Paulo César Brandão Veiga Jardim

Hipertensão arterial e alguns fatores de risco em uma capital brasileira

OBJECTIVES: Estimate the prevalence of hypertension and some cardiovascular risk factors in the adult population of a major city in Brazil. METHODS: Descriptive, observational, transversal population-based study substantiated by the home survey of a simple random sample (>18 years old). Standardized questionnaires were used to obtain sociodemographic information, measurements of blood pressure (2 measurements), weight, height, and abdominal circumference (AC). Microsoft Access and Epi Info 6 were used for data storage and analysis, respectively. The last blood pressure reading was used (hypertension: BP>140x90mmHg). RESULTS: The study evaluated 1,739 individuals (87% of the estimated sample). There was a predominance of females (65.4%) and mean age was 39.7 years (±15.6); arterial hypertension prevalence was 36.4%, higher for the male population (41.8%) when compared to females (31.8%). Correlation between Hypertension and Body Mass Index was positive, as well as with AC and age. The female gender and higher income were protective factors against hypertension. There was no correlation with schooling. Prevalence of overweight and obesity were 30.0% and 13.6%, respectively; overweight was higher among females and obesity among males. The prevalence of smoking was 20.1%, more frequent among males (27.1%), when compared to females (16.4%). A sedentary lifestyle was observed in 62.3% of the population, with no difference between the genders. Regular alcohol consumption was reported by 44.4% of the individuals, being more frequent in males. CONCLUSION: Hypertension and other cardiovascular risk factors (particularly overweight/obesity) indicators are high, reinforcing the need for objective nationwide measures to fight this disease, in order to reduce CVD morbidity and mortality.

Validade do peso e da altura auto-referidos: o estudo de Goiânia

OBJECTIVE To assess the validity of self-reported weight and height at the time of diagnosing obesity, and to identify the sociodemographic and individual characteristics that might be a source of information bias. METHODS This was a cross-sectional population-based study carried out in the city of Goiânia in 2001. Interviews were conducted with 1,023 individuals aged 20-64 years, in their homes, to collect sociodemographic and self-reported weight and height information. On the same occasion, weight and height measurements were made on these individuals. The mean differences and correlation coefficients between self-reported and measured data were calculated according to age, body mass index (BMI), schooling, income and height. RESULTS Both the men and women overestimated their heights (p<0.05), by 0.9 cm and 2.2 cm, respectively. There was no difference between self-reported and measured weights, either for the men (-0.44 kg; p=0.06) or for the women (-0.03 kg; p>0.05). The behavior of overestimating height was influenced by age, schooling, height and body mass index. Although this index obtained from the self-reported data was underestimated (p<0.05), by 0.27 kg/m(2) and 0.67 kg/m(2) for men and women respectively, the measured and self-reported data presented a high degree of agreement. Both the sensitivity and specificity of the self-reported body mass index were high, in relation to identifying the measured index. CONCLUSIONS In epidemiological studies for monitoring the prevalence of excess weight in populations, self-reported weights and heights constitute reliable data, which gives validity to the methodology utilized.

Determinantes de risco para doenças cardiovasculares em escolares

OBJECTIVE To investigate the occurrence and association of arterial hypertension with several lifestyle variables. METHODS Transversal population-based study with a random sample of students (7 to 14 years of age) of public and private schools. Variables investigated were nutritional status, blood pressure, and lifestyle (tobacco use, alcohol intake, physical activity and eating habits). RESULTS Out of the 3,169 schoolchildren assessed, 5.0% had arterial hypertension and 6.2% had normal-high blood pressure. Classification by gender shows boys 6.4% and girls 6.0% with normal-high blood pressure, and boys 4.3% and girls 5.7% with arterial hypertension. Body mass index (BMI) measurements identified 16.0% excess weight students, 4.9% of whom were obese. A significant association (p = 0.01) between arterial hypertension and excess weight was observed. Among the students participating in the study, 11.6% did not attend physical education classes and 37.8% had sedentary leisure habits. Twenty students (0.6%) were smokers and 32.7% had already experimented with alcohol. None of these variables showed statistical significance as to blood pressure values and nutritional status. CONCLUSION In light of the findings in this study which show schoolchildren with a higher than expected frequency of mean blood pressure and BMI values, associated with a lifestyle that tends to favour the development of cardiovascular diseases, we felt led to propose interventional measures focused on the school as an agent of change and capable of conveying information to family units. This possibility encourages us to propose that schools be partners in promoting health.

Circunferência da cintura e índice de massa corporal como preditores da hipertensão arterial

OBJECTIVE: To evaluate the association between anthropometric indexes - body mass index (BMI) and waist circumference (WC) - and hypertension, and to evaluate the predictive value of these indexes in detecting hypertension. METHODS: Cross-sectional population study conducted in the city of Goiânia (GO) with a sample of 1,238 adults aged twenty to 64 years, in 2001. Total obesity was defined as BMI > 30 kg/m2; abdominal obesity was defined as level 2 WC > 88 cm for women and > 102 cm for men, and hypertension was defined as systolic pressure > 140 mmHg, or diastolic pressure > 90 mmHg, or utilization of hypotensive drugs). Multiple logistic regression analysis was used to evaluate the associations between anthropometric indexes and hypertension. The Receiver Operating Characteristic (ROC) curve analysis was used to evaluate sensitivity and specificity of BMI (> 30) and level 2 WC as predictive factors of hypertension, and to determine the best predictive cut-off points for hypertension. RESULTS: WC was associated with hypertension in both genders. Level 2 WC and BMI >30 kg/m2 showed a low sensitivity in identifying hypertension. The best predictive cut-off points for hypertension coincided with level 1 WC (> 80 cm) and with BMI >25 kg/m2 (overweight) for women, and were lower than the values of level 1 WC and of overweight for men. CONCLUSION: Level 2 WC and BMI > 30 kg/m2 are not adequate to identify the groups at the highest risk of hypertension, since this risk rises with small increases in adiposity.

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.

The relationship between body mass index and lifestyle in a Brazilian adult population: a cross-sectional survey

This study focused on adult obesity prevalence in Goiânia, Goiás State, Brazil, and the association between socio-demographic variables, lifestyle, physical activity, eating habits, and food consumption frequency and body mass index (BMI). A cross-sectional study was conducted in 2001 with a sample of 1,252 individuals from 20 to 64 years of age. The association between socio-demographic variables, lifestyle, food consumption, and physical activity and BMI was evaluated by hierarchical multiple linear regression analysis. Obesity prevalence was 10.7% in men and 13.9% in women. In males, age, income, and meat consumption showed a positive association with BMI, while physical activity during leisure time and commuting and the habit of eating > 4 meals per day were inversely associated with BMI. In women, positively associated factors were age, no smoking, and no meat consumption; in contrast, consumption of grains was inversely associated with BMI. High obesity prevalence was observed; active lifestyle coupled with ingestion of more grains and less meat appeared to protect against increased BMI.

[The influence of programmed physical activity on blood pressure of hypertensive elderly patients on non-pharmacological treatment].

OBJECTIVE Assess the influence of physical activity on the blood pressure of hypertensive elderly patients on non-pharmacological treatment (NPT). METHODS The authors studied men and women, over 60 years, with stage I hypertension who were not using antihypertensive medication. These patients had been randomly allocated to one of two groups: Control Group (CG) - oriented to NPT; and Study Group (SG) - NPT and a program that included supervised physical activity consisting of 1-hour sessions, 3 times a week. Duration of the study was 6 months. Screening and follow-up tests every 3 months, at Visits 1, 2 and 3 included a clinical evaluation, ECG, a treadmill stress test, Ambulatory Blood Pressure Measurement (ABPM) and an Echocardiogram. The authors used the Friedman test for the evolutionary analysis of the intra-groups means and Students t test to compare independent data between groups. RESULTS Twenty-four patients were randomized in the SG (5 men) and 21 in the CG (4 men). The 6-month follow-up period was completed by 22 patients in the SG and 13 in the CG. Blood pressures found by the ABPM in V1, V2 and V3 were 134.2 +/-14.5, 136.1 +/-9 and 143.7+/-13.9 mmHg for Systolic Blood Pressure in the CG; and 135.6 +/-11.4, 138.7 +/-12.2 and 133.9 +/-8.5 mmHg in the SG. For Diastolic Blood Pressure, values in the CG were 78.7+/-5.8, 82.3+/-6.2 and 83.3 +/-9.2 mmHg; and in the SG, 80.1 +/-6.8, 81+/-6.6 and 80.8 +/-7.3 mmHg. CONCLUSION Programmed and supervised physical activity was more efficient for maintaining adequate blood pressure control in these elderly with stage I hypertension in the study group, when compared to the control group.

Fatores associados à prática de atividade física na população adulta de Goiânia: monitoramento por meio de entrevistas telefônicas

INTRODUCAO: A pratica regular de atividades fisicas entre os niveis moderados e vigorosos tem relacao inversa com a morbidade-mortalidade por doencas cardiovasculares e obesidade. E fundamental a identificacao dos determinantes desta pratica para serem propostas estrategias populacionais com vista a adocao de um estilo de vida fisicamente ativo. OBJETIVO: O presente estudo teve por objetivo determinar os fatores associados a pratica de atividade fisica e ao sedentarismo na populacao adulta de Goiânia. MATERIAL E METODOS: Trata-se de parte de um estudo multicentrico, transversal, realizado na cidade de Goiânia/GO com amostra probabilistica da populacao adulta atendida por linhas telefonicas fixas. Foram realizadas 2.002 entrevistas por meio de ligacoes telefonicas, definindo uma taxa de sucesso de 73,1%. A construcao do banco de dados e as analises estatisticas foram realizadas com auxilio do aplicativo STATA, versao 8.0. RESULTADOS: O sedentarismo foi mais prevalente entre as mulheres (55,5%) que entre os homens (42,0%). A prevalencia de hipertensao foi menor naqueles individuos que praticavam atividade fisica (p=0,0002). Em relacao a atividade fisica no lazer, as mulheres foram mais inativas (79,3%) que os homens (66,9%). Houve relacao inversa entre sedentarismo e escolaridade em ambos os sexos. CONCLUSAO: Diante do quadro encontrado de alta frequencia de sedentarismo na populacao, sugere-se a implementacao de estrategias de prevencao primaria para melhorar o perfil de risco para doencas cronicas nao transmissiveis.

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.