INTRODUÇÃO: O exercício aeróbio é recomendado para o tratamento da hipertensão. Sua intensidade pode ser prescrita com base na porcentagem da frequência cardíaca máxima (%FCmáx) ou no consumo pico de oxigênio (%VO2pico) em que os limiares ventilatórios (LV) são alcançados. Entretanto, alguns hipertensos que iniciam o treinamento podem estar tomando betabloqueadores, o que pode influenciar esses parâmetros. OBJETIVO: verificar os efeitos do atenolol sobre os LV de hipertensos sedentários. MÉTODOS: Nove voluntários realizaram dois testes ergoespirométricos máximos após quatro semanas de tratamento com atenolol (25 mg administrado por via oral duas vezes por dia) e com placebo, administrados em ordem fixa e de forma cega. Durante os testes, a frequência cardíaca (FC), a pressão arterial (PA) e o VO2 no repouso, limiar anaeróbio (LA), ponto de compensação respiratória (PCR) e pico do esforço foram analisados. RESULTADOS: O VO2 aumentou progressivamente no exercício e seus valores foram semelhantes nos dois tratamentos. A PA sistólica e a FC também aumentaram no exercício, mas seus valores absolutos foram significativamente menores com o atenolol. Porém, o aumento da PA sistólica e da FC no exercício foi semelhante com os dois tratamentos. Assim, o percentual da FCmáx e o percentual do VO2pico em que LA e PCR foram alcançados não diferiram entre o placebo e o atenolol. CONCLUSÃO: O atenolol na dosagem de 50 mg/dia não afetou o percentual do VO2pico e da FCmáx em que os LV são atingidos, o que confirma que a prescrição de intensidade de treinamento com base nessas porcentagens pode ser mantida em hipertensos que recebem betabloqueadores.

INTRODUCTION: Aerobic exercise is recommended for the treatment of hypertension. Its intensity can be prescribed based on the percentage of maximum heart rate (% MHR) or peak oxygen consumption (VO2peak%) in which the ventilatory thresholds (VT) are achieved. However, some hypertensive patients who begin aerobic training may be receiving beta-blockers, which can influence these parameters. OBJECTIVE: To investigate the effects of atenolol on VT of sedentary hypertensive patients. METHODS: Nine volunteers performed two cardiopulmonary exercise tests until exhaustion after 4 weeks of treatment with atenolol (25 mg orally twice daily) and with placebo, administered in a fixed order and in a blinded manner. During the tests, heart rate (HR), blood pressure (BP), VO2 at rest, anaerobic threshold (AT), respiratory compensation point (RCP) and peak effort were analyzed. RESULTS: VO2 increased progressively throughout the exercise and the values were similar for both treatments. Systolic blood pressure and heart rate also increased progressively during the exercise, but their absolute values were significantly lower with atenolol. However, the increase in systolic BP and HR during exercise was similar in both treatments. Thus, the % of MHR and %VO2peak at which LA and PCR were achieved were not different between placebo and atenolol. CONCLUSION: Atenolol, at a dosage of 50mg/day, did not affect the % of VO2peak and % of MHR corresponding to the VTs, which confirms that prescription of training intensity based on these percentages is adequate to hypertensive patients receiving beta-blockers.

FUNDAMENTO: A felipressina foi adicionada ao anestésico local para aumentar a duração do efeito anestésico e reduzir a toxicidade nos procedimentos dentários. No entanto, o efeito sobre a pressão arterial é incerta, e isso pode ser altamente relevante no tratamento dentário de pacientes hipertensos. OBJETIVO: Investigar o efeito da felipressina sobre a pressão arterial em pacientes hipertensos com pressão arterial controlada. MÉTODOS: Foram estudados 71 indivíduos com essas características e com necessidade de tratamento periodontal. Após 10 minutos de repouso, a anestesia local (prilocaína) foi infiltrada com e sem adição de felipressina. Em seguida, uma raspagem subgengival profunda foi realizada. A pressão arterial foi medida por um equipamento oscilométrico automático (DIXTAL DX2010). Dez minutos após a administração do anestésico, o pico de ação anestésica foi gravado. O Inventário de Ansiedade Traço-Estado (IDATE) foi utilizado para avaliar o traço de ansiedade nos pacientes. RESULTADOS: A pressão arterial sistólica aumentou após a anestesia, independentemente da associação com felipressina, durante todo o procedimento dentário (p < 0,05), e essa resposta pode ser explicada, pelo menos em parte, pelos níveis de traço de ansiedade dos indivíduos. No entanto, um aumento adicional na pressão arterial diastólica foi observado quando a prilocaína foi associada a felipressina (p < 0,05), mas essa resposta não se alterou com os níveis de traço de ansiedade. CONCLUSÃO: A felipressina aumentou a pressão arterial diastólica de pacientes hipertensos com pressão arterial controlada. Pacientes com traço de ansiedade elevado apresentaram aumento na pressão arterial sistólica em alguns procedimentos, sugerindo que um aumento da pressão arterial também pode estar relacionado ao medo ou à ansiedade.

BACKGROUND: Felypressin has been added to local anesthetic to increase the length of the anesthetic effect and reduce toxicity during dental procedures. However, the effect on blood pressure remains uncertain, and this may be highly relevant in the dental treatment of hypertensive patients. OBJECTIVE: To investigate the effect of felypressin on blood pressure in hypertensive patients with controlled BP. METHODS: 71 subjects with these characteristics and in need of periodontal treatment were studied. After 10 minutes of rest, local anesthesia (prilocaine) was infiltrated with and without addition of felypressin. Then, a deep subgingival scaling was performed. Blood pressure was measured by an automated oscillometric device (DIXTAL DX2010). Ten minutes after the administration of the anesthetic, peak anesthetic action was recorded. The State-Trait Anxiety Inventory (STAI) was used to assess the patients' trait anxiety. RESULTS: Systolic blood pressure increased after anesthesia, regardless of association with felypressin, throughout the dental procedure (p<0.05) and this response can be explained, at least in part, by the trait anxiety levels of the subjects. However, a further increase in diastolic blood pressure was observed when prilocaine was associated with felypressin (p<0.05), but this response did not change with trait anxiety levels. CONCLUSION: Felypressin increased the diastolic blood pressure of hypertensive patients with controlled blood pressure. Patients with high trait anxiety presented increases in systolic blood pressure upon some procedures, suggesting that an increase in blood pressure might also be related to fear or anxiety.

FUNDAMENTO: A hipertensão complicada pode ser influenciada pelas características dos pacientes hipertensos. OBJETIVO: Associar a condição de hipertensão complicada com variáveis biossociais, tais como as atitudes e as crenças sobre a doença e o tratamento e o bem-estar subjetivo. MÉTODOS: Foram estudados 251 hipertensos não complicados (PAS > 140 mmHg e/ou 90 < PAD < 110 mmHg para pacientes sem tratamento e PAD < 110 mmHg para pacientes com tratamento, sem lesões em órgãos-alvo e outras doenças) e 260 hipertensos complicados (PAD > 110 mmHg com ou sem tratamento, com lesões em órgãos-alvo ou outras doenças). RESULTADOS: Os hipertensos complicados foram significativamente diferentes dos não complicados (p < 0,05) em relação a: 1 - Predomínio de homens, não brancos (53,0%), maior índice de massa corporal (29,5 ± 4,6 vs 28,5 ± 4,0 kg/m²), mais de 10 anos de doença (54,0%), realização de tratamento anterior (53,0%) e referência de tristeza em relação a sua vida como um todo (74,0%); 2 - Os hipertensos complicados nunca levam os remédios quando viajam (59,0%), nem os providenciam antes de acabarem (71,0%) e raramente seguem as orientações sobre alimentação (69,0%); 3 - Os hipertensos não complicados apontaram mais enxaqueca, dor articular e, entre as mulheres, presença de menopausa e tratamento de reposição hormonal; 4 - Dos que tinham a pressão controlada (< 140/90 mmHg), 61,9% eram hipertensos não complicados; e 5 - Os hipertensos complicados desconheciam que o tratamento pode evitar problemas renais e desconheciam ainda que a hipertensão também pode acometer pessoas jovens. CONCLUSÃO: Hipertensos complicados apresentaram mais características estruturais e psicossociais desfavoráveis, mais atitudes negativas frente ao tratamento e desconhecem a doença.

BACKGROUND: Complicated hypertension can be influenced by the characteristics of hypertensive patients. OBJECTIVE: To associate the condition of complicated hypertension with biosocial variables such as attitudes and beliefs about the disease and treatment and subjective well-being. METHODS: We studied 251 uncomplicated hypertensive patients (SBP > 140 mmHg and/or 90 < DBP < 110 mmHg for patients under no treatment and DBP <110mmHg for patients under treatment without target organ damage and other diseases) and 260 complicated hypertensive patients (DBP > 110 mmHg with or without treatment, with target organ damage or other diseases). RESULTS: Complicated hypertensive patients were significantly different from uncomplicated ones (p <0.05) in relation to: 1 - Prevalence of men, not white (53.0%), higher body mass index (29.5 ± 4.6 vs 28.5 ± 4.0 kg/m²), over 10 years of disease (54.0%), completion of previous treatment (53.0%) and reports of sadness about life as a whole (74.0%) 2 - Complicated hypertensive patients never bring the drugs when they travel (59.0%), nor do they buy them before running out the drugs (71.0%) and rarely follow eating guidelines (69.0%) 3 - Uncomplicated hypertensive patients showed no more migraines, joint pain and, among women, menopausal status and hormone replacement therapy, and 4 - Of those who had pressure control (< 140/90 mmHg), 61.9% were uncomplicated hypertensive patients; and 5 - Complicated hypertensive patients were not aware that treatment can prevent kidney problems and they thought that young people do not have high blood pressure. CONCLUSION: Complicated hypertensive patients showed more negative structural and psychosocial characteristics, more negative attitudes towards treatment and are unaware of the disease.

FUNDAMENTO: Pouco se conhece sobre a prevalência da hipertensão arterial na cidade de São Paulo, SP, Brasil. OBJETIVO: Identificar a prevalência da hipertensão referida na cidade de São Paulo. MÉTODOS: Realizaram-se 613 entrevistas por telefone, a partir das listas residenciais do sistema de telefonia fixa. A amostra foi calculada com prevalência estimada de hipertensão em 20,0%. RESULTADOS: A prevalência referida de hipertensão foi de 23,0% e 9,0% dos entrevistados referiram que o valor de sua última medida da pressão foi maior que 140/90 mmHg, porém não tinham conhecimento de que eram hipertensos, totalizando uma prevalência de 32,0%. Os hipertensos referiram que: 89,0% fazem tratamento e 35,2% estavam controlados; 27,0% faltam às consultas; 16,2% deixam de tomar os remédios; 14,8% apresentam história de acidente vascular encefálico, 27,8% cardiopatia e 38,7% hipercolesterolemia; 71,2% receberam orientação para diminuir sal, 64,6% para realizar atividade física, 60,0% para perder peso e 26,2% para controlar estresse; e 78,9% mediam a pressão regularmente. Houve relação estatisticamente significante (p < 0,05) para: 1) faltar às consultas com maior tempo de tratamento e acompanhamento irregular de saúde; 2) deixar de tomar os remédios com tabagismo, etilismo e a não realização de acompanhamento de saúde; 3) realizar tratamento para hipertensão com dislipidemia, idade mais elevada e maior tempo de uso de anticoncepcional, no caso das mulheres; e 4) índice de massa corporal alterado com presença de diabete, hipercolesterolemia, pressão sistólica não controlada e uso de mais de um anti-hipertensivo. CONCLUSÃO: A prevalência referida de hipertensão na cidade de São Paulo assemelha-se à prevalência identificada em outros estudos.

BACKGROUND: Little is known about the prevalence of hypertension in São Paulo, Brazil. OBJECTIVE: To identify the prevalence of self-reported hypertension in the city of São Paulo. METHODS: There were 613 telephone interviews using directories of household landlines. The sample was calculated with an estimated prevalence of hypertension in 20.0%. RESULTS: The prevalence of self-reported hypertension was 23.0% and 9.0% of respondents reported that the value of their last pressure measurement was greater than 140/90 mmHg, but they were unaware that they were hypertensive, with a total prevalence 32.0%. Hypertensive patients reported that: 89.0% were under treatment and 35.2% were controlled; 27.0% miss medical appointments; 16.2% stop taking drugs; 14.8% have a history of stroke; 27.8% had heart disease and 38.7% had hypercholesterolemia; 71.2% received advice to reduce salt, 64.6% to perform physical activity, 60.0% to lose weight loss and 26.2% to control stress; and 78.9% measured pressure regularly. There was a statistically significant relation (p < 0.05) for: 1) missing medical appointments with longer treatment and irregular health monitoring; 2) stop taking the drugs with smoking, alcohol and failure to monitore health; 3) carry out treatment for hypertension with dyslipidemia, higher age and longer use of contraceptives for women; and 4) body mass index changed with diabetes, hypercholesterolemia, uncontrolled systolic blood pressure and use of more than one anti-hypertension drug. CONCLUSION: The prevalence of self-reported hypertension in the city of São Paulo resembles the prevalence found in other studies.

FUNDAMENTO: Poco se conoce sobre la prevalencia de la hipertensión arterial en la ciudad de São Paulo, SP, Brasil. OBJETIVO: Identificar la prevalencia de la hipertensión referida en la ciudad de São Paulo. MÉTODOS: Se realizaron 613 entrevistas por teléfono, a partir de las listas residenciales del sistema de telefonía fija. La muestra fue calculada con prevalencia estimada de hipertensión en 20,0%. RESULTADOS: La prevalencia referida de hipertensión fue de 23,0% y 9,0% de los entrevistados refirieron que el valor de su última medición de la presión fue mayor que 140/90 mmHg, sin embargo no sabían que eran hipertensos, totalizando una prevalencia de 32,0%. Los hipertensos refirieron que: 89,0% hacen tratamiento y 35,2% estaban controlados; 27,0% faltan a las consultas; 16,2% dejan de tomar los remedios; 14,8% presentan historia de accidente cerebro vascular, 27,8% cardiopatía y 38,7% hipercolesterolemia; 71,2% recibieron orientación de disminuir la sal, 64,6% de realizar actividad física, 60,0% para perder peso y 26,2% de controlar el stress; y 78,9% medían la presión regularmente. Hubo relación estadísticamente significativa (p < 0,05) para: 1 - faltar a las consultas con mayor tiempo de tratamiento y acompañamiento irregular de salud; 2 - dejar de tomar los remedios con tabaquismo, etilismo y la no realización de acompañamiento de salud; 3 - realizar tratamiento para hipertensión con dislipidemia, edad más elevada y mayor tiempo de uso de anticonceptivo, en el caso de las mujeres; y 4 - índice de masa corporal alterado con presencia de diabetes, hipercolesterolemia, presión sistólica no controlada y uso de más de un antihipertensivo. CONCLUSIÓN: La prevalencia referida de hipertensión en la ciudad de São Paulo se asemeja a la prevalencia identificada en otros estudios.

FUNDAMENTO: O controle da pressão arterial (PA) é fundamental na hipertensão arterial (HA). OBJETIVO: Conhecer o porcentual de pacientes exigindo metas específicas de controle da PA, atendidos em consultórios no Brasil. MÉTODOS: Cada pesquisador, em número de 291, deveria avaliar, por medida convencional da PA, em cinco dias consecutivos, os dois primeiros pacientes atendidos. Determinou-se o número de hipertensos tratados por, pelo menos, quatro semanas, e com controle da pressão arterial, de acordo com as metas desejadas para o grupo de risco a que pertenciam. RESULTADOS: Foram avaliados 2.810 pacientes, em 291 centros. Os indivíduos obedeceram à seguinte distribuição, por grupo: A (HA estágios 1 e 2, risco adicional baixo e médio) = 1.054 (37,51%); B (HA e PA limítrofe, risco adicional alto) = 689 (24,52%); C (HA e PA limítrofe risco adicional muito alto, incluindo diabéticos) = 758 (26,98%) e D (HA com nefropatia e proteinúria > 1 g/l) = 309 (11%). As médias de PA na população foram: 138,9 ± 17,1 e 83,1 ± 10,7 mmHg. Fatores relacionados ao menor controle da PA: idade, circunferência abdominal, diabete, tabagismo e doença coronariana. Os porcentuais de controle da PA em cada um dos grupos foram, respectivamente: 61,7; 42,5; 41,8 e 32,4. CONCLUSÃO: O baixo controle da PA segundo as metas predefinidas, como explicitado nos resultados, reforça a necessidade de medidas que promovam melhores taxas de controle.

BACKGROUND: Blood pressure (BP) control is crucial in arterial hypertension (AH). OBJECTIVE: To determine the percentage of patients requiring specific BP control goals treated in medical offices throughout Brazil. METHODS: Each researcher, from a total number of 291, had to evaluate, through conventional BP measurement performed during five consecutive days, the two first patients treated on that day. We determined the number of hypertensive patients treated for at least four weeks who presented BP control, according to the goals established for the risk group they belonged to. RESULTS: A total of 2,810 patients were assessed in 291 centers. The individuals were divided in groups as follows: A (AH stages 1 and 2, low and moderate additional risk) = 1,054 (37.51%); B (AH and borderline BP, high additional risk ) = 689 (24.52%); C (AH and borderline BP, very high additional risk, including diabetic patients) = 758 (26.98%) and D (AH with nephropathy and proteinuria > 1 g/l) = 309 (11%). The BP means in the population were: 138.9 ± 17.1 and 83.1 ± 10.7 mmHg. Factors associated with a worse BP control were: age, abdominal circumference, diabetes, smoking and coronary disease. The BP control percentages in each of the groups were, respectively: 61.7; 42.5; 41.8 and 32.4%. CONCLUSION: The low BP control according to the predefined goals, as demonstrated in the results, reinforces the necessity to establish measures to promote better control rates.

FUNDAMENTO: El control de la presión arterial (PA) es fundamental en la hipertensión arterial (HA). OBJETIVO: Conocer el porcentaje de pacientes que requieren metas específicas de control de la PA, atendidos en consultorios en Brasil. MÉTODOS: Cada investigador, en número de 291, debería evaluar, por medición convencional de la PA, en cinco días consecutivos, los dos primeros pacientes atendidos. Se determinó el número de hipertensos tratados durante, por lo menos, cuatro semanas, y con control de la presión arterial, de acuerdo con las metas deseadas para el grupo de riesgo al que pertenecían. RESULTADOS: Fueron evaluados 2.810 pacientes, en 291 centros. Los individuos obedecieron a la siguiente distribución, por grupo: A (HA Estadios 1 y 2, riesgo adicional bajo y medio) = 1.054 (37,51%); B (HA y PA Limítrofe, riesgo adicional alto) = 689 (24,52%); C (HA y PA Limítrofe riesgo adicional muy alto, incluyendo diabéticos) = 758 (26,98%) y D (HA con nefropatía y proteinuria > 1 g/l) = 309 (11%). Los promedios de PA en la población fueron: 138,9 ± 17,1 y 83,1 ± 10,7 mmHg. Factores relacionados al menor control de la PA: edad, circunferencia abdominal, diabetes, tabaquismo y enfermedad coronaria. Los porcentajes de control de la PA en cada uno de los grupos fueron, respectivamente: 61,7; 42,5; 41,8 y 32,4. CONCLUSIÓN: El bajo control de la PA según las metas predefinidas, como se explica en los resultados, refuerza la necesidad de medidas que promuevan mejores índices de control.

Hypertension is a ubiquitous and serious disease. Regular exercise has been recommended as a strategy for the prevention and treatment of hypertension because of its effects in reducing clinical blood pressure; however, ambulatory blood pressure is a better predictor of target-organ damage than clinical blood pressure, and therefore studying the effects of exercise on ambulatory blood pressure is important as well. Moreover, different kinds of exercise might produce distinct effects that might differ between normotensive and hypertensive subjects. The aim of this study was to review the current literature on the acute and chronic effects of aerobic and resistance exercise on ambulatory blood pressure in normotensive and hypertensive subjects. It has been conclusively shown that a single episode of aerobic exercise reduces ambulatory blood pressure in hypertensive patients. Similarly, regular aerobic training also decreases ambulatory blood pressure in hypertensive individuals. In contrast, data on the effects of resistance exercise is both scarce and controversial. Nevertheless, studies suggest that resistance exercise might acutely decrease ambulatory blood pressure after exercise, and that this effect seems to be greater after low-intensity exercise and in patients receiving anti-hypertensive drugs. On the other hand, only two studies investigating resistance training in hypertensive patients have been conducted, and neither has demonstrated any hypotensive effect. Thus, based on current knowledge, aerobic training should be recommended to decrease ambulatory blood pressure in hypertensive individuals, while resistance exercise could be prescribed as a complementary strategy.

OBJECTIVE: The aim of this study was to describe blood pressure responses during resistance exercise in hypertensive subjects and to determine whether an exercise protocol alters these responses. INTRODUCTION: Resistance exercise has been recommended as a complement for aerobic exercise for hypertensive patients. However, blood pressure changes during this kind of exercise have been poorly investigated in hypertensives, despite multiple studies of normotensives demonstrating significant increases in blood pressure. METHODS: Ten hypertensive and ten normotensive subjects performed, in random order, two different exercise protocols, composed by three sets of the knee extension exercise conducted to exhaustion: 40% of the 1-repetition maximum (1RM) with a 45-s rest between sets, and 80% of 1RM with a 90-s rest between sets. Radial intra-arterial blood pressure was measured before and throughout each protocol. RESULTS: Compared with normotensives, hypertensives displayed greater increases in systolic BP during exercise at 80% (+80±3 vs. +62±2 mmHg, P<0.05) and at 40% of 1RM (+75±3 vs. +67±3 mmHg, P<0.05). In both exercise protocols, systolic blood pressure returned to baseline during the rest periods between sets in the normotensives; however, in the hypertensives, BP remained slightly elevated at 40% of 1RM. During rest periods, diastolic blood pressure returned to baseline in hypertensives and dropped below baseline in normotensives. CONCLUSION: Resistance exercise increased systolic blood pressure considerably more in hypertensives than in normotensives, and this increase was greater when lower-intensity exercise was performed to the point of exhaustion.

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.

OBJETIVO: O estudo LOTHAR avaliou a eficácia, tolerabilidade e os efeitos metabólicos em médio e longo prazo (um ano) da combinação fixa de anlodipino e losartana versus anlodipino e losartana isoladamente. MÉTODOS: Estudo multicêntrico brasileiro, randomizado, duplo-cego e comparativo realizado com 198 pacientes com hipertensão arterial primária em estágios 1 e 2. RESULTADOS: A combinação fixa apresenta alta eficácia anti-hipertensiva que se mantém em longo prazo com percentual reduzido de escape do controle pressórico, inferior a dos dois regimes monoterápicos de comparação. Em longo prazo, mais de 60% dos pacientes tratados com a combinação fixa permaneceram com níveis da PAD < 85 mmHg e o efeito anti-hipertensivo quando avaliado pela MAPA persistiu nas 24 horas com relação vale-pico de 76,7%. A freqüência de eventos adversos foi bastante reduzida neste grupo sendo a incidência em longo prazo de edema de membros inferiores cerca de quatro vezes menor que a observada com o anlodipino isolado. A combinação fixa não alterou os metabolismos da glicose e dos lípides tanto em médio quanto em longo prazos. CONCLUSÃO: Estes resultados nos permitem afirmar que a combinação de anlodipino e losartana, a primeira combinação fixa de um antagonista dos canais de cálcio e um bloqueador do receptor da angiotensina II disponível no mercado farmacêutico constitui-se em excelente opção para o tratamento da hipertensão arterial em larga gama de pacientes hipertensos.

OBJECTIVE: The LOTHAR study evaluated medium and long term (one year) efficacy, tolerability and metabolic effects of the fixed combination of amlodipine and losartan compared to amlodipine or losartan alone. METHODS: Brazilian multicenter, randomized, double-blind and comparative trial performed with 198 patients in stage 1 and 2 essential hypertension. RESULTS: The fixed combination has a high antihypertensive efficacy that is sustained in the long term with very low percentage of loss of blood pressure control. This percentage is incidentally lower than that of the two monotherapy comparative regimens. In the long term, more than 60% of the patients treated with the fixed combination remained with DBP < 85 mmHg, and the antihypertensive effect, when assessed by ABPM persisted for 24 hours with a trough-to-peak ratio of 76.7%. The frequency of adverse events was quite low in this group, and the long-term incidence of leg edema was approximately four-fold lower than that observed with amlodipine alone. The fixed combination did not change glucose and lipid metabolism in the medium or in the long term. CONCLUSION: Based on these results, we can say that the combination of amlodipine and losartan - the first fixed combination of a calcium channel blocker and an angiotensin II receptor blocker available in the pharmaceutical market, is an excellent option for the treatment of a wide range of hypertensive patients.

Foram entrevistados 205 hipertensos em tratamento ambulatorial para avaliar o papel do perfil bio-social no conhecimento e grau de gravidade da doença. As características da população foram: 72% mulheres, 63% brancos, 78% com mais de 40 anos, 60% casados, 68% com baixa escolaridade, 41% com renda de 1 a 3 salários, 75% com peso elevado, 76% não fumantes, 89% sem atividade física regular, e das mulheres 48% já tinham usado hormônios anticoncepcionais. A análise evidenciou que a ausência de conhecimento se associou com sexo masculino, idade entre 20 e 40 anos, viúvo, não branco e peso normal. Pressão arterial mais elevada (diastólica> 110 mm Hg) se associou com mais de 60 anos, não casado, acima do peso, baixa escolaridade, baixa renda, com mais de 5 anos de hipertensão e já ter feito tratamento anterior.

We interviewed 205 hypertensives to characterize social demographic data, life style, history and awareness of hypertension. Most patients were female (72%), white (63%), over 40 years old (78%), married (60%), and had low level of education (68%). Their family income was lower than US$ 3000 a year (41%). In terms of weight, 75% were classified as overweight, 76% were non smoker, and 89% did not do any regular physical activity. The profile of the hypertensives who were unaware of the disease was: male, 20-40 years old, widow, not white, and non-obese. The profile of the hypertensives who had high level of hypertension (diastólic> 110 mm Hg) was older than 60 years old, not married, overweight, low level of education, low income, with more than 5 years of hypertension, and previously treated.

We interviewed 205 hypertensives to characterize social demographic data, life style, history and awareness of hypertension. Most patients were female (72%), white (63%), over 40 years old (78%), married (60%), and had low level of education (68%). Their family income was lower than US$ 3000 a year (41%). In terms of weight, 75% were classified as overweight, 76% were non smoker, and 89% did not do any regular physical activity. The profile of the hypertensives who were unaware of the disease was: male, 20-40 years old, widow, not white, and non-obese. The profile of the hypertensives who had high level of hypertension (diastólic> 110 mm Hg) was older than 60 years old, not married, overweight, low level of education, low income, with more than 5 years of hypertension, and previously treated.

Foram entrevistados 205 hipertensos em tratamento ambulatorial para avaliar o papel do perfil bio-social no conhecimento e grau de gravidade da doença. As características da população foram: 72% mulheres, 63% brancos, 78% com mais de 40 anos, 60% casados, 68% com baixa escolaridade, 41% com renda de 1 a 3 salários, 75% com peso elevado, 76% não fumantes, 89% sem atividade física regular, e das mulheres 48% já tinham usado hormônios anticoncepcionais. A análise evidenciou que a ausência de conhecimento se associou com sexo masculino, idade entre 20 e 40 anos, viúvo, não branco e peso normal. Pressão arterial mais elevada (diastólica> 110 mm Hg) se associou com mais de 60 anos, não casado, acima do peso, baixa escolaridade, baixa renda, com mais de 5 anos de hipertensão e já ter feito tratamento anterior.

OBJECTIVE: To evaluate the influence of the siesta in ambulatory blood pressure (BP) monitoring and in cardiac structure parameters. METHODS: 1940 ambulatory arterial blood pressure monitoring tests were analyzed (Spacelabs 90207, 15/15 minutes from 7:00 to 22:00 hours and 20/20 minutes from 22:01 to 6.59hours) and 21% of the records indicated that the person had taken a siesta (263 woman, 52±14 years). The average duration of the siesta was 118±58 minutes. RESULTS: (average ± standard deviation) The average of systolic/diastolic pressures during wakefulness, including the napping period, was less than the average for the period not including the siesta (138±16/85±11 vs 139±16/86±11 mmHg, p<0.05); 2) pressure loads during wakefulness including the siesta, were less than those observed without the siesta); 3) the averages of nocturnal sleep blood pressures were similar to those of the siesta, 4) nocturnal sleep pressure drops were similar to those in the siesta including wakefulness with and without the siesta; 5) the averages of BP in men were higher (p<0.05) during wakefulness with and without the siesta, during the siesta and nocturnal sleep in relation to the average obtained in women; 6) patients with a reduction of 0- 5% during the siesta had thickening of the interventricular septum and a larger posterior wall than those with a reduction during the siesta >5%. CONCLUSION: The siesta influenced the heart structure parameters and from a statistical point of view the average of systolic and diastolic pressures and the respective pressure loads of the wakeful period.

OBJETIVO: Avaliar a eficácia terapêutica do verapamil COER-24 180/240 mg, em dose única, ao deitar, como monoterapia para a hipertensão arterial leve a moderada. MÉTODOS: Estudo multicêntrico, aberto, não comparativo com 81 pacientes de ambos os sexos, com idade >20 anos e hipertensão arterial essencial leve e moderada. Medimos a pressão arterial no consultório e com a monitorização ambulatorial (MAPA) durante 24h antes e ao final de 8 semanas do uso da medicação. RESULTADOS: Verificou-se diminuição (p<0,0001) das pressões sistólicas e diastólicas medidas no consultório às semanas 3 e 8. A MAPA demonstrou que tanto a pressão sistólica, diastólica, média e freqüência cardíaca, quando as cargas pressóricas médias de 24h apresentaram reduções após 8 semanas de tratamento, além da redução do duplo-produto, especialmente pela manhã. A tolerabilidade foi boa, 68% dos pacientes não apresentaram eventos adversos. CONCLUSÃO: A monoterapia com o verapamil COER-24 180/240mg em dose única é eficaz para o controle da pressão arterial em hipertensos leves e moderados, com redução tanto na pressão casual quanto na MAPA/24h, além de apresentar boa tolerabilidade.

OBJECTIVE: To evaluate the anti-hypertensive effecft of verapamil COER-24 180/240 mg in a single dose at bedtime as single therapy in mild to moderate hypertensives. METHODS: A multicentric, open, placebo controlled study of 81 hypertensive patients older than 20 years-old followed to 8 weeks. Blood pressure was measured in doctor's office and by 24h ambulatory monitoring (ABPM). RESULTS: We observed a decreased in systolic and diastolic blood pressure in doctor's office at 4th and 8th weeks. ABPM showed that both systolic, diastolic and mean blood pressure, heart rate and the mean 24-hour blood pressure load decreased after the 8-week treatment. In addition, there was a reduction of the double-product, especially in the morning and 68% of the patients didn't have any adverse events. CONCLUSION: The theraphy verapamil COER-24 180/240mg in a single dose is useful for mild and moderate hypertensive patients, with significant pressure decrease in both office blood pressure measurements and in the ABPM/24 hours, as well as showing good tolerability.