Subacute blood pressure behavior in elderly hypertensive women after resistance exercise session.

AIM: The objective of this study was to determine the subacute blood pressure behavior of pharmacologically-treated elderly hypertensive patients after a session of resistance exercise. This was a controlled clinical trial carried out on 30 elderly hypertensive women. The study procedures took place over three days with an interval of 48 hours, and included a test session, an experimental protocol (EP) and a control protocol (CP). METHODS: A 10RM test was carried out to define the EP load for the following exercises: leg press, knee extension, pull-up, biceps curl and machine bench press. In the EP, three sets of exercises with 8 to 10 repetitions were carried out at 2-minute intervals. In the CP all procedures were the same as in the EP, but without the exercises. BP was measured before, immediately after and every ten minutes up to 60 minutes after the EP and CP. RESULTS: There was no significant variation in systolic blood pressure (SBP) or diastolic blood pressure (DBP) in either the EP or the CP immediately after the exercises. In the period up to sixty minutes after the exercises, there was a significant difference in BP, with a decrease in SBP and DBP for both EP and CP. CONCLUSION: The data from the present study offer a good indication that resistance exercises may be prescribed safely to this group of patients. The pressure reduction appears to be influenced by the rest that occurred after the protocols and not by exercise.

Influence of low birth weight on microalbuminuria and blood pressure of school children.

UNLABELLED: Low birth weight (LBW) is associated to an increased incidence of hypertension, renal and cardiovascular diseases in adulthood. The objective of this study was to evaluate possible changes in microalbuminuria (MA) and blood pressure (BP) in children with LBW. MATERIAL AND METHODS: The birth weight (BW) of 1,049 children between 8 and 11 years of age, enrolled in schools in the city of Goiânia/Brazil was investigated. Those in the LBW group (BW < or = 2.5 kg) were compared to a similar group with normal birth weight - NBW (BW > or = 3.0 kg). BP and 24-hour urine MA were evaluated. BW and prematurity (gestational age < 37 weeks) were obtained from the information contained in the children's card. RESULTS: There were 34 children with LBW and 34 with NBW. No significant difference was found regarding age, sex, race, weight, height, BMI, and family history of hypertension or diabetes. Children with LBW presented higher systolic BP (p = 0.019) and more albumin in the 24-hour urine then children with NBW (p = 0.024). CONCLUSION: We concluded that school children with LBW present with higher BP and more albumin excretion in the 24-hour urine. These findings can indicate presence of changes in both blood pressure and microalbuminuria in prepubertal children with low birth weight..

Diet and medication in the treatment of hyperuricemia in hypertensive patients.

OBJECTIVE: To evaluate the effects of diet and medication, either isolated or associated, on serum levels of uric acid in patients with hyperuricemia. METHODS: We studied patients from the Hypertension Unit of the University of Goias who had hyperuricemia (men > or =8.5 mg/dL and women > or =7.5 mg/dL). We divided the patients into three groups: G1 (low purine diet), G2 (low purine diet + medication), and G3 (medication only). Patients received allopurinol, 150 mg/day titrated up to 300 mg/dL when necessary. Patients were evaluated with regards to their lifestyles (diet, smoking, physical, activity, alcohol consumption), uric acid, blood pressure, use of medication, body mass index, cholesterol, and triglyceride. Follow-up took place in weeks 0 (M1), 6 (M2), 12 (M3) during the intervention and in week 36 (M4) after the study was completed. RESULTS: Fifty-five patients participated in the study, 31 women, mean age 54.4+/-10.6 years, body mass index 28.6+/-3.9 kg/m2. A similar reduction (p<0.001) in uric acid levels occurred in the three intervention groups. In week 36 (M4), after 24 weeks without intervention, a tendency toward elevation of uricemia was noted in G2 and G3, and a continuous drop in uricemia was noted in G1. No significant modifications were observed in the other variables analyzed. CONCLUSION: Considering the cost x benefit relationship, a diet low in purine should be the 1st therapeutic option for controlling hyperuricemia in patients with similar characteristic to the ones presented in this study.

[Single daily dose of verapamil (COER-24 180/24 mg) in mild and moderate hypertension evaluated by ambulatory blood pressure monitoring]. / Verapamil COER-24 180/240 mg na hipertensão arterial leve a moderada em dose única diária avaliado pela monitorização ambulatorial da pressão arterial.

OBJECTIVE: To evaluate the anti-hypertensive effect of verapamil COER-24 180/240 mg in a single dose at bedtime as single therapy in mild to moderate hypertensives. METHODS: A multicentric, open, placebo controlled study of 81 hypertensive patients older than 20 years-old followed to 8 weeks. Blood pressure was measured in doctor's office and by 24 h ambulatory monitoring (ABPM). RESULTS: We observed a decreased in systolic and diastolic blood pressure in doctor's office at 4th and 8th weeks. ABPM showed that both systolic, diastolic and mean blood pressure, heart rate and the mean 24-hour blood pressure load decreased after the 8-week treatment. In addition, there was a reduction of the double-product, especially in the morning and 68% of the patients didn't have any adverse events. CONCLUSION: The therapy verapamil COER-24 180/240 mg in a single dose is useful for mild and moderate hypertensive patients, with significant pressure decrease in both office blood pressure measurements and in the ABPM/24 hours, as well as showing good tolerability.

Increased efficacy and tolerability with losartan plus hydrochlorothiazide in patients with uncontrolled hypertension and therapy-related symptoms receiving two monotherapies.

The efficacy and tolerability of losartan 100 mg/hydrochlorothiazide (HCTZ) 25 mg and enalapril 10 mg/HCTZ 25 mg were compared in a double-blind, randomized trial in hypertensive patients inadequately controlled and experiencing side effects on prior therapy. Patients with moderate or severe hypertension, currently treated with at least two single-agent drugs (excluding angiotensin-converting enzyme inhibitors), with a sitting diastolic blood pressure (DBP) above 90 mm Hg, and at least one undesirable drug-related symptom were randomized to once-daily treatment with one of the combinations for 12 weeks. Losartan/HCTZ lowered sitting DBP from the prior therapy baseline by 13.7 mm Hg and sitting systolic blood pressure 19.3 mm Hg; similar reductions occurred with enalapril/HCTZ. Trough sitting DBP was reduced to normal levels (< 90 mm Hg) in 63% of patients switched to the losartan combination and in 58% of those treated with the enalapril combination. Each combination was associated with improved tolerability compared with prior therapy, although fewer patients reported each of 24 undesirable symptoms after 12 weeks of losartan/HCTZ. The improvement from prior therapy in the occurrence of cough was significantly greater with losartan/HCTZ (P = .005). Enalapril/HCTZ, but not losartan/HCTZ, increased serum uric acid levels at week 12. In conclusion, the combination of losartan 100 mg/HCTZ 25 mg offers a beneficial therapeutic option for patients with a history of moderate to severe hypertension whose blood pressure is not adequately controlled or who exhibit side effects while on two or more single-agent antihypertensive drugs. In this population, the switch from prior antihypertensive therapies to once daily losartan 100 mg/HCTZ 25 mg improves blood pressure control and reduces side effects.

Brazilian multicenter study on efficacy and tolerability of trandolapril in mild-to-moderate essential arterial hypertension. EMBATHE substudy with ambulatory blood pressure monitoring.

OBJECTIVE: A double-blind, placebo-controlled multicenter study involving 34 centers from different Brazilian regions was performed to evaluate the antihypertensive efficacy and tolerability of trandolapril, an angiotensin I converting enzyme inhibitor, in the treatment of mild-to-moderate systemic arterial hypertension. METHODS: Of 262 patients enrolled in this study, 127 were treated with trandolapril 2 mg/day for 8 consecutive weeks, and the remaining 135 patients received placebo for the same period of time. Reduction in blood pressure (BP) and the occurrence of adverse events during this period were evaluated in both groups. RESULTS: Significantly reductions in both systolic and diastolic pressures were observed in patients treated with trandolapril when compared with those on placebo. Antihypertensive efficacy was achieved in 57.5% of the patients on trandolapril and in 42% of these normal values of BP were obtained. The efficacy of trandolapril was similar in all centers, regardless of the area of the country. In a subset of 30 patients who underwent ABPM, responders showed a significant hypotensive effect to trandolapril throughout the 24 hour day. The adverse event profile was similar in both trandolapril and placebo groups. CONCLUSION: Our results demonstrate, for the first time in a large group of hypertensive patients from different regions in Brazil, good efficacy and tolerability of trando-lapril during treatment of mild-to-moderate essential systemic hypertension.

[Different therapies in the treatment of obesity in hypertensive patients]. / Diferentes terapias no tratamento da obesidade em pacientes hipertensos.

PURPOSE: To evaluate the efficacy and tolerability of different therapies associated with diet in the treatment of hypertensive obese patients. METHODS: In a clinical study we randomly evaluated 39 hypertensive obese patients (body mass index (BMI) > or = 30 kg/m2). After 45 days of diet the patients were again randomly distributed in 3 groups and received in double blind way: group 1-hypocaloric diet+placebo; group 2-hypocaloric diet+dexfenfluramine; group 3-hypocaloric diet+spiruline+fucus+gelatin. We followed their progress during 12 weeks under medication and further 24 weeks without. We evaluated the groups comparing: weight, BMI, blood pressure and side-effects. RESULTS: Twenty seven patients completed the observation. In those patients from groups 1 and 3 no changes in any of parameters were observed. In group 2 we observed a clear loss of weight (-3.8 Kg) and a fall in BMI. Blood Pressure changes were only observed in group 2 (-9.6%). The only patients to maintain weight loss after the termination of use of medicines were those from group 2. We did not observe any side-effects. CONCLUSION: In hypertensive obese patients, when isolated diet is not enough to control weight loss, dexfenfluramine could be useful in association with a controlled diet. The drug assists in weight loss, does not promote side-effects and does not interfere in the treatment of blood pressure.

[Blood pressure in a Xavante tribe. Comparison after 15 years]. / Pressão arterial em tribo Xavante. Comparação 15 anos depois.

PURPOSE: To evaluate arterial blood pressure (BP), variations that occur with age, influence of new habits, in indians of a Xavante tribe, located in the state of Mato Grosso, Brazil. METHODS: The evaluation procedures took place in 9/75 and 10/90. Fifty Xavante were examined in 1975. Thirty-five of them were men and 15 women. The mean age of the men was 45 and of the women, 31. In 1990, only 46 of those indians were re-examined (two were not located and two had already died of cancer and pneumonia), and evaluated with regard to arterial BP, food ingestion, physical activities, obesity, tobacco, alcoholic beverage consumption and social organization. RESULTS: In both occasions we did not find individuals with hypertension. The highest BP observed was of 140 x 90 in a 70-year-old indian. His result is consistent with what had been noted in 1975. Among the women, the highest level was of 130 x 60 in a 55-year-old female indian. The women maintained a lower level of BP as compared to the men of any age group. The average blood pressure showed a discrete increase going from 79.2 to 83.8 mmHg in the men and from 75.7 to 77.0 mmHg in the women. In this tribe we observed the habit of smoking in 30% of the individuals. Alcoholic beverage consumption is rare, physical activities remained constant and obesity is absent. As for the eating habits, with the decrease of hunting grounds, the indians acquired a more rural behavior with regular use of rice and beans. Salt is practically not added to the food. Competitiveness is not an acquired trait to that culture. CONCLUSION: In "isolated" populations that maintain their cultural traits and basic life styles, the occurrence of arterial hypertension is very rare and the increase in BP with age is modest and significant only for systolic.

[A Brazilian multicenter study to evaluate the clinical effectiveness and tolerance of isradipine SRO using ambulatory monitoring of arterial pressure in the treatment of mild and moderate arterial hypertension]. / Estudo multicêntrico brasileiro de avaliação de eficácia clínica e tolerabilidade da isradipina SRO através da monitorização ambulatorial da pressão arterial no tratamento da hipertensão arterial leve e moderada.

PURPOSE: To evaluate clinical efficacy and tolerability of isradipine SRO (I.SRO), 5 mg O.D. in essential hypertensives. METHODS: Eighty-three of 87 selected outpatients with a mean age of 51.3 years (ranging from 25 to 65), 33 male, 48 white, 29 black and others of different races, who had clinical supine and orthostatic diastolic blood pressure (DBP) > or = 95 mmHg and < or = 115 mmHg underwent the study. After a three-week wash-out period, patients received I.SRO 5 mg O.D. at 8:00 am for a six-week period (phase I). After this phase, patients received I.SRO 5 mg O.D. at 8:00 pm for a six-week period (phase II). The patients had a follow-up with an interval of three weeks and the ambulatorial blood pressure monitoring (ABPM) for 24 hours was performed with a SpaceLabs 90207 or Del Mar Avionics devices after the wash-out period and at the end of phases I and II. Measurements were performed at 15-min intervals during the day (6 am to 10 pm) and at 30-min intervals during the night (10 pm to 6 am). RESULTS: a) Heart rate did not show significant changes during the treatment period (phases I and II) when compared with the wash-out period; b) causal blood pressure: at the end of both treatment periods (phases I and II) there were statistically significant decreases (p < 0.001) in supine SBP and DBP compared with wash-out values. The mean SBP decreased from 161.6 +/- 14 to 144.3 +/- 13 mmHg (phase I) and to 141.8 +/- 13 mmHg (phase II). The mean DBP decreased from 103.4 +/- 6 to 91.2 +/- 7 (phase I) and to 89.1 +/- 8 (phase II); c) ABPM: the mean systolic 24-h ambulatory blood pressure was significantly reduced (p < 0.001) from 148.8 +/- 17 to 137.2 +/- 15 mmHg (phase I) and to 133.4 +/- 13 mmHg (phase II). The mean diastolic 24-h ambulatory blood pressure was significantly decreased (p < 0.001) from 94.3 +/- 9 to 87.0 +/- 9 (phase I) and to 85.8 +/- 8 mmHg (phase II). The mean daytime and nighttime, systolic and diastolic 24-h ambulatory blood pressure were: wash-out--152.3 +/- 17, 140.2 +/- 21, 97.4 +/- 9, 86.8 +/- 13; phase I--139.9 +/- 15, 130.0 +/- 17, 89.3 +/- 9, 81.3 +/- 10; phase II--136.7 +/- 13, 125.3 +/- 15, 88.5 +/- 8, 79.1 +/- 10, respectively. Blood pressure load (percentage of systolic blood pressure values > 140 mmHg or of diastolic blood pressure values > 90 mmHg) was significantly reduced from 62.2/62% (SBP/DBP), on the was-out, to 37.9/39.9% (SBP/DBP) on phase I and to 32.3/34.3% (SBP/DBP) on phase II; d) side effects: most frequently related were palpitations (2.3%), headache (1.1%), flush (1%) and ankle oedema (1%). They were in general, mild-to-moderate and disappeared after the first 3 weeks of treatment. Only two patients were withdrawn because of headache (one of them with previous diagnosis of migraine). CONCLUSION: I.SRO, given by oral route, in the dosage of 5 mg O.D. as monotherapy, was effective and well tolerated, promoted significant reduction on 24-h ambulatory blood pressure attenuating the early morning rise and did not interfere with the circadian rhythm of blood pressure. No significant differences were detected in the BP lowering effect when I.SRO was given during the morning or evening. These results may indicate that the drug is as suitable as one of the first choice for treating mild and moderate hypertensive patients.

[Multidisciplinary experience in the approach to the hypertensive patient]. / Uma experiência multiprofissional na abordagem ao paciente hipertenso.

PURPOSE: To evaluate the impact of the educational activities on the approach of patients with hypertension, with an interdisciplinary team. METHODS: Fifty patients divided into two groups: A) with 25 patients who participated in educational activities in the Hypertension League (HL) and B) who were also registered and did not take part in the activities. They were studied regarding blood pressure (BP), weight control, smoking habits, alcoholic beverage consumption, physical activities and frequency of medical care. RESULTS: There was a drop in BP of 84% of the patients in group A and 88% in group B, a drop in weight in 60% of group A and 44% of group B. We registered the presence of 4% of smokers in group A and 16% in group B. Physical activities were regular in 56% of group A and 36% in group B. Absenteeism to meetings was slightly higher among group B (44%) when compared with group A (30%). CONCLUSION: In spite of not having observed any significant differences between both approaches, regarding to strict BP control, we were able to observe a noticeable advantage in favor of the educational approach to the group, with participation of interdisciplinary team.

[Arterial blood pressure in the remaining isolated black community of a quilombo north of Goiás-Kalunga]. / Pressão arterial em comunidade negra isolada remanescente de Quilombo-norte de Goiás-Kalunga.

PURPOSE: To evaluate, in an isolated group of black individuals from a quilombo--a previous stronghold of rebel slaves (Kalunga) in the north of Goiás, the arterial blood pressure, as it related to age, sex, salt consumption, physical activities, obesity, tobacco and alcoholic beverage consumption and social organization. METHODS: We studied 159 people (74 males and 85 females) representing 15% of the adult population. All measurements, were taken by the first author with the patient both sitting and supine, after 3 minutes of relaxation. This procedure was repeated 3 times and only the last measurement was used for research purposes. RESULTS: Of the studied cases only 10 individuals with hypertension (PAd > or = 95 mmHg) representing 6.28% of the population were found. Of the patients with hypertension 2 were between 18 and 29 years of age, 3 between 30 and 45 and 5 over 46 years old. They were 7 females and 3 males. We did not find any significant difference between sexes or any significant elevation in the medium BP value. The salt intake is relatively low among them and 81.7% of the population do not use any salt at all in their food. Alcohol consumption and the habit of smoking are moderate. They have intense physical activity and obesity is rare. The Kalunga have a cooperativist society and money is not frequently used as they favor the barter system. CONCLUSION: In isolated population that maintain their cultural traits and basic life style, not adding salt to their diet, not being obese and maintaining intense physical activities, the occurrence of arterial hypertension is rare and the increases in BP level with age is not significant.

Tratamento da hipertensão arterial com dose única diária de guanfacina / Treatment of arterial hypertension with a single daily dose of guanfacine

Foram estudados 52 pacientes portadores de hipertensao arterial leve ou moderada (pressao diastolica ate 115 mm Hg), com guanfacina, em dose unica. Em todos foi afastada disfuncao renal ou outra doenca concomitante. Apos 2 semanas de placebo, iniciou-se medicacao na dose de 0,5 mg por dia ao deitar, aumentando-se progressivamente quando necessario, a cada duas semanas, ate o maximo de 3 mg por dia. Os pacientes foram seguidos por 10 semanas.Terminaram o estudo 47 pacientes conseguindo-se normalizacao da pressao arterial diastolica (< igual 90 mm Hg) em 39 (83%). Nos demais, (17%), houve diminuicao da mesma.A dose media ideal sitou-se entre 1 e 2 mg.Em apenas um caso, foi necessaria a suspensao do tratamento por efeito colateral (intensa sonolencia). Os demais efeitos colaterais foram de intensidade leve ou moderada, sendo boca seca e sonolencia os mais frequentes (53% e 28%, respectivamente). Conclui-se que a guanfacina, como monoterapia, representa mais uma opcao para o tratamento de pacientes com hipertensao arterial leve ou moderada