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INTRODUCTION: Atrial fibrillation increases five times the risk of stroke. Anticoagulation reduces the incidence of cerebrovascular events. However, many patients do not receive thromboprophylaxis. OBJECTIVES: To estimate the prevalence of atrial fibrillation in the older patients at a Brazilian university hospital and the proportion of anticoagulation prescription. Secondary objectives were to identify the therapeutic options, the main reasons for non-prescription and the factors associated with ineffectiveness or lack of treatment. METHODS: This was a cross-sectional study with a consecutive sample of 1,630 outpatients selected at Hospital de Clínicas de Porto Alegre between April and June of 2017. Atrial fibrillation was identified in 220 (13.50%) individuals. t Medical records from 145 patients were accessed, followed by a telephone interview. The association between variables and “ outcomes was checked using the Mann-Whitney’s U Test and a chi-squared test. RESULTS: The prevalence of atrial fibrillation was 13.50%. Anticoagulation therapy was prescribed in 77.93% of cases. In 76.11% of patients, warfarin was the chosen drug. < There was a tendency towards no prescription in patients with previous bleeding (RR = 2.32; 95%CI 0.95 - 5.64; p = 0.06) and falls (RR = 2.02; 95%CI 0.82 - 5.03; p = 0.08). We found an association between reduced functional capacity (Barthel’s Activities of Daily Living Score < 80) and higher rate of anticoagulation in therapeutic target (RR = 0.22; 95%CI 0.06 - 0.87; p = 0.04). CONCLUSION: The prevalence of atrial fibrillation in this population was 13.50% and in 77.93% of cases anticoagulant were prescribed. Functional impairment was associated with a higher rate of anticoagulation in therapeutic target.

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Introduction. Sarcopenia is a prevalent condition in the elderly population, imposing a significant impact over their functional ability as well as their quality of life. Furthermore, it is associated with greater incidence of major geriatric outcomes, as reduced mobility, falls, loss of independence, cognitive impairment, and all-cause mortality. Physical Exercise Programs directed to improve muscle mass and its function may be key to reduce sarcopenia consequences. However, a significant heterogeneity is found in clinical trials, especially as a consequence of different exercise protocols applied to research subjects. Objectives. To access the effects of physical exercise programs compared to no exercise interventions to improve sarcopenia components and its determinants in sarcopenic elder individuals. Methods. A systematic review was conducted in the Pubmed database to identify randomized clinical trials (RCTs) which tested the effects of physical exercise programs to manage sarcopenia components in sarcopenic elder individuals. Two independent reviewers assessed the studies’ eligibility according to specified inclusion criteria in a four-step strategy. Data regarding population characteristics, muscle mass, muscle quality, muscle strength, and muscle function were extracted from each one of the included studies. Assessment of quality and individual studies risk of bias were assessed through Cochrane Risk of Bias Tool®. Assuming theoretical expected heterogeneity among studies, especially regarding different physical exercise programs and different outcome measurements, authors decided to be conservative and present study results in descriptive tables. Results. Search strategy retrieved 298 papers on PubMed database. Three more were identified through manual search, being 301 studies revised for inclusion. 278 were excluded during title/abstract review. After further evaluation of 23 full-texts, 5 RCTs were included. All 5 trials tested the efficacy of isolated exercise programs to improve sarcopenia components in the elderly compared to no physical intervention. Resistance training was the main intervention component in all included trials compared to inactive control groups (health education mainly). Physical training improved muscle strength, muscle quality, and muscle function compared to inactive control groups. Considering muscle mass, no differences were demonstrated. Data meta-analysis was not possible to be performed due to high heterogeneity among trials and small number of studies for each outcome comparison. Conclusion. Heterogeneity among trials and small number of RCTs limited robust conclusions and data meta-analysis. However, resistance training protocols can improve muscle strength and physical performance in elders previously diagnosed with sarcopenia, although its effect size and clinical impact are barely relevant.

Background: The social isolation imposed by COVID-19 pandemic can have a major impact on the mental health of dementia patients and their caregivers. Objective: We aim to evaluate the neurological decline of patients with dementia and the caregivers’ burden during the pandemic. Methods: We performed a cross-sectional study. Caregivers of dementia patients following in the outpatient clinic were included. A structured telephone interview composed of the Neuropsychiatric Inventory Questionnaire (NPI-Q), Zarit Burden Interview (ZBI), Beck Depression (BDI) and Anxiety (BAI) Inventories to address cognitive, behavioral, and functional changes associated with social distancing during the Sars-Cov-2 outbreak. Patients were divided in two groups according to caregivers’ report: with perceived Altered Cognition (AC) and Stable Cognition (SC). Results: A total of 58 patients (median age: 57 years [21–87], 58.6%females) and caregivers (median age: 76.5 years [55–89], 79.3%females) were included. Cognitive decline was shown by most patients (53.4%), as well as behavioral symptoms (48.3%), especially apathy/depression (24.1%), and functional decline (34.5%). The AC group (n = 31) presented increased behavioral (67.7%versus 25.9%, p = 0.002) and functional (61.3%versus 3.7%, p

OBJECTIVE: To evaluate the effectiveness of levothyroxine administration strategies in the treatment of hypothyroidism in older persons in a tertiary outpatient clinic. METHODS: A randomized controlled trial of older persons with a diagnosis of primary hypothyroidism who had been receiving levothyroxine for at least 6 months with a stable dose in the last 3 months. Patients were randomly assigned to one of two administration strategies: morning (1 hour before breakfast) or night (1 hour after the last meal). In a period ≥ 12 weeks, patients were instructed to cross over between strategies. Laboratory tests for thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were performed at visit 0 (baseline), visit 1 (period ≥ 12 weeks), and visit 2 (completion — period ≥ 24 weeks); a standardized questionnaire was also applied. Preliminary analyses of the period before crossover are presented. RESULTS: The preliminary sample consisted of 98 patients, with a mean age of 71.26 (SD 7.12) years; 83.67% were women. Fifty-three patients started with the morning strategy and 45 with the night strategy, and one patient did not return for reassessment. Median TSH levels ranged from 2.74 (IQR 1.06–4.19) at baseline to 2.77 (IQR 0.75–4.41) after a 12-week follow-up in the morning group, and from 2.36 (IQR 1.48–4.85) to 2.28 (IQR 1.69–3.56) in the night group. Mean FT4 levels ranged from 1.44 (SD 0.39) to 1.42 (SD 0.36) in the morning group, and from 1.35 (SD 0.27) to 1.37 (SD 0.32) in the night group. CONCLUSIONS: The administration of levothyroxine at night was as effective as morning administration at controlling primary hypothyroidism in older persons. Therefore, this can be considered an alternative dosage strategy for the treatment of this condition.

Introdução: No Brasil, a faixa etária com idade igual ou superior a 80 anos é a que mais cresce proporcionalmente. À medida que a população envelhece, torna-se cada vez mais evidente a necessidade do estudo dos fatores associados à sarcopenia. Objetivo: Investigar a associação entre variáveis nutricionais e sarcopenia em longevos. Metodologia: Estudo transversal, arrolou indivíduos com idade igual ou superior a 80 anos em acompanhamento ambulatorial. Para consumo alimentar, utilizou-se o recordatório alimentar de 24 horas. Estado nutricional foi categorizado conforme a Miniavaliação Nutricional. Sarcopenia foi diagnosticada através dos critérios do European Working Group on Sarcopenia in Older People de 2010 e 2018. Para aferição das medidas aplicou-se o exame de Biompedância elétrica, dinamometria de preensão manual e velocidade de marcha aferida em teste de 4 metros. Resultados: A amostra foi composta por 119 longevos, população predominantemente feminina (n=67; 56,3%), com média de idade de 83,4 anos (±3,0). As prevalências de sarcopenia variaram significativamente conforme o critério utilizado, sendo maior quando se adotou diagnóstico conforme critérios diagósticos de 2010 ou 2018 (46,7% vs 17,6%). Sexo feminino e baixa pontuação na Miniavaliação Nutricional aumentaram o risco para sarcopenia segundo pelo critério de 2010. Valor energético total reduzido e ingesta proteica elevada associaram-se significativamente com maior prevalência de sarcopenia e sarcopenia grave, independentemente do critério diagnóstico utilizado ou de fatores de confusão testados. Conclusão: Estado nutricional pela Miniavaliação Nutricional, consumo energético total reduzido e dieta hiperproteica, associaram-se a maior prevalência de sarcopenia.

O objetivo do presente trabalho foi descrever as definições conceitual e operacional da síndrome de fragilidade recomendadas pelo Consenso Brasileiro de Fragilidade em Idosos. Em 2015, uma força-tarefa composta de especialistas brasileiros em envelhecimento humano conduziu uma revisão bibliográfica sobre fragilidade em idosos no Brasil e estabeleceu um consenso acerca dos principais achados por meio de reuniões periódicas. No total, 72 artigos foram incluídos para análise, entre os quais, uma revisão sistemática, duas discussões conceituais, duas descrições metodológicas, quatro estudos longitudinais focando mortalidade e piora do perfil de fragilidade, oito estudos de adaptação transcultural e 55 estudos transversais ou de prevalência. O Quarenta e cinco estudos (62,5%) utilizaram a escala de fragilidade do Cardiovascular Health Study (EFCHS), dos quais sete (15,2%) usaram pontos de corte não ajustados para a amostra e 17 (36,9%) modificaram pelo menos um dos cinco itens que compõem o instrumento. A prevalência de fragilidade variou entre 6,7 e 74,1%. Quando utilizada a EFCHS, a ampla variação de prevalência — de 8 a 49,3% — dependeu dos pontos de corte empregados para classificar as alterações na velocidade de marcha e na força de preensão palmar, bem como do cenário de investigação. Os estudos foram baseados em quatro grandes modelos conceituais de fragilidade. A fragilidade em idosos representa um estado de vulnerabilidade fisiológica e não deve ser confundida com incapacidades ou multimorbidades. Na população brasileira, a prevalência de fragilidade ainda não está adequadamente estimada, e os pontos de corte dos itens que compõem as escalas de fragilidade devem ser adaptados aos parâmetros dessa população. The aim of the present study was to describe the conceptual and operational definitions of the frailty syndrome recommended by the Brazilian Consensus on Frailty in Older People. In 2015, a task force consisting of Brazilian specialists on human aging conducted a bibliographical review on frailty among older people in Brazil and established a consensus on the main findings through periodic meetings. A total of 72 articles were included in the analysis, comprising one systematic review, two conceptual discussions, two methodological descriptions, four longitudinal studies focusing on mortality and worsening of the frailty profile, eight cross-cultural adaptation studies, and 55 cross-sectional or prevalence studies. Forty-five studies (62.5%) used the Cardiovascular Health Study (CHS) frailty scale, of which seven (15.2%) used unadjusted cut-off points for their samples and 17 (36.9%) modified at least one of the five items of the instrument. The prevalence of frailty varied between 6.7 and 74.1%. When the CHS frailty scale was used, the wide range of prevalence — from 8 to 49.3% — depended on the cut-off points used to classify changes in gait speed and handgrip strength, as well as the research setting. The studies were based on four major conceptual models of frailty. Frailty in older people represents a state of physiological vulnerability and should not be confused with disabilities or multi-morbidities. In the Brazilian population, the prevalence of frailty has not yet been adequately estimated, and the cut-off points of the items of the frailty scales should be adapted to the parameters of this population.

Despite the fact that simultaneous performance of resistance and aerobic exercises (i.e., concurrent exercise) has become a standard exercise prescription for the elderly, no information is available on its effects on post-exercise hypotension (PEH) in elderly men with hypertension. Purpose To compare the effects of different types of exercise on PEH in elderly men with hypertension. Methods Twenty elderly men with essential hypertension participated in three crossover interventions, in random order, and on separate days: a non-exercise control session at seated rest, aerobic exercise performed for 45 min, and 45 min of concurrent resistance and aerobic exercise consisted of 4 sets of 8 repetitions at 70% 1RM of resistance exercise followed by aerobic exercise on treadmill. After each session, blood pressure (BP) was measured continuously for 1 h in the laboratory and for 24 h under ambulatory conditions. Results During the first hour in laboratory, diastolic BP was lower after aerobic (− 5 mm Hg) and concurrent exercise (− 6 mm Hg) in comparison with Control. Day-time diastolic BP was significantly lower after aerobic exercise (− 7 mm Hg) when compared to the control. No significant differences were found among the three experimental sessions for night-time and 24-hour diastolic BP, as well as day-time, night-time and 24-hour systolic BP. Conclusion Concurrent exercise produced acute PEH similar to aerobic exercise but such effect did not last as long as aerobic exercise in elderly patients with essential hypertension.

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To compare the blood pressure (BP)-lowering efficacy of a chlorthalidone/amiloride combination pill with losartan, during initial management of stage I hypertension.In a randomized, double-blind, controlled trial, 655 participants were followed for 18 months in 21 Brazilian academic centers. Trial participants were adult volunteers aged 30-70 years with stage I hypertension (BP 140-159 or 90-99 mmHg) following 3 months of a lifestyle intervention. Participants were randomized to 12.5/2.5 mg of chlorthalidone/amiloride (N = 333) or 50 mg of losartan (N = 322). If BP remained uncontrolled after 3 months, study medication dose was doubled, and if uncontrolled after 6 months, amlodipine (5 and 10 mg) and propranolol (40 and 80 mg twice daily) were added as open-label drugs in a progressive fashion. At the end of follow-up, 609 (93%) participants were evaluated.The difference in SBP during 18 months of follow-up was 2.3 (95% confidence interval: 1.2 to 3.3) mmHg favoring chlorthalidone/amiloride. Compared with those randomized to diuretic, more participants allocated to losartan had their initial dose doubled and more of them used add-on antihypertensive medication. Levels of blood glucose, glycosilated hemoglobin, and incidence of diabetes were no different between the two treatment groups. Serum potassium was lower and serum cholesterol was higher in the diuretic arm. Microalbuminuria tended to be higher in patients with diabetes allocated to losartan (28.5 ± 40.4 versus 16.2 ± 26.7 mg, P = 0.09).Treatment with a combination of chlorthalidone and amiloride compared with losartan yielded a greater reduction in BP.NCT00971165.

OBJECTIVE: To compare the efficacy of a cycle ergometer-based exercise program to a standard protocol on the increment of the maximum distance walked during the six-minute walk test in the postoperative rehabilitation of patients submitted to coronary artery bypass grafting. METHODS: A controlled clinical trial pilot, blinded to the outcome, enrolled subjects who underwent coronary artery bypass grafting in a hospital from Southern Brazil. Subjects were designated for the standard physical rehabilitation protocol or to an alternative cycle ergometer-based protocol through simple random sampling. The primary outcome was the difference in the maximum distance walked in the six-minute walk test before and after the allocated intervention. RESULTS: Twenty-four patients were included in the analysis, 10 in the standard protocol and 14 in the alternative protocol group. There was an increment in the maximum distance walked in both groups, and borderline superiority in the intervention group comparing to the control group (312.2vs. 249.7; P=0.06). CONCLUSION: There was an increase in the maximum distance walked in the alternative protocol compared to the standard protocol. Thus, it is postulated that the use of a cycle ergometer can be included in physical rehabilitation in the hospital phase of postoperative coronary artery bypass grafting. However, randomized studies with larger sample size should be conducted to assess the significance of these findings.

To evaluate the association between overweight and abdominal obesity with all-cause and cardiovascular mortality in the elderly aged 80 and over. A prospective cohort study. A population-based study of community-dwelling very elderly adults in a city in southern Brazil. 236 very elderly adults, number that represents 85% of the population aged 80 and over living in the city in the period (mean age 83.4 ± 3.2). Overweight and abdominal obesity were assessed using recommended cut-off points for body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR). The association between these anthropometric measurements and all-cause and cardiovascular mortality were independently estimated by Cox proportional hazards model. Kaplan-Meier was used to assess survival time. Increased WC (>80cm F and >94cm M) and WHtR (>0.53 F and >0.52 M) were associated with lower all-cause mortality, but only WHtR remained associated even after controlling for residual confounding (HR 0.55 CI95% 0.36-0.84; p

Objective The purpose of our study was to evaluate the association between short and long sleep duration and all-cause and cardiovascular mortality among elderly individuals. Design Systematic review and meta-analysis of population-based cohort studies. Setting Articles were retrieved from international and national electronic databases. Study selection Studies were identified in PubMed, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), IBECS (Bibliographic Index on Health Sciences from Spain) and CAPES (PhD thesis repository) between 1980 and 2015. Studies which met all criteria were eligible: participants aged 60 years or over, assessment of sleep duration as 24 h, nighttime or daytime sleep, evaluation of all-cause or cause-specific mortality, population-based cohort studies conducted on representative samples. There was no language restriction and studies published as abstracts were excluded. Data extraction Data were analysed using the Comprehensive Meta-Analysis software (V.3.3.070), and summary estimates (relative risk (RR), 95% CI) were calculated using a random effects model. Heterogeneity and consistency were evaluated through Cochran9s Q and the I 2 statistics, respectively, and sensitivity analyses were conducted. Primary and secondary outcome measures All-cause and cardiovascular mortality. Results Overall, 27 cohort studies were selected, comprising >70 000 elderly individuals, and followed up from 3.4 to 35 years. In the pooled analysis, long and short sleep duration were associated with increased all-cause mortality (RR 1.33; 95% CI 1.24 to 1.43 and RR 1.07; 95% CI 1.03 to 1.11, respectively), compared with the reference category. For cardiovascular mortality, the pooled relative risks were 1.43 (95% CI 1.15 to 1.78) for long sleep, and 1.18 (95% CI 0.76 to 1.84) for short sleep. Daytime napping ≥30 min was associated with risk of all-cause mortality (RR 1.27; 95% CI 1.08 to 1.49), compared with no daytime sleep, but longer sleep duration (≥2.0 h) was not (RR 1.34; 95% CI 1.95 to 1.90). Conclusions Among elderly individuals, long and short sleep duration are associated with increased risk for all-cause mortality. Long sleep duration is associated with cardiovascular mortality.

Background Prehypertension is associated with higher cardiovascular risk, target organ damage, and incidence of hypertension. The Prevention of Hypertension in Patients with PreHypertension (PREVER‐Prevention) trial aimed to evaluate the efficacy and safety of a low‐dose diuretic for the prevention of hypertension and end‐organ damage. Methods and Results This randomized, parallel, double‐blind, placebo‐controlled trial was conducted in 21 Brazilian academic medical centers. Participants with prehypertension who were aged 30 to 70 years and who did not reach optimal blood pressure after 3 months of lifestyle intervention were randomized to a chlorthalidone/amiloride combination pill or placebo and were evaluated every 3 months during 18 months of treatment. The primary outcome was incidence of hypertension. Development or worsening of microalbuminuria, new‐onset diabetes mellitus, and reduction of left ventricular mass were secondary outcomes. Participant characteristics were evenly distributed by trial arms. The incidence of hypertension was significantly lower in 372 study participants allocated to diuretics compared with 358 allocated to placebo (hazard ratio 0.56, 95% CI 0.38–0.82), resulting in a cumulative incidence of 11.7% in the diuretic arm versus 19.5% in the placebo arm (P=0.004). Adverse events; levels of blood glucose, glycosylated hemoglobin, creatinine, and microalbuminuria; and incidence of diabetes mellitus were no different between the 2 arms. Left ventricular mass assessed through Sokolow‐Lyon voltage and voltage‐duration product decreased to a greater extent in participants allocated to diuretic therapy compared with placebo (P=0.02). Conclusions A combination of low‐dose chlorthalidone and amiloride effectively reduces the risk of incident hypertension and beneficially affects left ventricular mass in patients with prehypertension. Fundo A pré-hipertensão está associada a maior risco cardiovascular, lesão de órgãos-alvo e incidência de hipertensão. O estudo Prevention of Hypertension in Patients with PreHypertension (PREVER-Prevention) teve como objetivo avaliar a eficácia e a segurança de um diurético de baixa dosagem para a prevenção da hipertensão e danos aos órgãos-alvo. Métodos e Resultados Este estudo randomizado, paralelo, duplo-cego e controlado por placebo foi conduzido em 21 centros médicos acadêmicos brasileiros. Os participantes com pré-hipertensão com idades entre 30 e 70 anos e que não atingiram a pressão arterial ideal após 3 meses de intervenção no estilo de vida foram randomizados para uma pílula combinada de clortalidona/amilorida ou placebo e foram avaliados a cada 3 meses durante 18 meses de tratamento. O desfecho primário foi a incidência de hipertensão. Desenvolvimento ou agravamento de microalbuminúria, diabetes mellitus de início recente e redução da massa ventricular esquerda foram desfechos secundários. As características dos participantes foram distribuídas uniformemente pelos braços do ensaio. A incidência de hipertensão foi significativamente menor em 372 participantes do estudo alocados para diuréticos em comparação com 358 alocados para placebo (taxa de risco 0,56, IC 95% 0,38–0,82), resultando em uma incidência cumulativa de 11,7% no braço diurético versus 19,5% no braço braço placebo (P = 0,004). Eventos adversos; níveis de glicose no sangue, hemoglobina glicosilada, creatinina e microalbuminúria; e incidência de diabetes mellitus não foram diferentes entre os 2 braços. A massa ventricular esquerda avaliada por meio da voltagem de Sokolow-Lyon e do produto voltagem-duração diminuiu em maior extensão em participantes alocados para terapia diurética em comparação com placebo (P = 0,02). Conclusões Uma combinação de baixa dose de clortalidona e amilorida reduz efetivamente o risco de hipertensão incidente e afeta beneficamente a massa ventricular esquerda em pacientes com pré-hipertensão.

Recent guidelines for the diagnosis and management of hypertension reversed the historical trend to recommend lower blood pressure (BP) thresholds to diagnose hypertension in high-risk individuals, such as patients with diabetes and elderly patients. The decision to raise the BP thresholds for diagnosis of hypertension in patients with diabetes was mostly based on the findings of the ACCORD trial. Nonetheless, the results of the ACCORD trial are within the predicted benefit to prevent coronary artery disease and stroke by meta-analysis of randomized controlled trials (RCT), particularly in regard to the prevention of stroke. The Eighth Joint National Committee (JNC 8) did not address prehypertension. There are many RCT done in individuals with prehypertension and concomitant cardiovascular disease showing the benefit of treatment of these patients. Trials exploring the efficacy of interventions to prevent cardiovascular disease in individuals with prehypertension free of cardiovascular disease would be hardly feasible in face of the low absolute risk of these individuals. Considering the risks of prehypertension for cardiovascular disease and the fast progression to hypertension of a large proportion of individuals with prehypertension, it is worth to consider drug treatment for individuals with prehypertension. RCT showed that the progression to hypertension can be partially halted by BP-lowering agents. These and ongoing clinical trials are herein revised. Prehypertension may be a window of opportunity to prevent hypertension and its cardiovascular consequences.

The available, albeit rare, evidence indicates the superiority of home- over office blood pressure monitoring (HBPM vs OBP) to predict cardiovascular (CV) outcomes. We performed a systematic review to update the efficacy of HBPM vs OBP as predictors of all-cause mortality, CV death, and target organ damage. Two reviewers independently performed the literature search in various databases. A meta-analysis with a fixed-effect model was conducted, and the heterogeneity and inconsistency indices were assessed. The search identified 291 articles, of which 10 were eligible for inclusion in the study, and five articles published in 2012 were included in the meta-analysis. A previous meta-analysis showed the superiority of HBPM over OBP to predict all-cause mortality, CV mortality, and CV events. The meta-analysis of articles published in 2012 identified that HBPM was also a better predictor of proteinuria than OBP. In conclusion, the results of our systematic review and meta-analysis confirm that HBPM is a better predictor of CV outcomes and target organ damage than OBP.

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:25:30Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:31:08Z : No. of bitstreams: 1 2-s2.0-79952197520.pdf: 336059 bytes, checksum: 6887bfb6c66c449f86ed80f9d7459718 (MD5) Made available in DSpace on 2014-05-27T11:25:30Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-03-05 Background: Blood pressure (BP) within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a population-based intervention to prevent the incidence of hypertension and the development of target-organ damage.Methods: This is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution.Discussion: The early use of blood pressure-lowering drugs, particularly diuretics, which act on the main mechanism of blood pressure rising with age, may prevent cardiovascular events and the incidence of hypertension in individuals with hypertension. If this intervention shows to be effective and safe in a population-based perspective, it could be the basis for an innovative public health program to prevent hypertension in Brazil.Trial Registration: Clinical Trials NCT00970931. © 2011 Fuchs et al; licensee BioMed Central Ltd. Hospital de Clínicas de Porto Alegre Universidade Federal do Rio Grande do Sul, Porto Alegre Hospital Universitário Antônio Pedro Universidade Federal Fluminense, Niterói Hospital São Lucas Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre Hospital das Clinicas Universidade de São Paulo, São Paulo Instituto do Coração Universidade de São Paulo, São Paulo Faculdade de Medicina de Ribeirão Preto Universidade de São Paulo, Ribeirão Preto Faculdade de Medicina São José do Rio Preto, São José do Rio Preto Faculdade de Ciências Médicas Universidade de Campinas, Campinas Faculdade de Ciências Farmacêuticas Universidade de São Paulo, Ribeirão Preto Faculdade de Medicina de Botucatu Universidade Estadual de São Paulo, Botucatu Universidade do Estado do Rio de Janeiro, Rio de Janeiro Hospital das Clínicas Universidade Federal de Minas Gerais, Belo Horizonte Hospital das Clínicas de Goiânia Universidade Federal de Goiás, Goiânia Anis Rassi Hospital, Goiânia Hospital Universitário Júlio Muller Universidade Federal de Mato Grosso, Cuiabá Faculdade de Medicina Universidade de Ciências da Saúde Alagoas, Maceió Faculdade de Medicina Universidade Federal de Pernambuco, Recife Instituto de Medicina Integral Prof Fernando Figueira, Recife Hospital Universitário Oswaldo Cruz/PROCAPE Universidade de Pernambuco, Recife Hospital Universitário Valter Cantídio Universidade Federal do Ceará, Fortaleza Hospital Universitário Universidade Federal Maranhão, São Luiz Instituto de Cardiologia Fundação Universitária de Cardiologia, Porto Alegre Faculdade de Medicina Universidade Federal de Pelotas, Pelotas Hospital do Coração, São Paulo Faculdade de Medicina de Botucatu Universidade Estadual de São Paulo, Botucatu

OBJECTIVE: To estimate the annual cost of coronary artery disease (CAD) management in Public Health Care System (SUS) and HMOs values in Brazil. METHODS: Cohort study, including ambulatory patients with proven CAD. Clinic visits, exams, procedures, hospitalizations and medications were considered to estimate direct costs. Values of appointments and exams were obtained from the SUS and the Medical Procedure List (LPM 1999) reimbursement tables. Costs of cardiovascular events were obtained from admissions in public and private hospitals with similar diagnoses-related group classifications in 2002. The price of medications used was the lowest found in the market. RESULTS: The 147 patients (65±12 years old, 63% men, 69% hypertensive, 35% diabetic and 59% with previous AMI) had an average follow-up of 24±8 months. The average estimated annual cost per patient was R$ 2,733.00, for the public sector, and R$ 6,788.00, for private and fee-for-service plans. Expenses with medications (R$ 1,154.00) represented 80% and 55% of outpatient costs, and 41% and 17% of total expenses, in public and non-public sectors, respectively. The occurrence of cardiovascular event had a great impact (R$ 4,626.00 vs. R$ 1,312.00, in SUS, and R$ 13,453.00 vs. R$ 1,789.00, for HMOs, p

OBECTIVE: To compare the management of patients with ischemic heart disease being followed up in a general cardiology outpatient clinic with that of patients being followed up in an outpatient clinic specific for ischemic heart disease, emphasizing the lipid profile and the pharmacological treatment prescribed. METHODS: Data were collected from the medical records of 52 patients consecutively treated in the outpatient clinic for ischemic heart disease (group I) and of 43 patients treated in the general cardiology outpatient clinic (group II), the anatomical diagnosis of ischemic heart disease being the basic condition for their inclusion in the study. The criteria for dyslipidemia were as follows: total cholesterol > 200 mg/dL or LDL-cholesterol > 100 mg/dL, or both, in patients using or not lipid-lowering drugs, and the use of lipid-lowering drugs, even when the total cholesterol or LDL-cholesterol levels were < 200 mg/dL and 100 mg/dL, respectively, or both. The Fisher exact test was used for comparing the variables, and a 2-tailed p < 0.05 was accepted as significant. RESULTS: Demographic characteristics, risk factors for ischemic heart disease, prevalence of previous myocardial infarction, and previous revascularization procedures showed no significant differences between the patients in groups I and II. In group I, 98% of the patients received aspirin, while, in group II, 83% of the patients received that drug (p=0.02). In regard to the use of lipid-lowering drugs, the prevalences were 60% in group I and 19% in group II (p=0.001). The lipid profile examination was requested for 98% of group I individuals and 79% of group II individuals (p=0.003). CONCLUSION: In regard to new medical evidence, mainly prescription of aspirin and lipid-lowering drugs, the management was more reliable in the outpatient clinic specifically aimed at treating ischemic heart disease.