Prevalence of physical inactivity and its effects on blood pressure and metabolic parameters in a Brazilian Urban Population / Prevalência de inatividade física e seus efeitos na pressão arterial e parâmetros metabólicos em uma população urbana brasileira

Background: Cardiovascular disease is the leading cause of mortality in the world and physical inactivity represents an important risk factor. Objective: This study aimed to evaluate the prevalence of physical inactivity in the adult population and its effects on blood pressure, blood glucose and lipid profile. Methods: A population-based cross-sectional study with stratified simple random sampling was conducted in 1,717 adults divided by age groups: 18-39, 40-49, 50-59, 60-69 and ≥ 70 years. The participants answered the physical activity questionnaire and were classified as physically active or inactive. The bootstrap statistical method was used to assess physical activity, associated with lipid profile and blood glucose levels. The level of significance was 5%. Results:The prevalence of physical inactivity in the general population was 65.8%. There was a significant difference in the group older than 70 years. There was a significant decrease in physical activity in the group with lower educational level, with a significant difference between social classes AB and C. The prevalence of hypertension was 27.5% among physically inactive and 21.4% among active individuals (p = 0.04). The prevalence of metabolic syndrome was 26.1% in inactive and 16.7% in the active individuals (p = 0.007). Total cholesterol, low-density lipoprotein and triglycerides levels were more elevated in the physically inactive group, which was not observed with high-density lipoprotein levels. Blood glucose was also higher in the inactive group. Conclusion: This study shows a high prevalence of physical inactivity and a positive correlation between risk factors for cardiovascular disease, mainly blood pressure, glucose and lipids profiles

Efeitos da fisioterapia respiratória na bronquiectasia não fibrocística: uma revisão sistemática / Effects of chest physiotherapy in non-cystic fibrosis bronchiectasis: A systematic review

Bronchiectasis is the irreversible dilation and distortion of the bronchi in response to the destruction of the elastic and muscular components of their wall. The objective of this study was to analyze the efficacy of respiratory physiotherapy in patients with noncystic fibrosis bronchiectasis. The literature was reviewed systematically and clinical trials published between 2004 and 2015 in the databases PubMed, SciELO, and LILACS were selected using the keywords "respiratory therapy", "bronchiectasis", and "physiotherapy", in English and in Portuguese. A total of 717 clinical trials were found but only six met the inclusion criteria. Of these, five presented significant results from respiratory physiotherapy techniques and/or resources. According to the literature, the various techniques and resources of respiratory physiotherapy were effective therapeutic options for treating patients with non-cystic fibrosis bronchiectasis.

Nebivolol reduces central blood pressure in stage I hypertensive patients: experimental single cohort study / Nebivolol reduz pressão arterial central em pacientes hipertensos estágio I: estudo experimental de coorte única

CONTEXT AND OBJECTIVES: Assessment of central blood pressure (BP) has grown substantially over recent years because evidence has shown that central BP is more relevant to cardiovascular outcomes than peripheral BP. Thus, different classes of antihypertensive drugs have different effects on central BP despite similar reductions in brachial BP. The aim of this study was to investigate the effect of nebivolol, a β-blocker with vasodilator properties, on the biochemical and hemodynamic parameters of hypertensive patients. DESIGN AND SETTING: Experimental single cohort study conducted in the outpatient clinic of a university hospital. METHODS: Twenty-six patients were recruited. All of them underwent biochemical and hemodynamic evaluation (BP, heart rate (HR), central BP and augmentation index) before and after 3 months of using nebivolol. RESULTS: 88.5% of the patients were male; their mean age was 49.7 ± 9.3 years and most of them were overweight (29.6 ± 3.1 kg/m2) with large abdominal waist (102.1 ± 7.2 cm). There were significant decreases in peripheral systolic BP (P = 0.0020), diastolic BP (P = 0.0049), HR (P < 0.0001) and central BP (129.9 ± 12.3 versus 122.3 ± 10.3 mmHg; P = 0.0083) after treatment, in comparison with the baseline values. There was no statistical difference in the augmentation index or in the biochemical parameters, from before to after the treatment. CONCLUSIONS: Nebivolol use seems to be associated with significant reduction of central BP in stage I hypertensive patients, in addition to reductions in brachial systolic and diastolic BP. .

CONTEXTO E OBJETIVOS: A avaliação da pressão arterial central (PAc) tem crescido substancialmente nos últimos anos porque as evidências mostraram que PAc central é mais relevante para os desfechos cardiovasculares do que pressão arterial (PA) periférica. Assim, diferentes classes de anti-hipertensivos têm efeitos diferentes sobre PAc apesar de reduções semelhantes na PA braquial. O objetivo foi investigar o efeito do nebivolol, β-bloqueador com propriedades vasodilatadoras, nos parâmetros bioquímicos e hemodinâmicos de pacientes hipertensos. TIPO DE ESTUDO E LOCAL: Estudo de coorte única experimental realizado em ambulatório de hospital universitário. MÉTODOS: Todos os 26 pacientes recrutados foram submetidos à avaliação bioquímica e hemodinâmica (PA, frequência cardíaca, FC, PAc, augmentation index) antes e após três meses usando nebivolol. RESULTADOS: 88,5% dos indivíduos eram do sexo masculino, com média de idade de 49,7 ± 9,3 anos, predominância de sobrepeso (29,6 ± 3,1 kg/m2) e aumento da cintura abdominal (102,1 ± 7,2 cm). Houve diminuição significativa da PA sistólica periférica (P = 0,0020) e diastólica (P = 0,0049), da FC (P < 0,0001) e da PAc (129,9 ± 12,3 x 122,3 ± 10,3 mmHg, P = 0,0083) após o tratamento em comparação aos valores basais. Não houve diferença no augmentation index, nem nos parâmetros bioquímicos antes e após o período de tratamento. CONCLUSÕES: O uso de nebivolol parece estar associado à redução significativa da PAc em hipertensos estágio 1, além da redução da pressão sistólica e diastólica braquial. .

A avaliação da resposta anti-hipertensivana otimização da rigidez arterial e pressão central / The evaluation of anti-hypertensive response in optimization of arterial stiffness and central pressure

Em concordância com os avanços tecnológicos e a medicina baseada em evidências, pressão arterial central elevada e rigidez arterial são condições muito comuns presentes em idosos, hipertensos, diabéticos e dislipidêmicos. Apressão arterial central é um marcador de risco cardiovascular independente e maior preditor de morbidade e mortalidade do que a periférica. Métodos não invasivos para identificá-la e quantificá-la tem sido utilizados, norteando ainda mais a efetividade da terapia medicamentosa a ser instituída. A utilização de várias classes de anti-hipertensivos e sua influência sobre marcadores de rigidez arterial é atualmente muito abordada, principalmente no tocante às medicações de ação vasodilatadora e vasoconstritora.

In agreement with technological advances and evidence-based medicine, the elevated central blood pressure is preceded by arterial stiffness, a common condition in the elderly, besides hypertensive, diabetic and dyslipidemic individuals. The central blood pressure is an independent marker of cardiovascular risk and greater predictor of morbidity and mortality than peripheral pressure. Noninvasive methods to identify and quantify it have been used, guiding further the effectiveness of drug therapy to be instituted. Nowadays, the use of several classesof antihypertensive drugs and their influence on markers ofarterial stiffness is very discussed, especially with regard to vasodilator and vasoconstrictor medications.

Fatores associados ao aumento no índice de incremento de pressão radial em indivíduos hipertensos / Factors associated with increased radial augmentation index in hypertensive individuals

FUNDAMENTO: A rigidez arterial é uma variável preditora de morbimortalidade e um possível marcador de lesão vascular. Sua avaliação não invasiva por tonometria radial e análise do índice de incremento (r-AI) permite identificar os pacientes expostos a um maior risco cardiovascular. OBJETIVO: Analisar a influência do r-AI em variáveis clínico-bioquímicas e sua influência na prevalência de dano em órgão-alvo em pacientes hipertensos. MÉTODOS: Cento e quarenta pacientes hipertensos consecutivos, em seguimento clínico ambulatorial, foram submetidos à análise transversal. Os níveis de pressão arterial (PA) e o r-AI foram obtidos por tonometria de aplanação da artéria radial (HEM-9000AI, Onrom). Os pacientes foram alocados em tercis r-AI (r-AI < 85 por cento; 85 < r-AI < 97 por cento; r-AI > 97 por cento). RESULTADOS: A amostra era predominantemente composta por mulheres (56,4 por cento), com idade média de 61,7 ± 11,7 anos e índice de massa corporal de 29,6 ± 6,1 Kg/m². O maior tercil apresentou uma proporção maior de mulheres (p = 0,001), maior PA sistólica (p = 0,001) e pressão de pulso (p = 0,014), e menor peso (p = 0,044), altura (p < 0,001) e frequência cardíaca (p < 0,001). A análise multivariada demonstrou que o peso (β = -0,001, p = 0,017), frequência cardíaca (β = -0,001, p = 0,007) e pressão central (β = 0,015, p < 0,001) se correlacionam com o r-AI de maneira independente. Em análises de regressão logística, o 3º tercil r-AI foi associado a uma diminuição do diabete (DM) (OR = 0,41; 95 por cento CI 0,17-0,97; p = 0,042). CONCLUSÃO: Este estudo demonstrou que peso, frequência cardíaca e PA central se relacionam com o r-AI de maneira independente.

BACKGROUND: Arterial stiffness is a variable predictor of morbidity and mortality and a possible marker of vascular injury. Its non-invasive assessment by radial tonometry and analysis of the augmentation index (r-AI) allows identifying patients exposed to higher cardiovascular risk. OBJECTIVE: To analyze the influence of r-AI on clinical-biochemical variables and its influence on the prevalence of target-organ damage in hypertensive patients. METHODS: 140 consecutive hypertensive patients, followed-up in an outpatient clinic, were analyzed in a cross-sectional study. Blood pressure (BP) levels and r-AI were obtained by applanation tonometry of the radial artery (HEM-9000AI, Onrom). The patients were allocated into r-AI tertiles (r-AI < 85 percent; 85< r-AI < 97 percent; r-AI > 97 percent). RESULTS: The sample was predominantly composed of women (56.4 percent), mean age of 61.7 ± 11.7 years and body mass index 29.6 ± 6.1 Kg/m². The highest tertile showed higher proportion of women (p = 0.001), higher systolic BP (p = 0.001) and pulse pressure (p = 0.014), and lower weight (p = 0.044), height (p < 0.001) and heart rate (p < 0.001). Multivariate analysis demonstrated that weight (β = -0.001, p = 0.017), heart rate (β = -0.001, p = 0.007) and central pressure (β = 0.015, p < 0.001) correlated independently with r-AI. In logistic regression analyses, the 3rd r-AI tertile was associated to lower levels of diabetes (DM) (OR = 0.41; 95 percent CI 0.17-0.97; p = 0.042). CONCLUSION: This study demonstrated that weight, heart rate and central BP were independently related to r-AI.