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This is the first longitudinal study evaluating whether adiposity is associated with inter-arm blood pressure difference. We evaluated 714 overweight/obese individuals aged 40-65 years over a 3-year follow-up. Systolic and diastolic blood pressures were measured in both arms simultaneously using an automated machine. Linear regression assessed the associations of body mass index, fat %, waist, neck, thigh, and arm circumferences (cm), with absolute inter-arm differences in systolic (IAS) and diastolic (IAD) blood pressure (mm Hg). Poisson regression was used for binary outcomes (IAS and IAD ≥ 10 mm Hg). All models were adjusted for age, gender, smoking, physical activity, and HOMA-IR. Adiposity measures were associated with increased IAS and IAD (ß range: 0.09-0.20 and 0.09-0.30). Neck circumference showed the strongest association with IAS (ß = 0.20, 95% CI: 0.03, 0.37) and IAD (ß = 0.30, 95% CI: 0.12, 0.47); arm circumference showed a similar association with IAS, but lower with IAD. Highest quartiles of BMI, thigh, and arm showed significant associations with IAS (IRR: 2.21, 2.46 and 2.70). Highest quartiles of BMI, waist, neck, and arm circumferences were significantly associated with IAD (IRR: 2.38, 2.68, 4.50 and 2.24). If the associations are corroborated in other populations, adiposity may be an important modifiable risk factor for inter-arm blood pressure difference with a large potential public health impact.

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RESUMEN Se presenta la segunda parte de las recomendaciones latinoamericanas para el manejo de la Hipertensión Arterial (HTA) en adultos. En una primera fase se han descripto los aspectos más relevantes de la epidemiología, aspectos fisiopatológicos, cómo hacer diagnóstico, pautas terapéuticas, urgencias y emergencias hipertensivas, poblaciones especiales, hipertensión refractaria y la aplicación de las guías en la vida real. En esta segunda parte, se emiten recomendaciones respondiendo a preguntas específicas para prevención primaria, secundaria, terciaria y cuaternaria. En general pocas recomendaciones al respecto del manejo de la hipertensión arterial surgen desde la clínica médica/ medicina interna, a pesar de dos situaciones: la mayoría de los pacientes con hipertensión arterial son evaluados y manejados por los clínicos, y la clínica médica es la especialidad que permite la mirada holística e integrada de los problemas de salud del adulto, permitiendo agregar el enfoque biográfico al biológico, comprender e interpretar no solo el problema de salud sino sus causas y consecuencias (que muchas veces suelen corresponder a diferentes parénquimas, lo cual en el modelo fragmentado haría transitar al paciente por distintas especialidades). El bajo porcentaje de pacientes hipertensos controlados obliga a todos los profesionales involucrados en el manejo de los mismos a optimizar recursos y detectar problemas que se asocien a un control deficitario como la sub utilización del tratamiento farmacológico, baja tasa de pacientes tratados con estrategia combinada (la mayoría de los pacientes actualmente recibe monoterapia), falta de prescripción adecuada de los cambios en el estilo de vida, baja adherencia terapéutica e inercia clínica. En la presente publicación se presentan recomendaciones efectuadas por especialistas en clínica médica / medicina interna para el manejo de la hipertensión arterial en adultos, respondiendo preguntas de prevención primaria, secundaria, terciaria, y cuaternaria.

ABSTRACT The second part of the Latin American recommendations for the management of Arterial Hypertension (HTA) in adults is presented. In a first phase, the most relevant aspects of epidemiology, physiopathological aspects, how to diagnose, therapeutic guidelines, hypertension emergencies, special populations, refractory hypertension and the application of guides in real life have been described. In this second part, recommendations are issued answering specific questions for primary, secondary, tertiary and quaternary prevention. In general, few recommendations regarding the management of arterial hypertension arise from the medical clinic / internal medicine, despite two situations: the majority of patients with hypertension are evaluated and managed by the clinicians, and the medical clinic is the specialty that allows the holistic and integrated look of the health problems in adults, allowing to add the biographical approach to the biological, to understand and interpret not only the health problem but its causes and consequences (which often correspond to different parenchyma, which in the fragmented model would make the patient move through different specialties). The low percentage of controlled hypertensive patients forces all the professionals involved in the management of them to optimize resources and detect problems that are associated with a deficit control such as the under utilization of pharmacological treatment, low rate of patients treated with combined strategy (the most patients currently receive monotherapy), lack of adequate prescription of changes in lifestyle, low therapeutic adherence and clinical inertia. This publication presents recommendations made by specialists in medical clinic/internal medicine for the management of hypertension in adults, answering primary, secondary, tertiary and quaternary prevention questions.

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Introducción: la elevación de la expectativa de vida de la población se deduce por el aumento de pacientes que se operan en edades superiores a los 60 años, y una gran cantidad lo hace de manera urgente. Objetivo: describir la morbilidad y la mortalidad anestésicas de origen cardiovascular, en el paciente geriátrico intervenido quirúrgicamente de urgencia. Métodos: se realizó un estudio descriptivo, prospectivo y longitudinal de 123 pacientes mayores de 60 años en el Hospital General Docente Leopoldito Martínez, durante el período comprendido entre enero de 2010 y diciembre de 2011. Los datos fueron recogidos de las historias clínicas y los protocolos de anestesia. Resultados: se presentaron antecedentes patológicos cardiovasculares en 34,1 por ciento de los pacientes y predominó la hipertensión arterial en 15,4 por ciento. El factor de riesgo más frecuente fue el hábito de fumar (26,8 por ciento), y la herniorrafia fue la intervención más practicada en urgencia (33,3 por ciento). El método anestésico más empleado fue la anestesia general, en 68,3 por ciento de los casos, y dentro de ella, la anestesia general orotraqueal. Las complicaciones cardiovasculares fueron más frecuentes y ocurrieron en el período transoperatorio. Fallecieron 5 pacientes (4,1 por ciento) y ninguna muerte fue imputable al proceder anestésico. Conclusiones: la morbilidad anestésica de origen cardiovascular en el paciente geriátrico intervenido quirúrgicamente de urgencia tuvo relación directa con la mortalidad((AU)

Introduction: as a result of the increase in life expectancy, more patients aged over 60 undergo surgery, and a large number of them undergo emergency surgery. Objective: describe anesthetic morbidity and mortality of cardiovascular origin in geriatric patients undergoing emergency surgery. Methods: a prospective longitudinal descriptive study was conducted of 123 patients aged over 60 at Leopoldito Martínez General Teaching Hospital from January 2010 to December 2011. The data were collected from medical records and anesthesia protocols. Results: 34.1 percent of the patients had a history of cardiovascular disease, and arterial hypertension was predominant in 15.4 percent. Smoking was the most frequent risk factor (26.8 percent), and herniorrhaphy was the most common emergency intervention (33.3 percent). The anesthetic method most frequently used was general anesthesia (68.3 percent), with a predominance of general orotracheal anesthesia. Most cardiovascular complications appeared during the transoperative period. Five patients died (4.1 percent), with no death attributable to the anesthetic procedure applied. Conclusions: a direct relationship was found between anesthetic morbidity of cardiovascular origin and mortality in geriatric patients undergoing emergency surgery(AU)

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Introducción: la elevación de la expectativa de vida de la población se deduce por el aumento de pacientes que se operan en edades superiores a los 60 años, y una gran cantidad lo hace de manera urgente. Objetivo: describir la morbilidad y la mortalidad anestésicas de origen cardiovascular, en el paciente geriátrico intervenido quirúrgicamente de urgencia. Métodos: se realizó un estudio descriptivo, prospectivo y longitudinal de 123 pacientes mayores de 60 años en el Hospital General Docente "Leopoldito Martínez", durante el período comprendido entre enero de 2010 y diciembre de 2011. Los datos fueron recogidos de las historias clínicas y los protocolos de anestesia. Resultados: se presentaron antecedentes patológicos cardiovasculares en 34,1 % de los pacientes y predominó la hipertensión arterial en 15,4 %. El factor de riesgo más frecuente fue el hábito de fumar (26,8 %), y la herniorrafia fue la intervención más practicada en urgencia (33,3 %). El método anestésico más empleado fue la anestesia general, en 68,3 % de los casos, y dentro de ella, la anestesia general orotraqueal. Las complicaciones cardiovasculares fueron más frecuentes y ocurrieron en el período transoperatorio. Fallecieron 5 pacientes (4,1 %) y ninguna muerte fue imputable al proceder anestésico. Conclusiones: la morbilidad anestésica de origen cardiovascular en el paciente geriátrico intervenido quirúrgicamente de urgencia tuvo relación directa con la mortalidad.

Introduction: as a result of the increase in life expectancy, more patients aged over 60 undergo surgery, and a large number of them undergo emergency surgery. Objective: describe anesthetic morbidity and mortality of cardiovascular origin in geriatric patients undergoing emergency surgery. Methods: a prospective longitudinal descriptive study was conducted of 123 patients aged over 60 at Leopoldito Martínez General Teaching Hospital from January 2010 to December 2011. The data were collected from medical records and anesthesia protocols. Results: 34.1 % of the patients had a history of cardiovascular disease, and arterial hypertension was predominant in 15.4 %. Smoking was the most frequent risk factor (26.8 %), and herniorrhaphy was the most common emergency intervention (33.3 %). The anesthetic method most frequently used was general anesthesia (68.3 %), with a predominance of general orotracheal anesthesia. Most cardiovascular complications appeared during the transoperative period. Five patients died (4.1 %), with no death attributable to the anesthetic procedure applied. Conclusions: a direct relationship was found between anesthetic morbidity of cardiovascular origin and mortality in geriatric patients undergoing emergency surgery.

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Increased proteinuria is recognized as a risk predictor for all-cause and cardiovascular mortality in diabetic patients; however, no study has evaluated these relationships in Brazilian patients. The aim of this study was to investigate the prognostic value of gross proteinuria for all-cause and cardiovascular mortalities and for cardiovascular morbidity in a cohort study of 471 type 2 diabetic individuals followed for up to 7 years. Several clinical, laboratory and electrocardiographic variables were obtained at baseline. The relative risks for all-cause, cardiovascular and cardiac mortalities and for cardiovascular and cardiac events associated with the presence of overt proteinuria (>0.5 g/24 h) were assessed by Kaplan-Meier survival curves and by multivariate Cox regression model. During a median follow-up of 57 months (range 2-84 months), 121 patients (25.7 percent) died, 44 from cardiovascular and 30 from cardiac causes, and 106 fatal or non-fatal cardiovascular events occurred. Gross proteinuria was an independent risk predictor of all-cause, cardiovascular and cardiac mortalities and of cardiovascular morbidity with adjusted relative risks ranging from 1.96 to 4.38 for the different endpoints. This increased risk remained significant after exclusion of patients with prior cardiovascular disease at baseline from the multivariate analysis. In conclusion, gross proteinuria was a strong predictor of all-cause, cardiovascular and cardiac mortalities and also of cardiovascular morbidity in a Brazilian cohort of type 2 diabetic patients. Intervention studies are necessary to determine whether the reduction of proteinuria can decrease morbidity and mortality of type 2 diabetes in Brazil.

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É reconhecida a importância da atividade física e do estilo de vida na prevenção das doenças cardiovasculares. Programas corporativos de condicionamento físico têm sido utilizados por empresas na tentativa de melhorar a saúde de seus funcionários. O objetivo deste trabalho foi verificar se existe relação entre atividade física e morbidade cardiovascular referidas por gerentes e diretores de uma indústria automobilística. Como objetivos secundários avaliar a associação entre atividade física e outras variáveis relacionadas com o estilo de vida, com a utilização de serviços de saúde, absenteísmo e presenteísmo. Por último, avaliar se a participação em um programa de condicionamento físico supervisionado influenciou a atividade física habitual dessa população. Para tanto, foram estudados 376 indivíduos ativos ou inativos, participantes ou não do programa de condicionamento físico. A atividade física habitual, que foi avaliada por meio do Escore de Baecke, e outras variáveis relacionadas com o estilo de vida, como consumo alimentar de gorduras, frutas e vegetais, hábito de fumar e consumo de bebidas alcoólicas foram levantadas por meio de questionário. O escore de atividade física apresentou associação negativa tanto com relação ao absenteísmo como quanto em relação ao indivíduo que executa trabalho quando doente. Não houve associação estatisticamente significativa com morbidade cardiovascular referida, procura por atendimento médico e presenteísmo. Os indivíduos que relataram morbidade cardiovascular apresentam média de idade mais alta e índice de massa corpórea mais elevada. O presenteísmo se associou positivamente com o maior consumo de frutas e vegetais . E o inverso foi observado nos indivíduos com maior absenteísmo, que consumiram menor quantidade de frutas e vegetais. Verificou-se que os participantes regulares do programa de condicionamento físico supervisionado, por um lado, apresentaram escore mais elevado de atividade física, e por outro...

There is no doubt that the fitness activity together with a sound life style has a strong impact on preventing cardiovascular diseases. Corporate fitness programs have been utilized by most companies in an attempt to improve the overall health of their employees. The primary objective of this study was to verify if there is any relation between physical activity and cardiovascular morbidity as referred by a group of managers and directors of automotive industry. As a secondary objective we intended to evaluate the relationship between physical activity and other variants directly related to some issues, such as life style, utilization of health services, absenteeism and presenteeism. At last, evaluate if the attendance to a under supervision physical activity program has influenced the habitual physical activity of this mentioned population. In order to accomplish that, we have studied 376 individuals, actives or not, attending or not to a physical activity program. The habitual physical activity, which has been evaluated by the "Escore de Baecke" and some other variants related to life style, such as intake of fat, fruits and vegetables, smoking habits as well as alcohol intake. These data have collected by the application of a questionnaire. The physical activity score has shown a negative association either with regards to absenteeism or with regards to the individual who performs his or her job when sick. There has not been any significant statistic association among the referred cardiovascular morbidity, search for medical assistance and presenteeism. The individuals who reported cardiovascular morbidity showed a higher age average and also higher body mass. The presenteeism was positively associated with the higher intake of fruits and vegetables. And the opposite was also observed in individuals with higher absenteeism with a less intake of fruits and vegetables. It was also observed that the regular attendees of under supervision physical activity...

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