Una experiencia en la evaluación del Programa de Hipertensión Arterial basado en la Iniciativa HEARTS

Fundamento: la hipertensión se ha convertido en una de las condiciones de mayor prevalencia entre los adultos cubanos y en el principal factor de riesgo de morbilidad y de mortalidad por causas cardiovasculares. Objetivo: evaluar el impacto de la implementación del Programa de Hipertensión Arterial basado en la Iniciativa HEARTS en el Policlínico Comunitario Octavio de la Concepción y de la Pedraja en el municipio Cienfuegos. Métodos: se realizó un estudio descriptivo, de corte transversal en sistemas y servicios de salud desde el 2018 hasta el 2022. El universo fue la población mayor de 18 años y la muestra de 4 346 hipertensos. Se estudiaron las variables: sexo, control de hipertensión arterial, estructura tecnológica, índice de desempeño, índice de madurez y comportamiento de la mortalidad por enfermedades cardiovasculares. Resultados: el índice de desempeño de los Equipos Básicos de Salud fue excelente y el índice de madurez tuvo la categoría de avanzado. Se alcanzó el 85,5 % de cobertura diagnóstica y de registro, el 94,7 % de control entre tratados, un 39,5 % de control de los pacientes con alto riesgo cardiovascular y el 60,1 % de control poblacional. La mortalidad por enfermedades cardiovasculares para todas las edades en específico la mortalidad prematura disminuyó, con predominio del sexo masculino. Conclusiones: la implementación del programa de hipertensión arterial consolidó un sistema de trabajo para el perfeccionamiento de actuación en la Atención Primaria de Salud ante el paciente hipertenso. El uso de la política terapéutica estandarizada ha tenido impacto en el control de la presión arterial.

Foundation: hypertension has become one of the most prevalent conditions among Cuban adults and the main risk factor for morbidity and mortality due to cardiovascular causes. Objective: to evaluate the impact of the implementation of the Arterial Hypertension Program Based on the HEARTS Initiative in the Octavio de la Concepción y de la Pedraja Community Polyclinic in the Cienfuegos municipality. Methods: a descriptive, cross-sectional study was carried out in health systems and services from 2018 to 2022. The universe was the population over 18 years of age and the sample of 4,346 hypertensive patients. The variables were studied: sex, control of high blood pressure, technological structure, performance index, maturity index and mortality behavior due to cardiovascular diseases. Results: the performance index of the Basic Health Teams was excellent and the maturity index was in the advanced category. 85.5 % diagnostic and registration coverage were achieved, 94.7 % control among treated patients, 39.5 % control of patients with high cardiovascular risk and 60.1 % population control. Mortality from cardiovascular diseases for all ages, specifically premature mortality, decreased, with a predominance of the male sex. Conclusions: the implementation of the arterial hypertension program consolidated a work system for the improvement of action in Primary Health Care for hypertensive patients. The use of standardized therapeutic policy has had an impact on blood pressure control.

Asociación entre factores de riesgo modificables e hipertensión arterial en adolescentes de Moa

Fundamento: La hipertensión arterial en adolescentes se relaciona estadísticamente con factores de riesgo modificables que influyen en la aparición y evolución de la enfermedad. Objetivo: medir el grado de asociación entre factores de riesgo modificables y las cifras de tensión arterial en adolescentes de Moa, Holguín. Método: Se realizó un estudio observacional, longitudinal, prospectivo de corte transversal en el periodo comprendido entre septiembre-diciembre 2022. El universo lo constituyeron los 1561 adolescente de 15-19 años de edad y la muestra 524 (33,56 %). Se realizó un muestreo probabilístico sistemático. Se analizaron como variables: índice de masa corporal, índice de circunferencia abdominal, sueño nocturno, horas de actividad sedentaria y frecuencia semanal de comida chatarra. Se utilizaron los estadígrafos: frecuencia absoluta y porcentaje y las pruebas estadísticas; Chi cuadrado (p 97 pp eran hipertensos y el 37,21 % prehipertensos, X2p=167,1976 > X2c=20,0902, (VC=0,3646). El 40,00 % de los que tenían ICA > 97 pp fueron diagnosticados con HTA y el 40,00 % prehipertensión, X2p=239,6183 > X2c=20,0902, V de Cramer (VC=0,4366). El 14,14 % de los que dormían 6 horas o menos fueron estratificados como hipertensos, X2p=54,1834 > X2c=13,2767 (VC=0,2076). Los adolescentes que dedicaban más de seis horas diarias a actividades sedentarias (10,63 %) padecían hipertensión y prehipertensión (11,88 %), X2p=14,1081 > X2c=13,2767 (VC=0,1059). El 14,22 % ingerían comida chatarra con una frecuencia igual o superior a seis veces por semana y eran hipertensos, X2p=29,8662 > X2c=13,2767 (VC=0,1541). Conclusiones: Existió asociación moderada entre el índice masa corporal, el índice de circunferencia abdominal y la tensión arterial. La asociación entre horas de sueño nocturno, horas diarias de actividad sedentaria y frecuencia semanal de comida chatarra con las cifras de tensión arterial.

Foundation: High blood pressure in adolescents is statistically related to modifiable risk factors that influence the onset and evolution of the disease. Objective: Measure the degree of association between modifiable risk factors and blood pressure levels in adolescents from Moa, Holguín. Methods: An observational, prospective longitudinal cross-sectional study was carried out in the period between September-December 2022. The universe consisted of 1,561 adolescents aged 15-19-years and the sample was 524 (33.56%). A systematic probabilistic sampling was carried out. The following variables were analyzed: body mass index, abdominal circumference index, night sleep, hours of sedentary activity and weekly frequency of junk food. Statisticians were used: absolute frequency and percentage and statistical tests; Chi square (p 97pp were hypertensive and 37.21% were prehypertensive, X2p=167.1976 > X2c=20.0902, (VC=0.3646). 40.00% of those with ICA > 97pp were diagnosed with HTN and 40.00% with prehypertension, X2p=239.6183 > X2c=20.0902, Cramer's V (VC=0.4366). 14.14% of those who slept 6 hours or less were stratified as hypertensive, X2p=54.1834 > X2c=13.2767 (VC=0.2076). Adolescents who spent more than six hours a day in sedentary activities (10.63%) suffered from hypertension and prehypertension (11.88%), X2p=14.1081> X2c=13.2767 (VC=0.1059). 14.22% ate junk food with a frequency equal to or greater than six times a week and were hypertensive, X2p=29.8662 > X2c=13.2767 (VC=0.1541). Conclusions: There was a moderate association between body mass index, abdominal circumference index and blood pressure. The association between hours of night sleep, daily hours of sedentary activity and weekly frequency of junk food with blood pressure figures.

Mental Health of Elderly Hypertensive Patients in Primary Health Care: An Integrative Review

Introduction: The global context highlights several challenges and manifestations stemming from population aging, among which mental health care for elderly people stands out. Primary health care (PHC), the largest gateway to Brazil's health care network, is strategic in promoting health and care, and in preventing diseases such as systemic arterial hypertension (SAH). It is known that elderly people with SAH present various symptoms of psychological distress and mental disorders that can aggravate cardiac symptoms. This can lead to health, social, and financial impacts on the lives of elderly people and their families. Objective: To identify the evidence on mental health care for hypertensive elderly people in PHC. Materials and methods: This is an integrative literature review; data was collected in January 2023 from the following databases: PubMed, BVS/Bireme, Medline, Lilacs, Cinahl, Scopus, and APA PsycINFO. The studies included were those available in full, in Spanish, English, and Portuguese, and which answered the research question elaborated following the PICo strategy. The article's search and selection processes were performed independently by two trained researchers through peer review. The Prisma guidelines were followed. Results: The studies found were published between 2008 and 2020 and showed two analysis categories: integrated care provided by the multi-professional team and measures that emphasize health-related quality of life. The studies highlighted integrated care management programs, qualification of the bond and territorialization, health measures that have an impact on psychological suffering, and group activities. Conclusions: Mental health care provided in an integrated and shared manner, combined with health activities and groups, is a powerful tool for elderly hypertensive patients in PHC. These strategies still have some challenges in certain contexts, but the review emphasizes the importance of consolidating this form of care, provided in PHC and has outcomes at all levels of care.

Introducción: el contexto mundial destaca diversos desafíos y manifestaciones del envejecimiento de la población, entre ellos la atención a la salud mental de los ancianos. La atención primaria de salud (APS), la mayor puerta de entrada a la red asistencial de Brasil, es estratégica en la promoción de la salud, el cuidado y la prevención de enfermedades como la hipertensión arterial sistémica (HSA). Se sabe que los ancianos con HSA presentan diversos síntomas de angustia psicológica, así como trastornos mentales que pueden agravar los síntomas cardíacos. Esto puede tener repercusiones sanitarias, sociales y económicas en la vida del anciano y su familia. Objetivo: Identificar las evidencias sobre la atención a la salud mental de los ancianos hipertensos en APS. Materiales y método: se trata de una revisión bibliográfica integradora; los datos se recogieron en enero de 2023 de las siguientes bases de datos: PubMed, BVS/Bireme, Medline, Lilacs, Cinahl, Scopus y APA PsycINFO. Se incluyeron estudios disponibles en su totalidad, en español, inglés y portugués, que respondieran a la pregunta de investigación elaborada a la luz de la estrategia PICo. La búsqueda y selección de artículos fue realizada de forma independiente por dos investigadores capacitados mediante revisión por pares. Se siguieron las recomendaciones Prisma. Resultados: los estudios encontrados fueron publicados entre 2008 y 2020, y mostraron dos categorías de análisis: atención integrada por el equipo multiprofesional y acciones que enfatizan la calidad de vida relacionada con la salud. Los estudios encontrados destacaron los programas de gestión integrada de la atención, la cualificación del vínculo y la territorialización, las acciones sanitarias que inciden en el sufrimiento psicológico y las actividades grupales. Conclusiones: la atención a la salud mental realizada de forma integrada y compartida, articulada con actividades y grupos de salud, es poderosa para los pacientes hipertensos ancianos en APS. Estas estrategias aún presentan algunos desafíos en algunos contextos, pero la revisión refuerza la importancia de consolidar esta atención, que se realiza en APS y tiene resultados en todos los niveles de atención.

Introdução: o contexto global evidencia diversos desafios e manifestações do envelhecimento populacional, dos quais destaca-se o cuidado em saúde mental da pessoa idosa. A atenção primária à saúde (APS), maior porta de entrada na rede de atenção à saúde do Brasil, é estratégica na promoção à saúde, ao cuidado e à prevenção de agravos, como a hipertensão arterial sistêmica (HAS). Sabe-se que a pessoa idosa com HAS manifesta diversos sintomas de sofrimento psíquico, bem como transtornos mentais que podem agudizar os sintomas cardíacos. Esse fato pode causar impactos de saúde, sociais e financeiros na vida da pessoa idosa e sua família. Objetivo: identificar as evidências sobre o cuidado em saúde mental ao idoso hipertenso na APS. Materiais e método: trata-se de uma revisão integrativa da literatura; a coleta de dados ocorreu em janeiro de 2023, nas seguintes bases de dados: PubMed, BVS/Bireme, Medline, Lilacs, Cinahl, Scopus e APA PsycINFO. Incluíram-se estudos disponíveis na íntegra, em espanhol, inglês e português, que respondessem à questão de pesquisa elaborada à luz da estratégia PICo. A busca e a seleção dos artigos foram executadas por dois pesquisadores treinados, de modo independente, mediante discussão por pares. As recomendações do Prisma foram seguidas. Resultados: os estudos encontrados foram publicados de 2008 a 2020 e evidenciaram duas categorias de análise: cuidados integrados pela equipe multiprofissional e ações que enfatizam a qualidade de vida relacionada à saúde. Destacaram-se nos estudos encontrados programas de gestão do cuidado integrado, qualificação do vínculo e territorialização, ações de saúde que impactam no sofrimento psíquico e atividades de grupo. Conclusões: o cuidado em saúde mental realizado de maneira integrada e compartilhada articulado com atividades de saúde e grupos são potentes para os idosos hipertensos na APS. Essas estratégias ainda apresentam alguns desafios em alguns contextos, no entanto a condução da revisão reforça a importância da consolidação desse cuidado, que acontece na APS e tem desfechos em todos os níveis de atenção.

Associação entre parto cesáreo e pressão arterial elevada em pré-escolares: um estudo transversal / Association between cesarean section and high blood pressure among early elementary schoolchildren: a cross-sectional study / Asociación entre los partos por cesárea y la presión arterial alta en preescolares: un estudio transversal

O parto cesáreo é apontado como fator de risco para diversas doenças crônicas. Neste estudo, objetivou-se averiguar a associação entre parto cesáreo e pressão arterial (PA) de crianças de 6 anos. Trata-se de estudo transversal conduzido em Feira de Santana (BA), com 635 pares de mãe e filho. O tipo de parto foi categorizado em cesárea e vaginal. A PA foi aferida por meio de esfigmomanometria e considerada elevada quando atingiu níveis iguais ou maiores ao percentil 90 para idade, sexo e altura. Razões de prevalência brutas (RPbruta) e ajustadas (RPajustada) e respectivos intervalos de confiança de 95% (IC95%) foram estimados via regressão logística múltipla. A cesariana ocorreu em 46,5% dos casos, as prevalências de pressão arterial sistólica (PAS) e diastólica (PAD) elevadas foram de 17,2% e 5,6%, respectivamente. O excesso de peso foi verificado em 28,6% das crianças. A maior prevalência de PAS elevada foi observada entre as crianças que nasceram por cesariana (61%) em relação às que nasceram por parto vaginal (RPbruta: 1,51; IC95%: 1,07-2,14; RPajustada: 1,61; IC95%: 1,05-2,46). A idade materna ao nascimento da criança foi fator de interação na associação principal, assim, as crianças nascidas via parto vaginal exibiram maior prevalência de PAS elevada, comparadas às nascidas via cesárea. O parto cesáreo se associou à PAS elevada aos 6 anos de idade.

Cesarean delivery is considered a risk factor for several chronic diseases. This study aimed to investigate the association between cesarean section and blood pressure (BP) in 6-year-old children. This is a cross-sectional study carried out in Feira de Santana, (BA) with 635 mother-child pairs. The type of birth was categorized into cesarean and vaginal. The BP was measured by using sphygmomanometry and considered high when it reached levels equal or higher than the 90th percentile for age, gender, and height. Crude (PRcrude) and adjusted (PRadjusted) prevalence rate and respective 95% confidence intervals (95%CI) were estimated by multiple logistic regression. Cesarean section occurred in 46.5% of the cases, the prevalence of high systolic (SBP) and diastolic (DBP) blood pressure were 17.2% and 5.6%, respectively. Excess weight was verified in 28.6% of the children. The highest prevalence of high SBP was among children who were born by cesarean section (61%) compared with those who were born vaginally (PRcrude: 1.51; 95%CI: 1.07-2.14; PRadjusted: 1.61; 95%CI %: 1.05-2.46). Maternal age at the birth of the child was an interaction factor in the main association, thus, children born vaginally had a higher prevalence of elevated SBP, compared with those born via cesarean section. Cesarean section was associated with increased SBP at six years of age.

El parto por cesárea presenta un factor de riesgo para varias enfermedades crónicas. El objetivo de este estudio fue investigar la asociación entre el parto por cesárea y la presión arterial (PA) en niños de 6 años de edad. Se trata de un estudio transversal, realizado en Feira de Santana, en Bahía (Brasil), con 635 pares de madre e hijo. El tipo de parto se clasificó en cesárea y vaginal. La PA se midió mediante esfigmomanometría y se consideró alta cuando alcanzó niveles más altos o iguales al percentil 90 para edad, sexo y talla. Las razones de prevalencia crudas (RPcrudas) y ajustadas (RPajustadas) y los respectivos intervalos de confianza del 95% (IC del 95%) se estimaron mediante regresión logística múltiple. La cesárea ocurrió en el 46,5%, las prevalencias de presión arterial sistólica (PAS) y diastólica (PAD) altas fueron el 17,2% y el 5,6%, respectivamente. El exceso de peso se presentó en el 28,6% de los niños. La mayor prevalencia de PAS alta se observó entre los niños nacidos por cesárea (61%) en comparación con los nacidos por vía vaginal (RPcruda: 1,51; IC95%: 1,07-2,14; RPajustada: 1,61; IC95%: 1,05-2,46). La edad materna al nacimiento del niño fue un factor de interacción en la principal asociación, así, los niños nacidos por vía vaginal tuvieron una mayor prevalencia de PAS elevada en comparación con los nacidos por cesárea. El parto por cesárea se asoció con un aumento de la PAS a los 6 años de edad.

AT1 receptor downregulation: A mechanism for improving glucose homeostasis.

There is a pathophysiological correlation between arterial hypertension and diabetes mellitus, established since the pre-diabetic state in the entity known as insulin resistance. It is known that high concentrations of angiotensin-II enable chronic activation of the AT1 receptor, promoting sustained vasoconstriction and the consequent development of high blood pressure. Furthermore, the chronic activation of the AT1 receptor has been associated with the development of insulin resistance. From a molecular outlook, the AT1 receptor signaling pathway can activate the JNK kinase. Once activated, this kinase can block the insulin signaling pathway, favoring the resistance to this hormone. In accordance with the previously mentioned mechanisms, the negative regulation of the AT1 receptor could have beneficial effects in treating metabolic syndrome and type 2 diabetes mellitus. This review explains the clinical correlation of the metabolic response that diabetic patients present when receiving negatively regulatory drugs of the AT1 receptor.

Rate of Responders for Post-Exercise Hypotension after Beach Tennis, Aerobic, Resistance and Combined Exercise Sessions in Adults with Hypertension.

Post-exercise hypotension (PEH) is typically reported as mean values, but a great inter-individual variation in blood pressure (BP) response after a single exercise session is expected, especially when comparing different modalities of exercise. The purpose was to evaluate the inter-individual BP responses after beach tennis, aerobic, resistance and combined exercise sessions in adults with hypertension. We conducted a post hoc analysis of pooled crossover randomized clinical trials from six previously published studies of our research group, and analyzed data from 154 participants with hypertension (≥35 years). BP was assessed using office BP, and the mean changes throughout the 60 min after recreational beach tennis (BT, n = 23), aerobic (AE, n = 18), combined (COMB, n = 18), and resistance (RES, n = 95) exercise sessions were compared to a non-exercising control session (C). To categorize the participants as responders and non-responders for PEH, the typical error (TE) was calculated as follows: TE = SDdifference/√2, where SDdifference is the standard deviation of the differences in BP measured before the interventions in the exercise and control sessions. Participants who presented PEH greater than TE were classified as responders. The TE was 7 and 6 mmHg for baseline systolic and diastolic BP, respectively. The rate of responders for systolic BP was as follows: BT: 87%; AE: 61%; COMB: 56%; and RES: 43%. For diastolic BP, the rate of responders was as follows: BT: 61%; AE: 28%; COMB: 44%; and RES: 40%. Results evidenced that there was a high inter-individual variation of BP after a single bout of different physical activity modalities in adults with hypertension, suggesting that exercise protocols with aerobic characteristics (i.e., BT, AE, and COMB sessions) presented PEH in most of its practitioners.

Addressing hypertension among Haitian adults with insufficient access to quality healthcare: A discursive review.

AIM: The purpose of this article is to summarize research targeting hypertension and healthcare access among adults living in rural Haiti. BACKGROUND: Hypertension is a significant public health problem that impacts one in five persons globally. It is the leading cause of cardiovascular-related conditions such as stroke and myocardial infarction and accounts for most global non-communicable disease-related deaths. Limited healthcare access and social determinants of health are known contributors to poor health outcomes among persons with hypertension. Among Haitians, there are stark health disparities between those who live in urban versus rural areas. DESIGN: A discursive review. RESULTS: Several issues are identified as barriers to proper hypertension prevention and management. However, after examining the effective interventions, we found that social determinants of health such as transportation costs, lack of field care facilities close to patients, roadway conditions, political disturbance, and ineffective leadership and policies are major barriers to controlling hypertension in Haiti. Although Haiti has received help from international organizations, strengthening its internal infrastructure is paramount in improving healthcare access. DISCUSSION: The review concludes that Haitians living in rural parts of Haiti are less likely to receive healthcare to manage non-communicable diseases such as hypertension. Similar to other developing countries, a heightened awareness is needed to address the lack of healthcare access for those living in rural communities. IMPACT TO NURSING PRACTICE: Nurses and other healthcare professionals working with populations in Haiti should become aware of the barriers and facilitators that promote sufficient healthcare access. To achieve this goal, nurses must understand the social determinants and other factors that serve as barriers for achieving access to quality care for this vulnerable population. NO PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public involvement in the design or drafting of this discursive paper.

Cessation Restores Blood Pressure Levels and Endothelial Function Affected by Cadmium Exposure on Rats.

Chronic cadmium exposure produces high blood pressure and endothelial damage; however, it is not known whether these effects could be reversed by interrupting the exposure to the metal. Therefore, we evaluate the systolic blood pressure (SBP) and vascular reactivity during and following chronic cadmium-exposure discontinuance. Rats received 100 mg.L-1 cadmium chloride (CdCl2) in the drinking water or tap water (Ct) for 30 days and/or tap water for 30 days more. The cadmium plasma content, blood pressure and vascular reactivity of isolated aorta were evaluated. Cadmium exposure increased cadmium plasma content, SBP and aorta contractile responses to phenylephrine, all reversed after suspending exposure. Endothelial removal and nitric oxide synthase (NOS) inhibition increased phenylephrine response both on control and Cd-discontinuation models. Cd-discontinuation group presented increased CAMKII and PKA protein expression, as peNOSSer1177. Superoxide dismutase (SOD) incubation reduced contractile response on control group, and catalase incubation enhanced the response to phenylephrine in this group. Meanwhile, both SOD2 and catalase protein expression were increased in Cd-cessation rats. Our findings provide evidence that increased SBP and endothelial dysfunction induced by Cd chronic exposure are reversed by suspending the metal exposure probably due to an improvement of antioxidant enzymes and eNOS function.

Cytokine and microbiota profiles in obesity-related hypertension patients.

Background: Systemic arterial hypertension is linked to a heightened risk of cardiovascular diseases on a global scale. In Mexico, nearly half of adults in vulnerable conditions experience hypertension. Imbalance in the oral and intestinal microbiota composition has been observed in patients with hypertension, documented by a decrease of bacteria producing short-chain fatty acids, which play a critical role in blood pressure regulation. Aim: To examine the cytokines' profile and assess the characteristics of oral and gut microbiota in obesity-related hypertension in Mexican patients. Methods: A cross-sectional, observational, and analytical study was carried out. Twenty-two patients were categorized by their body mass index (BMI) as overweight and obese, and the diagnosis of primary hypertension. DNA from supragingival dental plaque and feces samples was used to carry out 16S rRNA sequencing. Additionally, 13 cytokines were quantified. Results: In the oral microbiota, Kluyvera was found to be significantly enriched in obese compared to overweight patients. Instead, the gut microbiota was dominated by Firmicutes. However, the correlation between certain genera and proinflammatory cytokines was noted. Conclusion: This exploratory study provides insights into the complex relationship between the oral and gut microbiota and their association with systemic inflammation in obesity-related hypertension.

Inter-individual responses of post-exercise hypotension in older adults with hypertension: An exploratory analysis of different exercise modalities.

Background: Various physical exercise modalities can acutely reduce blood pressure (BP). However, not all individuals respond similarly after an exercise session. Purpose: To measure inter-individual variations in 24-h BP after a single bout of various exercise modalities in older adults with hypertension. Methods: This retrospective study analyzed data from participants with hypertension (≥60 years) previously included in three randomized controlled trials on this topic. BP was assessed using ambulatory BP monitoring. We compared the mean changes in total 24-h, daytime, and nighttime BP after aerobic (AE, n = 19), combined (COMB, n = 19), resistance (RES, n = 23), and isometric handgrip (ISO, n = 18) exercise sessions to a non-exercising control session (C). The minimum detectable changes to classify the participant as a "Responder" for the corresponding exercise protocol were 4 and 2 mmHg for systolic and diastolic BP, respectively. Results: The prevalence of Responders for systolic BP was as follows: AE 24-h: 37%, daytime: 47% and nighttime: 37%; COMB 24-h: 26%, daytime: 21% and nighttime: 32%; RES 24-h: 26%, daytime: 26% and nighttime: 35%; and ISO 24-h: 22%, daytime: 22% and nighttime: 39%. For diastolic BP, the prevalence of Responders was as follows: AE 24-h: 53%, daytime: 53% and nighttime: 31%; COMB 24-h: 26%, daytime: 26% and nighttime: 31%; RES 24-h: 35%, daytime: 22% and nighttime: 52%; and ISO 24-h: 44%, daytime: 33% and nighttime: 33%. Conclusion: There was a high inter-individual variation of BP after a single bout of various exercises in older adults. Responders had higher BP values on the control day without exercise. Various exercise modalities might acutely reduce 24-h BP in older adults with hypertension.

[Role of polypills in cardiovascular risk reduction in primary prevention]. / Rol de las polipíldoras en la reducción del riesgo cardiovascular en prevención primaria.

Unlike medications that contain fixed-dose combinations, such as those recommended by clinical guidelines for treating high blood pressure, the so-called polypills contain several drugs that simultaneously treat two or more cardiovascular conditions or risk factors. They were proposed 2 decades ago, both for primary and secondary prevention with the hypothesis that they could have wide dissemination and population penetration, improving the use of therapeutics with proven benefits individually, thanks to an increase in patient adherence by reducing the number of daily tablets and also by having an equal or lower cost. In this simple review, we present a look at risk stratification different from that posed by clinical scores and summarize the benefits of polypills in the treatment of risk factors and in the reduction of major cardiovascular events. Additionally, we review the clinical messages of the HOPE-3 trial, which aim to control two of the most prevalent conditions, such as high blood pressure and high cholesterol, through a combination of candesartan, hydrochlorothiazide and rosuvastatin. Finally, we propose its potential indication in a heterogeneous health system such as that of our country, both at the population level based on intermediate or low risk, determined intuitively or using a risk calculator, as well as in the personalized care that is practiced in many health scenarios.

A diferencia de los medicamentos que contienen combinaciones de dosis fijas, como los recomendados por las guías clínicas para tratar la hipertensión arterial, las llamadas polipíldoras contienen varios fármacos que tratan simultáneamente dos o más afecciones cardiovasculares o factores de riesgo. Se propusieron hace 2 décadas, tanto para prevención primaria como secundaria, con la hipótesis de que tengan amplia difusión y penetración poblacional, es decir, que mejoren el uso de terapéuticas con probados beneficios en forma individual, gracias a un incremento en la adherencia de los pacientes al reducir el número de comprimidos diarios y también al tener un costo igual o menor. En esta revisión simple, planteamos una mirada de la estratificación del riesgo distinta a la planteada por los puntajes clínicos y resumimos los beneficios de las polipíldoras en el tratamiento de los factores de riesgo y en la reducción de eventos cardiovasculares mayores. Adicionalmente, repasamos los mensajes clínicos del ensayo HOPE-3, que apuntan a controlar dos de las condiciones más prevalentes, como son la hipertensión arterial y el colesterol elevado, mediante una combinación de candesartán, hidroclorotiazida y rosuvastatina. Finalmente, proponemos su potencial indicación en un sistema sanitario heterogéneo como el de nuestro país, tanto a nivel poblacional basado en el riesgo intermedio o bajo, determinado intuitivamente o usando un calculador de riesgo, así como también en la atención personalizada que se practica en muchos escenarios sanitarios.

Rol de las polipíldoras en la reducción del riesgo cardiovascular en prevención primaria / Role of polypills in cardiovascular risk reduction in primary prevention

Resumen A diferencia de los medicamentos que contienen combinaciones de dosis fijas, como los recomendados por las guías clínicas para tratar la hipertensión arterial, las llamadas polipíldoras contienen varios fármacos que tratan simultáneamente dos o más afecciones cardiovasculares o factores de riesgo. Se propusieron hace 2 décadas, tanto para prevención primaria como secundaria, con la hipótesis de que tengan amplia difusión y penetración poblacional, es decir, que mejoren el uso de terapéuticas con probados beneficios en forma individual, gracias a un incremento en la adherencia de los pacientes al reducir el número de com primidos diarios y también al tener un costo igual o menor. En esta revisión simple, planteamos una mirada de la estratificación del riesgo distinta a la planteada por los puntajes clínicos y resumimos los beneficios de las polipíldoras en el tratamiento de los factores de riesgo y en la reducción de eventos cardiovasculares mayores. Adicionalmente, repasamos los mensajes clínicos del ensayo HOPE-3, que apuntan a controlar dos de las con diciones más prevalentes, como son la hipertensión arterial y el colesterol elevado, mediante una combinación de candesartán, hidroclorotiazida y rosuvastatina. Finalmente, proponemos su potencial indicación en un sistema sanitario heterogéneo como el de nuestro país, tanto a nivel poblacional basado en el riesgo intermedio o bajo, determinado intuitivamente o usando un calculador de riesgo, así como también en la atención personalizada que se practica en muchos escenarios sanitarios.

Abstract Unlike medications that contain fixed-dose combinations, such as those recommended by clinical guidelines for treating high blood pressure, the so-called polypills contain several drugs that simultaneously treat two or more cardiovascular conditions or risk factors. They were proposed 2 decades ago, both for primary and secondary prevention with the hypothesis that they could have wide dissemination and population penetration, improving the use of therapeutics with proven benefits individually, thanks to an increase in patient adherence by reducing the number of daily tablets and also by having an equal or lower cost. In this simple review, we present a look at risk stratification different from that posed by clinical scores and summarize the benefits of polypills in the treatment of risk factors and in the reduction of major cardiovascular events. Additionally, we review the clinical messages of the HOPE-3 trial, which aim to control two of the most prevalent conditions, such as high blood pressure and high cholesterol, through a combination of candesartan, hydrochlorothiazide and rosuvastatin. Finally, we propose its potential indication in a heterogeneous health system such as that of our country, both at the population level based on intermediate or low risk, determined intuitively or using a risk calculator, as well as in the personalized care that is practiced in many health scenarios.

Effects of aerobic, strength, and combined training during pregnancy in the blood pressure: A systematic review and meta-analysis.

Gestational hypertension can lead to fetal complications, and, if untreated, high blood pressure during pregnancy may cause eclampsia and even death in the mother and fetus. Exercise is a strategy for preventing blood pressure disorders. There is little knowledge about the physiological impacts of different physical types of training on blood pressure during pregnancy. For that, this meta-analysis aimed to compare the effects of different physical exercise modalities (i.e., aerobic training-AT, strength training-ST, and combined training-AT + ST) on systolic blood pressure (SBP) and diastolic blood pressure (DBP) of pregnant women. A search was performed on PUBMED, LILACS, CINAHL, Sport discus, EMBASE, SCOPUS, and Cochrane Central Register of Controlled Trials to identify researchers. From 3,450 studies, 20 and 19 were included in the qualitative and quantitative analyses. AT studies presented a medium effect size (ES) on SBP [-0.29 (-2.95 to 2.36) p = 0.83], with substantial heterogeneity (I2 = 64%), and had a large impact on DBP [-1.34 (-2.98 to 0.30) p = 0.11], with moderate heterogeneity (I2 = 30%). ST researchers showed a large ES on SBP [-1.09 (-3.66 to 1.49) p = 0.41], with a reduced heterogeneity (I2 = 0%), and a medium ES on DBP [-0.26 (-2.77 to 2.19) p = 0.83] with moderate heterogeneity (I2 = 38%). AT + ST studies had a large ES on SBP [-1.69 (-3.88 to 0.49) p = 0.13] and DBP [-01.29 (-2.26 to 0.31) p = 0.01] with considerable (I2 = 83%) and moderate heterogeneity (I2 = 47%), respectively. These findings are essential for developing new research protocols to avoid gestational hypertension and preeclampsia. AT + ST had a large impact on the SBP and DBP reduction; however, there is a need for more similar procedures to reduce heterogeneity between studies, promoting consensual results. Systematic Review Registration: [PROSPERO], identifier [CRD42021256509].

Insuficiencia cardíaca de novo: Un reto diagnóstico / Di novo heart failure: A diagnostic challenge

Introducción: El término insuficiencia cardíaca de novo hace referencia a pacientes sin diagnóstico previo de dicha enfermedad. La revisión de este tema deviene de un problema real, pues muchos pacientes acuden a la atención secundaria sin diagnóstico previo de insuficiencia cardíaca y además en estadios avanzados. Objetivo: Describir los elementos claves para el diagnóstico precoz de insuficiencia Cardíacas. Métodos: Se llevó a cabo una búsqueda bibliográfica en las siguientes bases de datos: Pubmed, SciELO, ESBCO, Cochrane y BVS, así como en diferentes webs médicas durante tres meses entre febrero de 2021 al 31 de mayo de 2021. Conclusiones: El diagnóstico precoz de insuficiencia cardíaca permitió disminuir el número de pacientes que llegan a la Atención Secundaria sin diagnóstico previo. Existen clasificaciones que identifican estadios tempranos de la enfermedad y la de la ACC/AHA es relevante para lograr este objetivo. En atención primaria esto es un reto si no se emplean pruebas diagnósticas como el ecocardiograma. Es importante la determinación de las concentraciones circulantes del péptido natriurético tipo B (BNP) y del fragmento N-terminal de su protohormona (N-terminal BNP). Este biomarcador debería estar accesible en las consultas ambulatorias para pacientes que presentan sospecha clínica de insuficiencia cardíaca «de novo»(AU)

Introduction: The term di novo heart failure refers to patients without a previous diagnosis of this disease. The review of this issue comes from a real problem, since a group of patients attend secondary care without a previous diagnosis of heart failure and also have in advanced stages. Objective: The objective is to provide a clue that facilitates the early diagnosis of heart failure. Methods: A bibliographic search was carried out in the following databases: Pubmed, SciELO, ESBCO, Cochrane and BVS, as well as in different medical websites for three months (February 1, 2021 to May 31, 2021). Conclusions: The early diagnosis of heart failure will allow us to reduce the number of patients who arrive at Secondary Care without a previous diagnosis. There are classifications that identify early stages of the disease, being in our opinion the ACC / AHA classification the one that should carry the most weight. In primary care this can be a challenge if diagnostic tests such as echocardiography are not used. Dosification of serum levels of type B natriuretic peptide (BNP) and the N-terminal fragment of its protohormone (N-terminal BNP) is very useful. This biomarker should be accessible in outpatient clinics for patients with clinical suspicion of di novo heart failure(AU)

Comportamiento epidemiológico de la hipertensión arterial en países en vía de desarrollo y recomendaciones de la Sociedad Internacional de Hipertensión en el año 2020 / Epidemiological behavior of hypertension in developing countries and recommendations of the International Society of Hypertension in 2020

Resumen La hipertensión arterial se considera como una de las principales causas de morbimortalidad en todo el mundo. Asimismo, su elevada prevalencia en los países en vías de desarrollo se relaciona directamente con el desconocimiento de la enfermedad, e inversamente con la prevalencia del tratamiento y el control de la hipertensión arterial. El objetivo de esta revisión es compilar la evidencia sobre los factores que influencian la prevalencia de conocimiento del diagnóstico de hipertensión arterial, el tratamiento y el control óptimo de la enfermedad dependiendo del contexto epidemiológico. Por ello, se enfatiza que gran parte del desafío en los países en vías de desarrollo consiste en evaluar la escasa evidencia epidemiológica de base poblacional para realizar recomendaciones que se adapten a los recursos disponibles en las diferentes regiones. Para este propósito se realizó una breve revisión sobre las recomendaciones de las guías de práctica clínica propuestas por la Sociedad Internacional de Hipertensión en el año 2020.

Abstract High blood pressure is one of the leading causes of morbidity and mortality worldwide. In addition, its high prevalence in developing countries is directly related to the lack of awareness of the diagnosis and conversely to the prevalence of treatment and control of high blood pressure. This literature review aims to compile evidence on the factors that influence the prevalence of knowledge of the diagnosis of high blood pressure, the treatment and optimal control of the disease depending on the epidemiological context. In this review, we emphasize that much of the challenge in developing countries is to assess the limited population-based epidemiological evidence to make recommendations that are tailored to the resources available in the different regions. For this purpose, a brief review is carried out on the recommendations of the clinical practice guides proposed by the International Hypertension Society in 2020.

Accuracy of anthropometric indicators of obesity to identify high blood pressure in adolescents-systematic review.

Background: Anthropometric indicators of obesity have been associated with blood pressure in adolescents. However, the accuracy of anthropometric indicators of obesity for screening for high blood pressure (HBP) in adolescents is not known. Thus, the aim of the present study was to summarize the set of evidence regarding the predictive ability of anthropometric indicators of obesity to identify HBP in adolescents. Methods: Searches were performed in five databases: MEDLINE, Web of Knowledge, Scopus, Scientific Electronic online (SciELO) and SportDiscus. The inclusion criteria for studies were: adolescents aged 10-19 years or mean age included in this range, observational and intervention studies, studies that proposed cutoff points for anthropometric indicators of obesity, and studies in English, Portuguese and Spanish. The methodological quality of studies was assessed using the QUADAS-2 instrument. Results: Ten studies met the inclusion criteria and had their information summarized. Based on the information described in these studies, the anthropometric indicators body mass index (BMI), waist circumference (WC), waist-to-height-ratio (WHtR), triceps skinfold thickness, body adiposity index, C index, body mass, waist-to-arm span ratio, arm fat area, average arm perimeter, fat percentage and arm span were likely to be used in high blood pressure (HBP) screening among adolescents. However, only one study showed acceptable values (moderate to high precision) in relation to the accuracy measurements of described cutoffs. Conclusion: Caution is suggested in the use of anthropometric indicators of obesity for HBP screening in adolescents, in which a greater number of studies with accurate diagnostic tools are necessary.

Manifestaciones bucales en pacientes con medicación antihipertensiva / Oral manifestations in patients with antihypertensive medication

Objetivo: caracterizar las manifestaciones bucales en pacientes con medicación anti- hipertensiva que acuden al servicio estomatológico sur del municipio Morón, Ciego de Ávila, Cuba. Métodos: se realizó un estudio observacional, descriptivo, transversal, en el período enero 2019 a enero 2020. Se trabajó con la totalidad del universo, constituido por 162 pacientes. La información se recopiló de las historias clínicas estomatológicas individuales y de una ficha de recolección de datos creada por los autores de la investigación. Se estudiaron las variables grupo de edad, sexo, grupo de medicamentos antihipertensivos, dosis del medicamento, signos y síntomas clínicos, así como enfermedades bucales. Se utilizó estadística descriptiva (frecuencias absolutas y relativas porcentuales). Resultados: el 42,6 % representó el grupo de edad 35 a 59 años y el 53,7% al sexo femenino. Se observó que 88 pacientes (54,3 %) se encontraban medicados con inhibidores de la enzima convertidora de angiotensina; de ellos, 38 en su dosis mínima. La xerostomía estuvo presente en el 59,9 % de los casos. El 63,6 % presentó caries dental como enfermedad estomatológica. Conclusiones: existió predominio de la xerostomía y la caries dental en la mayoría de los pacientes.

Objective: To characterize the oral manifestations in patients with antihypertensive medication who attend the southern dental service of the Moron municipality, Ciego de Avila, Cuba. Method: An observational, descriptive, cross-sectional study was carried out in the period from January 2019 to January 2020. We worked with the entire universe which was made up of 162 patients. The information was collected from individual dental medical records and from a data collection form created by the authors of the research. The variables age group, sex, antihypertensive drug group, dose of antihypertensive drug, clinical signs and symptoms, and oral diseases were studied. Descriptive statistics were used (absolute and relative percentage frequencies). Results: 42,6 % represented the age group 35 to 59 years and 53,7 % the female sex. It was observed that 88 (54,3 %) patients were medicated with angiotensin converting enzyme inhibitors, 38 of them at their minimum dose. Xerostomia was present in 59,9% of the cases. 63,6 % presented dental caries as a dental disease. Conclusions: There was a predominance of xerostomia and dental caries in most of the patients.

La dispensarización de pacientes hipertensos en el Policlínico Rafael Echezarreta / The classification of hypertensive patients at Rafael Echezarreta Polyclinic

Introducción: Uno de los principales problemas de salud que afectan a la población de Cuba y del mundo es la hipertensión arterial. En San José de Las Lajas aparece dispensarizada como hipertensa el 14 por ciento de su población, pero se observan múltiples deficiencias en su dispensarización. Objetivo: Determinar la situación de la dispensarización de las personas que padecen hipertensión arterial en los consultorios del médico y la enfermera de la familia del policlínico Rafael Echezarreta del municipio San José. Métodos: Se realizó una investigación descriptiva rápida de corte transversal, en enero de 2020. Se revisaron las historias clínicas individuales de una muestra de 379 pacientes hipertensos, que representaron el 11 por ciento de los 3446 hipertensos registrados en el policlínico. Resultados: Solo cerca del 20 por ciento de los hipertensos estaba dispensarizados. A excepción de los grupos de edades extremas, en el resto predominó el sexo femenino. Con el aumento de la edad aumentó la proporción de pacientes hipertensos. Ninguno de los pacientes tenía evidencia registrada en su historia clínica de haber sido atendido en los últimos cuatro meses y casi el 68 por ciento del total no había sido visto hacía más de un año. Conclusiones: La dispensarización mantiene insuficiencias que no garantizan atención médica integral a la población, no se cumple la frecuencia mínima de evaluación establecida para cada grupo dispensarial y el método clínico presenta fallas en su aplicación. Por lo que se puede afirmar que existe un número potencial de pacientes hipertensos aún sin controlar(AU)

Introduction: One of the main health problems that affect Cuban and worldwide population is high blood pressure. In San José de Las Lajas municipality, 14 percent of its population appears to be hypertensive, but there are multiple deficiencies in its classification. Objective: To determine the situation of the classification of people suffering from arterial hypertension in the Family Doctor´s Offices belonging to Rafael Echezarreta polyclinic, San José municipality. Methods: A rapid cross-sectional descriptive research was conducted in January 2020. The individual medical records (HCIs) of a sample of 379 hypertensive patients were reviewed, representing 11 percent of the 3446 hypertensive patients registered in the polyclinic. Results: Only about 20 percent of hypertensive patients were classified. With the exception of the extreme age groups, the female sex predominated in the rest. With increasing age, the proportion of hypertensive patients increased. None of the patients had evidence recorded in their medical records of having been attended in the last four months and almost 68 percent of the total had not been attended more than a year ago. Conclusions: The classification has insufficiencies that do not guarantee comprehensive medical care to the population, the minimum frequency of evaluation established for each classification group is not met and the clinical method presents failures in its application. So it can be said that there is a potential number of hypertensive patients still uncontrolled(AU)

Effects of Aerobic Training Progression on Blood Pressure in Individuals With Hypertension: A Systematic Review With Meta-Analysis and Meta-Regression.

INTRODUCTION: Aerobic training of moderate intensity is the primary modality recommended in the management of hypertension. The manipulation of training variables can be an important strategy for the continuity of health benefits; however, little is known about the effects of the progression of aerobic training variables in the adaptations of blood pressure in hypertensive adults. OBJECTIVE: To analyze, through a systematic review with meta-analysis, the effects of aerobic training with and without progression on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in hypertensive adults. METHOD: The search for the studies was carried out in the PubMed, Cochrane Central, SPORTDiscus and LILACS databases. Clinical trials that analyzed the effect of aerobic training, lasting at least six weeks, on blood pressure in hypertensive individuals comparing with a control group without intervention were selected. The selection of studies and data extraction were carried out independently by two pairs of researchers. The results are presented as mean difference and 95% confidence interval. Statistical significance was considered with p < 0.05. RESULTS: Of the 13,028 studies found, 24 were selected and included in this review, 12 with progression of training variables and 12 without progression, with a total of 1,207 participants analyzed. There was a reduction in SBP after aerobic training with progression (-10.67 mmHg; 95% CI -15.421, -5.926; p < 0.001) and without progression (-10.17 mmHg; CI -12.213, -8.120; p < 0.001). DBP also decreased after aerobic training with progression (-5.49 mmHg; 95% CI -8.663, -2.310; p < 0.001) and without progression (-6.51 mmHg; 95% CI -9.147, -3.868; p < 0.001). According to the results of the meta-regression analyses, only age showed an association with the reduction of SBP (ß: -0.323; CI -0.339, -0.307; p < 0.001). CONCLUSION: Aerobic training promotes a reduction in the SBP and DBP levels of adults with hypertension, regardless of whether or not the training variables progression.

Handgrip Strength-Related Factors in a Colombian Hypertensive Population: A Cross-Sectional Study.

(1) Background: This study determined the factors associated with manual grip strength in people with high blood pressure (HBP); (2) Methods: 219 subjects participated in this cross-sectional study, which evaluated muscle strength (manual dynamometer), sociodemographic factors, clinical characteristics, level of physical activity (International Physical Activity Questionnaire-IPAQ score), and depression (Zung's Depression Self-Rating Scale); (3) Results: The bivariate analysis found that handgrip strength in people with HPB was associated with sex (p = 0.000), age (p = 0.000), ethnicity (p = 0.019), smoking habits (p = 0.037), alcohol consumption (p = 0.004), diastolic blood pressure (p = 0.012), weight (p = 0.000), height (p = 0.000), measurement of waist circumference (p = 0.002), depression (p = 0.041), and IPAQ score (p = 0.000). Regardless of being male or female, handgrip strength was associated with age (p = 0.009), IPAQ (p = 0.000), weight (p = 0.038), height (p = 0.000), DPB units (p = 0.043), and depression (p = 0.020). The multivariate generalized linear gamma regression model showed that the coefficient with the greatest weight, regardless of sex, was age (p = 0.043), level of physical activity (24% more at high level than at low level, p = 0.031), and depression (moderate/severe depression level) associated with lower handgrip strength (p = 0.025); (4) Conclusions: Handgrip strength showed an association with level of physical activity, age, and level of depression in a middle-aged population with HBP.