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Mayra Cristina da Luz Pádua Guimarães,1 Juliana Chaves Coelho,1 Giovanio Vieira da Silva,2 Luciano Ferreira Drager,2,3 Rita de Cassia Gengo e Silva Butcher,1 Howard K Butcher,4 Angela Maria Geraldo Pierin1 1Graduate Program in Adult Health Nursing (PROESA), University of São Paulo Nursing School, São Paulo, SP, Brazil; 2Hypertension Unit, Renal Division, University of São Paulo Medical School, São Paulo, SP, Brazil; 3Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, SP, Brazil; 4Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USACorrespondence: Mayra Cristina da Luz Pádua GuimarãesGraduate Program in Adult Health Nursing (PROESA), University of São Paulo Nursing School, São Paulo, SP, BrazilEmail mayraguimaraes@usp.brObjective: To evaluate and identify variables associated with the control of hypertension and adherence to antihypertensive drug treatment in a group of patients with hypertension monitored in a specialized, highly complex outpatient service.Methods: A prospective, cross-sectional study was carried out in the hypertension unit of a tertiary teaching hospital. Patients diagnosed with hypertensive aged 18 years and over and accompanied for at least six months were included in the study. Patients with secondary hypertension and pregnant women were excluded. The sample consisted of 253 patients. Adherence/concordance to antihypertensive treatment was assessed using the Morisky Green Levine Scale. Blood pressure control was set for values less than 140/90 mmHg. Variables with p≤ 0.20 in univariate analysis were included in multiple logistic regression. The level of significance adopted was p ≤ 0.05.Results: Most of patients were white, married and women, with a mean age of 65 (13.3) years old, low income, and education levels. Blood pressure control and adherence were observed in 69.2% and 90.1% of the patients, respectively. Variables that were independently associated with blood pressure control were (OR, odds ratio; CI, 95% confidence interval): married marital status (OR 2.3; CI 1.34– 4.28), use of calcium channel blockers (OR 0.4; CI 0.19– 0.92) and number of prescribed antihypertensive drugs (OR 0.78; CI 0.66– 0.92). Adherence was not associated with any of the variables studied.Conclusion: There was a high frequency of patients with satisfactory adherence to antihypertensive drug treatment. Blood pressure control was less frequent and was associated with social and treatment-related factors.Keywords: hypertension, control, adherence, pharmacological treatment

Objective: To identify the association between blood pressure control and the following variables: a) bio-social and lifestyle characteristics of hypertensive patients; and b) factors related to the antihypertensive treatment., Methods: This is an exploratory study with 290 people with hypertension from primary care. We used a specific instrument, self-administered, with 21 questions on factors that can hinder treatment, divided into four dimensions: medication, socioeconomic, institutional and personal beliefs. We adopted a significance level of p <0.05., Results: The control of blood pressure was associated (p <0.05) with female gender, Caucasian ethnicity, primary/secondary education, not drinking alcohol, higher income and regular physical activity. Regarding the factors that can hinder treatment, there was association of hypertension control with only two questions: "feel nothing" and "have to do treatment for life"., Conclusion: Sociodemographic variables and beliefs concerning the absence of symptoms and chronicity of the disease influenced the control of hypertension and should be considered in the adherence process to the treatment., Objetivo: Identificar a associação entre o controle da pressão arterial e as seguintes variáveis: a) características biossociais e hábitos de vida dos hipertensos; e b) fatores relacionados ao tratamento anti-hipertensivo., Métodos: Realizou-se estudo exploratório com 290 hipertensos da atenção primária. Utilizou-se de instrumento específico, autoaplicável, com 21 questões sobre fatores que podem dificultar o tratamento, divididas em quatro domínios: medicamentos, socioeconômico, institucional e crenças pessoais. Adotou-se nível de significância de p < 0,05., Resultados: O controle da pressão arterial se associou (p < 0,05) com sexo feminino, etnia branca, ensino fundamental/médio, não ingerir bebida alcoólica, maior renda e atividade física regular. Quanto aos fatores que podem dificultar o tratamento, houve associação do controle com apenas duas questões: "não sentir nada" e "ter que fazer tratamento para vida toda"., Conclusão: Variáveis sociodemográficas e crenças relativas à ausência de sintomatologia e cronicidade da doença influenciaram o controle dos hipertensos e devem ser consideradas no processo de adesão ao tratamento.

Objective: To compare men and women who have hypertension with reference to the following: high blood pressure, biosocial variables, habits and life styles, mental disorders, and social support networks., Method: 290 hypertensive patients (women, 62.1%) were evaluated. The assessments involved the following: measuring blood pressure with an automatic measuring device, evaluating social status through the Social Support Scale, and the use of a Self-Report Questionnaire (SRQ-20) to identify common mental disorders. A value of p<0.05 was considered statistically significant., Results: Women were found to be different to men (p<0.05) in the following areas having: better control of their blood pressure (64.4% vs 52.7%), less salary incomes, less diabetes, higher total cholesterol, higher body mass index and wider abdominal circumferences. They also had lower systolic blood pressure, lower levels of alcohol consumption and a greater prevalence for mental disorders. The social support assessment revealed that hypertensive women received less help with preparing meals but had more company from people which allowed them to engage in enjoyable activities., Conclusion: Women had more control over their blood pressure than men, despite the presence of negative biopsychosocial factors that may have influenced their adherence to the treatments.

Objective: Evaluating the evidence of hypertension prevalence among indigenous populations in Brazil through a systematic review and meta-analysis., Methods: A search was performed by two reviewers, with no restriction of date or language in the databases of PubMed, LILACS, SciELO, Virtual Health Library and Capes Journal Portal. Also, a meta-regression model was designed in which the last collection year of each study was used as a moderating variable., Results: 23 articles were included in the review. No hypertension was found in indigenous populations in 10 studies, and its prevalence was increasing and varied, reaching levels of up to 29.7%. Combined hypertension prevalence in Indigenous from the period of 1970 to 2014 was 6.2% (95% CI, 3.1% - 10.3%). In the regression, the value of the odds ratio was 1.12 (95% CI, 1.07 - 1.18; p <0.0001), indicating a 12% increase every year in the probability of an indigenous person presenting hypertension., Conclusion: There has been a constant increase in prevalence despite the absence of hypertension in about half of the studies, probably due to changes in cultural, economic and lifestyle habits, resulting from indigenous interaction with non-indigenous society.

OBJECTIVE To identify the prevalence of arterial hypertension and associated factors in patients submitted to myocardial revascularization. METHOD Cross-sectional study using the database of a hospital in São Paulo (SP, Brazil) containing 3010 patients with coronary artery disease submitted to myocardial revascularization. A multiple logistic regression was performed to identify variables independently associated with hypertension (statistical significance: p<0.05). RESULTS Prevalence of hypertension was 82.8%. After the variables were adjusted, the associated factors were as follows: age, odds ratio (OR): OR=1.01; 95% confidence interval (CI): CI:1.00-1.02; female gender: (OR=1.77;CI:1.39-2.25); brown-skin race: (OR=1.53;CI:1.07-2.19); obesity: (OR=1.53;CI:1.13-2.06); diabetes: (OR=1.90;CI:1.52-2.39); dyslipidemia: (OR=1.51;CI:1.23-1.85); and creatinine>1.3: (OR=1.37;CI:1.09-1.72). CONCLUSION A high prevalence of arterial hypertension and association with both non-modifiable and modifiable factors was observed.

Objective To compare hypertensive patients with and without chronic kidney disease and identify factors associated with their clinical condition and antihypertensive treatment. Method This was a cross-sectional study conducted with patients hospitalized in a general medical ward at a university hospital in the city of São Paulo, Brazil. Data were collected from medical records. Significance was set at p<0.05. Results Of the 386 patients studied, 59.3% presented hypertension and, of these, 37.5% presented chronic kidney disease. The data showed an independent association between chronic kidney disease and prior history of diabetes (OR 1.86; CI 1.02-3.41), congestive heart failure (OR 3.42; CI 1.36-9.03) and living with a partner (OR 1.99; CI 1.09-3.69). Regarding antihypertensive treatment, there was a difference (p<0.05) between hypertensive patients with and without chronic kidney disease in terms of administering healthcare treatment (93.2% versus 77.7%); ongoing use of antihypertensive drugs, (79.1% versus 66.4%); higher number of antihypertensive drugs; the use of beta-adrenergic blockers (34.9%versus 19.6%), calcium channel blockers (29.1%versus 11.2%), loop diuretics (30.2%versus 10.5%) and vasodilators (9.3%versus 2.1%). Conclusion The hypertensive patients with chronic kidney disease presented a more compromised clinical profile; however, the attitudes of these patients toward antihypertensive treatment were more positive than those without chronic kidney disease.

Introduction: Chronic kidney disease (CKD) is a major public health problem worldwide. Nonetheless, little is known about its features in Brazil., Objective: To identify prevalence and factors associated with CKD among hospitalized patients in a university hospital., Methods: We randomly selected 826 medical records of patients admitted in 2009 in the medical inpatient unit. We defined CKD as the presence of medical diagnosis or personal history. We collected a number of clinical and demographic information and these variables were compared between patients with and without CKD., Results: CKD prevalence was 12.7%. Patients with CKD differed from patients without (p < 0.05) regarding to: living with a partner (59.8% vs. 47.3%), older age (65.8 ± 15.6 vs. 55.3 ± 18.9 years-old), more comorbidities as hypertension (75.2% vs. 46.3%), diabetes (49.5% vs. 22.4%), dyslipidemia (23.8% vs. 14.9%), acute myocardial infarction (14.3% vs. 6.0%) and congestive heart failure (18.1% vs. 4.3%); length of hospitalization (11 (8-18) vs. 9 (6-12) days); and death occurrence (12.4% vs. 1.4%). The logistic regression analysis showed an independent association (OR, odds ratio, CI, confidence interval 95%) of CKD with age (OR 1.019, CI 1.003 to 1.036), hypertension (OR 2.032, CI 1.128 to 3.660), diabetes (OR 2.097, CI 1.232 to 3.570) and congestive heart failure (OR 2.665, CI 1.173 to 6.056)., Conclusion: CKD prevalence among patients in a medical inpatient unit was high and CKD patients were more complex, as they were older and had a great number of co-morbidities, reflecting a greater risk of death during hospitalization.

Objective: This study assessed pharmacological treatment adherence using the Morisky-Green Test and identified related variables., Method: A longitudinal and retrospective study examined 283 patients with hypertension (62.5% women, 73.4 [10.9] years old) who were being monitored by a chronic disease management program for 17 months between 2011 and 2012. Nurses performed all the actions of the program, which consisted of advice via telephone and periodic home visits based on the risk stratification of the patients., Results: A significant increase in treatment adherence (25.1% vs. 85.5%) and a decrease in blood pressure were observed (p<0.05). Patients with hypertension and chronic renal failure as well as those treated using angiotensin-converting enzyme inhibitors were the most adherent (p<0.05). Patients with hypertension who received angiotensin receptor blockers were less adherent (p<0.05)., Conclusions: Strategies such as nurse-performed chronic disease management can increase adherence to anti-hypertensive treatment and therefore contribute to the control of blood pressure, minimizing the morbidity profiles of patients with hypertension.

Objective: To describe the prevalence and identify the factors associated with excess weight in restaurant employees at a public university in the city of São Paulo., Methods: A socioeconomic and nutritional census was conducted with 174 individuals to obtain data on body mass, height, and socioeconomic status, using a structured questionnaire. The body mass index was determined, and the cut-off points recommended by the World Health Organization were used. Student's t test, Fisher's exact test, and the χ² test were used to verify the differences between the means and prevalences. Poisson regression analyses with robust variance were performed, and the outcomes were excess weight or no excess weight., Results: Most of the employees (57.5%) were women; 59.8% were non-white, 45.4% lived with a partner, 26.4% were smokers, and 50.6% were sedentary. There was a predominance of individuals with excess weight (60.9%), and most of them (64.0%) were women, non-white (66.3%), lived alone (58.8%), and were non-smokers (63.3%); furthermore, 62.8% of the subjects engaged in physical activities. There was a significant difference (p=0.03) regarding body mass index and gender, demonstrating more excess weight among the women. Excess weight was dependent on the age group and was more likely to occur in individuals over 50 years of age (adjusted prevalence ratio: 1.72; 95% confidence interval: 1.02 - 2.98)., Conclusion: There was a high prevalence of excess weight in these professionals, indicating the necessity for interventions to control this important risk factor for chronic non-communicable diseases.

Hypertension is a major public health problem due to its high prevalence and cardiovascular complications. Its treatment is aimed at reducing cardiovascular morbidity and mortality, its goal being to maintain blood pressure levels below 140/90 mm Hg. Hypertension control in Brazil is low, and nationwide rates are unknown. The objective of this review was to provide an overview on hypertension control in Brazil from publications in a database. We identified 45 publications. In population-based studies, the highest control rate (57.6%) was reported in a multicenter study in 100 municipalities and the city of São José do Rio Preto, São Paulo state (52.4%), while the lowest rates (around 10%) were identified in microregions of the Rio Grande do Sul state and in the city of Tubarão, Santa Catarina state. In conclusion, the studies assessed showed a wide variation in hypertension control rates. It is worth noting that the comparison between studies was a major limiting factor, because of the different methods used.

A randomized comparative study was performed to evaluate the control of hypertension with use of home blood pressure measurement (HBPM) and casual blood pressure measurement, and analyze the white coat effect. Hypertensive patients in primary health care units were randomly divided into two groups: group I, participating of the educational activities and group II that followed the routine treatment. The hypertensive patients from group I realized HBPM at the beginning and the end of the study. White-coat effect was evaluated by the difference between the casual blood pressure measurement and HBPM. The study included 290 hypertensive patients, but realized HBPM 82 hypertensive patients. There was increase in blood pressure control from the beginning to end of study in hypertensive patients from group I (p < 0.05) measured by HBP (60% to 68.3%) and casual measurement (62% to 71%) and in group II, HMBP hypertension control was higher than the casual blood pressure measurement (63% vs 50%). The white coat effect was greater in hipertensive patients from group II.

This qualitative study was performed with 71 hypertensive patients, with the objectives to compare outpatient and home blood pressure monitoring (HBPM), to assess blood pressure control, and characterize white-coat hypertension. A nurse performed the outpatient blood pressure measurement. The home blood pressure monitoring was carried out over seven days. White-coat hypertension was quantified as a difference between the outpatient measurement and home blood pressure monitoring in the ranges from 1 to 5, 6 to 10 and > 10 mmHg. The outpatient blood pressure measurement was significantly higher (p<0.05) than the home blood pressure measurement. Pressure control corresponded to 9.9% in the outpatient measurement and 23.9% in the home blood pressure measurement. The white-coat effect > 10 mmHg was 57.7% for systolic and 32.4% for diastolic pressure, in the range from 6 to 10 mmHg. Home blood pressure measurement provided a better assessment of hypertensive patients' control.

Background: Inadequate life habits are known to favor hypertension, and Adventists recommend healthy life habits., Objective: To assess the prevalence of hypertension among Seventh-Day Adventists from the inner São Paulo state and São Paulo state capital., Methods: This study assessed 264 Adventists (mean age, 41.17 ± 15.27 years; women, 59.8%) with a high religiosity level assessed by use of the Duke University Religion Index. Blood pressure was measured with a validated automatic device. The significance level adopted was p < 0.05., Results: The total prevalence of hypertension was 22.7% (27.4% in the inner state and 15% in the capital). The Adventists from the capital differed from those of inner state as follows (p < 0.05), respectively: higher education (62% vs 36.6%); employed by a third party (44%) vs self-employed (40.9%); family income (8.39 ± 6.20 vs 4.59 ± 4.75 minimum wages); individual income (4.54 ± 5.34 vs 6.35 ± 48; couple responsible for family income (35% vs 39.6%); vegetarianism (11% vs 3%); blood pressure (115.38 ± 16.52/68.74 ± 8.94 vs 123.66 ± 19.62/74.88 ± 11.85 mmHg); white ethnicity (65% vs 81.1%); married (53% vs 68.9%); lower tangible support in the social aspect (15.7 ± 5.41 vs 16.9 ± 4.32); and recalling the last time one's blood pressure was measured (65% vs 48.8%). On multivariate analysis, hypertension associated with the following: 1) vegetarianism (OR 0.051; 95% CI: 0.004-0.681); 2) educational level (OR 5.317; 95% CI: 1.674-16.893); 3) recalling the last time one's blood pressure was measured (OR 2.725; 95% CI: 1.275-5.821); 4) being retired (OR 8.846; 95% CI: 1.406-55.668); and 5) being responsible for family income (OR 0.422; 95% CI: 0.189-0.942)., Conclusion: The prevalence of hypertension among Adventists was lower as compared with that reported in Brazilian studies, and it was lower in the São Paulo state capital as compared with that in the inner São Paulo state, possibly because of the better socioeconomic conditions and life habits of the former.

The objective of this study was to assess the cardiovascular risk factors among health professionals, particularly hypertension, and stratify them according to the Framingham Risk Score (FRS). The participants were 154 professionals working in pre-hospital care in São Paulo, Brazil, and on the Br-116 highway. Values were considered significant for p<0.05. The prevalence of hypertension was 33%, 20.1% were smokers, 47% consumed alcoholic beverages, 64% were sedentary, 66% were obese/overweight and 70% had an altered abdominal circumference. In terms of laboratory values: glucose>110mg/dL- 11%, total cholesterol >200mg/dL- 36%, LDL-c>130mg/dL- 33%, HDL-c<60mg/dL- 89%, triglycerides>150mg/dL- 30% and C reactive protein>0.5mg/dL- 16%. The FRS was average in 10.3% and high in 1.3%. In logistic regression analysis, it was verified that hypertension was associated with: HDL-c (odds ratio: 0.257,) and FRS (odds ratio: 23.159). There was strong correlation between hypertension and FRS. Data are noteworthy, as this is a relatively young sample of health professionals.

Arterial blood pressure measurement is an essential conduct to evaluate the condition of the cardiovascular system. Digital teaching environment is a powerful tool for the teaching-learning process, because it adds meaning and concreteness to the content to be learned, and it can be useful to instruct this procedure. The objective of this study was to create educational hypermedia for teaching arterial blood pressure measurement, and to describe the steps of that creation process. The pedagogical framework of Robert Gagné was used; and the construction followed the model proposed by Price. The final product presents videos, photos, animations and simulations that demonstrate and teach the procedure. Although hypermedia construction has been difficult to use, it can positively enhance the teaching of nursing procedures.

This is a review article on home blood pressure monitoring (HBPM) developed with the purpose to increase the current scientific knowledge and present the importance of this approach in the care to patients with hypertension in our setting. This technique has advantages over the causal measurement, as it provides more measurements, a better relationship with the target-organs injuries, it also quantifies the white-coat effect, has good reproducibility, good acceptability by the patients, assesses blood pressure without the influence from the observer and the environment of the appointment, reduces the number of visits to the doctor and promotes greater adherence to treatment. The importance of nursing practice in HBPM is associated with the education process, using teaching-learning strategies, implementing team-patient communication and encouraging patients towards performing self-care.

The objective of this study was to characterize blood pressure control of 440 hypertensive patients. The subjects were interviewed and had their blood pressure measurement by means of an automatic device. The results showed that 45.5% had an adequate blood pressure control. People under control were different (p<0.05) from those without control: the ones under blood pressure control were mainly women, younger, with a shorter time of disease, with previous treatment for hypertension, less interruptions in treatment and more conscious about the importance of physical activities. They also rarely forgot to take the medicines in the right time, generally using less than, 3 or more antihypertensive drugs, with family history of cardiovascular diseases, reporting physical activity more frequently and less sadness. The multivariate analysis revealed a statistically significant association of uncontrolled hypertension with previous treatment (OR = 2.26; IC 95%, 1.4-3.6), no family history of cardiovascular diseases (OR = 2.2; IC 95%, 1.3 3.5) and unaware of the importance of physical activities for blood pressure control (OR = 3.5; IC 95%, 1.1 10.8). Blood pressure control was associated with biological variables, behavior and information about hypertension as a risk factor and its treatment.

Background: Complicated hypertension can be influenced by the characteristics of hypertensive patients., Objective: To associate the condition of complicated hypertension with biosocial variables such as attitudes and beliefs about the disease and treatment and subjective well-being., Methods: We studied 251 uncomplicated hypertensive patients (SBP > 140 mmHg and/or 90 < DBP < 110 mmHg for patients under no treatment and DBP <110mmHg for patients under treatment without target organ damage and other diseases) and 260 complicated hypertensive patients (DBP > 110 mmHg with or without treatment, with target organ damage or other diseases)., Results: Complicated hypertensive patients were significantly different from uncomplicated ones (p <0.05) in relation to: 1 - Prevalence of men, not white (53.0%), higher body mass index (29.5 ± 4.6 vs 28.5 ± 4.0 kg/m²), over 10 years of disease (54.0%), completion of previous treatment (53.0%) and reports of sadness about life as a whole (74.0%) 2 - Complicated hypertensive patients never bring the drugs when they travel (59.0%), nor do they buy them before running out the drugs (71.0%) and rarely follow eating guidelines (69.0%) 3 - Uncomplicated hypertensive patients showed no more migraines, joint pain and, among women, menopausal status and hormone replacement therapy, and 4 - Of those who had pressure control (< 140/90 mmHg), 61.9% were uncomplicated hypertensive patients; and 5 - Complicated hypertensive patients were not aware that treatment can prevent kidney problems and they thought that young people do not have high blood pressure., Conclusion: Complicated hypertensive patients showed more negative structural and psychosocial characteristics, more negative attitudes towards treatment and are unaware of the disease.

Background: Little is known about the prevalence of hypertension in São Paulo, Brazil., Objective: To identify the prevalence of self-reported hypertension in the city of São Paulo., Methods: There were 613 telephone interviews using directories of household land-lines. The sample was calculated with an estimated prevalence of hypertension in 20.0%., Results: The prevalence of self-reported hypertension was 23.0% and 9.0% of respondents reported that the value of their last pressure measurement was greater than 140/90 mmHg, but they were unaware that they were hypertensive, with a total prevalence 32.0%. Hypertensive patients reported that: 89.0% were under treatment and 35.2% were controlled; 27.0% miss medical appointments; 16.2% stop taking drugs; 14.8% have a history of stroke; 27.8% had heart disease and 38.7% had hypercholesterolemia; 71.2% received advice to reduce salt, 64.6% to perform physical activity, 60.0% to lose weight loss and 26.2% to control stress; and 78.9% measured pressure regularly. There was a statistically significant relation (p < 0.05) for: 1) missing medical appointments with longer treatment and irregular health monitoring; 2) stop taking the drugs with smoking, alcohol and failure to monitor health; 3) carry out treatment for hypertension with dyslipidemia, higher age and longer use of contraceptives for women; and 4) body mass index changed with diabetes, hypercholesterolemia, uncontrolled systolic blood pressure and use of more than one anti-hypertension drug., Conclusion: The prevalence of self-reported hypertension in the city of São Paulo resembles the prevalence found in other studies.

Hypertension is one of the main risk factors for cardiovascular diseases. Nursing carries a large responsibility in care delivery to hypertensive individuals. Thus, the goal was to assess a nursing team's knowledge on hypertension and its treatment before and after educational interventions. A questionnaire was used, addressing theoretical aspects of hypertension knowledge among nurses (5), technicians (2), auxiliaries (11) and community agents (37) at two Basic Health Units in São Paulo City, Brazil. For statistical analysis, Student's T test was used, as well as variance analysis and p < 0.05. A knowledge increase was verified after the educational interventions for the group constituted by nurses, technicians and nursing auxiliaries (84.6 +/- 12.0% vs. 92.7 +/- 15.0%, p < 0.05), while no significant change occurred for community health agents (80.8 +/- 12.2% vs. 83.5 +/- 24.0%). Thus, it was concluded that the educational actions were effective and must be put in practice in the nursing team, which they can influence the improvement of care delivery for hypertensive patients.

Objectives: To evaluate the importance of providing guidelines to patients via active telephone calls for blood pressure control and for preventing the discontinuation of treatment among hypertensive patients., Introduction: Many reasons exist for non-adherence to medical regimens, and one of the strategies employed to improve treatment compliance is the use of active telephone calls., Methods: Hypertensive patients (n=354) who could receive telephone calls to remind them of their medical appointments and receive instruction about hypertension were distributed into two groups: a) "uncomplicated" - hypertensive patients with no other concurrent diseases and b) "complicated" - severe hypertensive patients (mean diastolic ≥ 110 mmHg with or without medication) or patients with comorbidities. All patients, except those excluded (n=44), were open-block randomized to follow two treatment regimens ("traditional" or "current") and to receive or not receive telephone calls ("phone calls" and "no phone calls" groups, respectively)., Results: Significantly fewer patients in the "phone calls" group discontinued treatment compared to those in the "no phone calls" group (4 vs. 30; p<0.0094). There was no difference in the percentage of patients with controlled blood pressure in the "phone calls" group and "no phone calls" group or in the "traditional" and "current" groups. The percentage of patients with controlled blood pressure (<140/90 mmHg) was increased at the end of the treatment (74%), reaching 80% in the "uncomplicated" group and 67% in the "complicated" group (p<0.000001)., Conclusion: Guidance to patients via active telephone calls is an efficient strategy for preventing the discontinuation of antihypertensive treatment.

Introduction: The goal of antihypertensive treatment is to reduce blood pressure without interfering in health-related quality of life (HRQL) OBJECTIVE: This study aimed to assess the influence of hypertension control upon HRQL in hypertensive patients with and without complications., Materials and Methods: Seventy-seven hypertensive outpatients (71% women, 58% white, 60% with elementary school level education, average age 54 +/- 8 years) were observed during a 12-month special care program (phase 1: clinical visits every two months, donation of all antihypertensive medications, meetings with a multidisciplinary team, and active telephone calls) and three years of standard care (phase 2: clinical visits every four months, medication provided by the drugstore of the hospital with a two-hour wait and a possible lack of medication, no meetings with a multidisciplinary team or active telephone calls). The patient HRQL was assessed using Bulpitt and Fletcher's Specific Questionnaire, as well as the SF-36 scores. Hypertensive patients were divided into "with complications" (n=37, diastolic blood pressure great than 110 mm Hg for patients with or without treatment, with clinically evident target-organ or other associated illness) and "without complications" (n=40). The variables studied were quality of life, blood pressure control, hypertension gravity, and demographic characteristics., Results: In hypertensive patients with and without complications, both the systolic and diastolic blood pressure were significantly higher (p<0.05) in phase 2 of observation (143+/-18/84+/-11 and 144+/-21/93+/-11 mm Hg for patients with and without complications, respectively) relative to phase 1 (128+/-17/75+/-13 and 128+/-15/83+/-11 mm Hg). The proportion of patients with controlled blood pressure (defined as a blood pressure less than 140/90 mm Hg) decreased from 70% to 49% in the "with complications" group and from 78% to 50% in the "without complications" group during phase 2 of observation. The patients with complications showed a decrease in bodily pain, vitality, and mental health component summary scores in both phases. In phase 2, the patients without complications had significantly better HRQL scores compared to complicated patients using both the Bulpitt and Fletcher's Questionnaire and the SF-36 assessment of physical capacity, bodily pain, and vitality domain summary scores. With regards to hypertension control, there was a significant decrease from phase 1 to phase 2 in the vitality component summary scores and an increase in the emotional aspect component summary scores assessed by the SF-36, whereas Bulpitt and Fletcher's Questionnaire showed no differences in these scores., Conclusion: Special care programs with multidisciplinary activities, individualized and personalized assistance, easy access to pharmacological treatment, frequent meetings, and active telephone calls for hypertensive patients significantly increase blood pressure control but do not interfere with the HRQL.

The objective of this study was to determine the Metabolic Syndrome prevalence as well as identify variables related in truck drivers who work on Highway BR-116 (São Paulo, Brazil). A total of 258 truck drivers were assessed and the variables studied were: body mass index, waist circumference, blood pressure, triglycerides, total and fraction cholesterol, glycemia and C reactive protein. Cardiovascular disease risk was evaluated by Framingham's risk score whereas the Metabolic Syndrome based on the First Brazilian Guideline for Diagnosis and Treatment of the Metabolic Syndrome. The significance level adopted was p< 0.05 and univariate and multivariate analysis were applied. The average age was of 37.5+/-10.1. According to the anthropometric data, it was observed body mass index > or =25 kg/m(2) in 82%, waist circumference > or =94 cm in 58%, total cholesterol >240 mg/dL in 9%, LDL-c >160 mg/dL in 10%; HDL-c <40 mg/dL in 20%, triglycerides >200mg/dL in 22%, glycemia >110 mg/dL in 7%, and C reactive protein >0.5 mg/dL in 19%. Hypertension prevalence was 37%, 9% were identified at the highest/medium Framingham's risk score and 24% showed Metabolic Syndrome. The logistical regression analysis indicated independent association of the Metabolic Syndrome for the following variables (OD odds ratio, CI confidence interval at 95%): body mass index (OR = 1.4007 CI 95% 1.192-1.661), use to check cholesterol (OR = 0.1020 CI 0.017-0.589) and Framingham's risk score (OR = 26.389 CI 2.520-276.374). As a conclusion, it was observed a quite expressive prevalence of cardiovascular risk factors as well as Metabolic Syndrome in truck drivers.

Objective: To compare blood pressure measurements taken at home by physicians, nurses, and patients with office blood pressure measurement , ambulatory blood pressure monitoring and home blood pressure measurement., Methods: A total of 44 patients seen by a home care program were studied. Protocol 1 a) blood pressure was measured by the patient, a physician and a nurse during a regular home visit (Home1); b) home blood pressure measurement was measured for 4 days (HBPM1); c) office blood pressure measurement was measured by a physician, a nurse, and the patient; and by 24-hour ambulatory blood pressure monitoring. Protocol 2 blood pressure was measured by the patient, a physician, and a nurse during a special home visit in the presence of a physician and a nurse only (Home2); and b) home blood pressure measurement was taken for the second time (HBPM2). Echocardiography, guided by a two-dimensional echocardiograph, was performed., Results: Protocol 1: a) office blood pressure measurement and Home1 were significantly higher than ambulatory blood pressure monitoring, except for systolic and diastolic office blood pressure measurement taken by the patient or a family member, systolic blood pressure taken by a nurse, and diastolic blood pressure taken by a physician. b) ambulatory blood pressure monitoring and HBPM1 were similar. Protocol 2: a) HBPM2 and Home2 were similar. b) Home2 was significantly lower than Home1, except for diastolic blood pressure taken by a nurse or the patient. There were significant relationships between: a) diastolic blood pressure measured by the patient and the thickness of the interventricular septum, posterior wall, and left ventricular mass; and b) ambulatory and HBPM2 diastolic and systolic blood pressure taken by a physician (home2) and left ventricular mass. Therefore, the data indicate that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic values relative to "office measurement.", Conclusion: This study showed that the measurement most similar to home blood pressure measurement and ambulatory blood pressure monitoring was blood pressure measured by the patient, and that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic value relative to "office measurements".

A total of 440 hypertensive patients participated in the study (57 years old +/-12, 66% women, 51% white, 57% married, 52% with primary school and 44% with income from 1 to 3 minimum salaries) to characterize biosocial, beliefs, attitudes and knowledge variables, absence to consultation and treatment interruption, and to associate the socioeconomic level to the variables studied. An index of accumulated goods, from the possession of household appliances converted in minimum salaries/mo., was elaborated in order to evaluate the economic status. The hypertensive people who disagreed with "there is nothing you can do to prevent high blood pressure" presented significantly higher levels of accumulated goods; those who affirmed never getting late to their consultations presented lower levels of accumulated goods; in the subjective well-being evaluation, sadness was associated to a lower accumulated goods index (p<0,05). Results showed that low economic status was associated with factors that can influence the attitude and adherence to anti-hypertensive treatment.

Purpose: To find out the prevalence of hypertension in employees of the Hospital and relate it to social demographic variables., Methods: Blood pressure measurement was performed with a mercury sphygmomanometer, using an appropriate cuff size for arm circumference, weight, and height in a population sample of 864 individuals out of the 9,905 employees of a University General Hospital stratified by gender, age, and job position., Results: Hypertension prevalence was 26% (62% of these reported being aware of their hypertension and 38% were unaware but had systolic/diastolic blood pressures of >140 and/or >90 mm Hg at the moment of the measurement). Of those who were aware of having hypertension, 51% were found to be hypertensive at the moment of the measurement. The prevalence was found to be 17%, 23%, and 29% (P <.05) in physicians, nursing staff, and "others", respectively. The univariate analysis showed a significant odds ratio for the male gender, age >50 years, work unit being the Institute of Radiology and the Administration Building, educational level 10 years, and body mass index >30 kg/m2. The multivariate logistic regression model revealed a statistically significant association of hypertension with the following variables: gender, age, skin color, family income, and body mass index., Conclusions: Hypertension prevalence was high, mainly in those who were not physicians or members of the nursing staff. High-risk groups (obese, non-white, men, low family income) should be better advised of prevention and early diagnosis of hypertension by means of special programs.

This study investigated the theoretical and technical knowledge of blood pressure measurement from 110 nursing assistants, 44 physicians and 25 nurses by answering to a questionnaire and practical knowledge through the observation of the blood pressure measurement procedure. In the theoretical knowledge the three categories showed statistically significant differences (p<0,05), the nursing assistants showed a lower indicator of the correctness (32%+/-12%) followed by nurses (44%+/-14%) and physicians (56%+/-13%). In the practical knowledge the physicians showed higher percentage of correctness (50%+/-12%) (p<0.05);followed by nurses (44%+/-10%) and nursing assistants (41%+/-6%). In conclusion, the knowledge of blood pressure measurement was not satisfactory.

Background: It is well known that blood pressure measurement with a standard 12-13 cm wide cuff is erroneous for large arms., Objective: To compare arm blood pressure measurements with an appropriate cuff and forearm blood pressure measurements (BPM) with a standard cuff, and both measurements by the Photopletismography (Finapres) method., Methods: One hundred and twenty-nine obese patients were studied (body mass index=40+/-7 kg/m2). The patients had three arm BPM taken by an automatic oscillometric device using an appropriate cuff and three forearm BPM with a standard cuff in the sitting position after a five-minute rest. Data were analysed by the analysis of variance. The correction values were obtained by the linear regression test., Results: Systolic and diastolic arm BPM with an appropriate cuff were significantly lower (p<0.05) than forearm BPM with a standard cuff. The measurements obtained by Finapres were significantly lower (p<0.05) than those found for forearm systolic and diastolic blood pressures and upper arm diastolic blood pressure. The equation to correct BPM in forearm in obese patients with arm circumference between 32-44 cm was: systolic BPM=33.2+/-0.68 x systolic forearm BPM, and diastolic BPM=25.2+0.59 x forearm diastolic BPM., Conclusion: This study showed that forearm blood pressure measurement overestimates the values of arm blood pressure measurement. In addition, it is possible to correct forearm BPM with an equation.

Objective: To assess the relation between blood pressure control and the following: the Morisky-Green test, the patient's consciousness regarding high blood pressure, the patient's attitude in face of medicine intake, the patient's attendance at medical consultations, and the subjective physician's judgment., Methods: We studied 130 hypertensive patients with the following characteristics: 73% females, 60 +/- 11 years, 58% married, 70% white, 45% retired, 45% with incomplete elementary schooling, 64% had a familial income of 1 to 3 minimum wages, body mass index of 30 +/- 7 kg/m , consciousness regarding the disease for a mean period of 11 +/- 9.5 years, and mean treatment duration of 8 +/- 7 years., Results: Only 35% of the hypertensive individuals had blood pressure under control and a longer duration of treatment (10 +/- 7 vs 7 +/- 6.5 years; P<0.05). The retiree predominated. The result of the Morisky-Green test did not relate to blood pressure control. In evaluating the attitude in face of medicine intake, the controlled patients achieved significantly higher scores than did the noncontrolled patients (8 +/- 1.9 vs 7 +/- 2, P<0.05). The hypertensive patients had higher levels of consciousness regarding their disease and its treatment, and most (70%) patients attended 3 or 4 medical consultations, which did not influence blood pressure control. The physicians attributed significantly higher scores regarding adherence to treatment to controlled patients (6 +/- 0.8 vs 5 +/- 1.2; P<0.05)., Conclusion: Consciousness regarding the disease, the Morisky-Green test, and attendance to medical consultations did not influence blood pressure control.

Objective: To assess the prevalence of white-coat normortension, white-coat hypertension, and white-coat effect., Methods: We assessed 670 medical records of patients from the League of Hypertension of the Hospital das Clínicas of the Medical School of the University of S o Paulo. White-coat hypertension (blood pressure at the medical office: mean of 3 measurements with the oscillometric device > or = 140 or > or = 90 mmHg, or both, and ambulatory blood pressure monitoring mean during wakefulness < 135/85) and white-coat normotension (office blood pressure < 140/90 and blood pressure during wakefulness on ambulatory blood pressure monitoring > or = 135/85) were analyzed in 183 patients taking no medication. The white-coat effect (difference between office and ambulatory blood pressure > 20 mmHg for systolic and 10 mmHg for diastolic) was analyzed in 487 patients on treatment, 374 of whom underwent multivariate analysis to identify the variables that better explain the white-coat effect., Results: Prevalence of white-coat normotension was 12%, prevalence of white-coat hypertension was 20%, and prevalence of the white-coat effect was 27%. A significant correlation (p<0.05) was observed between white-coat hypertension and familial history of hypertension, and between the white-coat effect and sex, severity of the office diastolic blood pressure, and thickness of left ventricular posterior wall., Conclusion: White-coat hypertension, white-coat normotension, and white-coat effect should be considered in the diagnosis of hypertension.

Objective: To determine technical procedures and criteria used by Brazilian physicians for measuring blood pressure and diagnosing hypertension., Methods: A questionnaire with 5 questions about practices and behaviors regarding blood pressure measurement and the diagnosis of hypertension was sent to 25,606 physicians in all Brazilian regions through a mailing list. The responses were compared with the recommendations of a specific consensus and descriptive analysis., Results: Of the 3,621 (14.1%) responses obtained, 57% were from the southeastern region of Brazil. The following items were reported: use of an aneroid device by 67.8%; use of a mercury column device by 14.6%; 11.9% of the participants never calibrated the devices; 35.7% calibrated the devices at intervals < 1 year; 85.8% measured blood pressure in 100% of the medical visits; 86.9% measured blood pressure more than once and on more than one occasion. For hypertension diagnosis, 55.7% considered the patient's age, and only 1/3 relied on consensus statements., Conclusion: Despite the adequate frequency of both practices, it was far from that expected, and some contradictions between the diagnostic criterion for hypertension and the number of blood pressure measurements were found. The results suggest that, to include the great majority of the medical professionals, disclosure of consensus statements and techniques for blood pressure measurement should go beyond the boundaries of medical events and specialized journals.

Objective: To assess the Dixtal DX2710 automated oscillometric device used for blood pressure measurement according to the protocols of the BHS and the AAMI., Methods: Three blood pressure measurements were taken in 94 patients (53 females 15 to 80 years). The measurements were taken randomly by 2 observers trained to measure blood pressure with a mercury column device connected with an automated device. The device was classified according to the protocols of the BHS and AAMI., Result: The mean of blood pressure levels obtained by the observers was 148+/-38/93+/-25 mmHg and that obtained with the device was 148+/-37/89+/-26 mmHg. Considering the differences between the measurements obtained by the observer and those obtained with the automated device according to the criteria of the BHS, the following classification was adopted: "A" for systolic pressure (69% of the differences < 5; 90% < 10; and 97% < 15 mmHg); and "B" for diastolic pressure (63% of the differences < 5; 83% < 10; and 93% < 15 mmHg). The mean and standard deviation of the differences were 0+/-6.27 mmHg for systolic pressure and 3.82+/-6.21 mmHg for diastolic pressure., Conclusion: The Dixtal DX2710 device was approved according to the international recommendations.

Introduction: The third Brazilian Consensus of Hypertension recomends the usage of pharmacological (PT) and non-pharmacological treatment (NPT). In Brazil, we don't know how if this recommedation has been followet by doctors., Objectives: a) to characterize NPT regarding prescription and acceptability by hypertensive patients; b) characterize PT concerning the criterion used for choosing medication and medication prescribed; and c) identify doctors' opinions about patients' degree of acceptability to PT and NPT., Methods: 37904 questionnaires with reply-paid envelopes were sent to Brazilian doctors and 2519 of those were replied (57% from the Southeast region, 41% were cardiologists, and 26% clinicians)., Results: 1- 62% of doctors recommend NPT to 25% of their patients. 2 - The most recommended NP treatments are: hyposodic diet (55%), weight reduction (29%) and physical exercises (8%), considering that doctors believe that 50% of their patients follow a hyposodic diet, 20% do physical exercises and 19% lose weight. 3 - Only one medication is prescribed at the beginning of a PT (88%) and when blood pressure isn't under control, 55% of the doctors associate other medications with it whereas 33% of them increase the dose. 4 - The most prescribed medications are: diuretics (53%) and ECA inhibitors (24%). 5 - The main criteria for choosing medication are: personal experience (32%) and characteristics of patients (31%). 6 - Doctors (60%) believe that acceptability to PT is better., Conclusion: The recommendations of the Third Brazilian Consensus of Hypertension have been followed partially concerning NPT and as expected regarding PT.

Objective: To evaluate the influence of the siesta in ambulatory blood pressure (BP) monitoring and in cardiac structure parameters., Methods: 1940 ambulatory arterial blood pressure monitoring tests were analyzed (Spacelabs 90207, 15/15 minutes from 7:00 to 22:00 hours and 20/20 minutes from 22:01 to 6.59hours) and 21% of the records indicated that the person had taken a siesta (263 woman, 52+/-14 years). The average duration of the siesta was 118+/-58 minutes., Results: (average +/- standard deviation) The average of systolic/diastolic pressures during wakefulness, including the napping period, was less than the average for the period not including the siesta (138+/-16/85+/-11 vs 139+/-16/86+/-11 mmHg, p<0. 05); 2) pressure loads during wakefulness including the siesta, were less than those observed without the siesta); 3) the averages of nocturnal sleep blood pressures were similar to those of the siesta, 4) nocturnal sleep pressure drops were similar to those in the siesta including wakefulness with and without the siesta; 5) the averages of BP in men were higher (p<0.05) during wakefulness with and without the siesta, during the siesta and nocturnal sleep in relation to the average obtained in women; 6) patients with a reduction of 0- 5% during the siesta had thickening of the interventricular septum and a larger posterior wall than those with a reduction during the siesta >5%., Conclusion: The siesta influenced the heart structure parameters and from a statistical point of view the average of systolic and diastolic pressures and the respective pressure loads of the wakeful period.

The blood pressure measure is part of the physical exam and it should be accomplished in every medical consultation. To verify the blood pressure measured in the accomplished medical consultations record of first they were consulted it consults 500 patient's ambulatorial being 335 (67%) coming of medical and surgical clinics and 165 (33%) of the gynecological and obstetric clinics. The blood pressure was written down in 39% of the accomplished consultations (135 + 32 mm Hg 85 + 19 mm Hg), and 11% of this annotations the pressure diastólica was above 90 mm Hg. In relation to the previous diagnosis of hypertension it was verified that: a) in 62% of the records there was not this information; b) 20% referred to have hypertension, and in 79% of these the arterial pressure was scored; and c) 18% referred not to have hypertension and 46% of these had registration of the arterial pressure. Therefore, most of the patients didn't have its logged arterial pressure.

OBJECTIVE: To evaluate the sphygmomanometers calibration accuracy and the physical conditions of the cuff-bladder, bulb, pump, and valve. METHODS: Sixty hundred and forty five aneroid sphygmomanometers were evaluated, 521 used in private practice and 124 used in hospitals. Aneroid manometers were tested against a properly calibrated mercury manometer and were considered calibrated when the error was < or = 3 mm Hg. The physical conditions of the cuffs-bladder, bulb, pump, and valve were also evaluated. RESULTS: Of the aneroid sphygmomanometers tested, 51% of those used in private practice and 56% of those used in hospitals were found to be not accurately calibrated. Of these, the magnitude of inaccuracy ranged from 4 to 8 mm Hg in 70% and 51% of the devices, respectively. The problems found in the cuffs--bladders, bulbs, pumps, and valves of the private practice and hospital devices were bladder damage (34% vs. 21%, respectively), holes/leaks in the bulbs (22% vs. 4%, respectively), and rubber aging (15% vs. 12%, respectively). Of the devices tested, 72% revealed at least one problem interfering with blood pressure measurement accuracy. CONCLUSION: Most of the manometers evaluated, whether used in private practice or in hospitals, were found to be inaccurate and unreliable, and their use may jeopardize the diagnosis and treatment of arterial hypertension.

The aim of this study was to evaluate scientific articles published between 1991-1995, in order to identify the compliance in antihypertensive therapy, One hundred seven scientific articles were evaluated. The results showed that 68% were related to patient, 63% to pharmacological treatment, 62% general, 39% non pharmacological treatment, 34% organizational factors, and 8% related to disease. Compliance with antihypertensive therapy was the major challenge of hypertension management and to know how this aspect was focalized in scientific articles possible reduce non compliance in hypertension.

Purpose: To compare both home blood pressure measurement (HBPM) and ambulatory blood pressure monitoring (ABPM) with office blood pressure measurement (OBP); and also to compare the correlation between HBPM and OBP with LVMI (left ventricular mass index)., Methods: Protocol 1--68 hypertensive patients (58 +/- 12 years, 37 females): a) self recorded blood pressure at home in the 7 days; b) recorded the ABPM during 24 hours; and c) the physician recorded blood pressure in the office. Protocol 2-41 hypertensive patients underwent the HBPM, OBP, and BI-dimensional echocardiogram., Results: Protocol 1--OBP (153 +/- 24/96 +/- 13 mmHg) was higher (p < 0.05) than HBPM (133 +/- 18/84 +/- 12 mmHg) and ABPM (137 +/- 17/87 +/- 12 mmHg); Protocol 2--LVMI correlated better with HBPM (r = 0.39/0.49, p < 0.05, systolic and diastolic, respectively) than OBP (r = 0.02/ 0.22, p > 0.05, systolic and diastolic, respectively)., Conclusion: This study showed that HBPM has a better correlation with LVMI than OBP.

The objective of this study was to assess the accuracy and reliability of mercury and aneroid sphygmomanometers. Measurement of accuracy of calibration and evaluation of physical conditions were carried out in 524 sphygmomanometers, 351 from a hospital setting, and 173 from private medical offices. Mercury sphygmomanometers were considered inaccurate if the meniscus was not '0' at rest. Aneroid sphygmomanometers were tested against a properly calibrated mercury manometer, and were considered calibrated when the error was < or =3 mm Hg. Both types of sphygmomanometers were evaluated for conditions of cuff/bladder, bulb, pump and valve. Of the mercury sphygmomanometers tested 21 % were found to be inaccurate. Of this group, unreliability was noted due to: excessive bouncing (14%), illegibility of the gauge (7%), blockage of the filter (6%), and lack of mercury in the reservoir (3%). Bladder damage was noted in 10% of the hospital devices and in 6% of private medical practices. Rubber aging occurred in 34% and 25%, leaks/holes in 19% and 18%, and leaks in the pump bulb in 16% and 30% of hospital devices and private practice devices, respectively. Of the aneroid sphygmomanometers tested, 44% in the hospital setting and 61% in private medical practices were found to be inaccurate. Of these, the magnitude of inaccuracy was 4-6 mm Hg in 32%, 7-12 mm Hg in 19% and > 13 mm Hg in 7%. In summary, most of the mercury and aneroid sphygmomanometers showed inaccuracy (21% vs 58%) and unreliability (64% vs 70%).

Purpose: To evaluate the criteria used for the technique of blood pressure measurement in scientific articles published in Brazilian journals., Methods: Two hundred twenty three scientific articles from 18 medical journals, published between 1989 and 1994 were evaluated, in order to identify the type of sphygmomanometer used; the state of calibration; the cuff size; the position of the patient during the measurement; whether the blood pressure measurement was obtained after a resting period; the phase used to identify the systolic and diastolic pressures; and the number of readings taken., Results: There was no reference in the articles about the following data: the type of sphygmomanometer in 51%, the accuracy of calibration in 82%, the cuff size in 64%, the position of the patient in 25%, the rest period before measurement in 60%, the systolic and diastolic phases in 49%, and the number of measurements in 52%., Conclusion: Most of the papers analyzed did not follow or omitted important aspects cited in national and international recommendations for the correct blood pressure measurement.

The purpose of this article is to emphasize the nurse's role toward persons with arterial hypertension. Therefore it's introduced an application form that is used for nursing consultation to outpatients.

A study was carried out with 23 hypertensive individuals after educational process in order to verify the retention of knowledge and its influence on the hypertension control. After drug treatment it was observed that the level of knowledge was inversely proportional to the blood pressure levels.

This study analyses the importance of self-recorded blood pressure at home. The data will be compared with measurements by patient, nurse and physician in ambulatory.

The objective of this study was to characterize the patients of two intensive care units (ICU) considering the structural variables, provenance, permanence and the destination after the discharge, the main diagnosis, invasive procedures and to classify them based on therapeutic procedures.