RESUMO
Introduction: Hypertension and kidney function are closely related. However, there are few studies on renal function during acute elevation of blood pressure (BP), denominated hypertensive crisis (HC). Objectives: To evaluate the relationship between renal function and inflammatory cytokines in HC, subdivided into hypertensive urgency (HUrg) and emergency (HEmerg). Materials and methods: This cross-sectional study was carried out in 74 normotensive (NT) and 74 controlled hypertensive individuals (ContrHT) followed up in outpatient care. Additionally, 78 subjects with hypertensive emergency (HEmerg) and 50 in hypertensive urgency (HUrg), attended in emergency room, were also evaluated. Hypertensive crisis was classified into HEmerg, defined by systolic blood pressure (BP) ≥ 180 mmHg and/or diastolic BP ≥ 120 mmHg in presence of target-organ damage (TOD), and HypUrg, clinical situation with BP elevation without TOD. The glomerular filtration rate (eGFR) was estimated, and cytokine levels were measured. Statistical analysis was performed using the Kruskal-Wallis or Mann-Whitney test and Spearman's correlation, with significant differences p-value < 0.05. Results: The median age was 53.5 years in the NT group (52 female), 61 years in the ContrHT group (52 female), and 62.5 years in the HC group (63 female) (p-value < 0.0001). The median BP was 118.5/75 mmHg for NT, 113.5/71 for ContrHT, and 198.5/120 mmHg for HC, respectively (p-value < 0.0001 among groups). BP and heart rate levels were significantly higher in the HC group compared to the NT and ContrHT groups (P < 0.001 for all). The eGFR was significantly lower in HC group compared to the NT and ContrHT groups. The cytokine levels were higher in the HEmerg and HUrg groups compared to ContrHT group (P < 0.0001, except for IL-1ß in HUrg vs. ContrHT), without difference between the acute elevation of BP groups. Thus, all cytokines were significantly elevated in patients with HC compared to the control groups (NT and ContrHT). There was a negative correlation between eGFR and the cytokines (IL-1ß, IL-6, IL-8, IL-10, and TNF-α) in the HC group. Conclusion: Elevated inflammatory cytokines are associated with reduced eGFR in individuals with HC compared to control groups, suggesting that the inflammatory process participates in the pathogenesis of acute elevations of BP.
RESUMO
Objetivo: provocar reflexões teóricas acerca da segurança do paciente no contexto das instituições de saúde. Método: estudo descritivo, a partir de revisão narrativa da literatura, possibilitando a abordagem reflexiva ampliada e contextualizada. Após análise e reflexões apresentam-se os resultados em quatro eixos temáticos. Resultados: foram identificados quatros eixos analíticos fundamentais: << Eixo I: Segurança do paciente x práticas de higiene e limpeza do ambiente hospitalar >>, << Eixo II: Segurança do paciente x Higienização das mãos >>, << Eixo III: Segurança do paciente x risco nutricional >>, << Eixo IV: Segurança do paciente x gerenciamento de risco >>. Conclusão: conclui-se que os riscos sempre existem e que em grande parte poderiam ser evitados por meio da adesão dos profissionais da saúde às medidas de prevenção e controle, garantindo assim a segurança do paciente.(AU)
Objective: to incite theoretical reflections on patient safety in the context of health services. Method: this descriptive, narrative literature review enabled a comprehensive and contextualized reflective approach to the research topic. The results of the analysis and reflections are presented in four thematic axes. Results: we identified four key analytical axes: << Axis I: Patient Safety x hygiene practices and the cleanliness of the hospital environment >>, << Axis II: Patient Safety x hand hygiene >>, << Axis III: Patient Safety x nutritional risk >>, and << Axis IV: Patient Safety x >> risk management. Conclusion: we conclude that risks always exist, but could be largely avoided if health professionals adhered to prevention and control strategies, thus ensuring patient safety.(AU)
Objetivo: provocar reflexiones teóricas sobre la seguridad del paciente en el contexto de las instituciones de salud. Métodos: este estudio descriptivo, a partir de una revisión narrativa de la literatura, posibilitó un análisis reflexivo amplio y contextualizado sobre el tema. Los resultados del análisis y de las reflexiones se presentan en cuatro ejes temáticos. Resultados: se identificaron cuatro ejes analíticos fundamentales: << Eje I: Seguridad del paciente x prácticas de higiene y limpieza del ambiente hospitalario >>, << Eje II: Seguridad del paciente x lavado de manos >>, << Eje III: Seguridad del paciente x riesgo nutricional >>, << Eje IV: Seguridad del paciente x gestión de riesgos >>. Conclusión: se concluye que los riesgos siempre existen, y que en gran medida podrían evitarse a través de la adherencia de los profesionales sanitarios a las estrategias de prevención y control, garantizando así la seguridad del paciente.(AU)
