6ª Diretriz de monitorização ambulatorial da pressão arterial e 4ª diretriz de monitorização residencial da pressão arterial

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Relação entre a assiduidade às consultas ambulatoriais e o controle da pressão arterial em pacientes hipertensos Relationship between regular attendance to ambulatory appointments and blood pressure control among hypertensive patients

OBJETIVO: Nosso objetivo foi determinar a taxa de pacientes hipertensos com a pressão arterial (PA) controlada (OBJECTIVE: Our objective was to determine the rate of hypertensive patients with controlled BP (BP <140X90 mmHg) and to study its relationship with regular attendance to ambulatory appointments. METHODS: A total of 245 medical records from patients followed up at the Unidade Clínica de Hipertensão Arterial (Clinical Unit of Arterial Hypertension) HCFMRP-USP for a period of one year were randomly and retrospectively reviewed. The patients were classified as assiduous (A) and as regularly absent to scheduled appointments (F), with the second group being defined as those who failed to appear longer than 30 days after the scheduled appointment. The mean of three measurements prior to the date of the scheduled appointment was calculated to determine the rate of patients with controlled BP. Compliance with the treatment was inferred through a questionnaire applied by the nurse team before the appointment. RESULTS: From the 245 patients analyzed, 220 were classified as A (89.7%) and 25 (10.3%) as F. Group A patients showed a higher rate of BP control than F patients (30% vs. 8%, p=0.02, Fischer exact test). Compliance with pharmacological treatment was higher in A patients than in F patients (91% vs. 56 %, p<0.05) as well as to non-pharmacological treatment (63% vs. 44%, p<0.05). CONCLUSION: Although the rate of blood pressure control was low in the population studied, lower compliance with the treatment and BP control was observed in individuals who usually missed the scheduled appointments

Congnitive status, depression and biochemical indices as predictors of mortality in elderly subjects on haemodialysis

OBJECTIVES: To characterize the geriatric population under dialysis in a specialized center. To identify factors possibly involved with death risk in this population. METHODS: Sixty two volunteers, (83% of the older patients of that center, six were excluded) were submited to the application of the Mini-Mental State Examination (MMSE), the Clock-Drawing test (CDT), the Verbal Fluency test and the Geriatric Depression Scale (GDS). Biochemical tests were also performed. After 12 months, the patients' files were reassessed as to mortality and associated factors data. RESULTS: Volunteers alive after 12 months were younger (68.18 ± 5.7 years) than those that died (74.06 ± 7.36 years), p = 0.001. Male gender was predominant (60.7%). In alive and deceased groups, the results for blood tests were, respectively: parathormone 369.87 ± 318.90 and 368.50 ± 501.47 (p &gt; 0.05); creatinine 6.89 ± 2.05 and 5.23 ± 1.15 (p = 0.002); albumine 3.66 ± 0.35 and 3.74 ± 0.644 (p &gt; 0.05); total cholesterol 165.55 ± 45.16 and 169.35 ± 38.68 (p &gt; 0.05); triglycerides 144.57 ± 80.95 and 126.94 ± 77.71 (p &gt; 0.05); HDL 38.27 ± 14.26 and 44.22 ± 10.78 (p &gt; 0.05); calcium 9.40 ± 0.77 and 9.14 ± 0.68 (p &gt; 0.05); KT/V 1.64 ± 0.32 and 1.63 ± 0.27 (p &gt; 0.05). MMSE differed between groups (p = 0.03) and creatinine showed to be a potential death-related factor. GDS had similar scores between the two groups (p = 0.06). CONCLUSIONS: MMSE scores were directly associated with mortality in older patients submitted to hemodialysis. The correlation between lower serum creatinine level and mortality is possibly caused by a worse nutritional status of those patients.</p