Afonso Augusto Carvalho Loureiro

Prevalência e fatores de risco para hipertensão em uma população urbana brasileira

FUNDAMENTO: Os estudos disponiveis nao analisaram de modo abrangente os varios fatores envolvidos na genese da hipertensao (HT), especialmente a associacao entre pressao arterial, excrecao urinaria de sodio e disfuncao renal. OBJETIVO: Avaliar a prevalencia dos fatores de risco para HT em diferentes grupos etarios em uma amostra representativa da uma populacao urbana brasileira. METODOS: A populacao estudada (1.717 individuos adultos) foi avaliada por grupos etarios: 18 a 39 anos; 40 a 49; 50 a 59; 60 a 69 e > 70 anos. As medias das variaveis quantitativas e as variaveis categoricas dos grupos normotenso e hipertenso foram comparadas. RESULTADOS: A prevalencia geral ajustada para HT foi de 25,23%. A prevalencia aumentou com a idade e era mais alta em individuos com baixo nivel educacional. Indice de massa corporal e circunferencia abdominal aumentados estavam positivamente associados com uma maior prevalencia de HT. Havia uma associacao positiva significante entre HT e excrecao urinaria de sodio. Os individuos hipertensos apresentavam maior frequencia de disfuncao renal, definida como clearance de creatinina <60 ml/min/m2. A prevalencia de diabetes mellitus na populacao geral era de 5,6% e 14,5% nos individuos hipertensos. A hipertensao era uma condicao conhecida por 74,4% dos individuos hipertensos. Entre os individuos hipertensos tratados, 52,4% tinham a hipertensao controlada e apenas 34,3% dos pacientes hipertensos no geral (tratados ou nao) tinham a pressao arterial controlada. CONCLUSAO: Esse estudo de base populacional e especial devido ao fato de agregar diferentes fatores demograficos, epidemiologicos e de risco envolvidos na genese da hipertensao na avaliacao de uma unica amostra com um calculo populacional que pode ser extrapolado para outras populacoes hipertensas.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/m(2). 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.

Hypertension prevalence and risk factors in a Brazilian urban population

FUNDAMENTO: Os estudos disponiveis nao analisaram de modo abrangente os varios fatores envolvidos na genese da hipertensao (HT), especialmente a associacao entre pressao arterial, excrecao urinaria de sodio e disfuncao renal. OBJETIVO: Avaliar a prevalencia dos fatores de risco para HT em diferentes grupos etarios em uma amostra representativa da uma populacao urbana brasileira. METODOS: A populacao estudada (1.717 individuos adultos) foi avaliada por grupos etarios: 18 a 39 anos; 40 a 49; 50 a 59; 60 a 69 e > 70 anos. As medias das variaveis quantitativas e as variaveis categoricas dos grupos normotenso e hipertenso foram comparadas. RESULTADOS: A prevalencia geral ajustada para HT foi de 25,23%. A prevalencia aumentou com a idade e era mais alta em individuos com baixo nivel educacional. Indice de massa corporal e circunferencia abdominal aumentados estavam positivamente associados com uma maior prevalencia de HT. Havia uma associacao positiva significante entre HT e excrecao urinaria de sodio. Os individuos hipertensos apresentavam maior frequencia de disfuncao renal, definida como clearance de creatinina <60 ml/min/m2. A prevalencia de diabetes mellitus na populacao geral era de 5,6% e 14,5% nos individuos hipertensos. A hipertensao era uma condicao conhecida por 74,4% dos individuos hipertensos. Entre os individuos hipertensos tratados, 52,4% tinham a hipertensao controlada e apenas 34,3% dos pacientes hipertensos no geral (tratados ou nao) tinham a pressao arterial controlada. CONCLUSAO: Esse estudo de base populacional e especial devido ao fato de agregar diferentes fatores demograficos, epidemiologicos e de risco envolvidos na genese da hipertensao na avaliacao de uma unica amostra com um calculo populacional que pode ser extrapolado para outras populacoes hipertensas.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/m(2). 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.

Infarto agudo do miocárdio e dissecção aguda de aorta: um importante diagnóstico diferencial

We report on a case of a 54-year-old man suffering from untreated high blood pressure who presented with a hypertensive emergency and target-organ damage. Initially, he was treated for myocardial infarction but later was diagnosed as having a type-A aortic dissection which was successfully operated with adequate control of blood pressure within the first 24 hours. We emphasize the necessity of the differential diagnosis of thoracic pain in the hospital emergency department and the correct treatment of arterial hypertension aiming at a better prognostic over the long term.

Coronary emergency and diabetes as manifestations of pheochromocytoma

We report on a woman with refractory hypertension and diabetes suffering from hypertensive crises, one with chest pain suggesting acute coronary syndrome, and another with an abdominal pain, after which a para-aortic abdominal mass was diagnosed, by ultrasound, as pheochromocytoma, later confirmed by an adrenal scintigraphic study with (131)I-labeled metaiodobenzylguanidine. The patient was successfully treated with complete reversal of hypertension and diabetes. Our case illustrates the importance of maintaining a high index of suspicion in patients simultaneously presenting with an acute myocardial event and hypertensive crises.

Ausência de descenso noturno se associa a acidente vascular cerebral e infarto do miocárdio

BACKGROUND The arterial hypertension varies in according to the circadian cycle, presenting physiologic fall of blood pressure (BP) during sleep (dipping). The absence of this fall or its increase associates to higher incidence of target-organ damages. OBJECTIVE To analyze the prevalence of dipping in hypertensive individuals, to correlate dipping to the blood pressure levels, clinic, and socio-demographic factors, and biochemical characteristics and to associate it cardiovascular events (stroke and myocardial infarction). METHODS Hypertensive individuals were submitted to the ambulatory blood pressure monitoring. Presence of dipper was defined as fall >10% of the systolic BP of the day for sleep. RESULTS 163 evaluated patients were divided in dippers (D, n=53) and nondippers (ND, n=110). Between the groups there was not significant difference to the age, sex, race, time of hypertension, glycemia, LDL-cholesterol, total cholesterol, triglycerides, schooling, smoking, and history of diabetes. D presented BP higher than the ND during the day and lower during sleep. ND had higher body mass index (BMI) (p=0.0377), lower level of HDL-cholesterol (p=0.0189), and higher pulse pressure during sleep (p=0.0025). History of stroke alone (p=0,046) and combined with myocardial infarction (p=0.032) were more frequent in nondippers individuals. In the logistic regression, only ND was associated independently with stroke or myocardial infarction. CONCLUSION ND was associated in an independent way with the target-organ damages analyzed, what demonstrates its importance and strengthens the necessity of more aggressive treatment with objective to reach BP goals e, consequently, to prevent the development of new cardiologic and cerebrovascular events.FUNDAMENTO: A pressao arterial (PA) varia de acordo com o ciclo circadiano, apresentando quedas fisiologicas durante o sono (descenso noturno - DN). A ausencia dessa queda se associa a maior incidencia de lesoes em orgaos-alvo. OBJETIVO: Analisar a prevalencia de DN em individuos hipertensos, correlacionar DN aos niveis pressoricos, variaveis clinicas, fatores sociodemograficos e bioquimicos e associa-lo a eventos cardiovasculares (acidente vascular cerebral - AVC e infarto agudo do miocardio - IAM). METODOS: Foram avaliados 163 hipertensos, submetidos a monitorizacao ambulatorial da pressao arterial. DN foi definido como queda >10% da PA sistolica do periodo da vigilia para o de sono. RESULTADOS: Os pacientes foram divididos em grupos dipper (D) e nao dipper (ND). Nao houve diferenca significante entre os grupos quanto a idade, sexo, raca, tempo de hipertensao, glicemia, LDL-colesterol, colesterol total, triglicerides, escolaridade, tabagismo, historia de diabetes. Grupo dipper apresentou PA superior a ND durante a vigilia e inferior durante o sono. Grupo ND cursou com maior indice de massa corporea (IMC) (p=0,0377), menor HDL-colesterol (p=0,0189) e maior pressao de pulso durante o sono (p=0,0025). Historia de AVC ou IAM foram mais frequentes em ND. A regressao logistica, apenas a ausencia de descenso noturno associou-se independentemente a AVC ou IAM. CONCLUSAO: A ausencia de DN associou-se de maneira independente as lesoes em orgaos-alvo analisadas, o que demonstra a sua importância e reforca a necessidade de tratamento mais agressivo com objetivo de se atingir as metas pressoricas e, consequentemente, evitar o desenvolvimento de novos eventos cardiocerebrovasculares.Correspondencia: Renan Oliveira Vaz de Melo • Rua Professor Enjolrras Vampré, 201/44 Bloco 3 Vila Santa Cândida 15091-290 São José do Rio Preto, SP Brasil E-mail: renanovmelo@gmail.com Artículo recibido el 15/10/08; revisado recibido el 01/02/09; aceptado el 15/05/09. Resumen Fundamento: La presión arterial (PA) varía de acuerdo al ciclo circadiano, presentando descensos fisiológicos durante el sueño (descenso nocturno DN). La ausencia de ese descenso se asocia a mayor incidencia de lesiones en órganos blanco.

Absence of nocturnal dipping is associated with stroke and myocardium infarction

BACKGROUND The arterial hypertension varies in according to the circadian cycle, presenting physiologic fall of blood pressure (BP) during sleep (dipping). The absence of this fall or its increase associates to higher incidence of target-organ damages. OBJECTIVE To analyze the prevalence of dipping in hypertensive individuals, to correlate dipping to the blood pressure levels, clinic, and socio-demographic factors, and biochemical characteristics and to associate it cardiovascular events (stroke and myocardial infarction). METHODS Hypertensive individuals were submitted to the ambulatory blood pressure monitoring. Presence of dipper was defined as fall >10% of the systolic BP of the day for sleep. RESULTS 163 evaluated patients were divided in dippers (D, n=53) and nondippers (ND, n=110). Between the groups there was not significant difference to the age, sex, race, time of hypertension, glycemia, LDL-cholesterol, total cholesterol, triglycerides, schooling, smoking, and history of diabetes. D presented BP higher than the ND during the day and lower during sleep. ND had higher body mass index (BMI) (p=0.0377), lower level of HDL-cholesterol (p=0.0189), and higher pulse pressure during sleep (p=0.0025). History of stroke alone (p=0,046) and combined with myocardial infarction (p=0.032) were more frequent in nondippers individuals. In the logistic regression, only ND was associated independently with stroke or myocardial infarction. CONCLUSION ND was associated in an independent way with the target-organ damages analyzed, what demonstrates its importance and strengthens the necessity of more aggressive treatment with objective to reach BP goals e, consequently, to prevent the development of new cardiologic and cerebrovascular events.FUNDAMENTO: A pressao arterial (PA) varia de acordo com o ciclo circadiano, apresentando quedas fisiologicas durante o sono (descenso noturno - DN). A ausencia dessa queda se associa a maior incidencia de lesoes em orgaos-alvo. OBJETIVO: Analisar a prevalencia de DN em individuos hipertensos, correlacionar DN aos niveis pressoricos, variaveis clinicas, fatores sociodemograficos e bioquimicos e associa-lo a eventos cardiovasculares (acidente vascular cerebral - AVC e infarto agudo do miocardio - IAM). METODOS: Foram avaliados 163 hipertensos, submetidos a monitorizacao ambulatorial da pressao arterial. DN foi definido como queda >10% da PA sistolica do periodo da vigilia para o de sono. RESULTADOS: Os pacientes foram divididos em grupos dipper (D) e nao dipper (ND). Nao houve diferenca significante entre os grupos quanto a idade, sexo, raca, tempo de hipertensao, glicemia, LDL-colesterol, colesterol total, triglicerides, escolaridade, tabagismo, historia de diabetes. Grupo dipper apresentou PA superior a ND durante a vigilia e inferior durante o sono. Grupo ND cursou com maior indice de massa corporea (IMC) (p=0,0377), menor HDL-colesterol (p=0,0189) e maior pressao de pulso durante o sono (p=0,0025). Historia de AVC ou IAM foram mais frequentes em ND. A regressao logistica, apenas a ausencia de descenso noturno associou-se independentemente a AVC ou IAM. CONCLUSAO: A ausencia de DN associou-se de maneira independente as lesoes em orgaos-alvo analisadas, o que demonstra a sua importância e reforca a necessidade de tratamento mais agressivo com objetivo de se atingir as metas pressoricas e, consequentemente, evitar o desenvolvimento de novos eventos cardiocerebrovasculares.Correspondencia: Renan Oliveira Vaz de Melo • Rua Professor Enjolrras Vampré, 201/44 Bloco 3 Vila Santa Cândida 15091-290 São José do Rio Preto, SP Brasil E-mail: renanovmelo@gmail.com Artículo recibido el 15/10/08; revisado recibido el 01/02/09; aceptado el 15/05/09. Resumen Fundamento: La presión arterial (PA) varía de acuerdo al ciclo circadiano, presentando descensos fisiológicos durante el sueño (descenso nocturno DN). La ausencia de ese descenso se asocia a mayor incidencia de lesiones en órganos blanco.

La ausencia de descenso nocturno de la presión arterial se asocia a accidente cerebrovascular e infarto de miocardio

BACKGROUND The arterial hypertension varies in according to the circadian cycle, presenting physiologic fall of blood pressure (BP) during sleep (dipping). The absence of this fall or its increase associates to higher incidence of target-organ damages. OBJECTIVE To analyze the prevalence of dipping in hypertensive individuals, to correlate dipping to the blood pressure levels, clinic, and socio-demographic factors, and biochemical characteristics and to associate it cardiovascular events (stroke and myocardial infarction). METHODS Hypertensive individuals were submitted to the ambulatory blood pressure monitoring. Presence of dipper was defined as fall >10% of the systolic BP of the day for sleep. RESULTS 163 evaluated patients were divided in dippers (D, n=53) and nondippers (ND, n=110). Between the groups there was not significant difference to the age, sex, race, time of hypertension, glycemia, LDL-cholesterol, total cholesterol, triglycerides, schooling, smoking, and history of diabetes. D presented BP higher than the ND during the day and lower during sleep. ND had higher body mass index (BMI) (p=0.0377), lower level of HDL-cholesterol (p=0.0189), and higher pulse pressure during sleep (p=0.0025). History of stroke alone (p=0,046) and combined with myocardial infarction (p=0.032) were more frequent in nondippers individuals. In the logistic regression, only ND was associated independently with stroke or myocardial infarction. CONCLUSION ND was associated in an independent way with the target-organ damages analyzed, what demonstrates its importance and strengthens the necessity of more aggressive treatment with objective to reach BP goals e, consequently, to prevent the development of new cardiologic and cerebrovascular events.FUNDAMENTO: A pressao arterial (PA) varia de acordo com o ciclo circadiano, apresentando quedas fisiologicas durante o sono (descenso noturno - DN). A ausencia dessa queda se associa a maior incidencia de lesoes em orgaos-alvo. OBJETIVO: Analisar a prevalencia de DN em individuos hipertensos, correlacionar DN aos niveis pressoricos, variaveis clinicas, fatores sociodemograficos e bioquimicos e associa-lo a eventos cardiovasculares (acidente vascular cerebral - AVC e infarto agudo do miocardio - IAM). METODOS: Foram avaliados 163 hipertensos, submetidos a monitorizacao ambulatorial da pressao arterial. DN foi definido como queda >10% da PA sistolica do periodo da vigilia para o de sono. RESULTADOS: Os pacientes foram divididos em grupos dipper (D) e nao dipper (ND). Nao houve diferenca significante entre os grupos quanto a idade, sexo, raca, tempo de hipertensao, glicemia, LDL-colesterol, colesterol total, triglicerides, escolaridade, tabagismo, historia de diabetes. Grupo dipper apresentou PA superior a ND durante a vigilia e inferior durante o sono. Grupo ND cursou com maior indice de massa corporea (IMC) (p=0,0377), menor HDL-colesterol (p=0,0189) e maior pressao de pulso durante o sono (p=0,0025). Historia de AVC ou IAM foram mais frequentes em ND. A regressao logistica, apenas a ausencia de descenso noturno associou-se independentemente a AVC ou IAM. CONCLUSAO: A ausencia de DN associou-se de maneira independente as lesoes em orgaos-alvo analisadas, o que demonstra a sua importância e reforca a necessidade de tratamento mais agressivo com objetivo de se atingir as metas pressoricas e, consequentemente, evitar o desenvolvimento de novos eventos cardiocerebrovasculares.Correspondencia: Renan Oliveira Vaz de Melo • Rua Professor Enjolrras Vampré, 201/44 Bloco 3 Vila Santa Cândida 15091-290 São José do Rio Preto, SP Brasil E-mail: renanovmelo@gmail.com Artículo recibido el 15/10/08; revisado recibido el 01/02/09; aceptado el 15/05/09. Resumen Fundamento: La presión arterial (PA) varía de acuerdo al ciclo circadiano, presentando descensos fisiológicos durante el sueño (descenso nocturno DN). La ausencia de ese descenso se asocia a mayor incidencia de lesiones en órganos blanco.

Prevalencia y factores de riesgo para hipertensión en una población urbana brasilera

FUNDAMENTO: Os estudos disponiveis nao analisaram de modo abrangente os varios fatores envolvidos na genese da hipertensao (HT), especialmente a associacao entre pressao arterial, excrecao urinaria de sodio e disfuncao renal. OBJETIVO: Avaliar a prevalencia dos fatores de risco para HT em diferentes grupos etarios em uma amostra representativa da uma populacao urbana brasileira. METODOS: A populacao estudada (1.717 individuos adultos) foi avaliada por grupos etarios: 18 a 39 anos; 40 a 49; 50 a 59; 60 a 69 e > 70 anos. As medias das variaveis quantitativas e as variaveis categoricas dos grupos normotenso e hipertenso foram comparadas. RESULTADOS: A prevalencia geral ajustada para HT foi de 25,23%. A prevalencia aumentou com a idade e era mais alta em individuos com baixo nivel educacional. Indice de massa corporal e circunferencia abdominal aumentados estavam positivamente associados com uma maior prevalencia de HT. Havia uma associacao positiva significante entre HT e excrecao urinaria de sodio. Os individuos hipertensos apresentavam maior frequencia de disfuncao renal, definida como clearance de creatinina <60 ml/min/m2. A prevalencia de diabetes mellitus na populacao geral era de 5,6% e 14,5% nos individuos hipertensos. A hipertensao era uma condicao conhecida por 74,4% dos individuos hipertensos. Entre os individuos hipertensos tratados, 52,4% tinham a hipertensao controlada e apenas 34,3% dos pacientes hipertensos no geral (tratados ou nao) tinham a pressao arterial controlada. CONCLUSAO: Esse estudo de base populacional e especial devido ao fato de agregar diferentes fatores demograficos, epidemiologicos e de risco envolvidos na genese da hipertensao na avaliacao de uma unica amostra com um calculo populacional que pode ser extrapolado para outras populacoes hipertensas.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/m(2). 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.