Luiz César Nazário Scala

Prevalência, controle e tratamento da hipertensão arterial sistêmica em Nobres - MT

Metodos: Estudio transversal, de base poblacional, con muestreo aleatorio y con reposicion. El criterio para la clasificacion de la HAS fue la presion arterial (PA) ≥ 140/90 mmHg o el uso actual de antihipertensivos. Se realizaron las entrevistas utilizandose encuestas estandarizadas y comprobadas previamente. Se describieron las variables por promedios ± desviaciones estandar y frecuencias. Se compararon los promedios utilizandose el test t-Student y las asociaciones por medio del test de chi-cuadrado de Pearson, con nivel de significancia del 5%.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) > or =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 > or = 25 kg/m(2); 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.

Associação entre marcadores antropométricos de adiposidade corporal e hipertensão arterial na população adulta de Cuiabá, Mato Grosso

OBJECTIVE: To assess the association between the anthropometric indexes of body adiposity (body mass index - BMI and waist circumference) and hypertension. METHODS: This is a population-based cross-sectional study, carried out from 2003 to 2004, with 1,298 individuals between 20 and 59 years of age. Individuals with blood pressure > 140/90 mmHg using anti-hypertensive medication were considered hypertensive. The associations between anthropometric indexes and hypertension were analyzed through Poissons regression, adjusted for potential confounding factors (sex, age, schooling, smoking, alcohol consumption and physical activity during leisure time). The ROC curve was used to determine the best BMI cutoff point for detection of hypertension. RESULTS: The prevalence of hypertension was 28.3%, being 33.5% among males, and 23.5% among females. After adjustment for BMI and potential confounding factors, waist circumference lost its association with the evaluated outcomes, and BMI alone accounted for hypertension (PR = 1.05, p = 0.001). The best cutoff point for BMI for males was 25.6 Kg/m2, and for females, 25.7 Kg/m2. CONCLUSIONS: The association observed between waist circumference and hypertension in several studies may be related to the lack of control of potential confounding factors in analyses, and to the fact that the effect of total body adiposity was not eliminated. Further investigations should be conducted in the Brazilian population to check true associations among anthropometric indexes with several outcomes, also investigating the best cutoff points for such indexes.

Metabolic syndrome in patients with high blood pressure in Cuiabá - Mato Grosso State: prevalence and associated factors

BACKGROUND Metabolic Syndrome (MS) is a cluster of predisposing factors for cardiovascular diseases and diabetes mellitus, whose epidemiological characteristics are poorly known at regional and national levels. OBJECTIVE To estimate the prevalence of MS and its associated factors in a sample of patients with high blood pressure in the urban area of Cuiabá, Mato Grosso State. METHODS This was a cross-sectional study (May to November 2007) in a sample of 120 patients with high blood pressure (aged > or = 20 years), paired by gender and selected by the systematic sampling of a source population of 567 patients with high blood pressure in Cuiabá. All patients answered to home inquiries to provide sociodemographic and life habits data. The following measurements were taken: blood pressure; body mass index (BMI); waist and hip circumferences; plasma glucose, insulin, and lipid levels; homeostasis model assessment-estimated insulin resistance (HOMA); C-reactive protein, uric acid and fibrinogen levels. High blood pressure criterion: average systolic blood pressure > or = 140 mmHg and/or diastolic blood pressure > or = 90 mmHg; and Metabolic Syndrome diagnosis according to the I Brazilian Directive for Metabolic Syndrome and the NCEP-ATP III criteria. RESULTS 120 patients (60 women), with high blood pressure and an average age of 58.3 +/- 12.6 years, were analyzed. We found a MS prevalence of 70.8% (95%CI 61.8 to 78.8), predominantly among women (81.7% vs. 60.0%; p=0.009), with no difference between adults (71.4%) and elderly patients (70.2%). The multiple regression analysis showed a positive association between MS and BMI > or = 25 kg/m(2), insulin resistance and family history of high blood pressure. CONCLUSION A high prevalence of MS was observed among patients with high blood pressure living in Cuiabá, with a significant association with BMI > or = 25 kg/m(2), insulin resistance (HOMA index) and, especially, a family history of high blood pressure. These results suggest the need for deeper studies on this subject.

Prevention of hypertension in patients with pre-hypertension: protocol for the PREVER-prevention trial

BackgroundBlood pressure (BP) within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a population-based intervention to prevent the incidence of hypertension and the development of target-organ damage.MethodsThis is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution.DiscussionThe early use of blood pressure-lowering drugs, particularly diuretics, which act on the main mechanism of blood pressure rising with age, may prevent cardiovascular events and the incidence of hypertension in individuals with hypertension. If this intervention shows to be effective and safe in a population-based perspective, it could be the basis for an innovative public health program to prevent hypertension in Brazil.Trial RegistrationClinical Trials NCT00970931.

Hipertensão arterial e sua associação com índices antropométricos em adultos de uma cidade de pequeno porte do interior do Brasil

OBJECTIVE Estimate the prevalence of Arterial Hypertension (AH) and its association with Body Mass Index (BMI) and Abdominal Circumference (AC) in the adult population from the city of Firminópolis, in the state of Goiás, Brazil. METHODS Descriptive, observational, cross sectional population-based study substantiated by a home survey of a simple random sample (> or = 18 years old). The study evaluated 1168 individuals. Standardized questionnaires. Measurements performed were Blood Pressure (BP) (hypertension: BP > or = 140 x 90 mmHg), weight, height and AC. Microsoft Office Access and Epi-info, 3.3.2 version were used for data storage and analysis, respectively. RESULTS There was a predominance of females (63.2%), mean age was 43.2 +/-14.9 years old. Prevalence of hypertension was 32.7%, with tendency to be higher among the male population (35.8%) when compared to the female (30.9%) (p=0.084). Association between AH and BMI was positive (p < 0.001), as well as between AC and age. Prevalence of overweight was 33.7% and obesity, 16.0%. Overweight was higher among the male population and obesity among the female population. Prevalence of increased as well as greatly increased AC in 51.9% of the studied population, with 28.6% among males and 65.5% among females. CONCLUSION A high prevalence of hypertension and a large number of individuals with BMI and AC above the ideal values were found.OBJETIVO: Estimar a prevalencia da Hipertensao Arterial (HA) em adultos e sua associacao com o Indice de Massa Corporal (IMC) e Circunferencia da Cintura (CC). METODOS: Estudo descritivo, observacional e transversal, de base populacional, com amostra aleatoria simples (>18 anos). Investigados 1.168 individuos. Questionarios padronizados. Realizadas medidas de pressao arterial (criterio de HA > 140x90mmHg), peso, altura e CC. Dados armazenados (programa Microsoft Access) e analisados por meio do programa Epi-info, versao 3.3.2. RESULTADOS: Predominio do sexo feminino (63,2%), idade media 43,2 ± 14,9 anos. Prevalencia de HA de 32,7%, com tendencia a ser maior entre homens (35,8%) que entre mulheres (30,9%) (p=0,084). Associacao positiva (p<0,001) da HA com a idade, IMC e CC. Prevalencia de sobrepeso 33,7% e de obesidade 16,0%. Sobrepeso maior entre homens e obesidade entre mulheres. Prevalencia CC aumentada e muito aumentada em 51,9% da populacao estudada, sendo de 28,6% entre homens e 65,5% entre mulheres. CONCLUSAO: Foi encontrada alta prevalencia de HA e grande contingente de individuos com IMC e CC acima de valores ideais.

Fatores associados à hipertensão arterial sistêmica em Nobres-MT

OBJECTIVE: To identify the factors associated to systemic arterial hypertension (SAH) in Nobres -MT, Brazil. METHOD: A cross-sectional study was carried out in Nobres-MT, from January to March, 2006; 1003 individuals aged more than 18 years, resident in the urban region were analyzed. Data was obtained through household questionnaires. Measurements of weight, height, waist circumference and blood pressures (BP) were taken. The second of three BP measurements was used in the analysis; SAH was defined as BP > 140/90 mmHg. The Poisson regression method was used for controlling confounding factors, with adjusted prevalence ratio (PR) estimates and their respective 95% confidence intervals. RESULTS: 1003 individuals were evaluated (51.3% male). SAH prevalence was 30.1%, and it was higher among women than men (30.1% vs. 20.9%). Adjusted analysis confirmed independent association between SAH, aging and body mass index equal or over 25 Kg/m2. CONCLUSION: We reaffirm the need of actions both at population and individual levels targeting weight control, especially for people over 30 years of age, which could significantly reflect on SAH control.

Effectiveness of Chlorthalidone Plus Amiloride for the Prevention of Hypertension: The PREVER‐Prevention Randomized Clinical Trial

Background Prehypertension is associated with higher cardiovascular risk, target organ damage, and incidence of hypertension. The Prevention of Hypertension in Patients with PreHypertension (PREVER‐Prevention) trial aimed to evaluate the efficacy and safety of a low‐dose diuretic for the prevention of hypertension and end‐organ damage. Methods and Results This randomized, parallel, double‐blind, placebo‐controlled trial was conducted in 21 Brazilian academic medical centers. Participants with prehypertension who were aged 30 to 70 years and who did not reach optimal blood pressure after 3 months of lifestyle intervention were randomized to a chlorthalidone/amiloride combination pill or placebo and were evaluated every 3 months during 18 months of treatment. The primary outcome was incidence of hypertension. Development or worsening of microalbuminuria, new‐onset diabetes mellitus, and reduction of left ventricular mass were secondary outcomes. Participant characteristics were evenly distributed by trial arms. The incidence of hypertension was significantly lower in 372 study participants allocated to diuretics compared with 358 allocated to placebo (hazard ratio 0.56, 95% CI 0.38–0.82), resulting in a cumulative incidence of 11.7% in the diuretic arm versus 19.5% in the placebo arm (P=0.004). Adverse events; levels of blood glucose, glycosylated hemoglobin, creatinine, and microalbuminuria; and incidence of diabetes mellitus were no different between the 2 arms. Left ventricular mass assessed through Sokolow‐Lyon voltage and voltage‐duration product decreased to a greater extent in participants allocated to diuretic therapy compared with placebo (P=0.02). Conclusions A combination of low‐dose chlorthalidone and amiloride effectively reduces the risk of incident hypertension and beneficially affects left ventricular mass in patients with prehypertension. Clinical Trial Registration URL: http://www.ClinicalTrials.gov, www.ensaiosclinicos.gov. Unique identifiers: NCT00970931, RBR‐74rr6s.

Hipertensão arterial e sua correlação com alguns fatores de risco em cidade brasileira de pequeno porte

BACKGROUND: Arterial hypertension (AH) is a health problem that affects a large number of undiagnosed or inadequately treated hypertensive individuals and presents a high rate of treatment nonadherence. OBJECTIVE: To estimate the prevalence of AH and its correlation with some cardiovascular risk factors among the adult population of the town of Firminopolis, state of Goias, Brazil. METHODS: Descriptive, observational and cross-sectional population-based study of a simple random sample (age > 18 years): standardized questionnaires with blood pressure (BP) measurements (AH criterion: BP > 140 x 90 mmHg), weight, height, Body Mass Index (BMI) and waist circumference (WC). Data were stored (Microsoft Access) and analyzed using Epi-info software. RESULTS: We evaluated 1,168 individuals, with a predominance of the female sex - 63.2% and a mean age of 43.2 ± 14.9 years. There was a prevalence of overweight in 33.7% of the individuals and obesity in 16.0% of the individuals. There was a prevalence of altered WC in 51.8% demand of smoking in 23.2%. A sedentary life style at work and leisure activities was present in 67.6% and 64.8% of the individuals, respectively, with a higher proportion seen among the women. Alcohol consumption was observed in 33.3% of the sample. The prevalence of AH was 32.7%, higher among the men (35.8%) than among the women (30.9%). A positive correlation with AH was identified with BMI, WC and age range. A negative correlation was observed between AH and level of schooling, with 18.2% of hypertensive individuals with 9 or more years of schooling. CONCLUSION: A high prevalence of AH, overweight and WC alteration was identified. The female sex represented a protective factor for the risk of AH. A positive correlation was found between AH and BMI, WC and age range; a negative correlation was identified between AH and level of schooling.BACKGROUND arterial hypertension (AH) is a health problem that affects a large number of undiagnosed or inadequately treated hypertensive individuals and presents a high rate of treatment nonadherence. OBJECTIVE to estimate the prevalence of AH and its correlation with some cardiovascular risk factors among the adult population of the town of Firminopolis, state of Goiás, Brazil. METHODS descriptive, observational and cross-sectional population-based study of a simple random sample (age > 18 years): standardized questionnaires with blood pressure (BP) measurements (AH criterion: BP > 140 x 90 mmHg), weight, height, Body Mass Index (BMI) and waist circumference (WC). Data were stored (Microsoft Access) and analyzed using Epi-info software. RESULTS we evaluated 1,168 individuals, with a predominance of the female sex - 63.2% and a mean age of 43.2 ± 14.9 years. There was a prevalence of overweight in 33.7% of the individuals and obesity in 16.0% of the individuals. There was a prevalence of altered WC in 51.8% demand of smoking in 23.2%. A sedentary life style at work and leisure activities was present in 67.6% and 64.8% of the individuals, respectively, with a higher proportion seen among the women. Alcohol consumption was observed in 33.3% of the sample. The prevalence of AH was 32.7%, higher among the men (35.8%) than among the women (30.9%). A positive correlation with AH was identified with BMI, WC and age range. A negative correlation was observed between AH and level of schooling, with 18.2% of hypertensive individuals with 9 or more years of schooling. CONCLUSION a high prevalence of AH, overweight and WC alteration was identified. The female sex represented a protective factor for the risk of AH. A positive correlation was found between AH and BMI, WC and age range; a negative correlation was identified between AH and level of schooling.

Arterial hypertension and its correlation with some risk factors in a small brazilian town

BACKGROUND: Arterial hypertension (AH) is a health problem that affects a large number of undiagnosed or inadequately treated hypertensive individuals and presents a high rate of treatment nonadherence. OBJECTIVE: To estimate the prevalence of AH and its correlation with some cardiovascular risk factors among the adult population of the town of Firminopolis, state of Goias, Brazil. METHODS: Descriptive, observational and cross-sectional population-based study of a simple random sample (age > 18 years): standardized questionnaires with blood pressure (BP) measurements (AH criterion: BP > 140 x 90 mmHg), weight, height, Body Mass Index (BMI) and waist circumference (WC). Data were stored (Microsoft Access) and analyzed using Epi-info software. RESULTS: We evaluated 1,168 individuals, with a predominance of the female sex - 63.2% and a mean age of 43.2 ± 14.9 years. There was a prevalence of overweight in 33.7% of the individuals and obesity in 16.0% of the individuals. There was a prevalence of altered WC in 51.8% demand of smoking in 23.2%. A sedentary life style at work and leisure activities was present in 67.6% and 64.8% of the individuals, respectively, with a higher proportion seen among the women. Alcohol consumption was observed in 33.3% of the sample. The prevalence of AH was 32.7%, higher among the men (35.8%) than among the women (30.9%). A positive correlation with AH was identified with BMI, WC and age range. A negative correlation was observed between AH and level of schooling, with 18.2% of hypertensive individuals with 9 or more years of schooling. CONCLUSION: A high prevalence of AH, overweight and WC alteration was identified. The female sex represented a protective factor for the risk of AH. A positive correlation was found between AH and BMI, WC and age range; a negative correlation was identified between AH and level of schooling.BACKGROUND arterial hypertension (AH) is a health problem that affects a large number of undiagnosed or inadequately treated hypertensive individuals and presents a high rate of treatment nonadherence. OBJECTIVE to estimate the prevalence of AH and its correlation with some cardiovascular risk factors among the adult population of the town of Firminopolis, state of Goiás, Brazil. METHODS descriptive, observational and cross-sectional population-based study of a simple random sample (age > 18 years): standardized questionnaires with blood pressure (BP) measurements (AH criterion: BP > 140 x 90 mmHg), weight, height, Body Mass Index (BMI) and waist circumference (WC). Data were stored (Microsoft Access) and analyzed using Epi-info software. RESULTS we evaluated 1,168 individuals, with a predominance of the female sex - 63.2% and a mean age of 43.2 ± 14.9 years. There was a prevalence of overweight in 33.7% of the individuals and obesity in 16.0% of the individuals. There was a prevalence of altered WC in 51.8% demand of smoking in 23.2%. A sedentary life style at work and leisure activities was present in 67.6% and 64.8% of the individuals, respectively, with a higher proportion seen among the women. Alcohol consumption was observed in 33.3% of the sample. The prevalence of AH was 32.7%, higher among the men (35.8%) than among the women (30.9%). A positive correlation with AH was identified with BMI, WC and age range. A negative correlation was observed between AH and level of schooling, with 18.2% of hypertensive individuals with 9 or more years of schooling. CONCLUSION a high prevalence of AH, overweight and WC alteration was identified. The female sex represented a protective factor for the risk of AH. A positive correlation was found between AH and BMI, WC and age range; a negative correlation was identified between AH and level of schooling.

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

Metodos: Estudio transversal, de base poblacional, con muestreo aleatorio y con reposicion. El criterio para la clasificacion de la HAS fue la presion arterial (PA) ≥ 140/90 mmHg o el uso actual de antihipertensivos. Se realizaron las entrevistas utilizandose encuestas estandarizadas y comprobadas previamente. Se describieron las variables por promedios ± desviaciones estandar y frecuencias. Se compararon los promedios utilizandose el test t-Student y las asociaciones por medio del test de chi-cuadrado de Pearson, con nivel de significancia del 5%.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) > or =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 > or = 25 kg/m(2); 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.