Hipertensão arterial em idosos: prevalência, fatores associados e práticas de controle no Município de Campinas, São Paulo, Brasil

Este estudo teve como objetivo avaliar a prevalência da hipertensão arterial referida em idosos de Campinas, São Paulo, Brasil, identificando os fatores associados, o uso de serviços de saúde e o conhecimento e as práticas quanto às opções do tratamento. Trata-se de estudo transversal, de base populacional, com amostra de conglomerados, estratificada e em múltiplos estágios. A análise dos dados referentes aos 426 indivíduos (sessenta anos e mais) levou em conta o desenho amostral e o efeito do delineamento. A prevalência de hipertensão foi de 51,8% (46,4% nos homens e 55,9% nas mulheres) e mostrou-se mais elevada em idosos: com menor escolaridade (55,9%), migrantes de outros estados (60,2%) e com sobrepeso ou obesidade (57,2%). Os resultados indicam que os serviços de saúde estão garantindo o acesso ao atendimento médico (71,6% visitam o médico regularmente) e aos medicamentos (86,7% tomam medicamento de rotina), sem distinção de nível sócio-econômico. Persistem, no entanto, desigualdades sociais quanto ao conhecimento e utilização de outras práticas de controle da pressão arterial, como dieta adequada e atividade física, que são insuficientemente utilizadas também pelos segmentos socialmente mais favorecidos.

Prevalência de pressão arterial elevada em crianças e adolescentes do ensino fundamental

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Preditores de insuficiência renal crônica em pacientes de centro de referência em hipertensão arterial

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Efeito de estresse ambiental sobre a pressão arterial de trabalhadores

OBJETIVO: Analisar o comportamento de pressão arterial (PA) e a freqüência cardíaca (Fc) de indivíduos ao longo da jornada de trabalho em dois ambientes com estresses ambientais distintos. MÉTODOS: Foram avaliados 46 funcionários, trabalhadores de uma indústria processadora de madeira, de Botucatu, SP, sendo 27 funcionários da linha de produção (esforço físico moderado-intenso, altas temperaturas e elevados níveis de ruído) (G1), e 19 da administração (sem esforço físico, salas aclimatadas, baixos níveis de ruído) (G2). Todos foram submetidos a avaliação antropométrica da composição corporal (obesidade e adiposidade) e bioquímica do sangue (lipidemia) e, adicionalmente, o registro da PA e da Fc em três momentos do turno de serviço: início, meio e fim. RESULTADOS: Houve semelhança na variação da PA entre G1 e G2, mas com maiores elevações de PA e Fc em G1. Os resultados mostraram grande variabilidade na resposta da PA, levando à subdivisão dos grupos G1 e G2 em respondedores (GR, aumento maior de 10% na PA média) e não respondedores (GN). Os subgrupos GR e GN apresentaram semelhanças nos padrões antropométrico e bioquímico diferindo apenas na resposta pressórica e no caso do GR1 na história familiar de hipertensão. Comparando os subgrupos GR1 e GR2, foi constatado que os primeiros apresentaram maiores variações de PA e Fc que os segundos. CONCLUSÕES: A variação individual da resposta pressórica e da Fc conforme o tipo de estresse ambiental indica ser este um fator adicional a ser considerado na avaliação da pressão arterial e, talvez, na gênese da hipertensão arterial de operários.

Segmentação anatomocirúrgica arterial dos pulmões de ovinos da raça ideal (Ovis aires - L.1758)

Foram estabelecidos segmentos anatomocirúrgicos em pulmões de ovinos da raça Ideal (dezessete segmentos no pulmão direito e doze no esquerdo), mediante dissecação de peças coradas com látex colorido e fixadas em formol. Na maioria dos casos, a artéria pulmonar direita emite, a partir de um tronco, o ramo ascendente e descendente para as partes cranial e caudal do lobo cranial respectivamente; o ramo do lobo médio; o ramo do lobo caudal e o ramo do lobo acessório. Invariavelmente, a artéria pulmonar esquerda emite o ramo do lobo cranial e o ramo do lobo caudal.

ESTUDO COMPARATIVO DUPLO-CEGO DA EFICACIA E SEGURANCA DO CILAZAPRIL COMPARADAS A NIFEDIPINE 'RETARD' NO TRATAMENTO DA HIPERTENSAO ARTERIAL LEVE E MODERADA

Purpose: To evaluate the antihypertensive efficacy and safety of cilazapril compared to nifedipine retard in mild to moderate hypertension. Methods: Forty randomized out-patients with mild moderate hypertension, diastolic pressure (DP) between 95 and 115 mmg/Hg, with placebo for 15 days were randomized and allocated for treatment, double-blind, once daily with cilazapril 2.5 mg (n = 20) or nifedipine retard 20 mg (20 = n) for four weeks. The non-responders (DP > 90 mmHg) had the dosage increased twice, b.i.d., while responders were maintained up to 10 weeks. Clinical visits were performed before, at baseline and every two weeks and the laboratory test was performed after placebo run-in, 4th and 10th weeks of treatment. Results: The blood pressure (BP) were similar between groups at the end of the placebo (cilazapril 151 ± 14/103 ± 5 - nifedipine 157 ± 17/108 ± 7 mmHg, p > 0.05). DP decreased already at second weeks (cilazapril 95 ± 9 - nifedipine 96 ± 11 mmHg, p < 0.05, compared to week 0) in both groups at the end of study with no differences inter groups. BP normalization was obtained in 58% of the patients with cilazapril and in 61% in the nifedipine group. Adverse biochemical effects were not observed in any group. Six (16%) patients of the cilazapril and 15 (39%) of nifedipine related collateral events, although no difference were observed between groups. Conclusion: Cilazapril 2.5 to 5 mg normalized BP in 58% of mild and moderate hypertension patients, and this efficacy was similar to sustained-release nifedipine 20 to 40 mg. Cilazapril had no adverse effects on the biochemical parameters with low incidence of collateral effects.

TRATAMENTO DA HIPERTENSAO ARTERIAL LEVE E MODERADA COM FOSINOPRIL. COMPARACAO DE EFEITOS ADVERSOS COM OUTROS ANTI-HIPERTENSIVOS

Purpose - To evaluate the adverse reactions of fosinopril with other antihypertensives used as monotherapy. Methods - Out-patients (n = 2,568) with diagnostic of mild to moderate hypertension, diastolic blood pressure (DBP) 95-115 mmHg, with no antihypertensive treatment for 15 days, were included to treatment initially with fosinopril (F) 10mg, once daily, for six weeks. After this period, patients with DBP >95mmHg had the dosage, once daily, increased to 20 mg, while the others were maintained with the same dosage for six more weeks. Adverse reactions of 822 patients treated as monotherapy were grouped as absent, musculoskeletal, cardiovascular, cough, gastrointestinal, neurological, genital-urinary dysfunctions and dermatological and compared with 1,568 with F. Monotherapy consist in α-methyldopa (100 patients); β-blocker (129); calcium blocker (106); diuretic (394); and another ACE inhibitors (93). Results - At the end of the period without treatment, the blood pressure (BP), 165 ± 16/105 ± 7 mmHg decreased significantly at 6(th) week to 144 ± 15/91 ± 9 mmHg (p < 0.05 vs week 0) with further lowering to 139 ± 13/86 ± 7 mmHg till the end of 12(th) week. BP response (DBP ≤90 mmHg) was obtained in 89% of the patients with F. Absence of adverse reactions were ≥70% in patients with F compared to other drugs. Conclusion - Fosinopril has demonstrated therapeutic efficacy and less adverse reactions compared to antihypertensives used previously as monotherapy.

HIPERTENSAO ARTERIAL EM PACIENTES OBESOS COM HIPERTROFIA CARDIACA. EFEITOS DO CAPTOPRIL SOBRE A SENSIBILIDADE A INSULINA E HORMONIO DE CRESCIMENTO

Purpose. To evaluate the effects of captopril (Cpt) on carbohydrate metabolism and growth hormone (GH) in adults hypertensive obese patients with normal (NGT) or impaired (IGT) glucose tolerance and left ventricular hypertrophy. Methods. Ten patients (53 ± 8 years), 8 women and 2 men, white, body mass index (BMI) ≥ 26 kg/m2, left ventricular mass index (LVMI) > 135 g/m2 in man and > 110 g/m2 in woman, with diastolic blood pressure (DBP) 95-115 mmHg after 3 weeks of placebo, were identified by oral glucose tolerance test (OGTT-75 g) as either with NGT or IGT, and treated with Cpt 25 mg t.i.d. for 8 weeks. At the 8 weeks, dosage was increased to 50 mg b.i.d. if DBP > 90 mmHg or the decrease of the DBP < 10%, during the next 8 weeks. OGTT and clonidine tests (0,04 mg/kg) with determinations, every 30 minutes of glucose, insulin, and GH during 2 hours, were performed. Results. Cpt lowered SBP and DBP in the NGT group and IGT group. The LVMI and the left ventricular mass (LVM) decreased in the IGT group with no significant change in the NGT group. Cpt promoted in the IGT group decrease in the area under the curve (AUC) of glucose, and AUC of insulin, with increase of the AUC of the percent of the β cell function, AUC of HC, and insulin sensitivity index with no significantly change in the NGT group. Conclusion. Adults hypertensive obese patients with IGT had decreased significantly in mean fasting level of GH concentrations compared to age, race, and BMI matched hypertensive patients with NGT. Treatment with Cpt induced a significant increased of the GH, with improvement of the metabolism in patients with IGT.

EFICACIA E TOLERABILIDADE DA ASSOCIACAO CAPTOPRIL + HIDROCLOROTIAZIDA NO TRATAMENTO DA HIPERTENSAO ARTERIAL LEVE A MODERADA. ESTUDO MULTICENTRICO

Purpose. To evaluate the antihypertensive efficacy and tolerability of captopril 50 mg + hydrochlorothiazide 25 mg daily in mild to moderate primary hypertension. Methods. Out-patients (n = 471) with mild to moderate hypertension, diastolic blood pressure (DBP) 95-115 mmHg, with 15 days of washout, were included to the treatment initially with half tablet of the association of captopril 50 mg + hydrochlorothiazide 25 mg once daily, for 30 days. After this period, patients with DBP > 90 mmHg had the dosage duplicated, while the others had the same dosage for 60 days more. Evaluation was performed 15 days before and then every month during active drug. Results. Twenty six patients were withdrawn, 13 (2,7%) by adverse effects and 13 by protocol violation. At the end of the wash-out period, the blood pressure (BP), 162 ± 16/103 ± 6 mmHg decreased significantly at the 30th day to 146 ± 14/92 ± 8 mmHg (p < 0,001 vs 0th day); 139 ± 12/86 ± 7 mmHg at the 60th day, (p < 0,001 vs 30th day), and further to 136 ± 11/84 ± 5 mmHg (p < 0,001 vs day 0) till the end of the 90th day. Antihypertensive efficay (DBP ≤ 90 mmHg and decreased for the DBP ≥ 10 mmHg) was obtained in 82% of the patients. There was no difference in BP control considering race, hypertension level, previous antihypertensive treatment and obesity. Cough (4%) was the main adverse event. Conclusion. Captopril + hydrochlorothiazide was effective and safe in the treatment of mild to moderate hypertension. The favorable response was observed in 82% of the patients independently of race, hypertensive level, previous antihypertensive treatment and obesity. Low incidence of side effects was reported, with no difference from others reported in the literature.