RESUMEN

INTRODUCTION: Although some studies have reported the association between uric acid (UA) and hypertension, evidence on prehypertension is still lacking. Therefore, the objective of this study was to determine the levels of UA and other cardiovascular markers among prehypertensive and hypertensive patients and assess their risk for developing arterial hypertension. METHODS: 157 individuals were recruited: 67 normotensive, 23 pre-hypertensive and 67 hypertensive. Blood samples were collected to measure biochemical parameters and anthropometric measurements and blood pressure were evaluated. We calculated the product of lipid accumulation and the visceral adiposity index to assess cardiovascular risk. RESULTS: Our data showed an increase in UA levels in normotensives (4.9±1.3mg/dL), prehypertensives (5.2±1.3mg/dL) and hypertensives (5.9±1.6mg/dL) (p=0.004). We found a higher frequency of hyperuricemia in the hypertensive group (34.3%) than in the normotensive group (13.4%, p<0.05). Hypertensive volunteers had lower levels of HDL-C (p=0.004 and p=0.003) and higher body mass indexes (p<0.001 and p=0.007), glucose (p<0.001 and p=0.033), triglycerides (p=0.001 and p=0.005), visceral adiposity index (p<0.001 and p=0.002) and lipid accumulation product (p<0.001 and p=0.007) than normotensive and prehypertensive participants. We also observed that individuals with UA≥6.2mg/dL had an increased risk of hypertension of 4.77 (p=0.003) compared to individuals with levels≤4.3mg/dL. CONCLUSION: Our results showed that UA is associated with increased blood pressure and unfavorable changes in anthropometric and biochemical parameters, which represent risk factors for hypertension and cardiovascular diseases.

Asunto(s)

RESUMEN

Cardiac innervation by the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS) modulates the heart rate (HR) (chronotropic activity) and the contraction of the cardiac muscle (inotropic activity). The peripheral vasculature is controlled only by the SNS, which is responsible for peripheral vascular resistance. This also mediates the baroreceptor reflex (BR), which in turn mediates blood pressure (BP). Hypertension (HTN) and the autonomic nervous system (ANS) are closely related, such that derangements can lead to vasomotor impairments and several comorbidities, including obesity, hypertension, resistant hypertension, and chronic kidney disease. Autonomic dysfunction is also associated with functional and structural changes in target organs (heart, brain, kidneys, and blood vessels), increasing cardiovascular risk. Heart rate variability (HRV) is a method of assessing cardiac autonomic modulation. This tool has been used for clinical evaluation and to address the effect of therapeutic interventions. The present review aims (a) to approach the heart rate (HR) as a CV risk factor in hypertensive patients; (b) to analyze the heart rate variability (HRV) as a "tool" to estimate the individual risk stratum for Pre-HTN (P-HTN), Controlled-HTN (C-HTN), Resistant and Refractory HTN (R-HTN and Rf-HTN, respectively), and hypertensive patients with chronic renal disease (HTN+CKD).

RESUMEN

Prehypertension is a clinical condition that increases the risk of hypertension and cardiovascular disease. In South American countries, prehypertension affects almost one-third of the population. The aim of the present study was to determine the association between prehypertension and the main cardiometabolic risk factors according to the US National Cholesterol Education Program Adult Treatment Panel III by sex in the Peruvian population. A total of 863 participants surveyed were included in the study. A total of 21.1% had prehypertension, 14.4% of whom were female, and 30.5% were male. Women belonging to the age group 50-59 years, having abdominal obesity and being a current smoker, were more likely to have prehypertension, while the likelihood of having prehypertension increased in men with abdominal obesity. Three out of 10 men and one out of 10 women in Peru have prehypertension. In women, being 50 to 59 years of age, having abdominal obesity, and being a current smoker, increased the probability of having prehypertension, whereas, in men, only abdominal obesity was found to be associated with prehypertension. Our findings will allow the development of prevention strategies focused on the appropriate diagnosis of prehypertension and cardiometabolic risk factors according to sex.

Asunto(s)

RESUMEN

BACKGROUND: Systemic arterial hypertension (HTN) is the leading risk factor of cardiovascular disease death. Lifestyle changes are key for the prevention and management of HTN. Regular aerobic exercise training is recommended as part of the management of HTN, and dynamic resistance exercise should be prescribed as an adjuvant to aerobic training. Recent evidence points to the potential benefits of isometric resistance training in reducing blood pressure (BP). Yet, the hypotensive effect of isometric exercise in prehypertensive and hypertensive individuals is not fully understood. Thus, we will examine the effect of isometric exercise in prehypertensive and hypertensive individuals through a systematic review and meta-analysis. METHODS: Our systematic review study will include randomized controlled trials (RCTs) selected from the electronic databases MEDLINE (PubMed), Cochrane, LILACS, EMBASE, Web of Science, and PEDro published in English, Spanish, and Portuguese languages. We will follow the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) and PICOS framework. Our search will involve studies with both male and female participants aged 18 years or more diagnosed with prehypertension or HTN performing one session of isometric exercise (acute effect) or isometric exercise training (chronic effect) compared to a control group (no exercise). We will use the Cochrane Risk of Bias 2 (RoB 2) tool to evaluate the quality of the studies and RStudio software (v1.3.959 for Windows) for statistical analyses. DISCUSSION: A meta-analysis of a homogeneous sample of prehypertensive and hypertensive individuals involving isometric handgrip exercise alone can further support previous findings and improve our understanding and recommendations for the management of these populations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020213081.

Asunto(s)

RESUMEN

Resumo Objetivou-se estimar a prevalência e fatores associados à pré-hipertensão e hipertensão arterial entre trabalhadores de saúde que atuam em setores de alta complexidade para pacientes críticos e crônicos. Foi realizado um estudo epidemiológico, transversal com 490 trabalhadores de saúde da macrorregional do norte de Minas Gerais, Brasil. A variável dependente pressão arterial foi categorizada em normal, pré-hipertensão e hipertensão. Para análise múltipla, foi utilizada a Regressão Logística Multinomial. A prevalência da hipertensão arterial foi de 21,8% e da pré-hipertensão foi de 25,9%. As chances de se desenvolver a hipertensão arterial e a pré hipertensão foram maiores nos profissionais do sexo masculino, com idade ≥40 anos, em trabalhadores com vínculo empregatício concursado e naqueles obesos ou com sobrepeso. O uso de medicamento contínuo e o trabalho no turno noturno estiveram associados à hipertensão e pré-hipertensão, respectivamente. A prevalência de hipertensão arterial no grupo de trabalhadores foi menor do que a da população brasileira. São necessários estudos com trabalhadores desse grupo e investimentos em medidas preventivas e que incentivem a mudança para um estilo de vida saudável.

Abstract The objective was to estimate the prevalence and factors associated with prehypertension and hypertension among health workers who work in high-complexity services for critically-ill and chronic patients. An epidemiological, cross-sectional study was carried out with 490 health workers in the macroregional region of Northern Minas Gerais, Brazil. The dependent variable blood pressure (BP) was categorized as normal BP, prehypertension and hypertension. Multinomial Logistic Regression was used for the multiple analysis. The prevalence of arterial hypertension was 21.8% and that of prehypertension was 25.9%. The chances of developing arterial hypertension and prehypertension were higher in male professionals, aged ≥40 years, in civil servant workers and those who were obese or overweight. The use of continuous medication and night shift work were associated with hypertension and prehypertension, respectively. The prevalence of arterial hypertension in the group of workers was lower than that of the Brazilian population. It is necessary to carry out studies with workers from this group and investments are required in preventive measures that encourage a change to a healthy lifestyle.

Asunto(s)

RESUMEN

The Blood pressure control diet is well described; however, it has not been implemented in clinical care, possibly due to the impracticability of the diet assessment in these contexts. In order to facilitate the dietary assessment, we developed and assessed the validity and reproducibility of two food group-based food frequency questionnaires (FG-FFQs), with a one-week (7-day FG-FFQ) and a one-month (30-day FG-FFQ) period of coverage for patients with pre-hypertension or hypertension. In 2010, 155 men and women, 30-70 years old, were invited to participate in a prospective study in two outpatient clinics in Porto Alegre, southern Brazil. The participants responded to two 30-day, two 7-day FG-FFQ, four 24-h dietary recalls, and underwent demographic, anthropometric, and blood pressure assessments. The validity and reproducibility were assessed using partial correlation coefficients adjusted for sex and age, and the internal validity was tested using the intra-class correlation coefficient. The participants were aged 61 (±10) years and 60% were women. The validity correlation coefficient was higher than r = 0.80 in the 30-day FG-FFQ for whole bread (r = 0.81) and the 7-day FG-FFQ for diet/light/zero soda and industrialized juices (r = 0.84) in comparison to the 24-h dietary recalls. The global internal validity was α = 0.59, but it increased to α = 0.76 when 19 redundant food groups were excluded. The reproducibility was higher than r = 0.80 for pasta, potatoes and manioc, bakery goods, sugar and cocoa, and beans for both versions. The 30-day had a slightly higher validity, both had good internal validity, and the 7-day FG-FFQ had a higher reproducibility.

Asunto(s)

RESUMEN

Resumo Fundamento O interesse pela hipertensão em crianças e adolescentes aumentou desde a atualização do sistema de classificação da pressão arterial para comparar com o sistema de classificação dos adultos, alterando a terminologia de "normal alta" para "pré-hipertensão". Objetivo O objetivo deste estudo foi analisar a associação da modulação autonômica cardíaca com os níveis pressóricos dos adolescentes. Métodos 203 adolescentes foram agrupados de acordo com a pressão arterial sistólica (PAS) e a pressão arterial diastólica (PAD). Um grupo foi caracterizado como pré-hipertensão, e o outro como normotenso. Foram coletadas características antropométricas, cardiovasculares e de qualidade do sono. Inicialmente, os dados foram submetidos ao teste de normalidade Kolmogorov-Smirnov . As variáveis quantitativas contínuas foram analisadas por meio do teste T de Student não pareado. Para análise das variáveis categóricas, foi utilizado o teste qui-quadrado. Um modelo de regressão logística foi realizado. O nível de significância estabelecido foi p<0,05. Os dados foram expressos como média ± desvio padrão e intervalo de confiança. O software R foi utilizado para análise dos dados. O tamanho do efeito foi calculado com a fórmula de Cohen. Resultados O grupo pré-hipertensão apresentou aumento da entropia de Shannon e diminuição da variância total. Além disso, no modelo de regressão logística, os adolescentes deste grupo tiveram 1,03 mais chances de ter a entropia de Shannon afetada quando a PAS foi ajustada ao gênero, maturação sexual, tempo escolar, idade, circunferência da cintura e qualidade do sono. Conclusão Nossos dados mostram que a modulação autonômica pode desempenhar um papel importante no desenvolvimento da pressão arterial elevada em adolescentes ao controlar fatores como tempo escolar e qualidade do sono.

Abstract Background The interest regarding hypertension among children and adolescents has increased since the blood pressure rating system was updated to be compared with the adult rating system, changing the terminology from "normal high" to "prehypertension". Objective This study aimed to analyze the association between cardiac autonomic modulation and pressure levels of adolescents. Methods 203 adolescents were grouped according to systolic blood pressure (SBP) and diastolic blood pressure (DBP). One group was characterized as prehypertension, and the other as normotensive. Anthropometric, cardiovascular and sleep quality characteristics were collected. Initially, the data were submitted to the Kolmogorov-Smirnov normality test. Continuous quantitative variables were analyzed using the unpaired Student t-test. For the analysis of categorical variables, a chi-square test was used. A logistic regression model was performed. The level of significance was set at p<0.05. The data were expressed as mean ± standard deviation and confidence interval. The R software was used for data analysis. The effect size was calculated using the Cohen's formula. Results The prehypertension group showed an increase in Shannon entropy and a decrease in total variance. Also, in the logistic regression model, adolescents in this group were 1.03 times more likely to have Shannon entropy's affected when SBP was adjusted for gender, sexual maturation, school time, age, waist circumference, and sleep quality. Conclusion Our data show that autonomic modulation may play an important role in the development of elevated blood pressure in adolescents, when controlling for other factors, such as school time and sleep quality.

Asunto(s)

Asunto(s)

RESUMEN

RESUMEN Introducción: La enfermedad arterial periférica (EAP) puede presentarse de forma asintomática, de ahí la necesidad de su diagnóstico para evitar complicaciones. Objetivo: Determinar la presencia de enfermedad arterial periférica mediante el índice tobillo-brazo obtenido por fotopletismografía en pacientes prehipertensos. Método: Se realizó un estudio descriptivo de corte transversal, en un universo constituido por los 35 pacientes mayores de 18 años, con diagnóstico presuntivo de prehipertensión arterial, del Consultorio 2 perteneciente al Policlínico Universitario Josué País García de Santiago de Cuba. Para medir el índice tobillo-brazo se empleó el pletismógrafo digital ANGIODIN® PD 3000. Resultados: El 100% de los pacientes carecía de síntomas de EAP, pero al realizar la medición del índice tobillo-brazo se encontró que el 51,43% de ellos tenía signos de esta enfermedad. La EAP fue más frecuente en hombres (52,94 vs. 50,0%), sin que se encontraran diferencias estadísticas significativas (p>0,05). Conclusiones: El índice tobillo-brazo obtenido mediante fotopletismografía resultó útil para determinar la presencia de enfermedad arterial periférica asintomática en pacientes prehipertensos. Se identificó una alta incidencia de la enfermedad, con mayor frecuencia en el sexo masculino.

ABSTRACT Introduction: Peripheral artery disease (PAD) may present with no symptoms at all, hence the need for diagnosis to avoid complications. Objective: To determine the presence of peripheral artery disease by means of the ankle-brachial index obtained by photoplethysmography in prehypertensive patients. Method: A descriptive cross-sectional study was carried out in a population of 35 patients over 18 years of age, with a presumptive diagnosis of prehypertension, belonging to the Family Doctor's Office 2 from the Policlínico Universitario Josué País García in Santiago de Cuba. The ANGIODIN® PD 3000 digital plethysmograph was used to measure the ankle-brachial index. Results: None of the patients had symptoms of PAD, but after measuring the ankle-brachial index, 51.43% of them were found to have signs of this disease. Peripheral artery disease was more frequent in men (52.94 vs. 50.0%), with no significant statistical differences (p>0.05). Conclusions: The ankle-brachial index obtained by photoplethysmography was useful in determining the presence of asymptomatic peripheral artery disease in prehypertensive patients. A high incidence of the disease was identified, with a higher frequency in the male sex.

RESUMEN

Background: The long-term impact of elevated blood pressure on mortality outcomes has been recently revisited due to proposed changes in cut-offs for hypertension. This study aimed at assessing the association between high blood pressure levels and 10-year mortality using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology and the American Heart Association (ACC/AHA) 2017 blood pressure guidelines. Methods: Data analysis of the PERU MIGRANT Study, a prospective ongoing cohort, was used. The outcome of interest was 10-year all-cause mortality, and exposures were blood pressure categories according to the JNC-7 and ACC/AHA 2017 guidelines. Log-rank test, Kaplan-Meier and Cox regression models were used to assess the associations of interest controlling for confounders. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated. Results: A total of 976 records, mean age of 60.4 (SD: 11.4), 513 (52.6%) women, were analyzed. Hypertension prevalence at baseline almost doubled from 16.0% (95% CI 13.7%-18.4%) to 31.3% (95% CI 28.4%-34.3%), using the JNC-7 and ACC/AHA 2017 definitions, respectively. Sixty-three (6.4%) participants died during the 10-year follow-up, equating to a mortality rate of 3.6 (95% CI 2.4-4.7) per 1000 person-years. Using JNC-7, and compared to those with normal blood pressure, those with pre-hypertension and hypertension had 2.1-fold and 5.1-fold increased risk of death, respectively. Similar mortality effect sizes were estimated using ACC/AHA 2017 for stage-1 and stage-2 hypertension. Conclusions: Blood pressure levels under two different definitions increased the risk of 10-year all-cause mortality. Hypertension prevalence doubled using ACC/AHA 2017 compared to JNC-7. The choice of blood pressure cut-offs to classify hypertension categories need to be balanced against the patients benefit and the capacities of the health system to adequately handle a large proportion of new patients.

Asunto(s)

RESUMEN

Objective: to identify the risk factors associated with prehypertension and arterial hypertension among Munduruku indigenous people in the Brazilian Amazon. Method: a cross-sectional study carried out with 459 Munduruku indigenous people selected by means of stratified random sampling. Sociodemographic variables, habits and lifestyles, anthropometric data, fasting glucose and lipid profiles were evaluated. An automatic device calibrated and validated to measure blood pressure was used. The analyses of the data collected were carried out in the R software, version 3.5.1. For continuous variables, the Kruskall-Wallis test was used; for the categorical ones, Fischer's Exact. The significance level was set at 5% and p-value≤0.05. Results: the prevalence of altered blood pressure levels was 10.2% for values suggestive of hypertension and 4.1% for pre-hypertension. The risk of prehypertension among indigenous people was associated with being male (OR=1.65; 95% CI=0.65-4.21) and having a substantially increased waist circumference (OR=7.82; 95% CI=1.80-34.04). Regarding the risk for arterial hypertension, it was associated with age (OR=1.09; 95% CI=1.06-1.12), with increased waist circumference (OR=3.89; 95% CI=1.43-10, 54) and with substantially increased waist circumference (OR=5.46; 95% CI=1.78-16.75). Conclusion: among Munduruku indigenous people, men were more vulnerable to developing hypertension; age and increased waist circumference proved to be strong cardiovascular risk factors.

Objetivo: identificar os fatores de risco associados à préhipertensão e hipertensão arterial entre indígenas Munduruku da Amazônia brasileira. Método: estudo transversal realizado com 459 indígenas Munduruku selecionados por meio de amostragem aleatória estratificada. Foram avaliadas variáveis sociodemográficas, hábitos e estilos de vida, dados antropométricos, glicemia de jejum e perfis lipídicos. Utilizou-se aparelho automático calibrado e validado para medir a pressão arterial. As análises dos dados coletados foram realizadas pelo software R versão 3.5.1. Para as variáveis contínuas, utilizou-se o teste Kruskall-Wallis; para as categóricas, o Exato de Fischer. Considerou-se nível de significância de 5% e valor p≤0,05. Resultados: a prevalência de níveis pressóricos alterados foi de 10,2% para valores sugestivos de hipertensão e de 4,1% para pré-hipertensão. O risco de pré-hipertensão entre indígenas associou-se a ser do sexo masculino (OR=1,65; IC95% 0,65-4,21) e ter circunferência da cintura aumentada substancialmente (OR=7,82; IC95% 1,80-34,04). Quanto ao risco para hipertensão arterial, associou-se à idade (OR=1,09; IC95% 1,06-1,12), à circunferência da cintura aumentada (OR=3,89; IC95% 1,43-10,54) e à circunferência da cintura aumentada substancialmente (OR=5,46; IC95% 1,78-16,75). Conclusão: entre indígenas Munduruku, os homens estavam mais vulneráveis para desenvolver hipertensão; a idade e a circunferência da cintura aumentada mostraram-se como fortes fatores de risco cardiovascular.

Objetivo: identificar los factores de riesgo asociados con la prehipertensión y la hipertensión arterial entre los indígenas Munduruku en la Amazonía brasileña. Método: estudio transversal realizado con 459 indígenas Munduruku seleccionados mediante muestreo aleatorio estratificado. Se evaluaron variables sociodemográficas, hábitos y estilos de vida, datos antropométricos, glucosa en ayunas y perfiles lipídicos. Se utilizó un dispositivo automático calibrado y validado para medir la presión arterial. Los análisis de los datos recopilados se llevaron a cabo mediante el software R versión 3.5.1. Para las variables continuas se utilizó la prueba de KruskalWallis; para las categóricas, Exacto de Fischer. El nivel de significancia se estableció en 5% y p≤0,05. Resultados: la prevalencia de niveles alterados de presión arterial fue del 10,2% para valores sugestivos de hipertensión y del 4,1% para prehipertensión. El riesgo de prehipertensión entre los indígenas se asoció al sexo masculino (OR=1,65; IC95% 0,65-4,21) y a un aumento sustancial de la circunferencia de cintura (OR=7,82; IC95% 1,80-34,04). En cuanto al riesgo de hipertensión arterial, se asoció con la edad (OR=1,09; IC95% 1,06-1,12), con un aumento de la circunferencia de la cintura (OR=3,89; IC95% 1,43-10,54) y con un aumento sustancial de la circunferencia de la cintura (OR=5,46; IC95% 1,78-16,75). Conclusión: entre los indios Munduruku, los hombres eran más vulnerables a desarrollar hipertensión, la edad y el aumento de la circunferencia de la cintura demostraron ser fuertes factores de riesgo cardiovascular.

Asunto(s)

RESUMEN

OBJECTIVE: To explore the association between prehypertension and the development of perinatal complications. METHODS: Retrospective cohort study (n = 293) that included pregnant women over 18 years of age carrying a single fetus of a gestational age of less than 20 weeks. Participants with chronic disease, assisted reproduction, fetal anomalies, early gestational loss, multiple pregnancy or who were delivered in a different institution were excluded. Pregnant women with and without prehypertension were compared. Multiple logistic regression was carried out. RESULTS: Prehypertension increased the incidence of hypertensive disorders (aOR 3.54, 95% CI 1.83-6.83) and hospitalization (aOR 2.41, 95% CI 1.17-4.95). No differences were found for other perinatal complications. CONCLUSIONS: Prehypertension increases the incidence of hypertensive disorders and hospitalization during pregnancy.

Asunto(s)

RESUMEN

Resumo Fundamento Os efeitos da redução na ingestão do sal sobre a pressão arterial (PA) casual de hipertensos já foram amplamente estudados, entretanto essa análise ainda é escassa no contexto da redução exclusiva do sal de adição na rigidez arterial e em indivíduos normotensos e pré-hipertensos. Objetivo Avaliar os efeitos da redução progressiva na ingestão do sal de adição (de 6 para 4 g/dia) sobre os valores da pressão periférica e central, a rigidez arterial em normotensos, pré-hipertensos e hipertensos. Métodos Ensaio clínico, simples cego com 13 semanas de seguimento. Foram avaliados normotensos (≤130/85 mmHg), pré-hipertensos (≥130 e <139/≥85 e <90 mmHg) e hipertensos estágio 1 (≥140 e <160/≥90 e <100 mmHg). Utilizou-se medida casual e monitorização residencial da PA com aparelho automático OMRON 705CP, medida central da PA com Sphygmocor®, dosagem do sódio urinário de 24h (colhido no intervalo entre cada visita) e mensuração de sal de adição. Foi adotado nível de significância p<0,05 para todas as análises. Resultados Foram avaliados 55 participantes (18 normotensos; 15 pré-hipertensos; 22 hipertensos) com mediana 48 anos (IQ:39-54). Os grupos foram semelhantes em relação a idade e sexo. Não houve diferença entre medidas de PA e excreção de sódio antes e depois da intervenção. Os parâmetros de rigidez arterial também não sofreram alterações significativas. Conclusão A redução gradativa da ingestão de sal de adição num seguimento de 13 semanas não foi capaz de reduzir de maneira significativa os valores periféricos e centrais da PA. (Arq Bras Cardiol. 2020; 114(3):554-561)

Abstract Background Although the effects of salt intake reduction on casual blood pressure have been extensively studied in hypertensive individuals, data on reductions of added salt on arterial stiffness in both normotensive and prehypertensive subjects are scarce. Objective To evaluate the effects of progressive reduction in added salt intake (from 6 grams to 4 grams per day) on peripheral and central blood pressure and arterial stiffness in normotensive, prehypertensive and hypertensive individuals. Methods This was a single-blinded clinical trial with 13 weeks of follow-up. Normotensive (≤ 130/85 mmHg), prehypertensive (≥ 130 e < 139/≥ 85 e < 90 mmHg) and stage 1 hypertensive individuals (< 139/≥ 85 and < 90 mmHg) were assessed. Casual blood pressure measurements and ambulatory blood pressure monitoring were performed using the automated OMRON 705CP device, and central blood pressure was measured using the Sphygmocor®. Twenty-four-hour urinary sodium excretion and the amounts of added salt consumed were measured. Statistically significance level was set at p < 0.05 for all analysis. Results A total of 55 participants (18 normotensive, 15 prehypertensive and 22 hypertensive), median age 48 years (IQR:39-54) were studied. The groups were not different in age or sex. No difference was observed in blood pressure or sodium excretion levels before and after the intervention. No significant changes in arterial stiffness parameters were observed. Conclusion The progressive reduction in added salt intake during a period of 13 weeks did not cause significant reductions in peripheral and central blood pressure. (Arq Bras Cardiol. 2020; 114(3):554-561)

Asunto(s)

RESUMEN

Nas últimas décadas, um número crescente de evidências destacou a importante contribuição dos fatores de risco vasculares para o declínio cognitivo acelerado e demências, incluindo a doença de Alzheimer. Apesar dos grandes progressos nesse campo de estudo, as evidências sobre o papel da rigidez arterial e da hipertensão na cognição não é conclusivo. O objetivo desta tese foi verificar se a rigidez arterial, a idade e a hipertensão arterial sistêmica estão associadas à diminuição do desempenho em testes de função cognitiva em adultos de meia idade e idosos após cerca de quatro anos de seguimento. Foram utilizados dados da linha de base (onda 1: 2008-2010) e do primeiro acompanhamento (onda 2: 2012-2014) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). No primeiro artigo, utilizando modelos lineares de efeitos mistos, foi investigado se a rigidez aórtica, medida pela velocidade da onda de pulso carotídeo-femoral (VOP-cf) e a idade na linha de base, estariam associados ao declínio no desempenho cognitivo avaliado por três testes cognitivos (Teste de Memória, Teste de Fluência Verbal Fonêmica e Semântica e Teste de Trilhas B), aplicados nas duas visitas da coorte. Encontramos que a rigidez aórtica foi associada de forma independente da pressão arterial sistólica e da idade ao declínio mais rápido em duas habilidades cognitivas, memória e fluência. Entretanto, o declínio no Teste de Memória foi restrito aos participantes com altos valores de VOP-cf na linha de base. A idade também foi associada ao declínio mais rápido no desempenho de todos os testes cognitivo avaliados entre as ondas. No entanto, apenas os participantes mais velhos apresentaram uma trajetória de desempenho descendente nos Testes de Memória e Trilha B. No segundo artigo, por meio de regressão linear de efeitos mistos, foi investigado se a exposição à hipertensão arterial sistêmica (HAS) e a pré-hipertensão estariam associados ao declínio no desempenho do escore cognitivo global (avaliado pelo fator g) e em Teste de Memória, Fluência Verbal Fonêmica e Semântica e Trilhas B, todos analisados como escores padronizados. Também foi investigado se a HAS diagnosticada na meia idade, o tempo de exposição a HAS e o status de tratamento e de controle da HAS na linha de base da coorte estariam associados ao declínio cognitivo mais acelerado entre visita. Encontramos que tanto a exposições à HAS quanto à Pré-HAS na linha de base foram associadas ao declínio no desempenho cognitivo, avaliado pelo escore cognitivo global (fator g). A HAS também foi associada à redução nos escores padronizados dos Testes de Memória e Fluência Verbal, enquanto a Pré-HAS permaneceu longitudinalmente associada apenas à redução no escore padronizado do Teste de Fluência Verbal. Não encontramos evidências de que a exposição à HAS na meia idade estivesse associada ao declínio cognitivo, somente a exposição à HAS na idade mais velha permaneceu associada a redução do escore cognitivo global e do Teste de Memória. Também não identificamos que maior tempo de exposição à HAS estivessem associadas ao declínio cognitivo relacionado à idade. O status de tratamento da HAS não foi associado a alterações nos escores padronizados dos testes cognitivos avaliado, mas a HAS não controlada quando comparada a controlada foi associada ao declínio mais acelerado no escore cognitivo global e no Teste de Memória. Nenhuma das variáveis de HAS analisadas foram associadas a alterações nos escores padronizados do Teste de trilhas B. O aumento da rigidez aórtica, a exposição à HAS, a pré-HAS e a HAS de início tardio foram associadas à uma pior trajetória longitudinal no desempenho cognitivo global e em diferentes habilidades cognitivas. Embora a magnitude dos efeitos seja pequena, é notável detectar o impacto direto desses fatores no declínio cognitivo relacionado à idade, uma vez que, avaliamos uma população altamente instruída e com idade relativamente jovem em um curto intervalo de tempo. Os resultados reforçam a importância de estudar a função cognitiva na meia-idade, com vistas a identificar precocemente indivíduos em maior risco de declínio, assim como, fatores de risco que podem potencialmente acelerar o processo de envelhecimento cognitivo e impactar negativamente na função cognitiva ao longo do tempo.

In recent decades, increasing evidence has highlighted the critical contribution of vascular risk factors to the risk of accelerated cognitive decline and dementia, including Alzheimer's disease. Despite significant progress in this field of study, how to reduce the role of arterial stiffness and hypertension in cognition is not conclusive. This thesis aimed to verify whether arterial stiffness, age, and systemic arterial hypertension are associated with decreased performance on cognitive function tests in middle-aged and elderly adults after approximately four years of follow-up. We used data from baseline (wave 1: 2008-2010), and the first follow - up (wave 2: 2012-2014) Study of Adult Health Longitudinal (ELSA-Brazil). In the first paper, using mixed effects linear models, we investigated whether aortic stiffness, measured by carotid-femoral pulse wave velocity (cf-PWV) and age at baseline, were associated with the decline in three cognitive tests (Memory Test, Phonemic and Semantic Verbal Fluency Test, and Trail B Test), applied at both cohort visits. We found that aortic stiffness was independently associated with systolic blood pressure and age with the fastest decline in two cognitive skills, memory and fluency. However, the decrease in the Memory Test was restricted to participants with high baseline cf-PWV values. Age was also associated with the faster decline in the performance of all cognitive tests evaluated between waves. Still, only older participants showed a downward performance trajectory on Memory and Trail B tests. In the second paper, using mixed effects linear regression was investigated whether exposure to hypertension and prehypertension would be associated with the decline in the performance global cognitive score (assessed by the g factor) and Memory, Verbal Fluency Phonemic and Semantics and Trail B Tests. It was also investigated whether hypertension diagnosed in middle age, the time of exposure to hypertension and the treatment and control status of hypertension at the baseline of the cohort were associated with more accelerated cognitive decline between visits. We found that exposure to hypertension and prehypertension at baseline were associated with a decrease in cognitive performance assessed by the global cognitive score (g factor). Hypertension was also associated with a reduction in the standardized Memory and Verbal Fluency tests scores, whereas prehypertension remained longitudinally associated only with a decrease in the standardized Verbal Fluency Test score. We found no evidence that exposure to hypertension in middle age was associated with cognitive decline; only exposure to hypertension in older age remained associated with a reduction in the global cognitive score and the Memory Test. We also did not identify that longer exposure to hypertension was associated with age-related cognitive decline. The treatment status of hypertension was not associated with changes in the standardized scores of the assessed cognitive tests, but uncontrolled hypertension when compared to controlled hypertension was associated with the more accelerated decline in the global cognitive score and the Memory Test. None of the hypertension variables analyzed were associated with changes in the standardized scores of the Trail B test. The increase in aortic stiffness, exposure to hypertension, prehypertension and late-onset hypertension were associated with a worse longitudinal trajectory in global cognitive performance at different cognitive abilities. Although the magnitude of the effects is small, it is noteworthy to detect the direct impact of these factors on age-related cognitive decline, since we evaluated a highly educated and relatively young age population over a short time. The results reinforce the importance of studying cognitive function in middle-aged, in order to identify early individuals at higher risk of decline, as well as risk factors that can potentially accelerate the cognitive aging process and negatively impact cognitive function over time.

Asunto(s)

RESUMEN

OBJECTIVE: To determine the stability of ambulatory blood pressure monitoring (ABPM) over time in children referred for evaluation of elevated BPs and assess for factors predicting change. STUDY DESIGN: This retrospective chart review conducted at Seattle Children's Hospital and University of Pittsburgh Medical Center Children's Hospital of Pittsburgh identified 124 children referred for elevated BPs with 2 ABPM studies at least 6 months apart. All subjects received lifestyle counseling. Subjects with secondary hypertension (HTN) or on antihypertensive medication were excluded. ABPM phenotype was classified using American Heart Association guidelines as showing normal BP, prehypertension, and HTN. Generalized linear mixed effect regression models were used to regress stable, improving, or worsening HTN outcomes at study follow-up on baseline BP index and load variables. RESULTS: The median age of patients was 14.1 years (73% males) and the median interval between studies was 18 months. ABPM phenotype changed in 58 of 124 children, with 16% worsening and 31% improving. Older age was associated with persistence of HTN. Although not significant, decrease in body mass index z-score tracked with sustained normal ambulatory BPs. CONCLUSIONS: Although the sample size is small, our study suggests ABPM phenotype shows variability over time. Further study is required to identify factors supporting risk for progression of ABPM phenotype over time.

Asunto(s)

RESUMEN

Hypertension is one of the main risk factors for cardiovascular disease. Functional foods containing bioactive peptides have been proposed as a strategy to decrease blood pressure (BP) in subjects under no pharmacological treatment. The aim of this study was to compare the effect of low-sodium, low-fat (LSLF) cheese and LSLF cheese containing Lactobacillus delbrueckii subsp. lactis CRL 581 (LSLF581) on BP in pre-hypertensive and stage 1 hypertensive subjects. Sixty-one pre-hypertensive and stage 1 hypertensive subjects assigned to one of twos (LSLF, n= 29 and LSLF581, n= 32) participated in this 12-month prospective, randomized, double-blind, crossover trial. Twenty-four h ambulatory BP monitoring was performed at the beginning and at the end of each four-week study period. Systolic and diastolic BP decreased in both study groups, but differences between groups were not significant (systolic, -1.78 and -0.2 mmHg; diastolic, -1.54 and -0.42 mmHg in LSLF581 and LSLF, respectively). Although our results could not support a BP lowering effect of LSLF581, small BP reductions could favorably prevent cardiovascular disease development.

La hipertensión arterial es uno de los principales factores de riesgo de enfermedad cardiovascular. Los alimentos funcionales que contienen biopéptidos constituyen una estrategia útil para disminuir la presión arterial (PA) en personas que no están bajo tratamiento farmacológico. El objetivo del estudio fue comparar el efecto de un queso bajo en sodio y bajo en grasas (BSBG) y el mismo queso con Lactobacillus delbrueckii subsp. lactis CRL 581 (BSBG581) sobre la PA en personas con prehipertensión y estadio 1 de hipertensión arterial. Realizamos un estudio prospectivo, randomizado, cruzado y doble ciego durante 12 meses en 61 personas con prehipertensión y estadio 1 de hipertensión arterial, asignadas a dos grupos: BSBG (n= 29) y BSBG581 (n= 32). Se realizó monitoreo ambulatorio de la PA (MAPA) durante 24 h al comienzo y al final de cada etapa del estudio (cuatro semanas). La PA sistólica y diastólica disminuyó en ambos grupos, aunque las diferencias entre grupos no fueron significativas (sistólica, -1.78 y -0.2 mmHg; diastólica -1.54 y -0.42 mmHg en BSBG581 y BSBG respectivamente). Aunque nuestros resultados no pueden confirmar el efecto hipotensor del queso BSBG581, las reducciones moderadas de la PA podrían prevenir el desarrollo de enfermedad cardiovascular.

Asunto(s)

RESUMEN

High blood pressure (BP) is associated with higher rates of cardiovascular events, even in stage I hypertension (HTN) and prehypertension (preHTN). Lower left ventricular (LV) systolic function, assessed by global longitudinal strain (GLS), has been demonstrated in individuals with HTN compared to individuals with normal BP, but a comparison of individuals with preHTN and stage I HTN was not described to date. The PREVER study includes two randomized double-blind controlled trials, performed in volunteers with preHTN (PREVER-prevention trial) or stage I HTN (PREVER-treatment trial), aged 30-70 years. A subsample of patients of both trials had GLS measured from 2D echocardiograms performed at baseline and after 18 months of follow-up. We compared baseline data from both studies and, among stage I HTN patients, clinical and echocardiographic correlates of GLS were determined. Participants with preHTN (n = 91;53% female; 55 ± 9 yo) and stage I HTN (n = 105; 44% female; 55 ± 8 yo) had similar clinical parameters beyond the expected differences in BP levels. Participants with stage I HTN had lower GLS (-17.5 ± 2.5% vs -18.2 ± 2.4%, P = .03) compared with those with preHTN. In stage I HTN, lower GLS was associated with lower e' and lower LV ejection fraction. In conclusion, patients in Stage I HTN may already express changes in GLS compared with individuals with preHTN, suggesting that even mildly difference in BP can be impact in subclinical systolic function.

Asunto(s)

RESUMEN

ABSTRACT Introduction: Physical exercise promotes positive physiological adaptations, reducing the risk of developing cardiovascular diseases and promoting greater autonomic control of heart rate and reduction in pressure levels. Objective: To compare the behavior of arterial pressure and autonomic heart rate modulation in the 1-repetition maximum knee extension test, performed on the 45-degree leg press machine in normotensive and prehypertensive subjects. Methods: Twenty-four male volunteers were assessed. Blood pressure (BP) and heart rate variability (HRV) were evaluated at rest, immediately after the maximum load achieved and during the 10, 20, 30 and 40-minute recovery phases. Statistical analyses were obtained using SigmaStat 3.5 software and a level of significance of 5%. Results: Mean and standard deviation were used to identify 12 normotensive patients (N) aged = 25.5 ± 5.7 years; height = 174.3 ± 6.6 cm; BMI = 24.9 ± 2.4; SBP on average = 112.6 ± 5.6 mmHg and 12 prehypertensive (PH) patients aged = 29.8 ± 6.5 years; height = 175.7 ± 6.7 cm; BMI = 27.8 ± 6.5; mean SBP = 131.1 ± 3.2 mmHg. There was a statistical difference in the pNN50 index (%) at rest (PH = 1.13 ± 0.66 and N = 1.58 ± 0.35) and in the LF/HF index, also at rest (PH = 0.18 ± 0.29 and N = −0.18 ± 0.36). Conclusion: The one-repetition maximum (1RM) test did not promote cardiovascular risk in the prehypertensive group during its execution, with double product results lower than 30,000 mmHg.bpm, demonstrating lower cardiac overload. Moreover, HRV exhibited similarity in sympathetic-vagal behavior, in the time/frequency domain, between the groups. Level of Evidence III; Study Case-control.

RESUMO Introdução: O exercício físico promove adaptações fisiológicas de caráter positivo, diminuindo os riscos de desenvolvimento de doenças cardiovasculares, além de promover um maior controle autonômico da frequência cardíaca e redução nos níveis pressóricos. Objetivo: Comparar o comportamento da pressão arterial e da modulação autonômica da frequência cardíaca no teste de uma repetição máxima de extensão de joelhos, realizado no aparelho de Leg press 45° em sujeitos normotensos e pré-hipertensos. Métodos: Foram avaliados 24 voluntários do sexo masculino. Foi feita a avaliação da pressão arterial (PA) e da variabilidade da frequência cardíaca (VFC) no momento de repouso, imediatamente após a carga máxima alcançada e durante as fases de 10, 20, 30 e 40 minutos de recuperação. As análises estatísticas foram obtidas através do software SigmaStat 3.5 e nível de significância igual a 5%. Resultados: A média e o desvio padrão foram utilizados para identificação de 12 normotensos (N) com idade = 25,5 ± 5,7 anos; altura = 174,3 ± 6,6 cm; IMC = 24,9 ± 2,4; PAS em média = 112,6 ± 5,6 mmHg e 12 pré-hipertensos (PH) com idade = 29,8 ± 6,5 anos; altura = 175,7 ± 6,7 cm; IMC = 27,8 ± 6,5; PAS em média = 131,1 ± 3,2 mmHg. Houve diferença estatística no índice pNN50 (%) no momento repouso (PH = 1,13 ± 0,66 e N =1,58 ± 0,35) e no índice LF/HF igualmente no momento repouso (PH = 0,18 ± 0,29 e N = −0,18 ± 0,36). Conclusão: O teste de uma repetição máxima (1RM) não promoveu risco cardiovascular no grupo pré-hipertenso durante sua execução, com resultados de duplo produto menor que 30.000 mmHg.bpm, demonstrando menor sobrecarga cardíaca, e a VFC apresentou similaridade no comportamento simpático-vagal no domínio do tempo e frequência entre os grupos. Nível de evidência III; Estudo Caso controle.

RESUMEN Introducción: El ejercicio físico promueve adaptaciones fisiológicas de carácter positivo, disminuyendo los riesgos de desarrollo de enfermedades cardiovasculares, además de promover un mayor control autonómico de la frecuencia cardíaca y reducción en los niveles presóricos. Objetivo: Comparar el comportamiento de la presión arterial y de la modulación autonómica de la frecuencia cardíaca en el test de una repetición máxima de extensión de rodillas, realizado en el aparato de Leg press 45° en sujetos normotensos y pre-hipertensos. Métodos: Fueron evaluados 24 voluntarios del sexo masculino. Fue hecha la evaluación de la presión arterial (PA) y de la variabilidad de la frecuencia cardíaca (VFC) en el momento de reposo, inmediatamente después de la carga máxima alcanzada y durante las fases de 10, 20, 30 y 40 minutos de recuperación. Los análisis estadísticos fueron obtenidos a través del software SigmaStat 3.5 y nivel de significancia igual a 5%. Resultados: El promedio y la desviación estándar fueron utilizados para identificación de 12 normotensos (N) con edad = 25,5 ± 5,7 años; altura = 174,3 ± 6,6 cm; IMC = 24,9 ± 2,4; PAS en promedio = 112,6 ± 5,6 mmHg y 12 pre-hipertensos (PH) con edad = 29,8 ± 6,5 años; altura = 175,7 ± 6,7 cm; IMC = 27,8 ± 6,5; PAS en promedio = 131,1 ± 3,2 mmHg. Hubo diferencia estadística en el índice pNN50 (%) en el momento reposo (PH = 1,13 ± 0,66 y N =1,58 ± 0,35) y en el índice LF/HF igualmente en el momento reposo (PH = 0,18 ± 0,29 y N = −0,18 ± 0,36). Conclusión: El test de una repetición máxima (1RM) no promovió riesgo cardiovascular en el grupo pre-hipertenso durante su ejecución, con resultados de doble producto menor que 30.000 mmHg.bpm, demostrando menor sobrecarga cardíaca, y la VFC presentó similitud en el comportamiento simpático-vagal en el dominio del tiempo y frecuencia entre los grupos. Nivel de evidencia III; Estudio Caso control.

RESUMEN

Abstract Background: Fragmented QRS (fQRS) is a sign of adverse cardiovascular events in various cardiovascular diseases. It is also associated with increased blood pressure and non-dipping in hypertensive patients. However, no study has investigated the importance of fQRS in prehypertensive patients. Objectives: The aim of our study is to investigate the relationship between fQRS and non-dipper status in prehypertensive patients. Methods: Two hundred and sixteen eligible, newly diagnosed prehypertensive patients who underwent 24-hour ambulatory blood pressure monitoring (ABPM) for further evaluation of blood pressure between June 2015 and July 2016 were included into the study. Patients were divided into three groups according to ABPM results: normotensives, dipper prehypertensives, and non-dipper prehypertensives. Groups were compared regarding presence of fQRS on electrocardiography. Additionally, multinomial logistic regression analysis was used to determine the relationship between fQRS and blood pressure pattern in prehypertensive patients. Results: According to ABPM recordings, 61 patients had normotensive blood pressure pattern (systolic blood pressure < 120 mmHg and diastolic blood pressure < 80 mmHg). Of the remaining 155 prehypertensive patients, 83 were dippers and 72 were non-dippers. Non-dipper prehypertensives had a significantly higher frequency of fQRS compared to normotensives (p = 0.048). Furthermore, multinomial logistic regression analysis revealed that fQRS is an independent predictor of non-dipping blood pressure pattern in prehypertensive patients (p = 0.017, OR: 4.071, 95% CI: 1.281-12.936). Conclusions: We found that fQRS is a predictor of non-dipping in prehypertensives. As a marker of fibrosis and higher fibrotic burden within myocardium, fQRS may be useful in identifying high-risk prehypertensive patients before the development of hypertension.

Resumo Fundamento: A fragmentação do QRS (fQRS) é um sinal de eventos cardiovasculares adversos em várias doenças cardiovasculares. É associado também à pressão arterial elevada e à ausência de descenso da pressão arterial durante o sono (non-dipping) em pacientes pré-hipertensos. Objetivos: O objetivo do estudo presente é investigar a relação entre fQRS e ausência de descenso da pressão arterial durante o sono em pacientes pré-hipertensos. Métodos: Duzentos e dezesseis pacientes elegíveis, recém-diagnosticados com pré-hipertensão, que foram submetidos a monitorização ambulatorial da pressão arterial (MAPA) durante 24 horas para avaliação mais aprofundada da pressão arterial entre junho de 2015 e julho de 2016, foram incluídos no estudo. De acordo com os resultados da MAPA, os pacientes foram divididos em três grupos: normotensos, pré-hipertensos com descenso da pressão arterial durante o sono (padrão dipping) e pré-hipertensos com ausência de descenso da pressão arterial durante o sono (padrão non-dipping). Os grupos foram comparados quanto à presença de fQRS no eletrocardiograma. Adicionalmente, utilizou-se a análise de regressão logística multinomial para determinar a relação entre a fQRS e o padrão de pressão arterial em pacientes pré-hipertensos. Resultados: De acordo com os registos da MAPA, 61 pacientes apresentavam padrão de pressão arterial normotenso (pressão arterial sistólica < 120 mmHg e pressão arterial diastólica < 80 mmHg). Dos 155 pacientes pré-hipertensos, 83 tinham padrão dipping e 72 tinham padrão non-dipping. Os pacientes pré-hipertensos com padrão non-dipping tinham uma frequência significativamente mais alta de fQRS em comparação com os pacientes normotensos (p = 0,048). Além disso, a análise de regressão logística multinomial revelou que fQRS é um preditor independente do padrão non-dipping de pressão arterial em pacientes pré-hipertensos (p = 0,017, OR: 4,071, 95 % CI: 1,281-12,936). Conclusões: Verificamos que a fQRS é um preditor do padrão non-dipping em pacientes pré-hipertensos. Como marcador de fibrose e aumento na carga fibrótica do miocárdio, a fQRS pode ser útil na identificação de pacientes pré-hipertensos de alto risco antes do desenvolvimento da hipertensão.

Asunto(s)

Asunto(s)