Search

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

Paragangliomas (PGLs) are extra-adrenal neuroendocrine tumors, classified as sympathetic or parasympathetic according to their origin in the paraganglia of the autonomic nervous system. Sympathetic PGLs are mostly functional, presenting in a variable and non-specific way. We report a case of PGL, which was diagnosed following investigation of acute myocardial infarction in a postpartum woman, highlighting that the absence of typical symptoms may delay the diagnosis.

Introduction: Ambulatory blood pressure monitoring by automatic device is the best blood pressure evaluation method and sleep apnea syndrome is the leading cause of poor control. Oximetry allows screening these individuals but its usefulness has been poorly explored in Primary Health Care. The aim was to evaluate the blood pressure control at the office and with ambulatory blood pressure monitoring by automatic device and to relate it to sleep apnea syndrome. Material and Methods: We selected a sample of 50 participants, representative of 3036 hypertensive patients. The variables were: blood pressure value at the office and blood pressure with ambulatory blood pressure monitoring by automatic device; presence of criteria of sleep apnea syndrome in oximetry. Results: The prevalence of uncontrolled blood pressure was 56% on office evaluation and 68% on ambulatory blood pressure monitoring by automatic device. It was found: 36% of daytime hypertension, 52% nocturnal hypertension, 40% non-dipper profile, 16% of white coat hypertension and 28% masked hypertension. The prevalence of sleep apnea syndrome was 16%. Blood pressure in ambulatory blood pressure monitoring by automatic device and blood pressure in office showed no statistically significant association (p = 0.761). We found a statistically significant association between sleep apnea syndrome and daytime hypertension (p = 0.019) and non-dipper profile (p = 0.005). Discussion and Conclusion: Ambulatory blood pressure monitoring by automatic device detected more 12% of uncontrolled hypertension than office blood pressure. Sleep apnea syndrome is strongly associated with uncontrolled hypertension and oximetry may be a good screening method, but should be studied further.

Objective: Pulse Wave Velocity (PWV) is considered a marker of cardiovascular (CV) risk prognosis. The objective was to evaluate the association of PWV, other features and CV events in a sample of hypertensive patients. Design and method: We studied 314 hypertensive patients without previous CV events evaluated by PWV in a Portuguese average-size hospital, through its descriptive and survival analysis. Results: Of the 314 patients (51% male) ageing 54.0 ± 14.2 years, 31.5% had resistant hypertension, 26.8% were diabetic, 66.6% had hyperlipidaemia, the average body mass index was 28.3 kg m−2, and 16.6% were active smoker. Through a follow-up of 2.1 ± 2.2 years, 28 patients (8.9%) had a CV event. Comparison of the patients with PWV ≤ 10 ms−1 and the patients with PWV >10 ms−1, showed statistical significance for age (64.3 ± 10.5 vs 50.2 ± 13.4 years, p < 0.0001), casual systolic blood pressure (137.4 ± 16.3 mmHg vs 154.4 ± 21.4 mmHg, p < 0.0001), PWV (7.9 ± 1,2 ms−1 vs 12.2 ± 1.9 ms−1, p < 0.0001) left ventricular hypertrophy (193,3 ± 58.6 vs 235,8 ± 65.1, p < 0.01) and left auricular volume (19,9 ± 3.9 vs 23.3 ± 5.8, p < 0.002). Patients with PWV>10ms−1, 77,3% had left ventricular hypertrophy (p < 0.004) and 70% had left auricular enlargement (p < 0.08). In the survival analysis, the Kaplan Meier curve showed a worse prognosis for CV events with PWV > 10 ms−1 (log rank 6.0, p < 0,014). Conclusions: Higher PWV indicating worse artery damage is associated with end organ damage like left ventricular hypertrophy and left auricular enlargement. In patients with no previous CV events, PWV>10 ms−1 is an indicator for worse prognosis for CV events.

Resumo: Introdução: A associação da dieta mediterrânica e de exercício físico parecem apresentar um papel protetor na diminuição do risco cardiovascular. Este estudo pretende verificar os efeitos de sessões de educação fundamentadas na dieta mediterrânica e de um programa de exercícios na modificação de comportamentos alimentares, composição corporal e gordura abdominal. Métodos: Estudo experimental composto por 20 indivíduos, com doença arterial coronária conhecida, distribuídos aleatoriamente em dois grupos: experimental (n = 10) e controlo (n = 10). Ambos os grupos foram sujeitos às sessões de educação para a saúde, mas o grupo experimental executou um programa suplementar de exercícios específicos durante oito semanas. Foi utilizado o questionário semiquantitativo de frequência alimentar para análise da ingestão de alimentos, a bioimpedância para medição do peso, massa gorda e massa magra, e o perímetro da cintura para cálculo da razão cintura‐estatura. Resultados: Após as oito semanas, o grupo experimental ingeriu significativamente menos proteínas (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‐

Objectives: to report a case of hypereosinophilic syndrome which presented clinically acute coronary syndrome. Materials and methods: we describe a case of a 69-year-old woman with acute coronary syndrome and peripheral hypereosinophilia. Results: the condition rapidly evolved to severe heart failure. Coronary disease was excluded by cardiac catheterization. Systemic corticosteroid therapy was initiated and further secondary causes of hypereosinophilia were excluded.

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

Heart failure (HF) is a clinical entity included in cardiovascular diseases affecting millions of people worldwide, being a leading cause of hospitalization of older adults, and therefore imposing a substantial economic burden on healthcare systems. HF is characterized by dyspnea, fatigue, and edema associated with elevated blood levels of natriuretic peptides, such as N Terminal pro-B-type Natriuretic Peptide (NT-proBNP), for which there is a high demand for point of care testing (POCT) devices. Optical fiber (OF) biosensors offer a promising solution, capable of real-time detection, quantification, and monitoring of NT-proBNP concentrations in serum, saliva, or urine. In this study, immunosensors based on plasmonic uncladded OF tips were developed using OF with different core diameters (200 and 600 µm). The tips were characterized to bulk refractive index (RI), anddetection tests were conducted with NT-proBNP concentrations varying from 0.01 to 100 ng/mL. The 200 µm sensors showed an average total variation of 3.6 ± 2.5 mRIU, an average sensitivity of 50.5 mRIU/ng·mL−1, and a limit of detection (LOD) of 0.15 ng/mL, while the 600 µm sensors had a response of 6.1 ± 4.2 mRIU, a sensitivity of 102.8 mRIU/ng·mL−1, and an LOD of 0.11 ng/mL. Control tests were performed using interferents such as uric acid, glucose, and creatinine. The results show the potential of these sensors for their use in biological fluids.

Treatment options for hypertension have been evolving over time. However, prevalence rates keep increasing and perpetuate hypertension as a major cardiovascular risk factor. Exercise training is effective in reducing blood pressure, cardiovascular disease risk factors and mortality, besides improving quality of life. However, participation rates for hypertensive patients remain shockingly low and adherence to exercise training tends to decline following exercise programs. These trends emphasize the need to deepen our knowledge of modifiable intrapersonal, interpersonal, and socioeconomic and environmental factors that help explain exercise adherence among people with hypertension. The present review focuses on the determinants of adherence and long-term maintenance of a physically active lifestyle in hypertensive individuals.

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 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.