Ankle-brachial index according to pulse pressure and microalbuminuria in hypertensive patients: a prospective study in family medicine.

INTRODUCTION: Microalbuminuria, as determined by the urinary albumin to creatinine (AC) ratio, is a marker of target organ damage (TOD) in hypertensive patients. Pulse pressure (PP) predicts arterial elasticity and the ankle-brachial index (ABI) is a marker of cardiovascular morbidity. TOD reduction should be achieved through improvements in these indices. OBJECTIVE: To determine whether ABI, calculated as the ratio between mean PP in the upper and lower limbs, is associated with a reduction in renal damage, as measured by the AC ratio. METHODS: This was a prospective interventional study based on an intention-to-treat analysis in an opportunity sample of patients treated by three specialists in family medicine, with three-monthly follow-up over a total of six months. Blood pressure was measured in arms and ankles, and PP was calculated and used to determine right and left ABI and mean overall ABI. The AC ratio was determined by urine dipstick test. Descriptive and inferential statistical analysis was performed. RESULTS: A sample of 75 patients were studied (42.4% women), of whom(42.4% women), of whom 27.6% were diabetic, 46.7% overweight/obese and 49.3% dyslipidemic. overweight/obese and 49 dyslipidemic. There were statistical differences for right ABI (as determined by PP) and for mean overall ABI (as determined by mean PP in lower and upper limbs). Bivariate correlation analysis showed that in the group with improved PP between the first and the third observations, n=23 (40%), there was a statistically significant reduction in AC ratio (r = -0.924, two-tailed p < 0.001); the opposite was observed in the group with reduced PP, in which the AC ratio increased. DISCUSSION: ABI determined by systolic blood pressure is an excellent predictor of hemodynamic alterations. Increased ABI, based on PP, was accompanied by improved urinary AC ratio. These results are in line with the international literature. CONCLUSIONS: An improvement in urinary AC ratio--a predictor of TOD--is observed when an improvement in the ankle PP/brachial PP ratio is achieved.

[Medicines, anxiety and depression]. / O medicamento, a ansiedade e a depressão.

OBJECTIVE: To ascertain the opinion about anxiety, depression and the medicines to treat them by gender, labour activity and age. MATERIAL AND METHODS: validated questionnaire; patients attending a Central Portugal Health Centre; doctors and nurses that proposed the questionnaire to all attending patients. Cross sectional observational study, by anonymous and secret self-fulfilment, in a convenience sample drawn from a population composed by all those attending the Health Centre between the 22nd June and the 3rd July (both inclusive) 2009. Descriptive and inferential statistics were performed by means of a SPSS 11.0 statistical package. Age groups were defined as: < 36 years, 36-55 years, =56 years and professional activity groups as non-actives (students, retired and unemployed) and actives (housewives, and workers in primary, secondary and tertiary sectors). RESULTS: A n = 281 sample was studied age distribution of < 36 years = 47,7%, 36-55 years = 36,7% and = 56 years = 15,6%, mostly active (69,4% actives) and predominantly female (71,6% women). Age distribution is normal (Kolmogorov-Smirnov Z = 1,644 2 tailed p = 0,009). As results of agreement vs disagreement, showing the significant differences, 'In general medicines for anxiety and for depression are capable of making me feel well' (71,4% vs 15,2%, p = 0,035 by age group), 'In general medicines can relieve the unpleasant sensations caused by day by day stress of actual society' (67,7% vs 22,6%, ns), 'If necessary medicines can relieve my anxiety or depression problems' (52,0% vs 34,1%, p = 0,000 by gender) and 'Anxiety and depression problems are displays of body illnesses' (42,8% vs 33,2%, ns). There is a majority of disagreement for 'In general medicines can, by themselves cure depression or anxiety' (72,5% vs 20,7%, p = 0,013 by sex), 'In general medicines for anxiety or depression can help change the way one sees the problems' (49,4% vs 43,4%, p = 0,041 by age group, p = 0,004 by sex, p = 0,002 by group of professional activity), 'I can feel good just by taking medicines' (71,4% vs 19,8%, p =0,008 by sex, p = 0,006 by professional activity group) and 'Medicines can bring more joy to my life' (58,5% vs 23,9%, p = 0,008 by sex, p = 0,006 by professional activity group). Anxiety problems and depression problems are demonstrations of body diseases, 42,8% vs 33,2%, ns). CONCLUSIONS: The pharmacological treatment for anxiety or depression must be individualised by sex, gender, age and activity of patients. In general medicines are judged capable of curing anxiety and depression problems but in the particular own case their activity is considered. Anxiety problems and depression problems are considered as manifestations of the body's disease.