Blood pressure – ABC CARDIOL

IJCS

Letter to the Editor

Comments on "Assessment of Overweight/Obesity and Elevation of Blood Pressure in Schools in Rural and Urban Areas in the Backlands of Bahia – A Cross-Sectional Study"

Rubah Noor et al. Ritika Kumari

Dear Editor,

I recently came across the article titled “Assessment of Overweight/Obesity and Elevation of Blood Pressure in Schools in Rural and Urban Areas in the Backlands of Bahia – A Cross-Sectional Study,” and I felt compelled to write in. First and foremost, I want to commend the authors for tackling a subject that’s growing more urgent with each passing year. Childhood obesity and elevated blood pressure are emerging earlier and becoming more frequent across the globe, and this study makes a meaningful contribution by examining the problem in a region that’s often overlooked.

[…]

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IJCS

Original Article

Risk Factors for In-Hospital Mortality from Cardiac Causes After Acute Myocardial Infarction

Gabriel Vasconcelos Oliveira et al. Maria Beatriz Guimarães Raponi Patricia Magnabosco Maria Angélica Melo e Oliveira … Suely Amorim de Araújo Vanderlei José Haas Valéria Nasser Figueiredo

Abstract

Background:

Risk stratification on admission of patients with acute ST-elevation myocardial infarction (STEMI) is considered a clear strategy for effective treatment, early intervention, and survival.

Objective:

The purpose of this study was to determine the risk factors for in-hospital mortality from cardiac causes after STEMI.

Methods:

Observational, retrospective, longitudinal study, with a quantitative approach, based on data from the medical records of individuals diagnosed with STEMI treated at the Emergency Room of a large hospital in the state of Minas Gerais, Brazil, from January 2011 to July 2016. The outcome of interest was 30-day in-hospital mortality from after STEMI. For statistical analysis, the Pearson’s chi-square test, Spearman’s correlation and multivariable Cox-regression analysis were used, with a significance level of α = 0.05.

Results:

Of the 459 patients, 55 (12%) died from cardiac causes within 30 days after STEMI. Mean admission SBP of these patients was 109.08mmHg. The incidence of death was higher in women (23.7%), patients with systemic arterial hypertension (SAH) (13.8%) and elderly patients (16.5%). The elderly — heart rate (HR) = 3.54 — and women — HR = 2.55 — had a statistically significant higher risk of progressing to death when compared to younger adults and men. The highest admission SBP had a protective effect (HR = 0.97), reducing the chance of death by 3%.

Conclusion:

SBP on admission, female gender and advanced age were significant risk factors for death within 30 days after STEMI.

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IJCS

Original Article

Factors Associated With Elevated Blood Pressure in Nursing Workers

Vivian de Moraes Coelho et al. Camila Oliveira Sinhoroto Patrícia Magnabosco Maria Beatriz Guimarães Raponi … Maria Angélica Melo e Oliveira Omar Pereira de Almeida Neto Valéria Nasser Figueiredo

Abstract

Introduction

Nurses from the night shift are exposed to sleep deprivation, which is associated with circadian rhythm alteration, lifestyle changes, psychosocial stress, and, consequently, increased risk of blood pressure (BP) deregulation and hypertension.

Objective

To analyze risk factors associated with elevated BP levels in nursing workers.

Methods

A transversal, quantitative study was conducted with 172 nursing professionals of a large hospital in the state of Minas Gerais, Brazil. The following data were collected: anthropometric and BP measurements, sociodemographic characteristics, clinical variables, and lifestyle habits. Results were evaluated by bivariate analysis and logistic regression. The level of significance adopted in the statistical analysis was 5%.

Results

Participants’ average age was 42.7 ± 9.6 years old; 86.6% (n = 149) were female, and 20.3% (n = 35) had previous diagnosis of hypertension. Overweight and obesity (odds ratio [OR]: 2.187, 95% confidence interval [CI]: 1.060 – 4.509) and night shift (OR: 2.100, CI 95%: 1.061 – 4.158) were statistically significant (p < 0.05) for increased risk of elevated BP level.

Conclusion

Excessive weight and night shift were significant factors for increased BP in nursing workers.

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IJCS

Original Article

Possible Effects of Oriented Magnetic Fields on Human Blood Pressure

Eugenio E. Vogel et al. Nataly Belmar Benjamín Stockins

Abstract

Background:

There have been scattered reports indicating the possibility that applied magnetic fields can lower human blood viscosity, which has been considered as encouraging for decreasing blood pressure as a result of greater fluidity. Additional motivation comes from partial studies in animals showing some response of vascular variables to magnetic fields. Recently developed FeNbB magnets enable topical application to appropriate sites of much stronger permanent magnetic fields than previously available.

Objectives:

To establish whether powerful magnetic fields permanently applied along important arteries of the human body can lower blood pressure and, if so, to what extent.

Methods:

Ambulatory blood pressure tests were performed on 70 patients, half of them wearing real magnets, while the other 35 patients were wearing a similar placebo. Magnets or placebo devices were assigned at random. Each patient underwent two consecutive ambulatory 24-hour blood pressure (BP) tests; the first without a device and the second one with a device.

Results:

Results were compiled and analyzed only after the last measurement was completed. Individual responses, average values, standard deviations, information content, and Student’s t test showed that no difference was found between measurements in either group.

Conclusion:

Permanent strong magnetic fields applied along the main arteries of the human body do not alter blood pressure. This was observed both in statistical terms and in individuals as well.

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IJCS

Editorial

We need to talk about why we don’t talk about exercise!

Fabrício Braga da Silva

We usually avoid subjects that make us feel uncomfortable. As in general these subjects are those we cannot deal with, the consequences of such omission can be really bad. Problems with our children are classical examples of topics we avoid. Published in 2003, “We Need to Talk About Kevin” is a novel written by Lionel Shriver, adapted to the big screen in 2011. The film addresses the vicious cycle of problems caused by the mother who neglects her child with overt psychopathy, culminating in a catastrophe. In this fiction, avoiding the subject cost the lives of many people.

This introductory metaphor was the preamble to the following question: based on available evidence, why do we not have proper conversation about exercise with our patients? Why is physical exercise little addressed in medical visits? Why are healthcare providers not concerned about individual and collective consequences of physical inactivity?

[…]

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IJCS

Editorial

Are Wistar Rats the Most Suitable Normotensive Controls for Spontaneously Hypertensive Rats to Assess Blood Pressure and Cardiac Structure and Function?

Nazareth Novaes Rocha

The first animal models of hypertension involved constriction of renal arteries (the Goldblatt kidney) or parenchyma (the Page kidney). Although these human analogs closely mimicked the pathophysiology of the disease, renovascular hypertension and the Page kidney represent only a small fraction of human hypertension.

Most experimental studies of hypertension using animals have focused on understanding the mechanisms of primary hypertension. Models of primary hypertension have been more difficult to develop. Some models may have greater face validity than others with respect to phenotypic aspects of hypertension such as age at onset, temporal course, severity, variability, and associated comorbidities. Given the clinical importance of hypertension-related target organ damage, it is noteworthy that models exhibiting face validity for left ventricular hypertrophy, metabolic abnormalities, heart failure, renal damage, and stroke (e.g., spontaneously hypertensive rats [SHR] and Dahl salt-sensitive [DSS] rats) are also available. However, other conditions such as spontaneous development of atherosclerosis or acute myocardial infarction are not typically observed in current models.

[…]

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IJCS

Original Article

Family History of Hypertension: Impact on Blood Pressure, Anthropometric Measurements and Physical Activity Level in Schoolchildren

Tatiana Affornali Tozo et al. Beatriz Oliveira Pereira Francisco José de Menezes Junior Cristianne Morgado Montenegro … Carla Marisa Maia Moreira Neiva Leite

Abstract

Background:

A family history of arterial hypertension (AH), combined with environmental risk factors, is directly related to the development of AH.

Objectives:

To evaluate the frequency of AH, anthropometric indicators and level of physical activity and their association with a family history (FH) of AH in school children.

Methods:

Cross-sectional study with 118 students, aged between 11 and 17 years, of both sexes. Waist circumference (WC), weight, height, level of physical activity and FH of HA were collected. Body mass index z score (BMI-z) and waist-to-height ratio (WHtR) were calculated. Binary logistic regression model was used to verify the chance risk, with significance p <0.05.

Results:

Of the 118 parents who answered the questionnaire, 34.7% had a positive FH of AH. Girls with a positive FH had higher means of WC (p= 0,004), BMI (p=0,020), and systolic blood pressure (SBP) (p=0,006) than boys, and a higher risk of being overweight (OR=4,48; 95%CI:1,55–12,94), and having elevated WHtR (OR=5.98; 95%CI:1.66– 21.47) and SBP (OR=3,07; 95%CI:1,03–9,13) than girls without a FH, but they practice more vigorours moderate physical activity (MVPA) (p=0,039). On the other hand, no differences in these parameters were observed between boys with and without a FM of AH.

Conclusion:

Overweight and a FH of hypertension were associated with an increased risk for AH in girls. This was not observed among boys, perhaps due to more active lifestyle.

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ABCIC

Review Article

Diastolic Function: Current Approach to Echocardiographic Diagnosis

Oscar Francisco Sanchez-Osella et al. Rafael Castilla-Fassio Marcelo Luiz Campos-Vieira

Abstract

Echocardiography allows the detection and quantification of diastolic dysfunction using numerous parameters that seem to make the task very complex, particularly in more severe dysfunctions. In this article, the parameters used, and the available technological resources are reviewed and updated. An algorithm is proposed to guide the progressive incorporation of the necessary variables, according to the findings. The evaluation, performed in a methodical way, following an adequate algorithm allows reaching the diagnosis with high sensitivity and specificity in almost all cases, making echocardiography the best non-invasive method for the diagnosis and evaluation of this frequent dysfunction.

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IJCS

Original Article

Effects of Breaking up Deskwork with Physical Activity Combined with Tea Consumption on Cerebrovascular Function, Mood, and Affect

Guilherme F. Speretta et al. Alessandro Fornasiero Jarrett A. Johns Nicola Hopkins … Dick H. Thijssen David A. Low

Abstract

Background:

Prolonged sitting, typical of desk work, decreases cerebral blood flow (CBF), mood and affect. Conversely, short physical activity breaks from sitting may prevent these detrimental effects and provide cardiometabolic benefits.

Objective:

We evaluated the effect of interrupting prolonged sitting with short breaks of light physical activity combined with tea consumption on CBF, cerebral autoregulation (CA), mood, and affect in desk workers.

Methods:

Nineteen healthy desk workers (ten male, 27±10 years) performed desk work in a laboratory for six hours on two separate intervention days: tea breaks (TEA-BREAK: short walk combined with ingestion of one cup of tea every hour) and sedentary (SED: ingestion of one cup of water every hour, while seated). Before and after desk work, we assessed mean arterial pressure (MAP), middle cerebral artery blood velocity (MCAv) and CA. Questionnaires were used to assess mood (Bond & Lader, PANAS) and affect (Affect grid) before and after the intervention. Data are expressed as mean ± standard deviation. Two-way ANOVA with repeated measurements followed by Sidak post hoc test was used for data analysis. Paired Student’s t-test was also used to compare changes (Δ) between trials. Statistical significance was at p<0.05.

Results:

Desk work increased MAP (4.6±4.6 Δ mmHg; P<0.05), and decreased MCAv (-5.2±7.0 Δ cm/s; P<0.05), with no difference between interventions in these parameters. TEA-BREAKS, but not SED, decreased gain (-0.08±0.12 Δ cm.s⁻¹.mmHg.⁻¹) and increased phase (5.26±8.84 Δ radians) at very low frequency (P<0.05), but not at low frequency. Small changes in positive affect were found after the six hours of desk work (-5.5±7.3 Δ scale; P<0.05), with no differences between interventions.

Conclusion:

Changes in MCAv and positive affect induced by prolonged desk work could not be prevented by TEA-BREAKS. However, TEA-BREAKS improved CA, suggesting a higher efficiency in maintaining MCAv in response to blood pressure fluctuations.

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IJCS

Original Article

Is the Wistar Rat a more Suitable Normotensive Control for SHR to Test Blood Pressure and Cardiac Structure and Function?

Leonardo Mateus Teixeira de Rezende et al. Leôncio Lopes Soares Filipe Rios Drummond Pedro Zavagli Suarez … Luciano Leite Joel Alves Rodrigues Tiago Leal Lukiya Favarato Emily Correna Carlo Reis Evandro Favarato Miguel Carneiro Júnior Antônio José Natali Cândido Coimbra Thales Prímola Gomes

Abstract

Background:

There are divergences in the literature regarding the experimental model (Wistar-WIS or Wistar Kyoto-WKY) to be used as a Spontaneously Hypertensive Rat (SHR) control. The characterization of these models in terms of cardiovascular parameters provides researchers with important tools at the time of selection and application in scientific research.

Objective:

The aim of this study was to evaluate the use of WIS and WKY as a Spontaneously Hypertensive Rat (SHR) control by assessing the long-term behavior of blood pressure and cardiac structure and function in these strains.

Methods:

To this end, WIS, WKY, and SHR underwent longitudinal experiments. Blood pressure and body mass were measured every two weeks from the 8th to the 72nd. Echocardiographic analysis was performed in all groups with 16, 48, and 72 weeks of life. After having applied the normality test, the Two-Way ANOVA of repeated measures followed by the Tukey post hoc test was used. A significance level of 5% was established.

Results:

The WIS group showed higher body mass (p<0.05), while the WKY and SHR presented higher body mass variation over time (p<0.05). SHR exhibited increased values of systolic, diastolic, and mean blood pressure when compared to WKY and WIS, whereas the WKY generally showed higher values than WIS (p<0.05). Regarding the cardiac function, SHR showed reduced values, while the WKY presented an early decrease when compared to WIS with aging (p<0.05).

Conclusion:

WIS is a more suitable normotensive control for SHR than WKY in experiments to test blood pressure and cardiac structure and function.

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IJCS

Editorial

Blood Pressure Control and Therapeutic Adherence – The Challenges of Hypertension

Elizabeth Silaid Muxfeldt

Blood pressure control is the greatest challenge in the treatment of hypertension.^, The control rate varies from 10% to 32% among continents, and it is related to the development level of each country, with averages ranging from 27% in low- and middle-income countries to 51% in high-income countries. In Brazil, the rates of awareness (22% – 77%), treatment (11% – 78%), and blood pressure control (10% – 36%) also vary depending on the population studied. Clinical inertia, inappropriate lifestyle, and poor therapeutic adherence are the main reasons for difficulty in reaching the therapeutic target.

Several factors affect adherence to treatment, including sociodemographic factors, as well as factors related to patients, drug treatment, and healthcare providers.^, The main sociodemographic factors are age (younger and very elderly patients), poverty, ethnicity (minorities), and lack of social support. Few studies have assessed the difference in adherence between men and women, and they present controversial results.

[…]

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IJCS

Original Article

Clinical Characteristics and Therapeutic Adherence of Women in a Referral Outpatient Clinic for Severe Hypertension

Pedro Henrique Barletta et al. Eduardo Faria Soares de Magalhães Vitor Fernandes de Almeida Júlia Lasserre Moreira … Murilo Jorge da Silva Cristiano Macedo Roque Aras

Abstract

Background

Cardiovascular disease is the main cause of death worldwide. There is a lack of studies addressing this issue in women and its risk factors, such as hypertension.

Objective

To evaluate the clinical and therapeutic profile of women with hypertension and to determine which factors are related to treatment adherence and blood pressure control.

Methods

Cross-sectional study of 181 hypertensive women treated at an outpatient referral clinic. Data were obtained from medical records, face-to-face interviews, and physical examination, using a standardized form. Statistical analysis was performed with prevalence ratio, chi-square and Student’s t test. Significance was accepted at p<0.05.

Results

Most patients were mixed-race or black (91.7%) and the mean age was 66.09 years. Only 44.2% of patients had controlled blood pressure. The prevalence of stroke was 14.9%, whereas the prevalence of coronary artery disease was 19.3%. The mean number of oral antihypertensive drugs prescribed to each individual was 3.41. A history of stroke was more often found in patients with uncontrolled blood pressure (p=0.013) and in those using three or more antihypertensives (p=0.023). Eighty patients (44.2%) had high treatment adherence. Depression was more frequently reported by patients with poorer adherence to treatment (p=0.026).

Conclusion

Women with hypertension presented a high prevalence of cardiovascular risk factors and cardiovascular events, including a significantly higher prevalence of stroke in those with uncontrolled hypertension. Self-reported depression may help identify patients at risk of nonadherence to treatment.

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IJCS

Brief Communication

Increased Maximal Expiratory Pressure, Abdominal and Thoracic Respiratory Expansibility in Healthy Yoga Practitioners Compared to Healthy Sedentary Individuals

Cláudia Fetter et al. Liliane Appratto de Souza Daniela Ravizzoni Dartora Andressa Schein … Bruna Eibel Karina Casali Maria Cláudia Irigoyen

Abstract

Background

Increasing thoracic expansion is effective at reducing blood pressure in hypertensive subjects. Yoga prescribes many respiratory techniques with a growing number of practitioners. However, very little is known whether sedentary or yoga practitioners show measurable differences in their respiratory patterns.

Objective

This study aims to demonstrate differences between healthy sedentary individuals and healthy yoga practitioners regarding maximal respiratory pressures and thoracic and abdominal respiratory expansibility.

Methods

Maximal inspiratory and expiratory pressures (MIP and MEP, respectively) were evaluated by manovacuometry, while respiratory expansion was assessed by the cirtometry of abdominal (CA), thoracic xiphoidal (CTX), and thoracic axillary (CTA) circumferences at rest (end expiratory moment) and at full inspiration in healthy sedentary individuals (SED) and yoga practitioners (YOGA). A delta derived from rest and full inspiration measures (ΔCA, ΔCTX, and ΔCTA, respectively), followed by a percentage of each item (ΔCA/CA, ΔCTX/CTX, and ΔCTA/CTA) was then calculated. Groups were compared by means of an unpaired Student’s t-test, with a significance level p < 0.05.

Results

All respiratory expansion measures were significantly higher in in the YOGA group. A significantly higher MEP (cmH₂O) was also detected in yoga practitioners: SED 89.3 ± 19.3 and YOGA 114.7 ± 24.8 ( p = 0.007), along with decreased heart rate at rest (bpm): SED 84±6 and YOGA 74±15 ( p = 0.001).

Conclusions

Yoga practitioners have shown greater thoracic and abdominal expansion and increased MEP, when compared to healthy sedentary individuals, as well as significantly lower heart rates at rest and body mass index (BMI). However, whether or not these findings are related to respiratory patterns is uncertain.

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IJCS

Review Article

Effect of Physical Training on Nitric Oxide Levels in Patients with Arterial Hypertension: An Integrative Review

Tábata de Paula Facioli et al. Mariana Colombini Buranello Eloisa Maria Gatti Regueiro Renata Pedrolongo Basso-Vanelli Marina de Toledo Durand

Abstract

The regular practice of physical exercise as a non-pharmacological treatment of arterial hypertension (AH) has been encouraged due to causing a series of physiological responses in the cardiovascular system, such as the production of vasoactive substances, including nitric oxide (NO). NO is a relaxation factor released by the endothelium, and the decrease in its bioavailability is related to coronary and arterial diseases, such as AH. This study aimed to perform an integrative literature review to elucidate the effect of physical training on NO levels in patients with AH and to establish a relationship between these levels and blood pressure (BP) control. A literature review was was performed by searching PubMed / MEDLINE, Lilacs, Scielo, Cinahl and Embase databases. The search string used was (“arterial hypertension” OR hypertension) AND (exercise OR “physical exercise” OR “aerobic exercise” OR “exercise training” or “physical activity”) AND (“nitric oxide”). We included fully available controlled and uncontrolled clinical trials published in English and Portuguese languages in the last 10 years. The review consisted of 16 articles, of which 13 reported an increase in NO production after the physical training intervention, and three studies found no change. In addition, 15 studies observed a reduction in BP after the intervention. In conclusion, regular practice of physical exercises, advocating moderate intensity, can improve NO bioavailability in pre-hypertensive and hypertensive individuals, which seems to be one of the mechanisms responsible for BP reduction.

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IJCS

Original Article

Does Hypertension Knowledge Influence Levels of Physical Activity in Hypertensive Patients From a Southern Brazilian Community?

Rafaella Zulianello dos Santos et al. Andrea Schaefer Korbes Eliara Ten Caten Martins Mateus De Lucca … Leonardo De Lucca Marlus Karsten Magnus Benetti

Abstract

Background:

Increased level of physical activity (PA) and health education are known as non-pharmacological treatments of hypertension (HP). There is a lack of studies investigating the influence of HP knowledge on the level of PA among hypertensive patients.

Objective:

To examine the influence of patient’s knowledge about HP on PA level and the relationship between these variables.

Methods:

A cross-sectional study was conducted in in a primary care center located in a city in the southern Brazil. A total of 199 hypertensive patients (median 61.2 [13] years; body mass index (BMI) 21.9 (7.5) kg/m2; 72.4% women) were included. The level of PA was assessed by measuring the number of steps taken daily. The knowledge about HP was assessed by a standardized questionnaire (HIPER-Q). The Kruskall-Wallis test was used to compare age, BMI and PA level between HP knowledge categories, and the Spearman test was used to assess correlations (p <0.05).

Results:

The median score of knowledge about HP for patients categorized as insufficient (n=6, 3%), poor (n=24; 12.1%), acceptable (n=101; 50.8%) and good (n=68; 34.2%) was 11.0 (8.0), 20.0 (4.0), 26.0 (5.0) and 38.0 (2.0), respectively. No patient has achieved an “excellent” level of knowledge. There was no significant difference in PA level (p = 0.341), BMI (p = 0.510) or age (p = 0.073) between these categories. Age was negatively correlated with knowledge about HP (p <0.05 and rho = 0.02).

Conclusions:

Patient’s knowledge about HP did not influence the level of PA in hypertensive patients. Age, number of steps per day and BMI were not significantly different between the categories of knowledge. Public policies and organizational strategy should be addressed to improve health education and avoid sedentary behavior in this population. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

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IJCS

Original Article

Potential Impact of the New American High Blood Pressure Guidelines on Hypertension Prevalence in a Primary Health Care Unit in Rio de Janeiro – the LapARC Study

Marcelle Guimarães de Oliveira et al. Angélica Furriel de Almeida da Silva Taissa Lorena dos Santos Mariana Loureiro Cunha … Bruna Rosenbrock Ferreira Taveira Elizabeth Silaid Muxfeldt

Abstract

Background

The new American Heart Association guidelines for hypertension (HT) proposed a reduction of the diagnostic cut-off point, leading to a substantial increase in the prevalence of HT.

Objectives

To assess the prevalence of HT determined by the traditional criteria, the AHA criteria, and home blood pressure monitoring (HBPM) in a population of young adults attending a primary healthcare unit, and its association with cardiovascular risk.

Methods

A cross-sectional population study on adults aged from 20 to 50 years attending a primary healthcare unit, in Rio de Janeiro, Brazil. Sociodemographic and anthropometric data, cardiovascular risk factors, office blood pressure and HBPM were registered. The diagnosis of HT was defined by traditional criteria (office BP ≥ 140 x 90 mmHg) and by the new (AHA) criteria (office BP ≥ 130 x 80 mmHg). Bivariate analysis was used for comparisons between the two diagnostic criteria, and Kappa coefficient was used to assess the agreement in diagnosis between office BP and HBPM. The level of significance adopted was 5% (p<0.05).

Results

A total of 472 individuals were evaluated (male: 39%; mean age: 38.5 ± 8.7 years). The prevalence of HT was 23.5% and raised to 41.1% with the new AHA criteria. The prevalence of HT using HBPM was 25.5%, but the diagnostic agreement was low (kappa=0.028) with changes in diagnosis in 18% of the cases.

Conclusion

The prevalence of HT almost doubled with the new AHA diagnostic criteria for HT. HBPM seemed to be an important instrument in HT diagnosis in this population. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

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IJCS

Original Article

Acute Blood Pressure Response to Different Resistance Programs in Trained Men

Ariani França Conceição et al. Daniell Lima Muniz Clarcson Plácido Conceição dos Santos Ciro Oliveira Queiroz

Abstract

Background

Resistance training is used in different exercise programs, with different objectives and different levels of physical fitness. Training-related variables, such as volume, rest time and intensity, can affect the response of blood pressure (BP), but studies on the effect of these variables on BP are still needed.

Objective

To evaluate the acute response of BP in trained individuals undergoing two different methods of resistance training.

Methods

The sample was divided into three groups: (1) the German volume training (GVT) (n= 15), which consisted of 10 series of 10 repetitions at 50% of 1-repetition maximum (RM) with intervals of 30 seconds; (2) the sarcoplasm stimulating training (SST) (n= 16), performed at 8 RM and 85% of 1-RM and interval of 10 seconds until failure, followed by removal of 20% of weight and repetition of the whole series (total of three sets), and the control group (CG) (n= 15) who underwent BP measurements only. The two-way repeated measures ANOVA was used for analysis of variations, and a p< 0.05 was considered statistically significant.

Results

In the within-group analysis, a significant lowering of systolic blood pressure (SBP) was found at 10 minutes (125.4±10.8 mmHg, p= 0.045) and 20 minutes (124.5±8.5 mmHg, p= 0.044) post-training compared with immediately after training. In the between-group comparison, higher SBP values were observed immediately after training in the SST group (142.1±28.2, p= 0.048) compared with the CG.

Conclusion

High-volume and high-intensity resistance training programs did not cause abnormal changes in blood pressure. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

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IJCS

Original Article

Drug Profile and Therapeutic Adherence of African-Brazilians with Apparent Resistant Hypertension

Pedro Henrique Andrade Araújo Salvatore Barletta et al. Júlia Lasserre Moreira Vitor Fernandes de Almeida Mateus Andrade Bomfim Machado … Breno Lima de Almeida Tayla Samanta Silva dos Santos Yana Mendonça Nascimento Thaise Almeida Silva Roque Aras Cristiano Macedo

Abstract

Background

Resistant hypertension (RH) is manifested by the presence of blood pressure values resistant to antihypertensive therapy. RH is highly prevalent among black individuals, increasing cardiovascular risk in this population and requiring effective control of this comorbidity.

Objectives

To investigate the medication profile and therapeutic adherence in black people with apparent RH.

Methods

This is a cross-sectional study, with a convenience sample of individuals with apparent RH. Data were obtained from medical records. Therapeutic adherence was assessed using the Morisky Therapeutic Adherence Scale of 8 items (MMAS-8) and statistical analysis was performed using the SPSS, version 23. Significance was set at p <0.05.

Results

Of the 120 individuals, 90 (75%) were women and 72 (60%) were black. Mean SBP was 153.09 (SD 25.59) mm Hg and mean DBP, 90.82 (SD 16.91) mm Hg, with a statistical difference in relation to the target pressure for SBP. Regarding the medication profile, 79.2% of the individuals used the recommended regimen for RH (ACEI / ARB + Diuretic + CCB), with the fourth most used drug being beta-blockers. The average score in MMAS-8 was 6.62 (SD 1.38) points, with 19.2%, 50.0%, and 30.8% showing low, medium, and high adherence, respectively.

Conclusions

It was evidenced that two-thirds of the individuals did not have high therapeutic adherence and not all used the ideal regimen for the management of RH, nor full doses. Thus, most individuals were probably affected by pseudoresistance, which was initially diagnosed as apparent RH. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

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IJCS

Editorial

Study of Arterial Stiffness – Based on Scientific Evidence, What are the Current Tools for the Study of Arterial Stiffness?

Ronaldo Rodrigues

One of the biggest challenges in modern medicine is the early identification of patients with higher cardiovascular risks. The early identification of vascular damage in hypertensive patients is a challenge for cardiologists around the world in their attempt to reduce the risk of cardiovascular complications in patients.

We know how important it is today to measure the thickness of the carotid intima-media complex through ultrasound examination in order to identify a greater or lesser cardiovascular risk. Arterial stiffness has proven to be a marker of arterial disease, which is why it has become an important parameter for the assessment of cardiovascular risk. It is also well-known that ventricular ejection generates a pressure wave that travels through the heart at a certain speed, which is known as the pulse wave velocity (PWV). The study of PWV in the carotid and femoral arteries is considered the gold standard in the assessment of arterial stiffness.

[…]

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IJCS

Editorial

Impact of Continuing Education on the Quality of Blood Pressure Measurement

Erika Campana et al. Bruno Daniel Ferrari

Cardiovascular diseases are the leading cause of death worldwide, and a key risk factor for these diseases—hypertension—is unquestionably the most prevalent disease in the population. Cardiovascular semiology is extremely important in the setting of hypertension (HTN), since the determination of blood pressure values through established indirect measurement techniques plays an essential role in initiating further diagnostic investigation, prompting treatment, and allowing monitoring of patients with HTN. The environment in which measurement is performed; the patient’s dietary habits, use of tobacco and alcohol, and engagement in physical activity before measurement; the adequacy of cuff size in relation to the limb; and proper cuff positioning are among the several important aspects which may interfere with measurement reliability. In this context, assessing the technical knowledge of healthcare providers is critical to preventing diagnostic errors.

Differences in magnitude between office BP and mean daytime BP can be attributed both to the environment and to the technical quality of blood pressure measurement by the examiner. Beckett et al. obtained an average of three manual BP readings from 481 hypertensive patients in family practices. The average clinic BP (151/83 mmHg) was significantly (P<0.001) higher than the daytime mean BP measured by ambulatory blood pressure monitoring (ABPM) (142/80 mmHg).

[…]

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IJCS

Original Article

Correlation between Epicardial Fat Thickness and Clinical and Anthropometric Variables in an Elderly Population

Joaquim Castanheira et al. Cristiana Nunes Telmo Pereira

Abstract

Background

Epicardial fat (EF) thickness is a marker of visceral adiposity and consequently considered an important predictive marker of cardiovascular and metabolic risk.

Objective

To describe echocardiographic features of the heart in an elderly population and to study the correlation between EF thickness and clinical and anthropometric variables.

Methods

A sample of 34 individuals (25 women) aged between 65 and 92 years, who attended a private institution in the central region of Continental Portugal, was analyzed. A standardized sociodemographic questionnaire was applied, and anthropometric assessment, echocardiography and blood pressure measurement were performed in all subjects. A correlational analysis of EF thickness with anthropometric and clinical parameters was performed. The association between variables was tested by Pearson’s correlation and point-biserial correlation. A value of p < 0.05 was defined as statistically significant.

Results

EF thickness was higher in males (6.0 ± 1.4 mm vs 5.2 ± 0.9 mm in females), and ranged from 4 to 9 mm. There were statistically significant correlations between EF thickness and weight (r = 0.4; p = 0.02), body surface area (r = 0.4; p = 0.02), lean mass (r = 0.4; p = 0.03), calf circumference (r = 0.5; p = 0.01) and left ventricular end-diastolic diameter (r = 0.3; p = 0.04).

Conclusion

EF thickness was higher in males and was significantly correlated with anthropometric parameters of adiposity and left ventricular end-diastolic diameter. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

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Original Article

Carotid Intima and Media Thickness Correlation with Central Blood Pressure Measurements by Tonometric and Oscillometric Methods: A Proof of Concept

Weimar Kunz Sebba Barroso et al. Milena de Andrade Melo Priscila Valverde Vitorino Claudia Gonçalves … João Alexandre Berigó Ana Carolina Arantes Jeeziane Rezende Thiago Veiga Jardim Ana Luiza Lima Souza Paulo César Veiga Jardim

Abstract

Background

The early detection of vascular damage in subclinical stages of hypertensive disease may be the key point in the prevention of cardiovascular outcomes.

Objectives

to correlate parameters of structural vascular damage (measurement of the carotid intima-media thickness) with parameters of functional vascular damage (central hemodynamic measurements) in pre-hypertensive and hypertensive patients taking up to two classes of anti-hypertensive drugs.

Methods

This was a cross-sectional descriptive study conducted with a convenience sample of patients attending the Liga de Hipertensão Arterial , a multidisciplinary program for the diagnosis and treatment of systemic hypertension, of the Federal university of Goias. Patients with arrythmia, diabetes, previous cardiovascular or cerebrovascular diseases, and end-stage diseases were excluded. Carotid Doppler test, measurements of peripheral and central blood pressure by applanation tonometry (Sphygmocor®) and oscillometry (Mobil-O-Graph®) were performed. The t-test was used for comparisons and the Pearson correlation test for correlations, considering a p<0.05 statistically significant.

Results

twenty patients (12 women) were evaluated, mean age 53.8 ± 14.3 years. Higher values of central pulse pressure (42.9±13.9 vs. 34.7±9.6, p=0.01) and pulse wave velocity (PWV) (9.0±1.9 vs. 7.9±1.5, p=0.01) were obtained by applanation tonometry compared with oscillometry. No difference between the methods was observed for the other measures. A significant correlation was found between carotid artery intima-media thickness (CA-IMT) and PWV (r=0.659; p=0.002) by the oscillometric test, but not with applanation tonometry. No correlation was found between central hemodynamic variables and the presence of carotid artery plaques.

Conclusion

PWV, estimated by oscillometry, was the only central hemodynamic parameter that correlated significantly with CA-IMT in pre-hypertensive and hypertensive patients at low cardiovascular risk. International Journal of Cardiovascular Sciences. 2020; [online].ahead print, PP.0-0

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Editorial

Relevance of Animal Models and Echocardiogram for Hypertensive Disease Studies

Karyne Pollo de Souza et al. Christianne Brêtas Viera Scaramello

Hypertension is the main risk factor for the development of cardiovascular diseases, such as cerebrovascular and ischemic heart diseases, as well as for premature death worldwide. The prevalence of this condition was about 30% in low-, middle- and high-income countries in 2010. Cardiovascular pharmacotherapy and lifestyle changes constitute important measures to manage cardiovascular diseases, and the reduction of blood pressure is a fundamental strategy to prevent and treat them. Systemic arterial hypertension is a clinical multifactorial condition. The underlying mechanisms of hypertensive disease are complex, which is why it is essential to elucidate them. Many animal models of hypertension can serve this purpose, most of which were developed considering the probable causes of this condition, such as high salt intake and renin-angiotensin-aldosterone system overactivity. It is important that each model exploit a single pathway to hypertension development.

Spontaneously hypertensive rats (SHR) are genetically modified animals commonly chosen for several studies, including antihypertensive drugs screening. They provide an inexpensive experimental model and have a hypertensive phenotype similar to human patients. There are also endocrine models of hypertension, including the administration of deoxycorticosterone acetate (plus salt) and N-ω-nitro-L-arginine methyl- ester (L-NAME). According to the literature, both SHR and L-NAME models are related to sympathetic overactivity.^,

[…]

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Editorial

“Simplicity is the ultimate sophistication” (Leonardo Da Vinci)

Weimar Kunz Sebba Barroso et al. Paulo Gentil

Although scientists are developing many complex tools for the detection and prevention of diseases, simple measures are still proven to be valid. For example, body mass index (BMI) have been criticized for not considering lean body mass. However, recent studies have shown that a high BMI is associated with cardiometabolic risks, even in the presence of high levels of lean body mass. Therefore, with a weight scale and a stadiometer, we can say many important things. Based on the article by Silva et al., we can add another tool to the toolbox: a measure tape. The authors show that waist circumference is associated with blood pressure, glucose, and lipid levels. In some cases, waist circumference explained more than 60% of the variability of a risk factor. Important to say that many of these parameters underlie some of the more prevalent diseases and most common causes of death, like hypertension, diabetes, and cancer.

It has been long known that excess fat is associated with health problems; however, it has been found that not all fats are the same. Central fat is more associated with health risks than gluteofemoral fat, which is largely explained by the endocrine characteristics of visceral fat, mediated by adypocitokines.

[…]

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