Hypertension – ABC CARDIOL

IJCS

ORIGINAL ARTICLE

Evaluation of Different Pharmacological Strategies and Intracranial Compliance in Hypertensive Patients

Thiago Oliveira Costa et al. Sayuri Inuzuka Mikaelle Costa Correia Matheus Martins da Costa … Priscila Valverde de Oliveira Vitorino Gustavo Frigieri Ana Luíza Lima Sousa Weimar Kunz Sebba Barroso

Abstract

Background:

Intracranial compliance (IC) refers to the brain’s ability to accommodate variations in intracranial volume without substantial increases in pressure. Alterations in compliance are associated with cardiovascular (CV) conditions such as hypertension. Understanding the relationship between blood pressure (BP) control, pharmacological treatment strategies, and IC may aid in managing cerebrovascular risk.

Objective:

To evaluate the association between IC parameters, BP control, and different antihypertensive therapeutic strategies in patients with systemic arterial hypertension (AH).

Methods:

This cross-sectional study included 140 hypertensive patients followed in a specialized outpatient clinic between November 2022 and August 2023. Clinical data, CV risk factors, antihypertensive drug classes, central and peripheral BP, and IC parameters obtained using the Brain4Care (B4C) system were collected. Patients were classified into Group A (vasodilators), Group B (non-vasodilators), and Group C (mixed therapy). Continuous variables were presented as mean and standard deviation and compared using Student’s t-test. Categorical variables were compared using Pearson’s chi-square or Fisher’s exact tests. Correlations were assessed using Pearson’s correlation coefficient. A significance level of 5% was adopted.

Results:

A total of 140 patients were included; 77.9% were women, with a mean age of 67.9 ± 11.1 years. All patients were using antihypertensive medication, predominantly combination therapy (62.1%), especially mixed therapy (65%). Uncontrolled peripheral BP was associated with higher P2/P1 values. Among those with P2/P1 > 1.4, 85.7% had uncontrolled BP (p = 0.002). There was no association between type of therapy and changes in IC parameters.

Conclusion:

In this sample of hypertensive patients followed in a specialized outpatient clinic, no statistically significant differences in IC parameters were observed across the therapeutic groups evaluated. Peripheral BP control was the factor most strongly associated with more favorable IC values. Prospective studies with more balanced groups are needed to confirm these findings.

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Letter to the Editor

Metabolic Challenges in The Semiarid Region: A Critical Analysis of Nutritional Transition and Early Cardiovascular Risk

Leonardo Alves Santos et al. Álvaro Eduardo Santos Oliveira Beatriz Vitória Carvalho Lordêlo Luis Antonio Cavalcanti Matias … Rodrigo Mendes Pedro Pereira Tenório

Dear Editor,

We had the opportunity to review the article entitled “Assessment of Overweight/Obesity and Elevation of Blood Pressure in Schools in Rural and Urban Area in the Backlands of Bahia.” We would like to congratulate the authors for their initiative in investigating a pediatric cohort in a region marked by social and climatic vulnerability, frequently underrepresented in scientific literature, as well as for highlighting the relevance of addressing childhood obesity and arterial hypertension – two major cardiovascular risk factors with direct impact on future morbidity and mortality.

[…]

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Original Article

Is Hypertension a Predictor of Mortality in People Living With HIV/AIDS?

Gustavo Eduardo Fante et al. Pedro Antonio Pagote Dall’Omo Karina Bobato do Valle Arcelio Benetoli … Jean Fernando Sandeski Zuber Camila Marineli Martins Erildo Vicente Muller

Abstract

Background:

Hypertension is a chronic non-communicable disease that increases cardiovascular risk and significantly contributes to mortality. It is one of the most prevalent conditions among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS).

Objectives:

The objective of this study was to investigate hypertension as a predictor of mortality in people living with HIV/AIDS, analyzing the association of prior diagnosis of hypertension with morbidity and mortality in this population.

Methods:

This retrospective cohort study evaluated the medical records of 1207 patients receiving treatment at the Specialized Care Service (SAE) of a city in the state of Paraná over 264 months.

Results:

Among patients diagnosed with HIV/AIDS, 13.1% had hypertension. During the analyzed period, 52 deaths were recorded (4.31%), 30.77% of which occurred among patients with hypertension (p = 0.0002). Lower survival was observed among patients with hypertension (p < 0.0001), and mortality was significantly higher among women with hypertension (p < 0.0001). The hazard ratio (HR) for the general population was 3.1 (95% confidence interval [CI]: 1.7–5.6), with an HR of 1.7 for men (95% CI: 0.7–3.7) and 8.2 for women (95% CI: 3.1–21.6).

Conclusions:

Hypertension was a significant predictor of mortality in people living with HIV/AIDS, with a particularly strong impact among women.

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Original Article

Epidemiological Profile of Arterial Hypertension in the Municipality of Rio de Janeiro, Brazil, 2011 and 2019

Catia Martins Cristina Oliveira et al. Anna Carolina Pinho da Silva Bianca Ramos Marins Silva Ana Clara Campos

Abstract

Background:

Cardiovascular diseases are currently the leading global cause of morbidity and premature mortality. High blood pressure is one of the precursors to the disease, which, when undetected, can lead to other serious complications such as thrombosis, acute myocardial infarction, and stroke.

Objective:

To analyze the profile of hypertension and associated factors in the municipality of Rio de Janeiro in the years 2011 and 2019.

Method:

This is a population-based cross-sectional study that used data from the Vigitel telephone survey implemented by the Ministry of Health. The eligible population was that of the municipality of Rio de Janeiro, aged eighteen or older, in 2011 and 2019. To analyze the association between the outcome and the independent variables, multivariate logistic regression was used, estimating the Odds Ratio and its respective 95% confidence intervals.

Results:

The predominant sociodemographic profile remained similar in 2011 and 2019: a majority of women, 18-39 years, and with 9-12 years of schooling. Education level in 2011 appeared as a protective factor among individuals with 12 or more years of schooling (OR: 0.64, 95% CI: 0.43; 0.97). Obese individuals had a 2.81- and 2.96-times greater chance, in 2011 and 2019, respectively, of reporting hypertension, compared to non-obese individuals.

Conclusion:

The study highlights the need to expand the healthcare network to implement more effective strategies that consider the determinants of hypertension in order to achieve a greater impact on the management and control of the disease.

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Original Article

Protocol for a Structured, Health Policy and Systems–Oriented Scoping Review of Determinants of Single-Pill Combination Availability in Sub-Saharan Africa

Milena Soriano Marcolino et al. Michelle Ralil da Costa Isabella Viana Gomes Schettini Mayank Dalakoti … Hueiming Liu Mundih Noelar Njohjam

Abstract

Background:

Although international guidelines recommend single-pill combinations (SPCs) as first-line therapy for hypertension, their availability and use remain limited. Evidence on access to essential medicines is largely not specific to SPCs, and the determinants influencing their availability are dispersed across heterogeneous sources that are not well captured by traditional systematic review approaches.

Objective:

To describe the protocol for a structured, health policy and systems–oriented scoping review designed to map and synthesize the determinants of availability of antihypertensive SPCs in Sub-Saharan Africa (SSA) and to propose a transferable methodological framework applicable to other essential medicines and health system contexts.

Methods:

A comprehensive scoping review of peer-reviewed literature, grey literature, and policy documents will be conducted in accordance with the PRISMA extension for scoping reviews (PRISMA-ScR). Searches will be performed across bibliographic databases, government repositories, and relevant non governmental organization (NGO) sources. Eligible sources will include empirical studies, policy analyses, and institutional reports addressing SPC availability. Two independent reviewers will screen studies and extract data. Evidence will be synthesized narratively and mapped to the World Health Organization (WHO) Health System Building Blocks and the Bigdeli access-to-medicines framework.

Expected results:

The review will generate a structured mapping of regulatory, economic, health system, and sociocultural determinants influencing SPC availability in SSA and will identify key barriers, facilitators, and policy gaps relevant to hypertension management.

Conclusions:

This protocol outlines a replicable methodological approach for synthesizing heterogeneous evidence on access to essential medicines. The framework may be adapted to other therapeutic areas and low- and middle-income contexts, potentially supporting more informed policy and implementation decisions to reduce cardiovascular morbidity and mortality.

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Case Report

A Fixed-Dose Triple-Combination Therapy for the Initial Steps of Hypertension Treatment: Protocol for the NEXT Randomized Clinical Trial

Rogerio Orlow et al. Caroline Consuelo de Sousa Sayuri Inuzuka Audes Feitosa … Andréa Araujo Brandão Marco Mota Gomes Vanildo da Silva Guimarães Neto Elizabeth do Espírito Santo Cestario Eduardo Costa Duarte Barbosa Rodrigo Bezerra Mayara Cedrim Santos Ana Luiza Lima Sousa Sandro Rodrigues Batista Priscila Valverde de Oliveira Vitorino Weimar Kunz Sebba Barroso

Introduction

Complications from arterial hypertension account for an estimated 18 deaths per minute worldwide, establishing it as the second leading risk factor for global mortality. Between 1990 and 2019, the number of adults with arterial hypertension doubled from 650 million to 1.3 billion. Of these, only 54% are diagnosed, 42% are treated, and a mere 21% of those treated achieve adequate blood pressure (BP) control.

Although effective BP control often requires the use of multiple drugs, monotherapy remains a predominant initial approach to arterial hypertension management globally, which limits the timely achievement of therapeutic goals. This is significant because even modest reductions in systolic BP of 5 mmHg are associated with an approximate 10% reduction in the risk of major cardiovascular events, irrespective of pre-existing cardiovascular disease.

[…]

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Original Article

Protocol for Improving Hypertension and Diabetes Control Through Lifestyle Intervention in a Cluster Randomized Clinical Trial

Daisy Motta-Santos et al. Thiago Barbabela de Castro Soares Maria Cecília Ramos de Carvalho Regina Márcia Faria de Moura … Sueli Ferreira da Fonseca Larissa Morelli Ferraz Guimarães Reginaldo Gonçalves Clara Rodrigues Alves de Oliveira Aline Cristine Souza Lopes Milena Soriano Marcolino

Abstract

Background:

Hypertension and Diabetes Mellitus (DM) are prevalent chronic conditions and major risk factors for cardiovascular diseases. Adequate control of these conditions is challenging, and lifestyle changes are crucial to achieving better management.

Objectives:

To evaluate the effectiveness of a multifaceted and multidisciplinary intervention to improve the control of hypertension and DM in the primary care setting.

Methods:

This cluster randomized clinical trial focuses on lifestyle modifications for managing hypertension and DM, addressing gaps in current non-pharmacological interventions. Primary care professionals are trained to promote health education on physical activity and nutrition. Support is provided through a telementoring program, including messaging app communication, biweekly online meetings (teletutoring), and asynchronous teleconsultations. Primary care professionals conduct twice-weekly group activities with structured intensity adjustments and biweekly health education sessions using interactive methods like conversations, games, and group dynamics. For patients unable to join group activities, brief counseling and guidance on unsupervised physical activity are offered.

Results:

The primary outcomes are blood pressure and glycated hemoglobin values. The innovative intervention program aims to empower primary care professionals and reduce barriers to care through lifestyle changes, improved health education, and support systems for both supervised and unsupervised interventions. Conclusions: Supporting primary care professionals through education and remote assistance can enhance the effectiveness of lifestyle interventions, contributing significantly to the control of hypertension and DM in primary care settings. Trial registration: Previously registered with .

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Editorial

The Relationship Between Obesity and the Risk of Systemic Arterial Hypertension in Children and Adolescents: Lessons Learned

John Jairo Araujo

One out of five children around the world is overweight or obese. This is shown in the meta-analysis published by Zhang X et al. in 2024, which included 2,033 studies from 154 different countries or regions. Although the prevalence of childhood obesity varies between global regions, it is evident that its incidence is growing significantly. According to the latest United Nations International Children’s Emergency Fund (UNICEF) and World Bank estimates, 33.6% of children and adolescents 5-19 years old are affected by overweight or obesity, as are 8% of children under the age of five. Recently, Muyulema SL et al. published the results of global childhood overweight and obesity trends over the last 20 years. In this study, they analyzed 194 countries around the world, showing that the global prevalence of childhood overweight and obesity increased from 5.4% to 5.7% between 2000 and 2022.

Inflammation, Metabolic Syndrome and Systemic Hypertension: “a dangerous and synergistic triad”: Metabolic Syndrome (MS) has been well defined in adults, and includes various conditions like Systemic Arterial Hypertension (SAH), elevated fasting blood sugar levels (greater than 100 mg/dl) or type 2 diabetes mellitus, low HDL cholesterol levels (less than 40 mg/dl in men or 50 mg/dl in women), high triglyceride concentrations (greater than 150 mg/dl), and a waist circumference greater than 101 cm (men) or 90 cm (women). It is not clearly defined in children, due to the imprecision of the various factors that compose it and the changes in different stages of life. However, risk factors like obesity, increased waist circumference (increased visceral fat), insulin resistance, and, in certain cases, lipid profile abnormalities, are compatible with MS, especially in children over the age of 10.

[…]

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Original Article

Childhood Obesity and Systemic Arterial Hypertension in Children and Adolescents: A Cross-Sectional Study

Rafaella Farias da Franca Almeida et al. Lívia Menezes Escorel Letícia Odete Guedes de Andrade Carvalho Camila Batista Gaudêncio … Lara Ataide Diniz Marcela Leite Marina Romero Costa Alice Barbosa Maia Berenice Lempek dos Santos Michelle Barros de Aguiar Patrícia Vidal de Negreiros Nóbrega Eugênia Moreira Fernandes Montenegro Débora Alencar de Menezes Athayde Jessica Laureano Martins

Abstract

Background:

The increase in obesity cases and the lack of screening and diagnosis of childhood hypertension highlight the need to examine these comorbidities in children.

Objectives:

To investigate the relationships between systemic arterial hypertension (SAH) and childhood obesity (CO) in pediatrics and correlate the obesity level, abdominal circumference (AC), family history, and physical activity (PA) variables.

Methods:

This cross-sectional study assessed age, sex, height, weight, body mass index (BMI), AC, family history, PA, CO, and blood pressure (BP) percentiles. The Chi-square test, Fisher’s Exact test, and Spearman’s correlation were used for data analysis, with a statistical significance level of 5%.

Results:

After applying the inclusion and exclusion criteria, 30 patients aged between 3 and 18 years (incomplete) were evaluated at three different moments. The results showed that 83.3% (n = 25) of the patients were obese and 16.70% (n = 5) had severe obesity. Among them, 20% (n = 6) were diagnosed with SAH. Data showed an independence between CO and SAH (p = 0.702) and between SAH and PA time (p = 0.748). No correlations were observed between SAH and AC (p = 0.313). The history of SAH in first-degree relatives was significantly associated with the diagnosis of SAH (p = 0.004).

Conclusion:

This study showed no correlation between CO and SAH in the evaluated sample, supporting the need for further research in the area.

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Original Article

Innovative Health Education Strategies: Training Professionals in Hypertension and Diabetes Care in Primary Health Care

Thiago Barbabela de Castro Soares et al. Priscila Lenita Candida dos Santos Regina Márcia Faria de Moura Daisy Motta-Santos … Reginaldo Gonçalves Polianna Delfino Pereira Daniella Nunes Pereira Clara Rodrigues Alves de Oliveira Lilian Cristina Rezende Aline Cristine Souza Lopes Milena Soriano Marcolino

Abstract

Background:

Cardiovascular diseases (CVD) are the leading cause of death worldwide, and behavioral changes are a cornerstone of their prevention and treatment. However, implementing such changes can be challenging, and the use of validated protocols may support this process.

Objectives:

To develop, implement, and evaluate a continuing education protocol for primary care professionals focused on creating and monitoring action plans for the care of patients with arterial hypertension (AH) and diabetes mellitus (DM).

Methods:

The strategy involved 20 hours of in-person workshops and 15 hours of online training, based on Ministry of Health guidelines and covering topics such as physical activity, nutrition, and lifestyle. Evaluation was conducted through the development of team-based action plans and the administration of a satisfaction questionnaire.

Results:

The model was implemented in five municipalities, with 166 healthcare professionals participating in the in-person workshops. All teams developed action plans to implement the covered topics within their local contexts. The workshops on physical activity, nutrition, and lifestyle change were mostly rated as “good,” “very good,” or “excellent.” The most frequently mentioned terms in the qualitative assessments were “content,” “knowledge,” and “practices.” The strategy proved feasible, and partnerships with local public institutions enabled the active involvement of health professionals in proposing solutions to identified issues ().

Conclusion:

The action plans were tailored to local realities and reflected a high level of satisfaction with both the content and the hands-on approach of the sessions.

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Original Article

Exploring the Link Between ITGB3 Gene Polymorphism and Diastolic Dysfunction in Arterial Hypertension Patients

Vafa Nazirova et al. Zumrud Ismibayli Ismail Gafarov Faig Guliyev Konstantinos Kyriazis

Abstract

Background:

Arterial hypertension (AH) is a significant risk factor for cardiovascular diseases (CVDs), including myocardial infarction and stroke. The ITGB3 gene polymorphism, particularly T1565C (rs5918), has been implicated in various cardiovascular conditions, suggesting a potential role in diastolic dysfunction (DD) among AH patients.

Objectives:

The clinical-genetic relationship was studied between ITGB3 gene polymorphisms and DD in Azerbaijani patients with AH, with or without ischemic heart disease (IHD) and type 2 diabetes (T2D) mellitus.

Methods:

The study included 100 Azerbaijani patients, divided into case (n = 76) and control (n = 24) groups. Echocardiography was used to assess left ventricular diastolic function. ITGB3 gene was identified using the MassArray system. Statistical analysis involved both parametric and non-parametric tests using the IBM SPSS Statistics 26.

Results:

The study reported a significant association between ITGB3 gene polymorphisms and DD in AH patients. The T/C, C/C genotypes were particularly correlated with DD. The C/C variant, while more frequent in the AH group, did not reach statistical significance. A direct correlation was observed between DD and the C allele of the ITGB3 gene, with a higher E/e’ ratio and lower e’ velocity among carriers.

Conclusion:

This study highlights a significant association between ITGB3 gene polymorphisms and DD in Azerbaijani patients with AH. These findings suggest the potential for genetic screening to identify individuals at higher risk of DD among hypertensive patients, underscoring the importance of personalized approaches in managing hypertension and its complications. Further research with larger and more diverse cohorts is needed to validate these results and explore the underlying mechanisms.

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Original Article

Assessment of Overweight/Obesity and Elevation of Blood Pressure in Schools in Rural and Urban Area in the Backlands of Bahia

Andressa Lopes et al. Ana Luisa Vaz Valois Hanna Louise de Almeida Lisboa Alexvon Nunes Gomes … Renata Lago Camilla Almeida Menezes Ana Marice Teixeira Ladeia

Abstract

Background:

Childhood and adolescent obesity has been increasing, particularly in countries with greater social vulnerability. Given this context, assessing schoolchildren from Bahia’s backlands — a region known for its low-income population — is essential.

Objective:

To assess the frequency of overweight and obesity and their association with high blood pressure (BP) in children from urban and rural areas in four municipalities in the backlands of Bahia.

Methods:

This study is part of a project evaluating the impact of a school meal intervention on the health of children and adolescents in Bahia’s backlands. A subset of children aged five to ten from public schools in both rural and urban areas of four cities in Bahia’s backlands was selected through random and proportional sampling. The participants had their weight, height, waist circumference and BP measured using standardized protocols. The Body Mass Index (BMI) was expressed as a z-score to determine nutritional status. The Student’s t-test and Chi-square tests were used, with 5% statistical significance.

Results:

The sample consisted of 461 students, 264 (57.3%) from urban areas and 238 (51.6%) males. The prevalence of overweight was 27.9%, and that of increased waist circumference was 7.4%. High BP or hypertension had a prevalence of 8%. A significant difference (p = 0.049) was observed between rural and urban areas in relation to the increased waist circumference.

Conclusion:

The research revealed a high frequency of overweight, increased waist circumference and systemic BP in students, mainly those from urban areas.

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Original Article

Body Profile Impact on Blood Pressure and Lipid Profile in Rural and Urban Schoolchildren of a Brazilian Semiarid Region in The State of Bahia

Lívia Assis Mendonça et al. Alexvon Gomes Renata Lago Camilla Menezes … Sérgio Roberto Lemos de Carvalho Ana Marice Teixeira Ladeia

Abstract

Background:

The present study describes the prevalence of excess weight, obesity, and high blood pressure (BP) in children from a Brazilian semiarid region (Sertão) and its association with lipid profile and area of residence.

Objective:

To describe the prevalence of excess weight, obesity, and high BP in children, as well as the association between these variables, lipid profile, and area of residence.

Methods:

Thi work is a cross-sectional study conducted with schoolchildren, aged 6 to 10 years, from three municipalities in the countryside of Brazil. Weight, height, waist circumference (WC), and BP, together with the analysis of lipid markers, were assessed. Z-scores (BMI-Age) were used to determine the anthropometric classification. Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG) were meseared with eight hours of fasting. The Student’s t-test and the Mann-Whitney test were aplied. Perceptual maps were constructed through multiple correspondence analysis. A p-value<0.05 was considered statistically significant. The Institution's Ethics Committee approved this study (CAAE: 35038914.3.0000.5544).

Results:

Among 138 schoolchildren in this study, 76 (55.07%) were female and 81 (58.7%) were from urban areas. Twenty-one children (15.2%) were overweight, and 44 (31.9%) had a family history of obesity. Children from rural areas showed higher levels of TC (p = 0.041) and systolic BP (p = 0.028). The correlation between excess weight and a family history of obesity (p = 0.029), TG (p = 0.003), TG/HDL ratio (p = 0.009), systolic BP (p = 0.000), and WC (p = 0.000) were observed. In the correspondence analysis, the eutrophic group presented expected values for lipid variables.

Conclusion:

Overweight indicators are associated with cardiometabolic risk factors, reinforcing the need for early monitoring.

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Original Article

Lifestyle and Hypertension in Brazil and Spain

Giovanna Lucieri Alonso Costa et al. Jurema Correa Mota Marina Ururahy Soriano de Sousa Flavio Kapczinski … Jose Cervera-Martínez Vicent Balanzá-Martínez Raquel B. De Boni

Abstract

Background:

Hypertension is the main risk factor for cardiovascular mortality worldwide. Lifestyle medicine (LM) assesses health through seven domains (diet, physical activity, substance use, sleep, social support, stress management, and environmental exposure), which also include risk factors for hypertension.

Purpose:

To evaluate the association between lifestyle and hypertension in Brazil and Spain.

Methods:

Secondary analysis of data from two web surveys conducted in 2020 in Brazil and Spain, which assessed lifestyle through a multidimensional scale. We enrolled 5224 individuals of both genders, aged > 18 years, living in Brazil and Spain, and with Internet access. The main outcome was a self-reported hypertension diagnosis. We calculated the absolute and relative frequency of the independent variables and evaluated the factors associated with hypertension in logistic regression models.

Results:

76.2% of participants were women, 57.9% were > 42 years old, and 66.9% had finished higher education. Over the last 12 months, 19.6% of Brazilians and 9.2% of Spanish reported diagnosis/treatment of hypertension. Male and older groups living in Brazil, with lower education and worse lifestyles, were more likely to report hypertension. General lifestyle score was not associated with hypertension in Brazil, while hypertensive individuals had better scores in Spain (p < 0.001). Hypertensive individuals had worse lifestyle scores in physical activity (p < 0.05) and sleep (p < 0.05) in Brazil and better diet scores in Spain (p < 0.001). Environmental exposure was better among hypertensive individuals in both countries (p < 0.001). Our results point to cultural and socioeconomic differences between both countries.

Conclusion:

LM is an important strategy for the prevention/treatment of chronic diseases such as hypertension

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Original Article

Angiotensin-Converting Enzyme Inhibitors Evaluated by Office and Home Blood Pressure Measurements: TeleHBPM Study

Tariane Colombo et al. Priscila Valverde de Oliveria Vitorino Audes D. M. Feitosa Andréa Araujo Brandão … Eduardo C.D. Barbosa Roberto Dischinger Miranda Marco Mota Gomes Ana Luiza Lima Sousa Weimar Kunz Sebba Barroso

Abstract

Background

Angiotensin-converting enzyme inhibitors (ACEI) are a class of drugs fundamental to hypertension treatment; however, the individual medications within this class vary in their effectiveness at controlling Blood Pressure (BP).

Objectives

To analyze BP values obtained through casual measurements and home blood pressure monitoring (HBPM) in patients using ACEI as monotherapy or in dual combinations, focusing on BP control and goal achievement in a Brazilian population.

Methods

A cross-sectional study evaluating adult patients using ACEI between 2017 and 2020 included in the TeleHBPM platform. SBP and diastolic blood pressure (DBP) values were assessed by casual and home measurements. Those using three or more HBPMs were excluded. Paired t-tests, chi-square tests, and ANOVA were used, with a significance level of 5% (p < 0.05).

Results

3,466 patients who met the criteria were selected, 54% in a dual drug combination. The mean BP values obtained via casual measurement and HBPM, respectively, were 131.6 ± 18.7 mmHg and 125.5 ± 14.8 mmHg for SBP (p < 0.001), and 83.4 ± 11.3 mmHg and 79.1 ± 9.4 mmHg for DBP (p < 0.001). The combination of ACEI with calcium channel antagonists prevailed (29%). Enalapril had similar BP means to ACEI with longer half-lives. Captopril monotherapy and in combinations had higher SBP and DBP means.

Conclusion

Enalapril was the most commonly used ACEI, demonstrating a similar BP-lowering effect, both as monotherapy and in combination, when compared to other drugs in the same class with longer half-lives.

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Original Article

Development and Implementation of a Computerized Decision Support System for Screening Hypertension and Diabetes in a Resource-Constrained Region

Laura Defensor Ribeiro de Melo et al. Antonio Luiz Pinho Ribeiro João Antonio de Queiroz Oliveira Junia Xavier Maia … Thábata Queiroz Vivas de Sá Vânia Soares de Oliveira e Almeida Pinto Marcia Maria Oliveira Lima Patrick Wander Enlich Leonardo Bonisson Ribeiro Christiane Correa Rodrigues Cimini Milena Soriano Marcolino

Abstract

Background

Strategies aimed at improving the diagnosis and treatment of cardiovascular diseases (CVD) are of utmost importance. Clinical decision support systems (CDSS) are guided by updated guidelines and may be capable of benefiting screening and early diagnosis initiatives in remote regions.

Objective

To develop a CDSS for screening hypertension and diabetes mellitus (DM), as well as to assess its feasibility and usability in the context of a primary care setting in a resource-constrained region.

Methods

This research focused on the strategy of screening hypertension and DM based on CDSS. A software was developed and implemented in 10 municipalities in the Northeast of the state of Minas Gerais, Brazil, from April 2017 to October 2018. Patients of 30 to 69 years of age were attended by primary care practitioners using the software. A Likert-scale questionnaire with 15 questions to assess usability (System Usability Scale) and satisfaction was applied to the professionals at the end of study. Groups were compared by applying the chi-squared test for categorical variables. Statistical significance was considered as p < 0.05.

Results

In the field study, 13,775 individuals were assessed; 185 patients were diagnosed with hypertension; 35 were diagnosed with DM, and 5 were diagnosed with both diseases. For the usability and satisfaction assessment, 258 healthcare professionals participated. Fifty-one percent considered their prior knowledge for the use of technologies to be good; 53.7% reported a desire to use the application frequently, and 78.4% would recommend the platform.

Conclusion

The implementation of a CDSS developed to assist in the screening of hypertension and DM was feasible in the context of a primary care setting in a resource-constrained region, with good user satisfaction.

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Original Article

Single Nucleotide Variants in the Angiotensin II Receptor Type 2 and its Association With Arterial Hypertension: A Systematic Review

Armando Totomoch-Serra et al. César A. Brito-Carreón María de Lourdes Muñoz Nayely García-Méndez

Abstract

Background:

Arterial hypertension (AH) is a chronic disease distributed worldwide, and the Angiotensin II receptor type 2 (AGTR2) gene variants are potential DNA markers to study in association with this disease.

Objective:

This systematic review (SR) aimed to identify single nucleotide variants in the AGTR2 gene as genetic markers associated with AH.

Methods:

The electronic databases MEDLINE, Web of Science, SCOPUS, Cochrane Central Register, EMBASE, SciELO, and TripDatabase were searched for research up to September 2023. Case-control studies with DNA variants in the AGTR2 gene associated with AH as the outcome were included in the review. Boolean connectors and keywords were used according to each database.

Results:

After diverse rounds of scrutiny, a final number of eight articles were included for 8911 participants, comprising 5451 cases and 3460 controls. A significant proportion of the selected studies were performed in Asian populations and were heterogeneous. Although 238 variants were shown in the gnomAD v2.1.1 database for September 2023, only six variants were identified in all the analyzed studies.

Conclusions:

The results obtained were not conclusive that a specific variant located in the AGTR2 gene has a strong association with AH. The study of this gene re-emerged last year as an essential target to investigate due to its participation in the development of agonist therapy to treat mild COVID-19 cases. Future studies with better statistical power are desirable to replicate the primary findings.

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Original Article

Evaluation of the Profile and Quality of Sphygmomanometers Available at a Health Education Institution in Belo Horizonte

Matheus Evangelista da Costa et al. Sarah Mattos Moraes Kleisson Antonio Pontes Maia

Abstract

Background

Arterial hypertension affects around 30% of the Brazilian adult population, showing a direct and progressive relationship with an increased risk of cardiovascular diseases (CVDs). In this context, adjustments in the calibration and physical constitution of sphygmomanometers are essential conditions for obtaining correct blood pressure (BP) measurements.

Objectives

Analyze the profile and quality of sphygmomanometers used in various sectors of a health education institution in Belo Horizonte, Minas Gerais.

Methods

The present study conducted a cross-sectional, observational, and non-interventional study to assess adherence to various quality parameters of the sphygmomanometers available in the outpatient clinic, emergency department, and ward of an educational institution in the municipality of Belo Horizonte.

Results

We analyzed 78 devices, in which high rates of adherence were identified for velcro/pins, 93.5% (73/78); bulbs/rubbers, 92.1% (70/76); valves, 93.4% (71/76); the seal of the National Institute of Metrology, Quality, and Technology (INMETRO), 97.4% (76/78); and the clock, 92.1% (70/76). However, these parameters showed no statistical significance. Institutions (hospital/outpatient clinic) recorded higher calibration rates, 75% (39/52, p<0.001), in accordance with the deadlines stipulated by INMETRO, and the cuff/equipment compatibility showed its highest value (52%) among students (32/61, p = 0.004).

Conclusion

Our study showed that 38.4% (30/78) of the devices did not presented some type of inadequacy, with outpatient-owned devices had the highest compliance rate (p = 0.015). These findings are worrisome, as they can lead to inaccurate BP measurements.

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Original Article

Therapeutic Adherence According to the Morisky Scale in Patients with Hypertension

Vinícius Encenha Lanza et al. Gabriel Oliveira Silva Celi Cristina Calamita Quiroga Margaret Assad Cavalcante … Weimar Kunz Sebba Barroso Andréa Araujo Brandão Eduardo Costa Duarte Barbosa Marcus Vinicius Bolivar Malachias Marco Mota Gomes Celso Amodeo Rui Manoel dos Santos Povoa Dalton Bertolim Précoma Antônio Carlos Sobral Sousa João Miguel Malta Dantas Evandro José Cesarino Pedro G. M. de Barros e Silva Paulo Cesar B. Veiga Jardim Renato D. Lopes

Abstract

Background

In view of the high prevalence of hypertension and the importance of adequate drug therapy in the prevention of complications, it is necessary to know the adherence to drug treatment in this population.

Objective

To verify adherence to antihypertensive drug treatment in Brazilian patients with hypertension using the Morisky-Green Test (MGT), relating it with demographic data.

Methods

Prospective, observational, multicenter, national registry study, with 2,578 hypertensive patients participating in study I, the Brazilian Cardiovascular Registry of Arterial Hypertension (I-RBH), recruited in the five regions of Brazil. The analyses carried out on the data were descriptive statistics, qui-square tests, ANOVA, and logistic regression, adopting 5% as the significance level for the tests.

Results

The research shows that 56.13% of patients in the sample were female; 56.71% were elderly (≥ 65 years); 55.86% were White; 52.37% were from the Southeast Region; and 59.74% were non-adherent. Logistic regression showed an independent relationship between patients’ age, ethnicity, and region with medication adherence.

Conclusion

Adherence to treatment is the key to reducing high rates of cardiovascular complications. The study brings a successful outcome in the relationship between the factors ethnicity, age, and region of patients with hypertension and medication adherence. To this end, it is necessary to understand these factors, considering systematic evaluation in the care of patients with hypertension and other chronic non-communicable diseases. This study is a significant contribution to multidisciplinary teams, as it highlights which risk factors interfere with medication adherence, incorporating better strategies in health education.

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Original Article

Translation, Cross-Cultural Adaptation, and Validation of the Hypertension Self-Care Profile (HBP-SCP) for the Brazilian Population

Jussara Almeida de Oliveira Baggio et al. Beatriz Brito Ribeiro Jessica Lays Ferreira Ribeiro Fabricio Brito Silva … Lisiane Fernanda Simeão de Azevedo Renata Gonçalves Mendes Aldair Darlan Araújo Maria Claudia Gonçalves Rudys Rodolfo de Jesus Tavarez Denilson Menezes Almeida Daniela Bassi-Dibai

Abstract

Background

Self-care in the management of systemic arterial hypertension (SAH) is crucial, and validated instruments can help researchers and health professionals to plan strategies to improve self-care in people with SAH.

Objective

The main objective of this study was to translate, cross-culturally adapt, and validated the Hypertension Self-Care Profile (HBP-SCP) for Brazilian Portuguese.

Methods

The translation and cross-cultural adaptation was performed in five phases, and the pre-final version was tested in 30 individuals, native speakers of Portuguese with a diagnosis of hypertension. The final version was administered in 100 individuals. The inclusion criteria were: diagnosis of SAH, characterized by systolic arterial blood pressure ≥ 140 mmHg and/or diastolic arterial blood pressure ≥ 90mmHg, regular use of antihypertensive medications and over 18 years of age. The present study also used two other questionnaires, previously validated for the Brazilian population, to verify the validity of the construct, the Healthy Habits Perception Questionnaire (HHPQ) and the Quality of Life in Hypertension Mini-Questionnaire (MINICHAL-BRASIL).

Results

During the translation and cross-cultural adaptation phase, there were no disagreements. Adequate reliability — intraclass correlation coefficient (ICC) ≥ 0.89, standard error of measurement (SEM) % ≤ 4.34, minimum detectable change (MDC) % ≤ 12.04 — and internal consistency (Cronbach’s alpha ≥ 0.75) were observed. The behavior domain of HBP-SCP obtained significant correlations (p < 0.05) with the self-efficacy domain and HHPQ; the motivation domain with the self-efficacy domain; and the self-efficacy domain with the somatic manifestation domain of MINICHAL-BRASIL. No ceiling and floor effects were observed.

Conclusions

The Brazilian Portuguese version of the HBP-SCP has adequate psychometric properties, according to the best scientific recommendations.

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Original Article

Non-Targeted Self-Measured Blood Pressure and Hypertension Control in Public and Private Health Systems in Brazil

Gabriela de Oliveira Salazar et al. Glessiane de Oliveira Almeida José Augusto Soares Barreto-Filho Marcos Antônio Almeida-Santos … Enaldo Vieira de Melo Felipe J. Aidar José Ícaro Nunes Cruz Joselina Luzia Menezes Oliveira Leonardo Baumworcel Antônio Carlos Sobral Sousa

Abstract

Background:

It is estimated that more than 30% of the Brazilian population has systemic arterial hypertension (SAH), and mostly as an uncontrolled disease. The most recent Brazilian Guideline of Hypertension recommends the practice of self-measurement of blood pressure (BP) as one of the strategies for a better control of SAH, but there is no consensus about the efficiency of this tool.

Objective:

To assess the control of SAH and the practice of non-targeted self-measured BP (SMBP) among hypertensive users of the Unified Health System (SUS) and the Supplementary Network (SN).

Methods:

This is a cross-sectional, observational, analytical study, with a stratified probability sample. One thousand volunteers were investigated, being 500 from SUS and 500 from the SN. Uni and multivariate analyses were performed considering a 5% significance level.

Results:

Patients from SUS presented inferior sociodemographic data (schooling, social status) in relation to those of the SN (p < 0.001), and showed lower control of SAH (p = 0.014), as well as more visits to the emergency room in the past year due to hypertension (p = 0.002), and fewer regular appointments with the cardiologist (p = 0.004). SMBP was equally present in both assessed groups (p = 0.567), even though users of the SN have been more advised to not conduct such a practice (p = 0.002). SMBP (p < 0.001) was an independent factor for uncontrolled SAH both in SUS (OR = 3.424) and in the SN (OR = 3.474).

Conclusion:

Patients in SUS presented lower SAH control. The practice of SMBP, mostly practiced with an uncalibrated digital device, was equally present in both groups and became an independent factor of uncontrolled SAH.

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Original Article

Comparison of Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors in the Management of Arterial Stiffness and Target Organ Damage in Patients with Hypertension

Gilberto Campos Guimarães Filho et al. Reila Campos Guimarães de Araújo Karynne Borges Cabral Cácia Régia de Paula

Abstract

Background

Arterial stiffness and hypertension are strong predictors of cardiovascular disease and mortality. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are first-line antihypertensive agents in reducing blood pressure and arterial stiffness.

Objective

The objective of this study was to compare the effects of ACEI and ARB in reducing arterial stiffness and preventing target organ damage in patients with hypertension.

Methods

This observational study included 654 participants who attend routine consultations at an outpatient hypertension clinic in 2 university hospitals. Patients were interviewed, and they underwent central and peripheral blood pressure measurements. Doppler echocardiography, carotid ultrasound, biochemical tests, and anthropometric parameters were carried out. Shapiro-Wilk, chi-square, and Fisher’s exact test were used. A significance level of 5% was adopted.

Results

A total of 659 participants were evaluated in the study (398 from the ARB group and 256 from the ACEI group). Age, body mass index (BMI), central and peripheral blood pressure measurements, pulse wave velocity (PWV), left ventricular mass index, and carotid intima-media thickness did not show differences between the groups (p > 0.05). After linear regression analysis, the ACEI group had lower values of total vascular resistance (TVR) (p = 0.003) and augmentation pressure (p = 0.008), when compared to the ARB group.

Conclusion

This study showed that the ACEI group had a greater reduction in augmentation pressure and PWV. There were no differences between the groups regarding the improvement of outcomes related to central arterial pressure, PWV, and cardiac and vascular target organ damage.

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Editorial

Safety of Dental Anesthesia in ICD Recipients

Ricardo Alkmim Teixeira

Some anesthetic agents administered during general anesthesia can cause heart rhythm disorders, mainly associated with autonomic imbalance. Off-target cardiac sodium channel blockade is considered the canonical mechanism behind cardiotoxicity.

Lidocaine, the most common local anesthetic, produces a transient loss of sensory, motor, and autonomic function when the drug is injected or applied close to neural tissues; furthermore, it has a good safety margin before reaching toxic blood levels. However, care must be taken to keep track of the total dose given to minimize its systemic toxicity. In addition to direct nerve toxicity, systemic toxicity affecting the brain and/or cardiac muscle can also occur. Cardiovascular toxicity usually appears as tachycardia and hypertension; however, with increasing toxicity, bradycardia and hypotension can occur. Ventricular arrhythmias and cardiac arrest also have been described. Because of its potential effects upon the heart, it is also commonly used as an antiarrhythmic agent to depress ventricular arrhythmias in controlled doses.

[…]

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Original Article

Stroke Is Associated with Refractory Hypertension among Resistant and Refractory Patients in a Cross-Sectional Study

Guilherme de Andrade Costa et al. Jamary Oliveira Filho Luana Ferreira-Campos Alex Cleber Improta-Caria … Cristiano Macedo Marcelo Vincenzo Sarno Filho Leonardo Silva Roever Borges Roque Aras Júnior

Abstract

Background

Refractory hypertension (RfH) is a severe phenotype of resistant hypertension (RH) linked to higher risk of stroke and other adverse cardiovascular events, but knowledge about it is still lacking.

Objectives

To evaluate the association between RfH and stroke.

Methods

We conducted a cross-sectional study in a referral clinic for patients with severe hypertension in the period from 2018 to 2020. RH was defined as uncontrolled blood pressure (BP) despite the use of 3 antihypertensive agents, including a diuretic, or the use of ≥ 4 agents regardless of BP control. RfH was defined as lack of BP control despite use of ≥ 5 antihypertensive agents. Individuals were classified as RfH or RH, and multivariate logistic regression models were constructed to examine the association between RfH and stroke.

Results

We evaluated a total of 137 patients; 81% were female, and 93,3% were Black or multiracial. The mean age was 64.4 years. Stroke was more prevalent in the RfH group (35.7%), in comparison to the RH group (12.8%) (p value = 0.01). Unadjusted odds ratio (OR) and 95% confidence interval (CI) for factors associated with stroke were RfH (OR 3.77; 95% CI 1.45 to 9.80), systolic BP (OR 1.02; 95% CI 1.002 to 1.04) and diastolic BP (OR 1.03; 95% CI 1.001 to 1.06). Adjusted OR for factors associated with stroke were RfH (OR 3.55; 95% CI 1.02 to 12.42), systolic BP (OR 1.02; 95% CI 0.99 to 1.05) and diastolic BP (OR 1.01; 95% CI 0.96 to 1.06).

Conclusion

RfH was associated with higher prevalence of stroke. Efforts are required to better understand this association to prevent adverse cardiovascular outcomes in these patients.

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