Mission 70/26 Project: improving blood pressure control in Portugal.

PURPOSE: As reported in most European countries, the percentage of treated hypertensive patients achieving a well-controlled blood pressure (e.g. < 140/90 mmHg) is insufficient. This represents a major health concern particularly in countries with a high prevalence of cardiovascular events such as stroke. Therefore, there is a need to develop national programs to increase not only the awareness regarding elevated blood pressure but also the percentage of treated patients achieving recommended blood pressure targets. The present paper describes the new initiative of the Portuguese Society of Hypertension (PSH) to achieveat least 70% of controlled hypertensive patients, followed in primary care, in 2026. MATERIALS AND METHODS: The strategies used to improve blood pressure control are aimed at healthcare professionals and general population and include governmental and organizational interventions. To be able to analyze the control rate of HTN patients, and using BI-CSP reports (the Primary Care health unit platform), every six months, we will be addressing the proportion of HTN patients (age: 18-65 years) with BP < 140/90 mmHg and the proportion of HTN patients with at least one blood pressure recorded in the last semester. CONCLUSION: With Mission 70/26, the PHS aims to improve awareness among all health professionals and community alike about the problem of uncontrolled HTN and its role in the consequent disability and high mortality rate from cardiovascular causes.

Hypertension is the most prevalent cardiovascular risk factor worldwide, affecting 42,6% of adult portuguese population.Only 52,8% of hypertensive patients followed in primary public care had their HTN controlled.Mission 70/26 project was designed by the Portuguese Society of Hypertension with the purpose of achieving 70% control of hypertensive patients under Primary Healthcare by 2026.The strategies used to improve blood pressure control are aimed at healthcare professionals and general population and include governmental and organizational interventions.

[NT-proBNP for risk stratification of pulmonary embolism]. / NT-proBNP na estratificação de risco no tromboembolismo pulmonar.

INTRODUCTION: Pulmonary embolism (PE) is an entity with high mortality and morbidity, in which risk stratification for adverse events is essential. N-terminal brain natriuretic peptide (NT-proBNP), a right ventricular dysfunction marker, may be useful in assessing the short-term prognosis of patients with PE. AIMS: To characterize a sample of patients hospitalized with PE according to NT-proBNP level at hospital admission and to assess the impact of this biomarker on short-term evolution. METHODS: We performed a retrospective analysis of consecutive patients admitted with PE over a period of 3.5 years. Based on the median NT-proBNP at hospital admission, patients were divided into two groups (Group 1: NT-proBNP

Pseudonormalization of transmitral pulsed doppler flow: A/e' ratio during the valsalva maneuver--a new discriminative index.

UNLABELLED: The Valsalva maneuver (VM) has frequently been suggested as a useful method in evaluation of left ventricular (LV) grade II diastolic dysfunction (DDII) through inversion of a pseudonormalized ratio between diastolic transmitral early (E) and late atrial (A) waves assessed by pulsed Doppler. The purpose of our study was to determine the sensitivity and specificity of E/A inversion during VM in LV DDII patients and its correlation with mitral annulus motion evaluated by tissue Doppler imaging (TDI). Using the echocardiographic criteria of the European Society of Cardiology for the diagnosis of diastolic dysfunction, we studied a group of 44 patients, 27 male, aged 59 +/- 14 years, with DDII (DDII-group) and compared them with a control group (N group) composed of 33 healthy individuals, 17 male, aged 36 +/- 9 years. Using transmitral pulsed Doppler analysis, we quantified the peak diastolic velocities of transmitral flow (E and A waves in cm/sec), pulmonary venous systodiastolic flow (PVF: S35 cm/sec) and the first aliasing LV diastolic flow propagation velocity by color M-mode Doppler (PVF <45 cm/sec for LV DDII). Using TDI we measured the peak systolic (s'), and diastolic rapid filling (e') and atrial (a') velocities (Vm in cm/sec) at four points of the mitral annulus: adjacent to the interventricular septum (P4), and the lateral (P2), inferior (P3) and anterior (P4) LV walls. VM was performed by all patients, with repeated measurements of the above parameters (except for PVF) at the point of their maximum shift. RESULTS: Four patients in the DDII-group were excluded due to degradation of the acoustic window during VM. The sensitivity and specificity of E/A inversion during VM in diagnosing LV DDII were respectively 88% and 57%. On ROC curve analysis, the most discriminative index for DDII diagnosis A/e' > 4.06 in P2 during VM (area under ROC curve [AUROC] = 0.883 [0, 78, 0, 94]). There was a significant increase in AUROC (0.74 vs. 0.88, p = 0.006) during VM. For A/e' > 4.06, the sensitivity and specificity for DDII diagnosis were respectively 62% and 78% pre-VM and 85% and 78% during VM. CONCLUSIONS: Inversion of a pseudonormalized pulsed Doppler E/A ratio during VM has high sensitivity, but its low specificity makes it of little clinical use. An A/e' ratio > 4.1 during VM is a new, highly discriminative index that can be used in practice to diagnose LV grade II diastolic dysfunction in the presence of a pseudonormalized pulsed Doppler E/A ratio.