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Research Letter

Home Blood Pressure Monitoring and Blood Pressure Control in Treated Hypertensives

Andréa Araujo Brandão et al. Weimar Kunz Sebba Barroso Audes Feitosa Eduardo Costa Duarte Barbosa … Roberto Dischinger Miranda Priscila Valverde de Oliveira Vitorino Roberto Pozzan Lucio Paulo Ribeiro Abraham Epelman Giovanni Alves Saraiva Fabio Serra Silveira Antônio Almeida Braga Marco Mota Gomes

Introduction

Blood pressure (BP) control rates are very low in Brazil and in the world, around 20% only.^– Patients with uncontrolled hypertension despite treatment remain at high risk for cardiovascular (CV) events and mortality, comparably to untreated individuals.

According to recent recommendations,^,,, BP control should be monitored by both office BP and out-of-office BP measurements. In this way, it is possible to determine different hypertension phenotypes,^,,, which is very important to determine the prognosis and individualized therapy.^,,-

[…]

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Original Article

Compliance with the Prescription of Antihypertensive Medications and Blood Pressure Control in Primary Care

Mayra Faria Novello et al. Maria Luiza Garcia Rosa Ranier Tagarro Ferreira Icaro Gusmão Nunes … Antonio José Lagoeiro Jorge Dayse Mary da Silva Correia Wolney de Andrade Martins Evandro Tinoco Mesquita

Abstract

Background:

Hypertension is the most prevalent risk factor for cardiovascular disease, and its proper control can prevent the high morbidity and mortality associated with this disease.

Objective:

To assess the degree of compliance of antihypertensive prescriptions with the VI Brazilian Guidelines on Hypertension and the blood pressure control rate in primary care.

Methods:

Cross-sectional study conducted between August 2011 and November 2012, including 332 adults ≥ 45 years registered in the Family Doctor Program in Niteroi and selected randomly. The analysis included the prescribed antihypertensive classes, doses, and frequencies, as well as the blood pressure (BP) of the individuals.

Results:

The rate of prescription compliance was 80%. Diuretics were the most prescribed medications, and dual therapy was the most used treatment. The most common non-compliances were underdosing and underfrequencies. The BP goal in all cases was < 140/90 mmHg, except for diabetic patients, in whom the goal was set at < 130/80 mmHg. Control rates according to these goals were 44.9% and 38.6%, respectively. There was no correlation between prescription compliance and BP control.

Conclusions:

The degree of compliance was considered satisfactory. The achievement of the targets was consistent with national and international studies, suggesting that the family health model is effective in BP management, although it still needs improvement.

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Artigo Original

Prevalence, control and treatment of arterial hypertension in Nobres – MT

Tânia Maria do Rosário et al. Luiz César Nazário Scala Giovanny Vinícius Araújo de França Márcia Regina Gomes Pereira Paulo César Brandão Veiga Jardim

BACKGROUND: Systemic Arterial Hypertension (SAH), considered a public health problem due to its high prevalence and difficult control, is also described as one of the most important risk factors for cardiovascular diseases. OBJECTIVE: This study aimed to determine the prevalence of SAH, as well as characteristics related to its control and treatment, among individuals aging between 18 and 90 years from the urban region of Nobres, MT. METHODS: Cross-sectional, population-based study, with random sampling and with replacement. For classification of SAH, criteria included blood pressure (BP) > 140/90 mmHg or current use of antihypertensive drugs. Individuals were interviewed with standardized questionnaires previously tested. Variables were described as means ± standard deviations and frequencies. Means were compared with the Student´s t test and associations were determined with the Pearson chi-square test, with a significance level of 5%. RESULTS: SAH has a prevalence of 30.1% in the sample, composed of 1,003 individuals older than 18 years. Among hypertensive individuals (N = 302), 73.5% knew about their condition, 61.9% were under treatment and for 24.2% the BP was under control. A positive association was observed between SAH and age; illiteracy; less than 8 years education; BMI > 25 kg/m²; high and very high waist circumference; waist-hip ratio (WHR) at risk level; sedentariness; and alcoholism. CONCLUSIONS: This study showed that SAH represents an important public health problem even in a small district in the interior region of Brazil. Levels of control and treatment of hypertension in the population were higher than those observed in similar studies, but were considered not satisfactory.

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Artigo Original

Effect of frequency of physical exercise on glycemic control and body composition in type 2 diabetic patients

Denise Maria Martins Vancea et al. José Nelson Vancea Maria Izabel Fernandes Pires Marco Antonio Reis … Rafael Brandão Moura Sergio Atala Dib

BACKGROUND: Diabetes and cardiovascular disease have emerged as key threats to human health, and the risk is increased in individuals with visceral obesity. The consensus is that physical exercise should be part of the treatment of diabetes mellitus (DM). OBJECTIVE: To compare the influence of guided and structured physical exercise programs (SPEP), three to five times per week, during a period of 20 weeks, on glycemic control and body composition of type 2 diabetic patients (DM2). METHODS: The research was conducted at the Universidade Federal de São Paulo (Federal University School of Medicine in São Paulo). At the clinical visit, patients from the Control Group (CG) n=17, mean age 55.8 years, were encouraged to engage in a physical exercise program. Patients from Group 3x (G3), n=14, mean age 57.4 years, were to engage in 1 hour of physical exercise, 3x/week, and Group 5x (G5), n=9, mean age 58.8 years, followed the same protocol but 5x/week. Mean of 5 years since diagnosis in all groups. Classes consisted of a 5-minute warm-up, 30-minute treadmill walk at 70% of maximum heart rate, and 10-minute relaxation. BMI, abdominal circumference (AC), percentage of body fat (BF), capillary glycemia (CG), fasting glycemia (FG), and glycated hemoglobin (HbA1c) were assessed. RESULTS: A comparison was made between the baseline time point (B) and the 20th week (20th). BMI in G3 (B:29.5±2.9 vs. 20th: 28.3 ± 2.2 Kg/sqm, p=0.005) and G5 (B:29.7±4.4 vs. 20th: 29.1 ± 4.3 Kg/sqm, p=0.025); abdominal circumference in G5 (B:100.5±11.9 vs. 20th: 933 ± 11.7 cm, p=0.001); BF in G3 (B:31±5.1 vs 20th: 26±5%, p=0.001) and G5 (B:32.4 ± 5.4 vs. 20th: 30.3 ± 6.9%, p=0.001); FG, G5 (B:150.8 ± 47.5 vs. 20th: 109.2± 30.5 mg/dL, p=0.034), showed statistically significant differences. CG did not show statistically significant differences for these variables. CG showed a tendency to drop after physical exercise in G5. HbA1c showed no statistically significant differences in the three groups. CONCLUSION: G5 did better than G3 in most parameters assessed. However, results failed to show a decrease of HbA1c in DM2 patients.

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Artigo Original

Evaluating the adequacy of cardiovascular risk factor control after myocardial revascularization surgery

Andrea Cristina Costa Barbosa et al. Luiz Carlos Santana Passos Antônio Alberto Lopes Wanewman Lins Guedes de Andrade … Luciano Rapold Souza Maurício Batista Nunes

BACKGROUND: Cardiovascular risk factors (RF) for coronary artery disease (CAD) are responsible for the occurrence of cardiovascular events. OBJECTIVE: To estimate the percentage of patients submitted to myocardial revascularization surgery (MRS) that attains adequate control of modifiable RF at least six months after the surgery. METHODS: Data collection was based on the review of medical records and a clinical interview of 88 patients submitted to MRS between January and December of 2004 at a reference hospital for cardiovascular diseases. The patients were interviewed in the follow-up period, between six and twelve months after the surgical revascularization. RESULTS: Mean age was 63.1 ± 9.9 years; 51 patients (58%) were males, 86 (97.7%) were hypertensive, 38 (43.2%) were diabetic, 85 (96.6%) had hypercholesterolemia and 10 (11.4%) were smokers. Hypertension control (PA < 140 x 90 mmHg) was attained by 24.4% of the patients; cholesterol (LDL cholesterol < 100 mg/dl) and diabetes control (blood glucose levels < 110 mg/dl) levels were 30.6% and 31.6%, respectively. The use of antihypertensive drugs, hypoglycemic agents and statins, when indicated, were 96.5%, 92.1% and 78.8%, respectively. However, only 14.8% patients had their blood pressure, glucose and cholesterol levels within the limits accepted as adequate control. CONCLUSION: Despite the frequent use of drugs to control hypertension, diabetes and hypercholesterolemia, a high proportion of patients still do not achieve the target levels of risk factor control recommended by current guidelines at least six months after revascularization surgery, which suggests there is a great potential for improvement in clinical practice.

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Original Article

The influence of patient's consciousness regarding high blood pressure and patient's attitude in face of disease controlling medicine intake

Maria Aparecida A Moura Strelec et al. Angela M. G. Pierin Décio Mion Jr.

OBJECTIVE: To assess the relation between blood pressure control and the following: the Morisky-Green test, the patient’s consciousness regarding high blood pressure, the patient’s attitude in face of medicine intake, the patient’s attendance at medical consultations, and the subjective physician’s judgment. METHODS: We studied 130 hypertensive patients with the following characteristics: 73% females, 60±11 years, 58% married, 70% white, 45% retired, 45% with incomplete elementary schooling, 64% had a familial income of 1 to 3 minimum wages, body mass index of 30±7 kg/m², consciousness regarding the disease for a mean period of 11±9.5 years, and mean treatment duration of 8 ±7 years. RESULTS: Only 35% of the hypertensive individuals had blood pressure under control and a longer duration of treatment (10±7 vs 7±6.5 years; P<0.05). The retiree predominated. The result of the Morisky-Green test did not relate to blood pressure control. In evaluating the attitude in face of medicine intake, the controlled patients achieved significantly higher scores than did the noncontrolled patients (8±1.9 vs 7 ±2, P<0.05). The hypertensive patients had higher levels of consciousness regarding their disease and its treatment, and most (70%) patients attended 3 or 4 medical consultations, which did not influence blood pressure control. The physicians attributed significantly higher scores regarding adherence to treatment to controlled patients (6±0.8 vs 5±1.2; P<0.05). CONCLUSION: Consciousness regarding the disease, the Morisky-Green test, and attendance to medical consultations did not influence blood pressure control.

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Home Blood Pressure Monitoring and Blood Pressure Control in Treated Hypertensives

Introduction

Compliance with the Prescription of Antihypertensive Medications and Blood Pressure Control in Primary Care

Abstract

Background:

Objective:

Methods:

Results:

Conclusions:

Prevalence, control and treatment of arterial hypertension in Nobres – MT

Effect of frequency of physical exercise on glycemic control and body composition in type 2 diabetic patients

Evaluating the adequacy of cardiovascular risk factor control after myocardial revascularization surgery

The influence of patient's consciousness regarding high blood pressure and patient's attitude in face of disease controlling medicine intake

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