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BACKGROUND: Obstructive sleep apnea (OSA) and hypertension are common conditions that may be linked through sympathetic activation and water retention. We hypothesized that diuretics, which reduce the body water content, may be more effective than amlodipine, a blood pressure (BP)-lowering agent implicated with edema, in controlling OSA in patients with hypertension. We also aimed to compare the effects of these treatments on ambulatory blood pressure monitoring (ABPM). METHODS: In a randomized, double-blind clinical trial, we compared the effects of chlorthalidone/amiloride 25/5 mg with amlodipine 10 mg on OSA measured by portable sleep monitor and BP measured by ABPM. The study included participants older than 40 who had moderate OSA (10-40 apneas/hour of sleep) and BP within the systolic range of 140-159 mmHg or diastolic range of 90-99 mmHg. RESULTS: The individuals in the experimental groups were comparable in age, gender, and other relevant characteristics. Neither the combination of diuretics nor amlodipine alone reduced the AHI after 8 weeks of treatment (AHI 26.3 with diuretics and 25.0 with amlodipine. P = 0.713). Both treatments significantly lowered office, 24-h, and nighttime ABP, but the two groups had no significant difference. CONCLUSION: Chlorthalidone associated with amiloride and amlodipine are ineffective in decreasing the frequency of sleep apnea episodes in patients with moderate OSA and hypertension. Both treatments have comparable effects in lowering both office and ambulatory blood pressure. The notion that treatments could offer benefits for both OSA and hypertension remains to be demonstrated. TRIAL REGISTRATION CLINICALTRIALS. GOV IDENTIFIER: NCT01896661.

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Myocardial injury (MI) is frequent in critically ill patients with COVID-19, but its pathogenesis remains unclear. We hypothesized that MI is not solely due to viral infection by SARS-CoV-2 but rather due to the common pathophysiological mechanisms associated with severe pulmonary infections and respiratory failure. This contemporary cohort study was designed to compare the incidence of MI in patients with acute respiratory failure caused by COVID-19 to patients with other pulmonary infections. In addition, we aimed to investigate whether MI was a distinct risk factor for in-hospital mortality in patients with COVID-19 compared to those with non-COVID-19 infections. This study included 1444 patients with COVID-19 (55.5% men; age 58 (46;68) years) and 182 patients with other pulmonary infections (46.9% men; age 62 (44;73) years). The incidence of MI at ICU admission was lower in COVID-19 patients (36.4%) compared to non-COVID-19 patients (56%), and this difference persisted after adjusting for age, sex, coronary artery disease, heart failure, SOFA score, lactate, and C-reactive protein (RR 0.84 (95% CI, 0.71-0.99)). MI at ICU admission was associated with a 59% increase in mortality (RR 1.59 (1.36-1.86); p < 0.001), and there was no significant difference in the mortality between patients with COVID-19 and those with other pulmonary infections (p = 0.271). We concluded that MI is less frequent in patients with critical COVID-19 pneumonia and respiratory failure compared to those with other types of pneumonia. The occurrence of MI is a significant risk factor for in-hospital mortality, regardless of the etiology of the pulmonary infection.

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INTRODUCTION: Nutritional status assessment commonly relies on body mass index (BMI), which overlooks lean mass and adipose tissue distribution. However, waist circumference (WC) and waist-to-height ratio (WHtR) provide additional insights into fat accumulation. By combining these indices, it may be possible to identify older adults needing weight management interventions. OBJECTIVES: To assess the WC and WHtR as strategies for identifying individuals requiring weight management. METHODS: A cross-sectional study was conducted with 509 elderly individuals in Northeast Brazil. Weight, height, hip circumference, and waist circumference were measured, and combined with indices such as BMI WC, WHR, and WHtR to identify those who require weight management. The DeLong test compared areas under the curves using receiver operating characteristic curves and statistical significance. Sensitivity, specificity, and positive and negative predictive values were calculated to verify usefulness for clinical application. A validation sample of 599 elderly individuals from the country's Southern region was used to confirm the results. RESULTS: Both WC and WHtR showed adequate diagnostic accuracy with no statistically significant difference in AUCs. WHtR ≥ 0.50 had 92% sensitivity in identifying men and women requiring nutritional management. WC presented lower sensitivity but 93% specificity, useful for excluding elderly individuals from the nutritional risk category. These results were consistent in the validation sample. CONCLUSION: WHtR is a valuable index for screening nutritional risk management in the elderly population, applicable to men and women. Conversely, WC performs better in excluding individuals who do not need nutritional risk management.

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There is sound evidence showing the efficacy of non-pharmacological interventions in lowering blood pressure (BP); however, adherence is usually poor. Interventions to induce behavioral changes aim to improve the ability to read labels, choose foods, and eat low-sodium meals, reinforcing adherence to sodium restriction. In this randomized parallel-controlled trial, we assessed the effectiveness of an educational intervention using the Dietary Sodium Restriction Questionnaire (DSRQ) scores. A follow-up period of 6 months was conducted. Participants were randomized into (1) an educational intervention provided by a registered dietitian on individual visits and dietary planning; (2) a control group with the usual care and dietary recommendations. Patients underwent 24-h ambulatory BP monitoring, 12-h fasting blood tests, spot urine collection, and assessment using DSRQ. We randomized 120 participants (67.5% women and 68.3% Caucasians), and 25 participants were lost to follow-up. The 24-h sodium urinary excretion changed in the control (Δ -1610 mg/day; 95% confidence interval [CI] -1800 to -1410) and intervention groups (Δ -1670 mg/day; 95% CI -1800 to -1450) over time. There was no significant difference in the 24-h estimated sodium between groups. In hypertensive patients, DSRQ-based educational intervention is effective for improving the ability to detect and overcome obstacles to a low-sodium restriction diet but is as effective as dietary recommendations for lowering sodium.

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Hypertension is highly prevalent in patients with obstructive sleep apnea (OSA), and fluid retention with its nighttime rostral distribution is one potential mechanism. We tested whether or not diuretics differ from amlodipine in their impact on echocardiographic parameters. Patients with moderate OSA and hypertension were randomized to receive diuretics (chlorthalidone plus amiloride) or amlodipine daily for 8 weeks. We compared their effects on left and right ventricular global longitudinal strain (LV-GLS and RV-GLS, respectively), on LV diastolic parameters, and on LV remodeling. In the 55 participants who had echocardiographic images feasible for strain analysis, all echocardiographic parameters were within normal ranges. After 8 weeks, the 24 h blood pressure (BP) reduction values were similar, while most echocardiographic metrics were kept unchanged, except for LV-GLS and LV mass. In conclusion, the use of diuretics or amlodipine had small and similar effects on echocardiographic parameters in patients with moderate OSA and hypertension, suggesting that they do not have important effects on mediating the interaction between OSA and hypertension.

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BACKGROUND: It is unknown whether unwitnessed BP (UBP) measurement or ambulatory BP (ABP) monitoring improves the prediction of adverse events estimated by risk scores. We intended to study associations between preoperative BP measured through these two methods and the incidence of adverse outcomes in patients undergoing cardiac surgery. METHODS: We included a cohort of 167 patients undergoing elective or urgent cardiac surgeries. Preoperative BP was measured by UBP and 24-hour ABP. Primary outcome was the combination of mortality from any cause, nonfatal myocardial infarction, nonfatal stroke, new hospital admission, and dialysis occurring within 30 days after surgery. The associations between preoperative BP and surgical outcomes were tested using the Chi-square test and Analysis of Variance. A generalized linear model with a logistic link function and a robust estimator was used to adjust for the EuroScore-II risk estimation. RESULTS: The incidence of the primary outcome increased in parallel with the quartiles of the 24-hour ABP in participants submitted to CABG: 10% in the first quartile, 13% in the second, 37% in the third, and 53% in the fourth quartile (P for trend<0.01). Quartiles of overnight ABP were also significantly associated with postoperative complications in patients undergoing CABG (P=0.04). The risks in CABG patients were independent of the EuroScore-II. There was no association between BP and outcomes in patients submitted to other surgeries. CONCLUSIONS: High preoperative BP measured by ABP monitoring is a risk factor for postoperative complications in patients submitted to CABG.

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Our objective was to evaluate the effect of a mobile health (mHealth) intervention on lifestyle adherence and anthropometric characteristics among individuals with uncontrolled hypertension. We performed a randomized controlled trial (ClinicalTrials.gov NCT03005470) where all participants received lifestyle counseling at baseline and were randomly allocated to receive (1) an automatic oscillometric device to measure and register blood pressure (BP) via a mobile application, (2) personalized text messages to stimulate lifestyle changes, (3) both mHealth interventions, or (4) usual clinical treatment (UCT) without technology (control). The outcomes were achieved for at least four of five lifestyle goals (weight loss, not smoking, physical activity, moderate or stopping alcohol consumption, and improving diet quality) and improved anthropometric characteristics at six months. mHealth groups were pooled for the analysis. Among 231 randomized participants (187 in the mHealth group and 45 in the control group), the mean age was 55.4 ± 9.5 years, and 51.9% were men. At six months, achieving at least four of five lifestyle goals was 2.51 times more likely (95% CI: 1.26; 5.00, p = 0.009) to be achieved among participants receiving mHealth interventions. The between-group difference reached clinically relevant, but marginally significant, reduction in body fat (-4.05 kg 95% CI: -8.14; 0.03, p = 0.052), segmental trunk fat (-1.69 kg 95% CI: -3.50; 0.12, p = 0.067), and WC (-4.36 cm 95% CI: -8.81; 0.082, p = 0.054), favoring the intervention group. In conclusion, a six-month lifestyle intervention supported by application-based BP monitoring and text messages significantly improves adherence to lifestyle goals and is likely to reduce some anthropometric characteristics in comparison with the control without technology support.

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The older population has an increasing burden of non-communicable disease, which can potentially be associated with physical and mental disabilities and shorten life spam. To investigate whether depression, loss of functionality for activities of daily living, and lower social support are associated with all-cause mortality in the older population of Italian descent. This population-based cohort study was conducted in Veranópolis, a country city from southern Brazil, among individuals aged 60 years or older. Interviews were performed in a systematic random sampling regarding demographic, socioeconomic, and psychosocial variables, in addition to depression (Geriatric Depression Scale), activities of daily living (Barthel Index), and social support (Medical Outcomes Study scale). In the follow-up, participants were reinterviewed or, in case of death, the next of kin, and hospital records were revised. Hierarchical analysis was used to determine characteristics independently associated with all-cause mortality, using Poisson regression with robust variance, expressed as relative risk with 95% confidence intervals (RR; 95%CI). A total of 997 participants were enrolled and 882 participants completed the study, after 7.24 ± 2.41 years; with 581 remaining alive. The mean age was 73.12 ± 8.03 years, 4% were nonagenarians or centennials, and 62% were women. Symptoms of depression (RR: 1.04; 1.01-1.06) and functional dependence for ADL (RR: 1.00; 0.99-1.00) were associated with all-cause mortality, even after controlling for confounding factors. Lower social support was not associated with mortality (RR: 1.00; 0.99-1.01). Depression and functional dependence are independent predictors of all-cause mortality in the older population from Italian descent.

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Post-exercise hypotension (PEH) is typically reported as mean values, but a great inter-individual variation in blood pressure (BP) response after a single exercise session is expected, especially when comparing different modalities of exercise. The purpose was to evaluate the inter-individual BP responses after beach tennis, aerobic, resistance and combined exercise sessions in adults with hypertension. We conducted a post hoc analysis of pooled crossover randomized clinical trials from six previously published studies of our research group, and analyzed data from 154 participants with hypertension (≥35 years). BP was assessed using office BP, and the mean changes throughout the 60 min after recreational beach tennis (BT, n = 23), aerobic (AE, n = 18), combined (COMB, n = 18), and resistance (RES, n = 95) exercise sessions were compared to a non-exercising control session (C). To categorize the participants as responders and non-responders for PEH, the typical error (TE) was calculated as follows: TE = SDdifference/√2, where SDdifference is the standard deviation of the differences in BP measured before the interventions in the exercise and control sessions. Participants who presented PEH greater than TE were classified as responders. The TE was 7 and 6 mmHg for baseline systolic and diastolic BP, respectively. The rate of responders for systolic BP was as follows: BT: 87%; AE: 61%; COMB: 56%; and RES: 43%. For diastolic BP, the rate of responders was as follows: BT: 61%; AE: 28%; COMB: 44%; and RES: 40%. Results evidenced that there was a high inter-individual variation of BP after a single bout of different physical activity modalities in adults with hypertension, suggesting that exercise protocols with aerobic characteristics (i.e., BT, AE, and COMB sessions) presented PEH in most of its practitioners.

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BACKGROUND: Secondary prevention is recommended for patients with evidence of coronary artery disease (CAD) regardless of the indication for treatment by coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI). OBJECTIVES: This study evaluated whether clinical treatment, PCI or CABG had an influence on adherence to the pharmacological secondary prevention in patients with stable CAD. METHODS: This cohort included patients aged ≥40 years with stable CAD confirmed by coronary angiography. The decision for medical treatment alone, or additionally with PCI or CABG, was made by the attending physicians. Adherence to the prescribed drugs recommended by the guidelines for secondary prevention (optimal pharmacological treatment), including antiplatelet agents, lipid-lowering drugs, beta-blockers, and renin-angiotensin-aldosterone system blockers, was assessed at follow-up. Differences were considered significant for p values <0.05. RESULTS: From 928 patients enrolled at baseline, 415 had mild CAD and 66 moderate to severe CAD. The average follow-up was 5.2 ± 1.5 years. Patients submitted to CABG were more likely to receive the optimal pharmacological treatment than those submitted to PCI or treated clinically (63.5% versus 39.1% versus 45.7% respectively, p=0.003). Baseline factors independently associated with greater probability of having a prescription of optimal treatment at follow-up were CABG [39% higher (6% - 83%, p=0.017) and diabetes [25% higher (1% - 56%), p=0.042] than their counterparts treated by other methods and participants without diabetes, respectively. CONCLUSIONS: Patients with CAD submitted to CABG are more commonly treated with optimal pharmacological secondary prevention than patients treated by PCI or exclusively with medical therapy.

FUNDAMENTO: A prevenção secundária é recomendada a pacientes com evidência de doença arterial coronariana (DAC) independentemente da indicação de tratamento por cirurgia de bypass da artéria coronária (CABG) ou intervenção coronária percutânea (ICP). OBJETIVOS: Este estudo avaliou se o tratamento clínico, a ICP ou o CABG teve influência na adesão à prevenção secundária farmacológica em pacientes com DAC estável. MÉTODOS: Esta coorte incluiu pacientes com idade ≥40 anos com DAC estável confirmada por angiografia coronária estável. A decisão por tratamento clínico isolado, ou combinado com ICP ou CABG foi feita por médicos assistentes. A adesão às drogas prescritas recomendadas pelas diretrizes de prevenção secundária (tratamento farmacológico ótimo), incluindo agentes antiplaquetários, drogas hipolipemianetes, betabloqueadores, e bloqueadores do sistema angiotensina aldosterona, foi avaliada no acompanhamento. Diferenças com valores de p < 0,05 foram consideradas estatisticamente significativas. RESULTADOS: Dos 928 pacientes incluídos inicialmente, 415 apresentaram DAC leve e 66 apresentaram DAC leve a moderada. O período médio de seguimento foi 5,2 ± 1,5 anos. Os pacientes submetidos ao CABG apresentaram maior probabilidade de receberem tratamento farmacológico ótimo que aqueles submetidos à ICP ou tratamento clínico (63,5% versus 39,1% versus 45,7% respectivamente, p=0,003). Fatores basais independentemente associados com maior probabilidade de prescrição de tratamento ótimo foram CABG [39% maior (6% - 83%, p=0,017)] em comparação a outros tratamentos e diabetes [25% maior (1% - 56%), p=0,042] em comparação à ausência de diabetes. CONCLUSÕES: Pacientes com DAC submetidos ao CABG são mais frequentemente tratados com prevenção secundária farmacológica ótima que pacientes tratados com ICP ou exclusivamente com tratamento clínico.

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Resumo Fundamento A prevenção secundária é recomendada a pacientes com evidência de doença arterial coronariana (DAC) independentemente da indicação de tratamento por cirurgia de bypass da artéria coronária (CABG) ou intervenção coronária percutânea (ICP). Objetivos Este estudo avaliou se o tratamento clínico, a ICP ou o CABG teve influência na adesão à prevenção secundária farmacológica em pacientes com DAC estável. Métodos Esta coorte incluiu pacientes com idade ≥40 anos com DAC estável confirmada por angiografia coronária estável. A decisão por tratamento clínico isolado, ou combinado com ICP ou CABG foi feita por médicos assistentes. A adesão às drogas prescritas recomendadas pelas diretrizes de prevenção secundária (tratamento farmacológico ótimo), incluindo agentes antiplaquetários, drogas hipolipemianetes, betabloqueadores, e bloqueadores do sistema angiotensina aldosterona, foi avaliada no acompanhamento. Diferenças com valores de p < 0,05 foram consideradas estatisticamente significativas. Resultados Dos 928 pacientes incluídos inicialmente, 415 apresentaram DAC leve e 66 apresentaram DAC leve a moderada. O período médio de seguimento foi 5,2 ± 1,5 anos. Os pacientes submetidos ao CABG apresentaram maior probabilidade de receberem tratamento farmacológico ótimo que aqueles submetidos à ICP ou tratamento clínico (63,5% versus 39,1% versus 45,7% respectivamente, p=0,003). Fatores basais independentemente associados com maior probabilidade de prescrição de tratamento ótimo foram CABG [39% maior (6% - 83%, p=0,017)] em comparação a outros tratamentos e diabetes [25% maior (1% - 56%), p=0,042] em comparação à ausência de diabetes. Conclusões Pacientes com DAC submetidos ao CABG são mais frequentemente tratados com prevenção secundária farmacológica ótima que pacientes tratados com ICP ou exclusivamente com tratamento clínico.

Abstract Background Secondary prevention is recommended for patients with evidence of coronary artery disease (CAD) regardless of the indication for treatment by coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI). Objectives This study evaluated whether clinical treatment, PCI or CABG had an influence on adherence to the pharmacological secondary prevention in patients with stable CAD. Methods This cohort included patients aged ≥40 years with stable CAD confirmed by coronary angiography. The decision for medical treatment alone, or additionally with PCI or CABG, was made by the attending physicians. Adherence to the prescribed drugs recommended by the guidelines for secondary prevention (optimal pharmacological treatment), including antiplatelet agents, lipid-lowering drugs, beta-blockers, and renin-angiotensin-aldosterone system blockers, was assessed at follow-up. Differences were considered significant for p values <0.05. Results From 928 patients enrolled at baseline, 415 had mild CAD and 66 moderate to severe CAD. The average follow-up was 5.2 ± 1.5 years. Patients submitted to CABG were more likely to receive the optimal pharmacological treatment than those submitted to PCI or treated clinically (63.5% versus 39.1% versus 45.7% respectively, p=0.003). Baseline factors independently associated with greater probability of having a prescription of optimal treatment at follow-up were CABG [39% higher (6% - 83%, p=0.017) and diabetes [25% higher (1% - 56%), p=0.042] than their counterparts treated by other methods and participants without diabetes, respectively. Conclusions Patients with CAD submitted to CABG are more commonly treated with optimal pharmacological secondary prevention than patients treated by PCI or exclusively with medical therapy.

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Background: Various physical exercise modalities can acutely reduce blood pressure (BP). However, not all individuals respond similarly after an exercise session. Purpose: To measure inter-individual variations in 24-h BP after a single bout of various exercise modalities in older adults with hypertension. Methods: This retrospective study analyzed data from participants with hypertension (≥60 years) previously included in three randomized controlled trials on this topic. BP was assessed using ambulatory BP monitoring. We compared the mean changes in total 24-h, daytime, and nighttime BP after aerobic (AE, n = 19), combined (COMB, n = 19), resistance (RES, n = 23), and isometric handgrip (ISO, n = 18) exercise sessions to a non-exercising control session (C). The minimum detectable changes to classify the participant as a "Responder" for the corresponding exercise protocol were 4 and 2 mmHg for systolic and diastolic BP, respectively. Results: The prevalence of Responders for systolic BP was as follows: AE 24-h: 37%, daytime: 47% and nighttime: 37%; COMB 24-h: 26%, daytime: 21% and nighttime: 32%; RES 24-h: 26%, daytime: 26% and nighttime: 35%; and ISO 24-h: 22%, daytime: 22% and nighttime: 39%. For diastolic BP, the prevalence of Responders was as follows: AE 24-h: 53%, daytime: 53% and nighttime: 31%; COMB 24-h: 26%, daytime: 26% and nighttime: 31%; RES 24-h: 35%, daytime: 22% and nighttime: 52%; and ISO 24-h: 44%, daytime: 33% and nighttime: 33%. Conclusion: There was a high inter-individual variation of BP after a single bout of various exercises in older adults. Responders had higher BP values on the control day without exercise. Various exercise modalities might acutely reduce 24-h BP in older adults with hypertension.

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Background: Scores for prediction of cardiovascular events in patients with stable coronary artery disease (CAD) submitted to coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) or medical-therapy (MT), such as the SYNTAX score (SXscore), have been proposed, but there is no comparative assessment of their performance with the coronary angiogram standard evaluation (CASE). This study aimed to evaluate the performance of the SXscore versus the CASE in the prediction of major cardiovascular outcomes (MACCE) in patients with chronic CAD who were treated with MT or additionally submitted to CABG or PCI. Methods: Prospective cohort study of 454 patients with CAD referred for elective diagnostic coronary angiography in Hospital de Clínicas de Porto Alegre, Brazil, with 40 years of age or over, which were followed on average for 6±2.0 years. Patients with acute coronary syndromes, valvular heart disease, aortic diseases, previous coronary revascularization, heart failure, chronic renal disease, history of cancer, or severe psychiatric illness were excluded. Agreement between the scores was evaluated by Kappa statistics. The performance of the scores to predict MACCE was evaluated by Cox proportional hazard models. Areas under the ROC curves were compared by the DeLong test. Results: Patients with moderate to high SXscores or with left main or multivessel CAD (LMMCAD) in the CASE evaluation had higher rates of all-cause death and MACCE than those with low SXscore or without LMMCAD. After adjusting for confounding, only LMMCAD remained associated with the incidence of all-cause death in the total sample (HR =2.81;95% CI: 1.17-6.74) and for MACCE in patients undergoing MT (HR =8.72; 95% CI: 1.73-44.10). The ROC curves for all treatments were similar. Kappa statistics was not significant in patients submitted to MT, poor for patients treated by PCI and fair for the whole sample and patients treated with CABG. Conclusions: The severity of CAD defined by CASE or the SXscore provides similar prediction of the occurrence of cardiovascular events in patients submitted to clinical, PCI or CABG therapies. CASE is easier to do and may be the preferential method in the stratification of risk of patients with stable CAD.

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Background: The effect of a single isometric handgrip exercise (IHG) on blood pressure (BP) variability (BPV) has not been addressed. This randomized controlled trial evaluated the effect of IHG vs. sham on BPV and BP. Methods: Hypertensive patients using up to two BP-lowering medications were randomly assigned to IHG (4 × 2 min; 30% of maximal voluntary contraction, MVC, with 1 min rest between sets, unilateral) or sham (protocol; 0.3% of MVC). Systolic and diastolic BP were assessed beat-to-beat in the laboratory before, during, and post-intervention and also using 24-h ambulatory BP monitoring (ABPM). BPV was expressed as average real variability (ARV) and standard deviation (SD). Results: Laboratory BPV, ARV and SD variability, had marked increase during the intervention, but not in the sham group, decreasing in the post-intervention recovery period. The overall change in ARV from pre- to 15 min post-intervention were 0.27 ± 0.07 (IHG) vs. 0.05 ± 0.15 (sham group), with a statistically significant p-value for interaction. Similarly, mean systolic BP increased during the intervention (IHG 165.4 ± 4.5 vs. sham 152.4 ± 3.5 mmHg; p = 0.02) as did diastolic BP (104.0 ± 2.5 vs. 90.5 ± 1.7 mmHg, respectively; p < 0.001) and decreased afterward. However, neither the short-term BPV nor BP assessed by ABPM reached statistically significant differences between groups. Conclusion: A single session of IHG reduces very short-term variability but does not affect short-term variability. IHG promotes PEH in the laboratory, but does not sustain 24-h systolic and diastolic PEH beyond the recovery period.

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BACKGROUND: The use of thiazide (T) diuretics for the treatment of hypertension may be associated with adverse metabolic effects, which can be minimized by combining thiazides with potassium-sparing (PS) diuretics. The additional blood pressure (BP)-lowering effect provided by the addition of a PS diuretic is unclear. Due to a large number of drugs in the T diuretics class, and the possible difference between them, there is a need to identify the best available evidence for health decision-making. This systematic review with network meta-analysis aims to compare the antihypertensive efficacy of T diuretics alone or in combination with a PS diuretic in patients with primary hypertension, as well as the safety of such drugs through the measurement of drug-related adverse events. METHODS: A comprehensive electronic search will be conducted in six electronic bibliographic databases (PubMed/MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, Lilacs), a registration database ( ClinicalTrials.gov ), and Educational Resources Information Center (ERIC [ProQuest]), published from inception to the date of the search. The search will be updated towards the end of the review. A hand search of the reference sections of the included studies and cited studies will also be performed. In case of missing data, authors will be contacted by e-mail or academic social networking sites whenever possible. To be included in the review, studies must be double-blind randomized controlled trials evaluating T diuretics alone or in combination with PS diuretics in patients with primary hypertension. The primary outcome measure will be office BP. Ambulatory BP monitoring (ABPM), non-melanoma skin cancer, major adverse cardiovascular events, laboratory parameters, and the number of withdrawals will be included as secondary outcomes. The results will be quantitatively summarized using differences between the mean change from baseline or differences between means for quantitative outcomes and relative risk for dichotomous outcomes. Results will be presented as mean or relative risk with credible intervals through a league table. The treatments will also be ranked using the surface under the cumulative ranking curve method. The risk of bias will be assessed through the RoB 1.0 tool. DISCUSSION: To the best of our knowledge, this review will be the first to synthesize currently available evidence on the antihypertensive efficacy of different T diuretics alone or in combination with PS diuretics in adults with hypertension. The goals of hypertension treatment are to control high BP and to reduce associated cardiovascular morbidity and mortality, using the most appropriate therapy. Thiazides are widely used for pharmacological treatment due to their demonstrated effectiveness in reducing BP, favorable safety profile, and low cost. The results of this study will provide evidence regarding the best therapeutic strategies with T and PS diuretics, evidencing interventions with better antihypertensive efficacy and safety profile. TRIAL REGISTRATION: This systematic review and network meta-analysis was prospectively registered at the PROSPERO database ( CRD42018118492 ).

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To determine the effect of mobile health (mHealth) focused on diet and lifestyle on blood pressure (BP). We performed a systematic review with meta-analysis using the mean difference (MD) of change from baseline as an effect measure. MEDLINE via PubMed, Cochrane Central, and EMBASE were reviewed until 6 May 2020. We included randomized controlled trials of adults who participated in mHealth focused on diet and lifestyle. Interventions were grouped according to the presence of health professional intervention (PI) (PI + mHealth or mHealth only). Eligible controls did not participate in mHealth and were classified as active comparator (PI) or no intervention (NI). Subgroup analyses were performed according to the presence of prior cardiovascular disease and hypertension status. We included 44 trials involving 24 692 participants. Mobile health interventions were superior to NI in reducing SBP in both situations: alone [MD = -1.8 mmHg; 95% confidence interval (CI): -3.6; 0.0] or with PI (MD = -5.3 mmHg; 95% CI: -7.5; -3.1), with a greater effect size in the latter group (P = 0.016). This benefit was not observed when the control was PI. DBP and SBP had consistent results. There was a marked effect of PI + mHealth vs. NI on the BP reduction among hypertensive participants. Current evidence shows that mHealth focused on diet and lifestyle can reduce BP, especially when implemented in hypertensive participants, and PI may provide additional benefit. PROSPERO ID CRD42019141475.

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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.

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BACKGROUND: Clinical, surgical, and percutaneous strategies similarly prevent major cardiovascular events in patients with stable coronary artery disease (CAD). The possibility that these strategies have differential effects on health-related quality of life (HRQoL) has been debated, particularly in patients treated outside clinical trials. METHODS: We assigned 454 patients diagnosed with CAD during an elective diagnostic coronary angiography to coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or optimal medical treatment (OMT), and followed them for an average of 5.2 ± 1.5 years. HRQoL was assessed using a validated Brazilian version of the 12-Item Short-Form Health Survey questionnaire. The association between therapeutic strategies and quality of life scores was tested using variance analysis and adjusted for confounders in a general linear model. RESULTS: There were no differences in the mental component summary scores in the follow-up evaluation by therapeutic strategies: 51.4, 53.7, and 52.3 for OMT, PCI, and CABG, respectively. Physical component summary scores were higher in the PCI group than the CABG and OMT groups (46.4 vs. 42.9 and 43.8, respectively); however, these differences were no longer different after adjustment for confounding variables. CONCLUSION: In a long-term follow-up of patients with stable CAD, HRQoL did not differ in patients treated by medical, percutaneous, or surgical treatments.

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PURPOSE: To examine the acute and chronic effects of alcohol on blood pressure (BP) and the incidence of hypertension. We discuss the most current understanding of the mechanisms underlining these effects and their associations with the putative cardioprotective effects of consumption of low-to-moderate amounts of alcoholic beverages. RECENT FINDINGS: A recent meta-analysis confirmed findings of experimental studies, demonstrating an acute biphasic effect of ethanol on BP, decreasing up to 12 h of ingestion and increasing after that. This effect is mediated by vagal inhibition and sympathetic activation. A meta-analysis found that chronic consumption of alcoholic beverages was associated with a high incidence of hypertension in men and women; it also found that, in women, the risk begins at moderate alcohol consumption. The risks of alcohol consumption are higher in Blacks than in Asians or Caucasians. The mechanism underlying the chronic effects of alcohol on BP, and particularly the differential effect on Blacks, is still unknown. Short-term trials showed that alcohol withdrawal promotes BP reduction; however, the long-term effectiveness of interventions that aim to lower BP through the restriction of alcohol consumption has not been demonstrated. The harmful effects of alcohol on BP do not support the putative cardioprotective effect of low-to-moderate consumption of alcoholic beverages. The absence of a tangible mechanism of protection, and the possibility that this beneficial effect is biased by socioeconomic and other characteristics of drinkers and abstainers, calls into question the hypothesis that consuming low amounts of alcoholic beverages improves cardiovascular health. The evidence from investigations with various designs converge regarding the acute biphasic effect of ethanol on BP and the risk of chronic consumption on the incidence of hypertension, particularly for Blacks. These effects do not support the putative cardioprotective effect of consumption of low-to-moderate amounts of alcoholic beverages. Mechanisms of chronic BP increase and the demonstration of long-term benefits of reducing alcohol intake as a means to treat hypertension remain open questions.

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