Controle da pressão central em paciente obeso, após infarto do miocárdio / Control of central pressure in an obese patient, post myocardial infarction

Pacientes hipertensos com evento cardiovascular agudo requerem intervenção adequada com alcance precoce de metas pressóricas pré-definidas, para redução de risco absoluto e residual de desfechos fatais e não fatais. O presente caso clínico trata-se de um paciente obeso, hipertenso que apresentou infarto agudo do miocárdio submetido a cateterismo e angioplastia com sucesso primário. Após alta da Unidade Coronariana, na enfermaria evoluiu com elevação dos valores pressóricos. Foram realizados teste de bioimpedância (para verificar volumetria) e avaliação da pressão central por tonometria de aplanação da artéria radial com Sphygmocor. A conduta a seguir foi orientada pelos resultados dos paramentos hemodinâmicos e realizada a escolha da medicação ideal para o tratamento

Hypertensive patients with an acute cardiovascular event require adequate intervention with early reach of pre-defined blood pressure goals to reduce absolute and residual risk of fatal and nonfatal outcomes. The present case is a hypertensive patient who presented acute myocardial infarction undergoing catheterization and angioplasty with primary success. After discharge from the Coronary Unit, the ward evolved with elevation of blood pressure values. Bioimpedance test (to verify volumetry) and evaluation of the central pressure by tonometry of radial artery aplanation with Sphygmocor were performed. The following conduct was guided by the results of the hemodynamic parameters and the choice of the ideal medication for the treatment was made.

Carotid intima-media thickness is associated with cognitive deficiency in hypertensive patients with elevated central systolic blood pressure.

BACKGROUND: The role of hypertension in the loss of cognitive function is controversial. Relationships between hypertension and increases in cerebral vascular resistance, diffused lesions and multiple lacunar infarcts of the white matter are well known. Thus, the objectives of this study were: to evaluate the relationship between hypertension and cognitive dysfunction (CD), identify risk factors and determine the association between early markers of vascular disease and CD in hypertensive individuals. METHODS: Two hundred individuals aged between 40 and 80 years old were evaluated in this cross-sectional prospective study. Fifty participants were controls (CT). The remaining 150 hypertensive patients were subdivided into two groups, those with CD (HCD) and those without CD (HNCD). All participants underwent clinical evaluations and biochemical blood tests were performed. CD was investigated using the Mini Mental State Examination (MMSE) following the guidelines for its use in Brazil. The impact of hypertension on the arterial bed was assessed by identifying and measuring changes in the intima-media thickness (IMT) by vascular ultrasonography of the carotid arteries and analyses of the central blood pressure and Augmentation Index by applanation tonometry of the radial artery. RESULTS: There were no significant differences in the total cholesterol, high-density lipoprotein cholesterol and triglycerides plasma concentrations between the three groups. The serum creatinine and estimated glomerular filtration rate were within normal ranges for all three groups. A significantly lower MMSE score was recorded for the HCD Group compared to the HNCD and CT Groups (p-value < 0.05).The IMT was significantly different between the HNCD and HCD Groups (p-value = 0.0124). A significant difference in the IMT was also observed between hypertensive patients and the CT Group (p-value < 0.0001). Age, low-density cholesterol, high-density cholesterol, triglycerides and IMT increased the Odds Ratio for cognitive dysfunction.The central systolic pressure was significantly higher in the HCD and HNCD Groups compared to CT Group (p-value < 0.0001). CONCLUSIONS: Hypertensive patients with CD have changes in the vascular morphology characterized by an increased carotid IMT, enhanced atherosclerotic lipid profile and impaired hemodynamic functional manifested by elevated central systolic blood pressure.