Diagnosis Of Systemic Arterial Hypertension Research Articles

Prevalence of concomitant hypertension and diabetes among adults and elderly living in rural riverside areas in the Amazon.

Considering the scarcity of information on the assessment of chronic diseases in traditional Amazonian populations, as well as public health policies focused on their specificities, this study aimed to estimate the prevalence of at least one of the chronic diseases (systemic arterial hypertension (SAH) or diabetes mellitus (DM)) and their concomitant occurrence in a rural riverside population of the Amazon, and determine the associated factors. A household-based cross-sectional survey was conducted with a sample of adults and elderly people living in rural riverside locations along the left bank of the Negro River, in the municipality of Manaus, Amazonas, Brazil. The outcomes evaluated were the presence of at least one of the evaluated chronic diseases and the concomitant occurrence, based on the self-reported medical diagnosis of SAH and DM. Analysis of associated factors (sociodemographic, behavioral, and access to health services variables) was performed by Poisson regression with robust variance. The sample consisted of 495 individuals (young adults (n=257; 51.9%), middle-aged (n=132; 26.7%), and elderly (n=106; 21.4%)), of whom 51.5% were women (n=255), mean age 43.3±17.1 years. The monthly household income was on average R$1100±902 (A$345±283). The diagnosis of any chronic disease was reported by 18.8% of the sample, with a preponderance of SAH (17.4%). The occurrence of at least one of the chronic diseases was associated with higher average age and worse health self-assessment. Regarding concomitant occurrence of SAH and DM, prevalent in 4.4% of the sample, the same associations were observed. The data for the occurrence of chronic diseases in the studied Amazon rural riverside populations are worrying, because these people live in areas of socioeconomic vulnerability, with a lack of basic sanitation infrastructure, difficult geographic access, and limited access to health care. Health policies fail to recognize the specificities of these populations, which implies deficiencies in the provision of necessary regular care. The findings also reinforce the need to strengthen health promotion and chronic disease prevention strategies in the context of primary care.

Frequency of Dyslipidemias and Cardiovascular Risk Determination in Patients with Systemic Arterial Hypertension

Objective: to determine the frequency of dyslipidemia and cardiovascular risk (CVR) in patients with systemic arterial hypertension (SAH) in a family medicine unit. Methods: analytical cross-sectional study conducted at the Family Medicine Unit No. 26 of the Mexican Institute of Social Security (IMSS) in Acapulco, Mexico, which included 150 patients with a confirmed diagnosis of systemic arterial hypertension in the electronic clinical record, obtained by non-probabilistic sampling by convenience, from November 2020 to May 2021. It was applied a questionnaire to obtain sociodemographic information, somatometry, laboratory tests, and the cardiovascular risk was assessed with the Globorisk estimation table. Descriptive statistics, bivariate and multivariate analysis were performed with the obtained data. Results: the frequency of dyslipidemia was 56.7% (n= 85), with a greater distribution in women 67% (n= 57), female to male ratio 2:1, 22.7% (n= 34) had mixed hyperlipidemia. 48% (72/150) presented moderate cardiovascular risk. Being a man and having a glomerular filtration rate <60 ml/min/1.27m2sc increased the possibility of presenting high cardiovascular risk. Conclusion: moderate cardiovascular risk was observed in almost half of the patients. Being male and having a gfr <60 ml/min/1.27m2sc increased the risk of presenting high cvr.

Triple retinal arterial macroaneurysms in a hypertensive patient with hypothyroidism

PurposeTo present the unique case of numerous, recurring retinal arterial macroaneurysms (RAMs) in a hypothyroid patient with hypertension.Methods67-year-old woman’s clinical findings, laboratory results, fundus fluorescein angiography, optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) are given. Over a two-year period, the patient was monitored.ResultsA 67-year-old woman presented to the outpatient clinic with vitreous and dense subretinal hemorrhages in her right eye. RAM rupture was discovered along the suprotemporal retinal arteriole. A diagnosis of systemic arterial hypertension was made. Two months later, the vitreous hemorrhage spontaneously resolved and the patient’s vision improved. After nine months of initial presentation, the patient developed another RAM. Meanwhile the patient developed ichthyosis caused by hypothyroidism. Because fundus fluorescein angiography revealed that the first RAM was still active, an intravitreal injection of anti-VEGF was administered six months afterwards. More proximal RAM with macular edema developed after another six months necessitating laser photocoagulation. However macular edema didn’t resolve and a second injection of intravitreal anti-VEGF was given.ConclusionsPatients with RAMs, particularly if multiple or recurring, should be thoroughly investigated and assessed, particularly for secondary causes of hypertension. OCT and OCTA are useful tools for RAM confirmation and follow-up. It is important to look into how RAM behavior interacts with coexisting macular edema, and other variables affecting hemodynamic status.

HOME BLOOD PRESSURE MONITORING (HBPM) IN CLINICAL PRACTICE: A SYSTEMATIC REVIEW AND EXPERIENCE REPORT OF ONLINE TOLL FOR RESULTS REPORT IN BRAZIL

Objective: Perform a systematic review of systemic arterial hypertension (SAH) diagnosis and follow-up using home blood pressure monitoring (HBPM) and report the experience of using an online tool (TeleMRPAÔ) for results report in Brazil. Design and method: The MedlineÔ, EmbaseÔ, and Cochrane LibraryÔ databases were searched for randomized studies on the effectiveness of the monitoring and diagnosis of SAH with HBPM from 2014 to 2018. The keywords used were hypertension, blood pressure, home blood pressure monitoring. A full review of 132 articles was performed and 36 studies were considered potentially eligible. Out of the 36 potentially eligible studies, 25 studies were published from 2014 to 2018, conducted in North America and Europe and included a wide variety of hypertension assessment methods. Only 10 studies aimed to analyze HBPM as a tool for the diagnosis and / or follow-up of SAH. TeleMRPAâ is an online tool (www.telemrpa.com) developed in Brazil to facilitate HBPM results reporting by cardiologists. Through this tool, it is possible to standardize the report and, from the data entered online, it is possible to generate a final report that gives greater feasibility, reproducibility of the method, minimizing errors. Results: The regular use of HBPM decreases the rates of cardiovascular events and SAH related mortality, as well as lower health care costs when compared to the monitoring of SAH only with office measurements. There was a consonance of the studies indicating a low sensitivity of the blood pressure measurement in the office to detect the optimal control of SAH when compared to the addition of HBPM. Thus, TeleMRPAâ made it possible for HBPM to be extended to more cardiologists and their patients. Conclusions: The use of HBPM showed to be effective. The HBPM should be included in the diagnosis and follow-up of SAH more routinely. Still, HBPM encourages the increase of patient participation in their self-care, as it reinforces patient-centered care, improving SAH control. In addition, in Brazil, the TeleMRPAâ has made SAH monitoring more comprehensive.

Necessidades de cuidado de mulheres no climatério com hipertensão: possibilidades de trabalho do enfermeiro

Objetivo: compreender as necessidades de cuidado de mulheres no climatério com Hipertensão Arterial Sistêmica (HAS). Método: pesquisa qualitativa desenvolvida em 21 Unidades de Saúde da Família (USFs), durante abril e junho de 2019. Participaram 15 mulheres com idade entre 40 e 69 anos; com diagnóstico referido de HAS, adstritas às USFs e que referiram não usar anticoncepcionais hormonais. Utilizou-se entrevista semiestruturada, seguida pela construção e devolução de narrativas, com análise participativa. Resultados: as necessidades de cuidado incluíam manejo dos sinais e sintomas; acompanhamento dos níveis pressóricos, efetividade e adesão ao tratamento; orientação sobre escolhas alimentares; busca por informações confiáveis e escuta ativa. A percepção acerca do trabalho do enfermeiro remeteu ao atendimento individual e pontual. Conclusão: o climatério é vivenciado de forma distinta e as necessidades das mulheres demonstram diferentes possibilidades de aprimoramento do cuidado. Essa identificação permite que o enfermeiro desenvolva atenção individualizada e adaptada às demandas das mulheres.

CAMINHOS PARA O ENVELHECIMENTO SAUDÁVEL: RELAÇÃO ENTRE HIPERTENSÃO ARTERIAL SISTÊMICA E PRINCIPAIS FATORES DE RISCOS MODIFICÁVEIS

Introdução: O Brasil vive um processo de envelhecimento e dentre as doenças mais comuns aos idosos, estão aquelas crônicas não transmissíveis, que apresentam desenvolvimento lento e efeitos deletérios a longo prazo, entre elas, a hipertensão arterial sistêmica, que apresenta como peculiaridade seu caráter multifatorial. Objetivo: Avaliar a relação entre a hipertensão arterial sistêmica e seus principais fatores de riscos modificáveis. Metodologia: Trata-se de estudo transversal de amostragem não probabilística, o levantamento ocorreu junto aos idosos do Programa Terceira Idade em Ação da Universidade Federal do Piauí, no período de agosto a dezembro de 2015. Participaram da coleta, idosos, independente do sexo, devidamente matriculados no programa em questão. Foram excluídos aqueles que apresentavam déficit cognitivo. Cada participante foi avaliado através de um formulário socioeconômico e físico; e avaliação física da circunferência da cintura. Os dados foram analisados por meio do software Statistical Product and Service Solutions versão 20.0. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal do Piauí. Resultados: Participaram do estudo 99 idosos, sendo 87,9% do sexo feminino. A maior prevalência de sexo feminino pode estar relacionada ao processo de feminização da velhice, que é caracterizado pela maior expectativa de vida das mulheres. Quanto à atividade física, apenas 15,2% dos idosos foram considerados praticantes de atividade física regular, sendo que o sedentarismo é um importante fator de risco para doenças crônicas não transmissíveis. Ao avaliar a situação de saúde observou-se que 50,5% dos pesquisados apresentavam hipertensão arterial sistêmica e correlação significativa com valores elevados de circunferência da cintura (p=0,03). Conclusões: Os hábitos de vida e situação de saúde apontaram que reduzido número de idosos encontram-se ativos; e a relação significativa entre a circunferência da cintura e o diagnóstico de hipertensão arterial sistêmica evidenciam a importância de atuar sobre as diversas variáveis que compõem a saúde.

Physical fitness of elderly persons with systemic arterial hypertension users of academies of the third age of Maringá-pr

This study investigated the physical fitness of elderly hypertensive users of the fitness zones of the city of Maringá-PR. The subjects were 79 male and female elderly users of 13 fitness zones located in the city of Maringá-PR, with a diagnosis of Systemic Arterial Hypertension (SAH). A semistructured questionnaire was used to identify the sociodemographic and health profile. Resting blood pressure and Body Mass Index (BMI) were measured. The arm flexion and the chair lift and sit tests were used to assess muscle strength and International Physical Activity Questionnaire (IPAQ) was used to identify the physical activity level. The results showed active / very active elderly, with controlled blood pressure, low sedentary behavior index and high limb strength, but with BMI representing overweight and low limb strength. Men presented higher body mass values ​​(p = 0.020); however, other factors related to physical fitness did not show a statistically significant difference between male and female elders. It was concluded that male and female elderly with a diagnosis of SAH, users of fitness zones presented excellent levels of physical activity, associated with good health behaviors, low sedentary behavior and controlled blood pressure.

Avaliação do cuidado às condições crônicas de saúde: a perspectiva do usuário

As Doenças Crônicas Não Transmissíveis representam as principais causas de mortalidade no mundo e são responsáveis por elevadas taxas de morbidade e diminuição na qualidade de vida. Tais condições apresentam como principais fatores de risco aqueles considerados modificáveis. Desse modo, é necessário que os profissionais de saúde desenvolvam ações intersetoriais e interdisciplinares, com o intuito de reverter o impacto dessas patologias. Dentre essas doenças, a Hipertensão Arterial Sistêmica (HAS) e a Diabetes Mellitus (DM) merecem destaque. Este artigo tem como objetivo a caracterização do perfil sociodemográfico e a avaliação do cuidado de usuários com diagnóstico de HAS e/ou DM residentes em três municípios da região central do Rio Grande do Sul. Trata-se de um estudo descritivo e exploratório, de natureza quantitativa, elaborado no interior da segunda edição do Programa de Educação pelo Trabalho para a Saúde - PET SAÚDE (2012 a 2014). Para a coleta de dados, utilizou-se a Avaliação do usuário sobre o Cuidado às Condições Crônicas e os preceitos da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). A amostra contou com 898 participantes residentes de três municípios pertencentes a 4ª Coordenadoria Regional de Saúde-RS. Observou-se a predominância de pessoas do sexo feminino, com ensino fundamental incompleto e casadas. Muitos usuários avaliaram o cuidado ofertado pelos serviços de Atenção Básica, como regular. Portanto, torna-se relevante modificar a forma do cuidar em saúde; uma possibilidade é envolver os usuários em seu processo de cuidado, garantindo uma co-responsabilização e maior resolutividade das demandas.

AORTIC PULSE WAVE VELOCITY AS A POTENTIALLY USEFUL DIAGNOSTIC TOOL FOR SUSPECTED NEW HYPERTENSION IN ADULTS – PRELIMINARY RESULTS

Objective: Aortic pulse wave velocity (PWV) is a well-established marker of arterial stiffness (AS) and is an independent predictor of cardiovascular risk. However, to which extent this hemodynamic parameter could be used for the diagnosis of systemic arterial hypertension (AH) has not been consistently addressed, and this was the objective of our study. Design and method: A cross-sectional study including 54 consecutive apparently healthy adults, with elevated office blood pressure (BP) (new AH), free of any chronic medication or relevant clinical condition. Carotid-femoral PWV was measured to all participants with the Complior SP device, complying with the methodological recommendations, and 24 h ambulatory blood pressure monitoring (ABPM) was used to confirm the presence of AH. All participants were evaluated by the same experienced clinician. Results: The 54 participants had a mean age of 46 ± 11 years, was predominantly male (n = 48; 89%), with a mean body mass index of 27 ± 4 Kg/m2, mean office BP was 163 ± 13 mmHg for systolic BP and 95 ± 9 mmHg for diastolic BP, and mean heart rate of 75 ± 12 bpm. Mean total cholesterol was 184 ± 35 mg/dL, HDL-cholesterol was 53 ± 11 mg/dL and glycaemia was 86 ± 11 mg/dL. PWV was significantly correlated with age, BP and potassium levels. Abnormal ABPM was identified in 44 participants (86%). The predictive capacity of PWV for the diagnosis of new HT was checked in a ROC-curve analysis (figure), from which an AUC of 0.76 (IC: 0.61–0.92; p = .02) was observed. A cut-off of 9.5 m/s had a sensibility of 94%, with a positive predictive value of 90% for an abnormal ABPM and confirmation of HT.Conclusions: This study provides promising preliminary results on the potential use of PWV for clinical decision-making concerning the diagnosis of new AH in adults, with PWV expressing predominant hemodynamic changes that are predictive for the presence of HT in adults with a first abnormal office BP measurement.

Polyneuropathy in Severely Obese Women Without Diabetes: Prevalence and Associated Factors.

Obesity and its complications are prevalent in women and increase with age. Polyneuropathy (PNP) is a complication of obesity and bariatric surgery (BS). In subjects with severe (grades II and III) obesity and without DM who are candidates for BS, the prevalence of PNP and associated conditions are not well characterized. The aim of this study was to evaluate the prevalence of PNP in severely obese (SO) women without DM or common nutritional deficiencies in order to determine factors associated with the presence of PNP. A cross-sectional study was performed on 450 SO women. They were evaluated with the Michigan Neuropathy Screening Instrument, a Sleep Apnea Questionnaire, and the short form of the International Physical Activity Questionnaire. Data on blood pressure, body mass index, waist circumference, serum glucose, glycated hemoglobin, LDL and HDL cholesterol, triglycerides, vitamin B12, and postmenopausal (PM) status were also collected. Patients with DM and other common causes of PNP were excluded. To evaluate which variables were independently associated with PNP (dependent variable), Poisson regression models were used. The prevalence of PNP was 11.6%. In univariate analysis, PNP was associated with age, PM status, and diagnosis of systemic arterial hypertension (p < 0.001, p < 0.001, and p = 0.016, respectively), and there was a trend toward an association with sleep apnea risk (p = 0.101). In multivariate analysis, PM status (PR = 2.836, 95% CI 1.735-4.636, p = 0.001) and age (PR = 1.0511, 95% CI 1.031-1.071, p = 0.001) were independently associated with PNP diagnosis in two different models. Even prior to BS, PNP is highly prevalent and is associated with PM status and age in SO women without diabetes.

Association of 5-HT2C (rs3813929) and UCP3 (rs1800849) gene polymorphisms with type 2 diabetes in obese women candidates for bariatric surgery.

Obesity can cause systemic arterial hypertension (SAH) and type 2 diabetes mellitus (DM2) factor that is also influenced by genetic variability. The present study aims to investigate the association between gene polymorphisms related with obesity on the prevalence of SAH and DM2 in the preoperative period and 1 year after Roux-en-Y gastric bypass surgery. In total, 351 obese women in a Brazilian cohort completed the study. The clinical diagnosis of SAH and DM2 was monitored from medical records. Twelve gene polymorphisms (rs26802; rs572169; rs7799039; rs1137101; rs3813929; rs659366; rs660339; rs1800849; rs7498665; rs35874116; rs9701796; and rs9939609) were determined using real-time polymerase chain reaction and TaqMan assay. In the preoperative period, prevalence of SAH and DM2 was 57% and 22%, respectively. One year postoperatively, 86.8% subjects had remission of DM2 and 99.5% had control of SAH. Subjects with T allele from the serotonin receptor gene (5-HT2C, rs3813929) had five times greater chance of DM2, and the CC genotype from uncoupling protein 3 gene (UCP3, rs1800849) had three times greater chance in the preoperative period. These findings indicate that polymorphisms rs3813929 and rs1800849 from 5-HT2C and UCP3 genes were related to DM2 prevalence among the Brazilian obese women candidates for bariatric surgery.

Strain Pattern on Electrocardiogram Is Associated with Increased Carotid Intima-Media Thickness in Patients with Aortic Valve Stenosis

Coronary artery disease is present in at least 30% of patients with degenerative aortic stenosis (AS). Atherosclerosis also performs an important role in the progression of AS, because of the similarities of pathological mechanisms in both conditions. The electrocardiogram (EKG) strain pattern is associated with structural myocardial change and subendocardial ischemia and has been worldwide used as a marker of AS severity. We hypothesized that EKG strain pattern would be a marker of atherosclerosis as well in AS patients. The aim of this study was to associate the presence of EKG strain pattern in AS patients with the carotid intima-media thickness (CIMT). Fifty-two consecutive patients referred from the cardiology clinic with moderate or severe AS were included in the study and underwent clinical evaluation, EKG, transthoracic echocardiography, and carotid ultrasonography, following statistical analysis of the results. There was a significant association between left ventricular EKG strain and increased CIMT (P=0.001). The presence of strain increased the odds of abnormal CIMT (P=0.004, odds ratio 9.7, 95% confidence interval 2.4-45.0), in a model adjusted for age and clinical diagnosis of systemic arterial hypertension. Additionally, EKG strain was associated with the presence of atherosclerotic plaque in at least one carotid artery (P=0.011). Our results suggest that AS patients with EKG strain pattern should be further investigated for the diagnosis of subclinical atherosclerotic disease.

Prevalencia de adherencia terapéutica en pacientes hipertensos con el uso del cuestionario Martín-Bayarre-Grau

Objective: to determine the prevalence of adherence of hypertensive patients in Reynosa, Tamaulipas, Mexico, from January to April 2011. Methods: observational, descriptive and cross-sectional study. 322 patients, attending the Mexican Social Security Institute (IMSS), assigned to the Family Medicine Unit no. 33 in Reynosa, Tamaulipas, were surveyed with diagnosis of Systemic Arterial Hypertension (SAH), between 20 to 69 years old and with previous informed signed consent. Blood pressure was taken after 10 minutes of their arrival to the clinic and 10 minutes later. After that, the Matin-Bayarre-Grau questionnaire was applied. Results: 39% (126 patients) had total adherence to the treatment, 59% (190) had partial adherence and 2% had no adherence; 62.4% of the patients had less than 10 years hypertension. Conclusions: therapeutic adherence can be improved and therefore, Systemic Arterial Hypertension control in order to reduce complications of the disease in the long run.

A nanostructured genosensor for the early diagnosis of systemic arterial hypertension.

The rapid progress of nanomedicine, especially in areas related to medical imaging and diagnostics, has motivated the development of new nanomaterials that can be combined with biological materials for specific medical applications. One such area of research involves the detection of specific DNA sequences for the early diagnosis of genetic diseases, using nanoparticles-containing genosensors. Typical genosensors devices are based on the use of sensing electrodes - biorecognition platforms - containing immobilized capture DNA probes capable of hybridizing with specific target DNA sequences. In this paper we show that upon an appropriate design of the biorecognition platform, efficient sandwich-type genosensors based upon DNA-AuNPs nanocomplexes can be efficiently applied to the detection of a Systemic Arterial Hypertension (SAH) polymorphism located in intron 16 of the Angiotensin-converter enzyme (ACE) gene. Since SAH is intimately related to heart diseases, especially blood hypertension, its early detection is of great biomedical interest. The biorecognition platforms were assembled using mixed self-assembled monolayers (SAMmix), which provided the immobilization of organized architectures with molecular control. Detection of the DNA target sequence at concentrations down to 1 nM was carried out using electrochemical impedance spectroscopy (EIS). We show that the use of EIS combined with specific nanobiocomplexes represents an efficient method for the unambiguous detection of complementary DNA hybridization for preventative nanomedicine applications.

Relevance to Home Blood Pressure Monitoring Protocol of Blood Pressure Measurements Taken Before First-Morning Micturition and in the Afternoon

BackgroundThe importance of measuring blood pressure before morning micturition and in the afternoon, while working, is yet to be established in relation to the accuracy of home blood pressure monitoring (HBPM). Objective: To compare two HBPM protocols, considering 24-hour ambulatory blood pressure monitoring (wakefulness ABPM) as gold-standard and measurements taken before morning micturition (BM) and in the afternoon (AM), for the best diagnosis of systemic arterial hypertension (SAH), and their association with prognostic markers.MethodsAfter undergoing 24-hour wakefulness ABPM, 158 participants (84 women) were randomized for 3- or 5-day HBPM. Two variations of the 3-day protocol were considered: with measurements taken before morning micturition and in the afternoon (BM+AM); and with post-morning-micturition and evening measurements (PM+EM). All patients underwent echocardiography (for left ventricular hypertrophy - LVH) and urinary albumin measurement (for microalbuminuria - MAU).ResultKappa statistic for the diagnosis of SAH between wakefulness-ABPM and standard 3-day HBPM, 3-day HBPM (BM+AM) and (PM+EM), and 5-day HBPM were 0.660, 0.638, 0.348 and 0.387, respectively. The values of sensitivity of (BM+AM) versus (PM+EM) were 82.6% × 71%, respectively, and of specificity, 84.8% × 74%, respectively. The positive and negative predictive values were 69.1% × 40% and 92.2% × 91.2%, respectively. The comparisons of intraclass correlations for the diagnosis of LVH and MAU between (BM+AM) and (PM+EM) were 0.782 × 0.474 and 0.511 × 0.276, respectively.Conclusions The 3 day-HBPM protocol including measurements taken before morning micturition and during work in the afternoon showed the best agreement with SAH diagnosis and the best association with prognostic markers.

Determination of radial artery compliance can increase the diagnostic power of pulse wave velocity measurement

Pulse wave velocity (PWV) is an indicator associated with the arterial stiffness. Although this technique has been used in the diagnosis of systemic arterial hypertension (SAH), it cannot supply alone enough information about the pathogenesis of this disturbance. This paper aims to determine the compliance of brachial-radial arterial segment by applying a three-element windkessel model, and by using the same pressure waveforms acquired to calculate the PWV. The proposed method to determine the arterial compliance was evaluated with a physical simulation of the arterial system, where parameters were known, resulting in an estimation error of 0.73 × 10−7 cm5 dyne−1. In a clinical study the estimated compliance was statistically different (p < 0.01) in a controlled group ((3.12 ± 3.53) × 10−7 cm5 dyne−1) and in an SAH group ((1.04 ± 0.74) × 10−7 cm5 dyne−1). It was observed that the PWV value calculated using the maximum of the first derivative of the pressure waveform upstroke as characteristic points was the best correlated (r = −0.71) with the determined compliance. Because SAH normally results, among other causes, from a decreased arterial compliance the results suggest that the determined compliance could be used concomitantly with PWV to supply more diagnostic information about the pathogenesis of SAH.

Current Diagnosis of Systemic Arterial Hypertension

Current Diagnosis of Systemic Arterial Hypertension