Fiberoptic endoscopic evaluation of swallowing and the Brazilian version of the Eating Assessment Tool-10 in resistant hypertensive patients with obstructive sleep apnea

Abstract Objective: The aim of this study was to describe the prevalence and characteristics of OD through Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and the Eating Assessment Tool-10 (EAT-10) in hypertensive patients with OSA, as well as to describe the sensitivity of EAT-10 for the detection of OD in this population. Methods: This study included a convenience sample in which 85 resistant hypertensive patients diagnosed with OSA in an university hospital participated. Participants were subjected to the EAT-10 (index test) and FEES (reference standard). Results: The median EAT-10 score was 2 (0-5.5). According to the FEES, 27 participants did not have dysphagia, 42 had mild dysphagia and 16 had mild to moderate dysphagia. The sensitivity of the EAT-10 was 70.7% (95% CI: 57.3-81.9) at a cutoff score ≤1, with a discriminatory power of 67.4% (p = 0.005). The most prevalent symptom in this population was "food stuck in the throat", while the most prevalent signs were delayed initiation of the pharyngeal phase of swallowing, premature bolus spillage and pharyngeal residue. Conclusion: In our study, the cutoff score for the EAT-10 for screening for OD in this population was ≥ 1. In conclusion, this population presented a high prevalence of dysphagia detected in FEES and its severity is associated with higher EAT-10 scores.

Cardiovascular Risk Profile of a Young Adult Women Population Assisted in Primary Care

Abstract Background Although cardiovascular disease is a major cause of death among women, cardiovascular risk assessment in young women is frequently postponed due to a number of factors. Objectives To assess cardiovascular risk of young adult women living in one of Rio de Janeiro's Family Health Strategy geographical units in the city's central area. Materials and Methods populational, cross-sectional study with adults between 20 and 50 years old. Sociodemographic characteristics such as educational level and employment status were recorded. Anthropometric measurements, traditional cardiovascular risk factors, gynecological and gestational history, and selected laboratory exams were assessed. The bivariate analysis compared the baseline characteristics of the population between genders and the prevalence of cardiovascular risk factors in women according to educational level and occupation status, using non-paired Student's t-test for normal continuous variables, Mann-Whitney test for asymmetrical continuous variables, and chi-square test for categorical variables. A significance level of 5% (p < 0.05) was adopted. Results A total of 710 individuals were enrolled. In women, who comprised 59.7% of our sample, central obesity and a sedentary lifestyle were more prevalent, whereas smoking and hypertension were less observed. However, women with lower educational status had a higher prevalence of smoking and hypertension. In hypertensive women, factors such as early menopause, higher prevalence of hypertensive disorders of pregnancy and higher number of pregnancies were noticed. Conclusion An adverse cardiovascular risk profile in our population of young women was particularly influenced by central obesity, sedentary lifestyle, hypertensive disorders of pregnancy and lower educational status.

Potential Impact of the New American High Blood Pressure Guidelines on Hypertension Prevalence in a Primary Health Care Unit in Rio de Janeiro - the LapARC Study

Abstract Background The new American Heart Association guidelines for hypertension (HT) proposed a reduction of the diagnostic cut-off point, leading to a substantial increase in the prevalence of HT. Objectives To assess the prevalence of HT determined by the traditional criteria, the AHA criteria, and home blood pressure monitoring (HBPM) in a population of young adults attending a primary healthcare unit, and its association with cardiovascular risk. Methods A cross-sectional population study on adults aged from 20 to 50 years attending a primary healthcare unit, in Rio de Janeiro, Brazil. Sociodemographic and anthropometric data, cardiovascular risk factors, office blood pressure and HBPM were registered. The diagnosis of HT was defined by traditional criteria (office BP ≥ 140 x 90 mmHg) and by the new (AHA) criteria (office BP ≥ 130 x 80 mmHg). Bivariate analysis was used for comparisons between the two diagnostic criteria, and Kappa coefficient was used to assess the agreement in diagnosis between office BP and HBPM. The level of significance adopted was 5% (p<0.05). Results A total of 472 individuals were evaluated (male: 39%; mean age: 38.5 ± 8.7 years). The prevalence of HT was 23.5% and raised to 41.1% with the new AHA criteria. The prevalence of HT using HBPM was 25.5%, but the diagnostic agreement was low (kappa=0.028) with changes in diagnosis in 18% of the cases. Conclusion The prevalence of HT almost doubled with the new AHA diagnostic criteria for HT. HBPM seemed to be an important instrument in HT diagnosis in this population. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

Practical Approach to Acute Coronary Syndrome in Patients with COVID-19

Abstract Acute cardiac injury is associated with higher mortality in patients with the novel coronavirus disease-2019 (COVID-19) and the exact etiology can be challenging to diagnose in the emergency setting during the pandemic. From a pathophysiological perspective, SARS-CoV-2 infection is characterized by an overproduction of inflammatory cytokines (IL-6, TNF-alpha) that leads to systemic inflammation and consequent increased risk of acute myocardial infarction (AMI) caused by atheromatous plaque rupture and significant myocardial oxygen supply-demand imbalance. Moreover, SARS-CoV-2 tropism to the renin-angiotensin-aldosterone system through the ACE2 receptor induces myocarditis that may rapidly progress to left ventricular dysfunction and hemodynamic instability. Myocardial inflammation with pericardial involvement, i.e. , myopericarditis, can progress to cardiac tamponade and obstructive shock. These cardiovascular complications, which are associated with a worse prognosis and higher mortality, can be associated with clinical manifestations, electrocardiographic changes, and troponin values similar to AMI. Thus, the diagnosis and treatment of patients with acute chest pain and dyspnea admitted to the emergency department is a significant challenge during the COVID-19 pandemic. Here, we provide a review of the literature focusing on a practical approach to acute coronary syndrome patients with confirmed or suspected COVID-19.

Resistant and refractory hypertension: two sides of the same disease? / Hipertensão resistente e refratária: duas faces de uma mesma doença?

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

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

Demographic and clinical characteristics of hypertensive patients in the internal medicine outpatient clinic of a university hospital in Rio de Janeiro

CONTEXTO: A hipertensão é um dos mais importantes fatores de risco cardiovasculares e a dificuldade de controle dos níveis tensionais é um desafio aos médicos em todo o mundo. Para melhorar o controle da pressão arterial é importante garantir a qualidade da assistência aos pacientes hipertensos, principalmente em hospitais de ensino nos quais futuros médicos estão sendo formados. OBJETIVOS: Caracterizar o perfil dos hipertensos do ambulatório de Clínica Médica de um hospital universitário no Rio de Janeiro e descrever o risco cardiovascular desses pacientes, identificando as falhas na assistência prestada aos hipertensos graves, visando nortear a implementação de um Programa de Hipertensão Arterial do hospital. TIPO DE ESTUDO: Estudo descritivo transversal. LOCAL: Ambulatórios de Clínica Médica do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. MÉTODOS: A população alvo foi composta pelos pacientes hipertensos em acompanhamento no ambulatório de Clínica Médica por um período de quatro meses. Os médicos assistentes obtiveram informações sobre dados demográficos, fatores de risco cardiovascular, lesões de órgãos-alvo, pressão arterial na consulta, terapêutica instituída e adesão do paciente ao tratamento. A distribuição das características dos pacientes foi descrita com as médias e respectivos desvios-padrão e proporções. RESULTADOS: Dentre os pacientes vistos no período, 24,2% (1.699 pacientes) eram hipertensos, dos quais 65% eram mulheres. A idade média foi de 63,9 anos (desvio-padrão = 11,6). Dislipidemia (49,2%) e diabetes (29,8%) foram os fatores de risco mais encontrados, o órgão alvo mais atingido foi o coração (46,1%) e 70% dos pacientes foram estratificados como de alto risco cardiovascular. Apesar da elevada intensidade de tratamento instituído nos pacientes mais graves (19,4% em um regime de tratamento anti-hipertensivo com três ou mais drogas) o controle da pressão arterial foi baixo (27%). Este estudo orientou a elaboração de uma rotina de diagnóstico e tratamento de hipertensão arterial e norteou os objetivos do Programa de Hipertensão Arterial do Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UCFF-UFRJ), recém-implantado. CONCLUSAO: Os pacientes hipertensos em tratamento neste Hospital têm elevado risco cardiovascular e controle inadequado dos níveis tensionais. Faz-se necessário maior esforço para controlar a pressão arterial, pois só assim será...