ABSTRACT
Hipertensão Arterial Sistêmica (HAS) é doença de alta prevalência e determinante de alta morbidade e mortalidade senão adequadamente diagnosticada e apropriadamente tratada. O diagnóstico depende da medida correta da pressão arterial (PA) utilizando-se atualmente métodos alternativos à medida convencional de consultório como a Monitorização Ambulatorial da Pressão Arterial (MAPA) ou a Monitorização Residencial da Pressão Arterial (MRPA). Uma adequada estratificação do risco adicional ao valor da PA obtido é indispensável para uma planificação do tratamento e o alcance das metas desejadas para cada grupo de indivíduos. Manter os pacientes sob tratamento é necessário e desejável para que os benefícios auferidos com o tratamento, medicamentoso e não medicamentoso, sejam obtidos.
Systemic Arterial Hypertension (SAH) is a highly prevalent disease causing high morbidity and mortalityif not adequately diagnosed and properly treated.The diagnosis depends on a correct measurement of arterial blood pressure (ABP), with alternative methods to the conventional office measurement being currently used, such as Ambulatory Blood Pressure Monitoring (ABPM) or Home Blood Pressure Monitoring (HBPM). An appropriate stratification of the additional risk besides the ABP value is essential for treatment planning and for achieving the desired goals for each group of individuals. It is necessary and desirable to maintain the patients under treatment in order to obtain the benefits derived from pharmacological or non-pharmacological treatment.
Subject(s)
Hypertension/diagnosis , Hypertension/therapyABSTRACT
OBJECTIVE: To evaluate the determinants of total plasma homocysteine levels and their relations with nutritional parameters, inflammatory status, and traditional risk factors for cardiovascular disease in renal failure patients on dialysis treatment. DESIGN: The study was conducted on 70 clinically stable patients, 50 of them on hemodialysis (70% men; 55.3 ± 14.5 years) and 20 on peritoneal dialysis (50% men; 62 ± 13.7 years). Patients were analyzed in terms of biochemical parameters (serum lipids, creatinine, homocysteine [Hcy], creatine-kinase [Ck], folic acid, and vitamin B(12)), anthropometric data, markers of inflammatory status (tumor necrosis factor-alpha, C-reactive protein, interleukin-6), and adapted subjective global assessment. RESULTS: The total prevalence of hyperhomocysteinemia (>15 µmol/L) was 85.7%. Plasma folic acid and plasma vitamin B(12) were within the normal range. Multiple regression analysis (r(2) = 0.20) revealed that the determinants of total Hcy were type of dialysis, creatinine, Ck, folic acid, and total cholesterol. Hcy was positively correlated with albumin and creatinine and negatively correlated with total cholesterol, high density lipoprotein cholesterol, folic acid, and vitamin B(12). CONCLUSIONS: The determinants of total Hcy in the study sample were type of dialysis, creatinine, Ck, folic acid, and total cholesterol. Evidently, the small sample size might have had an effect on the statistical analyses and further studies are needed. However, Hcy in patients on dialysis treatment may not have the same effect as observed in the general population. In this respect, the association between malnutrition and inflammation may be a confounding factor in the determination of the true relationship between Hcy, nutritional status, and cardiovascular risk factors in this group.
Subject(s)
Homocysteine/blood , Hyperhomocysteinemia/epidemiology , Peritoneal Dialysis , Renal Dialysis , Adult , Aged , Biomarkers/blood , Brazil , C-Reactive Protein/analysis , Creatine Kinase/blood , Creatinine/blood , Female , Folic Acid/blood , Follow-Up Studies , Humans , Hyperhomocysteinemia/etiology , Inflammation/complications , Interleukin-6/blood , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/physiopathology , Kidney Failure, Chronic/therapy , Linear Models , Lipids/blood , Male , Malnutrition/complications , Middle Aged , Prevalence , Risk Factors , Tumor Necrosis Factor-alpha/blood , Vitamin B 12/bloodABSTRACT
A hipertensão mascarada (HM) caracteriza-se pela ocorrência de pressão arterial (PA) de consultório normal, porém persistentemente elevada quando observada pela monitorização ambulatorial da pressão arterial (MAPA) ou por meio da medida residencial da pressão arterial (MRPA). Apresenta prevalência entre 8% e 23%, ou até mais elevada em indivíduos hipertensos e com PA controlada. Está relacionada à maior lesão em órgãos-alvo e a eventos cardiovasculares se comparada a indivíduos normotensos(NT), com risco relativo (RR) ao redor de dois nas principais metanálises. Fatores como idade, sexo, IMC, estresse, tabagismo ou abuso de álcool estão freqüentemente relacionados à presença de HM. Ainda é matéria de discussão se a HM é mero fenômeno estatístico ligado à variabilidade da PA ou a entidade clínica que merece ser identificada e caracterizada, assim como seu tratamento.
ABSTRACT: Masked hypertension (MH) is characterized by the occurrence of normal arterial blood pressure (ABP) measured in a doctors office but persistently elevated when observed by Ambulatory Blood Pressure Monitoring (ABPM) or by Home Blood Pressure Measurement (HBPM). The prevalence of MH is 8 to 23%, or even higher among hypertensive individuals with controlled ABP. Masked hypertension is related to greater target organs damage and to cardiovascular events compared to normotensive individuals, with a relative risk (RR) of about 2 in the main meta-analyses. Risk factors such as age, sex, Body Mass Index, stress, smoking habit or alcohol abuse are frequently related to the presence of MH. It is still a matter of debate whether MH is simply a statistical phenomenon linked to ABP variability or is a clinical entity that should be identified and characterized, and whether it should be treated.
