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IntroductionEmpowerment lifestyle programs are needed to reduce the risk of hypertension. Our study compared the effectiveness of two empowerment-based approaches toward blood pressure (BP) reduction: salt reduction-specific program vs. healthy lifestyle general program.MethodsThree hundred and eleven adults (median age of 44 years, IQR 34–54 years) were randomly assigned to a salt reduction (n = 147) or a healthy lifestyle program (n = 164). The outcome measures were urinary sodium (Na+) and potassium (K+) excretion, systolic (SBP) and diastolic (DBP) blood pressure, weight, and waist circumference.ResultsThere were no significant differences in primary and secondary outcomes between the two program groups. When comparing each program to baseline, the program focused on salt reduction was effective in lowering BP following a 12-week intervention with a mean change of −2.5 mm Hg in SBP (95% CI, −4.1 to −0.8) and − 2.7 mm Hg in DBP (95% CI, −3.8 to −1.5) in the intention-to-treat (ITT) analysis. In the complete-case (CC) analysis, the mean change was −2.1 mm Hg in SBP (95% CI, −3.7 to −0.5) and − 2.3 mm Hg in DBP (95% CI, −3.4 to −1.1). This effect increases in subjects with high-normal BP or hypertension [SBP − 7.9 mm Hg (95% CI, −12.5 to −3.3); DBP − 7.3 mm Hg (95% CI, −10.2 to −4.4)]. The healthy lifestyle group also exhibited BP improvements after 12 weeks; however, the changes were less pronounced compared to the salt reduction group and were observed only for DBP [mean change of −1.5 mm Hg (95% CI, −2.6 to −0.4) in ITT analysis and − 1.4 mm Hg (95% CI, −2.4 to −0.3) in CC analysis, relative to baseline]. Overall, improvements in Na+/K+ ratio, weight, and Mediterranean diet adherence resulted in clinically significant SBP decreases. Importantly, BP reduction is attributed to improved dietary quality, rather than being solely linked to changes in the Na+/K+ ratio.ConclusionSalt-focused programs are effective public health tools mainly in managing individuals at high risk of hypertension. Nevertheless, in general, empowerment-based approaches are important strategies for lowering BP, by promoting health literacy that culminates in adherence to the Mediterranean diet and weight reduction.

Objective: To compare unattended blood pressure (BP) with two attended BP, with 24-h ambulatory (ABPM) and central BP measurements in hypertensive patients with (DMs) and without diabetes (HTs). Methods: In the same hypertension clinic we evaluate 129 consecutive HTs (56% female, 59 + 16 yrs) and 91 DMs (62% female, 64 + 9 yrs) who were referred for 24-h ABPM. During 48 hours they underwent a first attended BP (5 minutes resting, 3 recordings 2 minutes apart), (AT1), an unattended BP (UnAT), 3 measurements 2 minutes apart with a pre-programmed oscillometric Omron M10- IT, a second attended BP (AT2) similar to AT1, a 24-h ABPM and an evaluation of central BP (C) from the aortic wave form (SpygmoCor). Results: BP (mm Hg) and differences (Δ) from UnAT = 135/82 ± 17/10 were 1AT = +13.8/3.9 ± 10.3/5.6, AT2 = +7.3/2.9 ± 7.4/4.9, 24-h = −1.3/−1.7 ± 7.5/7.5 and C = −2.4/1.2 ± 10.3/9.1, all p

Purpose In a prospective open study, with intervention, conducted in Primary Health Care Units by General Practitioners (GPs) in Portugal, the effectiveness of a single pill of candesartan/amlodipine (ARB/amlodipine), as the only anti-hypertension (anti-HTN) medication, in adult patients with uncontrolled HTN (BP > 140/or > 90 mm Hg), either previously being treated with anti-HTN monotherapies (Group I), or combinations with hydrochlorothiazide (HCTZ) (Group II), or not receiving medication at all (Group III), was evaluated across 12-weeks after implementation of the new therapeutic measure.Materials and methods A total of 118 GPs recruited patients with uncontrolled HTN who met inclusion/exclusion criteria. Participants were assigned, according to severity, one of 3 (morning) fixed combination candesartan/amlodipine dosage (8/5 or 16/5 or 16/10 mg/day) and longitudinally evaluated in 3 visits (v0, v6 and v12 weeks). Office blood pressure was measured in each visit, and control of HTN was defined per guidelines (BP< 140/90 mmHg).Results Of the 1234 patients approached, 752 (age 61 ± 10 years, 52% women) participated in the study and were assigned to groups according to previous treatment conditions. The 3 groups exhibited a statistically significant increased control of blood pressure after receiving the fixed combination candesartan/amlodipine dosage. The overall proportion of controlled HTN participants increased from 0,8% at v0 to 82% at v12. The mean arterial blood pressure values decreased from SBP= 159.0 (± 13.0) and DBP= 91.1 (± 9.6) at baseline to SBP= 132,1 (± 11.3) and DBP= 77,5 (± 8.8) at 12 weeks (p

Objective Real-life management of patients with hypertension and chronic kidney disease (CKD) among European Society of Hypertension Excellence Centres (ESH-ECs) is unclear : we aimed to investigate it. Methods A survey was conducted in 2023. The questionnaire contained 64 questions asking ESH-ECs representatives to estimate how patients with CKD are managed. Results Overall, 88 ESH-ECS representatives from 27 countries participated. According to the responders, renin-angiotensin system (RAS) blockers, calcium-channel blockers and thiazides were often added when these medications were lacking in CKD patients, but physicians were more prone to initiate RAS blockers (90% [interquartile range: 70–95%]) than MRA (20% [10–30%]), SGLT2i (30% [20–50%]) or (GLP1-RA (10% [5–15%]). Despite treatment optimisation, 30% of responders indicated that hypertension remained uncontrolled (30% (15–40%) vs 18% [10%–25%]) in CKD and CKD patients, respectively). Hyperkalemia was the most frequent barrier to initiate RAS blockers, and dosage reduction was considered in 45% of responders when kalaemia was 5.5–5.9 mmol/L. Conclusions RAS blockers are initiated in most ESH-ECS in CKD patients, but MRA and SGLT2i initiations are less frequent. Hyperkalemia was the main barrier for initiation or adequate dosing of RAS blockade, and RAS blockers’ dosage reduction was the usual management.

Objectives: Cerebral small vessel disease is a chronic, progressive disorder of arterioles, capillaries, and small veins supplying the brain’s white matter and deep structures of gray matter. The latest evidence seems to suggest that chronic oral infections such as periodontitis contribute to cerebral small vessel disease progression. This study evaluated the relationship between periodontal disease and brain white matter hyperintensities. Methods: Forty-three hypertensive patients, aged between 38-82, without previous cardiovascular events, of which 42% were female and 50% diabetic, were evaluated. An association between mean probing depth, mean attachment level, bleeding on probing, total periodontal inflamed surface area, and white matter hyperintensities diagnosed by magnetic resonance was studied. A significance level (α) of 0.05 was considered, and Pearson’s chi-square and Mann–Whitney tests were applied. Results: Data analysis revealed an inverse correlation between mean probing depth, bleeding on probing, total periodontal inflamed surface area, and white matter hyperintensities. A positive correlation was found between mean attachment level and white matter hyperintensities. Conclusions: In our study and within our sample, lower values of mean probing depth, bleeding on probing, and total periodontal inflamed surface area were associated with more white matter hyperintensities. Contrarily, mean attachment level was positively associated with white matter hyperintensities.

Background. Evidence regarding blood pressure (BP) variability (BPV) and its independent association with adverse outcomes has grown. Diabetic patients might have increased BPV, but there is still an evidence gap regarding relation between BPV and type 2 diabetes beyond mean values of BP. Objective. To examine the relationship between 24 h ambulatory BP monitoring (ABPM, short-term variability) and visit-to-visit in-office BPV (OBP, long-term variability), in diabetics (D) and nondiabetics (ND), and to explore BPV relation with estimated glomerular filtration rate (eGFR), and pulse wave velocity (PWV) as indicators of target organ lesion. Materials and Methods. We conducted a single-center cross-sectional study in an outpatient BP unit, including adult patients consecutively admitted from 1999 to 2019. Multivariate was performed to compare BPV between D and ND adjusted for clinical variables. Pearson’s correlation was performed to evaluate relation of BPV with eGFR and PWV. Results. A total of 1123 patients with ABPM and OBP measurements were included. Values of eGFR and PWV were worse in D than in ND. Measurements of OBPV did not differ between groups. Of ABPM BPV, the coefficient of variation and standard deviation for daytime systolic BP were higher in D compared to ND, but only in ND did BPV correlated with both eGFR and PWV. Conclusion. We found that diabetes is associated with higher variability of daytime BP than nondiabetics along with worse damage of vascular and renal function. However, in contrast to nondiabetics, in diabetics eGFR and PWV may not be dependent on BP variability, suggesting that other mechanisms might explain more rigorously the greater damage of target organ lesion markers.

N/a.

The mechanistic link between hypertension, diabetes and cerebral small vessel disease (CSVD) is still poorly understood. We hypothesized that hypertension and diabetes could impair cerebrovascular regulation prior to irreversibly established cerebrovascular disease. In this study, 52 hypertensive patients [54% males; age 64 ± 11 years; 58% with comorbid diabetes mellitus (DM)] without symptomatic cerebrovascular disease underwent transcranial Doppler (TCD) monitoring in the middle (MCA) and posterior (PCA) cerebral arteries, to assess vasoreactivity to carbon dioxide (VRCO2) and neurovascular coupling (NVC). 1.5T magnetic resonance imaging was also performed and white matter hyperintensity volume was automatically segmented from FLAIR sequences. TCD data from 17 healthy controls were obtained for comparison (47% males; age 60 ± 16 years). Hypertensive patients showed significant impairment of NVC in the PCA, with reduced increment in cerebral blood flow velocity during visual stimulation (22.4 ± 9.2 vs. 31.6 ± 5.7, p < 0.001), as well as disturbed NVC time-varying properties, with slower response (lower rate time: 0.00 ± 0.02 vs. 0.03 ± 6.81, p = 0.001), and reduced system oscillation (reduced natural frequency: 0.18 ± 0.08 vs. 0.22 ± 0.06, p < 0.001), when compared to controls. VRCO2 remained relatively preserved in MCA and PCA. These results were worse in hypertensive diabetic patients, with lower natural frequency (p = 0.043) than non-diabetic patients. White matter disease burden did not predict worse NVC. These findings suggest that hypertensive diabetic patients may have a precocious impairment of NVC, already occurring without symptomatic CSVD. Future research is warranted to evaluate whether NVC assessment could be useful as an early, non-invasive, surrogate marker for CSVD.

A doença renal crónica constitui um problema de saúde pública a nível global, estando associada a um aumento do risco da ocorrência de eventos cardiovasculares graves e aumento da mortalidade. Sendo Portugal um dos países europeus com maior incidência desta patologia, salientamos a importância de promover um aumento da notoriedade deste tema junto das autoridades de saúde, dos profissionais de saúde e da comunidade científica. Apresentamos algumas recomendações que consideramos relevantes para a melhor gestão desta problemática no nosso país, nomeadamente a promoção da comunicação entre diferentes especialidades médicas, organização dos cuidados e referimos outras que podem futuramente vir a desempenhar um papel importante na abordagem terapêutica, como os inibidores do co-transportador de sódio e glucose 2, na redução da morbilidade e mortalidade desta população.

Resumo: Nos anos 1980 assistiu‐se a uma evolução profunda do conhecimento sobre a fisiopatologia da insuficiência cardíaca (IC): outrora considerada uma síndrome clínica de origem fundamentalmente estrutural, a IC começou a ser vista como a consequência de um desequilíbrio de forças hormonais opostas. Foi, de facto, nesta década que surgiram os estudos basilares sobre o impacto dos sistemas neuro‐hormonais na IC. E destes destacam‐se oito: quatro de natureza vasoconstritora e antinatriurética (o sistema nervoso simpático [SNS], o sistema da renina‐angiotensina‐aldosterona [SRAA], o sistema da vasopressina arginina e a endotelina) e quatro de natureza vasodilatadora e natriurética (o sistema das protaglandinas [PGs], do óxido nítrico [NO], o sistema dopaminérgico e o sistema dos péptidos natriuréticos [NPS]). Fortemente interligados entre si e com um sistema de regulação intrincado, estes sistemas funcionam habitualmente numa homeostasia delicada, cuja disrupção é sinal característico da IC. Nesta revisão é explorado o desenvolvimento histórico do conhecimento sobre o impacto destes sistemas neuro‐hormonais na IC desde os seus primeiros estudos até ao conhecimento atual. Para além disso, são também revisitadas as oportunidades terapêuticas que cada um deles apresenta, bem como as famílias de antagonistas neuro‐hormonais atualmente utilizadas na terapia da IC. Nesta última parte dá‐se especial destaque ao último fármaco aprovado para utilização em doentes com IC com fração de ejeção reduzida, o sacubitril/valsartan, que combina dois antagonistas e que por isso atua simultaneamente em dois sistemas neuro‐hormonais: o SRAA e o NPS. Abstract: Our knowledge of the pathophysiology of heart failure (HF) underwent profound changes during the 1980s. Once thought to be of exclusively structural origin, HF began to be seen as the consequence of hormonal imbalance. A number of seminal studies were published in that decade focusing on the impact of neurohormonal activation in HF. Presently, eight neurohormonal systems are known to have a key role in HF development: four stimulate vasoconstriction and sodium/water retention (the sympathetic nervous system, the renin‐angiotensin‐aldosterone system [RAAS], endothelin, and the vasopressin‐arginine system), while the other four stimulate vasodilation and natriuresis (the prostaglandin system, nitric oxide, the dopaminergic system, and the natriuretic peptide system [NPS]). These systems are strongly interconnected and are subject to intricate regulation, functioning together in a delicate homeostasis. Disruption of this homeostasis is characteristic of HF. This review explores the historical development of knowledge on the impact of the neurohormonal systems on HF pathophysiology, from the first studies to current understanding. In addition, the therapeutic potential of each of these systems is discussed, and currently used neurohormonal antagonists are characterized. Special emphasis is given to the latest drug approved for use in HF with reduced ejection fraction, sacubitril/valsartan. This drug combines two different molecules, acting on two different systems (RAAS and NPS) simultaneously. Palavras‐chave: Insuficiência cardíaca, Sistemas neuro‐hormonais, Antagonistas neuro‐hormonais, Sacubitril/valsartan, Keywords: Heart failure, Neurohormonal systems, Neurohormonal antagonists, Sacubitril/valsartan

Resumo: A prevalência da diabetes mellitus tipo 2 (DMT2) continua a aumentar e a sua associação com a doença cardiovascular (CV) tem levado à incorporação e valorização de endpoints CV nos ensaios clínicos sobre o tratamento da DMT2.Este artigo faz uma revisão dos vários ensaios já realizados e em desenvolvimento, neste âmbito, com especial enfoque no estudo EMPA‐REG OUTCOME. Neste estudo, a empagliflozina, um inibidor do cotransportador tipo 2 de sódio/glicose (iSGLT2), demonstrou efeitos benéficos na redução do risco CV em doentes com DMT2 e doença CV estabelecida, para além de segurança CV e diminuição dos valores de HbA1c, representando uma mudança de paradigma com impacto ao nível das recomendações internacionais para o tratamento da DMT2. Estes resultados mantiveram‐se em análises de subgrupos posteriores, nomeadamente na insuficiência cardíaca, doença renal crónica e doença arterial periférica, ainda que muitas questões se coloquem sobre os mecanismos envolvidos nestes efeitos – se efeitos hemodinâmicos, efeitos metabólicos ou se a diminuição das concentrações de sódio citoplasmático no miocárdio.Com a diminuição do risco de eventos CV major em doentes com DMT2, os resultados do estudo EMPA‐REG OUTCOME demonstraram, pela primeira vez, proteção CV associada ao efeito de um fármaco anti‐hiperglicémico e iniciaram uma nova era no tratamento e gestão da DMT2. Este estudo levou ao desenvolvimento de outros ensaios, ainda a decorrer, que permitirão estabelecer quais os doentes que mais beneficiarão desta terapêutica, nomeadamente na relação à existência de comorbilidades. Abstract: The prevalence of type 2 diabetes (T2D) continues to increase, and its association with cardiovascular (CV) disease has led to the inclusion of CV endpoints in clinical trials on the treatment of T2D.This article explores the various trials already performed and under development in this field, with particular focus on the EMPA‐REG OUTCOME trial. In this trial, empagliflozin, a sodium‐glucose co‐transporter 2 inhibitor, demonstrated a reduction in CV risk in patients with T2D and established CV disease, in addition to CV safety and a decrease in glycated hemoglobin. This represents a paradigm shift that has led to changes in the international guidelines for the treatment of T2D. These results were maintained in subsequent subgroup analysis for heart failure, chronic kidney disease and peripheral arterial disease, although there are many questions concerning the mechanisms involved in these effects, including whether they are hemodynamic, metabolic or due to decreased myocardial cytoplasmic sodium concentrations.With this reduction in risk for major CV events in patients with T2D, the EMPA‐REG OUTCOME trial demonstrated CV protection from a hypoglycemic drug for the first time, and opened a new era in the treatment and management of T2D. This study has led to the development of ongoing trials that will establish which patients will benefit most from this therapy, particularly with regard to comorbidities. Palavras‐chave: Empagliflozina, Diabetes, Doença cardiovascular, Insuficiência cardíaca, Keywords: Empagliflozin, Diabetes, Cardiovascular disease, Heart failure

Introduction: The migration of African populations to Europe poses problems of adaptation that may increase the risk of cardiovascular disease. We assessed the cardiovascular risk of Cape Verdean university students studying in Portugal (CV-PT) compared to Cape Verdean university students in Cape Verde (CV-CV) and to Caucasian university students in Portugal (PT-PT). Methods: A cross-sectional study was performed comparing three university populations, 54-62% female, aged 19-28 years: CV-PT (n=104), CV-CV (n=100) and PT-PT (n=100). Anthropometric data, blood pressure (BP), pulse wave velocity (PWV), albuminuria and estimated 24-h urinary sodium excretion (UNa+) using the Kawasaki formula were measured. Results: The CV-PT group had higher body mass index and sodium intake (UNa+: CV-PT 235±91, CV-CV 197±85, PT-PT 194±90 mmol/24 h; p

Objective: To assess ambulatory blood pressure monitoring (ABPM) circadian patterns and their determinants in a large sample of normotensive and hypertensive patients. Methods: A total of 26 170 individual ABPM recordings from 1995 to 2015 were analyzed. Mean office blood pressure (OBP), 24-hour blood pressure (BP), daytime BP and nocturnal BP were measured. Circadian patterns were classified by nocturnal systolic BP fall as extreme dipper (ED, ≥20%), dipper (D, 10%-19.9%), non-dipper (ND, 0%-9.9%), and reverse dipper (RD, 30 kg/m2 vs. others (46.5 vs. 42.9%, p43%, including in NT. Age and BMI predicted non-dipping. Resumo: Objetivo: Avaliar os perfis circadiários da pressurometria ambulatória 24 h (ABPM) numa vasta população de normotensos e hipertensos. Métodos: Analisaram-se 26 170 registos de ABPM (1995-2015). Avaliou-se a pressão arterial (BP) de consultório (cBP), diurna (dayBP), noturna (nightBP) e de 24-horas (24hBP). Perfis circadiários definidos pela queda percentual noturna (Nqueda %) da pressão sistólica (SBP): extreme dipper (ED>=20%), dipper (D, 10%-19,9%), non-dipper (ND 0%-9,9%) e reverted dipper (RD =65 versus < 65 anos (54,9 versus 33,1%, p

Background. The long-term prognosis and transition towards sustained ambulatory hypertension (SHT) of white-coat hypertension (WCHT) remain uncertain particularly in those with both normal nighttime and daytime blood pressure (BP) values. Different classification criteria and the use of antihypertensive drugs may contribute to conflicting results. Patients and Methods. We prospectively evaluated for a 7.1 year transition to SHT in 899 nondiabetic subjects free from cardiovascular (CV) events: normotensive (NT) (n = 344; 52, 9% female; ageing 48 ± 14 years); untreated WCHT (UnWCHT n = 399; 50, 1% female; ageing 51 ± 14 years); and treated WCHT with antihypertensive drugs after baseline (TxWCHT n = 156; 54, 4% female; ageing 51 ± 15 years). All underwent 24 h ambulatory BP monitoring (24 h-ABPM) at baseline, at 30 to 60 months, and at 70 to 120 months thereafter. WCHT was at baseline (with no treatment) as office BP ≥ 140/or 90 mm·Hg, daytime BP

Resumo: Introdução: Permanece controverso se os indivíduos com hipertensão da bata branca (HBBs) exibem alterações hemodinâmicas e estruturais diferentes dos indivíduos normotensos (NTs) e hipertensos (HTs). Métodos: Comparamos marcadores de prognóstico cardiovascular (CV): velocidade da onda de pulso (VOP), índice rigidez aórtica (AASI) e as alterações da onda de pressão aórtica (índice de aumentação [AIx], pressão de aumentação [AugP] e amplificação central periférica da pressão de pulso [PPA]) entre NTs (n = 175), HBBs (n = 315) e HTs tratados (n = 691) todos com pressão arterial (PA) de 24 h

Background: Resistant Hypertension (RH) is associated with an increased risk of cardiovascular events and poor prognosis. Exercise training studies in RH patients have shown promising outcomes, nonetheless, none determine the impact of exercise on endothelial damage and repair. Circulating endothelial cells (CECs) are a reliable indicator of vascular damage and dysfunction. Recent studies in hypertension suggest that increased levels of endothelial progenitor cells (EPCs), a marker of endothelial repair, are related to increased CECs in order to compensate endothelial damage. Purpose: This study aimed to determine the effect of 12-week aerobic exercise program on the percentage of EPCs and CECs in RH patients. Methods: Patients with RH were randomized to a 12-week aerobic exercise program (3 xs/week) (n = 13) and a usual care control group (n = 8). Outcome measures included clinical data, ambulatory blood pressure data and circulating levels of EPCs, hematopoietic stem cells (HSC) and CECs, quantified by flow cytometry. (ClinicalTrials.gov: NCT03090529). Results: Baseline characteristics were similar between groups, including the number of antihypertensive drugs (5.0 ± 0.9 vs. 4.8 ± 0.7, p = 0.517). After 12 weeks, no significant changes were found in the levels of HSCs in both groups. The levels of CECs decreased in the exercise group [0.0073 (0.0016)% to 0.0058 (0.0029), p = 0.019]; no changes were observed in the control group. EPC’s decreased only in the exercise group [0.0071 (0.0027)% to 0.0052 (0.0037)%, p = 0.046]. Conclusions: Exercise training reduces endothelial injury/damage (reduced CECs levels) in RH patients, a specific group who is a challenge for clinicians as the available treatment options have reduced success.

Background: The relationship between arterial stiffness, blood pressure (BP) and cardiorespiratory fitness (CRF) has been studied in healthy populations and cardiovascular patients, since all of which proved to be independent predictors of all-cause mortality. We aimed to investigate the association of CRF with arterial stiffness and peripheral and central hemodynamics, in patients with resistant hypertension (RT). Methods: In this cross-sectional study, 30 patients (13 men, 17 women; age, 57.7 ± 8.1 years; weight, 79.2 ± 11.6 kg; body mass index, 29.7 ± 4.0 kg/m2) with resistant hypertension were recruited in the Hospital Infante D. Pedro (Aveiro) and Hospital Pedro Hispano (Matosinhos). Outcome measures included CRF (VO2peak), peripheral and central BP, and carotid-femoral pulse wave velocity (cf-PWV). Correlation analysis was conducted to assess the association between variables. Results: A significant negative correlation was found between VO2peak (33.7 ± 6.2 mLO2/kg/min) and central (141.0±21.3 mmHg; r = −0.395, p = 0.031) and peripheral systolic BP (148.4 ± 21.3 mmHg; r = −0.363, p = 0.049). VO2peak was also correlated with pulse pressure (PP) amplification ratio (1.2 ± 0.1 mmHg; r = 0.361, p = 0.050). The association with central systolic BP (r = −0.403, p = 0.035) and PP amplification ratio (r = 0.408, p = 0.033) remained significant after adjusted for age. VO2peak showed no correlation with PWV (9.4 ± 2.9 m/s; r = −0.075, p = 0.694) and peripheral (88.1 ± 12.2 mmHg; r = −0.138 p = 0.467) and central diastolic BP (88.5 ± 12.7 mmHg; r = −0.133, p = 0.483). Conclusion: This study confirms the inverse relationship between CRF and central systolic BP and PP amplification ratio in RH patients, regardless of age.

Objective: Carotid-femoral Pulse Wave velocity (cfPWV), the gold standard for measuring stiffness, is a marker of organ damage (OLD). Even though cfPWV correlates with casual (BPc), central (CBP) and ambulatory (ABPM) blood pressure (BP), evidence is limited for resistant hypertension (RH). Method: Thirty-three patients (age, 56.1 ± 8.2 years; weight, 78.0 ± 12.4 kg; height, 1.62 ± 0.08 m) with RH participated in a cross-sectional study. Outcomes included clinical data, BPc, ABPM, and carotid-femoral, cfPWV. Correlation analysis was conducted to assess the association between variables; independent t-tests were conducted to compare variables between those participants with cfPWV < and ≥ 10 m/s. Results: Patients (20 women and 13 men) presented a peripheral systolic and diastolic BPc of 144.0 ± 3.8 mmHg and 82.0 ± 1.9 mmHg, respectively. The cfPWV correlated with age (r = 0.356, p = 0.045), 24 h systolic BP (24 h SBP) nightime pulse pressure (night PP), 24 h pulse pressure (24hPP), casual systolic (SBPc) and diastolic BP (DBPc), central systolic (CSBP), diastolic (CDBP) and central pulse pressure (CPP); controlled for age the correlation remained significant for 24h SBP (r=0.446, p=0.009) 24hPP (r=0.464, p=0.007), nightPP (r=0.365, p=0.036), SBPc (r=0.620, p

Resumo: Introdução: Avaliar em indivíduos não medicados a reprodutibilidade dos valores médios e dos quatro perfis circadiários entre dois registos de pressurometria ambulatória de 24 horas (MAPA) separados de 1‐11 meses. Métodos: Análise retrospetiva de 481 indivíduos (59% mulheres) avaliados por MAPA em dois dias, visita um (V1) e visita dois (V2) separados por 5,5 + 0,2 meses. Perfis circadiários definidos pelos ratios noite/dia da pressão sistólica (PAS) em: reverted dippers, RD se ratio > 1,0, non‐dippers, ND se ratio 0,9‐ 1.0; non‐dippers (ND), ratio 0.9‐1.0; dippers (D), ratio 0.8‐

Resumo: Introdução e objetivos: Determinar a prevalência de microalbuminúria (MAU) em doentes hipertensos (HTA) e/ou diabéticos tipo 2 (DM2) e em normotensos não diabéticos (grupo controlo). Como objetivos secundários, analisar as diferenças de distribuição da MAU nas quatro subpopulações e observar a associação de variáveis clínicas e epidemiológicas diversas com a MAU. Métodos: O RACE (micRoAlbuminsCreeningsurvEy) é um estudo epidemiológico descritivo, observacional de corte transversal, multicêntrico, que incluiu doentes acompanhados nos Cuidados de Saúde Primários (CSP) em Portugal. Os doentes com causas potenciais de falsos positivos para MAU foram excluídos. As avaliações principais foram a frequência da MAU, determinada pelo teste da tira reativa Micral‐Test®, a pressão arterial (PA), as variáveis demográficas, as doenças concomitantes, a medicação cardiovascular e antidiabética e as variáveis bioquímicas. Resultados: Um total de 9198 participantes (3769 hipertensos, 3100 diabéticos tipo 2 hipertensos, 423 diabéticos normotensos e 1906 controlos), 54,7% do sexo feminino, foram incluídos na análise primária. A prevalência de MAU foi de 58% nos doentes com HTA + DM2, 51% nos doentes com DM2, 43% nos doentes com HTA e de 12% no grupo controlo (χ2: p

Resumo: Objetivo: Investigar alterações hemodinâmicas e das propriedades viscoelásticas da parede arterial em mulheres com prévia pré‐eclâmpsia (PE) versus mulheres com antecedentes de gravidezes normais (NT). Métodos: Estudo transversal em mulheres, 45 com prévia PE e 55 NT, emparelhadas para idade: PE: 38 ± 6 versus NT: 38 ± 5 anos, n.s., índice massa PE: 25 ± 4 versus NT: 26 ± 4 kg/m2, n.s, e 76 ± 34 (NT) e 86 ± 48 (PE) meses após o parto. Avaliamos rigidez arterial – velocidade onda pulso (PWV, Complior) e ondas refletidas (pressão de aumentação AP) e índice de aumentação (AIx,%) na onda de pressão central e a pressão arterial de 24 horas (MAPA). Resultados: PE apresentaram pressão sistólica (PAS) periférica PE: 131 ± 18 versus NT: 121 ± 19 e PAS central PE: 122 ± 18 versus NT: 110 ± 19 mais elevadas (p

A diabetes representa um sério e grave problema de saúde pública em Portugal, onde se estima que a prevalência desta patologia na população com idades compreendidas entre os 20 e os 79 anos seja de 13,1%, o que equivale a mais de um milhão de indivíduos diabéticos. A diabetes é uma patologia com importantes e graves implicações sociais, económicas e humanas. De facto, estima-se que os custos com esta patologia em Portugal representem aproximadamente 10% da despesa total em Saúde e 0,9% do PIB português. Em particular, registou-se nos últimos anos um aumento significativo dos encargos com os medicamentos antidiabéticos, decorrente, em grande medida, da recente introdução no mercado de novas classes terapêuticas que apresentam um custo elevado. Por estes motivos, facilmente se compreende que a diabetes representa uma séria ameaça à sustentabilidade financeira dos sistemas de saúde. O tema “A Diabetes em Portugal” foi objeto de uma reunião de reflexão, a qual teve como propósito debater as implicações socioeconómicas da diabetes, o papel dos antidiabéticos orais numa perspetiva holística da abordagem terapêutica desta patologia, a atualidade das normas de orientação clínica e a sua aplicabilidade na prática clínica, tendo em consideração as características específicas de cada doente e ainda estratégias que permitam garantir o acesso dos doentes às novas terapêuticas. Os especialistas que participaram nesta reunião expressaram, de forma consensual, a necessidade de serem implementados programas de prevenção da diabetes efetivos e direcionados para a população. Pese embora o facto de estes programas implicarem um investimento inicial significativo, a prevenção ou retardamento da progressão da doença tem um impacto substancial na saúde global da população e o potencial de gerar poupanças consideráveis para o sistema de saúde. O tratamento da Diabetes deve ser individualizado e centrado no doente, com o objetivo de incrementar a efetividade da terapêutica e de otimizar os resultados a longo prazo. As modificações do estilo de vida devem ser parte integrante de um plano terapêutico personalizado. Os doentes devem encontrar-se ativamente envolvidos na decisão do tratamento, devendo igualmente receber uma educação adequada sobre a patologia. Por fim, a prescrição de novas classes terapêuticas para a diabetes não deverá ser condicionada pelo seu custo elevado, uma vez que a escolha do tratamento deve fundamentar-se na evidência clínica e nas necessidades do doente. Contudo, as terapêuticas inovadoras acarretam um acréscimo dos encargos em Saúde, motivo, aliás, pelo qual o seu custo-efetividade é objeto de avaliação pelas entidades competentes.

Resumo: Introdução: A velocidade da onda de pulso carotideo-femoral (VOP) tem constituído um importante marcador de risco cardiovascular, traduzindo o reflexo arterial subsequente a um conjunto de contextos clínicos em que o impacto cardiovascular é manifesto. Este trabalho visou estabelecer parâmetros de normalidade da VOP para a população portuguesa, com base numa definição estatística. Método: O presente trabalho corresponde a uma sub-análise do Projecto EDIVA, envolvendo 668 indivíduos saudáveis (412 do sexo masculino), com idade média 39,73 ± 15,6 anos, índice de massa corporal 25,56 ± 4,05 kgm2, pressão arterial sistólica e diastólica respectivamente 125,47 ± 11,18 e 75,75 ± 9,27 mmHg. Estes indivíduos foram submetidos a um follow-up médio de 23,3 ± 3,34 meses, com avaliação anual da VOP. A normalidade foi definida em termos da história pessoal e familiar, da avaliação clínica, do ECG de superfície e da realização de exames analíticos de rotina. Resultados: A VOP média na amostra foi de 8,8 ± 1,4 m/s, sendo de 8,7 ± 1,6 m/s e 8,9 ± 1,5 m/s, respectivamente no sexo feminino e masculino (p = ns). A normalidade foi definida a partir do percentil 95 para cada faixa etária, e por género. A avaliação sequencial permitiu ainda avaliar o contributo percentual de agravamento da VOP face ao envelhecimento (5%), definindo-se assim uma variação positiva da VOP (em avaliações sequenciais) inferior a 5% como normal. Conclusão: Os resultados obtidos permitem: por um lado, estabelecer critérios de referência para a VOP tendo em consideração o papel determinante do envelhecimento na deterioração fisiológica da função das grandes artérias; por outro lado, estabelecer uma medida de valorização da variação longitudinal da VOP, aspecto que se reveste de grande importância face à adopção desta metodologia em programas integrados de seguimento de doentes com risco cardiovascular manifesto. Abstract: Introduction: Aortic pulse wave velocity (PWV) has been associated with cardiovascular risk in different clinical subsets. This subanalysis of the EDIVA project aimed to establish criteria for normality of PWV based on a statistical definition that considers the fundamental physiological role of aging in arterial stiffness. Methods: A sample of 668 healthy subjects (412 male) enrolled in the EDIVA Project (a prospective, multicenter, observational study) were studied. Mean age was 40.00 ± 13.42 years, body mass index was 25.90 ± 4.21 kg/m2, and systolic and diastolic blood pressure were respectively 125.47 ± 11.18 and 75.75 ± 9.27 mmHg. PWV was determined annually using a Complior device, and mean follow-up was 23.3 ± 3.34 months. Personal and family history, physical examination, electrocardiogram and biochemical analysis were used to determine individual health. Results: In the overall population PWV was 8.8 ± 1.4 m/sec, 8.7 ± 1.6 m/sec in men and 8.9 ± 1.5 m/sec in women (p = NS). Normal PWV was defined as the 95th percentile adjusted for age and gender, above which PWV was considered abnormal. Serial evaluation of PWV also enabled the annual age-dependent increase in PWV to be estimated at 5%, values above this cut-off being defined as abnormal vascular deterioration. Conclusion: This study establishes criteria for normality based on a statistical definition that takes into account the fundamental physiological role of aging in arterial stiffness. Additionally, it provides a cut-off for the clinical interpretation of serial PWV measurements. Palavras-chave: Velocidade da onda de pulso, Distensibilidade arterial, Normalidade, Risco cardiovascular, Keywords: Pulse wave velocity, Arterial stiffness, Normality, Reference values

OBJETIVO: Avaliar os resultados de intervenção para melhoria da quantidade e relevância das notificações de reacções adversas a medicamentos. MÉTODOS: Foi implementado um estudo controlado aleatorizado, por agrupamentos em farmacêuticos a exercer actividade profissional na região norte de Portugal, em 2007. Após aleatorização, 364 indivíduos foram alocados ao grupo de intervenção (261 na intervenção telefónica e 103 nos workshops); o grupo de controlo foi constituído por 1.103 farmacêuticos. Na intervenção educativa foram abordados a problemática das reacções adversas a medicamentos, o impacto na saúde pública e a notificação espontânea. Quanto à relevância, as reações adversas foram classificadas em graves e inesperadas. A análise estatística foi efectuada com base no princípio intention-to-treat; aplicaram-se modelos lineares generalizados mistos, utilizando o método penalized quasi-likelihood. Os farmacêuticos estudados foram seguidos durante um período de 20 meses. RESULTADOS: A intervenção aumentou três vezes a taxa de notificação espontânea das reações adversas (RR = 3,22; IC 95%: 1,33; 7,80) relativamente ao grupo de controlo. Houve incremento da relevância das notificações com aumento das reações adversas graves em cerca de quatro vezes (RR = 3,87; IC 95%: 1,29;11,61) e inesperadas em cinco vezes (RR = 5,02; IC 95%: 1,33;18,93), relativamente ao grupo de controlo. CONCLUSÕES: As intervenções educativas aumentam significativamente, por até quatro meses, a quantidade e a relevância das notificações espontâneas de reacções adversas a medicamentos por parte dos farmacêuticos da região norte de Portugal.OBJETIVO: Evaluar los resultados de intervención para mejoría de la cantidad y relevancia de las notificaciones de reacciones adversas a medicamentos. MÉTODOS: Fue implementado un estudio controlado aleatorio, por agrupaciones de farmacéuticos que ejercen actividad profesional en la región norte de Portugal, en 2007. Posterior a la aleatoriedad, 364 individuos fueron distribuidos en el grupo de intervención (261 en la intervención telefónica y 103 en los workshops); el grupo control fue constituido por 1.103 farmacéuticos. En la intervención educativa fueron abordados la problemática de las reacciones adversas a medicamentos, el impacto en la salud pública y la notificación espontánea. Con relación a la relevancia, las reacciones adversas fueron clasificadas en graves e inesperadas. El análisis estadístico fue efectuado con base en el principio intention-to-treat; se aplicaron modelos lineares generalizados mixtos, utilizando el método penalized quasi-likelihood. Los farmacéuticos estudiados fueron seguidos durante un período de 20 meses. RESULTADOS: La intervención aumentó tres veces la tasa de notificación espontánea de las reacciones adversas (RR=3,22; IC95%:1,33;7,80) con relación al grupo control. Hubo un incremento en la relevancia de las notificaciones con aumento de las reacciones adversas graves en cerca de cuatro veces (RR=3,87; IC95%:1,29;11,61) e inesperadas en cinco veces (RR=5,02; IC 95%: 1,33;18,93), con relación al grupo control. CONCLUSIONES: Las intervenciones educativas aumentan significativamente, en hasta cuatro meses, la cantidad y la relevancia de las notificaciones espontáneas de reacciones adversas a medicamentos por parte de los farmacéuticos de la región Norte de Portugal.OBJECTIVE: To evaluate the results of an intervention to improve the number and relevance of reports of adverse drug reactions. METHODS: A cluster-randomized controlled trial was conducted with pharmacists working in Northern Portugal, in 2007. After randomization, 364 individuals were placed into the intervention group (261 in telephone interviews and 103 in workshops), while the control group was comprised of 1,103 pharmacists. The following were approached in the educational intervention: the problem of adverse drug reaction, the impact on public health and spontaneous reporting. With regard to relevance, adverse reactions were classified into severe and unexpected. Statistical analysis was performed, based on the intention-to-treat principle; generalized linear mixed models were applied, using the penalized quasi-likelihood method. The pharmacists studied were followed during a period of 20 months. RESULTS: The intervention increased the rate of spontaneous reporting of adverse reactions three times (RR = 3.22; 95% CI 1.33;7.80), when compared to the control group. The relevance of reporting rose, with an increase in severe adverse reactions by approximately four times (RR = 3.87; 95% CI 1.29;11.61) and in unexpected adverse reactions by five times (RR = 5.02; 95% CI 1.33;18.93), compared to the control group. CONCLUSIONS: During a period of up to four months, educational interventions significantly increased the number and relevance of spontaneous reporting of adverse drug reactions by pharmacists in Northern Portugal.

Introdução: Os profissionais de saúde foram um grupo prioritário para vacinação contra a pandemia da Gripe A (H1N1), Pandemrix®. Assim, monitorizar os eventos adversos relacionados com esta vacina neste grupo específico poderá originar informação valiosa relacionada com o perfil de segurança da vacina. O nosso objetivo foi identificar os eventos adversos após imunização com a vacina Pandemrix® em profissionais de saúde. Material e Métodos: Foi desenhado um questionário de monitorização dos eventos adversos ocorridos com a vacina Pandemrix®. O questionário foi distribuído aos profissionais de saúde a trabalhar em três centros hospitalares da região norte do País, vacinados no período de 26 de Outubro de 2009 a 31 de janeiro de 2009. Resultados: Dos 2358 profissionais de saúde que aceitaram participar no estudo, 864 (37%) devolveram o questionário preenchido. Destes, 73% experienciaram pelo menos um evento adverso após imunização, mas só 8% experienciaram um evento inesperado. Os eventos adversos mais frequentemente reportados foram os esperados e muito comuns: reações locais no local de administração (57%), mialgia (31%), fadiga (incluindo astenia) (24%) e dor de cabeça (19%). Não foram reportados casos de eventos de maior gravidade para a saúde, tais como morte ou risco de vida. O género feminino e a existência de doença de base foram fatores de risco independentes para o desenvolvimento de pelo menos um evento adverso após imunização com a Pandemrix®. Conclusões: O nosso trabalho sugere um perfil de segurança aceitável da vacina pandémica Pandermix® em profissionais de saúde. Tanto a frequência como a severidade dos eventos adversos não se verificaram superiores ao esperado.