Dilma de Souza

Assessment of Resistant Hypertension with Home Blood Pressure Monitoring

BACKGROUND: Ambulatory blood pressure monitoring (ABPM) is considered the gold standard for the diagnostic confirmation of resistant hypertension (RH). However, home blood pressure monitoring (HBPM) has been considered an option, because of its lower cost and greater comfort. OBJECTIVE: To compare the values obtained by HBPM with those obtained by ABPM in the identification of patients with resistant hypertension. METHODS: A total of 51 consecutive patients with resistant hypertension were selected. All were adults of both genders and were undergoing treatment in an outpatient referral clinic from January 2007 to September 2009. Casual office blood pressure (BP), 24-hour ABPM, and HBPM were performed according to current guidelines, with a maximum two-week interval between the methods. RESULTS: The comparison of ABPM (mean daytime) with HBPM showed a good correlation between them, both for systolic blood pressure (SBP) and for diastolic blood pressure (DBP): SBP r = 0.70, CI = 0.51-0.82, DBP r = 0.69, CI = 0.52-0.81. RH was confirmed by ABPM in 33 patients and by HBPM in 37, with no significant difference between the methods. CONCLUSION: According to the results obtained, we conclude that HBPM is a method that can be used as an alternative to ABPM for the diagnostic confirmation of RH.BACKGROUND ambulatory blood pressure monitoring (ABPM) is considered the gold standard for the diagnostic confirmation of resistant hypertension (RH). However, home blood pressure monitoring (HBPM) has been considered an option, because of its lower cost and greater comfort. OBJECTIVE to compare the values obtained by HBPM with those obtained by ABPM in the identification of patients with resistant hypertension. METHODS a total of 51 consecutive patients with resistant hypertension were selected. All were adults of both genders and were undergoing treatment in an outpatient referral clinic from January 2007 to September 2009. Casual office blood pressure (BP), 24-hour ABPM, and HBPM were performed according to current guidelines, with a maximum two-week interval between the methods. RESULTS the comparison of ABPM (mean daytime) with HBPM showed a good correlation between them, both for systolic blood pressure (SBP) and for diastolic blood pressure (DBP): SBP r = 0.70, CI = 0.51-0.82, DBP r = 0.69, CI = 0.52-0.81. RH was confirmed by ABPM in 33 patients and by HBPM in 37, with no significant difference between the methods. CONCLUSION according to the results obtained, we conclude that HBPM is a method that can be used as an alternative to ABPM for the diagnostic confirmation of RH.

Duchenne muscular dystrophy: electrocardiographic analysis of 131 patients

FUNDAMENTO: E conhecido o envolvimento cardiaco em pacientes com distrofia muscular de Duchenne (DMD). O eletrocardiograma (ECG) apresenta algumas alteracoes tipicas na DMD, fato que o torna um exame util no diagnostico da lesao cardiaca nessa patologia. OBJETIVO: Avaliar as alteracoes eletrocardiograficas em pacientes portadores de DMD, correlacionando-as com a idade da populacao estudada. METODOS: Foram analisados os ECG de 131 pacientes com diagnostico de DMD. Avaliaram-se diversas variaveis eletrocardiograficas, sendo os pacientes separados em dois grupos: aqueles com e sem alteracoes, por variavel estudada. Fez-se a correlacao desses dois grupos com a idade dos pacientes. Foram utilizados os criterios de Garson para estabelecer os parâmetros eletrocardiograficos de normalidade. RESULTADOS: O ECG estava anormal em 78,6% dos pacientes. Todos apresentavam ritmo sinusal. Foram os seguintes os percentuais encontrados para as principais variaveis estudadas: PR curto = 18,3%, ondas R anormais em V1 = 29,7%, ondas Q anormais em V6 = 21,3%, alteracoes da repolarizacao ventricular = 54,9%, ondas QS anormais em paredes inferior e/ou lateral alta = 37,4%, disturbios de conducao pelo ramo direito = 55,7%, intervalo QTC prolongado = 35,8% e alargamento do QRS = 23,6%. O teste t nao pareado foi utilizado para se estabelecer a correlacao da idade com as variaveis eletrocardiograficas estudadas nos dois grupos e, apenas a variavel alteracao da repolarizacao mostrou diferenca estatisticamente significante. CONCLUSAO: As alteracoes eletrocardiograficas na DMD sao frequentes, revelando comprometimento cardiaco precoce. Apenas a variavel alteracao da repolarizacao ventricular foi mais frequente, porem em faixa etaria menor (p < 0,05).BACKGROUND Cardiac involvement is known to occur in patients with Duchenne muscular dystrophy (DMD). The electrocardiogram (ECG) shows some typical changes in DMD, which makes it a useful test for the diagnosis of cardiac lesion in this disease. OBJECTIVE To evaluate the electrocardiographic changes in patients with DMD and to correlate these changes with the age of the population studied. METHODS ECG of 131 patients diagnosed with DMD were examined. Several electrocardiographic variables were analyzed, and the patients were divided into two groups - one with and one without changes, for each variable studied. The correlation between the two groups and the age of the patients was analyzed. Garsons criteria were used to establish the electrocardiographic parameters of normality. RESULTS ECG was abnormal in 78.6% of the patients. All showed normal sinus rhythm. The following percentages were found for the main variables studied: short PR interval = 18.3%; abnormal R waves in V1 = 29.7%; abnormal Q waves in V6 = 21.3%; abnormal ventricular repolarization = 54.9%; abnormal QS waves in inferior and/or upper lateral wall = 37.4%; conduction disturbances in right bundle branch = 55.7%; prolonged QT C interval = 35.8%, and wide QRS = 23.6%. Unpaired t test was used to establish the correlation between age and the electrocardiographic variables studied in the two groups. Statistically significant differences were found only for the abnormal repolarization variable. CONCLUSION Electrocardiographic abnormalities are common in DMD, revealing early cardiac involvement. Only the abnormal ventricular repolarization variable was more frequent, however at a lower age range (p < 0.05).

Sensibilidade do eletrocardiograma na hipertrofia ventricular de acordo com gênero e massa cardíaca

BACKGROUND: Several factors are known to interfere with electrocardiogram (ECG) sensitivity when diagnosing Left Ventricular Hypertrophy (LVH), with gender and cardiac mass being two of the most important ones OBJECTIVE: To evaluate the influence of gender on the sensitivity of some of the criteria used to detect LVH, according to the progression of ventricular hypertrophy degree. METHODS: According to gender and the degree of LVH at the echocardiogram, the patients were divided in three groups: mild, moderate and severe LVH. ECG sensitivity to detect LVH was assessed between men and women, according to the LVH degree. RESULTS: Of the 874 patients, 265 were males (30.3%) and 609, females (69.7%). The [(S + R) X QRS], Sokolow-Lyon, Romhilt-Estes, Perugia and strain criteria showed high discriminatory power in the diagnosis of LVH between men and women in the three groups with LVH, with a superior performance in the male population and highlighting the importance of the [(S + R) X QRS] and Perugia scores. Conclusion: The diagnostic sensitivity of the ECG increases with the cardiac mass. The examination is more sensitive in men, highlighting the importance of the [(S + R) X QRS] and Perugia scores. CONCLUSION: The diagnostic sensitivity of the ECG increases with the cardiac mass. The examination is more sensitive in men, highlighting the importance of the [(S + R) X QRS] and Perugia scores.

Avaliação da hipertensão arterial resistente pela monitorização residencial da pressão arterial

BACKGROUND: Ambulatory blood pressure monitoring (ABPM) is considered the gold standard for the diagnostic confirmation of resistant hypertension (RH). However, home blood pressure monitoring (HBPM) has been considered an option, because of its lower cost and greater comfort. OBJECTIVE: To compare the values obtained by HBPM with those obtained by ABPM in the identification of patients with resistant hypertension. METHODS: A total of 51 consecutive patients with resistant hypertension were selected. All were adults of both genders and were undergoing treatment in an outpatient referral clinic from January 2007 to September 2009. Casual office blood pressure (BP), 24-hour ABPM, and HBPM were performed according to current guidelines, with a maximum two-week interval between the methods. RESULTS: The comparison of ABPM (mean daytime) with HBPM showed a good correlation between them, both for systolic blood pressure (SBP) and for diastolic blood pressure (DBP): SBP r = 0.70, CI = 0.51-0.82, DBP r = 0.69, CI = 0.52-0.81. RH was confirmed by ABPM in 33 patients and by HBPM in 37, with no significant difference between the methods. CONCLUSION: According to the results obtained, we conclude that HBPM is a method that can be used as an alternative to ABPM for the diagnostic confirmation of RH.BACKGROUND ambulatory blood pressure monitoring (ABPM) is considered the gold standard for the diagnostic confirmation of resistant hypertension (RH). However, home blood pressure monitoring (HBPM) has been considered an option, because of its lower cost and greater comfort. OBJECTIVE to compare the values obtained by HBPM with those obtained by ABPM in the identification of patients with resistant hypertension. METHODS a total of 51 consecutive patients with resistant hypertension were selected. All were adults of both genders and were undergoing treatment in an outpatient referral clinic from January 2007 to September 2009. Casual office blood pressure (BP), 24-hour ABPM, and HBPM were performed according to current guidelines, with a maximum two-week interval between the methods. RESULTS the comparison of ABPM (mean daytime) with HBPM showed a good correlation between them, both for systolic blood pressure (SBP) and for diastolic blood pressure (DBP): SBP r = 0.70, CI = 0.51-0.82, DBP r = 0.69, CI = 0.52-0.81. RH was confirmed by ABPM in 33 patients and by HBPM in 37, with no significant difference between the methods. CONCLUSION according to the results obtained, we conclude that HBPM is a method that can be used as an alternative to ABPM for the diagnostic confirmation of RH.

I Posicionamento Brasileiro sobre Pre-Hipertensao, Hipertensao do Avental Branco e Hipertensao Mascarada: Diagnostico e Conduta

Repeated BP measurement at the office allows the diagnosis of hypertension and normotension. To better assess BP behavior, there are methods that analyze BP by using a higher number of measurements, minimizing interferences of the environment, situation and observer. Those alternatives are as follows: 24-hour ambulatory BP monitoring (ABPM); and dwelling BP measurement [home BP monitoring (HBPM) and BP self-measurement (BPSM)]. Based on those methods, two other BP classifications were adopted: white coat hypertension (WCH) and masked hypertension (MH)1,3-5 (Figure 1).

Distrofia muscular de Duchenne: análise eletrocardiográfica de 131 pacientes

FUNDAMENTO: E conhecido o envolvimento cardiaco em pacientes com distrofia muscular de Duchenne (DMD). O eletrocardiograma (ECG) apresenta algumas alteracoes tipicas na DMD, fato que o torna um exame util no diagnostico da lesao cardiaca nessa patologia. OBJETIVO: Avaliar as alteracoes eletrocardiograficas em pacientes portadores de DMD, correlacionando-as com a idade da populacao estudada. METODOS: Foram analisados os ECG de 131 pacientes com diagnostico de DMD. Avaliaram-se diversas variaveis eletrocardiograficas, sendo os pacientes separados em dois grupos: aqueles com e sem alteracoes, por variavel estudada. Fez-se a correlacao desses dois grupos com a idade dos pacientes. Foram utilizados os criterios de Garson para estabelecer os parâmetros eletrocardiograficos de normalidade. RESULTADOS: O ECG estava anormal em 78,6% dos pacientes. Todos apresentavam ritmo sinusal. Foram os seguintes os percentuais encontrados para as principais variaveis estudadas: PR curto = 18,3%, ondas R anormais em V1 = 29,7%, ondas Q anormais em V6 = 21,3%, alteracoes da repolarizacao ventricular = 54,9%, ondas QS anormais em paredes inferior e/ou lateral alta = 37,4%, disturbios de conducao pelo ramo direito = 55,7%, intervalo QTC prolongado = 35,8% e alargamento do QRS = 23,6%. O teste t nao pareado foi utilizado para se estabelecer a correlacao da idade com as variaveis eletrocardiograficas estudadas nos dois grupos e, apenas a variavel alteracao da repolarizacao mostrou diferenca estatisticamente significante. CONCLUSAO: As alteracoes eletrocardiograficas na DMD sao frequentes, revelando comprometimento cardiaco precoce. Apenas a variavel alteracao da repolarizacao ventricular foi mais frequente, porem em faixa etaria menor (p < 0,05).BACKGROUND Cardiac involvement is known to occur in patients with Duchenne muscular dystrophy (DMD). The electrocardiogram (ECG) shows some typical changes in DMD, which makes it a useful test for the diagnosis of cardiac lesion in this disease. OBJECTIVE To evaluate the electrocardiographic changes in patients with DMD and to correlate these changes with the age of the population studied. METHODS ECG of 131 patients diagnosed with DMD were examined. Several electrocardiographic variables were analyzed, and the patients were divided into two groups - one with and one without changes, for each variable studied. The correlation between the two groups and the age of the patients was analyzed. Garsons criteria were used to establish the electrocardiographic parameters of normality. RESULTS ECG was abnormal in 78.6% of the patients. All showed normal sinus rhythm. The following percentages were found for the main variables studied: short PR interval = 18.3%; abnormal R waves in V1 = 29.7%; abnormal Q waves in V6 = 21.3%; abnormal ventricular repolarization = 54.9%; abnormal QS waves in inferior and/or upper lateral wall = 37.4%; conduction disturbances in right bundle branch = 55.7%; prolonged QT C interval = 35.8%, and wide QRS = 23.6%. Unpaired t test was used to establish the correlation between age and the electrocardiographic variables studied in the two groups. Statistically significant differences were found only for the abnormal repolarization variable. CONCLUSION Electrocardiographic abnormalities are common in DMD, revealing early cardiac involvement. Only the abnormal ventricular repolarization variable was more frequent, however at a lower age range (p < 0.05).

I Posicionamento Brasileiro sobre Combinação de Fármacos Anti-Hipertensivos

Arterial hypertension (AH) is a highly prevalent disease, and is a major cardiovascular (CV) risk factor1; therefore, achieving blood pressure (BP) control goals as soon as possible is paramount to reduce that risk2. That means that approximately 70% of hypertensive individuals will need antihypertensive drug combination3, and up to 30% of hypertensive individuals are estimated to use four or more drugs to achieve BP control4. Thus, drug combination is currently described as an important strategy to manage AH, providing effective and safe BP reduction. Drug choice is based on effective BP reduction and CV outcomes. Despite the existence of a significant number of drugs to treat AH, their control rates are still very low, contributing to the high CV morbidity and mortality rates observed in Brazil and worldwide1,2. According to the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) and the Hypertension Optimal Treatment (HOT) Study, only 26% and 33% of the patients, respectively, could control their BP with monotherapy, while in the Losartan Intervention for Endpoints Reduction (LIFE) Study, 90% of the patients needed combined therapy for that purpose3 . Drug combination is mainly aimed at increasing antihypertensive efficacy, with fewer adverse events. It is worth noting the importance of considering therapy adherence. The pathophysiology of AH involves multiple factors and mechanisms, making its control difficult when only one drug is used, because counterregulatory mechanisms that attenuate the antihypertensive effect of the drug can occur. The association of drugs with different mechanisms of action has a greater impact on BP reduction as long as there is pharmacokinetic compatibility and no disparity of effects and properties3-5. Thus, the choice of the drugs to be combined should contemplate two aspects: synergism of the mechanisms of action and opposition to counterregulatory mechanisms triggered after the beginning of therapy with a certain drug. The desired antihypertensive efficacy is more likely to be achieved by using lower doses of the drugs involved. Thus, fewer adverse events are observed, with no loss of antihypertensive drug potency3-5. Another important aspect is that drugs should be preferably combined in a single galenic presentation, facilitating their administration, and assuring lower cost, with a consequent improvement in treatment adherence2,6.

Distrofia muscular de duchenne: análisis electrocardiográfica de 131 pacientes

FUNDAMENTO: E conhecido o envolvimento cardiaco em pacientes com distrofia muscular de Duchenne (DMD). O eletrocardiograma (ECG) apresenta algumas alteracoes tipicas na DMD, fato que o torna um exame util no diagnostico da lesao cardiaca nessa patologia. OBJETIVO: Avaliar as alteracoes eletrocardiograficas em pacientes portadores de DMD, correlacionando-as com a idade da populacao estudada. METODOS: Foram analisados os ECG de 131 pacientes com diagnostico de DMD. Avaliaram-se diversas variaveis eletrocardiograficas, sendo os pacientes separados em dois grupos: aqueles com e sem alteracoes, por variavel estudada. Fez-se a correlacao desses dois grupos com a idade dos pacientes. Foram utilizados os criterios de Garson para estabelecer os parâmetros eletrocardiograficos de normalidade. RESULTADOS: O ECG estava anormal em 78,6% dos pacientes. Todos apresentavam ritmo sinusal. Foram os seguintes os percentuais encontrados para as principais variaveis estudadas: PR curto = 18,3%, ondas R anormais em V1 = 29,7%, ondas Q anormais em V6 = 21,3%, alteracoes da repolarizacao ventricular = 54,9%, ondas QS anormais em paredes inferior e/ou lateral alta = 37,4%, disturbios de conducao pelo ramo direito = 55,7%, intervalo QTC prolongado = 35,8% e alargamento do QRS = 23,6%. O teste t nao pareado foi utilizado para se estabelecer a correlacao da idade com as variaveis eletrocardiograficas estudadas nos dois grupos e, apenas a variavel alteracao da repolarizacao mostrou diferenca estatisticamente significante. CONCLUSAO: As alteracoes eletrocardiograficas na DMD sao frequentes, revelando comprometimento cardiaco precoce. Apenas a variavel alteracao da repolarizacao ventricular foi mais frequente, porem em faixa etaria menor (p < 0,05).BACKGROUND Cardiac involvement is known to occur in patients with Duchenne muscular dystrophy (DMD). The electrocardiogram (ECG) shows some typical changes in DMD, which makes it a useful test for the diagnosis of cardiac lesion in this disease. OBJECTIVE To evaluate the electrocardiographic changes in patients with DMD and to correlate these changes with the age of the population studied. METHODS ECG of 131 patients diagnosed with DMD were examined. Several electrocardiographic variables were analyzed, and the patients were divided into two groups - one with and one without changes, for each variable studied. The correlation between the two groups and the age of the patients was analyzed. Garsons criteria were used to establish the electrocardiographic parameters of normality. RESULTS ECG was abnormal in 78.6% of the patients. All showed normal sinus rhythm. The following percentages were found for the main variables studied: short PR interval = 18.3%; abnormal R waves in V1 = 29.7%; abnormal Q waves in V6 = 21.3%; abnormal ventricular repolarization = 54.9%; abnormal QS waves in inferior and/or upper lateral wall = 37.4%; conduction disturbances in right bundle branch = 55.7%; prolonged QT C interval = 35.8%, and wide QRS = 23.6%. Unpaired t test was used to establish the correlation between age and the electrocardiographic variables studied in the two groups. Statistically significant differences were found only for the abnormal repolarization variable. CONCLUSION Electrocardiographic abnormalities are common in DMD, revealing early cardiac involvement. Only the abnormal ventricular repolarization variable was more frequent, however at a lower age range (p < 0.05).

Evaluación de la Hipertensión Arterial Resistente por Monitoreo Residencial de la Presión Arterial

BACKGROUND: Ambulatory blood pressure monitoring (ABPM) is considered the gold standard for the diagnostic confirmation of resistant hypertension (RH). However, home blood pressure monitoring (HBPM) has been considered an option, because of its lower cost and greater comfort. OBJECTIVE: To compare the values obtained by HBPM with those obtained by ABPM in the identification of patients with resistant hypertension. METHODS: A total of 51 consecutive patients with resistant hypertension were selected. All were adults of both genders and were undergoing treatment in an outpatient referral clinic from January 2007 to September 2009. Casual office blood pressure (BP), 24-hour ABPM, and HBPM were performed according to current guidelines, with a maximum two-week interval between the methods. RESULTS: The comparison of ABPM (mean daytime) with HBPM showed a good correlation between them, both for systolic blood pressure (SBP) and for diastolic blood pressure (DBP): SBP r = 0.70, CI = 0.51-0.82, DBP r = 0.69, CI = 0.52-0.81. RH was confirmed by ABPM in 33 patients and by HBPM in 37, with no significant difference between the methods. CONCLUSION: According to the results obtained, we conclude that HBPM is a method that can be used as an alternative to ABPM for the diagnostic confirmation of RH.BACKGROUND ambulatory blood pressure monitoring (ABPM) is considered the gold standard for the diagnostic confirmation of resistant hypertension (RH). However, home blood pressure monitoring (HBPM) has been considered an option, because of its lower cost and greater comfort. OBJECTIVE to compare the values obtained by HBPM with those obtained by ABPM in the identification of patients with resistant hypertension. METHODS a total of 51 consecutive patients with resistant hypertension were selected. All were adults of both genders and were undergoing treatment in an outpatient referral clinic from January 2007 to September 2009. Casual office blood pressure (BP), 24-hour ABPM, and HBPM were performed according to current guidelines, with a maximum two-week interval between the methods. RESULTS the comparison of ABPM (mean daytime) with HBPM showed a good correlation between them, both for systolic blood pressure (SBP) and for diastolic blood pressure (DBP): SBP r = 0.70, CI = 0.51-0.82, DBP r = 0.69, CI = 0.52-0.81. RH was confirmed by ABPM in 33 patients and by HBPM in 37, with no significant difference between the methods. CONCLUSION according to the results obtained, we conclude that HBPM is a method that can be used as an alternative to ABPM for the diagnostic confirmation of RH.