Search

Background: In clinical practice, there is evidence of failure to prescribe evidence-based therapies for patients at high cardiovascular risk. However, in Brazil, data on 1-year outcomes of these patients remain insufficient., Objectives: To describe the use of evidence-based therapies and the occurrence of major cardiovascular outcomes and their major predictors in a 12-month follow-up of a Brazilian multicenter registry of patients at high cardiovascular risk., Methods: This prospective observational study documented the outpatient clinical practice of managing patients over 45 years of age and of high cardiovascular risk in both primary and secondary prevention. Patients were followed-up for 1 year, and the prescription of evidence-based therapies and the occurrence of major cardiovascular events (myocardial infarction, stroke, cardiac arrest, and cardiovascular death) were assessed. P-values < 0.05 were considered statistically significant., Results: From July 2010 to August 2014, a total of 5076 individuals were enrolled in 48 centers, 91% of the 4975 eligible patients were followed-up in cardiology centers, and 68.6% were in secondary prevention. At 1 year, the concomitant use of antiplatelet agents, statins, and angiotensin-converting enzyme inhibitors reduced from 28.3% to 24.2% (p < 0.001). Major cardiovascular event rate was 5.46%, and the identified predictors were age, patients in secondary prevention, and diabetic nephropathy., Conclusions: In this large national registry of patients at high cardiovascular risk, risk predictors similar to those of international registries were identified, but medical prescription adherence to evidence-based therapies was inferior and significantly worsened at 1 year. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

Background: Data on outpatient care provided to patients at high cardiovascular risk in Brazil are insufficient., Objective: To describe the profile and document the clinical practice of outpatient care in patients at high cardiovascular risk in Brazil, regarding the prescription of evidence-based therapies., Methods: Prospective registry that documented the ambulatory clinical practice in individuals at high cardiovascular risk, which was defined as the presence of the following factors: coronary artery disease, cerebrovascular and peripheral vascular diseases, diabetes, or those with at least three of the following factors: hypertension, smoking, dyslipidemia, age > 70 years, family history of coronary artery disease, chronic kidney disease or asymptomatic carotid artery disease. Basal characteristics were assessed and the rate of prescription of pharmacological and non-pharmacological interventions was analyzed., Results: A total of 2364 consecutive patients were included, of which 52.2% were males, with a mean age of 66.0 years (± 10.1). Of these, 78.3% used antiplatelet agents, 77.0% used statins and of patients with a history of myocardial infarction, 58.0% received beta-blockers. Concomitant use of these three classes of drugs was 34%; 50.9% of hypertensive, 67% of diabetic and 25.7% of dyslipidemic patients did not achieve the goals recommended by guidelines. The main predictors of prescription therapies with proven benefit were centers with a cardiologist and history of coronary artery disease., Conclusion: This national and representative registry identified important gaps in the incorporation of therapies with proven benefit, offering a realistic outlook of patients at high cardiovascular risk.

Background: Arterial stiffness is a variable predictor of morbidity and mortality and a possible marker of vascular injury. Its non-invasive assessment by radial tonometry and analysis of the augmentation index (r-AI) allows identifying patients exposed to higher cardiovascular risk., Objective: To analyze the influence of r-AI on clinical-biochemical variables and its influence on the prevalence of target-organ damage in hypertensive patients., Methods: 140 consecutive hypertensive patients, followed-up in an outpatient clinic, were analyzed in a cross-sectional study. Blood pressure (BP) levels and r-AI were obtained by applanation tonometry of the radial artery (HEM-9000AI, Onrom). The patients were allocated into r-AI tertiles (r-AI < 85%; 85< r-AI < 97%; r-AI > 97%)., Results: The sample was predominantly composed of women (56.4%), mean age of 61.7 ± 11.7 years and body mass index 29.6 ± 6.1 Kg/m². The highest tertile showed higher proportion of women (p = 0.001), higher systolic BP (p = 0.001) and pulse pressure (p = 0.014), and lower weight (p = 0.044), height (p < 0.001) and heart rate (p < 0.001). Multivariate analysis demonstrated that weight (β = -0.001, p = 0.017), heart rate (β = -0.001, p = 0.007) and central pressure (β = 0.015, p < 0.001) correlated independently with r-AI. In logistic regression analyses, the 3rd r-AI tertile was associated to lower levels of diabetes (DM) (OR = 0.41; 95% CI 0.17-0.97; p = 0.042)., Conclusion: This study demonstrated that weight, heart rate and central BP were independently related to r-AI.

Background: The available studies have not fully analyzed the several factors involved in the genesis of hypertension (HT), especially the association among blood pressure, urinary sodium excretion and renal dysfunction., Objective: To assess the HT prevalence and risk factors in different age groups in a representative sample of an urban Brazilian population., Methods: The studied population (1717 adult individuals) was evaluated by age groups: 18 to 39 years; 40 to 49; 50 to 59; 60 to 69 and > 70 years. Quantitative variable means and categorical variables of the hypertensive and normotensive groups were compared., Results: The adjusted overall prevalence of HT was 25.23%. The prevalence increased with age and was higher in individuals with low educational level. Increased body mass index and abdominal waist were positively related to a higher prevalence of HT. There was a significant positive association between HT and urinary sodium excretion. Hypertensive individuals presented higher frequency of renal dysfunction, defined as measured creatinine clearance <60 ml/min/m(2). The prevalence of diabetes mellitus was 5.6% in the overall population and 14.5% in hypertensive individuals. Hypertension was a known condition to 74.4% of the hypertensive individuals. Among treated hypertensive individuals, 52.4% achieved controlled blood pressure and only 34.3% of the overall hypertensive patients (treated or not) had blood pressure controlled., Conclusion: This population-based is unique by gathering different demographic, epidemiologic and risk factors involved in the genesis of hypertension in a single sample assessment with a population calculation, which might be extrapolated to other hypertensive populations.

Background: The arterial hypertension varies in according to the circadian cycle, presenting physiologic fall of blood pressure (BP) during sleep (dipping). The absence of this fall or its increase associates to higher incidence of target-organ damages., Objective: To analyze the prevalence of dipping in hypertensive individuals, to correlate dipping to the blood pressure levels, clinic, and socio-demographic factors, and biochemical characteristics and to associate it cardiovascular events (stroke and myocardial infarction)., Methods: Hypertensive individuals were submitted to the ambulatory blood pressure monitoring. Presence of dipper was defined as fall >10% of the systolic BP of the day for sleep., Results: 163 evaluated patients were divided in dippers (D, n=53) and nondippers (ND, n=110). Between the groups there was not significant difference to the age, sex, race, time of hypertension, glycemia, LDL-cholesterol, total cholesterol, triglycerides, schooling, smoking, and history of diabetes. D presented BP higher than the ND during the day and lower during sleep. ND had higher body mass index (BMI) (p=0.0377), lower level of HDL-cholesterol (p=0.0189), and higher pulse pressure during sleep (p=0.0025). History of stroke alone (p=0,046) and combined with myocardial infarction (p=0.032) were more frequent in nondippers individuals. In the logistic regression, only ND was associated independently with stroke or myocardial infarction., Conclusion: ND was associated in an independent way with the target-organ damages analyzed, what demonstrates its importance and strengthens the necessity of more aggressive treatment with objective to reach BP goals e, consequently, to prevent the development of new cardiologic and cerebrovascular events.

Background: Systemic arterial hypertension (SAH) is one of the greatest problems of public health in Brazil. Its detection and early treatment should be a priority to reduce the morbimortality of the cardiovascular diseases., Objective: This study aimed at assessing the prevalence of SAH and the sociodemographic factors in a population of hypertensive individuals from São José do Rio Preto, São Paulo, Brazil., Methods: A cross-sectional study was carried out in a stratified sample of 1,717 people, representative of the urban adult population from the city of São José do Rio Preto, between 2004 and 2005., Results: The sample consisted of 1,717 people, with 762 of them (25.2%) being characterized as hypertensive. The following results were observed: 54.6% were women; 78.4% were caucasian; 66.1% were illiterate or had not finished Elementary School; 63.9% were married, 40.9% belonged to social classes D and E; 37.9% were self-employed or wage earners., Conclusion: The results of study on SAH in the city of São José do Rio Preto shows the need for early-onset continuous educational interventions.

Postoperative cognitive dysfunction is frequent in cardiac surgeries leading to major consequences. The physiopathological processes involved in this condition are still not completely elucidated, despite the multifactor character. Besides pre-operative factors such as age and education, some intra-operative factors are also of extreme importance. However, according to a vast literature on the subject, these factors are not capable to clarify the totality of the cases, taking us to a genetic base for this neurological sequel. In this revision, we briefly assess the factors involved in this cognitive dysfunction as well as discuss the pharmacotherapy in the prevention of this event.

Objective: To assess the prevalence of hypertensive crisis, related clinical findings, and the organic lesions involved., Method: This retrospective study comprised the analysis of the medical records of symptomatic patients with an elevation in diastolic blood pressure levels > or = 120 mmHg, who sought the emergency unit of a university-affiliated hospital over 12 months. Hypertensive urgency was characterized as the symptomatic elevation of blood pressure levels with no evidence of target-organ lesions, and hypertensive emergency was characterized as the symptomatic elevation of blood pressure levels with evidence of acute or ongoing target-organ lesion., Results: This study comprised 452 patients with hypertensive crisis, accounting for 0.5% of all clinicosurgical emergencies, of which, 273 (60.4%) were hypertensive urgencies and 179 (39.6%) were hypertensive emergencies. Eighteen percent of the patients ignored their hypertensive condition. Smoking and diabetes were risk factors associated with the development of a hypertensive crisis in 1/4 and 1/5 of the patients, respectively. The patients with a hypertensive emergency were older (59.6+/-14.8 versus 49.9+/-18.6 years, p < 0.001) and had greater diastolic blood pressure (129.1+/-12 versus 126.6+/-14.4 mmHg, p < 0.05) than those with hypertensive urgencies. Ischemic stroke and acute pulmonary edema were the most common hypertensive emergencies, being in accordance with the most frequently found clinical manifestations of neurologic deficit and dyspnea., Conclusion: Hypertensive crises accounted for 0.5% of all emergency cases studied and for 1.7% of all clinical emergencies, hypertensive urgency being more common than hypertensive emergency. Ischemic stroke and acute pulmonary edema were the most frequent target-organ lesions in hypertensive emergencies.