PREVALÊNCIA DE TENSÃO ARTERIAL ELEVADA EM SOLICITANTES DE CARTÃO DE SAÚDE: ENFERMAGEM EM SEU CONTROLE.

Introduction: Non-transmitted diseases are the main cause of death and disability in America. Focusing on risk factors is the regional strategy to control them. Thisresearch evaluates high blood pressure in a high number of people in our country.Method: Blood pressure results of those who had the “health card” between 2008-2011 in Departamento de Clínicas Preventivas were analysed through health records technologically kept. Blood pressure prevalence is shown by age.Results: 74.420 individuals aged 15 – 89 were included in this study and 30,5% had high blood pressure. From these, 47,5% did not know they suffered this illness.31,8% of these had <140/90 mmHg. It must be taken into account that the figures were greatly rounded.Conclusions: A high prevalence of high blood pressure was found, lack of knowledge about it and inappropriate control. The way high blood pressure is treated should be improved, not only public policies but also how blood pressure is measured, being the nurse essential in this moment. Keeping a never ending research might help evaluate the development of this serious health problem which strikes the country. Las Enfermedades cardio vasculares (ECV) son la más importante causa de muerte en todo el mundo constituyéndose en un problema de salud Pública Mundial.Cada año mueren más personas por ECV que por cualquier otra causa.El objetivo de este estudio es evaluar la situación de la hipertensión arterial en una amplia población de individuos de nuestro país. Se analizaron las cifras de presión arterial de la población que asistió al Departamento de Clínicas Preventivas(División Salud Ambiental y Ocupacional/Ministerio de Salud Publica) para realizarse el Carnet de Salud en el período Noviembre de 2008 - junio de 2011; a partir de la historia clínica informática del servicio. La prevalencia de hipertensión arterial se presenta ajustada por edad. Participaron en el estudio 74.420 personas en un rango de edad de 15 a 89 años, comprobándose un 30,5% de hipertensión. El 47,5% de los hipertensos no sabían que lo era. Un 31,8% de los hipertensos tuvo presión arterial <140/90 mmHg. Existió una importante tendencia al redondeo en la medida de la presión arterial. Se constató una prevalencia elevada de hipertensión arterial, conocimientos deficientes de la misma y un grado de control inapropiado. Es necesario mejorar el manejo de la hipertensión, lo que abarca desde la optimización de las políticas públicas hasta mejorar la forma en que se determina la presión arterial, teniendo la enfermera profesional un importante papel al respecto. La reiteración periódica de este tipo de análisis permitirá evaluar la evolución de este serio problema de salud pública del país.As doenças não transmissíveis constituem a principal causa de morte e incapacidade em América. A estratégia regional destinada a controlá-las tem como componente essencial o acompanhamento de seus fatores de risco. O objetivo do presente estudo foi avaliar a situação da hipertensão arterial em uma vasta população de indivíduos no nosso país. Foram analisadas as cifras de pressão arterial das pessoas que fizeram o cartão de saúde no Departamento das Clínicas Preventivas, entre 2008 e 2011; isso foi feito com base no histórico clínico informático do serviço. A prevalência de hipertensão arterial referiu-se ajustadapor idade. Incluiu 74.420 indivíduos, de 15 a 89 anos de idade e comprovou 30,5% de hipertensão. 47,5% dos hipertensos não sabiam que o eram. 31,8% dos hipertensos teve pressão arterial <140/90 mmHg. Houve uma importantetendência a arredondar a medição da pressão arterial. Houve uma elevada prevalência de hipertensão arterial, pouco conhecimento da mesma, bem como impróprio grau de controle. É necessário melhorar o manejo da hipertensão; isso abrange do aprimoramento das políticas públicas ao melhoramento da forma na qual se determina a pressão arterial e, ao respeito, é relevante o papel da enfermeira profissional. A reiteração periódica deste tipo de análise permitirá avaliar a evolução deste sério problema na saúde pública do país

Opposing Age-Related Trends in Absolute and Relative Risk of Adverse Health Outcomes Associated With Out-of-Office Blood Pressure

Participant-level meta-analyses assessed the age-specific relevance of office blood pressure to cardiovascular complications, but this information is lacking for out-of-office blood pressure. At baseline, daytime ambulatory (n=12 624) or home (n=5297) blood pressure were measured in 17 921 participants (51.3% women; mean age, 54.2 years) from 17 population cohorts. Subsequently, mortality and cardiovascular events were recorded. Using multivariable Cox regression, floating absolute risk was computed across 4 age bands (80 years). Over 236 491 person-years, 3855 people died and 2942 cardiovascular events occurred. From levels as low as 110/65 mm Hg, risk log-linearly increased with higher out-of-office systolic/diastolic blood pressure. From the youngest to the oldest age group, rates expressed per 1000 person-years increased (P<0.001) from 4.4 (95% CI, 4.0-4.7) to 86.3 (76.1-96.5) for all-cause mortality and from 4.1 (3.9-4.6) to 59.8 (51.0-68.7) for cardiovascular events, whereas hazard ratios per 20-mm Hg increment in systolic out-of-office blood pressure decreased (P <= 0.0033) from 1.42 (1.19-1.69) to 1.09 (1.05-1.12) and from 1.70 (1.51-1.92) to 1.12 (1.07-1.17), respectively. These age-related trends were similar for out-of-office diastolic pressure and were generally consistent in both sexes and across ethnicities. In conclusion, adverse outcomes were directly associated with out-of-office blood pressure in adults. At young age, the absolute risk associated with out-of-office blood pressure was low, but relative risk high, whereas with advancing age relative risk decreased and absolute risk increased. These observations highlight the need of a lifecourse approach for the management of hypertension

Impact of the indoor smoking ban on hospital admissions due to acute myocardial infarction : scientific report

The number of hospital admissions was compared for acute myocardial infarction (AMI) in the 24 months preceding and following the introduction of a ban on smoking in indoor spaces in Uruguay, March 2006. The study covered all AMI admissions in 37 hospitals, accounting for 79.3% of AMI admissions in Uruguay. Results indicate that the ban on smoking in indoor public spaces led to a reduction of 17.1% in admissions for AMI after two years, with the greatest reduction occurring among younger persons admitted to private institutions

Outcome-Driven Thresholds for Home Blood Pressure Measurement International Database of HOme blood pressure in relation to Cardiovascular Outcome

The lack of outcome-driven operational thresholds limits the clinical application of home blood pressure (BP) measurement. Our objective was to determine an outcome-driven reference frame for home BP measurement. We measured home and clinic BP in 6470 participants (mean age, 59.3 years; 56.9% women; 22.4% on antihypertensive treatment) recruited in Ohasama, Japan (n=2520); Montevideo, Uruguay (n=399); Tsurugaya, Japan (n=811); Didima, Greece (n=665); and nationwide in Finland (n=2075). In multivariable-adjusted analyses of individual subject data, we determined home BP thresholds, which yielded 10-year cardiovascular risks similar to those associated with stages 1 (120/80 mm Hg) and 2 (130/85 mm Hg) prehypertension, and stages 1 (140/90 mm Hg) and 2 (160/100 mm Hg) hypertension on clinic measurement. During 8.3 years of follow-up (median), 716 cardiovascular end points, 294 cardiovascular deaths, 393 strokes, and 336 cardiac events occurred in the whole cohort; in untreated participants these numbers were 414, 158, 225, and 194, respectively. In the whole cohort, outcome-driven systolic/diastolic thresholds for the home BP corresponding with stages 1 and 2 prehypertension and stages 1 and 2 hypertension were 121.4/77.7, 127.4/79.9, 133.4/82.2, and 145.4/86.8 mm Hg; in 5018 untreated participants, these thresholds were 118.5/76.9, 125.2/79.7, 131.9/82.4, and 145.3/87.9 mm Hg, respectively. Rounded thresholds for stages 1 and 2 prehypertension and stages 1 and 2 hypertension amounted to 120/75, 125/80, 130/85, and 145/90 mm Hg, respectively. Population-based outcome-driven thresholds for home BP are slightly lower than those currently proposed in hypertension guidelines. Our current findings could inform guidelines and help clinicians in diagnosing and managing patients

Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study

BACKGROUND: Few studies have formally compared the predictive value of the blood pressure at night over and beyond the daytime value. We investigated the prognostic significance of the ambulatory blood pressure during night and day and of the night-to-day blood pressure ratio. METHODS: We did 24-h blood pressure monitoring in 7458 people (mean age 56.8 years [SD 13.9]) enrolled in prospective population studies in Denmark, Belgium, Japan, Sweden, Uruguay, and China. We calculated multivariate-adjusted hazard ratios for daytime and night-time blood pressure and the systolic night-to-day ratio, while adjusting for cohort and cardiovascular risk factors. FINDINGS: Median follow-up was 9.6 years (5th to 95th percentile 2.5-13.7). Adjusted for daytime blood pressure, night-time blood pressure predicted total (n=983; p or =0.07). Adjusted for the 24-h blood pressure, night-to-day ratio predicted mortality, but not fatal combined with non-fatal events. Antihypertensive drug treatment removed the significant association between cardiovascular events and the daytime blood pressure. Participants with systolic night-to-day ratio value of 1 or more were older, at higher risk of death, and died at an older age than those whose night-to-day ratio was normal (> or =0.80 to <0.90). INTERPRETATION: In contrast to commonly held views, daytime blood pressure adjusted for night-time blood pressure predicts fatal combined with non-fatal cardiovascular events, except in treated patients, in whom antihypertensive drugs might reduce blood pressure during the day, but not at night. The increased mortality in patients with higher night-time than daytime blood pressure probably indicates reverse causality. Our findings support recording the ambulatory blood pressure during the whole day.status: publishe

Article from the Milan proceedings 145

The objective of this study was to investigate the prognostic significance of the ambulatory blood pressure (BP) during night and day and of the night-to-day BP ratio (NDR). We studied 7458 participants (mean age 56.8 years; 45.8% women) enrolled in the International Database on Ambulatory BP in relation to Cardiovascular Outcome. Using Cox models, we calculated hazard ratios (HR) adjusted for cohort and cardiovascular risk factors. Over 9.6 years (median), 983 deaths and 943 cardiovascular events occurred. Nighttime BP predicted mortality outcomes (HR, 1.18-1.24; P &lt; 0.01) independent of daytime BP. Conversely, daytime systolic (HR, 0.84; P &lt; 0.01) and diastolic BP (HR, 0.88; P &lt; 0.05) predicted only noncardiovascular mortality after adjustment for nighttime BP. Both daytime BP and nighttime BP consistently predicted all cardiovascular events (HR, 1.11-1.33; P &lt; 0.05) and stroke (HR, 1.21-1.47; P &lt; 0.01). Daytime BP lost its prognostic significance for cardiovascular events in patients on antihypertensive treatment. Adjusted for the 24-h BP, NDR predicted mortality (P &lt; 0.05), but not fatal combined with nonfatal events. Participants with systolic NDR of at least 1 compared with participants with normal NDR ( Z 0.80 to &lt; 0.90) were older, at higher risk of death, but died at higher age. The predictive accuracy of the daytime and nighttime BP and the NDR depended on the disease outcome under study. The increased mortality in patients with higher NDR probably indicates reverse causality. Our findings support recording the ambulatory BP during the whole day