Comparison between Central and Brachial Blood Pressure in Hypertensive Elderly Women and Men

Aim. To compare the values of central and brachial systemic blood pressure (SBP) between women and men over 60 years of age with systemic arterial hypertension. Methods. This study was a quantitative, descriptive, cross-sectional study with elderly patients admitted to and selected from spontaneous and scheduled demand at basic health units in Uberlândia, Minas Gerais, Brazil, between March 2013 and March 2014. We included 69 study participants and compared central and brachial SBP using a Sphygmocor® XCEL device (AtCor Medical, Sydney, Australia). Results. Significant differences were found in the blood pressure values of the whole population in the central versus brachial systolic blood pressure (SP) [140(21) versus 153(23) mmHg] and in the central versus brachial pulse pressure (PP) [55(18) versus 70(18) mmHg]. Additionally, females exhibited higher blood pressure levels than males [central SP 144(23) versus 134(16) mmHg and brachial SP 161(26) versus 148(18) mmHg and central PP 62(17) versus 45(14) mmHg and brachial PP 80(21) versus 63(15) mmHg, resp.]. Conclusion. Elderly women exhibited higher blood pressure values than elderly hypertensive men

Comparison of Measured Creatinine Clearance and Clearances Estimated by Cockcroft-Gault and MDRD Formulas in Patients with a Single Kidney

There are doubts about whether the values obtained from the Cockroft-Gault (ClCG) and Modification of Diet in Renal Disease (GFRMDRD) formulas are comparable to the more traditional formula used to obtain the creatinine clearance from a 24-hour urine collection (ClCrm), particularly in patients with only one kidney. The present study aimed to compare these formulas in individuals with one remaining kidney after previous nephrectomy (Nx) and to verify which estimated formula correlates more closely with ClCrm. Thirty-six patients who had undergone Nx had their renal filtration analyzed with ClCG, GFRMDRD and by ClCrm. The average time after Nx was 11.6 ± 9.0 years, and the average age at the time of the study was 50.7 ± 10.6 years old (X ± SD). The results of three clearances were 81.1 ± 35.6 mL·min·m2 for ClCrm, 70.4 ± 24.0 mL·min·m2 for ClCrCG, and 71.2 ± 19.2 mL·min·m2 for GFRMDRD (with ClCrm > ClCrCG and GFRMDRD; P < .001). No difference was found between the ClCrCG and GFRMDRD values (P = .72). The data demonstrated that both estimate formulas were strongly correlated with ClCrm, although ClCrCG was more closely associated with ClCrm than GFRMDRD (ClCrCG with r2 : 0.64 and GFRMDRD with r2 : 0.34; P < .001). In conclusion, for people with only one kidney remaining after NX, our data showed that glomerular filtration rate estimation by ClCrCG is more related to the values obtained with the traditional clearance measurement based on a 24-hour urine collection test

Back to Basics: Pitting Edema and the Optimization of Hypertension Treatment in Incident Peritoneal Dialysis Patients (BRAZPD)

Systemic arterial hypertension is an important risk factor for cardiovascular disease that is frequently observed in populations with declining renal function. Initiation of renal replacement therapy at least partially decreases signs of fluid overload; however, high blood pressure levels persist in the majority of patients after dialysis initiation. Hypervolemia due to water retention predisposes peritoneal dialysis (PD) patients to hypertension and can clinically manifest in several forms, including peripheral edema. The approaches to detect edema, which include methods such as bioimpedance, inferior vena cava diameter and biomarkers, are not always available to physicians worldwide. For clinical examinations, the presence of pitting located in the lower extremities and/or over the sacrum to diagnose the presence of peripheral edema in their patients are frequently utulized. We evaluated the impact of edema on the control of blood pressure of incident PD patients during the first year of dialysis treatment. Patients were recruited from 114 Brazilian dialysis centers that were participating in the BRAZPD study for a total of 1089 incident patients. Peripheral edema was diagnosed by the presence of pitting after finger pressure was applied to the edematous area. Patients were divided into 2 groups: those with and without edema according to the monthly medical evaluation. Blood arterial pressure, body mass index, the number of antihypertensive drugs and comorbidities were analyzed. We observed an initial BP reduction in the first five months and a stabilization of blood pressure levels from five to twelve months. The edematous group exhibited higher blood pressure levels than the group without edema during the follow-up. The results strongly indicate that the presence of a simple and easily detectable clinical sign of peripheral edema is a very relevant tool that could be used to re-evaluate not only the patient's clinical hypertensive status but also the PD prescription and patient compliance