Revista Portuguesa de Hipertensão e Risco Cardiovascular

BEHIND ELEVATED BLOOD PRESSURE...

2024-10-12T08:58:35-07:00

Introduction: When hypertension is suspected in young adults, an appropriate clinical, laboratory and imaging investigation should be carried out in order to exclude secondary causes.

Clinical case: A 39-year-old male patient attended a consultation due to recurrent episodes of elevated blood pressure in an outpatient setting, with a few months of progression. He had visited the emergency department 2 days earlier due to nonspecific chest pain, without criteria for acute myocardial infarction. During the appointment, he was asymptomatic. His medical history included obesity and previous smoking habits. He was not taking any regular medication. On physical examination at the office, he had a blood pressure reading of 154/63 mmHg and a heart rate of 62 bpm. Cardiac auscultation revealed a diastolic murmur. At the follow-up consultation, a 12-lead electrocardiogram showed left ventricular hypertrophy, and a transthoracic echocardiogram demonstrated a deformed aortic valve, functionally bicuspid, without stenosis, but with severe insufficiency. Given these results, the patient was referred to a cardiology consultation, where he underwent a transesophageal echocardiogram and a coronary computed tomography angiography for surgical planning. He subsequently underwent an aortic valve replacement with a St. Jude Regent mechanical valve. He is currently being followed by his family doctor, with stabilized blood pressure and cardiovascular risk factors controlled by pharmacological therapy.

Conclusion: Although hypertension was an epiphenomenon in this case, its correct approach in primary health care allowed the early

diagnosis and timely intervention of a condition that could lead to the development of potentially fatal complications.

SERUM URIC ACID LEVEL AS A PREDICTOR OF CARDIOVASCULAR RISK - WHAT IS THE EVIDENCE?

2025-04-10T08:02:41-07:00

Introduction: Cardiovascular risk is defined as the probability of an individual developing cardiovascular disease in the future, influenced by well-established risk factors. Since cardiovascular disease is the leading cause of mortality and disability in Western countries, it is essential to manage these factors effectively and investigate the presence of additional contributors.

Methods: A narrative review of the scientific literature was conducted to assess the relationship between serum uric acid levels and cardiovascular risk. The study involved a search for articles published between January 1, 2022, and December 31, 2024, in the PubMed®, ScienceDirect®, and Cochrane Library® databases.

Results: Hyperuricemia is associated with an increased cardiovascular risk through its relationship with key risk factors, including chronic kidney disease, diabetes, obesity, left ventricular hypertrophy, and arterial stiffness. Additionally, indexing serum uric acid levels to renal function, using serum creatinine levels, has been shown to enhance its role as a comprehensive biomarker, suggesting its utility in patient screening.

Discussion and Conclusion: Hyperuricemia is considered an additional risk factor for both the development and progression of cardiovascular disease. Early monitoring of serum uric acid levels and appropriate management of hyperuricemia may be fundamental to reduce cardiovascular risk and improve patients’ quality of life.

RESUMOS DO 19º CONGRESSO PORTUGUÊS DE HIPERTENSÃO E RISCO CARDIOVASCULAR GLOBAL

2025-07-05T03:09:14-07:00

Editorial

2025-07-05T03:11:11-07:00

CHARACTERIZATION OF HYPERTENSION IN A INTERNAL MEDICINE WARD

2025-07-05T03:13:51-07:00

Introduction: Arterial hypertension is a serious disease, affecting more than 60% of individuals over 60 years-old. It is associated with the development of cardiac disease, terminal renal failure and cerebral disease, with increased risk of cognitive decline and dementia. The World Health Organization and the European Society of Cardiology forewarn about a low therapeutic compliance and impact, thus being controlled in just 14% of cases. They recommend starting with combined agents in a single pill to increase its compliance and efficacy, lowering adverse effects and minimizing the serious events associated with hypertension.

Objectives: Characterize the hypertensive patients in an internal medicine ward; evaluate the applicability of the Hypertension guidelines with combined therapy in the hypertensive patients admitted to an internal medicine ward; identify the main classes prescribed.

Methods: Hypertensive patients admitted in 12 beds in an internal medicine ward during 2021 were identified and characterized on their age, gender, target organ damage (ischemic cardiopathy records, cerebrovascular disease, chronic renal failure, atrial fibrilation, dementia) and antihypertensive class (angiotensin-converting enzyme (ACE) inhibitors [ACEi], angiotensin II receptor blockers [ARBs], calcium channel blockers [CCB], beta blockers or diuretic) at admission and discharge and it was recorded the combined single pill prescribed. Transferred or deceased patients were excluded.

Results: 130 patients were included, of which 53.1% (n=69) were male, with mean age of 82 years. Of these, 82.3% (n=107) had one or more target organ damaged, being heart failure (n=60, 46.2%) and cerebrovascular disease (n=49, 37.7%) the most commonly observed. At admission, 15 patients (11.5%) did not have antihypertensive drugs and 63.1% (n=82) used 2 or more antihypertensive agents. Combined therapy was identified in 42 patients (32.3%), mainly the combination of ARB and diuretic (n=19), ACEi and diuretic (n=8) or ACEi and CCB (n=7). At discharge it was shown that 13.1% (n=17) did not do antihypertensive treatment and 61.5% (n=80) used 2 or more antihypertensive agents. Combined therapy was prescribed in 17.7% (n=23) patients, more frequently ARB and diuretic, ACEi and diuretic and ACEi and CCB (n=13, n=5 e n= 4, respectively) the most commonly used. Only a patient was started on combined therapy (ACEi and CCB).

Conclusion: Contrary to the recommendations, a reduction in the prescription of combined therapy was observed, with suspension of antihypertensive agents in 13.1% of patients. The authors consider the lack of motives for the suspension of the agents as the main limitation to the study. In the elderly, compliance is directly conditioned by several risk factors, such as cognitive alterations, dependency status, multiple pathologies, polymedication, management of their secondary effects and medical interactions. Individualizing and simplifying therapies are essential tools to clinical practice.