Oral Fludrocortisone Test for Salt-Sensitive Screening in Hypertensive Patients: A Randomized Crossover Trial.

BACKGROUND: Salt sensitivity is associated with an increased cardiovascular risk, but the gold standard method (diet cycles) requires 24-h urine samples and has poor patient compliance. OBJECTIVES: Test the hypothesis that oral fludrocortisone (0.4 mg per day for 7 days) is a good alternative in identifying salt-sensitive patients. METHODOLOGY: We conducted a randomized crossover study with 30 hypertensive individuals comprising the following steps: (1) washout; (2) phase A (low- and high-sodium diet cycles); (3) washout 2; (4) phase B (fludrocortisone test). Phase A and B steps were performed in a random way. Consistent with the literature, we found that 53.3% were salt-sensitive according to the reference test. Using the ROC curve, the fludrocortisone test defined salt sensitivity by a median blood pressure increase of ≥3 mmHg. A good accuracy of fludrocortisone in detecting salt sensitivity was observed (AUC: 0.732±0.065; p<0.001), with 80% sensitivity and 53% specificity. CONCLUSION: The fludrocortisone test is a good option for screening salt sensitivity in hypertensive patients. However, the low specificity prevents this test from being an ideal substitute to the labor-intensive diet cycles exam in the definition of salt sensitivity. This clinical trial is registered with NCT01453959.

Captopril does not Potentiate Post-Exercise Hypotension: A Randomized Crossover Study.

To evaluate whether captopril (3×50 mg/day) potentiates post-resistance exercise hypotension (PREH) in hypertensives (HT), 12 HT men received captopril and placebo for 4 weeks each in a double-blinded, randomized-crossover design. On each therapy, subjects underwent 2 sessions: Control (C - rest) and Resistance Exercise (RE - 7 exercises, 3 sets to moderate fatigue, 50% of 1 RM -repetition maximum). Measurements were taken before and after 30-60 min (Post1) and 7 h (Post2), and ambulatory blood pressure (BP) was monitored for 24 h. There were no differences in PREH characteristics and mechanisms between the placebo and captopril periods. At Post1, systolic/diastolic BP decreased significantly and similarly after RE with both therapies (Placebo=-13±2/-9±1 mmHg vs. Captopril=-12±2/-10±1 mmHg, P<0.05). RE reduced cardiac output in some subjects and systemic vascular resistance in others. Heart rate and cardiac sympathetic modulation increased, while stroke volume and baroreflex sensitivity decreased after RE (Placebo: +13±2 bpm, +21±5 nu, -11±5 ml, -4±2 ms/mmHg; Captopril: +13±2 bpm, +35±4 nu, 17±5 ml, -3±1 ms/mmHg, P<0.05). At Post2, all variables returned to pre-intervention values. Ambulatory BP was similar between the sessions. Thus, captopril did not potentiate the magnitude and duration of PREH in HT men, and it did not influence PREH mechanisms.

Hipotensão pós-exercício resistido entre homens jovens e de meia idade / Post-resistance exercise hypotension is similar between Young and middle-aged men

A hipotensão pós-exercício foi extensivamente descrita em jovens. Entretanto, os parâmetros hemodinâmicos mudam com a idade e as respostas pós-exercício também podem variar. Assim, o objetivo deste estudo foi comparar a hipotensão pós-exercício resistido em sujeitos jovens e de meia idade. Método: Nove homens jovens (24 ± 1 anos) e oito de meia idade (42 ± 3 anos) participaram de duas sessões experimentais realizadas em ordem aleatória: controle (C: 40 minutos sentado em repouso) e exercício (E: seis exercícios, três séries, repetições até a fadiga moderada, em 50% de uma repetição máxima). Antes e 60 minutos após as intervenções, a pressão arterial clínica (PA) e frequência cardíaca (FC) foram medidas. Além disso, a PA e FC ambulatoriais foram mensuradas por 24 h após as sessões. O duplo produto (DP) foi calculado. Resultados: Os valores pré-intervenções foram semelhantes entre as sessões e os grupos. As respostas ao exercício também não diferiram entre os jovens e idosos. Assim, as PAs sistólica, diastólica e média diminuíram significante e similarmente pós-exercício nos dois grupos (valores combinados = -6,4 ± 1,6; -4,5 ± 1,8; -5,1 ± 1,5 mmHg, respectivamente, p ≤ 0,05) enquanto que a FC e o DP aumentaram (valores combinados = +11 ± 2 bpm e +803 ± 233 mmHg.bpm, respec¬tivamente, p ≤ 0,05). A PA e FC ambulatoriais pós-exercício foram semelhantes nas duas sessões e nos dois grupos. Conclusão: Uma única sessão de exercício resistido promove hipotensão pós-exercício semelhante em homens jovens e de meia-idade. A redução da PA se acompanha de aumento da FC e do trabalho cardíaco pós-exercício. Porém, estas respostas não se mantêm em condições ambulatoriais...

Post-resistance exercise hypotension has been extensively described in young subjects. However, hemodynamic parameters change with aging, and post-exercise responses may also vary. Thus, this study was designed to compare post-resistance exercise hypotension in young and middle-aged subjects. Method: Nine young (24 ± 1years) and eight middle-aged (42 ± 3years) healthy subjects underwent 2 experimental sessions conducted in a randomized order: control (C: 40 minutes of seated rest) and exercise (E: 6 exercises, 3 sets, repetitions until moderate fatigue, at 50% of 1-repetition maximum). Before and 60 minutes after the interventions, clinic blood pressure (BP) and heart rate (HR) were measured. In addition, ambulatory BP and HR were assessed for 24h after both sessions. Rate pressure product (RPP) was calculated. Results: Pre-interventions values were similar in both sessions and groups. Physiological responses to exercise were also similar between young and middle-aged subjects. Thus, clinic systolic, diastolic and mean BP decreased significantly and similarly after exercise in both groups (combined values = -6.4 ± 1.6, -4.5 ± 1.8, -5.1 ± 1.5 mmHg, respectively, p ≤ 0.05), while HR and RRP increased (combined values = +11 ± 2 bpm and +803 ± 233 mmHg. bpm, respectively, p ≤ 0.05). Ambulatory data were similar between sessions and groups. Conclusion: A single bout of resistance exercise promotes similar post-exercise hypotension in young and middle aged men. BP response is accompanied by an increase in HR and cardiac work. All these responses are not sustained under ambulatory conditions...

Betabloqueio com atenolol não reduz potência aeróbia nem muda limiares ventilatórios em hipertensos sedentários / Atenolol beta-block does not decrease aerobic power or alter ventilatory thresholds in sedentary hypertensive subjects

INTRODUÇÃO: O exercício aeróbio é recomendado para o tratamento da hipertensão. Sua intensidade pode ser prescrita com base na porcentagem da frequência cardíaca máxima (%FCmáx) ou no consumo pico de oxigênio (%VO2pico) em que os limiares ventilatórios (LV) são alcançados. Entretanto, alguns hipertensos que iniciam o treinamento podem estar tomando betabloqueadores, o que pode influenciar esses parâmetros. OBJETIVO: verificar os efeitos do atenolol sobre os LV de hipertensos sedentários. MÉTODOS: Nove voluntários realizaram dois testes ergoespirométricos máximos após quatro semanas de tratamento com atenolol (25 mg administrado por via oral duas vezes por dia) e com placebo, administrados em ordem fixa e de forma cega. Durante os testes, a frequência cardíaca (FC), a pressão arterial (PA) e o VO2 no repouso, limiar anaeróbio (LA), ponto de compensação respiratória (PCR) e pico do esforço foram analisados. RESULTADOS: O VO2 aumentou progressivamente no exercício e seus valores foram semelhantes nos dois tratamentos. A PA sistólica e a FC também aumentaram no exercício, mas seus valores absolutos foram significativamente menores com o atenolol. Porém, o aumento da PA sistólica e da FC no exercício foi semelhante com os dois tratamentos. Assim, o percentual da FCmáx e o percentual do VO2pico em que LA e PCR foram alcançados não diferiram entre o placebo e o atenolol. CONCLUSÃO: O atenolol na dosagem de 50 mg/dia não afetou o percentual do VO2pico e da FCmáx em que os LV são atingidos, o que confirma que a prescrição de intensidade de treinamento com base nessas porcentagens pode ser mantida em hipertensos que recebem betabloqueadores.

INTRODUCTION: Aerobic exercise is recommended for the treatment of hypertension. Its intensity can be prescribed based on the percentage of maximum heart rate (% MHR) or peak oxygen consumption (VO2peak%) in which the ventilatory thresholds (VT) are achieved. However, some hypertensive patients who begin aerobic training may be receiving beta-blockers, which can influence these parameters. OBJECTIVE: To investigate the effects of atenolol on VT of sedentary hypertensive patients. METHODS: Nine volunteers performed two cardiopulmonary exercise tests until exhaustion after 4 weeks of treatment with atenolol (25 mg orally twice daily) and with placebo, administered in a fixed order and in a blinded manner. During the tests, heart rate (HR), blood pressure (BP), VO2 at rest, anaerobic threshold (AT), respiratory compensation point (RCP) and peak effort were analyzed. RESULTS: VO2 increased progressively throughout the exercise and the values were similar for both treatments. Systolic blood pressure and heart rate also increased progressively during the exercise, but their absolute values were significantly lower with atenolol. However, the increase in systolic BP and HR during exercise was similar in both treatments. Thus, the % of MHR and %VO2peak at which LA and PCR were achieved were not different between placebo and atenolol. CONCLUSION: Atenolol, at a dosage of 50mg/day, did not affect the % of VO2peak and % of MHR corresponding to the VTs, which confirms that prescription of training intensity based on these percentages is adequate to hypertensive patients receiving beta-blockers.

Felipressina aumenta pressão arterial durante procedimento odontológico em pacientes hipertensos / Felypressin increases blood pressure during dental procedures in hypertensive patients

FUNDAMENTO: A felipressina foi adicionada ao anestésico local para aumentar a duração do efeito anestésico e reduzir a toxicidade nos procedimentos dentários. No entanto, o efeito sobre a pressão arterial é incerta, e isso pode ser altamente relevante no tratamento dentário de pacientes hipertensos. OBJETIVO: Investigar o efeito da felipressina sobre a pressão arterial em pacientes hipertensos com pressão arterial controlada. MÉTODOS: Foram estudados 71 indivíduos com essas características e com necessidade de tratamento periodontal. Após 10 minutos de repouso, a anestesia local (prilocaína) foi infiltrada com e sem adição de felipressina. Em seguida, uma raspagem subgengival profunda foi realizada. A pressão arterial foi medida por um equipamento oscilométrico automático (DIXTAL DX2010). Dez minutos após a administração do anestésico, o pico de ação anestésica foi gravado. O Inventário de Ansiedade Traço-Estado (IDATE) foi utilizado para avaliar o traço de ansiedade nos pacientes. RESULTADOS: A pressão arterial sistólica aumentou após a anestesia, independentemente da associação com felipressina, durante todo o procedimento dentário (p < 0,05), e essa resposta pode ser explicada, pelo menos em parte, pelos níveis de traço de ansiedade dos indivíduos. No entanto, um aumento adicional na pressão arterial diastólica foi observado quando a prilocaína foi associada a felipressina (p < 0,05), mas essa resposta não se alterou com os níveis de traço de ansiedade. CONCLUSÃO: A felipressina aumentou a pressão arterial diastólica de pacientes hipertensos com pressão arterial controlada. Pacientes com traço de ansiedade elevado apresentaram aumento na pressão arterial sistólica em alguns procedimentos, sugerindo que um aumento da pressão arterial também pode estar relacionado ao medo ou à ansiedade.

BACKGROUND: Felypressin has been added to local anesthetic to increase the length of the anesthetic effect and reduce toxicity during dental procedures. However, the effect on blood pressure remains uncertain, and this may be highly relevant in the dental treatment of hypertensive patients. OBJECTIVE: To investigate the effect of felypressin on blood pressure in hypertensive patients with controlled BP. METHODS: 71 subjects with these characteristics and in need of periodontal treatment were studied. After 10 minutes of rest, local anesthesia (prilocaine) was infiltrated with and without addition of felypressin. Then, a deep subgingival scaling was performed. Blood pressure was measured by an automated oscillometric device (DIXTAL DX2010). Ten minutes after the administration of the anesthetic, peak anesthetic action was recorded. The State-Trait Anxiety Inventory (STAI) was used to assess the patients' trait anxiety. RESULTS: Systolic blood pressure increased after anesthesia, regardless of association with felypressin, throughout the dental procedure (p<0.05) and this response can be explained, at least in part, by the trait anxiety levels of the subjects. However, a further increase in diastolic blood pressure was observed when prilocaine was associated with felypressin (p<0.05), but this response did not change with trait anxiety levels. CONCLUSION: Felypressin increased the diastolic blood pressure of hypertensive patients with controlled blood pressure. Patients with high trait anxiety presented increases in systolic blood pressure upon some procedures, suggesting that an increase in blood pressure might also be related to fear or anxiety.

Felypressin increases blood pressure during dental procedures in hypertensive patients.

BACKGROUND: Felypressin has been added to local anesthetic to increase the length of the anesthetic effect and reduce toxicity during dental procedures. However, the effect on blood pressure remains uncertain, and this may be highly relevant in the dental treatment of hypertensive patients. OBJECTIVE: To investigate the effect of felypressin on blood pressure in hypertensive patients with controlled BP. METHODS: 71 subjects with these characteristics and in need of periodontal treatment were studied. After 10 minutes of rest, local anesthesia (prilocaine) was infiltrated with and without addition of felypressin. Then, a deep subgingival scaling was performed. Blood pressure was measured by an automated oscillometric device (DIXTAL DX2010). Ten minutes after the administration of the anesthetic, peak anesthetic action was recorded. The State-Trait Anxiety Inventory (STAI) was used to assess the patients' trait anxiety. RESULTS: Systolic blood pressure increased after anesthesia, regardless of association with felypressin, throughout the dental procedure (p<0.05) and this response can be explained, at least in part, by the trait anxiety levels of the subjects. However, a further increase in diastolic blood pressure was observed when prilocaine was associated with felypressin (p<0.05), but this response did not change with trait anxiety levels. CONCLUSION: Felypressin increased the diastolic blood pressure of hypertensive patients with controlled blood pressure. Patients with high trait anxiety presented increases in systolic blood pressure upon some procedures, suggesting that an increase in blood pressure might also be related to fear or anxiety.

Hipertensão arterial nos pacientes com doença renal crônica / Hypertension in patients with chronic kidney disease

A hipertensão arterial é o maior fator de risco para doença cardiovascular e renal. Inversamente, a doença renal crônica é a forma mais comum de hipertensão secundária e várias evidências sugerem que é um fator de risco independente para mortalidade e morbidade cardiovascular. Balanço de sal positivo é o fator dominante, mas não único na gênese da hipertensão na doença renal crônica. As evidências experimentais demonstraram , claramente que a hipertensão devido à retenção de sal e água é mantida pelos aumento da resistência periférica.O diagnóstico da hipertensão é criticamente dependente das medidas adequadas da pressão arterial, principalmente em pacientes com doença renal crônica, cujo tratamento anti-hipertensivo precoce é mandatório para a prevenção de eventos cardiovasculares. A monitorização ambulatorial da pressão arterial permitiu identificar pacientes hipertensos de risco elevado. O tratamento da hipertensão em pacientes com doença renal crônica deve levar em consideração a natureza da doença renal subjacente. Pacientes com nefropatia diabética ou doença renal não diabética proteinúrica se beneficiam do tratamento com inibidores da enzima de conversãoda angiotensina ou bloqueadores do receptor de angiotensina II para a meta de pressão arterial < 130/80 mmHG, se tolerado. A meta abaixo de 140/90 mmHg é aceitável para muitos pacientes com outras formas de doença renal. Bloqueio duplo ou triplo do sistema renina angiotensina deve ser evitado.

Hypertension is a major risk factor for cardiovascular and renal disease. Conversely, chronic kidney disease is the most common form of secondary hypertension and mounting evidence suggest it is independent risk factor for cardiovascular morbidity and mortality. positive salt balance is the dominant but not the sole factor in the genesis of hypertension in chronic kidney disease. The experimental evidences have clearly demonstrated that hypertension due to retention of salt and water is maintained by increased peripheral resistance. The diagnosis of hypertension is critically dependent on accurate blood pressure measurement, especially in patients with chronic kidney disease, in whom early antihypertensive treatment is imperative to prevent cardiovascular events. Ambulatory blood pressure monitoring has successfully identified hypertensive patients at increased risk. The treatment of hypertension in chronic kidney disease patients should take into consideration the nature of the underlying kidney disease. Patients with diabetic nephropathy or proteinuric nondiabetic kidney disease benefit from treatment with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers to a goal blood pressure of < 140/90 mmHg is acceptable for most patients with other forms of chronic kidney disease. Dual or triple blockade of the renin-angiotensin system should generally be avoided.

An economic evaluation of antihypertensive therapies based on clinical trials.

OBJECTIVE: Hypertension is a major issue in public health, and the financial costs associated with hypertension continue to increase. Cost-effectiveness studies focusing on antihypertensive drug combinations, however, have been scarce. The cost-effectiveness ratios of the traditional treatment (hydrochlorothiazide and atenolol) and the current treatment (losartan and amlodipine) were evaluated in patients with grade 1 or 2 hypertension (HT1-2). For patients with grade 3 hypertension (HT3), a third drug was added to the treatment combinations: enalapril was added to the traditional treatment, and hydrochlorothiazide was added to the current treatment. METHODS: Hypertension treatment costs were estimated on the basis of the purchase prices of the antihypertensive medications, and effectiveness was measured as the reduction in systolic blood pressure and diastolic blood pressure (in mm Hg) at the end of a 12-month study period. RESULTS: When the purchase price of the brand-name medication was used to calculate the cost, the traditional treatment presented a lower cost-effectiveness ratio [US$/mm Hg] than the current treatment in the HT1-2 group. In the HT3 group, however, there was no difference in cost-effectiveness ratio between the traditional treatment and the current treatment. The cost-effectiveness ratio differences between the treatment regimens maintained the same pattern when the purchase price of the lower-cost medication was used. CONCLUSIONS: We conclude that the traditional treatment is more cost-effective (US$/mm Hg) than the current treatment in the HT1-2 group. There was no difference in cost-effectiveness between the traditional treatment and the current treatment for the HT3 group.

An economic evaluation of antihypertensive therapies based on clinical trials

OBJECTIVE: Hypertension is a major issue in public health, and the financial costs associated with hypertension continue to increase. Cost-effectiveness studies focusing on antihypertensive drug combinations, however, have been scarce. The cost-effectiveness ratios of the traditional treatment (hydrochlorothiazide and atenolol) and the current treatment (losartan and amlodipine) were evaluated in patients with grade 1 or 2 hypertension (HT1-2). For patients with grade 3 hypertension (HT3), a third drug was added to the treatment combinations: enalapril was added to the traditional treatment, and hydrochlorothiazide was added to the current treatment. METHODS: Hypertension treatment costs were estimated on the basis of the purchase prices of the antihypertensive medications, and effectiveness was measured as the reduction in systolic blood pressure and diastolic blood pressure (in mm Hg) at the end of a 12-month study period. RESULTS: When the purchase price of the brand-name medication was used to calculate the cost, the traditional treatment presented a lower cost-effectiveness ratio [US$/mm Hg] than the current treatment in the HT1-2 group. In the HT3 group, however, there was no difference in cost-effectiveness ratio between the traditional treatment and the current treatment. The cost-effectiveness ratio differences between the treatment regimens maintained the same pattern when the purchase price of the lower-cost medication was used. CONCLUSIONS: We conclude that the traditional treatment is more cost-effective (US$/mm Hg) than the current treatment in the HT1-2 group. There was no difference in cost-effectiveness between the traditional treatment and the current treatment for the HT3 group.

Atenolol blunts blood pressure increase during dynamic resistance exercise in hypertensives.

AIMS: This study was conducted to determine whether atenolol was able to decrease BP level and mitigate BP increase during dynamic resistance exercise performed at three different intensities in hypertensives. METHODS: Ten essential hypertensives (systolic/diastolic BP between 140/90 and 160/105mmHg) were blindly studied after 6 weeks of placebo and atenolol. In each phase, volunteers executed, in a random order, three protocols of knee-extension exercises to fatigue: (i) one set at 100% of 1RM; (ii) three sets at 80% of 1RM; and (iii) three sets at 40% of 1RM. Intra-arterial radial blood pressure was measured throughout the protocols. RESULTS: Atenolol decreased systolic BP maximum values achieved during the three exercise protocols (100% = 186 ± 4 vs. 215 ± 7, 80% = 224 ± 7 vs. 247 ± 9 and 40% = 223 ± 7 vs. 252 ± 16mmHg, P < 0.05). Atenolol also mitigated an increase in systolic BP in the first set of exercises (100% =+38 ± 5 vs.+54 ± 9; 80% =+68 ± 11 vs. +84 ± 13 and 40% =+69 ± 7 vs.+84 ± 14, mmHg, P < 0.05). Atenolol decreased diastolic BP values and mitigated its increase during exercise performed at 100% of 1RM (126 ± 6 vs. 145 ± 6 and +41 ± 6 vs.+52 ± 6, mmHg, P < 0.05), but not at the other exercise intensities. CONCLUSIONS: Atenolol was effective in both reducing systolic BP maximum values and mitigating BP increase during resistance exercise performed at different intensities in hypertensive subjects.

How to avoid discontinuation of antihypertensive treatment: The experience in São Paulo, Brazil.

OBJECTIVES: To evaluate the importance of providing guidelines to patients via active telephone calls for blood pressure control and for preventing the discontinuation of treatment among hypertensive patients. INTRODUCTION: Many reasons exist for non-adherence to medical regimens, and one of the strategies employed to improve treatment compliance is the use of active telephone calls. METHODS: Hypertensive patients (n=354) who could receive telephone calls to remind them of their medical appointments and receive instruction about hypertension were distributed into two groups: a) "uncomplicated" - hypertensive patients with no other concurrent diseases and b) "complicated" - severe hypertensive patients (mean diastolic ≥ 110 mmHg with or without medication) or patients with comorbidities. All patients, except those excluded (n=44), were open-block randomized to follow two treatment regimens ("traditional" or "current") and to receive or not receive telephone calls ("phone calls" and "no phone calls" groups, respectively). RESULTS: Significantly fewer patients in the "phone calls" group discontinued treatment compared to those in the "no phone calls" group (4 vs. 30; p<0.0094). There was no difference in the percentage of patients with controlled blood pressure in the "phone calls" group and "no phone calls" group or in the "traditional" and "current" groups. The percentage of patients with controlled blood pressure (<140/90 mmHg) was increased at the end of the treatment (74%), reaching 80% in the "uncomplicated" group and 67% in the "complicated" group (p<0.000001). CONCLUSION: Guidance to patients via active telephone calls is an efficient strategy for preventing the discontinuation of antihypertensive treatment.

Biopsychosocial variables and attitudes towards treatment influence complicated hypertension.

BACKGROUND: Complicated hypertension can be influenced by the characteristics of hypertensive patients. OBJECTIVE: To associate the condition of complicated hypertension with biosocial variables such as attitudes and beliefs about the disease and treatment and subjective well-being. METHODS: We studied 251 uncomplicated hypertensive patients (SBP > 140 mmHg and/or 90 < DBP < 110 mmHg for patients under no treatment and DBP <110mmHg for patients under treatment without target organ damage and other diseases) and 260 complicated hypertensive patients (DBP > 110 mmHg with or without treatment, with target organ damage or other diseases). RESULTS: Complicated hypertensive patients were significantly different from uncomplicated ones (p <0.05) in relation to: 1 - Prevalence of men, not white (53.0%), higher body mass index (29.5 ± 4.6 vs 28.5 ± 4.0 kg/m²), over 10 years of disease (54.0%), completion of previous treatment (53.0%) and reports of sadness about life as a whole (74.0%) 2 - Complicated hypertensive patients never bring the drugs when they travel (59.0%), nor do they buy them before running out the drugs (71.0%) and rarely follow eating guidelines (69.0%) 3 - Uncomplicated hypertensive patients showed no more migraines, joint pain and, among women, menopausal status and hormone replacement therapy, and 4 - Of those who had pressure control (< 140/90 mmHg), 61.9% were uncomplicated hypertensive patients; and 5 - Complicated hypertensive patients were not aware that treatment can prevent kidney problems and they thought that young people do not have high blood pressure. CONCLUSION: Complicated hypertensive patients showed more negative structural and psychosocial characteristics, more negative attitudes towards treatment and are unaware of the disease.

Variáveis biopsicossociais e atitudes frente ao tratamento influenciam a hipertensão complicada / Biopsychosocial variables and attitudes towards treatment influence complicated hypertension

FUNDAMENTO: A hipertensão complicada pode ser influenciada pelas características dos pacientes hipertensos. OBJETIVO: Associar a condição de hipertensão complicada com variáveis biossociais, tais como as atitudes e as crenças sobre a doença e o tratamento e o bem-estar subjetivo. MÉTODOS: Foram estudados 251 hipertensos não complicados (PAS > 140 mmHg e/ou 90 < PAD < 110 mmHg para pacientes sem tratamento e PAD < 110 mmHg para pacientes com tratamento, sem lesões em órgãos-alvo e outras doenças) e 260 hipertensos complicados (PAD > 110 mmHg com ou sem tratamento, com lesões em órgãos-alvo ou outras doenças). RESULTADOS: Os hipertensos complicados foram significativamente diferentes dos não complicados (p < 0,05) em relação a: 1 - Predomínio de homens, não brancos (53,0 por cento), maior índice de massa corporal (29,5 ± 4,6 vs 28,5 ± 4,0 kg/m²), mais de 10 anos de doença (54,0 por cento), realização de tratamento anterior (53,0 por cento) e referência de tristeza em relação a sua vida como um todo (74,0 por cento); 2 - Os hipertensos complicados nunca levam os remédios quando viajam (59,0 por cento), nem os providenciam antes de acabarem (71,0 por cento) e raramente seguem as orientações sobre alimentação (69,0 por cento); 3 - Os hipertensos não complicados apontaram mais enxaqueca, dor articular e, entre as mulheres, presença de menopausa e tratamento de reposição hormonal; 4 - Dos que tinham a pressão controlada (< 140/90 mmHg), 61,9 por cento eram hipertensos não complicados; e 5 - Os hipertensos complicados desconheciam que o tratamento pode evitar problemas renais e desconheciam ainda que a hipertensão também pode acometer pessoas jovens. CONCLUSÃO: Hipertensos complicados apresentaram mais características estruturais e psicossociais desfavoráveis, mais atitudes negativas frente ao tratamento e desconhecem a doença.

BACKGROUND: Complicated hypertension can be influenced by the characteristics of hypertensive patients. OBJECTIVE: To associate the condition of complicated hypertension with biosocial variables such as attitudes and beliefs about the disease and treatment and subjective well-being. METHODS: We studied 251 uncomplicated hypertensive patients (SBP > 140 mmHg and/or 90 < DBP < 110 mmHg for patients under no treatment and DBP <110mmHg for patients under treatment without target organ damage and other diseases) and 260 complicated hypertensive patients (DBP > 110 mmHg with or without treatment, with target organ damage or other diseases). RESULTS: Complicated hypertensive patients were significantly different from uncomplicated ones (p <0.05) in relation to: 1 - Prevalence of men, not white (53.0 percent), higher body mass index (29.5 ± 4.6 vs 28.5 ± 4.0 kg/m²), over 10 years of disease (54.0 percent), completion of previous treatment (53.0 percent) and reports of sadness about life as a whole (74.0 percent) 2 - Complicated hypertensive patients never bring the drugs when they travel (59.0 percent), nor do they buy them before running out the drugs (71.0 percent) and rarely follow eating guidelines (69.0 percent) 3 - Uncomplicated hypertensive patients showed no more migraines, joint pain and, among women, menopausal status and hormone replacement therapy, and 4 - Of those who had pressure control (< 140/90 mmHg), 61.9 percent were uncomplicated hypertensive patients; and 5 - Complicated hypertensive patients were not aware that treatment can prevent kidney problems and they thought that young people do not have high blood pressure. CONCLUSION: Complicated hypertensive patients showed more negative structural and psychosocial characteristics, more negative attitudes towards treatment and are unaware of the disease.

Sympathetic nerve activity is decreased during device-guided slow breathing.

It is known that slow breathing (<10 breaths min(-1)) reduces blood pressure (BP), but the mechanisms involved in this phenomenon are not completely clear. The aim of this study was to evaluate the acute responses of the muscle sympathetic nerve activity, BP and heart rate (HR), using device-guided slow breathing (breathe with interactive music (BIM)) or calm music. In all, 27 treated mild hypertensives were enrolled. Muscle sympathetic nerve activity, BP and HR were measured for 5 min before the use of the device (n=14) or while subjects listened to calm music (n=13), it was measured again for 15 min while in use and finally, 5 min after the interventions. BIM device reduced respiratory rate from 16+/-3 beats per minute (b.p.m) to 5.5+/-1.8 b.p.m (P<0.05), calm music did not affect this variable. Both interventions reduced systolic (-6 and -4 mm Hg for both) and diastolic BPs (-4 mm Hg and -3 mm Hg, respectively) and did not affect the HR (-1 and -2 b.p.m respectively). Only the BIM device reduced the sympathetic nerve activity of the sample (-8 bursts min(-1)). In conclusion, both device-guided slow breathing and listening to calm music have decreased BP but only the device-guided slow breathing was able to reduce the peripheral sympathetic nerve activity.

How to avoid discontinuation of antihypertensive treatment: The experience in São Paulo, Brazil

OBJECTIVES: To evaluate the importance of providing guidelines to patients via active telephone calls for blood pressure control and for preventing the discontinuation of treatment among hypertensive patients. INTRODUCTION: Many reasons exist for non-adherence to medical regimens, and one of the strategies employed to improve treatment compliance is the use of active telephone calls. METHODS: Hypertensive patients (n=354) who could receive telephone calls to remind them of their medical appointments and receive instruction about hypertension were distributed into two groups: a) "uncomplicated" - hypertensive patients with no other concurrent diseases and b) "complicated" - severe hypertensive patients (mean diastolic >110 mmHg with or without medication) or patients with comorbidities. All patients, except those excluded (n=44), were open-block randomized to follow two treatment regimens ("traditional" or "current") and to receive or not receive telephone calls ("phone calls" and "no phone calls" groups, respectively). RESULTS: Significantly fewer patients in the "phone calls" group discontinued treatment compared to those in the "no phone calls" group (4 vs. 30; p<0.0094). There was no difference in the percentage of patients with controlled blood pressure in the "phone calls" group and "no phone calls" group or in the "traditional" and "current" groups. The percentage of patients with controlled blood pressure (<140/90 mmHg) was increased at the end of the treatment (74 percent), reaching 80 percent in the "uncomplicated" group and 67 percent in the "complicated" group (p<0.000001). CONCLUSION: Guidance to patients via active telephone calls is an efficient strategy for preventing the discontinuation of antihypertensive treatment.

Home blood pressure monitoring in blood pressure control among haemodialysis patients: an open randomized clinical trial.

BACKGROUND: It is not known if the adjustment of antihypertensive therapy based on home blood pressure monitoring (HBPM) can improve blood pressure (BP) control among haemodialysis patients. METHODS: This is an open randomized clinical trial. Hypertensive patients on haemodialysis were randomized to have the antihypertensive therapy adjusted based on predialysis BP measurements or HBPM. Before and after 6 months of follow-up, patients were submitted to ambulatory blood pressure monitoring (ABPM) for 24 h, HBPM during 1 week and echocardiogram. RESULTS: A total of 34 and 31 patients completed the study in the HBPM and predialysis BP groups, respectively. At the end of study, the systolic (SBP) and diastolic (DBP) blood pressure during the interdialytic period measured by ABPM were significantly lower in the HBPM group in relation to the predialysis BP group (mean 24-h BP: 135 +/- 12 mmHg/76 +/- 7 mmHg versus 147 +/- 15 mmHg/79 +/- 8 mmHg; P < 0.05). In the HBPM analysis, the HBPM group showed a significant reduction only in SBP compared to the predialysis BP group (weekly mean: 144 +/- 21 mmHg versus 154 +/- 22 mmHg; P < 0.05). There were no differences between the HBPM and predialysis BP groups in relation to the left ventricular mass index at the end of the study (108 +/- 35 g/m(2) versus 110 +/- 33 g/m(2); P > 0.05). CONCLUSIONS: Decision making based on HBPM among haemodialysis patients has led to a better BP control during the interdialytic period in comparison with predialysis BP measurements. HBPM may be a useful adjuvant instrument for blood pressure control among haemodialysis patients.

Pré-hipertensão: conceito, epidemiologia e o que falam as diretrizes / Prehypertension: concept, epidemiology and what the guidelines say

A pressão arterial, como qualquer outra variável fisiológica, tem distribuição normal entre a população. Há uma relação contínua entre pressão arterial e doença cardiovascular, mas não há um valor-limite que separe os pacientes hipertensos que terão um evento cardiovascular futuro daqueles que não o terão. O risco de doença cardiovascular depende da pressão arterial, dos fatores de risco coexistentes e da existência de lesões em órgãos-alvo. O Seventh Joint National Committee (JNC 7) reuniu indivíduos com pressão arterial normal e normal-alta em único grupo, denominado “pré-hipertensão”. Nessa diretriz, a pré-hipertensão é considerada um precursor da hipertensão estágio 1 e índice prognóstico de risco cardiovascular. O estudo inicial deFramingham, porém, assim como as Diretrizes Europeias e Brasileiras de Hipertensão, não sustenta a ideia de rotular indivíduos com pressão arterial normal como sendo pré-hipertensos. A questão-chave que permanece sem resposta é se indivíduos com pressão arterial normal-alta devem ser tratados farmacologicamente antes que progridam para hipertensão. Sabemos que a elevação da pressão arterial representa um fator de risco independente, linear e contínuo para os pacientes, que podem ser vitimados por doenças cardiovasculares.

Blood pressure, like any physiological variable, is normally distributed in the population. There is a continuous relation between blood pressure and cardiovascular disease, but no clear threshold value separates hypertensive patients who will experience future cardiovascular events from those who will not. The risk of cardiovascular disease depends on blood pressure, coexistent risk factors, and whether there is hypertensive damage to target organs. The JNC 7 guidelines combined subjects with normal and high-normal blood pressure into a single group called“ prehypertension”. In this guideline, prehypertension is considered a precursor of stage 1 hypertension and a predictorof excessive cardiovascular risk. However, the initial Framingham study, European and Brazilian hypertension guidelines do not support the idea of labeling subjects with normal blood pressure as being prehypertensive. The key question whether subjects with high-normalblood pressure should be pharmacologically treated beforet hey progress to hypertension remains unanswered. Life-style measures can reduce blood pressure and may prove useful in those with high normal/prehypertension blood pressures

Adesão ao tratamento em hipertensão arterial sistólica isolada: [revisão] / Adhesion to the treatment in systolic hypertension: [review]

O arsenal terapêutico para doenças crônicas, como hipertensão arterial, recebe frequentemente novos medicamentos. Entretanto, mesmo com todo esse investimento, quem trata de pacientes com essas condições continua esbarrando em um problema secular, a falta de adesão à terapêutica, seja ela medicamentosa ou não. Em relação à hipertensão arterial sistólica isolada garantir a adesão é ainda mais difícil, porque é condição relacionada à faixa etária mais avançada. Neste grupo de pacientes, vários fatores agem para levar a pior adesão, desde limitações do paciente, necessidade de cuidadores e prescrições com muitos itens. Abordar o tema adesão em pacientes com essas peculiaridades requer visão individualizada, mas multiprofissional.

New drugs frequently enlarge therapeutic arsenal for chronic illnesses as hypertension. Despite all this investment, who deals with patients with these conditions, continues with a secular problem, the lack of adhesion to prescription. With regard to the systolic hypertension, to guarantee the adhesion is still more difficult because this condition is far more common in elderly. In this group of patients some factors act to take to worse adhesion, since patient’s limitations, caregivers’ need and a great number of medications. To approach the adhesion in patients with these peculiarities requires a differentiated view, but multiprofessional.