Stressful life events and current psychological distress are associated with self-reported hypertension but not with true hypertension: results from a cross-sectional population-based study

<p>Abstract</p> <p>Background</p> <p>The evidence linking stress to hypertension has been scarcely documented in population-based studies.</p> <p>Methods</p> <p>Participants were selected through a multi-stage probability sampling and interviewed at home, being submitted to measures of demographics, anthropometrics, blood pressure (BP), and risk factors for hypertension. Hypertension was defined as BP ≥ 140/90 mm Hg or use of BP-lowering drugs or as self-reported hypertension. Stressful life events were investigated through an inventory of nine major life events occurring in the year preceding the interview. Psychological distress was evaluated through a facial scale of expression of emotion in the last month.</p> <p>Results</p> <p>In the total, 1,484 adult individuals were investigated. Prevalence of hypertension was lower in individuals who reported any stressful life event in comparison with individuals who did not reported an event (34.3 versus 44.2%, P < 0.01), such as relative or friend death, loss of job, divorce, violence and migration. There was a trend for higher prevalence of hypertension in individuals with higher psychological distress in the last month, which was not longer significant after adjustment for confounding. In contrast, individuals who self-reported hypertension, but actually had normal blood pressure and were not using antihypertensive medication, reported higher numbers of stressful events.</p> <p>Conclusion</p> <p>Recent stressful life events and current psychological distress are not associated with hypertension. Associations between stress events and distress with self-reported hypertension are not intermediated by effects of stress on blood pressure, and may be ascribed to negative feeling about disease and not to the disease itself.</p

Outpatient satisfaction during pharmacotherapy followup

This study aimed to investigate the satisfaction of patients with uncontrolled hypertension referred for pharmacotherapy followup. A cross-sectional study by semi-structured interview was used. The sample comprised patients undergoing pharmacotherapy followup, patients who had discontinued pharmacotherapy followup and patients who had not kept the appointments. A total of 80 (76.9 %) out of 104 patients registered were contacted. The majority of patients undergoing pharmacotherapy followup (91.1 %) were fully satisfied with the pharmacists' care given, their relationship with them (94.9 %), the manner in which their therapy was conducted (99.2 %) and the environment where it was carried out (85.3 %). The reasons for non-attendance were mostly forgetting the date, illness on the appointment day and other arrangements on the same day. Interestingly, all of these patients were completely satisfied with the pharmacists' care given. The satisfaction of patients with the pharmaceutical care is high among patients that have continuous followup, but a relevant proportion discontinued followup. Newer approaches to keep these patients under followup are necessary.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Co-Infection by Hepatitis C Virus in HIV-Infected Patients in Southern Brazil: Genotype Distribution and Clinical Correlates

BACKGROUND: Prevalence rates of hepatitis C virus (HCV) co-infection, the distribution of HCV genotypes, and the frequency of spontaneous resolution of hepatitis C in patients infected with the Human Immunodeficiency Virus (HIV) have a worldwide disparity. The purpose of this study is to investigate the prevalence of HCV antibodies (anti-HCV) in patients with HIV, the proportion and correlates of infection by different HCV genotypes, and rates of spontaneous resolution of HCV infection. METHODS: A cross-sectional study was conducted among 1143 HIV patients under follow-up in a HIV/AIDS outpatient reference center of the Brazilian public health system. From 357 anti-HCV positive patients, a consecutive sample of 227 individuals HCV treatment-naïve was interviewed and 207 was tested for HCV-RNA and genotypes. RESULTS: Anti-HCV was detected in 357 patients (31.2%). HCV-RNA was undetectable in 16.4% of 207 anti-HCV positive individuals. Genotype 1 was diagnosed in 81.5% of the sample, genotype 2 in 1.7% and genotype 3 in 16.2%. Male gender was the unique characteristic associated with higher prevalence of genotype 1 HCV. CONCLUSIONS: Co-infection by HCV is frequent among patients with HIV in our State, and it is particularly high the infection by HCV genotype 1. Further investigation is necessary to explain the important regional variation in the proportion of infection by the different HCV genotypes and to better understand rates of spontaneous HCV clearance

Outpatient satisfaction during pharmacotherapy followup

This study aimed to investigate the satisfaction of patients with uncontrolled hypertension referred for pharmacotherapy followup. A cross-sectional study by semi-structured interview was used. The sample comprised patients undergoing pharmacotherapy followup, patients who had discontinued pharmacotherapy followup and patients who had not kept the appointments. A total of 80 (76.9 %) out of 104 patients registered were contacted. The majority of patients undergoing pharmacotherapy followup (91.1 %) were fully satisfied with the pharmacists' care given, their relationship with them (94.9 %), the manner in which their therapy was conducted (99.2 %) and the environment where it was carried out (85.3 %). The reasons for non-attendance were mostly forgetting the date, illness on the appointment day and other arrangements on the same day. Interestingly, all of these patients were completely satisfied with the pharmacists' care given. The satisfaction of patients with the pharmaceutical care is high among patients that have continuous followup, but a relevant proportion discontinued followup. Newer approaches to keep these patients under followup are necessary.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Prevalência de tabagismo e fatores associados em área metropolitana da região Sul do Brasil

A cross-sectional study was carried out for the purpose of evaluating, the prevalence of smoking and the factors associated with it in Porto Alegre, a city in southern Brazilian. Through proportional, multiple stage, random sampling, 1.091 individuals (92% of those eligible) of 18 or more years of age, were interviewed at home. Exposure to smoking was measured by a questionnaire that inquired about the type, quantity and frequency of tobacco use. The prevalence of smoking was 34.9% (Cl 31.9 - 37.8). It was higher -among men - 41.5% (Cl 38.5 - 44.4) then women - 29.5% (Cl 26.8 - 32.2). The former started smoking at mean age of 16 (&plusmn; 5.6), with mode of 15 and smoked an average of 19.0 (&plusmn; 14.0) cigarettes per day. Females started at a mean age of 17.8 (&plusmn; 6.7), with mode of 14 years old and smoked 14.5 (&plusmn; 10.3). The association of the drinking habit and demographic and socioeconomic variables with smoking was evaluated through logistic regression. The variables included in the model were sex, age, education, income, professional qualification and alcohol consumption. The prevalence of smoking was greater for men, individuals of lower sociecinomic level, between 30 and 39 years of age, and among those accustomed to consuming alcoholic beverages. In conclusion, this study demonstrated that smoking is a public health problem in Brazil as in another countries. It is associated with sex, age, education and professional qualification, as has been observed elsewhere. The association of alcohol consumption with smoking may be understood as risk behavior, both having similar determinants.Com o objetivo de avaliar a prevalência de tabagismo em Porto Alegre, RS, Brasil, e os fatores associados, executou-se estudo observacional, de delineamento transversal e base populacional. Através de amostragem aleatória proporcional, por estágios múltiplos e conglomerados, selecionaram-se 1.091 indivíduos, a partir de 18 anos, que responderam a um questionário, em entrevista domiciliar. Aferiu-se o hábito de fumar através de perguntas dirigidas ao tipo de fumo, freqüência e tempo de exposição. A prevalência foi de 34,9% (IC 31,9 - 37,8), sendo de 41,5% (IC 38,5 - 44,4) entre os homens e 29,5% (IC 26,8 - 32,2) entre as mulheres. O início foi, em média, aos 16 (&plusmn;5,6) e 17,8 (&plusmn;6,7) anos, com moda de 15 e 14 anos, respectivamente. Os homens fumavam 19,0 &plusmn; 14,0 cigarros por dia e as mulheres 14,5 &plusmn; 10,3. Analisaram-se as associações através de regressão logística, incluindo-se no modelo sexo, idade, educação, renda, qualificação profissional e consumo de álcool. O hábito de fumar foi mais freqüente entre os homens, indivíduos de menor nível socioeconômico, dos 30 aos 39 anos, e entre os usuários de bebidas alcoólicas. Conclui-se que o tabagismo é freqüente em Porto Alegre, constituindo-se problema de saúde pública similar ao referido pela literatura. O consumo de álcool deve estar associado ao fumo por serem ambos comportamentos de risco, com determinantes comuns

Association between different measurements of blood pressure variability by ABP monitoring and ankle-brachial index

<p>Abstract</p> <p>Background</p> <p>Blood pressure (BP) variability has been associated with cardiovascular outcomes, but there is no consensus about the more effective method to measure it by ambulatory blood pressure monitoring (ABPM). We evaluated the association between three different methods to estimate BP variability by ABPM and the ankle brachial index (ABI).</p> <p>Methods and Results</p> <p>In a cross-sectional study of patients with hypertension, BP variability was estimated by the time rate index (the first derivative of SBP over time), standard deviation (SD) of 24-hour SBP; and coefficient of variability of 24-hour SBP. ABI was measured with a doppler probe. The sample included 425 patients with a mean age of 57 ± 12 years, being 69.2% women, 26.1% current smokers and 22.1% diabetics. Abnormal ABI (≤ 0.90 or ≥ 1.40) was present in 58 patients. The time rate index was 0.516 ± 0.146 mmHg/min in patients with abnormal ABI versus 0.476 ± 0.124 mmHg/min in patients with normal ABI (P = 0.007). In a logistic regression model the time rate index was associated with ABI, regardless of age (OR = 6.9, 95% CI = 1.1- 42.1; P = 0.04). In a multiple linear regression model, adjusting for age, SBP and diabetes, the time rate index was strongly associated with ABI (P < 0.01). None of the other indexes of BP variability were associated with ABI in univariate and multivariate analyses.</p> <p>Conclusion</p> <p>Time rate index is a sensible method to measure BP variability by ABPM. Its performance for risk stratification of patients with hypertension should be explored in longitudinal studies.</p

Prevention of hypertension in patients with pre-hypertension: protocol for the PREVER-prevention trial

<p>Abstract</p> <p>Background</p> <p>Blood pressure (BP) within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a population-based intervention to prevent the incidence of hypertension and the development of target-organ damage.</p> <p>Methods</p> <p>This is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution.</p> <p>Discussion</p> <p>The early use of blood pressure-lowering drugs, particularly diuretics, which act on the main mechanism of blood pressure rising with age, may prevent cardiovascular events and the incidence of hypertension in individuals with hypertension. If this intervention shows to be effective and safe in a population-based perspective, it could be the basis for an innovative public health program to prevent hypertension in Brazil.</p> <p>Trial Registration</p> <p>Clinical Trials <a href="http://www.clinicaltrials.gov/ct2/show/NCT00970931">NCT00970931</a>.</p