Angela Maria Geraldo Pierin

How accurate are sphygmomanometers

The objective of this study was to assess the accuracy and reliability of mercury and aneroid sphygmomanometers. Measurement of accuracy of calibration and evaluation of physical conditions were carried out in 524 sphygmomanometers, 351 from a hospital setting, and 173 from private medical offices. Mercury sphyg- momanometers were considered inaccurate if the meniscus was not ‘0’ at rest. Aneroid sphygmomanometers were tested against a properly calibrated mercury manometer, and were considered calibrated when the error was ⩽3 mm Hg. Both types of sphygmomanometers were evaluated for conditions of cuff/bladder, bulb, pump and valve. Of the mercury sphygmomanometers tested 21% were found to be inaccurate. Of this group, unreliability was noted due to: excessive bouncing (14%), illegibility of the gauge (7%), blockage of the filter (6%), and lack of mercury in the reservoir (3%). Bladder damage was noted in 10% of the hospital devices and in 6% of private medical practices. Rubber aging occurred in 34% and 25%, leaks/holes in 19% and 18%, and leaks in the pump bulb in 16% and 30% of hospital devices and private practice devices, respectively. Of the aneroid sphygmomanometers tested, 44% in the hospital setting and 61% in private medical practices were found to be inaccurate. Of these, the magnitude of inaccuracy was 4–6 mm Hg in 32%, 7–12 mm Hg in 19% and > 13 mm Hg in 7%. In summary, most of the mercury and aneroid sphygmomanometers showed inaccuracy (21% vs 58%) and unreliability (64% vs 70%).

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

OBJECTIVE: To assess the relation between blood pressure control and the following: the Morisky-Green test, the patients consciousness regarding high blood pressure, the patients attitude in face of medicine intake, the patients attendance at medical consultations, and the subjective physicians judgment. METHODS: We studied 130 hypertensive patients with the following characteristics: 73 percent females, 60±11 years, 58 percent married, 70 percent white, 45 percent retired, 45 percent with incomplete elementary schooling, 64 percent 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 percent of the hypertensive individuals had blood pressure under control and a longer duration of treatment (10±7 vs 7±6.5 years; P

Avaliação de pacientes hipertensos acompanhados pelo Programa Saúde da Família em um Centro de Saúde Escola

Objective: The study compared two groups of hypertensive patients: one attended by the traditional process of basic health unit care and the other one followed by the Family Health Program (FHP). Method: 113 records of hypertensive patients attended by the traditional process basic heath unit care and 113 by the FHP Results: The results showed that hypertensive patients from FHP were different (p<0.05) in relation to the others on the predominance of the white race; lower education level; fewer workers; older age and higher weight; more tobacco users; less alcoholic beverage, less physical activity, and longer time of hypertension. The patients from FHP had more nursing appointments, nursing home visit, medical home visit, and participation in specific groups; however, there were fewer medical appointments and more attendance at the emergence room. The patients at FHP presented a significant reduction in the blood pressure (152 ± 24/92±15 vs 142 ± 21/85±13 mm Hg) from the beginning to the end of the period of the study with initial systolic blood pressure higher than the patients from the traditional program. Conclusion: Only 30% of the patients from the traditional program and 20% from FHP had their blood pressure controlled.OBJECTIVE: The study compared two groups of hypertensive patients: one attended by the traditional process of basic health unit care and the other one followed by the Family Health Program (FHP). METHOD: 113 records of hypertensive patients attended by the traditional process basic heath unit care and 113 by the FHP RESULTS: The results showed that hypertensive patients from FHP were different (p<0.05) in relation to the others on the predominance of the white race; lower education level; fewer workers; older age and higher weight; more tobacco users; less alcoholic beverage, less physical activity, and longer time of hypertension. The patients from FHP had more nursing appointments, nursing home visit, medical home visit, and participation in specific groups; however, there were fewer medical appointments and more attendance at the emergence room. The patients at FHP presented a significant reduction in the blood pressure (152 ± 24/92±15 vs 142 ± 21/85±13 mm Hg) from the beginning to the end of the period of the study with initial systolic blood pressure higher than the patients from the traditional program. CONCLUSION: Only 30% of the patients from the traditional program and 20% from FHP had their blood pressure controlled.

Síndrome metabólica em motoristas profissionais de transporte de cargas da rodovia BR-116 no trecho Paulista-Régis Bittencourt

The objective of this study was to determine the Metabolic Syndrome prevalence as well as identify variables related in truck drivers who work on Highway BR-116 (Sao Paulo, Brazil). A total of 258 truck drivers were assessed and the variables studied were: body mass index, waist circumference, blood pressure, triglycerides, total and fraction cholesterol, glycemia and C reactive protein. Cardiovascular disease risk was evaluated by Framinghams risk score whereas the Metabolic Syndrome based on the First Brazilian Guideline for Diagnosis and Treatment of the Metabolic Syndrome. The significance level adopted was p or =25 kg/m(2) in 82%, waist circumference > or =94 cm in 58%, total cholesterol >240 mg/dL in 9%, LDL-c >160 mg/dL in 10%; HDL-c 200mg/dL in 22%, glycemia >110 mg/dL in 7%, and C reactive protein >0.5 mg/dL in 19%. Hypertension prevalence was 37%, 9% were identified at the highest/medium Framinghams risk score and 24% showed Metabolic Syndrome. The logistical regression analysis indicated independent association of the Metabolic Syndrome for the following variables (OD odds ratio, CI confidence interval at 95%): body mass index (OR = 1.4007 CI 95% 1.192-1.661), use to check cholesterol (OR = 0.1020 CI 0.017-0.589) and Framinghams risk score (OR = 26.389 CI 2.520-276.374). As a conclusion, it was observed a quite expressive prevalence of cardiovascular risk factors as well as Metabolic Syndrome in truck drivers.

Comparação dos perfis dos pacientes hipertensos atendidos em Pronto-Socorro e em tratamento ambulatorial

: This study compares 100 hypertensive patients in emergency units with those who were seen in outpatient clinics. Hypertensive patients seen at the emergency unit showed to be different (p < 0.05) from those seen at the outpatient clinic regarding: higher blood pressure; lower income; not belonging to the hospital community; greater alcohol intake; became aware of their hypertension because felt bad; measured blood pressure less often; did not take the medicine more often. In conclusion, unfavorable characteristics can contribute to hypertensive patients who do not follow antihypertension treatment adequately, leading to care in emergency units.O estudo comparou 100 hipertensos atendidos no Pronto-socorro com 100 pacientes do Ambulatorio. Os hipertensos do Pronto-Socorro foram diferentes (p < 0,05) em relacao a: maior pressao arterial; menor renda salarial; maior consumo de bebida alcoolica; nao pertenciam a comunidade do hospital; descobriram ser hipertensos por sentirem-se mal; mediram menos a pressao; e deixaram de tomar mais medicamentos. A analise multivariada revelou diferencas significativas entre os dois grupos quanto a renda, ao local onde e medida a pressao e nao tomar os medicamentos. Concluiu-se que caracteristicas desfavoraveis podem contribuir para nao realizar o tratamento anti-hipertensivo, levando a atendimentos em unidades de emergencia.This study compares 100 hypertensive patients in emergency units with those who were seen in outpatient clinics. Hypertensive patients seen at the emergency unit showed to be different (p < 0.05) from those seen at the outpatient clinic regarding: higher blood pressure; lower income; not belonging to the hospital community; greater alcohol intake; became aware of their hypertension because felt bad; measured blood pressure less often; did not take the medicine more often. In conclusion, unfavorable characteristics can contribute to hypertensive patients who do not follow antihypertension treatment adequately, leading to care in emergency units.

Controle da hipertensão arterial e fatores associados na atenção primária em Unidades Básicas de Saúde localizadas na Região Oeste da cidade de São Paulo

Realizou-se estudo para caracterizar o controle de hipertensos atendidos na atencao primaria com amostra de 440 hipertensos. Os hipertensos foram entrevistados e a medida da pressao foi realizada com aparelho automatico validado. A relacao entre as variaveis classificatorias foi avaliada com o teste qui-quadrado e posterior analise multivariada. Os resultados mostraram que o controle da hipertensao arterial foi de 45,5% e se associou (p<0,05) a mulheres, idade menos elevada, menos tempo de doenca, ja ter feito tratamento para hipertensao, menos interrupcao do tratamento, conhecimento sobre a importância dos exercicios fisicos, raramente deixar de tomar remedio na hora certa, menor numero de drogas anti-hipertensivas prescritas, antecedentes para doencas cardiacas, pratica de exercicios fisicos e menos tristeza. A analise de regressao logistica mostrou que a falta de controle da hipertensao foi dependente de tratamento anterior para hipertensao (OR = 2,26; IC 95%, 1,4 - 3,6), falta de conhecimento sobre pratica de atividade fisica (OR = 3,5; IC 95%, 1,1 - 10,8) e ausencia de antecedente familiar para problemas cardiacos (OR = 2,2; IC 95%, 1,3 - 3,5). Menos da metade dos hipertensos estava controlada e o controle se associou a variaveis biologicas, tratamento, atitudes e conhecimento sobre a hipertensao e seu tratamento.

Profile of hypertensive patients: biosocial characteristics, knowledge, and treatment compliance

OBJECTIVE: To characterize a group of hypertensive patients in relation to beliefs, knowledge, attitudes and factors that could affect treatment compliance. METHODS: The data were collected by interviewing hypertensive outpatients. RESULTS: A total of 511 hypertensive patients were studied: most were women, white, with elementary education, and 53±11 years old. The patients had high levels of knowledge about hypertension and treatments. However, they interrupted the treatment due to the expensive medicines and the lack of instructions. Furthermore, they believed they had to take medicines only when they felt unwell, and they did not attend their medical appointment usually due to forgetfulness and personal problems. Regarding the attitudes against the antihypertensive treatment, hypertensive patients forgot to take the medicines, took the medication at different hours, stopped taking the medication on their own account, did not follow instructions, and did not exercise regularly. CONCLUSION: The profile of the hypertensive patients identified aspects that can hamper treatment compliance.Objective: To characterize a group of hypertensive patients in relation to beliefs, knowledge, attitudes and factors that could affect treatment compliance. Methods: The data were collected by interviewing hypertensive outpatients. Results: A total of 511 hypertensive patients were studied: most were women, white, with elementary education, and 53±11 years old. The patients had high levels of knowledge about hypertension and treatments. However, they interrupted the treatment due to the expensive medicines and the lack of instructions. Furthermore, they believed they had to take medicines only when they felt unwell, and they did not attend their medical appointment usually due to forgetfulness and personal problems. Regarding the attitudes against the antihypertensive treatment, hypertensive patients forgot to take the medicines, took the medication at different hours, stopped taking the medication on their own account, did not follow instructions, and did not exercise regularly. Conclusion: The profile of the hypertensive patients identified aspects that can hamper treatment compliance.

Health-related quality of life and blood pressure control in hypertensive patients with and without complications.

INTRODUCTION: The goal of antihypertensive treatment is to reduce blood pressure without interfering in health-related quality of life (HRQL) OBJECTIVE: This study aimed to assess the influence of hypertension control upon HRQL in hypertensive patients with and without complications. MATERIALS AND METHODS: Seventy-seven hypertensive outpatients (71% women, 58% white, 60% with elementary school level education, average age 54 ± 8 years) were observed during a 12-month special care program (phase 1: clinical visits every two months, donation of all antihypertensive medications, meetings with a multidisciplinary team, and active telephone calls) and three years of standard care (phase 2: clinical visits every four months, medication provided by the drugstore of the hospital with a two-hour wait and a possible lack of medication, no meetings with a multidisciplinary team or active telephone calls). The patient HRQL was assessed using Bulpitt and Fletcher’s Specific Questionnaire, as well as the SF-36 scores. Hypertensive patients were divided into “with complications” (n=37, diastolic blood pressure great than 110 mm Hg for patients with or without treatment, with clinically evident target-organ or other associated illness) and “without complications” (n=40). The variables studied were quality of life, blood pressure control, hypertension gravity, and demographic characteristics. RESULTS: In hypertensive patients with and without complications, both the systolic and diastolic blood pressure were significantly higher (p<0.05) in phase 2 of observation (143±18/84±11 and 144±21/93±11 mm Hg for patients with and without complications, respectively) relative to phase 1 (128±17/75±13 and 128±15/83±11mmHg). The proportion of patients with controlled blood pressure (defined as a blood pressure less than 140/90 mm Hg) decreased from 70% to 49% in the “with complications” group and from 78% to 50% in the “without complications” group during phase 2 of observation. The patients with complications showed a decrease in bodily pain, vitality, and mental health component summary scores in both phases. In phase 2, the patients without complications had significantly better HRQL scores compared to complicated patients using both the Bulpitt and Fletcher’s Questionnaire and the SF-36 assessment of physical capacity, bodily pain, and vitality domain summary scores. With regards to hypertension control, there was a significant decrease from phase 1 to phase 2 in the vitality component summary scores and an increase in the emotional aspect component summary scores assessed by the SF-36, whereas Bulpitt and Fletcher’s Questionnaire showed no differences in these scores. CONCLUSION: Special care programs with multidisciplinary activities, individualized and personalized assistance, easy access to pharmacological treatment, frequent meetings, and active telephone calls for hypertensive patients significantly increase blood pressure control but do not interfere with the HRQL.

Perfil de um grupo de hipertensos: aspectos biossociais, conhecimentos e adesão ao tratamento

OBJECTIVE: To characterize a group of hypertensive patients in relation to beliefs, knowledge, attitudes and factors that could affect treatment compliance. METHODS: The data were collected by interviewing hypertensive outpatients. RESULTS: A total of 511 hypertensive patients were studied: most were women, white, with elementary education, and 53±11 years old. The patients had high levels of knowledge about hypertension and treatments. However, they interrupted the treatment due to the expensive medicines and the lack of instructions. Furthermore, they believed they had to take medicines only when they felt unwell, and they did not attend their medical appointment usually due to forgetfulness and personal problems. Regarding the attitudes against the antihypertensive treatment, hypertensive patients forgot to take the medicines, took the medication at different hours, stopped taking the medication on their own account, did not follow instructions, and did not exercise regularly. CONCLUSION: The profile of the hypertensive patients identified aspects that can hamper treatment compliance.Objective: To characterize a group of hypertensive patients in relation to beliefs, knowledge, attitudes and factors that could affect treatment compliance. Methods: The data were collected by interviewing hypertensive outpatients. Results: A total of 511 hypertensive patients were studied: most were women, white, with elementary education, and 53±11 years old. The patients had high levels of knowledge about hypertension and treatments. However, they interrupted the treatment due to the expensive medicines and the lack of instructions. Furthermore, they believed they had to take medicines only when they felt unwell, and they did not attend their medical appointment usually due to forgetfulness and personal problems. Regarding the attitudes against the antihypertensive treatment, hypertensive patients forgot to take the medicines, took the medication at different hours, stopped taking the medication on their own account, did not follow instructions, and did not exercise regularly. Conclusion: The profile of the hypertensive patients identified aspects that can hamper treatment compliance.

O conhecimento de profissionais da área da saúde sobre a medida da pressão arterial

This study investigated the theoretical and technical knowledge of blood pressure measurement from 110 nursing assistants, 44 physicians and 25 nurses by answering to a questionnaire and practical knowledge through the observation of the blood pressure measurement procedure. In the theoretical knowledge the three categories showed statistically significant differences (p<0,05), the nursing assistants showed a lower indicator of the correctness (32%±12%) followed by nurses (44%±14%) and physicians (56%±13%). In the practical knowledge the physicians showed higher percentage of correctness (50%±12%) (p<0.05); followed by nurses (44%±10%) and nursing assistants (41%±6%). In conclusion, the knowledge of blood pressure measurement was not satisfactory.This study investigated the theoretical and technical knowledge of blood pressure measurement from 110 nursing assistants, 44 physicians and 25 nurses by answering to a questionnaire and practical knowledge through the observation of the blood pressure measurement procedure. In the theoretical knowledge the three categories showed statistically significant differences (p<0,05), the nursing assistants showed a lower indicator of the correctness (32%+/-12%) followed by nurses (44%+/-14%) and physicians (56%+/-13%). In the practical knowledge the physicians showed higher percentage of correctness (50%+/-12%) (p<0.05);followed by nurses (44%+/-10%) and nursing assistants (41%+/-6%). In conclusion, the knowledge of blood pressure measurement was not satisfactory.