Most advisable strategy in search of asymptomatic target organ damage in hypertensive patients.

OBJECTIVE: To evaluate the diagnostic potential of seven examinations in order to define the most suitable strategy for target organ damage (TOD) search in hypertensive patients. METHODS: This is a descriptive, cross-sectional study. 153 consecutive treated and essential hypertensive patients were enrolled. Patients with established cardiovascular or chronic renal disease (stage ≥4) were excluded. TOD search was assessed by: glomerular filtration rate (GFR), albumin/creatinine ratio (ACR), electrocardiogram (ECG), echocardiogram (ECO), ankle-brachial index (ABI), pulse wave velocity (PWV), and carotid ultrasound (intima media thickness and presence of plaques). The rationale of our strategy ought to determine the performance of applying a set of the most widely available tests (GFR, ACR, ABI, ECG) and advise about the optimal sequence of the remaining tests. RESULTS: The sample was 64.4±7.9 years old, 45.8% males. 82.6% of the sample had any TOD at all. The resulting algorithm found a 37% TOD in relation to GFR, ACR, ABI and ECG values. Adding carotid ultrasound added up to 70% of the studied population and properly classified (TOD+/TOD-) 89% of the cohort. When performing PWV, 78% of the patients had been identified as TOD+ and 96% of the population was correctly identified. Contribution of ECO was minor. CONCLUSION: After running the more widely available explorations (GFR, ACR, ABI, ECG), a step-by-step strategy that included carotid ultrasound, PWV and ECO could be the best sequence for TOD search in asymptomatic hypertensive patients.

Incidencia del virus C de la hepatitis en pacientes en hemodiálisis / Incidence of hepatitis C virus in hemodyalisis patients

Se realizó un estudio descriptivo y transversal de 107 pacientes con insuficiencia renal crónica terminal, tratados periódicamente con hemodiálisis en el Servicio de Hemodiálisis del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, de enero a junio del 2012, quienes habían recibido al menos 3 transfusiones sanguíneas y además presentaban el virus de la hepatitis C -- confirmado por el método inmunoenzimático de ELISA --, a fin de caracterizarles y determinar en ellos la morbilidad de dicho virus. En la investigación se obtuvo una preponderancia del sexo masculino (53,0 %), el grupo etario de 45-54 años (30,0 %) y la nefropatía hipertensiva como causa de insuficiencia renal crónica (50,5 %); además, se realizaron menos de 3 transfusiones en 48 pacientes (51,0 %). El virus de la hepatitis C mantenía una alta morbilidad en los pacientes con insuficiencia renal crónica terminal que recibieron tratamiento hemodialítico en este Servicio de Hemodiálisis.

A descriptive and cross-sectional study was carried out in 107 patients with end-stage chronic renal failure, treated with periodic hemodyalisis at the Hemodyalisis Service of "Dr. Juan Bruno Zayas Alfonso" General Teaching Hospital of Santiago de Cuba, from January to June 2012, who received at least three blood transfusions and also had the hepatitis C virus -- confirmed by ELISA immunoassay method--, in order to characterize them and to determine the virus morbidity in them. There was a predominance of males (53.0%), the age group of 45-54 years (30.0%) and hipertensive nephropathy as a cause of chronic renal failure (50.5%) in the study; also, less than three transfusions were made in 48 patients (51.0%). The hepatitis C virus remained a high morbidity in patients with end-stage chronic renal failure who received hemodyalisis in this Hemodyalisis Service.

Incidencia del virus C de la hepatitis en pacientes en hemodiálisis / Incidence of hepatitis C virus in hemodyalisis patients

Se realizó un estudio descriptivo y transversal de 107 pacientes con insuficiencia renal crónica terminal, tratados periódicamente con hemodiálisis en el Servicio de Hemodiálisis del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, de enero a junio del 2012, quienes habían recibido al menos 3 transfusiones sanguíneas y además presentaban el virus de la hepatitis C -- confirmado por el método inmunoenzimático de ELISA --, a fin de caracterizarles y determinar en ellos la morbilidad de dicho virus. En la investigación se obtuvo una preponderancia del sexo masculino (53,0 por ciento), el grupo etario de 45-54 años (30,0 por ciento) y la nefropatía hipertensiva como causa de insuficiencia renal crónica (50,5 por ciento); además, se realizaron menos de 3 transfusiones en 48 pacientes (51,0 por ciento). El virus de la hepatitis C mantenía una alta morbilidad en los pacientes con insuficiencia renal crónica terminal que recibieron tratamiento hemodialítico en este Servicio de Hemodiálisis(AU)

A descriptive and cross-sectional study was carried out in 107 patients with end-stage chronic renal failure, treated with periodic hemodyalisis at the Hemodyalisis Service of Dr Juan Bruno Zayas Alfonso General Teaching Hospital of Santiago de Cuba, from January to June 2012, who received at least three blood transfusions and also had the hepatitis C virus -- confirmed by ELISA immunoassay method--, in order to characterize them and to determine the virus morbidity in them. There was a predominance of males (53.0 percent), the age group of 45-54 years (30.0 percent) and hipertensive nephropathy as a cause of chronic renal failure (50.5 percent ) in the study; also, less than three transfusions were made in 48 patients (51.0 percent). The hepatitis C virus remained a high morbidity in patients with end-stage chronic renal failure who received hemodyalisis in this Hemodyalisis Service.

Implantação de um plano de intervenção para monitoramento da pressão arterial de pacientes hipertensos

A hipertensão arterial sistêmica é encontrada em grande parte da população e apenas uma pequena parcela realiza um controle normal ou ótimo da pressão arterial. Diante deste fato a população fica exposta às consequências dramáticas como infarto agudo do miocárdio, acidente vascular encefálico levando a um aumento do índice de pacientes renais crônicos, repercutindo na alta morbimortalidade que tais afecções provocam e seus gastos dispendiosos. O presente estudo objetivou elaborar um plano de intervenção, centralizado nos preceitos de promoção da saúde que tem o intuito de monitorar a pressão arterial dos idosos hipertensos pertencentes à área de abrangência da Estratégia Saúde da Família Dr. José Vale Filho. Para fundamentar o plano, fez-se pesquisa bibliográfica na Biblioteca Virtual em Saúde com os descritores: nefropatia hipertensiva, prevenção e Atenção Primária à Saúde além de documentos do Ministério da Saúde. O plano se baseou no Planejamento Estratégico Situacional (PES) de Carlos Matus. Acreditando no potencial da Estratégia de Saúde da Família espera-se com este Plano de Intervenção implantar uma nova forma de funcionamento dos grupos de hipertensos realizados atualmente para os usuários idosos portadores de hipertensão arterial sistêmica. Acredita-se que as atividades realizadas propiciarão uma nova concepção pedagógica para os profissionais da equipe e a comunidade, fortalecendo as ações de saúde