ABSTRACT
Objective: Characterize patients with hypertensive crisis and evaluate occurrences 30 days after the hypertensive event. Design and method: Cohort study was performed with 583 patients treated between August 2020 and July 2021, from an Emergency Unit in a Hospital specializes in cardiology in São Paulo, Brazil. Inclusion criteria: 18 years old, systolic pressure > 180 mmHg and/or diastolic pressure > 120 mmHg, have telephone contact. A consulting on the electronic medical record was made to identify the elegible patients, whom after were included on the REDCap platform, and 30 days of the hypertensive event, an interview by telephone was made to investigate cardiovascular events. Results: The sample characteristics were: women (53%), 66.24(13.89) years, white ethnicity (78.7%), married (50.5%), high school (27.9%), retired people (77.5%), average [(mean(SD)] monthly income R$2384.6 (R$3438). The mean(SD) systolic/diastolic blood pressure, respectively, in emergency department was 189.74(17.46)/99.28(19.89) mmHg. Hypertensive emergencies were 63.8%, urgencies 27.4% and 8.7% were not possible to classify. The prevalent symptoms in the emergency department were: chest pain (41.2%), dyspnea (34.3%), nausea (11.7%), dizziness (10,4%), radiating pain (10.1%). The most used treatments were: anticoagulant (35.1%), diuretic (28.1%), analgesic (25.3%), ACE inhibitor (23.8.7%). Regarding the performance of tests: 85.6% underwent laboratory tests, 71% electrocardiogram, 36.3% echocardiogram and 30.5% computed tomography. After being treated at the emergency department, 60.1% of patients were discharged, 35.8% hospitalized, 3.8% transferred to other hospitals and 0,3% died. Regarding comorbidities, 97.7% had hypertension, 68.7% high cholesterol, 48.4% diabetes, 34.1% acute myocardial infarction, 25.1% heart failure, 19.6% kidney disease and 12% stroke. Regarding outcomes 30 days after the hypertensive event, 1.4% had some type of stroke, being 85.7% ischemic and 14.3% hemorrhagic, 2.3% had acute infarction of the myocardium, and 2% cardiorespiratory arrest. Also, 14.5% returned to a health service for high blood pressure, and 23.1% for others reasons like angina, bradycardia, aortic aneurysm, covid-19, acute pulmonary edema, epigastric pain, dyspnea. Besides we identify that 4.7% died within 30 days. Conclusions: The findings indicate the need for tertiary systematization, through outpatient follow-up programs for people with hypertensive crisis in emergencies units.
ABSTRACT
Objective: To evaluate the adherence to antihypertensive treatment during the COVID-19 pandemic and associated variables. Design and method: Cross-sectional study was performed with outpatient, from a Hospital in São Paulo, Brazil. Inclusion criteria were: age >18 years old, telephone number, in treatment for at least six months. Pregnant women were excluded. The period defined to characterize the assessment of social distance due to the COVID-19 pandemic was from March, 24 until August, 31. Hypertensive patients were interviewed by telephone. The adherence to treatment was assessed by Morisky and Green scale and the BP control was systolic BP <140 mmHg and diastolic BP <90 mmHg. Biosocial data, habits and lifestyles and attitudes towards social distancing measures were evaluated. The study was approved by the Research Ethics Committee. The significance level was p<=0.05. Results: The sample was 281 hypertensive patients: 62.3% women;66 (14) years old;348,7 (255,8) $USA monthly income;43.8% completed high school;60.5% white;47.0% married;and 59.1% retired. It was found that 58.7% were adherent to antihypertensive treatment and BP control was 51.6%. The systolic BP was 138.5 (22.7) mmHg and diastolic BP was 77.3 (14.4) mmHg. As for drug treatment, 55.2% of hypertensive patients received the drugs sent by the hospital pharmacy via mail, 63.9% reported that during the COVID-19 pandemic there was a problem in receiving the drugs and 10% was without antihypertensive sometime at home. The variables associated with treatment adherence were: race black (OR 0.40;95% CI: 0.21-0.73), education elementary school II (OR 2.97;95% CI: 1.24-7.06), stayed without antihypertensive at home someday from quarantine (OR 0.40;95% CI: 0.17-0.95) and diastolic BP (OR 0.98;CI: 0.96-0.99). During the period of the pandemic evaluated, it was also observed that 77.6% reported leaving home, 13.5% had contact with people with the disease and 91.8% reported not feeling safe to leave the house after the end of quarantine. Conclusions: The rate of non-adherence to antihypertensive treatment during the COVID-19 pandemic was high and was associated with unfavorable biosocial variables.