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Supplemental Digital Content is available in the text., Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18–94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBPMAP/DBPcal), or bSBP/diastolic blood pressure (cSBPSBP/DBPcal), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBPMAP/DBPcal were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBPSBP/DBPcal, respectively. We pragmatically propose as upper normal limit for 24-hour cSBPMAP/DBPcal 135 mm Hg and for 24-hour cSBPSBP/DBPcal 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was −10.6 % in young participants and decreased with increasing age. Central SBPSBP/DBPcal dipping was less pronounced (−8.7% in young participants). In contrast, cSBPMAP/DBPcal dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigation.

AIM Patients with masked hypertension have a higher incidence of target organ damage, including increased left ventricular mass and carotid atherosclerosis and cardiovascular events when compared with normotensive patients. The adverse cardiovascular risks are even greater in patients already taking antihypertensive medication. OBJECTIVE To identify the prevalence and clinical characteristics of masked hypertension in a large multicenter Brazilian sample that underwent office and home blood pressure monitoring. METHODS This was an observational cross-sectional analytical study based on secondary data from the teleMRPA online platform, which included 32 cities from 15 states in the five regions of Brazil. The database included 3704 outpatient participants with office blood pressure

Made available in DSpace on 2022-04-28T19:29:26Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-02-01 Hospital de Clínicas de Porto Alegre 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 Division of Cardiology Hospital de Clínicas de Porto Alegre Universidade Federal do Rio Grande Do Sul INCT PREVER, CPC, 5º. and Ramiro Barcelos, 2350 Hospital Universitário Júlio Müller Universidade Federal de Mato Grosso Faculdade de Medicina São José Do Rio Preto Department of Epidemiology School of Public Health and Tropical Medicine Tulane University Faculdade de Medicina Hospital São Lucas PUCRS Hospital Universitário Walter Cantídio Universidade Federal do Ceará Faculdade de Medicina Instituto do Coração Universidade de São Paulo Hospital de Clínicas de Porto Alegre Universidade Federal do Rio Grande Do Sul Faculdade de Ciências Farmacêuticas USP Ribeirão Preto Instituto de Cardiologia, Av. Princesa Isabel Hospital Universitário Universidade Federal do Maranhão Universidade Federal de Pernambuco Universidade Federal de Pelotas Instituto de Medicina Integral Prof Fernando Figueira Universidade Do Estado do Rio de Janeiro Hospital das Clínicas da Universidade Federal de Minas Gerais Hospital das Clínicas de Goiânia Universidade Federal de Goiás Faculdade de Medicina de Botucatu Hospital do Coração de Alagoas Anis Rassi Hospital Hospital Universitário Procape Hospital Universitário Antônio Pedro UFF Faculdade de Medicina de Ribeirão Preto USP Ribeirão Preto Instituto de Pesquisa Hospital Israelita Albert Einstein Faculdade de Medicina de Botucatu Hospital de Clínicas de Porto Alegre: GPPG: 08-621

1. Definicao e Epidemiologia Coordenador: Heitor Moreno Junior. Autores: Juan Carlos Yugar-Toledo, Heitor Moreno Junior, Miguel Gus, Guido Bernardo Aranha Rosito e Luiz Cesar Nazario Scala. […] Posicionamento Brasileiro sobre Hipertensao Arterial Resistente – 2020

A systematic, nationwide assessment of care of patients with hypertension in Brazil is needed. The objective of the First National Registry of Patients with Hypertension in Brazil is to evaluate the clinical profile, treatment patterns, and outcomes of diagnosed hypertensive patients in the country.

Made available in DSpace on 2022-04-28T19:09:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-04-01 Ministry of Science and Technology Background: To determine the effectiveness of low-dose diuretic therapy to achieve an optimal level of blood pressure (BP) in adults with prehypertension. Methods: The PREVER-prevention trial was a randomized, parallel, double-blinded, placebo-controlled trial, with 18 months of follow-up, conducted at 21 academic medical centers in Brazil. Of 1772 individuals evaluated for eligibility, 730 volunteers with prehypertension who were aged 30-70 years, and who did not reach optimal blood pressure after 3 months of lifestyle intervention, were randomized to a fixed association of chlorthalidone 12.5mg and amiloride 2.5mg or placebo once a day. The main outcomes were the percentage of participants who achieved an optimal level of BP. Results: A total of 372 participants were randomly allocated to diuretics and 358 to placebo. After 18 months of treatment, optimal BP was noted in 25.6% of the diuretic group and 19.3% in the placebo group (P

Cardiovascular Diseases (CVD) are the main cause of death, hospitalization and outpatient care worldwide, including in developing countries like Brazil. More than 75% of deaths from these causes occur in low- or middle-income countries, and about 80% of deaths are due to acute myocardial infarction (AMI) and stroke. Vilela, PB et al. observed that mortality from cerebrovascular disease in Brazil is influenced by socioeconomic factors. Although the aging process is not necessarily related to diseases and disabilities, elderly people have [...]

Hypertension is the most frequence chronic noncomunicable disease (NCD) occurring in early propoductive stage of life and the main risk factor for attributable mortality, years of life lost and years lost for incapacity adjusted by age and disability-adjusted life year. The WHO estimated that hypertension prevalence is around 25% of the world population, predicting that it will increase by 60% by 2025...

Background: The diagnosis of arterial hypertension based on measurements of blood pressure in the office has low accuracy. Objective: To evaluate the prevalence of masked hypertension (MH) and white-coat hypertension through home blood pressure monitoring (HBPM) in pre-hypertensive and stage 1 hypertensive patients. Method: Retrospective study, of which sample consisted of individuals with BP ≥ 120/80 mmHg and < 160/100 mmHg at the medical office without the use of antihypertensive medication and who underwent exams on the HBPM platform by telemedicine (TeleMRPA) between May 2017 and September 2018. The four-day MRPA protocol was used, with 24 measurements, using automated, validated, calibrated equipment with a memory function. Results: The sample consisted of 1,273 participants, of which 739 (58.1%) were women. The mean age was 52.4 ± 14.9 years, mean body mass index (BMI) 28.4 ± 5.1 kg/m2. The casual BP was higher than the HBPM in 7.6 mmHg for systolic blood pressure (SBP) and 5.2 mmHg for diastolic blood pressure (DBP), both with statistical significance (p < 0.001). There were 558 (43.8%) normotensive individuals; 291 (22.9%) with sustained hypertension; 145 (11.4%) with MH and 279 (21.9%) with white-coat hypertension (WCH), with a diagnostic error by casual BP in the total sample in 424 (33.3%) patients. In stage 1 hypertensive individuals, the prevalence of WCH was 48.9%; in prehypertensive patients, the prevalence of MH was 20.6%. Conclusion: MH and WCH have a high prevalence rate in the adult population; however, in prehypertensive or stage 1 hypertensive patients, the prevalence is higher. Out-of-office BP measurements in these subgroups should be performed whenever possible to prevent misdiagnosis. Resumo Fundamento: O diagnóstico de hipertensão arterial baseado nas medidas do consultório tem baixa acurácia. Objetivo: Avaliar a prevalência de hipertensão mascarada (HM) e do avental branco pela monitorização residencial da pressão arterial (MRPA) em pacientes pré-hipertensos e hipertensos estágio. Método: Estudo retrospectivo com amostra constituída de indivíduos com pressão arterial (PA) na clínica ≥ 120/80 mmHg e < 160/100 mmHg sem uso de medicação anti-hipertensiva e que realizaram exames na plataforma de MRPA por telemedicina (TeleMRPA) entre maio de 2017 e setembro de 2018. Foi utilizado o protocolo MRPA de quatro dias, com 24 medidas, com equipamentos automáticos, validados, calibrados e com memória. Resultados: A amostra foi constituída de 1.273 participantes, sendo 739 (58,1%) mulheres. A idade média foi 52,4 ± 14,9 anos, índice de massa corporal (IMC) médio 28,4 ± 5,1 kg/m2. A PA casual foi maior que a MRPA em 7,6 mmHg para pressão arterial sistólica (PAS) e 5,2 mmHg para a pressão arterial diastólica (PAD), ambas com significância estatística (p < 0,001). Foram diagnosticados 558 (43,8%) normotensos; 291 (22,9%) hipertensos sustentados; 145 (11,4%) com HM e 279 (21,9%) com hipertensão do avental branco (HAB), com erro diagnóstico pela PA casual na amostra total em 424 (33,3%) pacientes. Em hipertensos estágio 1, a prevalência de HAB foi de 48,9%; nos pré-hipertensos a prevalência de HM foi de 20,6%. Conclusão: HM e HAB têm elevada prevalência na população adulta; entretanto, na população de pré-hipertensos ou hipertensos estágio 1 a prevalência é maior. Medidas da PA fora do consultório, nestes subgrupos, devem ser realizadas sempre que possível para evitar erro diagnóstico.

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

Background Fixed-dose combinations of antihypertensive agents demonstrate advantages in terms of efficacy, tolerability, and treatment adherence. Objective This study was designed to compare the efficacy and safety of 2 ramipril and hydrochlorothiazide (HCTZ) fixed-dose combinations in patients with hypertension stage 1 or 2. Patients' blood pressure (BP) profiles were evaluated by using 24-hour ambulatory BP monitoring (ABPM). Methods This was a multicenter, prospective, randomized, open-label, parallel-group, noninferiority trial of adult patients (age ≥18 years) with hypertension stage 1 or 2 and systolic blood pressure (SBP) within 140 to 179 mm Hg or diastolic blood pressure (DBP) 90 to 109 mm Hg. After a 2-week washout period, eligible patients were randomized to receive 1 of 2 ramipril/HCTZ fixed-dose combination formulations (5/25 mg/d) for 8 weeks. The primary end point was the difference in 24-hour ABPM SBP/DBP mean reductions between groups after 8 weeks of treatment. The secondary end points were the changes in daytime and nighttime ABPM and in office BP. Safety profile and tolerability assessments included monitoring of adverse events. Results A total of 102 patients with hypertension (54 in group A [test formulation] and 48 in group B [reference formulation]), aged 27 to 85 years, completed the 8-week treatment period. The decreases in SBP and DBP according to 24-hour ABPM from baseline to week 8 were significant and similar in both groups. SBP decreased from 149.1 to 133.0 mm Hg (−16.1 mm Hg) in group A and from 146.2 to 130.6 mm Hg in group B (−15.6 mm Hg) ( P = 0.8537); DBP was reduced by 8.8 mm Hg in group A and by 8.5 mm Hg in group B ( P = 0.8748). Because the lower 95% CI limit for the difference between groups A and B of 3.96 mm Hg in SBP and 3.54 mm Hg in DBP was lower than that preestablished by the trial protocol (4 mm Hg), noninferiority of the test formulation was demonstrated compared with the reference formulation. For the secondary end points, there was no significant difference between groups in SBP and DBP during daytime or nighttime at the end of week 8. Office BP was significantly reduced in both treatment groups, with no significant differences between groups. The incidence of adverse events was 23.7% in group A and 21.7% in group B. Conclusions Both treatment options were well tolerated and equally reduced BP. The results support the conclusion that group A (new fixed-dose combination of ramipril/HCTZ) was noninferior to group B (reference medication in Brazil). ISRCTN Register: ISRCTN05051235.

The guidelines and consensus documents on hypertension management have emphasized the need for a better arterial hypertension (AH) control, and, thus, have recommended an optimized treatment, which usually requires the combined use of drugs that block different mechanisms responsible for blood pressure (BP) increase. For stage 2 and 3 hypertensives, the association of two drugs is mandatory, and if the BP goal is not attained, the association of a third drug is the preferential option. For high CV risk patients, the current tendency is to block the renin-angiotensin-aldosterone system (RAAS) with an angiotensin-converting-enzyme inhibitor (ACEI) or with an angiotensin II type 1 receptor blocker (ARB) or even with a direct renin inhibitor (DRI), associated with a calcium channel blocker (CCB). When the BP goal is not reached with this type of association, a diuretic compound is the drug to be added. The triple combination of Olmesartan (OM), amlodipine (AM)L, and hydrochlorothiazide (HCTZ) seems to be one of the most adequate choice, due to the complementary mechanisms of action of their agents. This study aimed at reviewing both the rationale for the combined use of drugs for controlling AH and the results of the clinical trials on the triple association of OM, AML, and HCTZ.

FUNDAMENTO: A rigidez arterial é uma variável preditora de morbimortalidade e um possível marcador de lesão vascular. Sua avaliação não invasiva por tonometria radial e análise do índice de incremento (r-AI) permite identificar os pacientes expostos a um maior risco cardiovascular. OBJETIVO: Analisar a influência do r-AI em variáveis clínico-bioquímicas e sua influência na prevalência de dano em órgão-alvo em pacientes hipertensos. MÉTODOS: Cento e quarenta pacientes hipertensos consecutivos, em seguimento clínico ambulatorial, foram submetidos à análise transversal. Os níveis de pressão arterial (PA) e o r-AI foram obtidos por tonometria de aplanação da artéria radial (HEM-9000AI, Onrom). Os pacientes foram alocados em tercis r-AI (r-AI < 85%; 85 < r-AI < 97%; r-AI > 97%). RESULTADOS: A amostra era predominantemente composta por mulheres (56,4%), com idade média de 61,7 ± 11,7 anos e índice de massa corporal de 29,6 ± 6,1 Kg/m². O maior tercil apresentou uma proporção maior de mulheres (p = 0,001), maior PA sistólica (p = 0,001) e pressão de pulso (p = 0,014), e menor peso (p = 0,044), altura (p < 0,001) e frequência cardíaca (p < 0,001). A análise multivariada demonstrou que o peso (β = -0,001, p = 0,017), frequência cardíaca (β = -0,001, p = 0,007) e pressão central (β = 0,015, p < 0,001) se correlacionam com o r-AI de maneira independente. Em análises de regressão logística, o 3º tercil r-AI foi associado a uma diminuição do diabete (DM) (OR = 0,41; 95% CI 0,17-0,97; p = 0,042). CONCLUSÃO: Este estudo demonstrou que peso, frequência cardíaca e PA central se relacionam com o r-AI de maneira independente. BACKGROUND: Arterial stiffness is a variable predictor of morbidity and mortality and a possible marker of vascular injury. Its non-invasive assessment by radial tonometry and analysis of the augmentation index (r-AI) allows identifying patients exposed to higher cardiovascular risk. OBJECTIVE: To analyze the influence of r-AI on clinical-biochemical variables and its influence on the prevalence of target-organ damage in hypertensive patients. METHODS: 140 consecutive hypertensive patients, followed-up in an outpatient clinic, were analyzed in a cross-sectional study. Blood pressure (BP) levels and r-AI were obtained by applanation tonometry of the radial artery (HEM-9000AI, Onrom). The patients were allocated into r-AI tertiles (r-AI < 85%; 85< r-AI < 97%; r-AI > 97%). RESULTS: The sample was predominantly composed of women (56.4%), mean age of 61.7 ± 11.7 years and body mass index 29.6 ± 6.1 Kg/m². The highest tertile showed higher proportion of women (p = 0.001), higher systolic BP (p = 0.001) and pulse pressure (p = 0.014), and lower weight (p = 0.044), height (p < 0.001) and heart rate (p < 0.001). Multivariate analysis demonstrated that weight (β = -0.001, p = 0.017), heart rate (β = -0.001, p = 0.007) and central pressure (β = 0.015, p < 0.001) correlated independently with r-AI. In logistic regression analyses, the 3rd r-AI tertile was associated to lower levels of diabetes (DM) (OR = 0.41; 95% CI 0.17-0.97; p = 0.042). CONCLUSION: This study demonstrated that weight, heart rate and central BP were independently related to r-AI.

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

OBJETIVO: Testar um novo dispositivo simplificado de medicao chamado rastreometro, que poderia ser usado pelos Agentes de Saude. METODOS: O rastreometro foi desenvolvido a partir de um esfigmomanometro aneroide convencional, no qual se cobriu o visor do aneroide com um adesivo, cujo desenho tem uma faixa vermelha, indicativa de pressoes > 140 mmHg e uma faixa amarela, indicativa de pressoes < 140 mmHg. O inicio das oscilacoes da agulha do esfigmomanometro e considerado indicativo da pressao arterial sistolica. As medicoes pelo rastreometro foram comparadas com aquelas realizadas pelo metodo auscultatorio em 268 pacientes, por dois operadores. A influencia, sobre os resultados, de variaveis que podem causar confusao, como idade, sexo, IMC, comprimento do braco, circunferencia do braco, cor da pele e presenca de tratamento anti-hipertensivo, foram levadas em consideracao, assim como a variacao intra e interobservador. RESULTADOS: No grupo como um todo, a sensibilidade foi de 95,1%, a especificidade foi de 63,1%, o valor preditivo positivo foi de 62,4% e o valor preditivo negativo foi de 95,3%. O tratamento anti-hipertensivo afetou significativamente a especificidade, de 32,7%, em comparacao com 77,8%, no grupo nao medicado. Os dois operadores melhoraram seus resultados ao longo do tempo. CONCLUSAO: Este estudo sugere que a tecnica do rastreometro, como metodo de triagem para hipertensao, tem boa sensibilidade. Quanto a especificidade, ela e aceitavel se os pacientes nao estiverem sob tratamento anti-hipertensivo regular. Nesse ultimo caso, pode ser melhorada pela padronizacao adequada da leitura da pressao sistolica pelas oscilacoes da agulha. Alem disto, o uso dessa tecnica requer operadores bem treinados.

OBJECTIVE: To evaluate the influence of the siesta in ambulatory blood pressure (BP) monitoring and in cardiac structure parameters. METHODS: 1940 ambulatory arterial blood pressure monitoring tests were analyzed (Spacelabs 90207, 15/15 minutes from 7:00 to 22:00 hours and 20/20 minutes from 22:01 to 6.59hours) and 21% of the records indicated that the person had taken a siesta (263 woman, 52±14 years). The average duration of the siesta was 118±58 minutes. RESULTS: (average ± standard deviation) The average of systolic/diastolic pressures during wakefulness, including the napping period, was less than the average for the period not including the siesta (138±16/85±11 vs 139±16/86±11 mmHg, p5%. CONCLUSION: The siesta influenced the heart structure parameters and from a statistical point of view the average of systolic and diastolic pressures and the respective pressure loads of the wakeful period.

Arterial blood pressure (BP) is a very useful variable in clinical practice. Its measurement is simple, inexpensive and easy; it is worth noting that BP should be accurately obtained, following the recommendations of the VI Brazilian Guidelines on Hypertension (DBH VI)1. Office BP measurement is the central parameter for the diagnosis, treatment and follow-up of systemic arterial hypertension (SAH), being directly, continuously and independently related to the risk of fatal and non-fatal cardiovascular (CV) events1-3. Thus, the consideration of BP values closer to the upper limits of normality, the so-called prehypertension (PH)2, and intervention on those values have been emphasized over the last decade, because PH represents an important opportunity to prevent established SAH, contributing to reduce the associated CV risk. Repeated BP measurement at the office allows the diagnosis of hypertension and normotension. To better assess BP behavior, there are methods that analyze BP by using a higher number of measurements, minimizing interferences of the environment, situation and observer. Those alternatives are as follows: 24-hour ambulatory BP monitoring (ABPM); and dwelling BP measurement [home BP monitoring (HBPM) and BP self-measurement (BPSM)]. Based on those methods, two other BP classifications were adopted: white coat hypertension (WCH) and masked hypertension (MH)1,3-5 (Figure 1). Figure 1 Classification of blood pressure behavior considering office BP, ABPM and home BP measurements1. ABPM: ambulatory blood pressure monitoring; BP: blood pressure. Epidemiological and clinical studies on those conditions are still limited; however, they deserve attention because of their higher CV risk as compared with normotension6,7. This document represents the position of the Brazilian Society of Cardiology Arterial Hypertension Department (DHA/SBC) on the diagnosis and non-drug and drug therapy for PH, WCH and MH, aiming at contributing to a better clinical practice.

Item does not contain fulltext BACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75 mg daily). In a secondary analysis involving 2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel. RESULTS: At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel group (hazard ratio in the prasugrel group, 0.91; 95% confidence interval [CI], 0.79 to 1.05; P=0.21). Similar results were observed in the overall population. The prespecified analysis of multiple recurrent ischemic events (all components of the primary end point) suggested a lower risk for prasugrel among patients under the age of 75 years (hazard ratio, 0.85; 95% CI, 0.72 to 1.00; P=0.04). Rates of severe and intracranial bleeding were similar in the two groups in all age groups. There was no significant between-group difference in the frequency of nonhemorrhagic serious adverse events, except for a higher frequency of heart failure in the clopidogrel group. CONCLUSIONS: Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

A decisao terapeutica deve ser baseada no risco cardiovascular considerando-se a presenca de fatores de risco, lesao em orgao-alvo e/ou doenca cardiovascular estabelecida, e nao apenas no nivel da PA. ABORDAGEM PARA NIVEIS DE PA ENTRE 130-139/85-89 mmHg A justificativa para intervencoes em pessoas com esses niveis de PA baseia-se no fato de que metade do onus atribuivel ocorre para pressoes sistolicas entre 130 e 150 mmHg, isto e, incluindo o comportamento limitrofe de PA1 (Grau B). Uma importante consideracao a [...]

FUNDAMENTO: As diretrizes nacionais e internacionais enfatizam a importância do tratamento eficaz da hipertensão arterial. Apesar disso, verificam-se baixos índices de controle e alcance das metas preconizadas, indicando que é importante planejar e implementar melhores estratégias de tratamento. OBJETIVO: Avaliar a eficácia de um tratamento, em escalonamento de doses, tendo como base a olmesartana medoxomila. MÉTODOS: Este é um estudo aberto, nacional, multicêntrico e prospectivo, de 144 pacientes com hipertensão arterial primária nos estágios 1 e 2, virgens de tratamento ou após período de washout de duas a três semanas para aqueles em tratamento ineficaz. Avaliou-se o uso da olmesartana medoxomila num algoritmo de tratamento, em quatro fases: (i) monoterapia (20 mg), (ii-iii) associada à hidroclorotiazida (20/12,5 mg e 40/25 mg) e (iv) adição de besilato de anlodipino (40/25 mg + 5 mg). RESULTADOS: Ao fim do tratamento, em escalonamento, 86% dos sujeitos de pesquisa alcançaram a meta de pressão arterial (PA) < 130/85 mmHg. Ocorreram reduções na pressão arterial sistólica (PAS) e na pressão arterial diastólica (PAD) de, no máximo, -44,4 mmHg e -20,0 mmHg, respectivamente. A taxa dos respondedores sistólicos (PAS > 20 mmHg) foi de 87,5% e diastólicos (PAD > 10 mmHg) de 92,4%. CONCLUSÃO: O estudo se baseou em um esquema de tratamento semelhante à abordagem terapêutica da prática clínica diária e mostrou que o uso da olmesartana medoxomila, em monoterapia ou em associação a hidroclorotiazida e anlodipino, foi eficaz para o alcance de meta para hipertensos dos estágios 1 e 2. BACKGROUND: The national and international guidelines emphasize the importance of the effective treatment of essenssial hypertension. Nevertheless, low levels of control are observed, as well as low attainment of the recommended goals, indicating that it is important to plan and implement better treatment strategies. OBJECTIVE: To evaluate the efficacy of a based treatment algorithm with olmesartan medoxomil. METHODS: This is an open, national, multicentric and prospective study of 144 patients with primary arterial hypertension, stages 1 and 2, naïve to treatment or after a 2-to-3 week washout period for those in whom treatment was ineffective. The use of olmesartan medoxomil was assessed in a treatment algorithm divided into 4 phases: (i) monotherapy (20 mg), (ii-iii) associated to à hydrochlorothiazide (20/12.5 mg and 40/25 mg) and (iv) addition of amlodipine besylate (40/25 mg + 5 mg). RESULTS: At the end of the phased-treatment, 86% of the study subjects attained the goal of BP < 130/85 mmHg. Maximum reductions in SAP and DAP were -44.4 mmHg and -20.0 mmHg, respectively. The rate of systolic responders (SAP > 20 mmHg) and of diastolic responders (DAP > 10 mmHg) was 87.5% and 92.4%, respectively. CONCLUSION: The study was based on a treatment regimen that was similar to the therapeutic approach in daily clinical practice and showed that the use of olmesartan medoxomil in monotherapy or in association with hydrochlorothiazide and amlodipine was effective in the attainment of the recommended goals for hypertension stage 1 and 2 hypertensive individuals.

Background : A combination of antihypertensive agents of different drug classes in a fixed-dose combination (FDC) may offer advantages in terms of efficacy, tolerability, and treatment compliance. Combination of a calcium channel blocker with an angiotensin-converting enzyme inhibitor may act synergistically to reduce blood pressure (BP). Objective : The aim of this study was to compare the efficacy and tolerability of an amlodipine/ramipril FDC with those of amlodipine monotherapy. Methods : This 18-week, prospective, randomized, double-blind study was conducted at 8 centers across Brazil. Patients with stage 1 or 2 essential hypertension were enrolled. After a 2-week placebo run-in phase, patients received amlodipine/ramipril 2.5/2.5 mg or amlodipine 2.5 mg, after which the doses were titrated, based on BP, to 5/5 then 10/10 mg (amlodipine/ramipril) and 5 then 10 mg (amlodipine). The primary end point was BP measured in the intent-to-treat (ITT) population. Hematology and serum biochemistry were assessed at baseline and study end. Tolerability was assessed using patient interview, laboratory analysis, and physical examination, including measurement of ankle circumference to assess peripheral edema. Results : A total of 222 patients completed the study (age range, 40-79 years; FDC group, 117 patients [mean dose, 7.60/7.60 mg]; monotherapy, 105 patients [mean dose, 7.97 mg]). The mean (SD) changes in systolic BP (SBP) and diastolic BP (DBP), as measured using 24-hour ambulatory blood pressure monitoring (ABPM) and in the physician's office, were significantly greater with combination therapy than monotherapy, with the exception of office DBP (ABPM, −20.76 [1.25] vs −15.80 [1.18] mm Hg and −11.71 [0.78] vs −8.61 [0.74] mm Hg, respectively [both, P = 0.004]; office, −27.51 [1.40] vs −22.84 [1.33] mm Hg [ P = 0.012] and −16.41 [0.79] vs −14.64 [0.75] mm Hg [ P = NS], respectively). In the ITT analysis, the mean changes in ambulatory, but not office-based, BP were statistically significant (ABPM: SBP, −20.21 [1.14] vs −15.31 [1.12] mm Hg and DBP, −11.61 [0.72] vs −8.42 [0.70] mm Hg, respectively [both, P = 0.002]; office: SBP, −26.60 [1.34] vs −22.97 [1.30] mm Hg and DBP, −16.48 [0.78] vs −14.48 [0.75] mm Hg [both, P = NS]). Twenty-nine patients (22.1%) treated with combination therapy and 41 patients (30.6%) treated with monotherapy experienced ≥1 adverse event considered possibly related to study drug. The combination-therapy group had lower prevalence of edema (7.6% vs 18.7%; P = 0.011) and a similar prevalence of dry cough (3.8% vs 0.8%; P = NS). No clinically significant changes in laboratory values were found in either group. Conclusions : In this population of patients with essential hypertension, the amlodipine/ramipril FDC was associated with significantly reduced ambulatory and office-measured BP compared with amlodipine monotherapy, with the exception of office DBP. Both treatments were well tolerated.

OBJETIVO: Medir as pressões arteriais sistólica (PAS), diastólica (PAD) e de pulso (PP) por monitorização residencial da pressão arterial (MRPA) e correlacionar os seus valores com o do índice de massa do ventrículo esquerdo (IMVE). MÉTODOS: No ano de 2004, 127 pacientes submeteram-se à realização de MRPA em um serviço privado, conforme indicado por seus médicos. Desses, 83 haviam sido submetidos a ecocardiograma em um período de tempo inferior a seis meses. Excluindo-se aqueles com cardiopatia dilatada ou isquêmica e aqueles com valvopatias mitral e aórtica, foram avaliadas em 72 pacientes as correlações existentes entre a PAS, PAD e PP (diferença entre a PAS e a PAD) e o IMVE. RESULTADOS: A idade média do grupo foi de 51,9 ± 17,3 anos, sendo 43% dos pacientes do sexo masculino. A média do índice de massa corpórea (IMC) foi de 28,6 ± 6 kg/m² e 53% dos pacientes faziam uso de anti-hipertensivos. A PAS e a PP correlacionaram-se positivamente com o IMVE (r = 0,356; p = 0,002 e r = 0,429; p < 0,001, respectivamente). Não houve correlação entre a PAD e o IMVE. CONCLUSÃO: A PAS e a PP correlacionam-se positivamente com o IMVE. OBJECTIVE: Measure the systolic (SP), diastolic (DP) and pulse pressure (PP) using home blood pressure monitoring (HBPM) and correlate its values with the left ventricular mass index (LVMI). METHODS: In 2004, 127 individuals underwent HBPM in a private clinic. A total of 83 of these also underwent an echocardiographic study in a period shorter than 6 months. After excluding those with dilated or ischaemic cardiomyopathy and those with mitral or aortic valvopathies, 72 patients were evaluated for the correlation between SP, DP and PP (SP minus DP) and the LVMI. RESULTS: The group's mean age was 51.9 ± 17.3 years and the masculine gender represented 43% of their components. The mean body mass index (BMI) was 28.6 ± 6 kg/m² and 53% of the patients were using antihypertensive drugs. The PS and PP correlated positively to the LVMI (r = 0.356; p = 0.002 e r = 0.429; p < 0.001, respectively). There was no correlation between DP and LVMI. CONCLUSION: The PS and the PP correlate positively to the LVMI.

Background: Central hemodynamics and arterial stiffness evaluations are important for cardiovascular risk. The behavior of central blood pressure (CBP), and pulse wave velocity (PWV) during 24 hours is not well known. Objective: To investigate CBP and PWV in relation to brachial BP in 24 hours, awake and sleep periods in normotensive and untreated hypertensive individuals from 18 to 50 years old. Methods: A total of 104 subjects (60 females (57.7%) and 44 males (42.3%)), 48 (46.2%) individuals between 18 and 35 years old and 56 (53.8%) individuals between 36 and 50 years old were included. Exclusion criteria were: use of antihypertensive drugs, body mass index 35 kg/m, eGFR

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

OBJETIVO: O estudo LOTHAR avaliou a eficácia, tolerabilidade e os efeitos metabólicos em médio e longo prazo (um ano) da combinação fixa de anlodipino e losartana versus anlodipino e losartana isoladamente. MÉTODOS: Estudo multicêntrico brasileiro, randomizado, duplo-cego e comparativo realizado com 198 pacientes com hipertensão arterial primária em estágios 1 e 2. RESULTADOS: A combinação fixa apresenta alta eficácia anti-hipertensiva que se mantém em longo prazo com percentual reduzido de escape do controle pressórico, inferior a dos dois regimes monoterápicos de comparação. Em longo prazo, mais de 60% dos pacientes tratados com a combinação fixa permaneceram com níveis da PAD < 85 mmHg e o efeito anti-hipertensivo quando avaliado pela MAPA persistiu nas 24 horas com relação vale-pico de 76,7%. A freqüência de eventos adversos foi bastante reduzida neste grupo sendo a incidência em longo prazo de edema de membros inferiores cerca de quatro vezes menor que a observada com o anlodipino isolado. A combinação fixa não alterou os metabolismos da glicose e dos lípides tanto em médio quanto em longo prazos. CONCLUSÃO: Estes resultados nos permitem afirmar que a combinação de anlodipino e losartana, a primeira combinação fixa de um antagonista dos canais de cálcio e um bloqueador do receptor da angiotensina II disponível no mercado farmacêutico constitui-se em excelente opção para o tratamento da hipertensão arterial em larga gama de pacientes hipertensos. OBJECTIVE: The LOTHAR study evaluated medium and long term (one year) efficacy, tolerability and metabolic effects of the fixed combination of amlodipine and losartan compared to amlodipine or losartan alone. METHODS: Brazilian multicenter, randomized, double-blind and comparative trial performed with 198 patients in stage 1 and 2 essential hypertension. RESULTS: The fixed combination has a high antihypertensive efficacy that is sustained in the long term with very low percentage of loss of blood pressure control. This percentage is incidentally lower than that of the two monotherapy comparative regimens. In the long term, more than 60% of the patients treated with the fixed combination remained with DBP < 85 mmHg, and the antihypertensive effect, when assessed by ABPM persisted for 24 hours with a trough-to-peak ratio of 76.7%. The frequency of adverse events was quite low in this group, and the long-term incidence of leg edema was approximately four-fold lower than that observed with amlodipine alone. The fixed combination did not change glucose and lipid metabolism in the medium or in the long term. CONCLUSION: Based on these results, we can say that the combination of amlodipine and losartan - the first fixed combination of a calcium channel blocker and an angiotensin II receptor blocker available in the pharmaceutical market, is an excellent option for the treatment of a wide range of hypertensive patients.

In 2001 the first Brazilian guidelines for the use ofhome monitoring of blood pressure (HMBP) werepublished. Those guidelines stated that although a numberof HMBP protocols were in use at the time, there was nostandard pattern. Recommendation was then for at leasttwo measures in the morning - before medications andbefore breakfast -, and two in the evening - before dinneror three hours after dinner, in order to avoid post-prandialreduction of blood pressure (BP). The procedures shouldbe carried out at least for three consecutive days of routineactivities. First day measures should be disconsidered.

To test a simplified blood pressure device called Rastreometro that could be used by the Health Agents.The Rastreometro has been developed from an ordinary aneroid sphygmomanometer, in which the numeric display is covered by an adhesive with a red zone, indicating pressures equal or above 140 mmHg and a yellow zone indicating pressures below 140 mmHg. The onset of oscillations of the aneroid needle is taken as an indication of the systolic pressure value. The measurements made by the Rastreometro were compared with those made by the auscultatory method, and were carried out in 268 patients, by two operators. The influence on the results of confounding variables such as age, gender, BMI, arm length, upper arm circumference, skin colour and antihypertensive treatment were taken into consideration, as well as intra and interobserver variation.In the whole group, sensitivity was 95.1%, specificity was 63.1%, positive predictive value was 62.4% and negative predictive value was 95.3%. Hypertensive treatment significantly affected specificity, 32.7% as compared to 77.8% for the non-treated group. Both operators improved their results over time.This study suggests that the Rastreometro technique, as a screener for hypertension, has good sensitivity. Concerning specificity, it is acceptable, provided the patient is not on regular antihypertensive treatment. In this latter situation, it can be improved by a proper standardization of the method to read the systolic pressure by needle oscillations. Furthermore, the use of this technique requires well trained operators.

Hospital das Clinicas da FMUSP e Comissao Permanente das IV DiretrizesBrasileiras de Hipertensao ArterialEndereco para Correspondencia: Decio Mion Junior - Av. Dr. Eneas deCarvalho Aguiar, 255 - Inst. Central do HC - 7o andar, s/ 7032Cep 05403-000 - Sao Paulo - SP - E-mail: deciomion@uol.com.brRecebido para Pulbicacao em 02/12/2003Aceito em 9/03/2004

Objectives The use of low-dose amlodipine has not yet been well established in the elderly. This study therefore aimed to evaluate the efficacy and tolerability of low-dose amlodipine in elderly patients with Joint National Committee VI stage I or II hypertension. Patients and methods Sixty-five hypertensive individuals (aged 66.3 +/- 5.3 years) received amlodipine 2.5 mg per day for 12 weeks before and after two periods of 4 weeks of placebo. At weeks 0, 12 and 16, patients were submitted to office, 24 h ambulatory blood pressure monitoring and home blood pressure measurement. Results Office systolic and diastolic blood pressure showed decreases at weeks 8 (153 +/- 17, 90 +/- 9 mmHg) and 12 (152 +/- 16, 90 +/- 9 mmHg) compared with weeks 0 (164 +/- 16, 99 +/- 6 mmHg) and 16 (162 +/- 19, 95 +/- 9 mmHg). During ambulatory monitoring, a decrease was observed in the average 24 h systolic and diastolic pressure at week 12 (143 +/- 13, 86 +/- 7 mmHg) compared with weeks 0 (155 +/- 15, 93 +/- 6 mmHg) and 16 (152 +/- 16, 92 +/- 8 mmHg). A daytime and night-time reduction in systolic and diastolic pressure was observed on home blood pressure monitoring at week 12 (146 +/- 16/88 +/- 8, 144 +/- 16/93 +/- 8 mmHg) compared with weeks 0 (159 +/- 17/94 +/- 8, 161 +/- 19/93 +/- 8 mmHg) and 16 (153 +/- 16/93 +/- 8, 154 +/- 17/92 +/- 8 mmHg). Adverse reactions were infrequent. Conclusions Amlodipine at a dose of 2.5 mg per day showed efficacy and good tolerability in elderly hypertensives.

OBJETIVOS: Comparar a monitorização residencial da pressão arterial (MRPA) e monitorização ambulatorial da pressão arterial (MAPA) com os registros de consultório e correlacionar o índice de massa de ventrículo esquerdo (IMVE) com a MRPA e medida de consultório. MÉTODOS: Protocolo 1 - Sessenta e oito hipertensos (58±12 anos, 37 mulheres) realizaram: a) MRPA durante 7 dias; b) MAPA de 24h; e c) medida da pressão arterial no consultório, pelo médico. Protocolo 2 - 41 hipertensos (48 ± 14 anos, 25 mulheres) além de MRPA e medida no consultório, realizaram ecocardiograma bi-dimensional. RESULTADOS: Protocolo 1 - a medida de consultório (153±24/96±13mmHg) foi maior (p0,05). CONCLUSÃO: A MRPA apresentou valores menores do que a medida de consultório e semelhantes aos da MAPA, além de melhor correlação com IMVE do que a medida de consultório. PURPOSE: To compare both home blood pressure measurement (HBPM) and ambulatory blood pressure monitoring (ABPM) with office blood pressure measurement (OBP); and also to compare the correlation between HBPM and OBP with LVMI (left ventricular mass index). METHODS: Protocol 1 - 68 hypertensive patients (58±12 years, 37 females): a) self recorded blood pressure at home in the 7 days; b) recorded the ABPM during 24 hours; and c) the physician recorded blood pressure in the office. Protocol 2- 41 hypertensive patients underwent the HBPM, OBP, and BI-dimensional echocardiogram. RESULTS: Protocol 1 - OBP (153±24/96±13mmHg) was higher (p0.05, systolic and diastolic, respectively). CONCLUSION: This study showed that HBPM has a better correlation with LVMI than OBP.