Revista Portuguesa de Hipertensão e Risco Cardiovascular

Hypertension – Surveillance And Screening For Target Organ Damage

Mon, 27 Jan 2025 00:00:00 -0800

Introduction: Arterial hypertension is defined as systolic blood pressure (BP) in the office ≥140 mmHg and/or diastolic BP ≥90 mmHg. It has a global prevalence in adults of 30-45% and is considered the leading preventable cause of cardiovascular disease and all-cause mortality. Hypertension can cause structural or functional changes in major organs, designated hypertension-mediated organ damage. Standard examination of target organ damage is recommended for all hypertensive patients through analytical study [complete blood count, fasting glucose and/or glycated hemoglobin (HbA1c), lipid profile, electrolytes, uric acid, creatinine, liver function, albumin/creatinine ratio] and electrocardiogram.

Objective: To assess the prevalence of patients diagnosed with hypertension in a family health unit (FHU) with evaluation of systolic and diastolic blood pressure, body mass índex (BMI), and analytical study.

Material and Methods: Cross-sectional descriptive observational study, involving users enrolled in the FHU diagnosed with hypertension in September/2023. Variables such as sex, age, systolic and diastolic BP, BMI, creatinine, microalbuminuria, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, and HbA1c were analyzed with results from 2022/2023. Data were collected from the MIM@UF and SClínico® programs and analyzed using Excel2013®.

Results: 6671 users were identified with a diagnosis of hypertension, with 55,5% (n=3702) being female, with a mean age of 70,1 years. Of these, 96,2% (n=6417) had assessment of systolic and diastolic BP, and 88,2% (n=5881) had assessment of BMI. Regarding laboratory evaluation, 85,6% (n=5710) had a record of LDL cholesterol, 88,9% (n=5928) of total cholesterol, 87,2% (n=5814) of HDL cholesterol, 87,3% (n=5824) of triglycerides, 87,9% (n=5866) of creatinine, 65,5% (n=4367) of microalbuminuria, and 43,8% (n=2920) of HbA1c.

Discussion and Conclusion: It was found that 34,4% of FHU users have a diagnosis of hypertension, with the majority undergoing the necessary investigation. BP was assessed in more users than BMI, so it’s important to reinforce this evaluation for better control of this risk factor. Regarding laboratory studies, microalbuminuria was the least frequently performed analysis.

Study Of The Prevalence Of Hypertension In Children And Adolescents In Lisbon And Tejo Valley Region

Mon, 27 Jan 2025 00:00:00 -0800

Introduction: Hypertension (HTN) is an important risk factor for cardiovascular disease (CVD) at any age. Its prevalence in children is estimated at 3-5%. The knowledge of its prevalence allows for the adequacy of control, treatment and prevention measures, to decrease the morbidity and mortality associated with CVD.

Objectives: To assess the prevalence of hypertension in school-age children and adolescents and the effect of sociodemographic and clinical variables on the blood pressure profile. To compare the values using the classification criteria of the blood pressure defined by the European Society of Hypertension (ESH-2016) with the American Academy of Pediatrics criteria (AAP-2017).

Methodology: Multicenter, observational, prospective, cross-sectional study conducted between 2016 and 2019. The convenience sample is composed of children aged between 6-18 years, living in Lisbon and Tejo Valley Region. Blood pressure (BP) measurement by oscillometric method was performed in school environment. The classification of the BP profile into normal BP (NBP), elevated BP (EBP) and hypertension (HTN) was based in ESH-2016 criteria. Age, gender, race, education level, weight and height were recorded. A descriptive statistical analysis was performed.

Results: Participants: 1245 children, 215 from 6-10 years (17%); 720 from 11-15 years (58%) and 310 from 16-18 years (25%). Caucasian:88%; Female gender: 635 (51%). There were 16% overweight and 7% obese. The prevalence of HTN is 8.4% and EBP is 12.8%. Between 6-10 years old: 5.6% had HTN; 11-15 years old: 8.6% and 16-18 years old: 10%. In boys, 10.5% had HTN (vs F.6.5%-p<0.001). Caucasians: 8.7% with HTN, 6% in blacks and 5.9% among Asians. Children who were overweight or obese showed higher values of hypertension, 17% and 26% respectively.

Discussion/Conclusion: The prevalence of hypertension is high (8.4%) and it increases with age, male gender and more advanced level of education. Overweight and obesity contribute to the increase of HTN cases.

High Pressure, Low Control: The Challenging Side Of Resistant Arterial Hypertension

Mariana Caetano Coelho, Adriana Silva, Margarida Figueiredo, Sofia Paula — Mon, 27 Jan 2025 00:00:00 -0800

Arterial hypertension constitutes a highly prevalent cardiovascular risk factor in the global population. However, a significant portion of patients fails to achieve adequate blood pressure levels for effective risk control, challenging medical practice. Resistant hypertension is identified when the patient maintains blood pressure levels above the recommended value, even with the concurrent use of three anti-hypertensive medications at optimized doses, one of which is a diuretic. This clinical case illustrates a case of resistant arterial hypertension and the various therapeutic approaches used in blood pressure control.

A Rare Cause Of Asymmetry In Blood Pressure

Raquel Susana Vilas Boas Oliveira, Raquel Ervalho, Andreia Mandim — Mon, 27 Jan 2025 00:00:00 -0800

A constatação de assimetria na pressão arterial entre membros exige exclusão de vários diagnósticos. Uma forma rara de apresentação pode ocorrer nas vasculites, caracterizadas por inflamação e necrose da parede de vasos sanguíneos, podendo resultar em estreitamento ou oclusão dos seus lúmens.

Apresenta-se o caso de uma mulher de 67 anos referenciada a consulta por apresentar episódios transitórios de hipotensão por vezes com tonturas associadas. Ao exame objetivo, constatada assimetria na pressão arterial dos membros superiores relativamente aos inferiores.

Do estudo efetuado destaque para elevação analítica dos marcadores inflamatórios e angioTC a evidenciar aortite extensa desde aorta ascendente até à bifurcação das artérias ilíaca e ecodoppler dos vasos do pescoço e membros superiores com espessamento da parede média-intima nos eixos carotideos, artérias temporais superficais e axilares, sem estenose significativas. Após exclusão de outras causas inflamatórias e não inflamatórias, foi assumido como diagnóstico mais provável arterite de células gigantes, tendo iniciado corticoterapia, com pulsos de metilprednisolona e posteriormente prednisolona 1mg/Kg. As vasculites são um dos maiores desafios diagnósticos na medicina, pela sua apresentação clínica inespecífica, por vezes insidiosa, o que pode atrasar o seu reconhecimento e consequente tratamento.

Editorial

J. Braz Nogueira — Mon, 27 Jan 2025 00:00:00 -0800