RESUMO

RESUMEN Introducción: las enfermedades cardiovasculares son la principal causa de morbilidad y mortalidad, a pesar de las mejoras en los resultados clínicos y la introducción de nuevos fármacos. Objetivo: evaluar la influencia de factores riesgo en el desarrollo de enfermedades cardiovasculares en el adulto de 18 años o más. Método: se realizó un estudio retrospectivo de casos y testigos en pacientes con el diagnóstico de enfermedad cardiovascular que acuden al servicio de medicina interna del Hospital General Universitario "Carlos Manuel de Céspedes", Bayamo, Granma, desde el 5 de enero de 2017 hasta el 31 de diciembre de 2018. Dentro de los factores de riesgo se tuvo en cuenta la edad, género, comorbilidad y los marcadores biológicos. Resultados: dentro de las variables cualitativas el hábito de fumar fue el factor más importante (OR: 3,60; IC: 1,664-7,787; p: 0,001) mientras que de las cuantitativas fue la hipertensión sistólica (OR: 11,50; IC: 1,457-90,896; p: 0,004). El análisis multivariado, mostró que la hipertensión sistólica fue el factor de riesgo independiente más relevante (OR: 11,52; IC del 95%: 3,077- 43,168; p: 0,000) seguido tener como antecedentes de diabetes mellitus (OR: 5,91; IC del 95%: 1,674-20,910). Conclusiones: sobresale como factor de riesgo independiente más importante la hipertensión sistólica, seguida de padecer de diabetes mellitus y tener edad igual o superior a 60 años.

ABSTRACT Introduction: cardiovascular diseases are the main cause of morbidity and mortality, despite improvements in clinical results and the introduction of new drugs. Objective: to evaluate the influence of risk factors in the development of cardiovascular diseases in adults aged 18 years or older. Method: a retrospective study of cases and controls was carried out in patients diagnosed with cardiovascular disease who attend the internal medicine service of the General University Hospital "Carlos Manuel de Céspedes," Bayamo, Granma, from January 5, 2017 to December 31, 2018. Within the risk factors, age, gender, comorbidity and biological markers were taken into account. Results: among the qualitative variables, smoking was the most important factor (OR: 3.60; CI: 1.664-7.787; p: 0.001) while among the quantitative variables it was systolic hypertension (OR: 11.50; CI: 1457-90896, p: 0.004). Multivariate analysis showed that systolic hypertension was the most relevant independent risk factor (OR: 11.52; 95% CI: 3.077-43.168; p: 0.000) followed by having a history of diabetes mellitus (OR: 5.91 ;95% CI: 1674-20910). Conclusions: systolic hypertension stands out as the most important independent risk factor, followed by suffering from diabetes mellitus and being 60 years of age or older.

RESUMO Introdução: as doenças cardiovasculares são a principal causa de morbimortalidade, apesar da melhora nos resultados clínicos e da introdução de novos medicamentos. Objetivo: avaliar a influência dos fatores de risco no desenvolvimento de doenças cardiovasculares em adultos com 18 anos ou mais. Método: foi realizado um estudo retrospectivo de casos e controles em pacientes diagnosticados com doenças cardiovasculares que frequentam o serviço de medicina interna do Hospital Geral Universitário "Carlos Manuel de Céspedes", Bayamo, Granma, de 5 de janeiro de 2017 a 31 de dezembro de 2018 Dentro dos fatores de risco foram considerados idade, sexo, comorbidade e marcadores biológicos. Resultados: entre as variáveis ​​qualitativas, o tabagismo foi o fator mais importante (OR: 3,60; IC: 1,664-7,787; p: 0,001) enquanto entre as variáveis ​​quantitativas foi a hipertensão sistólica (OR: 11,50; IC: 1457-90896, p: 0,004). A análise multivariada mostrou que a hipertensão sistólica foi o fator de risco independente mais relevante (OR: 11,52; IC 95%: 3,077-43,168; p: 0,000) seguido por história de diabetes mellitus (OR: 5,91; IC 95%: 1674-20910 ). Conclusões: a hipertensão sistólica destaca-se como o fator de risco independente mais importante, seguido por diabetes mellitus e idade igual ou superior a 60 anos.

RESUMO

Little is known about the impact of the 2017 ACC/AHA hypertension guideline on the distribution pattern of hypertension modalities (isolated systolic hypertension [ISH], isolated diastolic hypertension [IDH], and systolic-diastolic hypertension [SDH]). This cross-sectional study had the following objectives: to compare the prevalence of hypertension, ISH, IDH, and SDH, according to the definitions of the JNC 7 or the 2017 guideline; to determine the relative contribution of the systolic and the diastolic components for the diagnosis of hypertension; and to compare the metabolic profile of ISH, IDH, or SDH among new hypertensive individuals by the 2017 guideline. The authors retrospectively evaluated 33 594 patients (42 ± 10 years, 67% male) who underwent a routine health evaluation. Hypertensive patients not using antihypertensive medication were classified into ISH, IDH, or SDH using guideline-defined thresholds. The prevalence of hypertension increased from 21.1% by the JNC 7 definition to 54.7% using the 2017 criteria (2.6-fold increase). More profound increases were seen in the prevalence of IDH (8.7-fold) and SDH (3.3-fold), whereas the prevalence of ISH reduced from 1.1% (JNC 7) to 0.5% (2017 definition). Among patients with Stage 1 hypertension by the 2017 document, 85% had IDH and fewer metabolic abnormalities compared to those with SDH or ISH. The authors concluded that the 2017 guideline inflates the role of the diastolic component and diminishes the contribution of the systolic component for the diagnosis of hypertension. Individuals with Stage 1 hypertension by the 2017 guideline are metabolically heterogeneous and may have different long-term prognoses.

Assuntos

RESUMO

Introducción: la hipertensión arterial sistólica aislada es un riesgo importante para la salud, por ser la expresión de la fase final del remodelado vascular, por su alta frecuencia y morbilidad y mortalidad asociadas. Representa entre el 45 por ciento y el 76 por ciento de los hipertensos no controlados. Objetivos: identificar criterios diagnósticos y terapéuticos sobre la hipertensión arterial sistólica aislada de médicos de diferentes especialidades clínicas de la ciudad de La Habana. Métodos: se realizaron tres encuestas a 1 098 médicos especialistas de la ciudad de La Habana por el mismo autor en los periodos, 2001-2005, 2006-2010 y 2015-2016 para dar respuestas a 4 preguntas básicas: ¿Cuál fue el criterio empleado para su diagnóstico?, ¿Cuáles eran las fuentes de conocimientos?, ¿Qué medidas terapéuticas empleaban para su tratamiento? ¿Cuáles fueron las metas de presión arterial sistólica a alcanzar? Resultados: entre el 23,2 por ciento y el 59,2 por ciento de los encuestados utilizan el 4to ruido de Korotkoff para el diagnóstico de la presión arterial diastólica. Las guías de consensos fueron utilizadas entre el 42,2 por ciento y el 8 por ciento y las cubanas entre 40,2 por ciento y el 79,2 por ciento, mientras que la experiencia clínica osciló entre el 78,8 por ciento y el 98,9 por ciento. El 100 por ciento emplean tratamiento no farmacológico. En el tratamiento farmacológico, los diuréticos (70 por ciento-85 por ciento) fueron la primera opción. La mayoría de los médicos encuestados inician tratamiento farmacológico con cifras a partir de hipertensión arterial sistólica de 140 mm Hg. Hasta un 40,7 por ciento en algunas de la encuestas no consideró necesario utilizar de medicamentos antihipertensivos en mayores de 60 años. Entre el 36 por ciento y 69 por ciento lo inician en menores de 60 años teniendo como meta presiones igual a 140 mmHg y entre 23 por ciento y el 74,4 por ciento en los mayores de 60 años usando de 140 mmHg como meta de tratamiento. Conclusiones: un tercio de médicos de especialidades clínicas emplea el 4to ruido de Korotkoff como técnica para medir la hipertensión sistólica aislada. Insuficiente utilización de las guías, tanto nacionales como las extranjeras. El tratamiento no farmacológico fue universalmente aceptado, no así el farmacológico, siendo los diuréticos la primera opción terapéutica. Hay especialistas que son tolerantes y no tratan adecuadamente la HSA, sobre todo en pacientes con 60 o más edad. La gran mayoría de los encuestados utilizan como objetivo del tratamiento cifras iguales o inferiores a 140 mmHg de presión arterial sistólica. Se necesita actualizar conceptos y criterios sobre la HSA(AU)

Introduction: Isolated systolic arterial hypertension (SAH) is an important risk for health, as it is the expression of vascular remodeling final phase, due to its high frequency and associated morbidity and mortality, representing between 45 percent - 76 percent of uncontrolled hypertensive patients. Objectives: Identify diagnostic and therapeutic criteria on isolated systolic arterial hypertension of professionals from different clinical specialties in Havana. Methods: Three surveys were conducted in Havana by the same author in 2001-2005, 2006-2010 and 2015-2016 to answer four basic questions: What was the criterion used for diagnosis? What were the sources of knowledge? What therapeutic measures did doctors use for their treatment? What were the goals of systolic blood pressure to achieve? Results: The respondents who used the 4th korotkoff noise for diastolic blood pressure diagnosis ranged between 23.2 percent and 59.2 percent. Consensus guidelines were used between 42.2 percent and 8 percent and the Cuban guidelines were used between 40.2 percent and 79.2 percent, while clinical experience ranged between 78.8 percent and 98.9 percent.100 percent uses non-pharmacological treatment. In the pharmacological treatment, diuretics (70 percent -85 percent) were the first option. Most of the doctors surveyed started pharmacological treatment with figures from systolic arterial hypertension of 140 mmHg. In some of the surveys, up to 40.7 percent do not consider it necessary to use antihypertensive drugs in people over 60 years of age. Those who started in patients under 60 years of age ranged between 36 percent and 69 percent with a target pressure of = 140 mmHg and between 23 percent and 74.4 percent in those over 60 using 140 mmHg as a treatment goal. Conclusions: One third of physicians of clinical specialties use the 4th korotkoff noise as a technique to measure isolated systolic hypertension. Insufficient use of the guides, both national and foreign was observed. The non-pharmacological treatment was universally accepted. Diuretics are still the first pharmacological option treatment. There are specialists who are tolerant and do not treat systolic arterial hypertension adequately, especially in patients older than 60 years. The vast majority of the respondents used figures of equal to or less than 140 mmHg systolic blood pressure as the treatment goal. It is necessary to update concepts and criteria about systolic arterial hypertension(AU)

Assuntos

RESUMO

Introducción: la hipertensión arterial sistólica aislada es un riesgo importante para la salud, por ser la expresión de la fase final del remodelado vascular, por su alta frecuencia y morbilidad y mortalidad asociadas. Representa entre el 45 por ciento y el 76 por ciento de los hipertensos no controlados. Objetivos: identificar criterios diagnósticos y terapéuticos sobre la hipertensión arterial sistólica aislada de médicos de diferentes especialidades clínicas de la ciudad de La Habana. Métodos: se realizaron tres encuestas a 1 098 médicos especialistas de la ciudad de La Habana por el mismo autor en los periodos, 2001-2005, 2006-2010 y 2015-2016 para dar respuestas a 4 preguntas básicas: ¿Cuál fue el criterio empleado para su diagnóstico?, ¿Cuáles eran las fuentes de conocimientos?, ¿Qué medidas terapéuticas empleaban para su tratamiento? ¿Cuáles fueron las metas de presión arterial sistólica a alcanzar? Resultados: entre el 23,2 por ciento y el 59,2 por ciento de los encuestados utilizan el 4to ruido de Korotkoff para el diagnóstico de la presión arterial diastólica. Las guías de consensos fueron utilizadas entre el 42,2 por ciento y el 8 por ciento y las cubanas entre 40,2 por ciento y el 79,2 por ciento, mientras que la experiencia clínica osciló entre el 78,8 por ciento y el 98,9 por ciento. El 100 por ciento emplean tratamiento no farmacológico. En el tratamiento farmacológico, los diuréticos (70 por ciento-85 por ciento) fueron la primera opción. La mayoría de los médicos encuestados inician tratamiento farmacológico con cifras a partir de hipertensión arterial sistólica de 140 mm Hg. Hasta un 40,7 por ciento en algunas de la encuestas no consideró necesario utilizar de medicamentos antihipertensivos en mayores de 60 años. Entre el 36 por ciento y 69 por ciento lo inician en menores de 60 años teniendo como meta presiones igual a 140 mmHg y entre 23 por ciento y el 74,4 por ciento en los mayores de 60 años usando de 140 mmHg como meta de tratamiento. Conclusiones: un tercio de médicos de especialidades clínicas emplea el 4to ruido de Korotkoff como técnica para medir la hipertensión sistólica aislada. Insuficiente utilización de las guías, tanto nacionales como las extranjeras. El tratamiento no farmacológico fue universalmente aceptado, no así el farmacológico, siendo los diuréticos la primera opción terapéutica. Hay especialistas que son tolerantes y no tratan adecuadamente la HSA, sobre todo en pacientes con 60 o más edad. La gran mayoría de los encuestados utilizan como objetivo del tratamiento cifras iguales o inferiores a 140 mmHg de presión arterial sistólica. Se necesita actualizar conceptos y criterios sobre la HSA(AU)

Introduction: Isolated systolic arterial hypertension (SAH) is an important risk for health, as it is the expression of vascular remodeling final phase, due to its high frequency and associated morbidity and mortality, representing between 45 percent - 76 percent of uncontrolled hypertensive patients. Objectives: Identify diagnostic and therapeutic criteria on isolated systolic arterial hypertension of professionals from different clinical specialties in Havana. Methods: Three surveys were conducted in Havana by the same author in 2001-2005, 2006-2010 and 2015-2016 to answer four basic questions: What was the criterion used for diagnosis? What were the sources of knowledge? What therapeutic measures did doctors use for their treatment? What were the goals of systolic blood pressure to achieve? Results: The respondents who used the 4th korotkoff noise for diastolic blood pressure diagnosis ranged between 23.2 percent and 59.2 percent. Consensus guidelines were used between 42.2 percent and 8 percent and the Cuban guidelines were used between 40.2 percent and 79.2 percent, while clinical experience ranged between 78.8 percent and 98.9 percent.100 percent uses non-pharmacological treatment. In the pharmacological treatment, diuretics (70 percent -85 percent) were the first option. Most of the doctors surveyed started pharmacological treatment with figures from systolic arterial hypertension of 140 mmHg. In some of the surveys, up to 40.7 percent do not consider it necessary to use antihypertensive drugs in people over 60 years of age. Those who started in patients under 60 years of age ranged between 36 percent and 69 percent with a target pressure of = 140 mmHg and between 23 percent and 74.4 percent in those over 60 using 140 mmHg as a treatment goal. Conclusions: One third of physicians of clinical specialties use the 4th korotkoff noise as a technique to measure isolated systolic hypertension. Insufficient use of the guides, both national and foreign was observed. The non-pharmacological treatment was universally accepted. Diuretics are still the first pharmacological option treatment. There are specialists who are tolerant and do not treat systolic arterial hypertension adequately, especially in patients older than 60 years. The vast majority of the respondents used figures of equal to or less than 140 mmHg systolic blood pressure as the treatment goal. It is necessary to update concepts and criteria about systolic arterial hypertension(AU)

Assuntos

RESUMO

Introduction: Warfarin causes arterial calcification, arterial stiffness and systolic hypertension in animals. Early evidence in humans indicates that a similar effect may occur in patients with diabetes mellitus (DM) and/or hypertension. Objective: To evaluate whether warfarin use causes elevated blood pressure and pulse pressure in patients with both DM and hypertension. Methods: Cross-sectional study of 159 subjects with both DM and hypertension who received warfarin for at least 2 years and 159 age-matched control subjects with DM and hypertension never exposed to warfarin. The primary focus of analysis was the difference in systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) between the two groups. Results: Average age was 73±10 years in both groups. Patients in the warfarin group had received it for an average of 5.5±3.1 years. Subjects in the warfarin group had higher rates of coronary disease and heart failure. SBP and PP were lower in the warfarin group (SBP 130±14 mmHg vs. 134±12 mmHg, P=0.003; PP 58±12 mmHg vs. 62±11 mmHg, P=0.004), while DBP was not different (72±8 vs. 72±7 mmHg, P=0.64). Warfarin patients received more antihypertensive drugsand were seen more often than controls. Multiple regression analyses adjusting for relevant variables did not disclose an association between warfarin useand higher BP; on the contrary, exposure to warfarin was associated with lower SBP and PP on the multivariable models. Conclusion: Use of warfarin in conventional doses for an average of 5.5 years was not associated with increased BP in this cross-sectional study of patients with DM and hypertension.

Introdução: Em animais, a warfarina provoca calcificação arterial, rigidez arterial e hipertensão arterial (HA) sistólica. Dados preliminares em humanos sugerem que o mesmo efeito pode acontecer em pacientes com diabetes mellitus (DM) e/ou HA. Objetivo: Determinar se o uso da warfarina em pacientescom DM e HA resulta em elevação da pressão arterial ou pressão de pulso. Métodos: Estudo transversal de 159 pacientes com DM e HA que haviam sidotratados com warfarina por pelo menos 2 anos, e 159 controles pareados por idade, com DM e HA, mas que nunca haviam usado warfarina. O enfoqueprincipal na análise foi a diferença na pressão arterial sistólica (PAS), diastólica (PAD) e pressão de pulso (PP) entre os dois grupos. Resultados: A média de idade foi 73±10 anos em ambos os grupos. Os pacientes no grupo da warfarina haviam usado a droga por 5.5±3.1 anos. Pacientes no grupo da warfarina tinham uma prevalência maior de doença coronariana e insuficiência cardíaca. A PAS e PP foram mais baixas no grupo warfarina (PAS 130±14 mmHgvs. 134±12 mmHg, P=0.003; PP 58±12 mmHg vs. 62±11 mmHg, P=0.004), mas a PAD não diferiu entre os grupos (72±8 vs. 72±7 mmHg, P=0.64).Pacientes do grupo warfarina usaram mais drogas antihipertensivas e foram avaliados clinicamente com maior freqüência do que os controles. Regressão múltipla ajustada para fatores de relevância clínica não demonstrou nenhuma associação entre o uso da warfarina e elevação da pressão arterial. Pelo contrário, nos modelos de regressão múltipla, a exposição à warfarina associou-se a valores mais baixos de PAS e PP. Conclusão: O uso da warfarina em doses convencionais, por 5.5 anos, não associou-se a um aumento da pressão arterial neste estudo tranversal de pacientes com DM e hipertensão.

Assuntos