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INTRODUÇÃO: O exercício aeróbio é recomendado para o tratamento da hipertensão. Sua intensidade pode ser prescrita com base na porcentagem da frequência cardíaca máxima (%FCmáx) ou no consumo pico de oxigênio (%VO2pico) em que os limiares ventilatórios (LV) são alcançados. Entretanto, alguns hipertensos que iniciam o treinamento podem estar tomando betabloqueadores, o que pode influenciar esses parâmetros. OBJETIVO: verificar os efeitos do atenolol sobre os LV de hipertensos sedentários. MÉTODOS: Nove voluntários realizaram dois testes ergoespirométricos máximos após quatro semanas de tratamento com atenolol (25 mg administrado por via oral duas vezes por dia) e com placebo, administrados em ordem fixa e de forma cega. Durante os testes, a frequência cardíaca (FC), a pressão arterial (PA) e o VO2 no repouso, limiar anaeróbio (LA), ponto de compensação respiratória (PCR) e pico do esforço foram analisados. RESULTADOS: O VO2 aumentou progressivamente no exercício e seus valores foram semelhantes nos dois tratamentos. A PA sistólica e a FC também aumentaram no exercício, mas seus valores absolutos foram significativamente menores com o atenolol. Porém, o aumento da PA sistólica e da FC no exercício foi semelhante com os dois tratamentos. Assim, o percentual da FCmáx e o percentual do VO2pico em que LA e PCR foram alcançados não diferiram entre o placebo e o atenolol. CONCLUSÃO: O atenolol na dosagem de 50 mg/dia não afetou o percentual do VO2pico e da FCmáx em que os LV são atingidos, o que confirma que a prescrição de intensidade de treinamento com base nessas porcentagens pode ser mantida em hipertensos que recebem betabloqueadores.

INTRODUCTION: Aerobic exercise is recommended for the treatment of hypertension. Its intensity can be prescribed based on the percentage of maximum heart rate (% MHR) or peak oxygen consumption (VO2peak%) in which the ventilatory thresholds (VT) are achieved. However, some hypertensive patients who begin aerobic training may be receiving beta-blockers, which can influence these parameters. OBJECTIVE: To investigate the effects of atenolol on VT of sedentary hypertensive patients. METHODS: Nine volunteers performed two cardiopulmonary exercise tests until exhaustion after 4 weeks of treatment with atenolol (25 mg orally twice daily) and with placebo, administered in a fixed order and in a blinded manner. During the tests, heart rate (HR), blood pressure (BP), VO2 at rest, anaerobic threshold (AT), respiratory compensation point (RCP) and peak effort were analyzed. RESULTS: VO2 increased progressively throughout the exercise and the values were similar for both treatments. Systolic blood pressure and heart rate also increased progressively during the exercise, but their absolute values were significantly lower with atenolol. However, the increase in systolic BP and HR during exercise was similar in both treatments. Thus, the % of MHR and %VO2peak at which LA and PCR were achieved were not different between placebo and atenolol. CONCLUSION: Atenolol, at a dosage of 50mg/day, did not affect the % of VO2peak and % of MHR corresponding to the VTs, which confirms that prescription of training intensity based on these percentages is adequate to hypertensive patients receiving beta-blockers.

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Felipressina aumenta pressão arterial durante procedimento odontológico em pacientes hipertensos
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Bronzo, Ana Lúcia Aparecida

; Cardoso Jr., Crivaldo Gomes

; Ortega, Kátia Coelho

; Mion Jr, Décio

Arquivos Brasileiros de Cardiologia

Journal Metrics
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aug 2012, Volume 99 N. 2 Pages 724 - 731

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

FUNDAMENTO: A felipressina foi adicionada ao anestésico local para aumentar a duração do efeito anestésico e reduzir a toxicidade nos procedimentos dentários. No entanto, o efeito sobre a pressão arterial é incerta, e isso pode ser altamente relevante no tratamento dentário de pacientes hipertensos. OBJETIVO: Investigar o efeito da felipressina sobre a pressão arterial em pacientes hipertensos com pressão arterial controlada. MÉTODOS: Foram estudados 71 indivíduos com essas características e com necessidade de tratamento periodontal. Após 10 minutos de repouso, a anestesia local (prilocaína) foi infiltrada com e sem adição de felipressina. Em seguida, uma raspagem subgengival profunda foi realizada. A pressão arterial foi medida por um equipamento oscilométrico automático (DIXTAL DX2010). Dez minutos após a administração do anestésico, o pico de ação anestésica foi gravado. O Inventário de Ansiedade Traço-Estado (IDATE) foi utilizado para avaliar o traço de ansiedade nos pacientes. RESULTADOS: A pressão arterial sistólica aumentou após a anestesia, independentemente da associação com felipressina, durante todo o procedimento dentário (p < 0,05), e essa resposta pode ser explicada, pelo menos em parte, pelos níveis de traço de ansiedade dos indivíduos. No entanto, um aumento adicional na pressão arterial diastólica foi observado quando a prilocaína foi associada a felipressina (p < 0,05), mas essa resposta não se alterou com os níveis de traço de ansiedade. CONCLUSÃO: A felipressina aumentou a pressão arterial diastólica de pacientes hipertensos com pressão arterial controlada. Pacientes com traço de ansiedade elevado apresentaram aumento na pressão arterial sistólica em alguns procedimentos, sugerindo que um aumento da pressão arterial também pode estar relacionado ao medo ou à ansiedade.

BACKGROUND: Felypressin has been added to local anesthetic to increase the length of the anesthetic effect and reduce toxicity during dental procedures. However, the effect on blood pressure remains uncertain, and this may be highly relevant in the dental treatment of hypertensive patients. OBJECTIVE: To investigate the effect of felypressin on blood pressure in hypertensive patients with controlled BP. METHODS: 71 subjects with these characteristics and in need of periodontal treatment were studied. After 10 minutes of rest, local anesthesia (prilocaine) was infiltrated with and without addition of felypressin. Then, a deep subgingival scaling was performed. Blood pressure was measured by an automated oscillometric device (DIXTAL DX2010). Ten minutes after the administration of the anesthetic, peak anesthetic action was recorded. The State-Trait Anxiety Inventory (STAI) was used to assess the patients' trait anxiety. RESULTS: Systolic blood pressure increased after anesthesia, regardless of association with felypressin, throughout the dental procedure (p<0.05) and this response can be explained, at least in part, by the trait anxiety levels of the subjects. However, a further increase in diastolic blood pressure was observed when prilocaine was associated with felypressin (p<0.05), but this response did not change with trait anxiety levels. CONCLUSION: Felypressin increased the diastolic blood pressure of hypertensive patients with controlled blood pressure. Patients with high trait anxiety presented increases in systolic blood pressure upon some procedures, suggesting that an increase in blood pressure might also be related to fear or anxiety.

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Variáveis biopsicossociais e atitudes frente ao tratamento influenciam a hipertensão complicada
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Pierin, Angela Maria Geraldo

; Jesus, Elaine dos Santos

; Augusto, Mônica Aparecida de Oliveira

; Gusmão, Josiane

; Ortega, Kátia

; Mion Jr, Décio

Arquivos Brasileiros de Cardiologia

Journal Metrics
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oct 2010, Volume 95 N. 5 Pages 648 - 654

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

FUNDAMENTO: A hipertensão complicada pode ser influenciada pelas características dos pacientes hipertensos. OBJETIVO: Associar a condição de hipertensão complicada com variáveis biossociais, tais como as atitudes e as crenças sobre a doença e o tratamento e o bem-estar subjetivo. MÉTODOS: Foram estudados 251 hipertensos não complicados (PAS > 140 mmHg e/ou 90 < PAD < 110 mmHg para pacientes sem tratamento e PAD < 110 mmHg para pacientes com tratamento, sem lesões em órgãos-alvo e outras doenças) e 260 hipertensos complicados (PAD > 110 mmHg com ou sem tratamento, com lesões em órgãos-alvo ou outras doenças). RESULTADOS: Os hipertensos complicados foram significativamente diferentes dos não complicados (p < 0,05) em relação a: 1 - Predomínio de homens, não brancos (53,0%), maior índice de massa corporal (29,5 ± 4,6 vs 28,5 ± 4,0 kg/m²), mais de 10 anos de doença (54,0%), realização de tratamento anterior (53,0%) e referência de tristeza em relação a sua vida como um todo (74,0%); 2 - Os hipertensos complicados nunca levam os remédios quando viajam (59,0%), nem os providenciam antes de acabarem (71,0%) e raramente seguem as orientações sobre alimentação (69,0%); 3 - Os hipertensos não complicados apontaram mais enxaqueca, dor articular e, entre as mulheres, presença de menopausa e tratamento de reposição hormonal; 4 - Dos que tinham a pressão controlada (< 140/90 mmHg), 61,9% eram hipertensos não complicados; e 5 - Os hipertensos complicados desconheciam que o tratamento pode evitar problemas renais e desconheciam ainda que a hipertensão também pode acometer pessoas jovens. CONCLUSÃO: Hipertensos complicados apresentaram mais características estruturais e psicossociais desfavoráveis, mais atitudes negativas frente ao tratamento e desconhecem a doença.

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.

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Hipertensão arterial na cidade de São Paulo: prevalência referida por contato telefônico
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Mion Jr, Décio

; Pierin, Angela MG

; Bensenor, Isabela M.

; Marin, Júlio César M.

; Costa, Karla Ryuko Abe

; Henrique, Luiz Fernando de Oliveira

; Alencar, Natália de Pinho

; Couto, Rodrigo do Carmo

; Laurenti, Tales Eduardo

; Machado, Thiago Arthur Oliveira

Arquivos Brasileiros de Cardiologia

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jul 2010, Volume 95 N. 1 Pages 99 - 106

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

FUNDAMENTO: Pouco se conhece sobre a prevalência da hipertensão arterial na cidade de São Paulo, SP, Brasil. OBJETIVO: Identificar a prevalência da hipertensão referida na cidade de São Paulo. MÉTODOS: Realizaram-se 613 entrevistas por telefone, a partir das listas residenciais do sistema de telefonia fixa. A amostra foi calculada com prevalência estimada de hipertensão em 20,0%. RESULTADOS: A prevalência referida de hipertensão foi de 23,0% e 9,0% dos entrevistados referiram que o valor de sua última medida da pressão foi maior que 140/90 mmHg, porém não tinham conhecimento de que eram hipertensos, totalizando uma prevalência de 32,0%. Os hipertensos referiram que: 89,0% fazem tratamento e 35,2% estavam controlados; 27,0% faltam às consultas; 16,2% deixam de tomar os remédios; 14,8% apresentam história de acidente vascular encefálico, 27,8% cardiopatia e 38,7% hipercolesterolemia; 71,2% receberam orientação para diminuir sal, 64,6% para realizar atividade física, 60,0% para perder peso e 26,2% para controlar estresse; e 78,9% mediam a pressão regularmente. Houve relação estatisticamente significante (p < 0,05) para: 1) faltar às consultas com maior tempo de tratamento e acompanhamento irregular de saúde; 2) deixar de tomar os remédios com tabagismo, etilismo e a não realização de acompanhamento de saúde; 3) realizar tratamento para hipertensão com dislipidemia, idade mais elevada e maior tempo de uso de anticoncepcional, no caso das mulheres; e 4) índice de massa corporal alterado com presença de diabete, hipercolesterolemia, pressão sistólica não controlada e uso de mais de um anti-hipertensivo. CONCLUSÃO: A prevalência referida de hipertensão na cidade de São Paulo assemelha-se à prevalência identificada em outros estudos.

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 landlines. 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 monitore 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.

FUNDAMENTO: Poco se conoce sobre la prevalencia de la hipertensión arterial en la ciudad de São Paulo, SP, Brasil. OBJETIVO: Identificar la prevalencia de la hipertensión referida en la ciudad de São Paulo. MÉTODOS: Se realizaron 613 entrevistas por teléfono, a partir de las listas residenciales del sistema de telefonía fija. La muestra fue calculada con prevalencia estimada de hipertensión en 20,0%. RESULTADOS: La prevalencia referida de hipertensión fue de 23,0% y 9,0% de los entrevistados refirieron que el valor de su última medición de la presión fue mayor que 140/90 mmHg, sin embargo no sabían que eran hipertensos, totalizando una prevalencia de 32,0%. Los hipertensos refirieron que: 89,0% hacen tratamiento y 35,2% estaban controlados; 27,0% faltan a las consultas; 16,2% dejan de tomar los remedios; 14,8% presentan historia de accidente cerebro vascular, 27,8% cardiopatía y 38,7% hipercolesterolemia; 71,2% recibieron orientación de disminuir la sal, 64,6% de realizar actividad física, 60,0% para perder peso y 26,2% de controlar el stress; y 78,9% medían la presión regularmente. Hubo relación estadísticamente significativa (p < 0,05) para: 1 - faltar a las consultas con mayor tiempo de tratamiento y acompañamiento irregular de salud; 2 - dejar de tomar los remedios con tabaquismo, etilismo y la no realización de acompañamiento de salud; 3 - realizar tratamiento para hipertensión con dislipidemia, edad más elevada y mayor tiempo de uso de anticonceptivo, en el caso de las mujeres; y 4 - índice de masa corporal alterado con presencia de diabetes, hipercolesterolemia, presión sistólica no controlada y uso de más de un antihipertensivo. CONCLUSIÓN: La prevalencia referida de hipertensión en la ciudad de São Paulo se asemeja a la prevalencia identificada en otros estudios.

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Controle da pressão arterial em pacientes sob tratamento anti-hipertensivo no Brasil: Controlar Brasil
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Nobre, Fernando

; Ribeiro, Artur Beltrame

; Mion Jr, Décio

Arquivos Brasileiros de Cardiologia

Journal Metrics
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may 2010, Volume 94 N. 5 Pages 663 - 670

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

FUNDAMENTO: O controle da pressão arterial (PA) é fundamental na hipertensão arterial (HA). OBJETIVO: Conhecer o porcentual de pacientes exigindo metas específicas de controle da PA, atendidos em consultórios no Brasil. MÉTODOS: Cada pesquisador, em número de 291, deveria avaliar, por medida convencional da PA, em cinco dias consecutivos, os dois primeiros pacientes atendidos. Determinou-se o número de hipertensos tratados por, pelo menos, quatro semanas, e com controle da pressão arterial, de acordo com as metas desejadas para o grupo de risco a que pertenciam. RESULTADOS: Foram avaliados 2.810 pacientes, em 291 centros. Os indivíduos obedeceram à seguinte distribuição, por grupo: A (HA estágios 1 e 2, risco adicional baixo e médio) = 1.054 (37,51%); B (HA e PA limítrofe, risco adicional alto) = 689 (24,52%); C (HA e PA limítrofe risco adicional muito alto, incluindo diabéticos) = 758 (26,98%) e D (HA com nefropatia e proteinúria > 1 g/l) = 309 (11%). As médias de PA na população foram: 138,9 ± 17,1 e 83,1 ± 10,7 mmHg. Fatores relacionados ao menor controle da PA: idade, circunferência abdominal, diabete, tabagismo e doença coronariana. Os porcentuais de controle da PA em cada um dos grupos foram, respectivamente: 61,7; 42,5; 41,8 e 32,4. CONCLUSÃO: O baixo controle da PA segundo as metas predefinidas, como explicitado nos resultados, reforça a necessidade de medidas que promovam melhores taxas de controle.

BACKGROUND: Blood pressure (BP) control is crucial in arterial hypertension (AH). OBJECTIVE: To determine the percentage of patients requiring specific BP control goals treated in medical offices throughout Brazil. METHODS: Each researcher, from a total number of 291, had to evaluate, through conventional BP measurement performed during five consecutive days, the two first patients treated on that day. We determined the number of hypertensive patients treated for at least four weeks who presented BP control, according to the goals established for the risk group they belonged to. RESULTS: A total of 2,810 patients were assessed in 291 centers. The individuals were divided in groups as follows: A (AH stages 1 and 2, low and moderate additional risk) = 1,054 (37.51%); B (AH and borderline BP, high additional risk ) = 689 (24.52%); C (AH and borderline BP, very high additional risk, including diabetic patients) = 758 (26.98%) and D (AH with nephropathy and proteinuria > 1 g/l) = 309 (11%). The BP means in the population were: 138.9 ± 17.1 and 83.1 ± 10.7 mmHg. Factors associated with a worse BP control were: age, abdominal circumference, diabetes, smoking and coronary disease. The BP control percentages in each of the groups were, respectively: 61.7; 42.5; 41.8 and 32.4%. CONCLUSION: The low BP control according to the predefined goals, as demonstrated in the results, reinforces the necessity to establish measures to promote better control rates.

FUNDAMENTO: El control de la presión arterial (PA) es fundamental en la hipertensión arterial (HA). OBJETIVO: Conocer el porcentaje de pacientes que requieren metas específicas de control de la PA, atendidos en consultorios en Brasil. MÉTODOS: Cada investigador, en número de 291, debería evaluar, por medición convencional de la PA, en cinco días consecutivos, los dos primeros pacientes atendidos. Se determinó el número de hipertensos tratados durante, por lo menos, cuatro semanas, y con control de la presión arterial, de acuerdo con las metas deseadas para el grupo de riesgo al que pertenecían. RESULTADOS: Fueron evaluados 2.810 pacientes, en 291 centros. Los individuos obedecieron a la siguiente distribución, por grupo: A (HA Estadios 1 y 2, riesgo adicional bajo y medio) = 1.054 (37,51%); B (HA y PA Limítrofe, riesgo adicional alto) = 689 (24,52%); C (HA y PA Limítrofe riesgo adicional muy alto, incluyendo diabéticos) = 758 (26,98%) y D (HA con nefropatía y proteinuria > 1 g/l) = 309 (11%). Los promedios de PA en la población fueron: 138,9 ± 17,1 y 83,1 ± 10,7 mmHg. Factores relacionados al menor control de la PA: edad, circunferencia abdominal, diabetes, tabaquismo y enfermedad coronaria. Los porcentajes de control de la PA en cada uno de los grupos fueron, respectivamente: 61,7; 42,5; 41,8 y 32,4. CONCLUSIÓN: El bajo control de la PA según las metas predefinidas, como se explica en los resultados, refuerza la necesidad de medidas que promuevan mejores índices de control.

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Intra-arterial blood pressure response in hypertensive subjects during low- and high-intensity resistance exercise
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Nery, Sandra de Souza

; Gomides, Ricardo Saraceni

; Silva, Giovanio Vieira da

; Forjaz, Claudia Lucia de Moraes

; Mion Jr, Décio

; Tinucci, Tais

Clinics

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2010, Volume 65 N. 3 Pages 271 - 277

Abstract: En | Text: En | PDF: En

OBJECTIVE: The aim of this study was to describe blood pressure responses during resistance exercise in hypertensive subjects and to determine whether an exercise protocol alters these responses. INTRODUCTION: Resistance exercise has been recommended as a complement for aerobic exercise for hypertensive patients. However, blood pressure changes during this kind of exercise have been poorly investigated in hypertensives, despite multiple studies of normotensives demonstrating significant increases in blood pressure. METHODS: Ten hypertensive and ten normotensive subjects performed, in random order, two different exercise protocols, composed by three sets of the knee extension exercise conducted to exhaustion: 40% of the 1-repetition maximum (1RM) with a 45-s rest between sets, and 80% of 1RM with a 90-s rest between sets. Radial intra-arterial blood pressure was measured before and throughout each protocol. RESULTS: Compared with normotensives, hypertensives displayed greater increases in systolic BP during exercise at 80% (+80±3 vs. +62±2 mmHg, P<0.05) and at 40% of 1RM (+75±3 vs. +67±3 mmHg, P<0.05). In both exercise protocols, systolic blood pressure returned to baseline during the rest periods between sets in the normotensives; however, in the hypertensives, BP remained slightly elevated at 40% of 1RM. During rest periods, diastolic blood pressure returned to baseline in hypertensives and dropped below baseline in normotensives. CONCLUSION: Resistance exercise increased systolic blood pressure considerably more in hypertensives than in normotensives, and this increase was greater when lower-intensity exercise was performed to the point of exhaustion.

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Acute and chronic effects of aerobic and resistance exercise on ambulatory blood pressure
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Cardoso Jr, Crivaldo Gomes

; Gomides, Ricardo Saraceni

; Queiroz, Andréia Cristiane Carrenho

; Pinto, Luiz Gustavo

; Lobo, Fernando da Silveira

; Tinucci, Tais

; Mion Jr, Décio

; Forjaz, Claudia Lucia de Moraes

Clinics

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2010, Volume 65 N. 3 Pages 317 - 325

Abstract: En | Text: En | PDF: En

Hypertension is a ubiquitous and serious disease. Regular exercise has been recommended as a strategy for the prevention and treatment of hypertension because of its effects in reducing clinical blood pressure; however, ambulatory blood pressure is a better predictor of target-organ damage than clinical blood pressure, and therefore studying the effects of exercise on ambulatory blood pressure is important as well. Moreover, different kinds of exercise might produce distinct effects that might differ between normotensive and hypertensive subjects. The aim of this study was to review the current literature on the acute and chronic effects of aerobic and resistance exercise on ambulatory blood pressure in normotensive and hypertensive subjects. It has been conclusively shown that a single episode of aerobic exercise reduces ambulatory blood pressure in hypertensive patients. Similarly, regular aerobic training also decreases ambulatory blood pressure in hypertensive individuals. In contrast, data on the effects of resistance exercise is both scarce and controversial. Nevertheless, studies suggest that resistance exercise might acutely decrease ambulatory blood pressure after exercise, and that this effect seems to be greater after low-intensity exercise and in patients receiving anti-hypertensive drugs. On the other hand, only two studies investigating resistance training in hypertensive patients have been conducted, and neither has demonstrated any hypotensive effect. Thus, based on current knowledge, aerobic training should be recommended to decrease ambulatory blood pressure in hypertensive individuals, while resistance exercise could be prescribed as a complementary strategy.

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How to avoid discontinuation of antihypertensive treatment: The experience in São Paulo, Brazil
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Ortega, Katia Coelho

; Gusmão, Josiane Lima de

; Pierin, Angela Maria Geraldo

; Nishiura, José Luiz

; Ignez, Edna Caetano

; Segre, Carlos Alexandre

; Ventura, Carlucci Gualberto

; Mano, Gisele Peixoto

; Fontes, Viviane

; Cunha, Francisco Mogadouro da

; Mion Jr, Décio

Clinics

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2010, Volume 65 N. 9 Pages 857 - 863

Abstract: En | Text: En | PDF: En

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.

2618 downloads Cited 2 times in SciELO

10.

Reasons for resubmission of research projects to the research ethics committee of a University Hospital in São Paulo, Brazil
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Bueno, Mariana

; Brevidelli, Maria Meimei

; Cocarelli, Thaís

; Santos, Gianni Mara Silva dos

; Ferraz, Maria Auxiliadora

; Mion Jr., Décio

Clinics

Journal Metrics
- Sobre o periódico
- SciELO Analytics

2009, Volume 64 N. 9 Pages 831 - 836

Abstract: En | Text: En | PDF: En

INTRODUCTION: It is important to know the reasons for resubmitting research projects to the Research Ethics Committee in order to help researchers to prepare their research projects, informed consent forms and needed research documentation. OBJECTIVES: To verify the reasons for resubmitting projects that were previously rejected by the Ethics Committee. METHOD: This is a cross-sectional study that evaluated research projects involving human beings. Research projects were submitted in 2007 to the Research Ethics Committee of the Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. RESULTS: One thousand two hundred and fifty six research projects were submitted to the ethics committee and the average time for evaluating the research projects and related documents until a final decision was reached was 49.95 days. From the total, 399 projects were reviewed in 2 or more meetings until a final decision was reached. Of these, 392 research projects were included in the study; 35 projects were subsequently excluded for involving animals. Among the research projects included, 42.5% concerned research with new drugs, vaccines and diagnostic tests, 48.5% consisted of undergraduate students' research projects, 68.9% of the research had no sponsorship, and 97.5% were eventually approved. The main reasons for returning the projects to the researchers were the use of inadequate language and/or difficulty of understanding the informed consent form (32.2%), lack of information about the protocol at the informed consent form (25.8%), as well as doubts regarding methodological and statistical issues of the protocol (77.1%). Other reasons for returning the research projects involved lack of, inaccuracy on or incomplete documentation, need of clarification or approval for participation of external entities on the research, lack of information on financial support. CONCLUSION: Among the research projects that were returned to the researchers for additional clarification, the main reasons were inadequacies or doubts about the terms used in the informed consent form as well as lack of information regarding the research at the informed consent form and methodological and statistical issues regarding the protocol.

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11.

Prevalência de hipertensão arterial em pacientes com oclusão do ramo da veia central da retina
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Rosa, Alexandre Antonio Marques

; Ortega, Kátia Coelho

; Mion Jr., Décio

; Nakashima, Yoshitaka

Arquivos Brasileiros de Oftalmologia

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apr 2008, Volume 71 N. 2 Pages 162 - 166

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVOS: Identificar em pacientes com oclusão do ramo da veia central da retina utilizando a monitorização ambulatorial da pressão arterial e medidas clínicas da pressão arterial: prevalência de hipertensão e o perfil noturno da pressão arterial. MÉTODOS: Prospectivamente, 93 olhos de 83 pacientes com oclusão do ramo da veia central da retina foram submetidos à avaliação oftalmológica. Após, os pacientes foram encaminhados para avaliação clínica e monitorização da pressão arterial. Pacientes sem descenso da pressão durante o sono ("non-dipper") foram definidos como um declínio na pressão arterial sistólica < 10%, e pacientes com descenso presente ("dipper") quando este valor fosse superior. RESULTADOS: A doença acometeu um olho em 73 (88%) pacientes. O ramo temporal superior foi o local da oclusão em 61 (65,6%) olhos, no restante o ramo temporal inferior foi afetado. Setenta e seis (92%) pacientes formam diagnosticados como hipertensos após a avaliação clínica. A monitorização ambulatorial da pressão arterial identificou 76 hipertensos, 5 normotensos, 1 hipertenso do avental branco e 1 hipertenso mascarado. Estes 2 últimos foram excluídos da análise. Dos 81 pacientes, analisados. Quarenta (49%) eram "dippers" e 41 (51%) "non-dippers". Entre os hipertensos (n=76), 36 (47,4%) eram "dippers" e 40 (52,6%) "non-dippers". CONCLUSÃO: Prevalência de hipertensão arterial em nosso estudo foi extremamente elevada (92,8%), que sugere que a fisiopatologia da doença tem íntima relação com as alterações promovidas pela hipertensão. Pouco mais da metade dos hipertensos eram "non-dipper" (n=40; 52,6%). Estas evidências sugerem que um nível sustentado de pressão arterial possa ser um fator de risco adicional para a oclusão do ramo da veia central da retina.

PURPOSE: To identify in patients with branch retinal vein occlusion using ambulatory blood pressure monitoring and clinical blood pressure measures: hypertension prevalence, and nocturnal profile of blood pressure. METHODS: Prospectively, 93 eyes of 83 patients with branch retinal vein occlusion were submitted to ophthalmological examination. Afterwards the patients were submitted to clinical evaluation and blood pressure monitoring. Non-dipper was defined as a fall in systolic blood pressure < 10%, and dipper when this value was higher. RESULTS: Disease affected one eye in 73 (88%) patients. The temporal superior branch was the site of occlusion in 61 (65.6%) eyes, while in the others the infero-temporal branch was affected. Seventy six (92%) patients were diagnosed as hypertensive after clinical evaluation. Ambulatory blood pressure monitoring identified 76 hipertensives, 5 normotensives, 1 white-coat hypertensive and one masked hypertensive subjects. The two latter were excluded from the analysis. Of the 81 analyzed patients, forty (49%) were dippers and 41 (51%) were non-dippers. Among the HT (n=76), 36 (47%) were dippers and 40 (53%) were non-dippers. CONCLUSION: Prevalence of hypertension in our series was extremely high (92%) which suggests that physiopathology of the disease has a close relationship with changes promoted by hypertension. A little more than half of the hypertensives were non-dippers (n=40; 52,6%). These evidences suggest that a 24-hour sustained level of blood pressure may be an additional risk factor for branch retinal vein occlusion.

3488 downloads

12.

Blood pressure measurements taken by patients are similar to home and ambulatory blood pressure measurements
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Pierin, Angela M. G.

; Ignez, Edna C.

; Jacob Filho, Wilson

; Barbato, Alfonso Júlio Guedes

; Mion Jr., Décio

Clinics

Journal Metrics
- Sobre o periódico
- SciELO Analytics

2008, Volume 63 N. 1 Pages 43 - 50

Abstract: En | Text: En | PDF: En

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".

2089 downloads

13.

Estudo "LOTHAR": avaliação de eficácia e tolerabilidade da combinação fixa de anlodipino e losartana no tratamento da hipertensão arterial primária
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Kohlmann Jr, Osvaldo

; Oigman, Wille

; Mion Jr., Décio

; Rocha, João Carlos

; Gomes, Marco Antonio Mota

; Salgado, Natalino

; Feitosa, Gilson Soares

; Dallaverde, Ernesto

; Ribeiro, Artur Beltrame

Arquivos Brasileiros de Cardiologia

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jan 2006, Volume 86 N. 1 Pages 39 - 51

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: O estudo LOTHAR avaliou a eficácia, tolerabilidade e os efeitos metabólicos em médio e longo prazo (um ano) da combinação fixa de anlodipino e losartana versus anlodipino e losartana isoladamente. MÉTODOS: Estudo multicêntrico brasileiro, randomizado, duplo-cego e comparativo realizado com 198 pacientes com hipertensão arterial primária em estágios 1 e 2. RESULTADOS: A combinação fixa apresenta alta eficácia anti-hipertensiva que se mantém em longo prazo com percentual reduzido de escape do controle pressórico, inferior a dos dois regimes monoterápicos de comparação. Em longo prazo, mais de 60% dos pacientes tratados com a combinação fixa permaneceram com níveis da PAD < 85 mmHg e o efeito anti-hipertensivo quando avaliado pela MAPA persistiu nas 24 horas com relação vale-pico de 76,7%. A freqüência de eventos adversos foi bastante reduzida neste grupo sendo a incidência em longo prazo de edema de membros inferiores cerca de quatro vezes menor que a observada com o anlodipino isolado. A combinação fixa não alterou os metabolismos da glicose e dos lípides tanto em médio quanto em longo prazos. CONCLUSÃO: Estes resultados nos permitem afirmar que a combinação de anlodipino e losartana, a primeira combinação fixa de um antagonista dos canais de cálcio e um bloqueador do receptor da angiotensina II disponível no mercado farmacêutico constitui-se em excelente opção para o tratamento da hipertensão arterial em larga gama de pacientes hipertensos.

OBJECTIVE: The LOTHAR study evaluated medium and long term (one year) efficacy, tolerability and metabolic effects of the fixed combination of amlodipine and losartan compared to amlodipine or losartan alone. METHODS: Brazilian multicenter, randomized, double-blind and comparative trial performed with 198 patients in stage 1 and 2 essential hypertension. RESULTS: The fixed combination has a high antihypertensive efficacy that is sustained in the long term with very low percentage of loss of blood pressure control. This percentage is incidentally lower than that of the two monotherapy comparative regimens. In the long term, more than 60% of the patients treated with the fixed combination remained with DBP < 85 mmHg, and the antihypertensive effect, when assessed by ABPM persisted for 24 hours with a trough-to-peak ratio of 76.7%. The frequency of adverse events was quite low in this group, and the long-term incidence of leg edema was approximately four-fold lower than that observed with amlodipine alone. The fixed combination did not change glucose and lipid metabolism in the medium or in the long term. CONCLUSION: Based on these results, we can say that the combination of amlodipine and losartan - the first fixed combination of a calcium channel blocker and an angiotensin II receptor blocker available in the pharmaceutical market, is an excellent option for the treatment of a wide range of hypertensive patients.

21378 downloads

14.

IV Diretriz para uso da Monitorização Ambulatorial da Pressão Arterial - II Diretriz para uso da Monitorização Residencial da Pressão Arterial IV MAPA / II MRPA
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Alessi, Alexandre

; Brandão, Andréa A.

; Pierin, Ângela

; Feitosa, Audes Magalhães

; Machado, Carlos Alberto

; Forjaz, Cláudia Lúcia de Moraes

; Atie, Cristina S.

; Giorgi, Dante Marcelo Artigas

; Mion Jr., Décio

; Rosa, Eduardo Cantoni

; Nobre, Fernando

; Silva, Giovânio Vieira

; Chaves Jr., Hilton

; Pascoal, Istênio José Fernandes

; Guimarães, Jorge Ilha

; Santello, José Luis

; Ribeiro, José Márcio

; Praxedes, José Nery

; Ortega, Kátia Coelho

; Costa, Lílian Soares da

; Bortolotto, Luis Aparecido

; Gomes, Marco Antonio Mota

; Wajngarten, Maurício

; Gus, Miguel

; Kohlmann Jr., Osvaldo

; Jardim, Paulo César Veiga

; Geleilete, Tufik José Magalhães

; Koch, Vera

Arquivos Brasileiros de Cardiologia

Journal Metrics
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jul 2005, Volume 85 Suppl. 2 Pages 1 - 18

Abstract: Pt | Text: Pt | PDF: Pt

13912 downloads Cited 3 times in SciELO

15.

O conhecimento de profissionais da área da saúde sobre a medida da pressão arterial
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Rabello, Cláudia Cristina Pereira

; Pierin, Angela Maria Geraldo

; Mion Jr., Décio

Revista da Escola de Enfermagem da USP

Journal Metrics
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jun 2004, Volume 38 N. 2 Pages 127 - 134

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Avaliou-se o conhecimento teórico e prático de 110 auxiliares de enfermagem, 44 médicos e 25 enfermeiros, por meio de 15 questões de múltipla escolha e pela observação do procedimento da medida da pressão arterial. O percentual de acerto quanto ao conhecimento teórico foi de 32%±12% para os auxiliares de enfermagem, 44%±14% para os enfermeiros e 56%±13% para os médicos, sendo que todos foram estatisticamente diferentes entre si (p<0,05). Quanto ao conhecimento prático, este foi de 41%±6% para os auxiliares de enfermagem, 44%±10% para os enfermeiros e 50%±12% para os médicos, sendo que os médicos apresentarem resultados significativamente superiores (p<0,05). Conclui-se que o conhecimento foi pouco satisfatório.

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.

Se evaluó el conocimiento teórico y práctico de 110 auxiliares de enfermería, 44 médicos y 25 enfermeros, por medio de 15 preguntas de opciones múltiples y por la observación del procedimiento de la médida de la presión arterial. El porcentaje de acierto en cuanto al conocimiento teórico fue de 32%±12% para los auxiliares de enfermería, 44%±14% para los enfermeros y 56%±13% para los médicos, siendo que todos fuerón estadistícamente diferentes entre si (p< 0,05). En cuanto al conocimiento práctico, este fue de 41%±6% para los auxiliares de enfermería, 44%±10% para los enfermeros y 50%±12% para los médicos, siendo que los médicos presentarón resultados significativamente superiores (p<0,05). Se concluye que el conocimiento fue poco satisfactorio.

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