Arquivos brasileiros de cardiologia最新文献

Background: The 2017 Brazilian Guideline on Dyslipidemias recommends a low-density lipoprotein (LDL-c) target of <50 mg/dL for patients under secondary prevention of cardiovascular events, with statin therapy and the addition of ezetimibe if necessary. For patients who do not achieve this target, additional pharmacotherapy is indicated.

Objectives: This study combined population data from the Brazilian Unified Health System (SUS) and the supplementary health system, epidemiological data, and the Delphi method, with participation from 29 specialists in the first round and 24 in the second, to estimate the size of the secondary prevention population not achieving LDL-c targets.

Results: The population under secondary prevention was estimated at 5,8 million in the public health system and 1,2 million in the supplementary health system. Approximately one million patients in SUS and 150 thousand in the supplementary system are not expected to reach the LDL-c target with oral lipid-lowering therapy.

Conclusion: Between 9% and 19% of patients under secondary prevention do not reach the recommended LDL-c target, making them potential candidates for additional LDL-c-lowering therapies.

Background: Hypertension (HTN) is a global public health issue, with high prevalence and a significant impact on cardiovascular morbidity and mortality. Cardioselective beta-blockers, such as atenolol, are widely used in the treatment of HTN, although their indication as first-line therapy remains controversial.

Objective: To evaluate the efficacy and safety of atenolol in the treatment of primary HTN, compared with other first-line classes of antihypertensive drugs.

Methods: A systematic review was conducted based on a research question structured using the PICO format. Randomized clinical trials comparing atenolol with other antihypertensive agents were included. Searches were performed in three international databases. Methodological quality was assessed using the RoB 2 tool, and the certainty of evidence was rated using the GRADE system. The primary composite outcome was the occurrence of major cardiovascular events. Secondary outcomes included all-cause mortality, acute myocardial infarction, and stroke, each analyzed separately.

Results: Seven clinical trials met the inclusion criteria. Compared with amlodipine and losartan, atenolol was associated with a slightly higher incidence of cardiovascular events, with low and moderate certainty of evidence, respectively. The combination of hydrochlorothiazide and amiloride demonstrated a greater reduction in cardiovascular events compared to atenolol, although with very low certainty of evidence. Blood pressure (BP) reduction was similar across the compared treatments.

Conclusions: Despite the limitations of available evidence, atenolol showed comparable efficacy in BP reduction, with small differences in cardiovascular outcomes favoring other antihypertensive classes. Its use may be considered among the options for combination therapy in the treatment of primary HTN in adults. Other beta-blockers were not evaluated in this systematic review.

Background: Although blood pressure (BP) thresholds are well established, there is a lack of data on potential hypertension phenotypes across sexes.

Objectives: To identify hypertension phenotypes in men and women undergoing antihypertensive treatment.

Methods: Adults aged 18 to 80 years with diagnosed hypertension and undergoing pharmacological treatment were opportunistically recruited from various regions of Brazil. Assessments included office BP measurements and home blood pressure monitoring (HBPM). Four hypertension phenotypes were defined: (i) controlled hypertension: office BP < 140/90 mmHg and HBPM < 130/80 mmHg; (ii) white-coat uncontrolled hypertension: office BP ≥ 140/90 mmHg and HBPM < 130/80 mmHg; (iii) masked uncontrolled hypertension: office BP < 140/90 mmHg and HBPM ≥ 130/80 mmHg; (iv) sustained uncontrolled hypertension: office BP ≥ 140/90 mmHg and HBPM ≥ 130/80 mmHg. A significance level of 5% (p < 0.05) was adopted.

Results: Among the 7,852 patients on antihypertensive therapy, 3,162 (40.3%) had controlled hypertension, including 1,115 (37.6%) men and 2,047 (41.9%) women (p < 0.001); 675 (8.6%) had white-coat uncontrolled hypertension, with 217 (7.3%) men and 458 (9.4%) women (p < 0.001); 1,605 (20.4%) had masked uncontrolled hypertension, including 645 (21.7%) men and 960 (19.7%) women (p < 0.001); and 2,410 (30.7%) had sustained uncontrolled hypertension, including 992 (33.4%) men and 1,418 (29%) women (p < 0.001).

Conclusions: This is the first Brazilian population-based study to assess hypertension phenotypes by sex. Women demonstrated better BP control than men, both in clinical settings and at home.

Background: Mean arterial pressure (MAP) has critical importance in tissue perfusion. In clinical practice, the most used formula was suggested by Gauer, which uses systolic (SBP), diastolic (DBP), and pulse (PP) pressures gathered via the iliac artery (MAP = DBP + 0.333 x PP). However, its results are not reliable for noninvasive recordings as blood pressures are higher.

Objectives: We derived a corrected formula for the correct calculation of MAP from the noninvasive cuff blood pressure recordings: MAP = DBPcuff + [0.33 + (0.43 - 0.0038 x DBPcuff)] x PPcuff.

Methods: 149 patients were included in this study. Intra-aortic and cuff blood pressure tracings were obtained simultaneously. The PP coefficient of the standard formula is 0.333 for all calculations. The PP coefficient deviation of the standard formula was calculated with the formula of PP coefficient - 0.333. These two formulas were compared using linear regression analysis and Akaike information criterion (AIC). The level of significance was set at 5% in the statistical analysis.

Results: The measured intra-aortic mean pressure was 111.5±13.0 mmHg. The calculated intra-aortic mean pressure by the standard formula and the corrected formula was 105.8±13.5 and 111.3±12.1, respectively. The R, R2, and AIC of the corrected formula were better than the standard formula [(0.905 vs 0.887), (0.818 vs 0.787), and (858.9 vs 1002.7), respectively].

Conclusion: To the best of our knowledge, this is the first study for the calculation of the MAP from cuff measurements, and the corrected formula has better accuracy than the standard formula for estimation of the MAP.

Background: The increasing occurrence of systemic arterial hypertension (SAH) is associated with multifactorial conditions, including lifestyle changes among Indigenous populations.

Objective: To estimate the prevalence and identify factors associated with SAH among Indigenous individuals receiving care at a specialized outpatient clinic in southern Brazil.

Methods: This cross-sectional study was conducted with a sample of Indigenous individuals of both sexes aged 20 years or older, using data collected from medical records. Hypertension was defined as the dependent variable based on the recorded diagnosis, for which prevalence was estimated with a 95% confidence interval (95% CI). Sociodemographic, health-related, and behavioral characteristics were analyzed as potential associated factors through estimates of crude and adjusted prevalence ratios (PR), along with their respective 95% CIs.

Results: The sample consisted of 570 Indigenous individuals, with a SAH prevalence of 26% (95% CI: 23-30). The associated factors were age 60 years or older (PR = 1.94; 95% CI: 1.22-3.09), having a partner (PR = 1.61; 95% CI: 1.04-2.48), and a diagnosis of diabetes mellitus (PR = 2.33; 95% CI: 1.48-3.66).

Conclusion: The prevalence of SAH was found to be high, reinforcing its significance as a public health issue within the Indigenous population as well. These findings underscore the need to strengthen primary health care with an emphasis on prevention, early diagnosis, and proper management.