78 results on '"Jardim PC"'
Search Results
2. Hypertensive diabetic patients: guidelines for conduct and their difficulties
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Couto Pv, Souza Cu, Ibrahim Fm, Jardim Ts, Silveira A, Jardim Pc, Barroso Wk, Magalh es Al, and Monego Et
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Drug ,Adult ,Male ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,hypertension ,media_common.quotation_subject ,medicine.medical_treatment ,Blood Pressure ,Referral service ,chemistry.chemical_compound ,Risk Factors ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Antihypertensive Agents ,media_common ,Aged ,Retrospective Studies ,Aged, 80 and over ,Creatinine ,diabetes ,treatment ,business.industry ,Insulin ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Blood pressure ,chemistry ,lcsh:RC666-701 ,Hypertension ,Practice Guidelines as Topic ,Female ,Cardiology and Cardiovascular Medicine ,business ,Body mass index ,Diabetic Angiopathies ,Follow-Up Studies - Abstract
OBJECTIVE: To assess the effect of blood pressure (BP) control and other cardiovascular risk factors in patients with diabetes mellitus in a referral service for the treatment of hypertension. METHODS: A retrospective study where diabetic patients (at least 2 fasting glucose levels above 126 mg/dL, use of hypoglycemic agents or insulin, or both of these) were included. They were evaluated at the first appointment (M1) and at the last appointment (M2), regarding blood pressure, body mass index (BMI), use of hypertensive drugs, glycemia, total cholesterol (TC), creatinine, and potassium. RESULTS: Of 1,032 patients studied, 146 patients with a mean age of 61.6 years had diabetes, and 27 were men (18.5%). Mean follow-up was 5.5 years. BP values were 161.6 x 99.9 mmHg in M1 and 146.3 x 89.5 mmHg in M2. In M1, 10.4% of the patients did not use medications, 50.6% used just 1 drug, 30.8% used 2 drugs, and 8.2% used 3 or more drugs. In M2, these values were 10.9%, 39%, 39.7%, and 10.4%, respectively. Diuretics were the most commonly used medication, whereas angiotensin-converting enzyme inhibitors (ACE inhibitors) were those drugs which presented greater increase when comparing M1 to M2 (24.6% and 41.7%, respectively). Only 17,1% reached the recommended goal (BP
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- 2003
3. Brazilian multicenter study on efficacy and tolerability of trandolapril in mild-to-moderate essential arterial hypertension. EMBATHE substudy with ambulatory blood pressure monitoring
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Jardim Pc, Wille Oigman, and Osvaldo Kohlmann
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Adult ,Male ,Trandolapril ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Indoles ,Ambulatory blood pressure ,Diastole ,Blood Pressure ,Placebo ,Double-Blind Method ,Internal medicine ,ACE inhibitor ,medicine ,Humans ,Adverse effect ,trandolapril ,Antihypertensive Agents ,business.industry ,Middle Aged ,mild-to-moderate hypertension ,Surgery ,Treatment Outcome ,Blood pressure ,Tolerability ,lcsh:RC666-701 ,Hypertension ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Brazil ,medicine.drug - Abstract
OBJECTIVE: A double-blind, placebo-controlled multicenter study involving 34 centers from different Brazilian regions was performed to evaluate the antihypertensive efficacy and tolerability of trandolapril, an angiotensin I converting enzyme inhibitor, in the treatment of mild-to-moderate systemic arterial hypertension. METHODS: Of 262 patients enrolled in this study, 127 were treated with trandolapril 2 mg/day for 8 consecutive weeks, and the remaining 135 patients received placebo for the same period of time. Reduction in blood pressure (BP) and the occurrence of adverse events during this period were evaluated in both groups. RESULTS: Significant reductions in both systolic and diastolic pressures were observed in patients treated with trandolapril when compared with those on placebo. Antihypertensive efficacy was achieved in 57.5% of the patients on trandolapril and in 42% of these normal values of BP were obtained. The efficacy of trandolapril was similar in all centers, regardless of the area of the country. In a subset of 30 patients who underwent ABPM, responders showed a significant hypotensive effect to trandolapril throughout the 24 hour day. The adverse event profile was similar in both trandolapril and placebo groups. CONCLUSION: Our results demonstrate, for the first time in a large group of hypertensive patients from different regions in Brazil, good efficacy and tolerability of trandolapril during treatment of mild-to-moderate essential systemic hypertension.
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- 1999
4. II Consenso Brasileiro para o uso da monitorização ambulatorial da pressão arterial
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Santelo Jl, JM Ribeiro, Mauricio Wajngarten, Introcaso L, Mvb Malachias, Nascimento R, Pascoal Ij, Mam Gomes, Passaro Lc, Eduardo Gomes Lima, Chaves Júnior H, Décio Mion, Jardim Pc, Koch, Celso Amodeo, Fernando Nobre, Lima Júnior E, Dante Marcelo Artigas Giorgi, Zanela Mt, and Atie Cs
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Gynecology ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,lcsh:RC666-701 ,business.industry ,medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 1997
5. MUSIC THERAPY CONTRIBUTING TO THE QUALITY OF LIFE OF HYPERTENSIVE PATIENTS: PP.33.300
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Zanini, C, primary, Jardim, PC, additional, Salgado, C, additional, and Jardim, T, additional
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- 2010
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6. Rate of abandon of the anttihypertensive treatment in the context of a multiprovessional service-A3-year analysis all
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Sousa, Jardim, PC, Monego, ET, Ferreirs, ML, Ferreirs, LD, and Olieira, MJA
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- 1995
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7. Correction to: Effectiveness of chlorthalidone/amiloride versus losartan in patients with stage I hypertension and diabetes mellitus: results from the PREVER-treatment randomized controlled trial.
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Fuchs FD, Scala LCN, Vilela-Martin JF, Whelton PK, Poli-de-Figueiredo CE, Pereira E Silva R, Gus M, Bortolotto LA, Consolim-Colombo FM, Schlatter RP, Cesarino EJ, Castro I, Figueiredo Neto JA, Chaves H, Steffens AA, Alves JG, Brandão AA, de Sousa MR, Jardim PC, Moreira LB, Franco RS, Gomes MM, Afiune Neto A, Fuchs FC, Sobral Filho DC, Nóbrega AC, Nobre F, Berwanger O, and Fuchs SC
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- 2021
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8. Effectiveness of chlorthalidone/amiloride versus losartan in patients with stage I hypertension and diabetes mellitus: results from the PREVER-treatment randomized controlled trial.
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Fuchs FD, Scala LCN, Vilela-Martin JF, Whelton PK, Poli-de-Figueiredo CE, Pereira E Silva R, Gus M, Bortolotto LA, Consolim-Colombo FM, Schlatter RP, Cesarino JE, Castro I, Figueiredo Neto JA, Chaves H, Steffens AA, Alves JG, Brandão AA, de Sousa MR, Jardim PC, Moreira LB, Franco RS, Gomes MM, Afiune Neto A, Fuchs FC, Sobral Filho DC, Nóbrega AC, Nobre F, Berwanger O, and Fuchs SC
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- Adult, Aged, Amiloride adverse effects, Antihypertensive Agents administration & dosage, Antihypertensive Agents adverse effects, Brazil, Chlorthalidone adverse effects, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 physiopathology, Double-Blind Method, Drug Therapy, Combination, Female, Humans, Hypertension complications, Hypertension pathology, Losartan adverse effects, Male, Middle Aged, Severity of Illness Index, Treatment Outcome, Amiloride administration & dosage, Blood Pressure drug effects, Chlorthalidone administration & dosage, Diabetes Mellitus, Type 2 drug therapy, Hypertension drug therapy, Losartan administration & dosage
- Abstract
Aims: To compare the blood pressure (BP)-lowering efficacy of a chlorthalidone/amiloride combination pill with losartan, during initial management of JNC 7 Stage I hypertension in patients with type 2 diabetes mellitus., Methods: In an a priori subgroup analysis of a randomized, double-blind, controlled trial, volunteers aged 30-70 years, with stage I hypertension and diabetes mellitus, were randomized to 12.5/2.5 mg of chlorthalidone/amiloride (N = 47) or 50 mg of losartan (N = 50), and followed for 18 months in 21 clinical centers. If BP remained uncontrolled after three months, study medication dose was doubled, and if uncontrolled after six months, amlodipine (5 and 10 mg) and propranolol (40 and 80 mg BID) were added as open label drugs in a progressive fashion., Results: Systolic BP decreased to a greater extent in participants allocated to diuretics compared to losartan (P < 0.001). After 18 months of follow-up, systolic BP was 128.4 ± 10.3 mmHg in the diuretic group versus 133.5 ± 8.0 in the losartan group (P < 0.01). In the diuretic group, 36 out of 43 participants (83.7%) had a JNC 7 normal BP, compared to 31/47 (66%) in the losartan group (P = 0.089). Serum cholesterol was higher in the diuretic arm at the end of the trial. Other biochemical parameters and reports of adverse events did not differ by treatment., Conclusions: Treatment of hypertension based on a combination of chlorthalidone and amiloride is more effective for BP lowering compared to losartan in patients with diabetes mellitus and hypertension., Trial Registration: Clinical trials registration number: NCT00971165.
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- 2021
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9. Spironolactone Versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension: The ReHOT Randomized Study (Resistant Hypertension Optimal Treatment).
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Krieger EM, Drager LF, Giorgi DMA, Pereira AC, Barreto-Filho JAS, Nogueira AR, Mill JG, Lotufo PA, Amodeo C, Batista MC, Bodanese LC, Carvalho ACC, Castro I, Chaves H, Costa EAS, Feitosa GS, Franco RJS, Fuchs FD, Guimarães AC, Jardim PC, Machado CA, Magalhães ME, Mion D Jr, Nascimento RM, Nobre F, Nóbrega AC, Ribeiro ALP, Rodrigues-Sobrinho CR, Sanjuliani AF, Teixeira MDCB, and Krieger JE
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- Adult, Aged, Antihypertensive Agents administration & dosage, Antihypertensive Agents adverse effects, Antihypertensive Agents classification, Blood Pressure Monitoring, Ambulatory methods, Drug Monitoring methods, Drug Resistance, Drug Therapy, Combination methods, Female, Humans, Male, Medication Adherence, Middle Aged, Treatment Outcome, Blood Pressure drug effects, Clonidine administration & dosage, Clonidine adverse effects, Hypertension diagnosis, Hypertension drug therapy, Hypertension physiopathology, Spironolactone administration & dosage, Spironolactone adverse effects
- Abstract
The aim of this study is to compare spironolactone versus clonidine as the fourth drug in patients with resistant hypertension in a multicenter, randomized trial. Medical therapy adherence was checked by pill counting. Patients with resistant hypertension (no office and ambulatory blood pressure [BP] monitoring control, despite treatment with 3 drugs, including a diuretic, for 12 weeks) were randomized to an additional 12-week treatment with spironolactone (12.5-50 mg QD) or clonidine (0.1-0.3 mg BID). The primary end point was BP control during office (<140/90 mm Hg) and 24-h ambulatory (<130/80 mm Hg) BP monitoring. Secondary end points included BP control from each method and absolute BP reduction. From 1597 patients recruited, 11.7% (187 patients) fulfilled the resistant hypertension criteria. Compared with the spironolactone group (n=95), the clonidine group (n=92) presented similar rates of achieving the primary end point (20.5% versus 20.8%, respectively; relative risk, 1.01 [0.55-1.88]; P =1.00). Secondary end point analysis showed similar office BP (33.3% versus 29.3%) and ambulatory BP monitoring (44% versus 46.2%) control for spironolactone and clonidine, respectively. However, spironolactone promoted greater decrease in 24-h systolic and diastolic BP and diastolic daytime ambulatory BP than clonidine. Per-protocol analysis (limited to patients with ≥80% adherence to spironolactone/clonidine treatment) showed similar results regarding the primary end point. In conclusion, clonidine was not superior to spironolactone in true resistant hypertensive patients, but the overall BP control was low (≈21%). Considering easier posology and greater decrease in secondary end points, spironolactone is preferable for the fourth-drug therapy., Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01643434., (© 2018 American Heart Association, Inc.)
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- 2018
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10. I Luso-Brazilian Positioning on Central Arterial Pressure.
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Brandão AA, Amodeo C, Alcântara C, Barbosa E, Nobre F, Pinto F, Vilela-Martin JF, Bastos JM, Yugar-Toledo JC, Mota-Gomes MA, Neves MF, Malachias MV, Rodrigues MC, Passarelli O Junior, Jardim PC, Cunha PG, Póvoa R, Fonseca T, Dias VP, Barroso WS, and Oigman W
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- Age Factors, Brazil, Female, Humans, Hypertension drug therapy, Male, Portugal, Reference Values, Risk Factors, Sex Factors, Aging physiology, Arterial Pressure physiology, Cardiovascular Diseases etiology, Cardiovascular Diseases physiopathology, Hypertension complications, Hypertension physiopathology
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- 2017
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11. Multiprofessional Treatment of High Blood Pressure in Very Elderly Patients.
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Jardim LM, Jardim TV, Souza WK, Pimenta CD, Sousa AL, and Jardim PC
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- Age Factors, Aged, Aged, 80 and over, Angiotensin Receptor Antagonists therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Calcium Channel Blockers therapeutic use, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Time Factors, Treatment Outcome, Antihypertensive Agents therapeutic use, Hypertension drug therapy, Patient Care Team
- Abstract
Background: As the world population ages, patients older than 80 years, known as very elderly, are more frequently found. There are no studies in this age group aimed at analyzing the multidisciplinary intervention in the treatment of systemic arterial hypertension (SAH) and some comorbidities., Objectives: To assess the effect of a multidisciplinary approach in very elderly hypertensives cared for at a specialized service., Methods: Longitudinal retrospective cohort study in a multidisciplinary service specialized in the SAH treatment in the Brazilian West-Central region. Patients aged 80 years and older by June 2015 were included. Data from the first (V1) and last visit (Vf) were assessed. Anthropometric variables, blood pressure (BP), renal function, pharmacological treatment, lifestyle, comorbidities and cardiovascular events were studied, comparing data from V1 and Vf. Controlled BP was defined as systolic blood pressure (SBP) lower than 140 mm Hg and diastolic blood pressure (DBP) lower than 90 mm Hg. Statistical analyses were performed with SPSSR software, version 21.0. Values of p<0,05 were considered significant., Results: Data of 71 patients were assessed with a mean follow-up time of 15,22 years. Their mean age at V1 was 69.2 years, and, at Vf, 84.53 years, and 26.8% of them were males. There was a significant reduction in mean SBP (157.3 x 142.1 mm Hg; p<0.001) and DBP (95.1 x 77.8 mm Hg; p<0.001), with an increase in BP control rates from V1 to Vf (36.6 x 83.1%; p<0.001). The number of antihypertensive drugs used increased (1.49 x 2.85; p<0.001), with an increase in the use of angiotensin-converting enzyme inhibitors (22.5 x 46.5%; p=0.004), angiotensin II receptor blockers (4.2 x 35.2%; p<0.001) and calcium-channel blockers (18.3 x 67.6%; p<0.001). There was a reduction in total cholesterol (217.9 x 191 mg/dL; p<0.001) and LDL-cholesterol (139.6 x 119.0 mg/dL; p<0.001), but worsening of the glomerular filtration rate (62.5 x 45.4 mL/min; p<0.001)., Conclusion: The multidisciplinary intervention in very elderly hypertensives increased BP control rate, with optimization of the pharmacological treatment., Competing Interests: Potential Conflict of Interest No potential conflict of interest relevant to this article was reported.
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- 2017
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12. Effectiveness of Chlorthalidone Plus Amiloride for the Prevention of Hypertension: The PREVER-Prevention Randomized Clinical Trial.
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Fuchs SC, Poli-de-Figueiredo CE, Figueiredo Neto JA, Scala LC, Whelton PK, Mosele F, de Mello RB, Vilela-Martin JF, Moreira LB, Chaves H, Mota Gomes M, de Sousa MR, Silva RP, Castro I, Cesarino EJ, Jardim PC, Alves JG, Steffens AA, Brandão AA, Consolim-Colombo FM, de Alencastro PR, Neto AA, Nóbrega AC, Franco RS, Sobral Filho DC, Bordignon A, Nobre F, Schlatter R, Gus M, Fuchs FC, Berwanger O, and Fuchs FD
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- Adult, Aged, Blood Pressure drug effects, Double-Blind Method, Drug Combinations, Female, Follow-Up Studies, Humans, Hypertension physiopathology, Hypertrophy, Left Ventricular physiopathology, Hypertrophy, Left Ventricular prevention & control, Male, Middle Aged, Treatment Outcome, Amiloride administration & dosage, Antihypertensive Agents administration & dosage, Chlorthalidone administration & dosage, Diuretics administration & dosage, Hypertension prevention & control
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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., Clinical Trial Registration: URL: http://www.ClinicalTrials.gov, www.ensaiosclinicos.gov. Unique identifiers: NCT00970931, RBR-74rr6s., (© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)
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- 2016
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13. Sedentary lifestyle and its associated factors among adolescents from public and private schools of a Brazilian state capital.
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Nascente FM, Jardim TV, Peixoto MD, Carneiro CS, Mendonça KL, Póvoa TI, Sousa AL, Barroso WK, and Jardim PC
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- Adolescent, Age Distribution, Blood Pressure, Brazil epidemiology, Cross-Sectional Studies, Exercise, Female, Humans, Male, Poisson Distribution, Prevalence, Regression Analysis, Sex Distribution, Social Class, Surveys and Questionnaires, Waist Circumference, Schools statistics & numerical data, Sedentary Behavior, Students statistics & numerical data
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Background: Adolescence is a transition stage between childhood and adulthood and is an important phase for the acquisition of future lifestyles, including the practice of physical activity (PA). The prevalence of sedentary lifestyle in adolescents is often high, creating the need for studies addressing the practice of PA and its associated factors for a better understanding of the phenomenon and possible interventions that would encourage positive changes., Methods: Cross-sectional study of a representative sample of students aged 14-18 years enrolled in both public and private schools of a large Brazilian city to determine the level of physical activity (PA) and its associated factors. Sedentary lifestyle was measured by applying the International Physical Activity Questionnaire. The independent variables were gender, age, race, tobacco use and alcohol consumption in the past 30 days, socioeconomic status, body mass index, waist circumference and blood pressure. The crude prevalence ratio was used as a measure of association and was estimated from a Poisson regression., Results: The sample consisted of 862 adolescents with a mean age of 15.4 ± 1.1 years. Females were predominant (52.8%), and the age between 14 and 15 years was the most frequent (52.2%). The majority of the group reported themselves as Caucasians (51.2%), belonging to socioeconomic class C (52.5%) and were attending to public schools (69.1%). The prevalence of sedentary lifestyle was 66.8% (95% confidence interval [CI]: 63.5-69.9), where values of 65.4% and 69.9% were observed among students from public and private schools, respectively (p = 0.196). Sedentary lifestyle was more frequent in females (78.0% vs 54.3%; p < 0.001). The factor directly associated with sedentary lifestyle was female gender both in public and private schools and the only independent variable related to sedentarism was also female gender., Conclusion: The prevalence of sedentary lifestyle was extremely high in the population of adolescents studied both in public and private schools. Female sex was directly associated with sedentary lifestyle.
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- 2016
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14. I RBH - First Brazilian Hypertension Registry.
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Jardim PC, Souza WK, Lopes RD, Brandão AA, Malachias MV, Gomes MM, Moreno Júnior H, Barbosa EC, and Póvoa RM
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- Blood Pressure Determination, Brazil, Hospitalization, Humans, Hypertension diagnosis, Hypertension therapy, Registries, Research Design
- Abstract
Background: A registry assessing the care of hypertensive patients in daily clinical practice in public and private centers in various Brazilian regions has not been conducted to date. Such analysis is important to elucidate the effectiveness of this care., Objective: To document the current clinical practice for the treatment of hypertension with identification of the profile of requested tests, type of administered treatment, level of blood pressure (BP) control, and adherence to treatment., Methods: National, observational, prospective, and multicenter study that will include patients older than 18 years with hypertension for at least 4 weeks, following up in public and private centers and after signing a consent form. The study will exclude patients undergoing dialysis, hospitalized in the previous 30 days, with class III or IV heart failure, pregnant or nursing, with severe liver disease, stroke or acute myocardial infarction in the past 30 days, or with diseases with a survival prognosis < 1 year. Evaluations will be performed at baseline and after 1 year of follow-up. The parameters that will be evaluated include anthropometric data, lifestyle habits, BP levels, lipid profile, metabolic syndrome, and adherence to treatment. The primary outcomes will be hospitalization due to hypertensive crisis, cardiocirculatory events, and cardiovascular death, while secondary outcomes will be hospitalization for heart failure and requirement of dialysis. A subgroup analysis of 15% of the sample will include noninvasive central pressure evaluation at baseline and study end. The estimated sample size is 3,000 individuals for a prevalence of 5%, sample error of 2%, and 95% confidence interval., Results: The results will be presented after the final evaluation, which will occur at the end of a 1-year follow-up., Conclusion: The analysis of this registry will improve the knowledge and optimize the treatment of hypertension in Brazil, as a way of modifying the prognosis of cardiovascular disease in the country., Competing Interests: Potential Conflict of Interest No potential conflict of interest relevant to this article was reported.
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- 2016
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15. Correlation of Insulin Resistance with Anthropometric Measures and Blood Pressure in Adolescents.
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Morais PR, Sousa AL, Jardim Tde S, Nascente FM, Mendonça KL, Povoa TI, Carneiro Cde S, Ferreira VR, Souza WK, and Jardim PC
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- Adolescent, Biomarkers blood, Blood Glucose analysis, Cardiovascular Diseases etiology, Case-Control Studies, Cross-Sectional Studies, Female, Humans, Hypertension blood, Hypertension physiopathology, Insulin blood, Logistic Models, Male, Obesity blood, Obesity physiopathology, Reference Values, Risk Factors, Statistics, Nonparametric, Blood Pressure physiology, Body Mass Index, Insulin Resistance physiology, Waist Circumference physiology
- Abstract
Background: Blood pressure is directly related to body mass index, and individuals with increased waist circumference have higher risk of developing hypertension, insulin resistance, and other metabolic changes, since adolescence., Objective: to evaluate the correlation of blood pressure with insulin resistance, waist circumference and body mass index in adolescents., Methods: Cross-section study on a representative sample of adolescent students. One group of adolescents with altered blood pressure detected by casual blood pressure and/or home blood pressure monitoring (blood pressure > 90th percentile) and one group of normotensive adolescents were studied. Body mass index, waist circumference were measured, and fasting glucose and plasma insulin levels were determined, using the HOMA-IR index to identify insulin resistance., Results: A total of 162 adolescents (35 with normal blood pressure and 127 with altered blood pressure) were studied; 61% (n = 99) of them were boys and the mean age was 14.9 ± 1.62 years. Thirty-eight (23.5%) adolescents had altered HOMA-IR. The group with altered blood pressure had higher values of waist circumference, body mass index and HOMA-IR (p<0.05). Waist circumference was higher among boys in both groups (p<0.05) and girls with altered blood pressure had higher HOMA-IR than boys (p<0.05). There was a significant moderate correlation between body mass index and HOMA-IR in the group with altered blood pressure (ρ = 0.394; p < 0.001), and such correlation was stronger than in the normotensive group. There was also a significant moderate correlation between waist circumference and HOMA-IR in both groups (ρ = 0.345; p < 0.05). Logistic regression showed that HOMA-IR was as predictor of altered blood pressure (odds ratio - OR = 2.0; p = 0.001)., Conclusion: There was a significant association of insulin resistance with blood pressure and the impact of insulin resistance on blood pressure since childhood. The correlation and association between markers of cardiovascular diseases was more pronounced in adolescents with altered blood pressure, suggesting that primary prevention strategies for cardiovascular risk factors should be early implemented in childhood and adolescence.
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- 2016
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16. Effectiveness of chlorthalidone/amiloride versus losartan in patients with stage I hypertension: results from the PREVER-treatment randomized trial.
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Fuchs FD, Scala LC, Vilela-Martin JF, de Mello RB, Mosele F, Whelton PK, Poli-de-Figueiredo CE, de Alencastro PR, E Silva RP, Gus M, Bortolotto LA, Schlatter R, Cesarino EJ, Castro I, Neto JA, Chaves H, Steffens AA, Alves JG, Brandão AA, de Sousa MR, Jardim PC, Moreira LB, Franco RS, Gomes MM, Neto AA, Fuchs FC, Filho DC, Nóbrega AC, Nobre F, Berwanger O, and Fuchs SC
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- Adult, Aged, Amiloride pharmacology, Antihypertensive Agents pharmacology, Blood Pressure drug effects, Chlorthalidone pharmacology, Humans, Losartan pharmacology, Middle Aged, Amiloride therapeutic use, Antihypertensive Agents therapeutic use, Chlorthalidone therapeutic use, Hypertension drug therapy, Losartan therapeutic use
- Abstract
Objectives: To compare the blood pressure (BP)-lowering efficacy of a chlorthalidone/amiloride combination pill with losartan, during initial management of stage I hypertension., Methods: 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., Results: 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)., Conclusion: Treatment with a combination of chlorthalidone and amiloride compared with losartan yielded a greater reduction in BP., Clinical Trials Registration Number: NCT00971165.
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- 2016
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17. ERICA: prevalences of hypertension and obesity in Brazilian adolescents.
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Bloch KV, Klein CH, Szklo M, Kuschnir MC, Abreu Gde A, Barufaldi LA, da Veiga GV, Schaan B, da Silva TL, de Vasconcellos MT, Moraes AJ, Borges AL, de Oliveira AM, Tavares BM, de Oliveira CL, Cunha Cde F, Giannini DT, Belfort DR, Santos EL, de Leon EB, Fujimori E, Oliveira ER, Magliano Eda S, Vasconcelos Fde A, Azevedo GD, Brunken GS, Guimarães IC, Faria Neto JR, Oliveira JS, de Carvalho KM, Gonçalves LG, Monteiro MI, Santos MM, Jardim PC, Ferreira PA, Montenegro RM Jr, Gurgel RQ, Vianna RP, Vasconcelos SM, and Goldberg TB
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- Adolescent, Brazil epidemiology, Epidemiologic Methods, Female, Humans, Hypertension etiology, Male, Obesity complications, Residence Characteristics, Sex Factors, Socioeconomic Factors, Hypertension epidemiology, Obesity epidemiology, Overweight epidemiology
- Abstract
OBJECTIVE To estimate the prevalence of arterial hypertension and obesity and the population attributable fraction of hypertension that is due to obesity in Brazilian adolescents. METHODS Data from participants in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), which was the first national school-based, cross-section study performed in Brazil were evaluated. The sample was divided into 32 geographical strata and clusters from 32 schools and classes, with regional and national representation. Obesity was classified using the body mass index according to age and sex. Arterial hypertension was defined when the average systolic or diastolic blood pressure was greater than or equal to the 95th percentile of the reference curve. Prevalences and 95% confidence intervals (95%CI) of arterial hypertension and obesity, both on a national basis and in the macro-regions of Brazil, were estimated by sex and age group, as were the fractions of hypertension attributable to obesity in the population. RESULTS We evaluated 73,399 students, 55.4% female, with an average age of 14.7 years (SD = 1.6). The prevalence of hypertension was 9.6% (95%CI 9.0-10.3); with the lowest being in the North, 8.4% (95%CI 7.7-9.2) and Northeast regions, 8.4% (95%CI 7.6-9.2), and the highest being in the South, 12.5% (95%CI 11.0-14.2). The prevalence of obesity was 8.4% (95%CI 7.9-8.9), which was lower in the North region and higher in the South region. The prevalences of arterial hypertension and obesity were higher in males. Obese adolescents presented a higher prevalence of hypertension, 28.4% (95%CI 25.5-31.2), than overweight adolescents, 15.4% (95%CI 17.0-13.8), or eutrophic adolescents, 6.3% (95%CI 5.6-7.0). The fraction of hypertension attributable to obesity was 17.8%. CONCLUSIONS ERICA was the first nationally representative Brazilian study providing prevalence estimates of hypertension in adolescents. Regional and sex differences were observed. The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5.
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- 2016
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18. ERICA: prevalence of metabolic syndrome in Brazilian adolescents.
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Kuschnir MC, Bloch KV, Szklo M, Klein CH, Barufaldi LA, Abreu Gde A, Schaan B, da Veiga GV, da Silva TL, de Vasconcellos MT, de Moraes AJ, Borges AL, de Oliveira AM, Tavares BM, de Oliveira CL, Cunha Cde F, Giannini DT, Belfort DR, Santos EL, de Leon EB, Fujimori E, Oliveira ER, Magliano Eda S, Vasconcelos Fde A, Azevedo GD, Brunken GS, Guimarães IC, Faria Neto JR, Oliveira JS, de Carvalho KM, Gonçalves LG, Monteiro MI, Santos MM, Muniz PT, Jardim PC, Ferreira PA, Montenegro RM Jr, Gurgel RQ, Vianna RP, Vasconcelos SM, Martins SM, and Goldberg TB
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- Adolescent, Brazil epidemiology, Cross-Sectional Studies, Female, Humans, Hypertension epidemiology, Male, Obesity epidemiology, Prevalence, Residence Characteristics, Risk Factors, Triglycerides blood, Metabolic Syndrome epidemiology
- Abstract
OBJECTIVE To determine the prevalence of metabolic syndrome and its components in Brazilian adolescents. METHODS We evaluated 37,504 adolescents who were participants in the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, school-based, national study. The adolescents, aged from 12 to 17 years, lived in cities with populations greater than 100,000 inhabitants. The sample was stratified and clustered into schools and classes. The criteria set out by the International Diabetes Federation were used to define metabolic syndrome. Prevalences of metabolic syndrome were estimated according to sex, age group, school type and nutritional status. RESULTS Of the 37,504 adolescents who were evaluated: 50.2% were female; 54.3% were aged from 15 to 17 years, and 73.3% were from public schools. The prevalence of metabolic syndrome was 2.6% (95%CI 2.3-2.9), slightly higher in males and in those aged from 15 to 17 years in most macro-regions. The prevalence was the highest in residents from the South macro-region, in the younger female adolescents and in the older male adolescents. The prevalence was higher in public schools (2.8% [95%CI 2.4-3.2]), when compared with private schools (1.9% [95%CI 1.4-2.4]) and higher in obese adolescents when compared with nonobese ones. The most common combinations of components, referring to 3/4 of combinations, were: enlarged waist circumference (WC), low HDL-cholesterol (HDL-c) and high blood pressure; followed by enlarged WC, low HDL-c and high triglycerides; and enlarged WC, low HDL-c, high triglycerides and blood pressure. Low HDL was the second most frequent component, but the highest prevalence of metabolic syndrome (26.8%) was observed in the presence of high triglycerides. CONCLUSIONS ERICA is the first Brazilian nation-wide study to present the prevalence of metabolic syndrome and describe the role of its components. Despite the prevalence of Metabolic Syndrome being low, the high prevalences of some components and participation of others in the syndrome composition shows the importance of early diagnosis of this changes, even if not grouped within the metabolic syndrome.
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- 2016
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19. The natural history of cardiovascular risk factors in health professionals: 20-year follow-up.
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Jardim TV, Sousa AL, Povoa TI, Barroso WK, Chinem B, Jardim L, Bernardes R, Coca A, and Jardim PC
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- Adolescent, Adult, Blood Glucose metabolism, Cardiovascular Diseases epidemiology, Exercise, Female, Follow-Up Studies, Health Knowledge, Attitudes, Practice, Humans, Hypercholesterolemia epidemiology, Hypertension epidemiology, Male, Obesity epidemiology, Prevalence, Risk Factors, Young Adult, Alcohol Drinking, Blood Pressure, Body Mass Index, Cardiovascular Diseases etiology, Cholesterol blood, Health Personnel education, Sedentary Behavior
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Background: The knowledge of the presence and evolution of cardiovascular risk factors in young people may significantly contribute to actions to modify the natural history of these risks and prevent the onset of cardiovascular disease., Objectives: To assess the presence and evolution of cardiovascular risk factors in health professionals over a 20-year period., Methods: A group of individuals was evaluated when they first started graduate programs in medicine, nursing, nutrition, dentistry, and pharmacy, and 20 years later. Data obtained in the two phases were compared. Questionnaires about hypertension, diabetes, hypercholesterolemia, family history of early-onset cardiovascular disease, smoking, alcohol consumption, and sedentary lifestyle were administered. Cholesterol, blood glucose, blood pressure, weight, height, and body mass index (BMI) were measured., Results: Of the 281 individuals (62.9 % women; mean age 19.7 years) initially analyzed, 215 (59.07 % women; mean age 39.8 years) were analyzed 20 years later. An increase in mean values of systolic (111.6 vs 118.7 mmHg- p < 0.001) and diastolic blood pressure (71 vs 77.1 mmHg - p < 0.001), cholesterol (150.1 vs 182.4 mg/dL - p < 0.001), blood glucose (74.3 vs 81.4 mg/dL - p < 0.001) and BMI (20.7 vs 23.7 kg/m(2) - p = 0.017) was observed. Despite the decrease of sedentarism (50.2 vs 38.1 % - p = 0.015), the prevalence of hypertension (4.6 vs 18.6 % - p < 0.001), excessive weight (8.2 vs 32.1 % - p < 0.001), hypercholesterolemia (7.8 vs 24.2 % - p < 0.001), and alcohol consumption (32.7 vs 34.9 % - p = 0.037) increased. There was no change in the prevalence of smoking., Conclusion: Health professionals presented an increase in systolic and diastolic blood pressure, blood glucose, body mass index, and cholesterol over the 20-year study period. Regarding the prevalence of cardiovascular risk factors, increased blood pressure, overweight, hypercholesterolemia and alcohol consumption, and a decrease in sedentary lifestyle were observed.
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- 2015
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20. Erratum to: The study of cardiovascular risk in adolescents--ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents.
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Bloch KV, Szklo M, Kuschnir MC, de Azevedo Abreu G, Barufaldi LA, Klein CH, de Vasconcelos MT, da Veiga GV, Figueiredo VC, Dias A, Moraes AJ, Sousa AL, Borges AL, Andrade de Oliveira AM, Schaan BD, Tavares BM, de Oliveira CL, de Freitas Cunha C, Giannini DT, Belfort DR, Ribas DL, Santos EL, de Leon EB, Fujimori E, Oliveira ER, da Silva Magliano E, de Assis Guedes Vasconcelos F, Azevedo GD, Brunken GS, Dias GM, Filho HR, Monteiro MI, Guimarães IC, Faria Neto JR, Oliveira JS, de Carvalho KM, Gonzaga de Oliveira Gonçalves L, Santos MM, Muniz PT, Veiga Jardim PC, Ferreira PA, Montenegro RM, Gurgel RQ, Vianna RP, Vasconcelos SM, Silva da Matta S, Martins SM, Goldberg TB, and Nogueira da Silva TL
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- 2015
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21. Progression of blood pressure and cardiovascular outcomes in hypertensive patients in a reference center.
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Guimarães Filho GC, Sousa AL, Jardim Tde S, Souza WS, and Jardim PC
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- Adult, Aged, Aged, 80 and over, Body Mass Index, Brazil, Cardiovascular Diseases etiology, Disease Progression, Female, Humans, Hypertension complications, Hypertension therapy, Male, Middle Aged, Myocardial Infarction epidemiology, Overweight complications, Risk Factors, Sedentary Behavior, Stroke epidemiology, Young Adult, Blood Pressure physiology, Cardiovascular Diseases mortality, Hypertension physiopathology
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Background: Hypertension is a public health problem, considering its high prevalence, low control rate and cardiovascular complications., Objective: Evaluate the control of blood pressure (BP) and cardiovascular outcomes in patients enrolled at the Reference Center for Hypertension and Diabetes, located in a medium-sized city in the Midwest Region of Brazil., Methods: Population-based study comparing patients enrolled in the service at the time of their admission and after an average follow-up of five years. Participants were aged ≥ 18 years and were regularly monitored at the Center up to 6 months before data collection. We assessed demographic variables, BP, body mass index, risk factors, and cardiovascular outcomes., Results: We studied 1,298 individuals, predominantly women (60.9%), and with mean age of 56.7 ± 13.1 years. Over time, there was a significant increase in physical inactivity, alcohol consumption, diabetes, dyslipidemia, and excessive weight. As for cardiovascular outcomes, we observed an increase in stroke and myocardial revascularization, and a lower frequency of chronic renal failure. During follow-up, there was significant improvement in the rate of BP control (from 29.6% to 39.6%; p = 0.001) and 72 deaths, 91.7% of which were due to cardiovascular diseases., Conclusion: Despite considerable improvements in the rate of BP control during follow-up, risk factors worsened and cardiovascular outcomes increased.
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- 2015
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22. The Study of Cardiovascular Risk in Adolescents--ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents.
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Bloch KV, Szklo M, Kuschnir MC, Abreu Gde A, Barufaldi LA, Klein CH, de Vasconcelos MT, da Veiga GV, Figueiredo VC, Dias A, Moraes AJ, Souza AL, de Oliveira AM, Schaan BD, Tavares BM, de Oliveira CL, Cunha Cde F, Giannini DT, Belfort DR, Ribas DL, Santos EL, de Leon EB, Fujimori E, Oliveira ER, Magliano Eda S, Vasconcelos Fde A, Azevedo GD, Brunken GS, Dias GM, Filho HR, Monteiro MI, Guimarães IC, Faria Neto JR, Oliveira JS, de Carvalho KM, Gonçalves LG, Santos MM, Muniz PT, Jardim PC, Ferreira PA, Montenegro RM Jr, Gurgel RQ, Vianna RP, Vasconcelos SM, da Matta SS, Martins SM, Goldberg TB, and da Silva TL
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- Adolescent, Blood Glucose, Blood Pressure, Body Weights and Measures, Brazil epidemiology, Cross-Sectional Studies, Diabetes Mellitus epidemiology, Female, Humans, Lipids blood, Male, Metabolic Syndrome epidemiology, Obesity epidemiology, Parents, Prevalence, Residence Characteristics, Risk Factors, Smoking epidemiology, Socioeconomic Factors, Cardiovascular Diseases epidemiology, Health Behavior, Life Style, Research Design, Urban Population
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Background: The Study of Cardiovascular Risk in Adolescents (Portuguese acronym, "ERICA") is a multicenter, school-based country-wide cross-sectional study funded by the Brazilian Ministry of Health, which aims at estimating the prevalence of cardiovascular risk factors, including those included in the definition of the metabolic syndrome, in a random sample of adolescents aged 12 to 17 years in Brazilian cities with more than 100,000 inhabitants. Approximately 85,000 students were assessed in public and private schools. Brazil is a continental country with a heterogeneous population of 190 million living in its five main geographic regions (North, Northeast, Midwest, South and Southeast). ERICA is a pioneering study that will assess the prevalence rates of cardiovascular risk factors in Brazilian adolescents using a sample with national and regional representativeness. This paper describes the rationale, design and procedures of ERICA., Methods/design: Participants answered a self-administered questionnaire using an electronic device, in order to obtain information on demographic and lifestyle characteristics, including physical activity, smoking, alcohol intake, sleeping hours, common mental disorders and reproductive and oral health. Dietary intake was assessed using a 24-hour dietary recall. Anthropometric measures (weight, height and waist circumference) and blood pressure were also be measured. Blood was collected from a subsample of approximately 44,000 adolescents for measurements of fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, glycated hemoglobin and fasting insulin., Discussion: The study findings will be instrumental to the development of public policies aiming at the prevention of obesity, atherosclerotic diseases and diabetes in an adolescent population.
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- 2015
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23. Impact of light salt substitution for regular salt on blood pressure of hypertensive patients.
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Barros CL, Sousa AL, Chinem BM, Rodrigues RB, Jardim TS, Carneiro SB, Souza WK, and Jardim PC
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- Adult, Aged, Blood Pressure Monitoring, Ambulatory, Female, Humans, Hypertension prevention & control, Hypertension urine, Male, Middle Aged, Potassium urine, Single-Blind Method, Sodium urine, Statistics, Nonparametric, Time Factors, Treatment Outcome, Young Adult, Blood Pressure physiology, Hypertension diet therapy, Sodium Chloride, Dietary
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Background: Studies have shown sodium restriction to have a beneficial effect on blood pressure (BP) of hypertensive patients., Objective: To evaluate the impact of light salt substitution for regular salt on BP of hypertensive patients., Methods: Uncontrolled hypertensive patients of both sexes, 20 to 65 years-old, on stable doses of antihypertensive drugs were randomized into Intervention Group (IG - receiving light salt) and Control Group (CG - receiving regular salt). Systolic BP (SBP) and diastolic BP (DBP) were analyzed by using casual BP measurements and Home Blood Pressure Monitoring (HBPM), and sodium and potassium excretion was assessed on 24-hour urine samples. The patients received 3 g of salt for daily consumption for 4 weeks., Results: The study evaluated 35 patients (65.7% women), 19 allocated to the IG and 16 to the CG. The mean age was 55.5 ± 7.4 years. Most participants had completed the Brazilian middle school (up to the 8th grade; n = 28; 80.0%), had a family income of up to US$ 600 (n = 17; 48.6%) and practiced regular physical activity (n = 19; 54.3%). Two patients (5.7%) were smokers and 40.0% consumed alcohol regularly (n = 14). The IG showed a significant reduction in both SBP and DBP on the casual measurements and HBPM (p < 0.05) and in sodium excretion (p = 0.016). The CG showed a significant reduction only in casual SBP (p = 0.032)., Conclusions: The light salt substitution for regular salt significantly reduced BP of hypertensive patients.
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- 2015
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24. Comparison of cardiovascular risk factors in different areas of health care over a 20-year period.
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Jardim TV, Sousa AL, Povoa TR, Barroso WS, Chinem B, and Jardim PC
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- Adolescent, Adult, Alcohol Drinking adverse effects, Brazil epidemiology, Cardiovascular Diseases prevention & control, Dyslipidemias complications, Dyslipidemias epidemiology, Female, Humans, Hypertension complications, Hypertension epidemiology, Longitudinal Studies, Male, Overweight complications, Overweight epidemiology, Risk Assessment, Risk Factors, Sedentary Behavior, Sex Distribution, Statistics, Nonparametric, Time Factors, Young Adult, Cardiovascular Diseases etiology, Delivery of Health Care statistics & numerical data
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Background: Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Knowledge about cardiovascular risk factors (CVRFs) in young adults and their modification over time are measures that change the risks and prevent CVDs., Objectives: To determine the presence of CVRFs and their changes in different health care professionals over a period of 20 years., Methods: All students of medicine, nursing, nutrition, odontology, and pharmacy departments of Federal University of Goiás who agreed to participate in this study were evaluated when they started their degree courses and 20 years afterward. Questionnaires on CVRFs [systemic arterial hypertension (SAH), diabetes mellitus, dyslipidemia, and family history of early CVD, smoking, alcohol consumption, and sedentarism] were administered. Cholesterol levels, blood sugar levels, blood pressure, weight, height, and body mass index were determined. The Kolmogorov-Smirnov test was used to evaluate distribution, the chi-square test was used to compare different courses and sexes, and the McNemar test was used for comparing CVRFs. The significance level was set at a p value of < 0.05., Results: The first stage of the study included 281 individuals (91% of all the students), of which 62.9% were women; the mean age was 19.7 years. In the second stage, 215 subjects were reassessed (76% of the initial sample), of which 59.07% were women; the mean age was 39.8 years. The sample mostly consisted of medical students (with a predominance of men), followed by nursing, nutrition, and pharmacy students, with a predominance of women (p < 0.05). Excessive weight gain, SAH, and dyslipidemia were observed among physicians and dentists (p < 0.05). Excessive weight gain and SAH and a reduction in sedentarism (p < 0.05) were observed among pharmacists. Among nurses there was an increase in excessive weight and alcohol consumption (p < 0.05). Finally, nutritionists showed an increase in dyslipidemia (p < 0.05)., Conclusion: In general, there was an unfavorable progression of CVRFs in the population under study, despite it having adequate specialized knowledge about these risk factors.
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- 2014
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25. Relevance of target-organ lesions as predictors of mortality in patients with diabetes mellitus.
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Bianco HT, Izar MC, Fonseca HA, Póvoa RM, Saraiva JF, Forti A, Jardim PC, Introcaso L, Yugar-Toledo J, Xavier HT, Faludi AA, and Fonseca FA
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- Aged, Brazil, Cardiovascular Diseases etiology, Cohort Studies, Diabetes Mellitus, Type 2 complications, Electrocardiography, Female, Glomerular Filtration Rate, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Obesity complications, Obesity mortality, Predictive Value of Tests, Prognosis, Renal Insufficiency mortality, Risk Assessment, Risk Factors, Statistics, Nonparametric, Cardiovascular Diseases mortality, Diabetes Mellitus, Type 2 mortality
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Background: Patients with diabetes are in extract higher risk for fatal cardiovascular events., Objective: To evaluate major predictors of mortality in subjects with type 2 diabetes., Methods: A cohort of 323 individuals with type 2 diabetes from several regions of Brazil was followed for a long period. Baseline electrocardiograms, clinical and laboratory data obtained were used to determine hazard ratios (HR) and confidence interval (CI) related to cardiovascular and total mortality., Results: After 9.2 years of follow-up (median), 33 subjects died (17 from cardiovascular causes). Cardiovascular mortality was associated with male gender; smoking; prior myocardial infarction; long QTc interval; left ventricular hypertrophy; and eGFR <60 mL/min. These factors, in addition to obesity, were predictors of total mortality. Cardiovascular mortality was adjusted for age and gender, but remained associated with: smoking (HR = 3.8; 95% CI 1.3-11.8; p = 0.019); prior myocardial infarction (HR = 8.5; 95% CI 1.8-39.9; p = 0.007); eGFR < 60 mL/min (HR = 9.5; 95% CI 2.7-33.7; p = 0.001); long QTc interval (HR = 5.1; 95% CI 1.7-15.2; p = 0.004); and left ventricular hypertrophy (HR = 3.5; 95% CI 1.3-9.7; p = 0.002). Total mortality was associated with obesity (HR = 2.3; 95% CI 1.1-5.1; p = 0.030); smoking (HR = 2.5; 95% CI 1.0-6.1; p = 0.046); prior myocardial infarction (HR = 3.1; 95% CI 1.4-6.1; p = 0.005), and long QTc interval (HR = 3.1; 95% CI 1.4-6.1; p = 0.017)., Conclusions: Biomarkers of simple measurement, particularly those related to target-organ lesions, were predictors of mortality in subjects with type 2 diabetes.
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- 2014
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26. Does nutritional status interfere with adolescents' body image perception?
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Mendonça KL, Sousa AL, Carneiro CS, Nascente FM, Póvoa TI, Souza WK, Jardim TS, and Jardim PC
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- Adolescent, Child, Cross-Sectional Studies, Female, Humans, Male, Obesity psychology, Overweight psychology, Personal Satisfaction, Thinness psychology, Body Image psychology, Body Mass Index, Nutritional Status
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Adolescents' body image (BI) may not match their nutritional status. This study selected representative sample of healthy adolescents aged between 12 and 18 from public and private schools. Anthropometric measures were performed in order to calculate the body mass index (BMI) percentile. The silhouette scale proposed by Childress was used to evaluate BI, making it possible to assess BI satisfaction and BI distortion. The sample was composed of 1168 adolescents with a mean age of 14.7 years; 52.9% were female, 50.9% were fair-skinned, 62.4% had consumed or still consume alcohol and 67% attended public school. Male adolescents presented more overweight and obesity (28.4%) (p<0.05) than the female (17.1%). It was observed that 69.4% were dissatisfied with BI, 91.1% of the obese and 69.8% of those with overweight wished to lose body weight and 82.5% of those underweight wished to gain body weight. BI distortion was identified, since 35% of the adolescents who were underweight did not regard themselves thin, 39.1% of the overweight individuals and 62.1% of the obese did not see themselves in their adequate classifications. Adolescents with overweight/obesity were those who presented higher dissatisfaction with BI, mainly the females. Male individuals presented a greater wish of gaining weight. BI distortion was present in adolescents of all classes of BMI percentile., (Copyright © 2014 Elsevier Ltd. All rights reserved.)
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- 2014
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27. Regarding hypertension treatment are we following worldwide tendencies?
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Jardim PC
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- Antihypertensive Agents therapeutic use, Diabetes Mellitus, Type 2 complications, Diabetic Angiopathies therapy, Humans, Hypertension complications, Hypertension diagnosis, Hypertension therapy, Internationality, Practice Guidelines as Topic standards
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- 2014
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28. I brazilian position paper on antihypertensive drug combination.
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Póvoa R, Barroso WS, Brandão AA, Jardim PC, Barroso O, Passarelli O Jr, Gemelli JR, Feitosa A, Jardim TV, Carneiro SB, Amodeo C, Moreira Filho O, Nogueira Ada R, Morais NS, Scala LC, Gonzaga C, Souza Ddo S, Paiva AM, Malachias MV, Mion D Jr, Mota-Gomes MA, Barbosa EC, Sousa MG, Bianco HT, Fonseca FA, Kalil M, Miranda RD, Uehara CA, and Sanjuliani AF
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- Blood Pressure drug effects, Brazil, Cerebrovascular Disorders complications, Coronary Disease complications, Drug Therapy, Combination methods, Humans, Renal Insufficiency, Chronic drug therapy, Risk Factors, Treatment Outcome, Antihypertensive Agents administration & dosage, Hypertension drug therapy, Practice Guidelines as Topic, Societies, Medical
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- 2014
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29. I Brazilian position paper on prehypertension, white coat hypertension and masked hypertension: diagnosis and management.
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Alessi A, Brandão AA, Paiva AM, Rocha Nogueira Ad, Feitosa A, Campos Gonzaga Cd, Amodeo C, Mion D, Souza Ddo S, Barbosa E, Lima Junior E, Nobre F, Fuchs FD, Chaves Junior H, Schneider JC, Gemelli J, Villela-Martin JF, Scala LC, Gomes MA, Malachias MV, Morais NS, Moreira Filho O, Passarelli Junior O, Jardim PC, Miranda RD, Póvoa R, Fuchs SC, Baiocchi S, Jardim TV, and Barroso WK
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- Blood Pressure Monitoring, Ambulatory, Brazil epidemiology, Female, Humans, Male, Masked Hypertension epidemiology, Practice Guidelines as Topic, Prehypertension epidemiology, Prognosis, Risk Factors, Societies, Medical, White Coat Hypertension epidemiology, Masked Hypertension diagnosis, Masked Hypertension therapy, Prehypertension diagnosis, Prehypertension therapy, White Coat Hypertension diagnosis, White Coat Hypertension therapy
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- 2014
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30. Risk factors associated with high blood pressure in two-to five-year-old children.
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Crispim PA, Peixoto Mdo R, and Jardim PC
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- Age Distribution, Anthropometry, Brazil epidemiology, Child, Preschool, Cross-Sectional Studies, Feeding Behavior, Female, Humans, Male, Nutritional Status, Overweight complications, Prevalence, Risk Factors, Sex Distribution, Socioeconomic Factors, Hypertension epidemiology, Hypertension etiology
- Abstract
Background: Over recent decades, the prevalence of high blood pressure (BP) has increased among children. Several risk factors are involved in the genesis of high BP during childhood, and their early identification can prevent the development of that disease., Objectives: To assess the prevalence of high BP and associated factors in children., Methods: Cross-sectional, population-based study, carried out at the household. This study included 276 two- to five-year-old children in the city of Goiânia, state of Goiás, and assessed their BP, sociodemographic characteristics, birth weight, high BP family history, passive smoking, maternal breastfeeding, dietary habits, sedentary lifestyle and nutritional status. Poisson regression was used to assess the association between risk factors and high BP., Results: Their mean age was 3.1 ± 0.79 years, and high BP and overweight were observed in 19.9% and 11.2% of the children, respectively. Direct association of high BP was identified with age [prevalence ratio (PR) = 2.3; 95%CI: 1.2 - 4.8; p = 0.017] and overweight (PR = 2.0; 95%CI: 1.2 - 3.6; p = 0.014). No other variable associated with high BP., Conclusions: The prevalence of high BP in children was high. Overweight and younger children had greater prevalence of high BP.
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- 2014
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31. Randomized, Double-Blind Clinical Trial to Assess the Acute Diuretic Effect of Equisetum arvense (Field Horsetail) in Healthy Volunteers.
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Carneiro DM, Freire RC, Honório TC, Zoghaib I, Cardoso FF, Tresvenzol LM, de Paula JR, Sousa AL, Jardim PC, and da Cunha LC
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In this double-blind, randomized clinical trial, 36 healthy male volunteers were randomly distributed into three groups (n = 12) that underwent a three-step treatment. For four consecutive days, we alternately administered a standardized dried extract of Equisetum arvense (EADE, 900 mg/day), placebo (corn starch, 900 mg/day), or hydrochlorothiazide (25 mg/day), separated by a 10-day washout period. Each volunteer served as his own control, and the groups' results were compared. We repeated the same evaluation after each stage of treatment to evaluate the safety of the drug. The diuretic effect of EADE was assessed by monitoring the volunteers' water balance over a 24 h period. The E. arvense extract produced a diuretic effect that was stronger than that of the negative control and was equivalent to that of hydrochlorothiazide without causing significant changes in the elimination of electrolytes. There was no significant increase in the urinary elimination of catabolites. Rare minor adverse events were reported. The clinical examinations and laboratory tests showed no changes before or after the experiment, suggesting that the drug is safe for acute use. Further research is needed to better clarify the mechanism of diuretic action and the other possible pharmacological actions of this phytomedicine.
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- 2014
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32. [I Brazilian Guidelines for cardiovascular prevention].
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Simão AF, Precoma DB, Andrade JP, Correa FH, Saraiva JF, Oliveira GM, Murro AL, Campos A, Alessi A, Avezum A Jr, Achutti AC, Miguel AC, Sousa AC, Lotemberg AM, Lins AP, Falud AA, Brandão AA, Sanjuliani AF, Sbissa AS, Alencar FA, Herdy AH, Polanczyk CA, Lantieri CJ, Machado CA, Scherr C, Stoll C, Amodeo C, Araújo CG, Saraiva D, Moriguchi EH, Mesquita ET, Fonseca FA, Campos GP, Soares GP, Feitosa GS, Xavier HT, Castro I, Giuliano IC, Rivera IV, Guimaraes IC, Issa JS, Souza JR, Faria NJ, Cunha LB, Pellanda LC, Bortolotto LA, Bertolami MC, Miname MH, Gomes MA, Tambascia M, Malachias MV, Silva MA, Izar MC, Magalhães ME, Bacellar MS, Milani M, Wajngarten M, Ghorayeb N, Coelho OR, Villela PB, Jardim PC, Santos Filho RD, Stein R, Cassani RS, D'Avila RI, Ferreira RM, Barbosa RB, Povoa RM, Kaiser SE, Ismael SC, Carvalho T, Giraldez VZ, Coutinho W, and Souza WK
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- Aspirin therapeutic use, Brazil, Evidence-Based Medicine, Female, Humans, Hypertension prevention & control, Meta-Analysis as Topic, Quality of Life, Randomized Controlled Trials as Topic, Risk Assessment, Risk Factors, Treatment Outcome, Cardiovascular Diseases prevention & control, Health Promotion
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- 2013
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33. I Brazilian position statement on arterial hypertension and diabetes mellitus.
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Alessi A, Bonfim AV, Brandão AA, Feitosa A, Amodeo C, Alves CR, Brasil DP, Souza Ddo S, Barbosa E, Consolim-Colombo FM, Borelli F, Fonseca FH, Lopes HF, Chaves H, Bortolotto LA, Martin LC, Scala LC, Mota-Gomes MA, Malachias MV, Izar MC, Fonseca MI, Neves MF, Morais NS, Passarelli O Jr, Jardim PC, Toscano PR, Miranda RD, Franco R, Betti RT, Pedrosa RP, Povoa R, Carneiro SB, Jardim T, and Barroso WK
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- Blood Glucose, Blood Pressure, Brain Diseases etiology, Brazil, Diabetes Complications therapy, Dyslipidemias drug therapy, Heart Diseases etiology, Humans, Hypertension therapy, Kidney Diseases etiology, Peripheral Arterial Disease etiology, Risk Factors, Societies, Medical, Diabetes Mellitus therapy, Hypertension complications
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- 2013
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34. Evaluation of project promoting health in adolescents.
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Ferreira JO, Jardim PC, and Peixoto Mdo R
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- Adolescent, Body Mass Index, Brazil, Chi-Square Distribution, Cross-Sectional Studies, Female, Humans, Male, Schools, Sedentary Behavior, Exercise, Feeding Behavior, Health Promotion, Program Evaluation
- Abstract
Objective: Evaluate a program promoting exercise and healthy eating among adolescents., Methods: This was a cross-sectional study of 911 adolescents aged 13 to 18 years old in public schools in Goiania, Midwestern Brazil, 2010. The participants were divided into two groups: intervention (schools taking part in the Healthy Living, project) and control. The following were deemed to be exercise: displacement, physical education classes in school, physical activity outside school, and leisure-time physical activity. Pupils who totaled 300 or more minutes per week were defined as active. Consuming protective foods five or more days a week was classified as adequate intake. Statistical analyses made using the Chi-square test., Results: Most adolescents were identified as inactive or insufficiently active, 65.7% in the Intervention Group and 65.2% Control Group, showing no significant differences between groups, and with higher prevalence among girls. Slightly more than half of adolescents consumed health protective foods 5 or more days a week, 56.6% in the Intervention Group and 50.4% in the Control Group (p = 0.373)., Conclusions: There were no differences between schools in the Intervention Group and Control Group with regard to food choices and physical activity. This indicates that the Healthy Living project needs to be reevaluated to improve the effectiveness in achieving its objectives.
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- 2013
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35. The influence of hypertension on quality of life.
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Carvalho MV, Siqueira LB, Sousa AL, and Jardim PC
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- Adult, Epidemiologic Methods, Female, Humans, Hypertension epidemiology, Hypertension physiopathology, Male, Middle Aged, Sex Distribution, Young Adult, Hypertension psychology, Quality of Life
- Abstract
Background: Systemic Hypertension (SH) is a major cardiovascular risk factor with a high prevalence in almost all countries. Studies show the negative effect of SH on health-related quality of life., Objective: To evaluate the quality of life of hypertensive patients when compared with the general population., Methods: A total of 333 individuals of both genders and older than 18 years were evaluated; they were divided into the Study Group, consisting of 246 hypertensive patients undergoing treatment in a multidisciplinary service and the Control group, comprised of 87 normotensive individuals from the community. A sociodemographic questionnaire and the SF-36 for quality of life assessment were administered to both groups. The Chi-square, Kolmogorov-Smirnov test, Mann Whitney U-test, Kruskal-Wallis test and multivariate analysis were used for the statistical analysis. Data were analyzed using SPSS and p values <0.05 were considered significant., Results: The groups were homogeneous for age, gender, ethnicity, educational level and marital status. It was observed that normotensive individuals showed a better health-related quality of life when compared with hypertensive patients., Conclusions: Although considered to be almost always a clinically silent disease, systemic hypertension impairs the quality of life of patients who suffer from it.
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- 2013
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36. First Brazilian position on resistant hypertension.
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Alessi A, Brandão AA, Coca A, Cordeiro AC, Nogueira AR, Diógenes de Magalhães F, Amodeo C, Saad Rodrigues CI, Calhoun DA, Barbosa Coelho E, Pimenta E, Muxfeldt E, Consolin-Colombo FM, Salles G, Rosito G, Moreno H Jr, Martin JF, Yugar JC, Aparecido Bortolotto L, Nazário Scala LC, Gonçalves de Sousa M, Gomes MA, Malachias MB, Gus M, Passarelli O Jr, Jardim PC, Toscano PR, Sánchez RA, Dischinger Miranda R, Póvoa R, and Barroso WK
- Subjects
- Blood Pressure physiology, Blood Pressure Determination methods, Brazil, Drug Resistance physiology, Humans, Hypertension complications, Hypertension diagnosis, Hypertension physiopathology, Antihypertensive Agents therapeutic use, Hypertension drug therapy
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- 2012
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37. The effect of educational intervention on the disease knowledge of diabetes mellitus patients.
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Pereira DA, Costa NM, Sousa AL, Jardim PC, and Zanini CR
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- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Diabetes Mellitus, Type 2 therapy, Health Knowledge, Attitudes, Practice, Patient Education as Topic
- Abstract
The prevention of diabetes and its complications is a challenge for the healthcare team. The aim of this study was to evaluate the effect of educational action on the disease knowledge of patients with type 2 diabetes. A randomized clinical trial was conducted with 62 patients registered in a service of reference in the treatment of hypertension in 2010. Data were collected through a questionnaire applied to the Intervention (IG) and Control (CG) groups at the beginning and at the end of the study. The IG participated in group educational activities, using problematization methodology. The results showed a significant increase in knowledge about diabetes in the patients of the IG, in all the topics (p<0.05). In the CG, some changes were observed in knowledge, however, these were fewer when compared with the IG. In conclusion, it was possible to increase disease knowledge through the performance of educational activities. Clinical trial identifier: RBR-58n26h.
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- 2012
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38. Subacute blood pressure behavior in elderly hypertensive women after resistance exercise session.
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Cunha RM and Jardim PC
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- Aged, Cross-Over Studies, Exercise Test, Female, Humans, Hypertension drug therapy, Middle Aged, Time Factors, Blood Pressure, Hypertension physiopathology, Resistance Training
- Abstract
Aim: The objective of this study was to determine the subacute blood pressure behavior of pharmacologically-treated elderly hypertensive patients after a session of resistance exercise. This was a controlled clinical trial carried out on 30 elderly hypertensive women. The study procedures took place over three days with an interval of 48 hours, and included a test session, an experimental protocol (EP) and a control protocol (CP)., Methods: A 10RM test was carried out to define the EP load for the following exercises: leg press, knee extension, pull-up, biceps curl and machine bench press. In the EP, three sets of exercises with 8 to 10 repetitions were carried out at 2-minute intervals. In the CP all procedures were the same as in the EP, but without the exercises. BP was measured before, immediately after and every ten minutes up to 60 minutes after the EP and CP., Results: There was no significant variation in systolic blood pressure (SBP) or diastolic blood pressure (DBP) in either the EP or the CP immediately after the exercises. In the period up to sixty minutes after the exercises, there was a significant difference in BP, with a decrease in SBP and DBP for both EP and CP., Conclusion: The data from the present study offer a good indication that resistance exercises may be prescribed safely to this group of patients. The pressure reduction appears to be influenced by the rest that occurred after the protocols and not by exercise.
- Published
- 2012
39. Self measurement of blood pressure for control of blood pressure levels and adherence to treatment.
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Souza WK, Jardim PC, Brito LP, Araújo FA, and Sousa AL
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- Female, Follow-Up Studies, Humans, Hypertension physiopathology, Hypertension psychology, Male, Middle Aged, Prospective Studies, Self Care adverse effects, Self Care instrumentation, Blood Pressure physiology, Blood Pressure Determination methods, Hypertension drug therapy, Life Style, Medication Adherence statistics & numerical data, Self Care methods
- Abstract
Background: The measurement of blood pressure (BP) by the patient himself without strict protocols, adequate training, and validated equipment at their own household is defined as self measured blood pressure (SMBP)., Objective: To evaluate the interference of the SMBP in treatment adherence and blood pressure control., Methods: The study included 57 patients, 38 in the study group (SG) and 19 in the control group (CG). These patients were followed for 12 months and assessed at randomization (V1) as well as in the sixth (V2) and the twelfth month (V3). Compare the mean blood pressure by casual measurement, by SMBP and by ambulatory monitoring of blood pressure (AMBP), laboratory tests and the answers to the questionnaire on lifestyle. The instruments used were: OMRON HEM 714, for SMBP; OMRON 705 CP, for the casual measurement, and Monitor SPACELABS 9002 for the AMBP., Results: The average age was 62.05 ± 10.78 in the SG and 55.42 ± 11.87 in the CG (p = 0.03). The values of systolic blood pressure (SBP) by casual measurement in the SG and CG were: 140.01 ± 16.73 mmHg and 141.79 ± 23.21 mmHg in V1 (p = 0.72), 135.49 ± 12.73 mmHg and 145.69 ± 19.31 mmHg in V2 (p = 0.02), 131.64 ± 19.28 mmHg and 134.88 ± 23.21 mmHg at V3 (p = 0.59). The values of diastolic blood pressure (DBP) were: 84.13 ± 10.71 mmHg and 86.29 ± 10.35 mmHg in V1 (p = 0.47), 81.69 ± 10.88 mmHg and 89.61 V2 ± 11.58 mmHg (p = 0.02), 80.31 ± 11.83 mmHg and 86 ± 13.38 mmHg in V3 (p = 0.12)., Conclusion: Patients in the SG had adherence to non-pharmacological treatment similar to the CG, but they had greater adherence to drug treatment and used fewer antihypertensive drugs. There was no difference between groups when comparing the metabolic profile and renal function.
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- 2012
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40. Hospitalizations due to primary care-sensitive cardiovascular conditions in municipalities of Central-West Brazil.
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Batista SR, Jardim PC, Sousa AL, and Salgado CM
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- Adult, Age Distribution, Analysis of Variance, Brazil epidemiology, Cities statistics & numerical data, Female, Humans, Male, Middle Aged, Quality of Health Care, Residence Characteristics, Retrospective Studies, Sex Distribution, Cardiovascular Diseases epidemiology, Delivery of Health Care statistics & numerical data, Hospitalization statistics & numerical data, Primary Health Care statistics & numerical data
- Abstract
Objective: To analyze rates of hospitalization due to primary care-sensitive cardiovascular conditions., Methods: This ecological study on 237 municipalities in the state of Goiás, Central-West Brazil, between 2000 and 2008, used data from the Hospital Information System and the Primary Care Information System. The hospitalization rates were calculated as the ratio between the number of hospitalizations due to cardiovascular conditions and the population over the age of 40 years. The data were evaluated over the three-year periods A (2000-2002), B (2003-2005) and C (2006-2008), according to sex, age group, population size, whether the individual belonged to the metropolitan region, healthcare macroregion, distance from the state capital, living conditions index and coverage within the Family Health Strategy. The potential population coverage of the Family Health Strategy was calculated in accordance with Ministry of Health guidelines. The variability of the rates was evaluated using the t test and ANOVA., Results: A total of 253,254 hospitalizations (17.2%) occurred due to primary care-sensitive cardiovascular conditions. The hospitalization rates diminished between the three-year periods: A (213.5, SD = 104.6), B (199.7, SD = 96.3) and C (150.2, SD = 76.1), with differences from A to C and from B to C (p < 0.001). Municipal population size did not influence the behavior of the rates. Municipalities near the state capital and those in the metropolitan area presented higher rates (p < 0.001). At all percentiles of the Life and Health Conditions Index, there were decreases in the rates (p < 0.001), except at percentile 1. Decreases were also observed in all the macroregions except for the northeastern region of the state. The reduction in rates was independent of the Family Health Strategy coverage., Conclusion: The rates of hospitalization due to primary care-sensitive cardiovascular conditions decreased in these municipalities, independent of the Family Health Strategy coverage.
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- 2012
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41. Home blood pressure in children and adolescents: a comparison with office and ambulatory blood pressure measurements.
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Salgado CM, Jardim PC, Viana JK, Jardim Tde S, and Velasquez PP
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- Adolescent, Blood Pressure, Blood Pressure Determination methods, Child, Child, Preschool, Cross-Sectional Studies, Female, Humans, Male, Office Visits, Blood Pressure Monitoring, Ambulatory methods, Hypertension diagnosis
- Abstract
Aim: To compare BP measurements of children and adolescents using different methods office BP (OBP), ambulatory BP monitoring (ABPM) and home BP measurement (HBPM) and to study their correlations., Method: Individuals were evaluated between 5 and 15 years of age who had been referred because of a previous high BP. OBP was measured with the OMRON-705CP. Three measurements were carried out at 5-min intervals. HBPM were taken using the same device, two measurements at 5-min intervals in the morning and in the evening during 7 days. ABPM was performed using the SpaceLabs 90207 monitors., Results: A total of 109 children and adolescents were evaluated (9.82 ± 2.63 years), 52.3% boys, 56.9% non-white. The office systolic BP (SBP) was lower than in daytime ABPM (p < 0.001) but similar HBPM (p = 0.294), and the office diastolic BP (DBP) was lower than daytime ABPM (p < 0.001) and in HBPM (p = 0.035). The SBP and DBP at HBPM was lower than daytime ABPM (p < 0.001). Daytime ambulatory BP was more closely associated with home readings (SBP r = 0.731 and DBP r = 0.616) than with office's readings (SBP r = 0.653 and DBP r = 0.394)., Conclusion: The BP of children and adolescents varies depending on the place and manner of measurement. ABPM presents better correlation with HBPM than with the office measurements., (© 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.)
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- 2011
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42. Comparison and correlation between self-measured blood pressure, casual blood pressure measurement and ambulatory blood pressure monitoring.
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Souza WK, Jardim PC, Porto LB, Araújo FA, Sousa AL, and Salgado CM
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- Adult, Aged, Blood Pressure Determination instrumentation, Blood Pressure Monitoring, Ambulatory instrumentation, Blood Pressure Monitoring, Ambulatory methods, Blood Pressure Monitoring, Ambulatory standards, Diastole physiology, Female, Humans, Male, Middle Aged, Prospective Studies, Statistics, Nonparametric, Systole physiology, Young Adult, Blood Pressure physiology, Blood Pressure Determination methods, Hypertension physiopathology
- Abstract
Background: Casual blood pressure (BP) measurement by healthcare professionals is subject to great variability and new methods are necessary to overcome this limitation., Objective: To compare and assess the correlation between the BP levels obtained by self-measured BP (SMBP), casual BP measurement and ambulatory blood pressure monitoring (ABPM)., Methods: We assessed hypertensive individuals submitted to the three methods of BP measurement at an interval < 30 days; the BP means were used for comparison and correlation. The following devices were used: OMRON 705 CP (casual measurement), OMRON HEM 714 (SMBP) and SPACELABS 9002 (ABPM)., Results: A total of 32 patients were assessed, of which 50.09% were females, with a mean age of 59.7 (± 11.2), BMI mean of 26.04 (± 3.3) kg/m(2). Mean systolic (SBP) and diastolic blood pressure (DBP) for SMBP were 134 (± 15.71) mmHg and 79.32 (± 12.38) mmHg. The casual measurement means of SBP and DBP were, respectively, 140.84 (± 16.15) mmHg and 85 (± 9.68) mmHg. The mean values of ABPM during the wakefulness period were 130.47 (± 13.26) mmHg and 79.84 (± 9.82) mmHg for SBP and DBP, respectively. At the comparative analysis, the SMBP had similar results to those obtained at ABPM (p > 0.05) and different from the casual measurement (p < 0.05). At the analysis of correlation, SMBP values were higher than the casual measurements, considering ABPM as the reference standard in BP measurements., Conclusion: SMBP showed a better correlation with ABPM than the casual measurement and was also better correlated with the latter, especially regarding the DBP and should be considered as a low-cost alternative for the follow-up of the hypertensive patient.
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- 2011
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43. Prevention of hypertension in patients with pre-hypertension: protocol for the PREVER-prevention trial.
- Author
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Fuchs FD, Fuchs SC, Moreira LB, Gus M, Nóbrega AC, Poli-de-Figueiredo CE, Mion D, Bortoloto L, Consolim-Colombo F, Nobre F, Coelho EB, Vilela-Martin JF, Moreno H Jr, Cesarino EJ, Franco R, Brandão AA, de Sousa MR, Ribeiro AL, Jardim PC, Neto AA, Scala LC, Mota M, Chaves H, Alves JG, Filho DC, Pereira e Silva R, Neto JA, Irigoyen MC, Castro I, Steffens AA, Schlatter R, de Mello RB, Mosele F, Ghizzoni F, and Berwanger O
- Subjects
- Adult, Aged, Blood Pressure drug effects, Brazil, Double-Blind Method, Drug Combinations, Female, Humans, Hypertension etiology, Hypertension physiopathology, Male, Middle Aged, Placebo Effect, Prehypertension complications, Prehypertension physiopathology, Treatment Outcome, Amiloride therapeutic use, Antihypertensive Agents therapeutic use, Chlorthalidone therapeutic use, Diuretics therapeutic use, Hypertension therapy, Prehypertension drug therapy, Research Design
- Abstract
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.
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- 2011
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44. A comparison between diuretics and angiotensin-receptor blocker agents in patients with stage I hypertension (PREVER-treatment trial): study protocol for a randomized double-blind controlled trial.
- Author
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Fuchs FD, Fuchs SC, Moreira LB, Gus M, Nóbrega AC, Poli-de-Figueiredo CE, Mion D, Bortolotto L, Consolim-Colombo F, Nobre F, Coelho EB, Vilela-Martin JF, Moreno H Jr, Cesarino EJ, Franco R, Brandão AA, de Sousa MR, Ribeiro AL, Jardim PC, Afiune Neto A, Scala LC, Mota M, Chaves H, Alves JG, Sobral Filho DC, Pereira e Silva R, Figueiredo Neto JA, Irigoyen MC, Castro I, Steffens AA, Schlatter R, de Mello RB, Mosele F, Ghizzoni F, and Berwanger O
- Subjects
- Adult, Aged, Amiloride adverse effects, Angiotensin II Type 1 Receptor Blockers adverse effects, Antihypertensive Agents adverse effects, Brazil, Chlorthalidone adverse effects, Diuretics adverse effects, Double-Blind Method, Drug Therapy, Combination, Female, Humans, Hypertension physiopathology, Losartan adverse effects, Male, Middle Aged, Severity of Illness Index, Time Factors, Treatment Outcome, Amiloride therapeutic use, Angiotensin II Type 1 Receptor Blockers therapeutic use, Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Chlorthalidone therapeutic use, Diuretics therapeutic use, Hypertension drug therapy, Losartan therapeutic use, Research Design
- Abstract
Background: Cardiovascular disease is the leading cause of death in Brazil, and hypertension is its major risk factor. The benefit of its drug treatment to prevent major cardiovascular events was consistently demonstrated. Angiotensin-receptor blockers (ARB) have been the preferential drugs in the management of hypertension worldwide, despite the absence of any consistent evidence of advantage over older agents, and the concern that they may be associated with lower renal protection and risk for cancer. Diuretics are as efficacious as other agents, are well tolerated, have longer duration of action and low cost, but have been scarcely compared with ARBs. A study comparing diuretic and ARB is therefore warranted., Methods/design: This is a randomized, double-blind, clinical trial, comparing the association of chlorthalidone and amiloride with losartan as first drug option in patients aged 30 to 70 years, with stage I hypertension. The primary outcomes will be variation of blood pressure by time, 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 subclinical atherosclerosis and sudden death. The study will last 18 months. The sample size will be of 1200 participants for group in order to confer enough power to test for all primary outcomes. The project was approved by the Ethics committee of each participating institution., Discussion: The putative pleiotropic effects of ARB agents, particularly renal protection, have been disputed, and they have been scarcely compared with diuretics in large clinical trials, despite that they have been at least as efficacious as newer agents in managing hypertension. Even if the null hypothesis is not rejected, the information will be useful for health care policy to treat hypertension in Brazil., Clinical Trials Registration Number: ClinicalTrials.gov: NCT00971165.
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- 2011
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45. [Arterial hypertension and its correlation with some risk factors in a small brazilian town].
- Author
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Nascente FM, Jardim PC, Peixoto Mdo R, Monego ET, Moreira HG, Vitorino PV, Souza WK, and Scala LN
- Subjects
- Adolescent, Adult, Body Mass Index, Brazil epidemiology, Cross-Sectional Studies, Female, Humans, Hypertension etiology, Male, Middle Aged, Obesity epidemiology, Prevalence, Risk Factors, Rural Population statistics & numerical data, Waist Circumference physiology, Young Adult, Hypertension epidemiology
- Abstract
Background: arterial hypertension (AH) is a health problem that affects a large number of undiagnosed or inadequately treated hypertensive individuals and presents a high rate of treatment nonadherence., Objective: to estimate the prevalence of AH and its correlation with some cardiovascular risk factors among the adult population of the town of Firminopolis, state of Goiás, Brazil., Methods: descriptive, observational and cross-sectional population-based study of a simple random sample (age > 18 years): standardized questionnaires with blood pressure (BP) measurements (AH criterion: BP > 140 x 90 mmHg), weight, height, Body Mass Index (BMI) and waist circumference (WC). Data were stored (Microsoft Access) and analyzed using Epi-info software., Results: we evaluated 1,168 individuals, with a predominance of the female sex - 63.2% and a mean age of 43.2 ± 14.9 years. There was a prevalence of overweight in 33.7% of the individuals and obesity in 16.0% of the individuals. There was a prevalence of altered WC in 51.8% demand of smoking in 23.2%. A sedentary life style at work and leisure activities was present in 67.6% and 64.8% of the individuals, respectively, with a higher proportion seen among the women. Alcohol consumption was observed in 33.3% of the sample. The prevalence of AH was 32.7%, higher among the men (35.8%) than among the women (30.9%). A positive correlation with AH was identified with BMI, WC and age range. A negative correlation was observed between AH and level of schooling, with 18.2% of hypertensive individuals with 9 or more years of schooling., Conclusion: a high prevalence of AH, overweight and WC alteration was identified. The female sex represented a protective factor for the risk of AH. A positive correlation was found between AH and BMI, WC and age range; a negative correlation was identified between AH and level of schooling.
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- 2010
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46. [Therapeutic decision and goals].
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Plavnik FL, Sanjuliani AF, Cury A, Chagas AC, Simão AF, Scherr C, Silva GV, Rocha JC, Mello Filho JX, Gomes MA, Azevedo MF, Passarelli O, Jardim PC, Luna RL, and Baiochi S
- Subjects
- Goals, Humans, Hypertension therapy
- Published
- 2010
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47. Cardiovascular risk factors in a cohort of healthcare professionals: 15 years of evolution.
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Jardim Tde S, Jardim PC, Araújo WE, Jardim LM, and Salgado CM
- Subjects
- Adolescent, Adult, Brazil epidemiology, Cardiovascular Diseases etiology, Cardiovascular Diseases pathology, Cohort Studies, Dyslipidemias epidemiology, Female, Follow-Up Studies, Humans, Hypertension epidemiology, Male, Overweight epidemiology, Risk Factors, Young Adult, Cardiovascular Diseases epidemiology, Health Personnel statistics & numerical data
- Abstract
Background: According to the World Health Organization (WHO), cardiovascular diseases (CVD) account for 16.7 million deaths per year. Evidence shows that CVD result from the interaction of multiple risk factors that are present from childhood., Objective: To evaluate the presence and evolution of several cardiovascular risk factors (CVRF) among medical professionals, in a period of 15 years., Methods: We analyzed a group of individuals when they entered medical school, and repeated the analysis after 15 years, comparing the data found. We used CVRF questionnaires (systemic arterial hypertension (SAH); diabetes mellitus (DM); dyslipidemia and family history of premature CVD; smoking habit; alcoholism; and sedentary lifestyle). Cholesterol, blood glucose, BP, weight, height, body mass index (BMI) values were determined., Results: We compared 100 subjects (64.0% men with a mean age of 19.9 years) with a total of 72 subjects (62.5% men, 34.8 years) that were included in the study 15 years later. There was an increase in the prevalence of hypertension (6.0% vs 16.7%, p = 0.024), overweight (9.0% vs 26.4%, p = 0.002), and dyslipidemia (4.0% vs 19.14%, p = 0.002). The other CVRF remained unchanged. Analyzing the values of systolic blood pressure (SBP); diastolic blood pressure (DBP); cholesterol; glucose; and BMI, we found an increase in the mean values of all variables (p < 0.05). We observed a positive correlation between the values of SBP, DBP, BMI, and blood glucose measured in the time interval (p < 0.05)., Conclusion: Among medical professionals, there was an elevation in SBP, DBP, glucose, BMI, and cholesterol values in 15 years. In the CVRF prevalence analysis, we found an increase in the prevalence of hypertension, overweight, and dyslipidemia.
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- 2010
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48. A high performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) method using solid phase extraction for the simultaneous determination of plasma concentrations of enalapril and enalaprilate in hypertensive patients treated with different pharmaceutical formulations.
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Lima DM, Mundim IM, Jardim PC, Jardim TS, Diniz DG, and Lima EM
- Subjects
- Angiotensin-Converting Enzyme Inhibitors pharmacokinetics, Calibration, Enalapril metabolism, Enalapril pharmacokinetics, Humans, Hypertension drug therapy, Limit of Detection, Reproducibility of Results, Solid Phase Extraction, Spectrometry, Mass, Electrospray Ionization, Therapeutic Equivalency, Angiotensin-Converting Enzyme Inhibitors blood, Chemistry, Pharmaceutical statistics & numerical data, Chromatography, High Pressure Liquid methods, Enalapril blood, Enalaprilat blood, Hypertension blood, Tandem Mass Spectrometry methods
- Abstract
Unlabelled: Enalapril maleate, available on the market in a variety of different pharmaceutical formulations, is commonly used for the control of systemic arterial hypertension. Many therapeutical failures have been reported thus far in clinical practice with respect to switching between different pharmaceutical formulations of the same product during pharmacological therapy. In the present study, plasma concentrations of enalapril and enalaprilate were measured in hypertensive patients undergoing treatment with different pharmaceutical formulations., Materials and Methods: Pharmaceutical formulations studied included the reference brand product, a generic formulation, and a third drug product marketed as "similar"; plasma samples were obtained from 30 hypertensive volunteer patients. Drug was extracted from the plasma by solid phase extraction and determined by liquid chromatography-tandem mass spectrometry. The method was validated for the main analytical parameters., Results: The analytical method developed in this study, using liquid chromatography-tandem mass spectrometry, was confirmed as suitable for application in the determination of plasma concentrations in patients and subsequently revealed statistically significant differences in plasma concentrations between the 3 treatment groups., Conclusions: Such differences reinforce the hypothesis that the bioequivalence tests currently proposed by the regulatory authorities to promote interchangeability between pharmaceutical formulations may not in fact represent a definitive parameter for guaranteeing similar plasma concentrations.
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- 2009
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49. Prevalence, control and treatment of arterial hypertension in Nobres - MT.
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Rosário TM, Scala LC, França GV, Pereira MR, and Jardim PC
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- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Attitude to Health, Body Mass Index, Brazil epidemiology, Educational Status, Epidemiologic Methods, Female, Humans, Male, Middle Aged, Sedentary Behavior, Waist-Hip Ratio adverse effects, Young Adult, Hypertension epidemiology, Hypertension etiology, Hypertension therapy
- Abstract
Background: Systemic Arterial Hypertension (SAH), considered a public health problem due to its high prevalence and difficult control, is also described as one of the most important risk factors for cardiovascular diseases., Objective: This study aimed to determine the prevalence of SAH, as well as characteristics related to its control and treatment, among individuals aging between 18 and 90 years from the urban region of Nobres, MT., Methods: Cross-sectional, population-based study, with random sampling and with replacement. For classification of SAH, criteria included blood pressure (BP) > or =140/90 mmHg or current use of antihypertensive drugs. Individuals were interviewed with standardized questionnaires previously tested. Variables were described as means +/- standard deviations and frequencies. Means were compared with the Student s t test and associations were determined with the Pearson chi-square test, with a significance level of 5%., Results: SAH has a prevalence of 30.1% in the sample, composed of 1,003 individuals older than 18 years. Among hypertensive individuals (N = 302), 73.5% knew about their condition, 61.9% were under treatment and for 24.2% the BP was under control. A positive association was observed between SAH and age; illiteracy; less than 8 years education; BMI > or = 25 kg/m(2); high and very high waist circumference; waist-hip ratio (WHR) at risk level; sedentariness; and alcoholism., Conclusions: This study showed that SAH represents an important public health problem even in a small district in the interior region of Brazil. Levels of control and treatment of hypertension in the population were higher than those observed in similar studies, but were considered not satisfactory.
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- 2009
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50. Music therapy effects on the quality of life and the blood pressure of hypertensive patients.
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Zanini CR, Jardim PC, Salgado CM, Nunes MC, Urzêda FL, Carvalho MV, Pereira DA, Jardim Tde S, and Souza WK
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- Aged, Chi-Square Distribution, Female, Humans, Hypertension therapy, Male, Statistics, Nonparametric, Treatment Outcome, Blood Pressure physiology, Hypertension physiopathology, Music Therapy standards, Quality of Life
- Abstract
Background: Arterial Hypertension (AH) is a mass disease, with consequences for the cardiocirculatory system, since its complications raise the rates of morbidity and mortality. Controlling blood pressure (BP) reduces complications and may preserve the quality of life (QOL) of patients. Studies show positive effects of music therapy as an adjuvant in the treatment of several diseases., Objective: to evaluate the effect of music therapy on the QOL and BP control of hypertensive patients., Methods: This was a controlled clinical study that evaluated patients of both genders, aged over 50 years, with stage 1 hypertension, in use of medication and enrolled in multidisciplinary service for treatment of hypertension. They were divided into an experimental group (EG) and a control group (CG). The EG, in addition to the conventional treatment, participated in weekly music therapy sessions for twelve weeks. The CG received the standard treatment of the service. Before and after the intervention, the SF-36 questionnaire was applied in both groups, and the BP of each patient was measured. The voice, an important element of communication, reflecting the patient's physical, mental and emotional state, was the main resource used., Statistics: Student T-test and Wilcoxon test were considered significant at p <0.05., Results: The groups were initially similar in gender, age, education, and the assessed QOL. In the initial and final comparison of EG patients, we observed a significant improvement on the QOL (p <0.05) and BP control (p <0.05), with no change in adhesion., Conclusions: Music therapy has contributed to an improvement on the QOL and BP control of patients, suggesting that this activity may represent a therapeutic approach to help strengthen the programs of multidisciplinary care of hypertensive patients.
- Published
- 2009
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