectional study, carried out at the Hospital Geral de Camaçari-BA. Patients diagnosed with PAD, both sexes, aged over 18 years, admitted to the hospital were included. Patients with psychiatric disorders and difficulty in understanding the questionnaires were excluded. To assess the level of physical activity, the International Physical Activity Questionnaire was used, for Quality of Life the Short Form Health Survey 36 questionnaire, for sleep quality Sleep Quality Index of Pittsburgh and for Intermittent Claudication the Edinburgh Questionnaire. Results: of the 27 patients analyzed, 55.6% (15/27) were female and 44,4% (12/27) were male, 37% (10/27) were black / colored. The mean age was 62.6 ± 8.3 years, weight 71.8 ± 16.2 kg, height 164.8 ± 8.3 cm and BMI 26.3 ± 5. The majority reported being active, 33.3% (9/27). According to SF-36, the most limiting domain was "pain" (28.6), the global PSQI score was 10.4 and the majority (81.5%) did not have intermittent claudication. Conclusion: the presence of PAD was more frequent in the elderly and the presence of sleep disorders and decreased quality of life was identified.

Degenerative Lumbar Spinal Stenosis / Estenose degenerativa do canal lombar

Abstract Degenerative lumbar spinal stenosis is the most frequent cause of low back pain and/or sciatica in the elderly patient. Epidemiology, pathophysiology, clinical manifestations and testing are reviewed in a wide current bibliographic investigation. The importance of the relationship between clinical presentation and imaging study, especially magnetic resonance imaging (MRI), is emphasized. Prior to treatment indication, it is necessary to identify the precise location of pain, as well as the differential diagnosis between neurological and vascular lameness. Conservative treatment combining medications with various physical therapy techniques solves the problem in most cases, while therapeutic testing with injections, whether epidural, foraminal or facetary, is performed when pain does not subside with conservative treatment and before surgery is indicated. Injections usually perform better results in relieving sciatica symptoms and less in neurological lameness. Equine tail and/or root decompression associated or not with fusion is the gold standard when surgical intervention is required. Fusion after decompression is necessary in cases with segmental instability, such as degenerative spondylolisthesis. When canal stenosis occurs at multiple levels and is accompanied by axis deviation, whether coronal and/or sagittal, correction of axis deviations should be performed in addition to decompression and fusion, especially of the sagittal axis, in which a lumbar lordosis correction is required with techniques that correct the rectified lordosis to values close to the pelvic incidence.

Resumo A estenose degenerativa do canal vertebral lombar é a causa mais frequente de dor lombar e/ou ciática no paciente idoso; sua epidemiologia, fisiopatogenia, manifestações e testes clínicos são revistos em ampla investigação bibliográfica atual. A importância da relação entre a clínica e o estudo por imagens, principalmente a ressonância magnética (RM), é ressaltada. Antes da indicação do tratamento, é necessário identificar a localização precisa da dor, bem como o diagnóstico diferencial entre a claudicação neurogênica e a vascular. O tratamento conservador associando medicações com as diversas técnicas fisioterápicas resolve o problema na maioria dos casos, já o teste terapêutico com os bloqueios, seja epidural, foraminal ou facetário, é realizado quando as dores não cedem com o tratamento conservador e antes da indicação da cirurgia. Os bloqueios costumam dar melhores resultados no alívio dos sintomas de ciatalgia e menos no quadro de claudicação neurogênica. A descompressão da cauda equina e/ou radicular associada ou não à artrodese é o padrão ouro quando a intervenção cirúrgica é necessária. A artrodese após a descompressão é necessária nos casos com instabilidade segmentar, como na espondilolistese degenerativa. Quando a estenose de canal acontece em múltiplos níveis e vem acompanhada de desvio de eixo, seja coronal e/ou sagital, deve ser realizada, além das descompressões e artrodese, a correção dos desvios de eixo, principalmente o eixo sagital, quando a correção da lordose lombar se impõe com técnicas que corrigem a lordose retificada para valores próximos à incidência pélvica.

Symptoms of anxiety and depression and their relationship with barriers to physical activity in patients with intermittent claudication

OBJECTIVES: Although the practice of physical exercise in patients with intermittent claudication (IC) is often encouraged, adherence is low. The difficulty in performing physical training may be related to the psychological characteristics of patients with claudication. To verify the association between anxiety and depression symptoms and barriers to physical exercise and walking capacity in patients with IC. METHODS: One-hundred and thirteen patients with a clinical diagnosis of IC were included in the study. Patients underwent clinical evaluation by a vascular surgeon, answered the Beck Depression Inventory, and Beck Anxiety Inventory tests were applied by the psychologist. The patients performed the 6-minute test and reported their barriers to physical activity practice in a questionnaire. RESULTS: Patients with signs of depression had a shorter pain-free walking distance (p=0.015) and total walking distance (p=0.035) compared to patients with no signs of depression. Pain-free walking distance (p=0.29) and total walking distance (p=0.07) were similar between patients with and without signs of anxiety. Patients with symptoms of moderate to severe depression reported more barriers to physical activity practice compared to patients without signs of depression. CONCLUSION: Symptoms of anxiety and depression are prevalent among patients with peripheral arterial occlusive disease (PAD). Depression symptoms are associated with personal barriers to exercise, while anxiety symptoms are not. The main barriers to physical activity among patients with IC are exercise-induced pain and the presence of other diseases.

Physical activity practice during COVID-19 pandemic in patients with intermittent claudication

SUMMARY OBJECTIVE: To describe physical activity habits and barriers for physical activity practice in patients with peripheral artery disease and claudication symptoms during Coronavirus 2019 (COVID-19) pandemic. METHODS: In this cross-sectional survey study, 127 patients with peripheral artery disease (59.8% men; 68±9 years old; and 81.9% had the peripheral artery disease diagnosis ≥5 years old) were included. The physical activity habits and barriers for physical activity practice were assessed through telephone interview using a questionnaire with questions related to: (a) COVID-19 personal care; (b) overall health; (c) physical activity habits; (d) for those who were inactive, the barriers for physical activity practice. RESULTS: Only 26.8% of patients reported practicing physical activity during the COVID-19 pandemic. Exercise characteristics more common among these patients include walking, performed at least 5 days a week, during 31-60 min at light intensity. In contrast, among physically inactive patients, pain, injury or disability (55%), the COVID-19 pandemic (50%), the need to rest due to leg pain (29%), and lack of energy (27%) were the most frequent barriers to physical activity practice. CONCLUSION: The physical activity level of patients with peripheral artery disease is impacted by the COVID-19 pandemic.

Importância do destreinamento físico sobre a capacidade funcional em indivíduos com doença arterial obstrutiva crônica periférica: estudo transversal piloto / Importance of physical detraining in functional capacity of individuals with chronic peripheral arterial occlusive disease: a cross-sectional pilot study

Resumo Contexto O treinamento físico é uma estratégia bem estabelecida para a reabilitação da capacidade funcional de indivíduos com doença arterial obstrutiva crônica periférica (DAOP). No entanto, após um programa de treinamento físico, alguns indivíduos podem descontinuá-lo, causando destreinamento. A literatura é escassa sobre os efeitos do destreinamento físico em indivíduos com DAOP; portanto, torna-se importante investigar os efeitos nessa temática. Objetivos Avaliar os efeitos do destreinamento físico sobre a capacidade funcional em indivíduos com DAOP. Métodos Estudo transversal com 22 indivíduos. Os participantes foram divididos em dois grupos: grupo destreinamento (GD), grupo controle (GC). Foram avaliadas a distância percorrida no teste de caminhada de 6 minutos (DTC6M) e a distância livre de dor claudicante (DLDC), a qual é referida pela distância percorrida até o início da claudicação, ou seja, sem dor. Resultados A média da idade foi de 66±8 para o GD e de 67±7 para o GC. Tanto a DTC6M como a DLDC não apresentaram diferenças entre os grupos (p = 0,428 e p = 0,537, respectivamente). Conclusões O presente estudo piloto permite concluir que indivíduos com DAOP que participaram de um programa de treinamento físico e posterior destreinamento não tiveram efeitos superiores na sua capacidade funcional em relação a indivíduos que não participaram de programa de treinamento físico. O resultado do presente estudo serve para incentivar a manutenção da prática de exercício físico, visto que o treinamento físico deixa de ser efetivo se ocorrer destreinamento.

Abstract Background Physical training is a well-established strategy for rehabilitation of the functional capacity of individuals with chronic peripheral arterial occlusive disease (PAOD). However, some individuals quit training after participating in a physical training program, undergoing detraining. There is scant literature on the effects of physical detraining in individuals with PAOD and it is therefore important to investigate the effects of this phenomenon. Objectives The objective of this article was to evaluate the effects of physical detraining on functional capacity in individuals with PAOD. Methods Cross-sectional study with 22 individuals. Participants were divided into two groups: a detraining group (DG) and a control group (CG). The distance covered in the 6-minute walk test (6MWTD) and the pain-free walking distance (PFWD) were evaluated. The PFWD is the distance covered until claudication begins, i.e., the distance covered without pain. Results Mean age was 66 ± 8 in the DG and 67 ± 7 in the CG. There were no differences between the groups in either the 6MWTD or the PFWD (p = 0.428; p = 0.537, respectively). Conclusions The present pilot study allows us to conclude that the functional capacity of individuals with PAOD who participated in a physical training program and subsequently underwent detraining was not superior in relation to individuals who did not participate in a physical training program. The results of the present study serve to encourage maintenance of physical exercise, since physical training is no longer effective if detraining occurs.

Impacto da pandemia da COVID-19 sobre o tratamento medicamentoso dos pacientes com doença arterial periférica: um estudo observacional transversal / Impact of the COVID-19 pandemic on drug treatment of patients with peripheral arterial disease: an observational cross-sectional study

Resumo Contexto A pandemia do Coronavírus 2019 (COVID-19) tem afetado negativamente o comportamento da população. Nesse contexto, o impacto da pandemia da COVID-19 no tratamento medicamentoso dos pacientes com doença arterial periférica (DAP) e claudicação intermitente (CI) permanece obscuro. Objetivos Analisar o impacto da pandemia da COVID-19 no tratamento medicamentoso dos pacientes com DAP e CI. Métodos Neste estudo observacional transversal, 136 pacientes com DAP e CI, recrutados do nosso banco de dados, responderam por telefone um questionário envolvendo as seguintes questões: a) cuidados com a COVID-19; b) saúde global; c) tratamento das doenças. Posteriormente, os pacientes foram divididos em dois grupos, de acordo com a dificuldade para a aquisição dos medicamentos (DAM: dificuldade e SDAM: sem dificuldade), para a comparação da saúde global entre os dois grupos. Resultados Dezessete porcento dos pacientes reportaram dificuldades para a aquisição dos medicamentos durante a pandemia. Uma maior prevalência desses pacientes reportou estar mais triste (56,5% versus 24,8%, p < 0,01) e com mais dificuldades para dormir (56,5% versus 24,8%, p < 0,01) em relação aos pacientes do grupo SDAM. Os grupos não apresentaram diferenças para o declínio na capacidade de caminhada, ansiedade, estresse e depressão (p > 0,05). Conclusões Uma maior prevalência de pacientes do grupo DAM reportou estar mais triste e com mais dificuldade para dormir em comparação ao grupo SDAM durante a pandemia da COVID-19.

Abstract Background The Coronavirus 2019 (COVID-19) pandemic has had a negative impact on the population's behavior. In this context, the effect of the COVID-19 pandemic on drug treatment of patients with peripheral arterial disease (PAD) and intermittent claudication (IC) remains unclear. Objectives To analyze the impact of the COVID-19 pandemic on drug treatment of patients with PAD and IC. Methods In this cross-sectional, observational study, 136 patients with PAD and IC were recruited from our database and answered a questionnaire by telephone involving the following questions: a) precautions related to COVID-19; b) general health status; and c) treatment of diseases. Subsequently, patients were divided into two groups according to difficulty in obtaining their drugs (DOD: difficulty obtaining drugs, or NDOD: no difficulty obtaining drugs) and overall health was compared between groups. Results Seventeen percent of patients reported difficulties with obtaining drugs during the pandemic. A higher proportion of these patients reported being sadder (56.5% vs. 24.8%, P < 0.01) and having more difficulty sleeping (56.5% vs. 24.8%, P < 0.01) than of the patients in the NDOD group (P <0.01). The groups did not differ in terms of impairment of walking capability, anxiety, stress, or depression (P> 0.05). Conclusions A higher proportion of patients in the DOD group reported being sadder and having greater difficulty sleeping compared to the NDOD group during the COVID-19 pandemic.

Importância do destreinamento físico sobre a capacidade funcional em indivíduos com doença arterial obstrutiva crônica periférica: estudo transversal piloto / Importance of physical detraining in functional capacity of individuals with chronic peripheral arterial occlusive disease: a cross-sectional pilot study

Resumo Contexto O treinamento físico é uma estratégia bem estabelecida para a reabilitação da capacidade funcional de indivíduos com doença arterial obstrutiva crônica periférica (DAOP). No entanto, após um programa de treinamento físico, alguns indivíduos podem descontinuá-lo, causando destreinamento. A literatura é escassa sobre os efeitos do destreinamento físico em indivíduos com DAOP; portanto, torna-se importante investigar os efeitos nessa temática. Objetivos Avaliar os efeitos do destreinamento físico sobre a capacidade funcional em indivíduos com DAOP. Métodos Estudo transversal com 22 indivíduos. Os participantes foram divididos em dois grupos: grupo destreinamento (GD), grupo controle (GC). Foram avaliadas a distância percorrida no teste de caminhada de 6 minutos (DTC6M) e a distância livre de dor claudicante (DLDC), a qual é referida pela distância percorrida até o início da claudicação, ou seja, sem dor. Resultados A média da idade foi de 66±8 para o GD e de 67±7 para o GC. Tanto a DTC6M como a DLDC não apresentaram diferenças entre os grupos (p = 0,428 e p = 0,537, respectivamente). Conclusões O presente estudo piloto permite concluir que indivíduos com DAOP que participaram de um programa de treinamento físico e posterior destreinamento não tiveram efeitos superiores na sua capacidade funcional em relação a indivíduos que não participaram de programa de treinamento físico. O resultado do presente estudo serve para incentivar a manutenção da prática de exercício físico, visto que o treinamento físico deixa de ser efetivo se ocorrer destreinamento.

Abstract Background Physical training is a well-established strategy for rehabilitation of the functional capacity of individuals with chronic peripheral arterial occlusive disease (PAOD). However, some individuals quit training after participating in a physical training program, undergoing detraining. There is scant literature on the effects of physical detraining in individuals with PAOD and it is therefore important to investigate the effects of this phenomenon. Objectives The objective of this article was to evaluate the effects of physical detraining on functional capacity in individuals with PAOD. Methods Cross-sectional study with 22 individuals. Participants were divided into two groups: a detraining group (DG) and a control group (CG). The distance covered in the 6-minute walk test (6MWTD) and the pain-free walking distance (PFWD) were evaluated. The PFWD is the distance covered until claudication begins, i.e., the distance covered without pain. Results Mean age was 66 ± 8 in the DG and 67 ± 7 in the CG. There were no differences between the groups in either the 6MWTD or the PFWD (p = 0.428; p = 0.537, respectively). Conclusions The present pilot study allows us to conclude that the functional capacity of individuals with PAOD who participated in a physical training program and subsequently underwent detraining was not superior in relation to individuals who did not participate in a physical training program. The results of the present study serve to encourage maintenance of physical exercise, since physical training is no longer effective if detraining occurs.

Impact of hypertension on arterial stiffness and cardiac autonomic modulation in patients with peripheral artery disease: a cross-sectional study / Impacto da hipertensão na rigidez arterial e modulação autonômica cardíaca em pacientes com doença arterial periférica: um estudo transversal

ABSTRACT Objective: To examine the impact of hypertension on cardiovascular health in patients with symptomatic peripheral artery disease and to identify factors associated with uncontrolled hypertension. Methods: A cross-sectional study including 251 patients with symptomatic peripheral artery disease (63.9% males, mean age 67±10 years). Following hypertension diagnosis, blood pressure was measured to determine control of hypertension. Arterial stiffness (carotid-femoral pulse wave velocity) and cardiac autonomic modulation (sympathovagal balance) were assessed. Results: Hypertension was associated with higher carotid-femoral pulse wave velocity, regardless of sex, age, ankle-brachial index, body mass index, walking capacity, heart rate, or comorbidities (ß=2.59±0.76m/s, b=0.318, p=0.003). Patients with systolic blood pressure ≥120mmHg had higher carotid-femoral pulse wave velocity values than normotensive individuals, and hypertensive patients with systolic blood pressure of ≤119mmHg (normotensive: 7.6±2.4m/s=≤119mmHg: 8.1±2.2m/s 120-129mmHg:9.8±2.6m/s=≥130mmHg: 9.9±2.9m/s, p<0.005). Sympathovagal balance was not associated with hypertension (p>0.05). Conclusion: Hypertensive patients with symptomatic peripheral artery disease have increased arterial stiffness. Arterial stiffness is even greater in patients with uncontrolled high blood pressure.

RESUMO Objetivo: Analisar a influência da hipertensão na saúde cardiovascular em pacientes com doença arterial periférica sintomática, e identificar fatores associados à hipertensão arterial não controlada. Métodos: Neste estudo transversal foram incluídos 251 pacientes com doença arterial periférica (63,9% homens e média de idade 67±10 anos). Hipertensão foi diagnosticada e pressão arterial foi avaliada para determinar o controle da hipertensão. Foram avaliadas rigidez arterial (velocidade da onda de pulso carótida-femoral) e modulação autonômica cardíaca (balanço simpatovagal). Resultados: Hipertensão foi associada com maior velocidade da onda de pulso carótida-femoral, independentemente do sexo, idade, índice tornozelo-braço, índice de massa corpórea, capacidade de deambulação, frequência cardíaca, ou comorbidades (ß=2,59±0,76m/s, b=0,318, p=0,003). Pacientes com pressão arterial sistólica ≥120mmHg tiveram maior velocidadeda onda de pulso carótida-femoral do que normotensos, e pacientes hipertensos com pressão arterial sistólica ≤119mmHg (normotensos: 7,6±2,4m/s=≤119mmHg: 8,1±2,2m/s 120-129mmHg: 9,8±2,6m/s=≥130mmHg: 9,9±2,9m/s, p<0,005). Balanço simpatovagal não foi associado à hipertensão. Conclusão: Pacientes hipertensos com doença arterial periférica sintomática apresentam maior rigidez arterial. Em pacientes com pressão arterial não controlada, a rigidez arterial é ainda mais elevada.