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Original Article

Angiotensin Receptor Blockers Evaluated by Office and Home Blood Pressure Measurements. TeleHBPM Study

Weimar Kunz Sebba Barroso et al. Andréa Araujo Brandão Priscila Valverde de Oliveira Vitorino Audes Diógenes de Magalhães Feitosa … Eduardo Costa Duarte Barbosa Roberto Dischinger Miranda Josep Redon Miguel Camafort-Babkowski Antonio Coca Marco Antônio Mota Gomes

Abstract

Background

Adequate treatment of arterial hypertension and achieving arterial hypertension goals in are important in reducing cardiovascular outcomes.

Objectives

To describe angiotensin receptor blockers in monotherapy or double combination therapy and the rate of arterial hypertension control.

Methods

This cross-sectional study evaluated patients who were using angiotensin receptor blockers between 2017 and 2020. Those using three or more antihypertensive drugs were excluded. The analyzed variables included sex, age, body mass index, valid home blood pressure monitoring (HBPM) measurements, casual and HBPM systolic and diastolic blood pressure measurements, blood pressure variability, and antihypertensive and angiotensin receptor blocker class. Paired t, chi-square, and Fisher’s exact tests were used, as well as overlapping 95% confidence intervals and a significance level of 5% (p < 0.05).

Results

Of 17,013 patients, 12,813 met the inclusion criteria, 62.1% of whom were female. The mean number of valid measurements was 23.3 (SD, 2.0). The mean HBPM and casual measurements for systolic blood pressure were 126.8 (SD, 15.8) mmHg and 133.5 (SD, 20.1) mmHg (p <0.001), respectively, while those for diastolic blood pressure were 79.1 (SD, 9.7 mmHg) and 83.6 (SD, 11.9) mmHg (p <0.001), respectively. Losartan was the most common angiotensin receptor blocker and resulted in the highest blood pressure values. Combinations of angiotensin receptor blockers with diuretics or calcium channel antagonists resulted in lower blood pressure values.

Conclusions

More than half of the patients used losartan, although it was the least efficient drug for reducing and controlling blood pressure.

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Original Article

Synergistic Effect of Disease Severity, Anxiety Symptoms and Elderly Age on the Quality of Life of Outpatients with Heart Failure

José Henrique Cunha Figueiredo et al. Gláucia Maria Moraes de Oliveira Basílio Bragança Pereira Ana Elisa Bastos Figueiredo … Emília Matos Nascimento Marcelo Iorio Garcia Sergio Salles Xavier

Abstract

Background:

Heart failure (HF) is a multifactorial syndrome with repercussions on quality of life (QoL).

Objectives:

To investigate the main interacting factors responsible to worsen quality of life of outpatients with HF.

Methods:

Cross-sectional observational study with 99 patients of both genders, attending a HF outpatient clinic at a university hospital, all with a reduced ejection fraction (<40%) by echocardiography. They were evaluated using sociodemographic and clinical questionnaires, the Minnesota Living with Heart Failure (MLwHF), and the Hospital Anxiety and Depression scale (HADS). QoL was the outcome variable. Two multivariate models were used: the parametric beta regression analysis, and the non-parametric regression tree, considering p < 0.05 and 0.05 < p < 0.10 for statistical and clinical significance, respectively.

Results:

Beta regression showed that depression and anxiety symptoms worsened the QoL of HF patients, as well as male sex, age younger than 60 years old, lower education level, lower monthly family income, recurrent hospitalizations and comorbidities such as ischemic heart diseases and arterial hypertension. The regression tree confirmed that NYHA functional class III and IV worsen all dimensions of MLwHF by interacting with anxiety symptoms, which influenced directly or indirectly the presence of poorer total score and emotional dimension of MLwHF. Previous hospitalization in the emotional dimension and age younger than 60 years in general dimension were associated with anxiety and NYHA functional class, also worsening the QoL of HF patients.

Conclusion:

HF with reduced ejection fraction was associated with poorer MLwHF. Anxiety symptoms, previous hospitalization and younger age were also associated with worsened MLwHF. Knowledge of these risk factors can therefore guide assessment and treatment of HF patients.

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Artigo Original

Hypertension prevalence and risk factors in a Brazilian urban population

José Paulo Cipullo et al. José Fernando Vilela Martin Luiz Alberto de Souza Ciorlia Maria Regina Pereira de Godoy … João Castilho Cação Afonso Augusto Carvalho Loureiro Cláudia Bernardi Cesarino Antônio C Carvalho José Antônio Cordeiro Emmanuel de Almeida Burdmann

BACKGROUND: The available studies have not fully analyzed the several factors involved in the genesis of hypertension (HT), especially the association among blood pressure, urinary sodium excretion and renal dysfunction. OBJECTIVE: To assess the HT prevalence and risk factors in different age groups in a representative sample of an urban Brazilian population. METHODS: The studied population (1717 adult individuals) was evaluated by age groups: 18 to 39 years; 40 to 49; 50 to 59; 60 to 69 and > 70 years. Quantitative variable means and categorical variables of the hypertensive and normotensive groups were compared. RESULTS: The adjusted overall prevalence of HT was 25.23%. The prevalence increased with age and was higher in individuals with low educational level. Increased body mass index and abdominal waist were positively related to a higher prevalence of HT. There was a significant positive association between HT and urinary sodium excretion. Hypertensive individuals presented higher frequency of renal dysfunction, defined as measured creatinine clearance <60 ml/min/m². The prevalence of diabetes mellitus was 5.6% in the overall population and 14.5% in hypertensive individuals. Hypertension was a known condition to 74.4% of the hypertensive individuals. Among treated hypertensive individuals, 52.4% achieved controlled blood pressure and only 34.3% of the overall hypertensive patients (treated or not) had blood pressure controlled. CONCLUSION: This population-based is unique by gathering different demographic, epidemiologic and risk factors involved in the genesis of hypertension in a single sample assessment with a population calculation, which might be extrapolated to other hypertensive populations.

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Artigo Original

Physical fitness, age and nutritional status of military personnel

Clarissa Stefani Teixeira et al. Érico Felden Pereira

BACKGROUND: Although there is a trend toward the decrease in levels of physical fitness, the intensity of this decrease due to the aging process and the nutritional status in adult male individuals is not well-known, especially in the Brazilian population. OBJECTIVE: To analyze the levels of physical fitness according to age and the nutritional status in adult male individuals. METHODS: Aerobic and muscular endurance tests as well as flexibility tests and nutritional status assessment were carried out in 1,011 male individuals. Analyses of correlation, covariance and prevalence ratio were performed through Poisson regression. RESULTS: The individuals presented a moderate performance at the physical fitness tests. A decrease in the levels of physical performance according to the aging process was verified, considering all age ranges analyzed. The analysis of covariance corrected by age showed differences (p<0.001) for all tests comparing normal individuals and those with overweight/obesity. The prevalence ratios showed a strong trend toward the decrease in the physical fitness from 18 to 54 years. Individuals aged 41 to 54 years presented prevalences of low VO2max index that were 3.22-fold higher when compared to those aged 18 to 20 and 1.40-fold higher when compared to individuals aged 21 to 25 years. There was a decrease in the VO2max scores in the 18 to 20 age range, when compared to the 41 to 54 age range, of 11.45% in the normal group and 20.91% in the group with overweight and obesity. CONCLUSION: Age and the nutritional status have a strong influence on the decreased physical performance scores, mainly after 30 years of age.

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Artigo Original

Cardiopulmonary responses to exercise in patients of different age group with congestive heart failure

Marcelo de Castro César et al. Fábio Tadeu Montesano Rosiane Vieira Zuza Diniz Dirceu Rodrigues Almeida … Antonio Sérgio Tebexreni Turíbio Leite de Barros

OBJECTIVES: This paper aims at comparing cardiorespiratory functional capacity during exercise – represented by indicators of functional limitation, maximal oxygen uptake (VO2max), and anaerobic threshold – plus cardiopulmonary responses to maximal exercise in congestive heart failure (CHF) patients belonging to different age groups. METHODS: Fifty-four CHF patients, stratified by age group, were evaluated as follows: group I – 30 to 39 years (n = 12); group II – 40 to 49 years (n = 18); group III – 50 to 59 years (n = 17); and group IV – 60 years and above (n = 7). All patients underwent maximal cardiopulmonary exercise testing (CPET) on treadmills. A single-factor analysis of variance (ANOVA) was performed to compare different age groups. RESULTS: No significant differences were found in maximal oxygen uptake and anaerobic threshold among the age groups, nor in maximal values for carbon dioxide production, oxygen pulse, respiratory exchange ratio, pulmonary ventilation, and ventilatory equivalents for oxygen and carbon dioxide. CONCLUSIONS: These findings suggest that cardiorespiratory functional capacity during exercise in patients with CHF, as well as cardiopulmonary variables at maximal exercise, may be similarly affected by the heart disease in all studied age groups.

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Original Article

Trends in Productive Years of Life Lost to Premature Mortality Due to Coronary Heart Disease

Ines Lessa

OBJECTIVE: To estimate the number of productive years of life lost to premature death due to coronary heart disease in Brazil and to report their trends over a 20-year period. METHODS: The Brazilian Ministry of Health raw database on death due to coronary heart disease from 1979-1998 was used. The productive years of life lost to premature death were estimated using 20 and 59 years of age as the cut points for the productive years, replacing the potential years of 1 and 70 of the original formula. A descriptive analysis was provided with adjustments, means, proportions, ratios, percentages of increase or reduction, and mobile means. RESULTS: A 35.8% increase in death for males and 51.3% for females was observed, +43.3% being the relative difference for females. The annual means of the productive years of life prematurely lost were analyzed in 140,865 males and 58,559 females, with the differential ratio between the age groups ranging from 2.3 to 2.5. The annual means were less favorable for males. Within each group (intragroup), the ratios decreased with the increase in age, and the age means at the time of death remained constant. The raw tendencies decreased in the 20- to 29-year age group and increased in the 40- to 59-year age group for females and the 40- to 49-year age group for males. When adjusted, the raw tendencies decreased. CONCLUSION: The 43.3% increase in the number of female deaths as compared with that of males and the ascending tendency in the productive years of life lost in the 40- to 59-year age group point to the influence of unfavorable changes in female lifestyles and suggest a deficiency in programs for prevention and control of risk factors and in their treatment in both sexes.

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Original Article

Left Ventricular Diastolic Function in Essential Hypertensive Patients: Influence of Age and Left Ventricular Geometry

Eduardo Cantoni Rosa et al. Valdir Ambrósio Moysés Ivan Rivera Ricardo da Cintra Sesso … Nárcia Kohlmann Maria Tereza Zanella Artur Beltrame Ribeiro Osvaldo Kohlmann Jr.

PURPOSE – To evaluate diastolic dysfunction (DD) in essential hypertension and the influence of age and cardiac geometry on this parameter. METHODS – Four hundred sixty essential hypertensive patients (HT) underwent Doppler echocardiography to obtain E/A wave ratio (E/A), atrial deceleration time (ADT), and isovolumetric relaxation time (IRT). All patients were grouped according to cardiac geometric patterns (NG – normal geometry; CR – concentric remodeling; CH- concentric hypertrophy; EH – eccentric hypertrophy) and to age (60 years). One hundred six normotensives (NT) persons were also evaluated. RESULTS – A worsening of diastolic function in the HT compared with the NT, including HT with NG (E/A: NT – 1.38±0.03 vs HT – 1.27±0.02, p<0.01), was observed. A higher prevalence of DD occurred parallel to age and cardiac geometry also in the prehypertrophic groups (CR). Multiple regression analysis identified age as the most important predictor of DD (r²=0.30, p<0.01). CONCLUSION – DD was prevalent in this hypertensive population, being highly affected by age and less by heart structural parameters. DD is observed in incipient stages of hypertensive heart disease, and thus its early detection may help in the risk stratification of hypertensive patients.

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