Quality of Life on Arterial Hypertension: Validity of Known Groups of
					MINICHAL

Soutello, Ana Lúcia Soares; Rodrigues, Roberta Cunha Matheus; Jannuzzi, Fernanda Freire; São-João, Thaís Moreira; Martinix, Gabriela Giordano; Nadruz Jr., Wilson; Gallani, Maria-Cecília Bueno Jayme

doi:10.5935/abc.20150009

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Original Articles • Arq. Bras. Cardiol. 104 (04) • Apr 2015 • https://doi.org/10.5935/abc.20150009 copy

Quality of Life on Arterial Hypertension: Validity of Known Groups of MINICHAL

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introductions:

In the care of hypertension, it is important that health professionals possess available tools that allow evaluating the impairment of the health-related quality of life, according to the severity of hypertension and the risk for cardiovascular events. Among the instruments developed for the assessment of health-related quality of life, there is the Mini-Cuestionario of Calidad de Vida en la Hipertensión Arterial (MINICHAL) recently adapted to the Brazilian culture.

Objective:

To estimate the validity of known groups of the Brazilian version of the MINICHAL regarding the classification of risk for cardiovascular events, symptoms, severity of dyspnea and target-organ damage.

Methods:

Data of 200 hypertensive outpatients concerning sociodemographic and clinical information and health-related quality of life were gathered by consulting the medical charts and the application of the Brazilian version of MINICHAL. The Mann-Whitney test was used to compare health-related quality of life in relation to symptoms and target-organ damage. The Kruskal-Wallis test and ANOVA with ranks transformation were used to compare health-related quality of life in relation to the classification of risk for cardiovascular events and intensity of dyspnea, respectively.

Results:

The MINICHAL was able to discriminate health-related quality of life in relation to symptoms and kidney damage, but did not discriminate health-related quality of life in relation to the classification of risk for cardiovascular events.

Conclusion:

The Brazilian version of the MINICHAL is a questionnaire capable of discriminating differences on the health‑related quality of life regarding dyspnea, chest pain, palpitation, lipothymy, cephalea and renal damage.

Hypertensions; Quality of Life; Validation Studies; Clinical Trial; Psychometry; Questionnaires

Sociodemographic variables	n	%	Mean (SD)	Median	Variation
Age (years)	200		57 (11.3)	57	21-82
Female gender	116	58.0
Caucasian	129	64.5
Level of education (years)			6 (4.1)	4	0-16
Marital status with partner	123	61.5
Employment status (n = 198)
Inactive	81	40.5
Active	76	38.0
Housewife	42	21.0
*Income, MW^ * MW in the period of data collection was R$465.00 (US$265.71). MW: minimum wage; SD: standard deviation.**
Monthly Personal income	199		1.6 (1.5)	1.29	0.0-8.6
Monthly family income	197		3.2 (2.1)	2.58	0.0-12.9

Clinical variables	n	%	Mean (SD)	Median	Variation
Time of arterial hypertension (years)	198		12.6 (10.5)	10	1-53
Associated risk factors/clinical conditions
Dyslipidemia	133	66.5
Abdominal obesity (WC^* * WC > 102 cm for men and > 88 cm for women; )	132	66.0
Family history of cardiovascular disease	117	58.5
Obesity (BMI^† † BMI > 30 kg/m2; )	90	45.0
Metabolic syndrome	82	41.0
Glucose intolerance^¶ ¶ blood glucose between 102-125 mg/dL;	55	27.5
Diabetes mellitus	32	16.2
Hyperuricemia^§ § uric acid > 7 mg/dL for men and > 6.5 mg/dL for women;	31	15.5
Current cigarette smoking	21	10.5
Number of associated clinical conditions			3.1 (1.7)	3	0-7
Acute coronary syndrome and/or myocardial revascularization	26	13.0
Heart failure	12	6.0
Stroke/transient ischemia	10	5.0
Peripheral artery disease	6	3.0
Target organ damage
LVH^‡ ‡ LVH ≥ 125 g/m2 ffor men and ≥ 110 g/m2 for women;	85	42.5
Diastolic dysfunction	80	40.0
Hypertensive renal damage^†† †† hypertensive renal damage: creatinine clearance ≤ 60 mL/minute and/or serum creatinine > 1.5 mg/dL for men and > 1.4 mg/dL for women and/or microalbuminuria > 300 mg/24 hours;	21	10.5
Hypertensive retinopathy^¶¶ ¶¶ hypertensive retinopathy: arteriolar narrowing and light reflex changes (grade 1); arteriolar narrowing and more marked reflex changes and arteriovenous nicking (grade 2); grade 2 changes, retinal hemorrhages and exudates (grade 3); or grade 3 changes and papilledema (grade 4) on fundoscopy;	21	10.5
Carotid thickening^§§ §§ intima-media > 0.9 mm;	6	3.0
Symptoms
Headache	94	47.0
Palpitations	71	35.5
Lipotimia	57	28.5
Dyspnea	57	28.5
Chest pain	54	27.0
Number of associated symptoms			2.1 (1.6)	2	0-6
Number of medications used			3.6 (2.4)	3	0-11
Risk stratification for cardiovascular events^‡‡ ‡‡ according to the European Society of Hypertension/European Society of Cardiology Guidelines7. SD: standard deviation; WC: waist circumference; BMI: body mass index; LVH: left ventricular hypertrophy.
No risk	33	16.5
Low risk	29	14.5
Moderate risk	37	18.5
High risk	65	32.5
Very high risk	36	18.0

		Domains of the Brazilian version of MINICHAL
			Mental Status	Somatic Manifestations	Total score
		n	Mean (SD)	Mean (SD)	Mean (SD)
LVH^† † left ventricular hypertrophy: ventricular mass/body surface ≥ 125 g/m2 for men and ≥ 110 g/m2 for women;	Yes	85	6.3 (5.3)	3.3 (2.6)	9.6 (6.8)
	No	115	7.0 (5.5)	3.5 (2.7)	10.5 (7.2)
	P value^* * Mann-Whitney test;		NS	NS	NS
Hypertensive retinopathy^¶ ¶ hypertensive retinopathy: presence of arteriolar narrowing and venous dilatation (type 1); arteries with spasms and pathological arteriovenous nicking (type 2); obvious arterial narrowing and irregularities, flame-shaped hemorrhage or cotton-wool spots (type 3); or papilledema associated with types 1, 2 and 3 (type 4) on fundoscopy;	Yes	21	6.2 (4.3)	3.9 (3.1)	10.1 (6.9)
	No	179	6.8 (5.6)	3.4 (2.6)	10.1 (7.0)
	P value^* * Mann-Whitney test;		NS	NS	NS
Renal damage^§ § renal damage: creatinine clearance ≤ 60mL/minute or serum creatinine > 1.5 mg/dL for men and > 1.4 mg/dL for women or microalbuminúria > 300 mg/24 hours;	Yes	21	7.7 (4.5)	4.8 (3.2)	12.5 (5.9)
	No	179	6.6 (5.5)	3.3 (2.5)	9.9 (7.1)
	P value^* * Mann-Whitney test;		NS	< 0.05	< 0.05
Diastolic function^‡ ‡ diastolic dysfunction: retrieved from Doppler echocardiogram report. SD: standard deviation; NS: not significant; LVH: left ventricular hypertrophy.	Yes	80	6.7 (5.9)	3.4 (2.7)	10.1 (7.5)
	No	83	6.9 (4.7)	3.7 (2.6)	10.7 (6.2)
	P value^* * Mann-Whitney test;		NS	NS	NS
Dyspnea	Yes	57	8.9(6.9)	4.9 (2.9)	13.9 (8.6)
	No	143	5.8 (4.5)	2.8 (2.3)	8.7 (5.7)
	P value^* * Mann-Whitney test;		< 0.01	< 0.001	< 0.001
Chest pain	Yes	54	9.2 (6.7)	5.3 (3.0 )	14.5 (7.9)
	No	146	5.8 (4.6)	2.7 (2.1)	8.5(5.9)
	P value^* * Mann-Whitney test;		< 0.001	< 0.001	< 0.001
Presyncope	Yes	57	8.0 (5.9)	4.0 (2.5)	12 (7.3)
	No	143	6.2 (5.2)	3.2 (2.7)	9.4 (6.8)
	P value^* * Mann-Whitney test;		< 0.05	< 0.05	< 0.05
Palpitations	Yes	71	9.0 (6.6)	4.9 (3.0)	13.9 (8.1)
	No	129	5.4 (4.2)	2.6 (2.0)	8.1 (5.4)
	P value^* * Mann-Whitney test;		< 0.001	< 0.001	< 0.001
Headache	Yes	94	8.2 (5.7)	4.0 (2.7)	12.2 (7.2)
	No	106	5.4 (4.9)	2.9 (2.5)	8.3 (6.4)
	P value^* * Mann-Whitney test;		< 0.001	< 0.01	< 0.001

		Domains of the Brazilian version of MINICHAL
		Mental Status		Somatic manifestations		Total score
	n	Mean (SD)	p value^* * ANOVA with rank transformation, followed by Tukey test:	Mean (SD)	p value	Mean (SD)	p value
Grade 0 – no dyspnea	145	5.8 (4.6)	< 0.01^† † degree 0 ≠ degree 5;	2.8 (2.3)	< 0.001^¶ ¶ degrees 3, 4, 5 ≠ 0;	8.7 (5.8)	< 0.001^§ § degrees 4, 5 ≠ 0.
Grade 1 – breathlessness on strenuous exercise	9	8.3 (10.0)		2.9 (2.5)		11.2 (12.3)
Grade 2 – breathlessness hurrying on the level or up a light hill	18	7.9 (5.7)		4.5 (2.8)		12.4 (7.0)
Grade 3 – Walks slower than people of the same age because of breathlessness or has to stop for breath even when walking at his/her own pace	6	10.0 (5.3)		6.7 (3.0)		16.7 (7.4)
Grade 4 – Has to stop for breath after walkin less than 100 m or after a few minutes	12	9.9 (7.3)		5.7 (3.0)		15.6 (9.4)
Grade 5 – Breathlessness prevents from leaving the house or when dressing	10	10.3 (5.7)		6.0 (2.7)		16.3 (15.2)

		Domains of the Brazilian version of MINICHAL
		Mental Status		Somatic manifestations		Total score
	n	Mean (SD)	p value^* * Kruskal-Wallis test;	Mean (SD)	p value	Mean (SD)	p value
Cardiovascular risk stratification ^† † European Society of Hypertension/European Society of Cardiology Guidelines7;
No additional risk	33	7.3 (6.8)	NS	3.4 (2.5)	NS	10.7 (8.5)	NS
Low risk	29	6.1 (5.0)		2.9 (2.5)		9.0 (6.6)
Moderate risk	37	7.1 (6.0)		3.3 (2.1)		10.4 (7.5)
High risk	65	6.8 (5.1)		3.6 (2.8)		10.3 (6.6)
Very high risk	36	6.1 (4.5)		3.9 (3.0)		10.0 (6.4)
Cardiovascular risk stratification ^¶ ¶ Clustered cardiovascular risk stratification. SD: standard deviation; NS: not significant.
No/ low and/ or moderate risk	99	6.9 (6.0)	NS	3.2 (2.4)	NS	10.1 (7.6)	NS
High/ very high risk	101	6.5 (4.9)		3.7 (2.9)		10.2 (6.5)

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