Association between pregnancy-related hypertension and severity of hypertension.

Hypertension in pregnancy is an emerging sex-specific risk factor for cardiovascular disease and may lead to more severe hypertension after pregnancy. The objectives of this study were to investigate the frequency of pregnancy-related hypertension among patients referred to a hypertension clinic and its association with the severity of hypertension and evidence of end-organ damage. In this cross-sectional study, women with hypertension were submitted to a systematic clinical evaluation. The occurrence of pregnancy-related hypertension was investigated by questionnaire. The association between pregnancy-related hypertension and severity of hypertension (stage 2 according to Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII)) and end-organ damage was assessed in a logistic regression model. The mean age, systolic and diastolic blood pressure and body mass index (BMI) of the 768 women examined were 51.6+/-12.7 years, 158.2+/-26.6 mm Hg, 93.8+/-14.3 mm Hg and 29.4+/-5.6 kg/m(2), respectively. The proportion of women with pregnancy-related hypertension was 32.9%. It was significantly associated with hypertension at stage 2 (OR: 1.60, 95% CI: 1.14-2.24; P=0.01) after controlling for confounders. The occurrence of a pregnancy-related hypertension was not associated with evidence of optic fundi abnormalities, left ventricular hypertrophy or abnormalities in kidney function. In conclusion, pregnancy-related hypertension is frequent in women referred to a hypertension clinic, and is associated with severe hypertension but not with evidence of end-organ damage.

Waist circumference cut-off values to predict the incidence of hypertension: an estimation from a Brazilian population-based cohort.

BACKGROUND AND AIMS: Central obesity is a key component in the definition of the metabolic syndrome, but the cut-off values proposed to define abnormal values vary among different guidelines and are mostly based on cross-sectional studies. In this study, we identify the best cut-off values for waist circumference (WC) associated with the incidence of hypertension. METHODS AND RESULTS: Participants for this prospectively planned cohort study were 589 individuals who were free of hypertension and selected at random from the community of Porto Alegre, Brazil. Hypertension was defined by a blood pressure measurement >or= 140/90 mmHg or the use of blood pressure lowering drugs. A logistic regression model established the association between WC and the incidence of hypertension. A receiver operating characteristics (ROC) curve analysis was used to select the best WC cut-off point to predict the incidence of hypertension. During a mean follow-up of 5.5+/-0.9 years, 127 subjects developed hypertension. The hazard ratios for the development of hypertension, adjusted for age, baseline systolic blood pressure, alcohol consumption, gender and scholarship were 1.02 (95% CI; 1.00-1.04; P=0.02) for WC. The best cut-off WC values to predict hypertension were 87 cm in men and 80 cm in women, with an area under the curve of 0.56 (95% CI; 0.47-0.64; P=0.17) and 0.70 (95% CI; 0.63-0.77; P<0.001), respectively. CONCLUSION: Excess visceral adiposity is a major risk factor for hypertension in individuals living in communities in Brazil, and this risk begins at lower values of WC that those recommended by some guidelines.

Absence of association between depression and hypertension: results of a prospectively designed population-based study.

The objective of this study was to examine the relation between hypertension and depression. In a cross-sectional study of the urban region of a State capital with more than 1.5 million inhabitants, 1174 men and women aged 18-80 years, selected at random from the population, were studied. Blood pressure, hypertension (blood pressure readings >or=140/90 mm Hg or use of blood pressure-lowering agents), risk factors for hypertension and depression according to the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) were investigated in home interviews. The prevalence of major depression and hypertension were 12.4% (95% confidence interval (CI): 10.5-14.3) and 34.7% (95% CI: 32.2-37.4), respectively. Systolic and diastolic blood pressures of individuals with and without a lifetime episode of depression were not different after adjustment for age and gender. Lifetime episodic major depression was not associated with hypertension in bivariate analysis (risk ratios (RR): 0.96, 95% CI: 0.76-1.23) and after adjustment for confounding (RR: 1.15; 95% CI:0.75-1.76). Hypertension and depression were not associated in this free-living population of adults, suggesting that their concomitant occurrence in clinical practice may be ascribed to chance.

Ansiedade em pacientes cardíacos pré-cirúrgicos / Anxiety in cardiac patients in the preoperative period

A ansiedade provocada pela possibilidade de intervençäo cirúrgica pode afetar o paciente se esse sentimento näo é expresso e conscientizado (Mello Filho, 1986). Nesse sentido, o grupo de atendimento psicológico proporciona aos pacientes a oportunidade de verbalizarem suas ansiedades e suas experiências relacionadas com a cirurgia e a anestesia. Esta pesquisa tem por objetivo investigar a ansiedade de uma amostra de 46 pacientes adultos cardíacos pré-cirurgicos, buscando avaliar a relaçäo entre o esdo de ansiedade antes e depois da participaçäo no grupo de atendimento psicológico. Foi utilizdo o Inventário de Ansiedade-Traço-Estado (IDATE) antes e depois da participaçäo dos pacientes no referido atendimento com o objetivo de comparar o nível de ansiedade, pois esse fator influi para o alívio desse sentimento. Percebe-se que, ao verbalizar suas emoçöes, associando também suas dúvidas a respeito dos procedimentos aos quais seräo submetidos, os pacientes compreendem melhor toda a situaçäo, o que contiui para a diminuiçäo de suas ansiedades (Ruschel, 1993).