Instrumento de evaluación de la calidad de vida para hipertensos de Bulpitt y Fletcher

Este estudo realizou a tradução para o português e a validação do questionário específico para avaliação da qualidade de vida em hipertensos de Bulpitt e Fletcher. A tradução e o back-translation foram realizados por 4 professores de inglês e a versão final submetida a um corpo de juizes. Questões com Índice de Validade de Conteúdo menor que 80% foram modificadas e reavaliadas. O questionário foi aplicado em 110 hipertensos ambulatoriais (52 &plusmn; 8 anos, 65% mulheres, pressão arterial 128&plusmn;17/ 75&plusmn;13 mmHg), que também responderam ao SF-36, e em 20 normotensos, com características semelhantes às dos hipertensos. Os domínios do SF-36 e do instrumento de Bulpitt e Fletcher se correlacionaram (p<0,05), exceto em relação a aspectos sociais (r=0,07, p=0,44) e a estado geral de saúde (r=0,04, p=0,61). Os hipertensos apresentaram mais respostas positivas a sintomas (40%) do que os normotensos (15%). O instrumento foi validado e está apto para ser usado em nosso meio.This study translated and validated Bulpitt and Fletcher's Specific Questionnaire for Quality of Life Assessment of hypertensive patients. The translation and the back-translation were performed by four English teachers, and the final version was submitted to a board of referees. Questions with a Content Validity Index lower than 80% were modified and re-evaluated. The questionnaire was applied in 110 hypertensive outpatients (52 &plusmn; 8 years old, 65 % female, blood pressure 128 &plusmn; 17/75 &plusmn; 13 mmHg), which also answered the SF-36, and also in 20 normotensive people, whose characteristics were similar to those of the hypertensive subjects. The domains of SF-36 and Bulpitt and Fletcher's instrument correlated to each other (p < 0.05), except for the social aspects (r=0.07, p= 0.04) and the general state of health (r=0.04, p= 0.61). Hypertensive patients showed more positive responses to the symptoms (40%) than the normotensives (15%). The instrument was validated and is now ready to be used in our midst.Este estudio ha realizado la traducción para el portugués y la validación del cuestionario específico para evaluación de la calidad de vida en hipertensos de Bulpitt y Fletcher. La traducción y el back-translation fueron realizados por 4 profesores de inglés y la versión final sometida a un cuerpo de jueces. Cuestiones con Índice de Validad de Contenido menor que 80% fueron modificadas y reevaluadas. El cuestionario fue aplicado en 110 hipertensos en seguimiento ambulatorial (52 &plusmn; 8 años, 65% mujeres, presión arterial 128&plusmn;17/ 75&plusmn;13 mmHg), que también respondieron al instrumento de evaluación de calidad de vida SF-36, y en 20 normotensos, con características semejantes a de los hipertensos. Los dominios del SF-36 y del instrumento de Bulpitt y Fletcher se correlacionaron (p<0,05), excepto en relación a aspectos sociales (r=0,07, p=0,44) e al estado general de salud (r=0,04, p=0,61). Los hipertensos presentaron mas respuestas positivas a síntomas (40%) de que los normotensos (15%). El instrumento fue validado y está apto la utilización en la lengua portuguesa

Health-related quality of life and blood pressure control in hypertensive patients with and without complications

INTRODUCTION: The goal of antihypertensive treatment is to reduce blood pressure without interfering in health-related quality of life (HRQL) OBJECTIVE: This study aimed to assess the influence of hypertension control upon HRQL in hypertensive patients with and without complications. MATERIALS AND METHODS: Seventy-seven hypertensive outpatients (71% women, 58% white, 60% with elementary school level education, average age 54 ± 8 years) were observed during a 12-month special care program (phase 1: clinical visits every two months, donation of all antihypertensive medications, meetings with a multidisciplinary team, and active telephone calls) and three years of standard care (phase 2: clinical visits every four months, medication provided by the drugstore of the hospital with a two-hour wait and a possible lack of medication, no meetings with a multidisciplinary team or active telephone calls). The patient HRQL was assessed using Bulpitt and Fletcher's Specific Questionnaire, as well as the SF-36 scores. Hypertensive patients were divided into "with complications" (n=37, diastolic blood pressure great than 110 mm Hg for patients with or without treatment, with clinically evident target-organ or other associated illness) and "without complications" (n=40). The variables studied were quality of life, blood pressure control, hypertension gravity, and demographic characteristics. RESULTS: In hypertensive patients with and without complications, both the systolic and diastolic blood pressure were significantly higher (p<0.05) in phase 2 of observation (143±18/ 84±11 and 144±21/93±11 mm Hg for patients with and without complications , respectively) relative to phase 1 (128±17/ 75±13 and 128±15/ 83±11mmHg). The proportion of patients with controlled blood pressure (defined as a blood pressure less than 140/90 mm Hg) decreased from 70% to 49% in the "with complications" group and from 78% to 50% in the "without complications" group during phase 2 of observation. The patients with complications showed a decrease in bodily pain, vitality, and mental health component summary scores in both phases. In phase 2, the patients without complications had significantly better HRQL scores compared to complicated patients using both the Bulpitt and Fletcher's Questionnaire and the SF-36 assessment of physical capacity, bodily pain, and vitality domain summary scores. With regards to hypertension control, there was a significant decrease from phase 1 to phase 2 in the vitality component summary scores and an increase in the emotional aspect component summary scores assessed by the SF-36, whereas Bulpitt and Fletcher's Questionnaire showed no differences in these scores. CONCLUSION: Special care programs with multidisciplinary activities, individualized and personalized assistance, easy access to pharmacological treatment, frequent meetings, and active telephone calls for hypertensive patients significantly increase blood pressure control but do not interfere with the HRQL

Instrumento de avaliação da qualidade de vida para hipertensos de Bulpitt e Fletcher

Este estudo realizou a tradução para o português e a validação do questionário específico para avaliação da qualidade de vida em hipertensos de Bulpitt e Fletcher. A tradução e o back-translation foram realizados por 4 professores de inglês e a versão final submetida a um corpo de juizes. Questões com Índice de Validade de Conteúdo menor que 80% foram modificadas e reavaliadas. O questionário foi aplicado em 110 hipertensos ambulatoriais (52 &plusmn; 8 anos, 65% mulheres, pressão arterial 128&plusmn;17/ 75&plusmn;13 mmHg), que também responderam ao SF-36, e em 20 normotensos, com características semelhantes às dos hipertensos. Os domínios do SF-36 e do instrumento de Bulpitt e Fletcher se correlacionaram (pEste estudio ha realizado la traducción para el portugués y la validación del cuestionario específico para evaluación de la calidad de vida en hipertensos de Bulpitt y Fletcher. La traducción y el back-translation fueron realizados por 4 profesores de inglés y la versión final sometida a un cuerpo de jueces. Cuestiones con Índice de Validad de Contenido menor que 80% fueron modificadas y reevaluadas. El cuestionario fue aplicado en 110 hipertensos en seguimiento ambulatorial (52 &plusmn; 8 años, 65% mujeres, presión arterial 128&plusmn;17/ 75&plusmn;13 mmHg), que también respondieron al instrumento de evaluación de calidad de vida SF-36, y en 20 normotensos, con características semejantes a de los hipertensos. Los dominios del SF-36 y del instrumento de Bulpitt y Fletcher se correlacionaron (pThis study translated and validated Bulpitt and Fletcher's Specific Questionnaire for Quality of Life Assessment of hypertensive patients. The translation and the back-translation were performed by four English teachers, and the final version was submitted to a board of referees. Questions with a Content Validity Index lower than 80% were modified and re-evaluated. The questionnaire was applied in 110 hypertensive outpatients (52 &plusmn; 8 years old, 65 % female, blood pressure 128 &plusmn; 17/75 &plusmn; 13 mmHg), which also answered the SF-36, and also in 20 normotensive people, whose characteristics were similar to those of the hypertensive subjects. The domains of SF-36 and Bulpitt and Fletcher's instrument correlated to each other (p < 0.05), except for the social aspects (r=0.07, p= 0.04) and the general state of health (r=0.04, p= 0.61). Hypertensive patients showed more positive responses to the symptoms (40%) than the normotensives (15%). The instrument was validated and is now ready to be used in our midst

La situación social del anciano en Brasil: una breve consideración

The national and international literature suggest that the process of becoming old in an issue of great interest for researchers, statisticians, and epidemiologists. The literature shows that the population of elderly worldwide is increasing rapidly. Particularly in countries in development, this population has been increasing significantly but the resources and support systems necessary to attend this population is not expanding at the same rate. Therefore, concerns regarding this population profile have led to many serious discussions and studies to provide data to those in political position to create adequate programs and policies to attend to the specific needs of the elderly population without isolating them from society. Thus, the goal of this paper is to discuss the social situation of the elderly in Brazil taken into consideration demographic, epidemiologic, and psychosocial. Emphasis is placed on retirement, the importance of the family, and on the interpersonal relationships.El envejecimiento es un asunto explorado por investigadores, epidemiólogos y estadísticos por medio de investigaciones científicas encontradas en la literatura nacional e internacional, que revelan la proyección notoria de esta población de ancianos. En el panorama mundial, así como en los países en desarrollo, la población anciana aumenta significativamente y el contrapunto de esta realidad señala que el soporte para esa nueva condición no ha evolucionado con la misma velocidad. Frente a esto, la preocupación por ese nuevo perfil poblacional viene generando, en los últimos años, innumerables discusiones y la realización de diversos estudios con el objetivo de ofrecer datos que subsidien el desarrollo de políticas y programas adecuados para esa parcela de la población. Esto se debe al hecho de que la referida población requiere cuidados específicos y orientados a las peculiaridades advenidas con el proceso del envejecimiento sin segregarlos de la sociedad. Siendo así, en este artículo se tuvo como objetivo discutir sobre la situación social del anciano en Brasil, considerando los aspectos demográficos, epidemiológicos y los aspectos psicosociales con destaque de la jubilación, la importancia de la familia y las relaciones interpersonales.O envelhecimento é uma questão explorada por pesquisadores, epidemiologistas e estatísticos por meio de investigações científicas encontradas na literatura nacional e internacional, que revelam a projeção notória desta população de idosos. No panorama mundial, bem como nos países em desenvolvimento, a população idosa aumenta significativamente e o contraponto desta realidade aponta que o suporte para essa nova condição não evolui com a mesma velocidade. Diante disto, a preocupação com esse novo perfil populacional vem gerando, nos últimos anos, inúmeras discussões e a realização de diversos estudos com o objetivo de fornecerem dados que subsidiem o desenvolvimento de políticas e programas adequados para essa parcela da população. Isto devido ao fato que a referida população requer cuidados específicos e direcionados às peculiaridades advindas com o processo do envelhecimento sem segregá-los da sociedade. Assim sendo, esse artigo tem como objetivo discutir sobre a situação social do idoso no Brasil, considerando os aspectos demográficos, epidemiológicos e os aspectos psicossociais com destaque para a aposentadoria, a importância da família e as relações interpessoais.Universidade Federal de São Paulo (UNIFESP)Universidade de São Paulo Escola de EnfermagemUniversidade de São Paulo Escola de Enfermagem Departamento de Enfermagem Médico-CirúrgicaUNIFESPSciEL

How to avoid discontinuation of antihypertensive treatment. The experience in São Paulo, Brazil

OBJECTIVES: To evaluate the importance of providing guidelines to patients via active telephone calls for blood pressure control and for preventing the discontinuation of treatment among hypertensive patients. INTRODUCTION: Many reasons exist for non-adherence to medical regimens, and one of the strategies employed to improve treatment compliance is the use of active telephone calls. METHODS: Hypertensive patients (n=354) who could receive telephone calls to remind them of their medical appointments and receive instruction about hypertension were distributed into two groups: a) "uncomplicated" - hypertensive patients with no other concurrent diseases and b) "complicated" - severe hypertensive patients (mean diastolic >110 mmHg with or without medication) or patients with comorbidities. All patients, except those excluded (n=44), were open-block randomized to follow two treatment regimens ("traditional" or "current") and to receive or not receive telephone calls ("phone calls" and "no phone calls" groups, respectively). RESULTS: Significantly fewer patients in the "phone calls" group discontinued treatment compared to those in the "no phone calls" group (4 vs. 30; p<0.0094). There was no difference in the percentage of patients with controlled blood pressure in the "phone calls" group and "no phone calls" group or in the "traditional" and "current" groups. The percentage of patients with controlled blood pressure (<140/90 mmHg) was increased at the end of the treatment (74%), reaching 80% in the "uncomplicated" group and 67% in the "complicated" group (p<0.000001). CONCLUSION: Guidance to patients via active telephone calls is an efficient strategy for preventing the discontinuation of antihypertensive treatment

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

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Evaluación de las condiciones de uso de esfigmomanómetros en servicios hospitalarios

OBJETIVO: Avaliar as condições de uso dos esfigmomanômetros em hospitais públicos e privados. MÉTODOS: Estudo descritivo de abordagem- quantitativa realizado em quatro hospitais de grande porte do Estado de São Paulo, no período entre 2009 e 2010. Os manômetros aneroides foram- testados contra manômetro de mercúrio calibrado. Foram considerados descalibrados quando as diferenças foram &gt; a 4 mmHg. RESULTADOS: Foram avaliados 162 esfigmomanômetros, (78 de um hospital público e 84 de instituições filantrópicas e privada) e 98,1% eram do tipo aneróide.- Verificou-se que 56,2% dos manômetros estavam descalibrados (48,6% do hospital privado e 63,1% dos hospitais públicos). Analisando-se as- médias das diferenças negativas da descalibração, houve diferença significativa entre os manômetros do hospital privado e os dos hospitais públicos- (-6,14±2,66 mmHg vs -8,97±6,74 mmHg, respectivamente, p<0,05). Observou-se ainda que em 70,2% não era feita avaliação periódica; 26,7%- tinham extensão de borracha envelhecida; 20,5% das válvulas apresentaram vazamento; e 27% dos manômetros não estavam com o ponteiro na- marca zero. CONCLUSÃO: A descalibração dos esfigmomanômetros aneróides foi expressiva e pode acarretar avaliação incorreta da pressão arterial

Effects of long term device-guided slow breathing on sympathetic nervous activity in hypertensive patients: a randomized open-label clinical trial

Purpose: Device-guided slow breathing (DGB) is indicated as nonpharmacological treatment for hypertension. The sympathetic nerve activity (SNA) reduction may be one of the mechanisms involved in blood pressure (BP) decrease. The aim of this study is to evaluate the long-term use of DGB in BP and SNA. Subjects and methods: Hypertensive patients were randomized to listen music (Control Group–CG) or DGB (aim to reduce respiratory rate to less than 10 breaths/minute during 15 minutes/day for 8 weeks). Before and after intervention ambulatory blood pressure monitoring (ABPM), catecholamines and muscle sympathetic nerve activity (MSNA) by microneurography were performed. Results: 17 volunteers in the DGB and 15 in the CG completed the study. There was no change in office BP before and after intervention in both groups. There was a reduction in systolic and diastolic BP in the awake period by ABPM only in the CG (131 ± 10/92 ± 9 vs 128 ± 10/88 ± 8mmHg, p < 0.05). In relation to SNA, no difference in catecholamines was observed. In the volunteers who had a microneurography record, there was no change the MSNA (bursts/minute): DGB (17(15–28) vs 19(13–22), p = 0.08) and CG (22(17–23) vs 22(18–24), p = 0.52). Conclusion: Long-term DGB did not reduce BP, catecholamines levels or MSNA in hypertensive patients. ClinicalTrials.gov identifier: NCT0139072

How to avoid discontinuation of antihypertensive treatment: The experience in São Paulo, Brazil

OBJECTIVES: To evaluate the importance of providing guidelines to patients via active telephone calls for blood pressure control and for preventing the discontinuation of treatment among hypertensive patients. INTRODUCTION: Many reasons exist for non-adherence to medical regimens, and one of the strategies employed to improve treatment compliance is the use of active telephone calls. METHODS: Hypertensive patients (n=354) who could receive telephone calls to remind them of their medical appointments and receive instruction about hypertension were distributed into two groups: a) "uncomplicated" - hypertensive patients with no other concurrent diseases and b) "complicated" - severe hypertensive patients (mean diastolic &gt;110 mmHg with or without medication) or patients with comorbidities. All patients, except those excluded (n=44), were open-block randomized to follow two treatment regimens ("traditional" or "current") and to receive or not receive telephone calls ("phone calls" and "no phone calls" groups, respectively). RESULTS: Significantly fewer patients in the "phone calls" group discontinued treatment compared to those in the "no phone calls" group (4 vs. 30;