Community-based stroke prevention: a Portuguese challenge.

Stroke is the leading cause of death in Portugal, accounting for about 20% of total mortality, despite a 25% decline in death rates from cerebrovascular diseases between 1980 and 1989. Epidemiological observations demonstrating that the high rates of cerebrovascular disease are accompanied by high levels of blood pressure have raised considerable interest concerning the primary prevention of hypertension. Excess salt consumption is considered to have an important role in the pathogenesis of hypertension. Since salt is widely consumed by the Portuguese population, priority has been given to salt reduction for the primary prevention of hypertension. Community-based programs have demonstrated that it is possible to improve lifestyles, for instance by reducing high salt intake. Integrated and multifactorial interventions have promoted health and better treatment of hypertension as well as better control of concomitant risk factors. As a consequence of the population aging, there is a high probability of an increase in stroke occurrence. The present and future number of stroke survivors, requiring both acute and long-term care, will increase the social and economic burden. It is important to raise the awareness of politicians and the public so that both the prevention and management of patients with stroke will be given high priority.

[Hypertension and well-being: a study with indapamide]. / Hipertensão e bem-estar: estudo com indapamida.

STUDY OBJECTIVE: Evaluate the clinical efficacy and quality of life of indapamide in patients with mild and moderate arterial systemic hypertension under indapamide. DESIGN: Open prospective design. SETTING: Outpatient clinics of the Instituto Nacional de Cardiologia Preventiva in Lisbon. PATIENTS: Thirty-two patients whose supine diastolic blood pressure was between 95 ans 115 mmHg without known secondary hypertension, unstable diabetes, cardiac, renal or hepatic failure, hypokalemia, coronary artery disease or stroke in the previous year. INTERVENTION: After a two week wash-out and four week placebo periods, indapamide has been given in a single daily dose of 2.5 mg at breakfast during 12 weeks. MEASUREMENTS AND MAIN RESULTS: The mean systolic/diastolic blood pressures was reduced from 155.7/103.7 to 138.6/86.1 mmHg (p < 0.0001). The mean standing systolic/diastolic blood pressure lowered from 160.2/103.7 to 141.6/85.9 mmHg (p < 0.0001). The questionnaires on quality of life and the analogic visual scale showed a progressive and significant improvement in general well-being. In the patient questionnaire the percentage of improvement was 80% (16/20 items) namely asthenia, headache, attention, dizziness, tinnitus and visual disturbance. In the physician questionnaire all the items improved. Biochemical acceptability was characterized by the stability of sodium, chlorine, glucose, creatinine, urea, cholesterol, triglycerides, uric acid and slight decrease in potassium from 4.38 to 4.14 mmol/l (p < 0.01) ranging in normal values. CONCLUSIONS: These results confirm the clinical efficacy of indapamide and its beneficial effects on quality of life in patients with mild and moderate hypertension when administered in monotherapy.

Hereditary protein C deficiency and portal-vein thrombosis.

Inherited defects of the natural coagulation inhibitors predispose patients to thrombosis. These disorders have similar clinical presentations with a strong family history of thrombosis, episodes of recurrent venous thromboembolism, beginning in early adulthood. We report a case of upper gastrointestinal bleeding in a patient with portal hypertension due to portal-vein thrombosis secondary to hereditary protein C deficiency, an association that has seldom been reported.

Hypertension and beta-blockers. Are they all the same?

The circadian rhythm of blood pressure derived from continuous recordings of blood pressure in hypertensive subjects, provides an accurate and repeatable method of describing blood pressure on a temporal scale which can be used to evaluate the effects of anti-hypertensive drugs. It has been postulated that the rapid rise of pressure between 0600 and 1000 hr is due to intrinsic sympathetic activity mediated at the peripheral arteriole by alpha-adrenoreceptors. Drugs which block beta-adrenoreceptors do not appear to influence blood pressure at this time, no matter how frequently they are administered or how long-acting they may be. Meteroprolol and sotolol are beta-adrenoreceptor blocking drugs which appear to be different in that they produce a considerable fall in nocturnal blood pressure, which is similar to the effects of alpha-adrenoreceptor blocking agents. The physiological and clinical significance of these findings remains to be defined, but they emphasise the need for full and complete information on blood pressure changes before the most effective method of blood pressure reduction can be defined.