[Treatment of hypertension - answers of Brazilian physicians to a survey]. / Tratamento da hipertensão arterial - respostas de médicos brasileiros a um inquérito.

INTRODUCTION: The third Brazilian Consensus of Hypertension recomends the usage of pharmacological (PT) and non-pharmacological treatment (NPT). In Brazil, we don't know how if this recommedation has been followet by doctors. OBJECTIVES: a) to characterize NPT regarding prescription and acceptability by hypertensive patients; b) characterize PT concerning the criterion used for choosing medication and medication prescribed; and c) identify doctors' opinions about patients' degree of acceptability to PT and NPT. METHODS: 37904 questionnaires with reply-paid envelopes were sent to Brazilian doctors and 2519 of those were replied (57% from the Southeast region, 41% were cardiologists, and 26% clinicians). RESULTS: 1- 62% of doctors recommend NPT to 25% of their patients. 2 - The most recommended NP treatments are: hyposodic diet (55%), weight reduction (29%) and physical exercises (8%), considering that doctors believe that 50% of their patients follow a hyposodic diet, 20% do physical exercises and 19% lose weight. 3 - Only one medication is prescribed at the beginning of a PT (88%) and when blood pressure isn't under control, 55% of the doctors associate other medications with it whereas 33% of them increase the dose. 4 - The most prescribed medications are: diuretics (53%) and ECA inhibitors (24%). 5 - The main criteria for choosing medication are: personal experience (32%) and characteristics of patients (31%). 6 - Doctors (60%) believe that acceptability to PT is better. CONCLUSION: The recommendations of the Third Brazilian Consensus of Hypertension have been followed partially concerning NPT and as expected regarding PT.

Tratamento da hipertensäo arterial - respostas de médicos brasileiros a um inquérito / Treatment of hypertension - answers of Brazilian physicians to a survey

O III Consenso Brasileiro de Hipertensäo Arterial recomenda o uso de tratamento farmacológico (TF) e näo-farmacológico (TNF). Em nosso meio näo se tem conhecimento como esta recomendaçäo vem sendo seguida pelos médicos. OBJETIVOS: a) caracterizar o TNF quanto à indicaçäo e aceitaçäo pelos hipertensos; b) caracterizar o TF quanto ao critério de escolha e drogas prescritas; e c) identificar a opiniäo do médico sobre o grau de adesäo do paciente ao TF e TNF. MÉTODOS: Foram enviados 37.904 questionários com carta-resposta por mala direta para médicos brasileiros e recebidas 2.519 respostas (57 por cento regiäo Sudeste, 41 por cento cardiologistas e 26 por cento clínicos). RESULTADOS: 1- 62 por cento dos médicos que responderam recomendam TNF para 25 por cento dos pacientes. 2- Os TNF mais recomendados säo: dieta hipossódica (55 por cento), perda de peso (29 por cento) e prática de exercícios (8 por cento), sendo que os médicos acreditam que 50 por cento dos pacientes seguem dieta hipossódica, 20 por cento prática de exercícios e 19 por cento perda de peso. 3- O TF é iniciado com o uso de droga isolada (88 por cento) e quando näo há controle da pressäo arterial 55 por cento indicam associaçäo de outras drogas e 33 por cento aumentam a dose. 4- As drogas mais utilizadas säo diuréticos (53 por cento) e inibidores da ECA (24 por cento). 5- Os principais critérios para escolha das drogas säo experiência pessoal (32 por cento) e características do paciente (31 por cento). 6- Os médicos (60 por cento) acreditam que a adesäo ao TF é melhor. CONCLUSÄO: As recomendaçöes do III Consenso Brasileiro de Hipertensäo Arterial estäo sendo seguidas parcialmente para o TNF e dentro do esperado para o TF

The effect of siesta in parameters of cardiac structure and in interpretation of ambulatory arterial blood pressure monitoring.

OBJECTIVE: To evaluate the influence of the siesta in ambulatory blood pressure (BP) monitoring and in cardiac structure parameters. METHODS: 1940 ambulatory arterial blood pressure monitoring tests were analyzed (Spacelabs 90207, 15/15 minutes from 7:00 to 22:00 hours and 20/20 minutes from 22:01 to 6.59hours) and 21% of the records indicated that the person had taken a siesta (263 woman, 52+/-14 years). The average duration of the siesta was 118+/-58 minutes. RESULTS: (average +/- standard deviation) The average of systolic/diastolic pressures during wakefulness, including the napping period, was less than the average for the period not including the siesta (138+/-16/85+/-11 vs 139+/-16/86+/-11 mmHg, p<0. 05); 2) pressure loads during wakefulness including the siesta, were less than those observed without the siesta); 3) the averages of nocturnal sleep blood pressures were similar to those of the siesta, 4) nocturnal sleep pressure drops were similar to those in the siesta including wakefulness with and without the siesta; 5) the averages of BP in men were higher (p<0.05) during wakefulness with and without the siesta, during the siesta and nocturnal sleep in relation to the average obtained in women; 6) patients with a reduction of 0- 5% during the siesta had thickening of the interventricular septum and a larger posterior wall than those with a reduction during the siesta >5%. CONCLUSION: The siesta influenced the heart structure parameters and from a statistical point of view the average of systolic and diastolic pressures and the respective pressure loads of the wakeful period.

The results of the campaign for evaluating sphygmomanometers accuracy and their physical conditions.

OBJECTIVE: To evaluate the sphygmomanometers calibration accuracy and the physical conditions of the cuff-bladder, bulb, pump, and valve. METHODS: Sixty hundred and forty five aneroid sphygmomanometers were evaluated, 521 used in private practice and 124 used in hospitals. Aneroid manometers were tested against a properly calibrated mercury manometer and were considered calibrated when the error was < or = 3 mm Hg. The physical conditions of the cuffs-bladder, bulb, pump, and valve were also evaluated. RESULTS: Of the aneroid sphygmomanometers tested, 51% of those used in private practice and 56% of those used in hospitals were found to be not accurately calibrated. Of these, the magnitude of inaccuracy ranged from 4 to 8 mm Hg in 70% and 51% of the devices, respectively. The problems found in the cuffs-bladders, bulbs, pumps, and valves of the private practice and hospital devices were bladder damage (34% vs. 21%, respectively), holes/leaks in the bulbs (22% vs. 4%, respectively), and rubber aging (15% vs. 12%, respectively). Of the devices tested, 72% revealed at least one problem interfering with blood pressure measurement accuracy. CONCLUSION: Most of the manometers evaluated, whether used in private practice or in hospitals, were found to be inaccurate and unreliable, and their use may jeopardize the diagnosis and treatment of arterial hypertension.

[Is blood pressure being measured?]. / A pressão arterial está sendo medida?

The blood pressure measure is part of the physical exam and it should be accomplished in every medical consultation. To verify the blood pressure measured in the accomplished medical consultations record of first they were consulted it consults 500 patient's ambulatorial being 335 (67%) coming of medical and surgical clinics and 165 (33%) of the gynecological and obstetric clinics. The blood pressure was written down in 39% of the accomplished consultations (135 + 32 mm Hg 85 + 19 mm Hg), and 11% of this annotations the pressure diastólica was above 90 mm Hg. In relation to the previous diagnosis of hypertension it was verified that: a) in 62% of the records there was not this information; b) 20% referred to have hypertension, and in 79% of these the arterial pressure was scored; and c) 18% referred not to have hypertension and 46% of these had registration of the arterial pressure. Therefore, most of the patients didn't have its logged arterial pressure.

How accurate are sphygmomanometers?

The objective of this study was to assess the accuracy and reliability of mercury and aneroid sphygmomanometers. Measurement of accuracy of calibration and evaluation of physical conditions were carried out in 524 sphygmomanometers, 351 from a hospital setting, and 173 from private medical offices. Mercury sphygmomanometers were considered inaccurate if the meniscus was not '0' at rest. Aneroid sphygmomanometers were tested against a properly calibrated mercury manometer, and were considered calibrated when the error was < or =3 mm Hg. Both types of sphygmomanometers were evaluated for conditions of cuff/bladder, bulb, pump and valve. Of the mercury sphygmomanometers tested 21 % were found to be inaccurate. Of this group, unreliability was noted due to: excessive bouncing (14%), illegibility of the gauge (7%), blockage of the filter (6%), and lack of mercury in the reservoir (3%). Bladder damage was noted in 10% of the hospital devices and in 6% of private medical practices. Rubber aging occurred in 34% and 25%, leaks/holes in 19% and 18%, and leaks in the pump bulb in 16% and 30% of hospital devices and private practice devices, respectively. Of the aneroid sphygmomanometers tested, 44% in the hospital setting and 61% in private medical practices were found to be inaccurate. Of these, the magnitude of inaccuracy was 4-6 mm Hg in 32%, 7-12 mm Hg in 19% and > 13 mm Hg in 7%. In summary, most of the mercury and aneroid sphygmomanometers showed inaccuracy (21% vs 58%) and unreliability (64% vs 70%).

[Home blood pressure measurement and ambulatory blood pressure measurement versus office blood pressure measurement]. / Monitorização residencial da pressão arterial e monitorização ambulatorial da pressão arterial versus medida de pressão arterial no consultório.

PURPOSE: To compare both home blood pressure measurement (HBPM) and ambulatory blood pressure monitoring (ABPM) with office blood pressure measurement (OBP); and also to compare the correlation between HBPM and OBP with LVMI (left ventricular mass index). METHODS: Protocol 1--68 hypertensive patients (58 +/- 12 years, 37 females): a) self recorded blood pressure at home in the 7 days; b) recorded the ABPM during 24 hours; and c) the physician recorded blood pressure in the office. Protocol 2-41 hypertensive patients underwent the HBPM, OBP, and BI-dimensional echocardiogram. RESULTS: Protocol 1--OBP (153 +/- 24/96 +/- 13 mmHg) was higher (p < 0.05) than HBPM (133 +/- 18/84 +/- 12 mmHg) and ABPM (137 +/- 17/87 +/- 12 mmHg); Protocol 2--LVMI correlated better with HBPM (r = 0.39/0.49, p < 0.05, systolic and diastolic, respectively) than OBP (r = 0.02/ 0.22, p > 0.05, systolic and diastolic, respectively). CONCLUSION: This study showed that HBPM has a better correlation with LVMI than OBP.

[Compliance in antihypertensive therapy: analyses in scientific articles]. / A adesão ao tratamento na hipertensão arterial: análise da produção científica.

The aim of this study was to evaluate scientific articles published between 1991-1995, in order to identify the compliance in antihypertensive therapy, One hundred seven scientific articles were evaluated. The results showed that 68% were related to patient, 63% to pharmacological treatment, 62% general, 39% non pharmacological treatment, 34% organizational factors, and 8% related to disease. Compliance with antihypertensive therapy was the major challenge of hypertension management and to know how this aspect was focalized in scientific articles possible reduce non compliance in hypertension.

[Blood pressure measurement. Criteria employed in scientific articles published in Brazilian journals]. / Medida da pressão arterial. Critérios empregados em artigos científicos de periódicos Brasileiros.

PURPOSE: To evaluate the criteria used for the technique of blood pressure measurement in scientific articles published in Brazilian journals. METHODS: Two hundred twenty three scientific articles from 18 medical journals, published between 1989 and 1994 were evaluated, in order to identify the type of sphygmomanometer used; the state of calibration; the cuff size; the position of the patient during the measurement; whether the blood pressure measurement was obtained after a resting period; the phase used to identify the systolic and diastolic pressures; and the number of readings taken. RESULTS: There was no reference in the articles about the following data: the type of sphygmomanometer in 51%, the accuracy of calibration in 82%, the cuff size in 64%, the position of the patient in 25%, the rest period before measurement in 60%, the systolic and diastolic phases in 49%, and the number of measurements in 52%. CONCLUSION: Most of the papers analyzed did not follow or omitted important aspects cited in national and international recommendations for the correct blood pressure measurement.

[An instrument for the nursing consultation of patients with arterial hypertension under outpatient treatment]. / Instrumento de consultana de enfermagem a pessoas com hipertensão arterial em tratamento ambulatorial.

The purpose of this article is to emphasize the nurse's role toward persons with arterial hypertension. Therefore it's introduced an application form that is used for nursing consultation to outpatients.

[The influence of the education process on the control of arterial hypertension]. / Estudo sobre a influência do processo educativo no controle da hipertensão arterial.

A study was carried out with 23 hypertensive individuals after educational process in order to verify the retention of knowledge and its influence on the hypertension control. After drug treatment it was observed that the level of knowledge was inversely proportional to the blood pressure levels.

[The arterial pressure values checked by the client, the nurse and the outpatient physician compared with those recorded at home. A preliminary note]. / Os valores da pressão arterial verificados pelo cliente, enfermeira e médico no ambulatório, comparados com os registrados no domicílio. Nota prévia.

This study analyses the importance of self-recorded blood pressure at home. The data will be compared with measurements by patient, nurse and physician in ambulatory.

[The characterization of the patients in 2 intensive therapy units (ICU): the biosocial conditions, the hospitalization process and the therapeutic interventions]. / Caracterização dos pacientes de duas unidades de terapia intensiva (UTI): condições bio-sociais, processo de internação e intervenções terapêuticas.

The objective of this study was to characterize the patients of two intensive care units (ICU) considering the structural variables, provenance, permanence and the destination after the discharge, the main diagnosis, invasive procedures and to classify them based on therapeutic procedures.

[The patient with arterial hypertension under outpatient treatment. The influence of variables, the knowledge of the complications of the disease and the expectations regarding nursing care (III)]. / A pessoa com hipertensão arterial em tratamento no ambulatório. Influência de variáveis, conhecimento das complicações da doença e expectativas quanto à assistência de enfermagem (Parte III).

This study analysed the knowledge about complications of arterial hypertension and influence of some variables. The population constituted of eighty patients. The stroke and infarct were the complications from hypertension related. The knowledge about hypertension most related was causes of disease and its complications. The expectancy about nursing care was to obtain orientation on the disease.