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Background: Studies have shown different mortalities due to cardiovascular diseases (CVD), ischemic heart disease (IHD) and cerebrovascular diseases (CbVD) in the five Brazilian regions. Socioeconomic conditions of those regions are frequently used to justify differences in mortality due to those diseases. In addition, studies have shown a reduction in the differences between the mortality rates of the five Brazilian regions., Objective: To update CVD mortality data in women and men in the five Brazilian regions., Methods: Mortality and population data were obtained from the Brazilian Institute of Geography and Statistics and Ministry of Health. Risk of death was adjusted by use of the direct method, with the 2000 world standard population as reference. We analyzed trends in mortality due to CVD, IHD and CbVD in women and men aged ≥ 30 years in the five Brazilian regions from 1980 to 2012., Results: Mortality due to: 1) CVD: showed reduction in the Northern, West-Central, Southern and Southeastern regions; increase in the Northeastern region; 2) IHD: reduction in the Southeastern and Southern regions; increase in the Northeastern region; and unchanged in the Northern and West-Central regions; 3) CbVD: reduction in the Southern, Southeastern and West-Central regions; increase in the Northeastern region; and unchanged in Northern region. There was also a convergence in mortality trends due to CVD, IHD, and CbVD in the five regions., Conclusion: The West-Central, Northern and Northeastern regions had the worst trends in CVD mortality as compared to the Southeastern and Southern regions. (Arq Bras Cardiol. 2016; [online].ahead print, PP.0-0)., Competing Interests: Potential Conflict of Interest No potential conflict of interest relevant to this article was reported.

Background: Studies have questioned the downward trend in mortality from cardiovascular diseases (CVD) in Brazil in recent years., Objective: to analyze recent trends in mortality from ischemic heart disease (IHD) and stroke in the Brazilian population., Methods: Mortality and population data were obtained from the Brazilian Institute of Geography and Statistics and the Ministry of Health. Risk of death was adjusted by the direct method, using as reference the world population of 2000. We analyzed trends in mortality from CVD, IHD and stroke in women and men in the periods of 1980-2006 and 2007-2012., Results: there was a decrease in CVD mortality and stroke in women and men for both periods (p < 0.001). Annual mortality variations for periods 1980-2006 and 2007-2012 were, respectively: CVD (total): -1.5% and -0.8%; CVD men: -1.4% and -0.6%; CVD women: -1.7% and -1.0%; DIC (men): -1.1% and 0.1%; stroke (men): -1.7% and -1.4%; DIC (women): -1.5% and 0.4%; stroke (women): -2.0% and -1.9%. From 1980 to 2006, there was a decrease in IHD mortality in men and women (p < 0.001), but from 2007 to 2012, changes in IHD mortality were not significant in men [y = 151 + 0.04 (R2 = 0.02; p = 0.779)] and women [y = 88-0.54 (R2 = 0.24; p = 0.320)., Conclusion: Trend in mortality from IHD stopped falling in Brazil from 2007 to 2012.

Background: Truck driver sleepiness is a primary cause of vehicle accidents. Several causes are associated with sleepiness in truck drivers. Obesity and metabolic syndrome (MetS) are associated with sleep disorders and with primary risk factors for cardiovascular diseases (CVD). We analyzed the relationship between these conditions and prevalence of sleepiness in truck drivers., Methods: We analyzed the major risk factors for CVD, anthropometric data and sleep disorders in 2228 male truck drivers from 148 road stops made by the Federal Highway Police from 2006 to 2011. Alcohol consumption, illicit drugs and overtime working hours were also analyzed. Sleepiness was assessed using the Epworth Sleepiness Scale., Results: Mean age was 43.1 ± 10.8 years. From 2006 to 2011, an increase in neck (p = 0.011) and abdominal circumference (p < 0.001), total cholesterol (p < 0.001), triglyceride plasma levels (p = 0.014), and sleepiness was observed (p < 0.001). In addition, a reduction in hypertension (39.6% to 25.9%, p < 0.001), alcohol consumption (32% to 23%, p = 0.033) and overtime hours (52.2% to 42.8%, p < 0.001) was found. Linear regression analysis showed that sleepiness correlated closely with body mass index (β = 0.19, Raj2 = 0.659, p = 0.031), abdominal circumference (β = 0.24, Raj2 = 0.826, p = 0.021), hypertension (β = -0.62, Raj2 = 0.901, p = 0.002), and triglycerides (β = 0.34, Raj2 = 0.936, p = 0.022). Linear multiple regression indicated that hypertension (p = 0.008) and abdominal circumference (p = 0.025) are independent variables for sleepiness., Conclusions: Increased prevalence of sleepiness was associated with major components of the MetS.

Background: Cardiovascular diseases (CVD) are the leading causes of death in our population. There was a progressive decrease in mortality due to CVD up to 2005., Objective: To update the trends in mortality from cardiovascular diseases in Brazil and in the metropolitan region of São Paulo (MRSP) from 1990 to 2009., Methods: Mortality and population data were obtained from the Brazilian Institute of Geography and Statistics and the Ministry of Health. The risk of death was adjusted by the direct method, having as reference the world population in 2000., Results: There was a progressive decrease in the risk of death from ischemic heart disease (IHD) and stroke in Brazil and in the MRSP. From 1990 to 2009, there was a decrease in mortality from IHD and stroke in men and women in Brazil and in the MRSP. There was a greater reduction in mortality from IHD in men in the MRSP than in Brazil (36.24% vs. 23.35%, p <0.001) and in women in the MRSP (44.55% vs. 29.5%; p <0.001). The highest reduction in stroke mortality was observed in men in the MRSP, when compared to Brazil (42.43% vs. 34.9%, p = 0.036) and an equal reduction in women in the MRSP and in Brazil (42.98% vs. 36.15%, p = 0.082). The decrease in mortality was significant for all age groups., Conclusion: We observed a progressive decrease in mortality from CVD, IHD and stroke in Brazil and in the MRSP. In spite of this decrease, we still have high rates of mortality from these diseases.

Background: The relationship between admission time to an emergency service and in-hospital outcomes in acute coronary syndrome (ACS) is controversial. Admission during off-hours would be associated with worse prognosis., Objective: To assess the influence of admission time on prolonged hospitalization and mortality for ACS patients, regarding regular hours (7AM-7PM) and off-hours (7PM-7AM)., Methods: The study assessed prospectively 1,104 consecutive ACS patients. In-hospital mortality and length of hospital stay ≥ 5 days were the outcomes analyzed., Results: Admission during regular hours was greater as compared with that during off-hours (63% vs. 37%; p < 0.001). Unstable angina was more prevalent during regular hours (43% vs. 32%; p < 0.001), while non-ST-segment elevation myocardial infarction (NSTEMI) was during off-hours (33% vs. 43%; p = 0.001). Differences in neither mortality nor length of hospital stay were observed in the time periods studied. Predictive factors for length of hospital stay ≥ 5 days were as follows: age [OR 1.042 (95%CI: 1.025 - 1.058), p < 0.001]; ejection fraction (EF) [OR 0.977 (95%CI: 0.966 - 0.988), p < 0.001]; NSTEMI [OR 1.699 (95%CI: 1.221 - 2.366), p = 0.001]; and smoking [OR 1.723 (95%CI: 1.113 - 2.668), p = 0.014]. Predictive factors for in-hospital mortality were as follows: age [OR 1.090 (95%CI: 1.047 - 1.134), p < 0.001]; EF [OR 0.936 (95%CI: 0.909 - 0.964), p < 0.001]; and surgical treatment [OR 3.781 (95%CI: 1.374 - 10.409), p = 0.01]., Conclusion: Prolonged length of hospital stay and in-hospital mortality in ACS patients do not depend on admission time.

Background: Restenosis after primary percutaneous coronary intervention (PPCI) remains an important clinical problem, even with stent implantation. The ability of noninvasive testing to diagnose restenosis has had only inconsistent demonstration., Objective: Our objective was to evaluate the ability of exercise treadmill testing (ETT) and myocardial perfusion imaging (MPI) to diagnose restenosis in patients treated by PPCI within 12 hours of ST-elevation myocardial infarction (STEMI)., Methods: From August 2003 to January 2006, 64 patients (mean age of 56.2±10.2 years, 53 males) were enrolled after PPCI. Only patients with left ventricular ejection fraction (LVEF) > 40%, as assessed by resting transthoracic echocardiography (TTE), were included. ETT with 12-lead ECG monitoring and right precordial leads, as also MPI were performed at 6 weeks, 6 months, and one year after intervention. Coronary angiography was performed at six months., Results: Single-vessel disease was observed in 46.9% of the patients. The left anterior descending coronary artery was treated in 48.4% of the patients. Angiographic restenosis occurred in 28.8%. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of ETT in detecting restenosis were not significant. Right precordial leads did not add information. MPI sensitivity, specificity, PPV, NPV, and accuracy correlated with restenosis only in the 6-month follow-up, both when considering summed difference score >2 (p=0.006) and >4 (p=0.014)., Conclusion: ETT did not discriminate restenosis in this population. MPI performed at 6 months correlated with restenosis and proved useful during follow-up.

Background: The effect of vaccination against the influenza virus on the mortality due to cardiovascular diseases (CVD) remains controversial., Objective: To analyze the mortality by CVD before and after the start of the vaccination against the Influenza virus in the city of Sao Paulo, Brazil., Methods: We analyzed the mortality due to ischemic heart diseases (IHD), cerebrovascular diseases (CbVD) and external causes (EC) in the population of the metropolitan region of the city of Sao Paulo, Brazil, aged > or = 60 years, before and after the start of the vaccination program against Influenza. The population estimates and mortality data were obtained, respectively, from the Brazilian Institute of Geography and Statistics (IBGE; www.ibge.gov.br) and from the Brazilian Ministry of Health (www.datasus.gov.br) for the period between 1980 and 2006. The risk of death was adjusted by the direct method, using the 1960 world standard population., Results: The comparisons between the inclinations of the regression lines were similar for CbVD (p = 0.931) and EC (p = 0.941); however, for IHD (p = 0.022), a significant decrease was observed in the regression line of the post-vaccination period, when compared to the pre-vaccination period. A change in the tendency towards mortality after 1996 was significant only for the IHD (p = 0.022), remaining unaltered for the CbVD (p = 0.931) and EC (p = 0.941)., Conclusion: The vaccination against the Influenza virus was associated with a significant decrease in the mortality due to IHD.

Introduction: Social turmoil associated with catastrophes such as flooding, earthquakes or air raids bring about an increased incidence of acute myocardial infarction. Premature death of media personalities with a strong public appeal may cause similar phenomena., Objective: To analyze the impact of this media coverage on the emergency service at a Heart Hospital in Brazil (InCor)., Methods: Demographic profiles of patients collected from the InCor's database were analyzed in the days following the death of an important TV personality (Group B). These patients were compared to a Control Group represented by those attended during the first semester of 2006., Results: When compared to the Control Group, Group B disclosed the following significant statistical changes: patients were younger and more of them were male. These findings reflect a change of profile in the control group tending to a greater similarity with the characteristics of the TV personality (man, 43 years old). These changes remained significant for four days (age) and one day (gender). Furthermore, the greater demand for the cardiologic emergency service was not followed by an increased number of deaths and hospitalizations for acute myocardial infarction., Conclusion: Media exposure on the circumstances of premature death by myocardial infarction of an important TV personality was associated with an increase in the number and a change in the profile of the patients seeking the emergency room at the InCor Heart Hospital. Differently from a situation such as catastrophes, this phenomenon was not followed by an increase in the incidence of myocardial infarction.

Objective: to compare the international normalized ratio (INR) measured by a point-of-care (POC) testing device with that measured by the conventional method in patients undergoing anticoagulation therapy with warfarin sodium., Methods: The INR of 383 warfarin-treated patients (mean age: 56.5 years; 207 female) was measured in capillary blood using the Hemochron Jr. device and compared with that of venous plasma samples determined by the conventional method performed in a Coag-A-Mate analyzer. Results were evaluated globally and for the following subgroups: INR < 2.0, from 2.0 to 3.5, and > 3.5., Results: Using both methods, the comparison between INR values yielded a correlation coefficient (r) of 0.86. However, mean differences in INR in both tests, considering the three subgroups, proved to be statistically significant (p <0.001): 0.14 +/- 0.21 (INR< 2.0); 0.54 +/- 0.31 (2.0 < or = INR < or = 3.5), and 1.64 +/- 1.10 (INR> 3.5). Paired Students t-test analysis revealed a p value < 0.001 for the three subgroups studied., Conclusion: The use of point-of-care testing for monitoring oral anticoagulation has some limitations. Anticoagulation intensity was underestimated by this method in the three subgroups studied.

Objective: The aim of this study was to evaluate the trends of ischemic and cerebrovascular death risk in the five regions--Midwest, Northeast, North, Southeast and South--of Brazil from 1981 to 2001., Methods: Data on mortality due to cerebrovascular and coronary heart diseases in the five regions of Brazil were obtained from the Brazilian Ministry of Health. The data source was the SIM--Sistema de Informações sobre Mortalidade (System of Information on Mortality), from the Department of Health Information Analysis. The population estimates were obtained from the IBGE (Brazilian Institute of Geography and Statistics) census of 1991 and 2000, and population estimates of 1996, all from DATASUS. The codes used in this study were International Classification of Diseases ICD-9 430-438 and ICD-10 I60-I69 for cerebrovascular diseases and ICD-9 410-414 and ICD-10 I21-I25 for ischemic disease. Statistical analysis was carried out by adjusted linear models., Results: There was a decline trend in death rates due to cerebrovascular disease at all age ranges and in both sexes in the South, Southwest, and Midwest regions. Additionally, death rates due to ischemic heart disease declined in the South and Southwest regions. There was a stabilization of the death risk in the Midwest and an increase in the Northeast region., Conclusion: The risk of death due to cerebrovascular and ischemic heart diseases declined in the Southwest and South, which are the more developed regions of Brazil, whereas the risk increased in the less developed ones, mainly in the Northeast region.

Objective: Analyze the trends in the risk of death from circulatory diseases (CD) in thirteen states in Brazil between 1980 and 1998., Methods: Data on mortality from CD, ischemic heart diseases (IHD), and cerebrovascular diseases (CVD) in thirteen states were obtained from the Ministry of Health data base. Populational estimates from 1980 to 1998 were calculated through interpolation, using the Lagrange method, based on data from the 1970, 1980, 1991 censuses, and 1996 populational count. The trends were analyzed by multiple linear regression model., Results: Mortality due to CD showed a trend towards decrease in most states. In Pernambuco state males presented increase in all age ranges, whereas in Goiás increase was shown from 40 years of age on, and in Bahia and Mato Grosso, from 50 years of age. Females showed increase starting at 30 in Mato Grosso, at 40 in Pernambuco, and in Goiás, in the age ranging from 30 to 49 years of age. In Goiás, increase was discreet in all other age ranges. As for IHD, mortality increase was reported in all age ranges in Mato Grosso and Pernambuco; in Bahia, Goiás and Pará, from 40 on. As for CVD, mortality increase was reported in all age ranges in Mato Grosso and Pernambuco; and from 40 on in Bahia and Goiás., Conclusion: Significant increase in the risk of death from circulatory diseases could be observed in less developed states in Brazil.

Objectives: Inflammation and activation of immune system cells play an important role in the pathogenesis of atherosclerosis. This study analyzes the white blood count, including neutrophils, eosinophils, lymphocytes, monocytes and basophils, of patients with chronic coronary artery disease (CAD) and acute myocardial infarction (AMI)., Methods: The white blood cell count was analyzed in 232 patients without diabetes between the ages of 15 and 88. One hundred and forty-two patients were angiographically diagnosed with CAD (57 with stable CAD and 85 with AMI) and compared to 90 control individuals. The control and CAD groups were similar in respect to age, body mass index, family history, smoking habits, hypertension, HDL and LDL (all variables with p > 0.25)., Results: The univariate analysis revealed a higher prevalence of leukocytosis in the CAD group, which in turn was higher in the AMI patients than the stable CAD patients. The same trend was observed for monocytes. However, the distribution of all other cells in the complete blood count (CBC) was similar. Multivariate analysis using the logistic regression method with the stepwise (all variables) and backward models (p < 0.25), showed that monocytosis was an independent variable for CAD and AMI., Conclusion: The number of monocytes, one of the most important components of the inflammatory process in the atherosclerosis plaque was an independent risk marker for CAD and AMI.

Objective: To assess the clinical and demographic characteristics of a population with ischemic heart disease admitted in the final decades of the 20th century., Methods: This study retrospectively assessed patients hospitalized with ischemic heart disease divided into the following 2 groups: acute group - 11.181 patients with acute myocardial infarction admitted from 1/1/82 to 12/31/94; and chronic group - 4.166 patients undergoing coronary artery bypass graft surgery from 1/1/84 to 12/31/94., Results: In the acute group, an increase in the percentage of females (from 22.7% to 27.7%, P<0.001) and diabetic individuals (from 12.4% to 17.5%, P<0.001) was observed, as was an increase in age (from 57.4 +/- 11.5 to 59.9 +/- 12.1 years, P<0.05). In-hospital mortality was greater among females (27.8% and 15.7%, P=0.001), among diabetic individuals (24.2% and 17.8%, P=0.001), and among the elderly (60.9 +/- 15.2 and 57.7 +/- 11.8 years, P=0.0001). In the chronic group, an increase in the percentage of females (from 17.5% to 27.2%, P=0.001) was observed, as was an increase in age (from 56.3 +/- 8.6 to 60.5 +/- 9.6 years, P=0.0001). In-hospital mortality was greater among females (8.3% and 5.8%, P<0.05) and among the elderly (58.1 +/- 9.1 and 62.1 +/- 7.9 years, P=0.0001)., Conclusion: The characteristics of the population studied with ischemic heart disease point towards a worse prognosis, due to the greater percentages of females, older patients, and diabetic patients, groups known to have greater in-hospital mortality.

Objective: Early coronary artery disease (CAD) is associated with risk factors (RF). Offspring of parents with a RF have a greater prevalence of them. However, the distribution of RF in parents and siblings of patients with early CAD is unknown., Methods: The study comprised the parents and siblings of 42 patients with early CAD (< 45 years), 29 males. Their mean age was 39.5 +/- 3.7 years. The following major RF were analyzed: smoking (> 5 cigarretes/day), hypercholesterolemia (total cholesterol > 200 mg/dL), hypertension (diastolic blood pressure > 90 mmHg), and diabetes (glycemia > 126 mg/dL)., Results: Of a total of 102 RF, 4, 3, 2, and 1 were observed in, respectively, 5, 15, 15, and 7 patients with early CAD, the most prevalent being smoking (86%) and hypercholesterolemia (83%). Diabetes was observed in 15 (36%) and hypertension in 16 (38%) patients. Smoking was more prevalent in the fathers (76%) and hypercholesterolemia in the mothers (30%). In 183 siblings, 131 RF were observed (1 patient with the disease had a mean of 4.7 siblings). The prevalences of smoking, hypertension, hypercholesterolemia, and diabetes in the siblings were, respectively, 32%, 18%, 14%, and 9%. The incidence of RF was as follows: 72 (39%) siblings had 1 RF, 25 (14%) siblings had 2 RF, and 3 (2%) siblings had 3 RF. In parents and their offspring, smoking was moderately correlated (r=0.43; P=0.02) with CAD., Conclusion: Smoking habit of parents is passed on to offspring, and, in association with hypercholesterolemia, it was the major cause of early CAD in offspring. High prevalence of smoking in offspring shows the potential responsibility of parents in the incidence of the disease in offspring.

Objective: To assess the trends of the risk of death due to circulatory (CD), cerebrovascular (CVD), and ischemic heart diseases (IHD) in 11 Brazilian capitals from 1980 to 1998., Methods: Data on mortality due to CD, CVD and IHD were obtained from the Brazilian Health Ministry, and the population estimates were calculated by interpolation with the Lagrange method based on census data from 1980 and 1991 and the population count of 1996. The trends were analyzed with the multiple linear regression method., Results: CD showed a trend towards a decrease in most capitals, except for Brasília, where a mild increase was observed. The cities of Porto Alegre, Curitiba, Rio de Janeiro, Cuiabá, Goiânia, Belém, and Manaus showed a decrease in the risk of death due to CVD and IHD, while the city of Brasília showed an increase in CVD and IHD. The city of São Paulo showed a mild increase in IHD for individuals of both sexes aged 30 to 39 years and for females aged 40 to 59 years. In the cities of Recife and Salvador, a reduction in CD was observed for all ages and both sexes. In the city of Recife, however, an increase in IHD was observed at younger ages (30 to 49 years), and this trend decreased until a mild reduction (-4%) was observed in males >/= 70 years., Conclusion: In general, a reduction in the risk of death due to CD and an increase in IHD were observed, mainly in the cities of Recife and Brasília.

Objective: Ischemic heart disease is associated with high rates of mortality and it is the most prevalent among cardiovascular diseases. It is a multifactorial disease, and its prevention depends on control of risk factors. Resting electrocardiogram can be used to detect manifestations of ischemic heart disease, since some electrocardiographic abnormalities are indicative of coronary disease in asymptomatic subjects. The aim of the study was to analyze the relationship between electrocardiographic abnormalities and risk factors for ischemic heart disease in an adult population from the metropolitan area of São Paulo., Methods: A cross-sectional study was carried out in an adult population (age 20 years and over) from Cotia, near São Paulo, southeastern of Brazil. The study population comprised 1067 subjects. The subjects were interviewed using a questionnaire. The variables studied were: gender, age, smoking behaviour, physical activity, body mass index, waist-to-hip ratio, blood pressure, diabetes mellitus, blood lipids (total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides) and electrocardiographic abnormalities. Electrocardiographic abnormalities were grouped according to the classification: ST-T changes, left ventricular hypertrophy and abnormalities non related to ischemic myocardial disease or without abnormalities., Results: The population was relatively -young (79% younger than 50 years, mean age 39.8 +/- 13.2 years old), and 59.3% were female. The resting electrocardiogram showed ST-T changes in 9.5% of the subjects and left ventricular hypertrophy in 3.3%. Female gender, age over 65 years for women and 55 years for men, diabetes, hypertension, total cholesterol >/= 200 mg/dl, LDL-cholesterol >/=130 mg/dl, Triglycerides >/=200 mg/dl, body mass index >/= 25 Kg/m2 and abnormal waist-to-hip ratio, were positively related to ST-T changes. Male gender, diabetes, hypertension and smoking behaviour were positively related to left ventricular hypertrophy. In the presence of ST-T changes on the ECG, we observed an odds ratio of 3.54 for the diagnosis of systolic hypertension an of 1.83 for total cholesterol >/= 200 mg/dl. In the presence of left ventricular hypertrophy on the ECG, we found an odds ratio of 5.92 for systolic hypertension diagnosis. Among the three most important risk factors correlated to electrocardiographic abnormalities indicative of myocardial ischemia, two can be controlled by nutritional intervention (hypertension and total cholesterol >/= 200 mg/dl). This findings suggest the importance of its early detection. Future studies should determine the predictive value of the electrocardiogram, a simple and inexpensive method, suggesting the presence of cardiovascular risk factors in epidemiological and nutritional studies.

Purpose: To evaluate the efficacy and safety of benazepril versus captopril in patients with mild or moderate systemic arterial hypertension (SAH)., Methods: A multicenter, double-blind, randomized trial analyzed 174 patients, mean age of 52 +/- 9 years, 68 (39%) men. After 2 weeks under placebo, 90 patients were treated, during 6 weeks, with 10 mg, once a day, of benazepril (BZ) and 50 mg, twice a day, of captopril (CPT). At week 3, 25 mg of hydrochlorothiazide (HCT) was added if diastolic blood pressure (DBP) was greater than 90 mmHg. Side effects were analyzed as a not related, unlikely, possible, probable and definitive regard to treatment., Results: Systolic (p < 0.001) and DBP (p < 0.0001) reductions were observed in both groups. Additional reduction was observed in both groups when 25 mg of HCT was added in patients with DBP > 90 mmHg at week 3. Heart rate was unchanged. The response to treatment was better at BZ group (74% versus 59% of good and excellent response; p = 0.037). Side effects classified as probable or definitive in relation to the treatment occur in 3 (3%) and 10 (11%), respectively at BZ an CPT groups. Laboratorial changes were not observed during treatment., Conclusion: BZ (10 mg) was superior to CPT (50 mg) in patients with discrete and moderate SAH.

Purpose: To evaluate the effects of the use of chlorthalidone on left ventricular mass of patients with mild and moderate systemic arterial hypertension (SAH)., Methods: Twenty-nine patients with mild and moderate SAH were studied with mean age of 48.4 years and 16 men. Clinical evaluation, systolic (SBP) and diastolic (DBP) blood pressure and heart rate (HR), in supine and standing positions, were obtained before and every 3 weeks, after 2 with placebo, during 12 weeks of treatment with 50mg of chlorthalidone each 48 hours. Laboratory data (hemogram, sodium, potassium, urea creatinine, glucose, hepatic aminotransferases and urinalysis) were done before and at end of study. Echocardiographic study was performed by M-mode before and after 6 and 12 weeks of treatment, and obtained the following data: diastolic diameter (DdLV), diastolic septum (DSTLV) and posterior wall thickness (PWTLV) of left ventricle. The left ventricular mass (LVM) was calculated by the formula: LVM = (DSTLV+PWTLV+DdLVE)3 - (DdLV)3 x 1.05/body surface, in g/m2., Results: A significant reduction of SBP (p < 0.0001), DBP (p < 0.001) in supine and standing positions. HR did not show statistical difference. At echocardiographic study, M-mode, was observed a significant reduction of LVM after 12 weeks of treatment (181 +/- 67 to 156 +/- 34 g/m2, p < 0.01)., Conclusion: Chlorthalidone was effective to control blood pressure and to reduce LVM of patients with SAH.

Purpose: To evaluate the efficacy of buspirone hydrochloride in patients of the cardiologic clinic with generalized anxiety., Methods: Fifty out-patients with psychosomatic cardiovascular symptoms in cardiology were treated for six weeks with initial dose of 5mg of buspirone hydrochloride t.i.d., Results: The results obtained were good in 76% of the patients, fair in 18% and ineffective in 6% of the cases. Thirteen patients (26%) reported at least one adverse event, the side effects reported were: somnolence, headache, flatulence, tinnitus, nasal congestion and dry mouth. No interruption of the treatment was needed., Conclusion: Buspirone hydrochloride is a valid alternative for treating pathological anxiety in patients in which the state of alertness and good psychomotor skills must be preserved.

Purpose: To evaluate the hemodynamic effects of low doses of chlorthalidone (CHT) in patients with systemic arterial hypertension (SAH)., Methods: Eight patients with mild SAH, mean age of 52 +/- 8.9 years, 7 men, were studied. Clinical evaluation, systolic (SBP) and diastolic (DBP) blood pressure and heart rate (HR), in supine and standing positions, were obtained before and every two weeks, first two in placebo, during 12 weeks. Laboratory data, hemogram, sodium, potassium, urea, creatinine, glucose, hepatic aminotransferases and urinalysis, were done and at end of study. Hemodynamic monitorization was performed by Swan-Ganz catheter in pulmonary artery to obtain RAP and PAWP, in mmHg. Cardiac output (CO) was obtained by thermodilution method. Systemic vascular resistance (SVR) arose from variables above. Hemodynamic variables were measured at 2nd and 12th weeks during treatment with 50mg of chlorthalidone each 48 h., Results: A significant reduction of SBP (p = 0.005 and p = 0.003), DBP (p < 0.0001 and p < 0.0001), respectively in supine and standing positions. HR did not show statistical difference. At hemodynamic monitoring was observed a significative reduction of SVR (p < 0.02), but not with CO., Conclusion: Chlorthalidone in low dosis was effective to treat mild SAH, basically by lowering SVR.

Purpose: To evaluate the effects of intravenous furosemide over hemodynamics variables and colloid osmotic pressure in patients with pulmonary edema., Methods: Eight patients with pulmonary edema, mean age of 58.3 +/- 7.5 years, 6 men, were evaluated. Hemodynamic monitoring was performed by Swan-Ganz catheter in pulmonary artery to obtain RAP and PAWP, in mmHg, and HR, in bpm. Cardiac output (CO) was obtained by thermodilution method. Cardiac index (CI) in L/min/m2, and systolic index, in ml, arose from variables above. Mean arterial pressure (MAP), in mmHg, was obtained through catheterization of radial artery. patients were treated with 20 mg of intravenous furosemide, and hemodynamic variables were measured before and after 5, 15, 30, 60 and 120 minutes. COP was measured in Weil oncometer (IL 196) at same intervals., Results: A significant reduction of RAP (p = 0.002) and PAWP (p < 0.0001), HR (p = 0.02), COP (p < 0.0001) and gradient between PAWP-COP (p < 0.0001) were observed. RAP and PAWP reduction was greater in the first five minutes and, otherwise, COP reduction was gradual in 120 min. PAWP-COP gradient initially positive, stayed negative during all study. MAP, CI, SI and SVR did not show statistical differences., Conclusion: Furosemide administration reduced RAP, PAWP, HR, COP and PAWP-COP gradient, probably by a redistribution of fluid excess in the interstitial to intravascular space, through changes in driving fluid forces, with predominance in colloid osmotic pressure, which reverse fluid from intravascular to interstitial observed in pulmonary edema.

Purpose: To evaluate the effects of diltiazem and propranolol in patients with unstable angina., Methods: Fifty-six patients with unstable angina, mean age of 55.4 +/- 8.5, 41 men and 15 women, were evaluated in a randomized, double-blind study of two groups of patients treated with diltiazem or propranolol at total daily doses of 180 mg and 120 mg respectively during the first 48 hours. After that the total daily doses was adjusted to 240 mg and 160 mg, respectively, until the 7th day. The first 48 hours, four times daily, clinical evaluation, CKMB data, ECG were obtained and two times daily until 7th day. A coronary arteriography was done on study entry., Results: A significative reduction of angina crisis number, duration, intensity and the number of sublingual nitrates doses were observed equally in both groups. The SAP, DAP, HR and RR did not show statistical differences between groups. Individual groups analysis showed significative reductions of SAP, DAP and HR in propranolol group. The CKMB data, ECG alterations and coronary arteriography characteristics were similar., Conclusion: Both drugs were effective for the unstable angina treatment.

Purpose: To evaluate the effects of sublingual administration of diazepam, nifedipine, propranolol and the association of nifedipine with propranolol patients with hypertensive crisis., Methods: Eighty patients with hypertensive crisis, DAP greater than 120 mmHg, and mean age of 54 +/- 7.4 years, 33 women and 47 men, were evaluated. The AP was measured with an aneroid sphygmomanometer, in mmHg, in orthostatic position, before and after 10, 20, 30 and 60 minutes of treatment. The heart rate in one minute was also measured at the same intervals. The patients were divided randomly into four groups and treated, respectively, with 10 mg of diazepam, 10 mg of nifedipine, 40 mg of propranolol and 10 mg of nifedipine associated with 40 mg of propranolol., Results: A significant and gradual reduction of SAP and DAP were observed in all groups of patients. The percentage of reduction, after 60 minutes, for SAP was, respectively, 10.1%, 12.9%, 15.4% and 16%, and for DAP 7.7%, 11.3%, 13.6% and 13% in groups I to IV. The heart rate did not change in groups I and II, but significative reduction was observed in groups III (p = 0.002) and IV (p = 0.009)., Conclusion: The drugs used were effective for the treatment of hypertensive crisis, and the sublingual administration is an important and easy way for their administration.

Purpose: To compare the ticlopidine and dipyridamole effects on platelets count and aggregation in patients with stable coronary artery disease., Patients and Methods: Eighty patients with stable coronary artery disease and mean of 58.3 +/- 5.8 years were studied. They were divided into two equal groups of 40 patients and each one treated with ticlopidine or dipyridamole. Platelets count and aggregation were examined before treatment and at first and fourth weeks of treatment., Results: At the end of fourth week of treatment, spontaneous, induced by ADP or by adrenalin platelet aggregation inhibition was observed, respectively, in 82.5%, 72.5% e 67.5% of the patients in ticlopidine group. The spontaneous, induced by ADP or by adrenalin, platelet aggregation inhibition in the patients of dipyridamole group was, respectively, 40%, 30% e 27.5% (p less than 0.001). The platelets count did not change in both groups., Conclusion: The ticlopidine effect is much more evident in platelet aggregation inhibition than dipyridamole, and maybe a choice in the prevention of cardiovascular events.

Anomalous origin of the left main coronary artery from the pulmonary artery in a 50 year-old patient whose initial symptom was effort angina during the last 8 months. The clinical features and treatment are also discussed.