7th Brazilian Guideline of Arterial Hypertension: Chapter 3 - Clinical and Complementary Assessment

A RELAÇÃO ENTRE HIPERTENSÃO ARTERIAL, ANSIEDADE E ESTRESSE: UMA REVISÃO INTEGRATIVA DA LITERATURA

  Este estudo teve por objetivo realizar uma revisão integrativa de literaturapara verificar o que os estudos têm abordado sobre a relação entre estresse e ansiedade em pessoas hipertensas. Para tanto, o levantamento dos estudos foi realizado nas bases PsycINFO, Portal da Capes, Scielo e Medline BVS-PSI, utilizando os descritores ‘hipertensão arterial’ and ‘estresse’ and ‘ansiedade’, e seus correspondentes na língua inglesa ‘arterial hypertension’ and ‘stress’ and ‘anxiety’ e espanhola ‘hipertensión’and ‘estrés’ and ‘ansiedad’, considerando os últimos seis anos (2013 a 2018). Foram selecionados 14 estudos. Os resultados foram agrupados em três categorias: a) o impacto causado pelo diagnóstico de doenças crônicas não transmissíveis, b) fatores psicológicos associados à hipertensão arterial e c)relação saúde física versus saúde mental: uma questão também de método. Os resultados mostraram que ansiedade e estresse, além da depressão podem apresentar-se como aspectos moduladores da hipertensão arterial. Portanto, considera-se necessária a desmistificação da lógica cartesiana entre mente e corpo, para que sejam efetivadas ações de cuidado integral dos sujeitos e de promoção à saúde. Espera-se que os resultados obtidos reafirmem a importância de considerar os aspectos psicológicos e emocionais nas doenças crônicas e que estudos futuros com diferentes delineamentos sejam desenvolvidos na área da psicologia.

Evaluation of the Post-Training Hypotensor Effect in Paralympic and Conventional Powerlifting

High blood pressure (HBP) has been associated with several complications and causes of death. The objective of the study was to analyze the hemodynamic responses in Paralympic bench press powerlifting (PP) and conventional powerlifting (CP) before and after training and up to 60 minutes (min) after training. Ten PP and 10 CP athletes performed five sets of five repetition maximal bench press exercises, and we evaluated systolic, diastolic, and mean blood pressure (SBP, DBP, and MBP, respectively), heart rate (HR), heart pressure product (HPP), and myocardial oxygen volume (MVO2). The SBP increased after training (p < 0.001), and there were differences in the post training and 30, 40, and 60 min later (p = 0.021), between 10 and 40 min after training (p = 0.031, η2p = 0.570), and between CP and PP (p =0.028, η2p = 0.570). In the MBP, there were differences between before and after (p = 0.016) and 40 min later (p = 0.040, η2p = 0.309). In the HR, there was a difference between before and after, and 5 and 10 min later (p = 0.002), and between after and 10, 20, 30, 40, 50, and 60 min later (p < 0.001, η2p = 0.767). In HPP and MVO2, there were differences between before and after (p = 0.006), and between after and 5, 10, 20, 30, 40, 50, and 60 min later (p < 0.001, η2p = 0.816). In CP and PP, there is no risk of hemodynamic overload to athletes, considering the results of the HPP, and training promotes a moderate hypotensive effect, with blood pressure adaptation after and 60 min after exercise.

Cut-Off Points of Visceral Adipose Tissue Associated with Metabolic Syndrome in Military Men

Visceral adipose tissue (VAT) has high metabolic activity and secretes a larger number of adipokines that are related to the inflammatory process. Quantifying VAT could estimate the risk of developing Metabolic Syndrome (MetS). This study was designed to determine the VAT cut-off points assessed by DXA associated with MetS in military men. In total, 270 (37.5 ± 6.9 years) military men from the Brazilian Army (BA) participated in the study. Anthropometric measurements, assessment of body composition by dual X-ray absorptiometry (DXA), hemodynamics and biochemical tests were performed. The Student’s t test, independent samples, Person’s correlation, ROC curve, Youden Index and positive (PPV) and negative predictive value (NPV) were used. The MetS prevalence was 27.4%, which means that 74 (38.0 ± 7.3 years) military men had at least three risk factors of MetS present. The cutoff point of VAT with the highest balance between sensitivity (77.0%) and specificity (69.9%) was 1025.0 cm³ (1086.0 g). An area on the ROC curve was 0.801 (p < 0.000), which was very good precision. VAT ≥ 1025.0 cm³ (1086.0 g) is associated with the risk factors of MetS and is, therefore, a predictor of the disease with good indicators of sensitivity and specificity and a robust indicator of MetS.

Vitamin D in the Preoperative and Postoperative Periods of Bariatric Surgery

OBJECTIVE

To evaluate the evolution of vitamin D levels (25OHD) in patients submitted to bariatric surgery.

METHODS

Retrospective study, conducted with patients submitted to bariatric surgery between 2013 and 2018, in a city in the Northeast of Brazil. The variations of 25OHD, weight, body mass index (BMI), and total lymphocyte count were analyzed and compared for preoperative and postoperative periods of 6 and 12 months. Vitamin D levels below 30ng/mL were considered insufficient. Analysis of variance (ANOVA) was used for repeated measures, followed by Bonferroni post hoc test. To identify variables related to vitamin D, Pearson's correlation test and linear regression analysis were used. A significance level of 5% (p <0.05) was adopted.

RESULTS

A total of 646 patients were evaluated, with a mean age of 41.3 ± 10.8 years. Most of the patients were female (75%) and had 25OHD insufficiency in the preoperative period (79.1%). It was found that in the postoperative period there was an increase in vitamin D levels. Linear regression showed that the variation in vitamin D is negatively influenced by BMI in the preoperative period (β = -0.20; p = 0.02) and by BMI (β = -0.38; p <0.001) and by age (β = -0.08; p = 0.02) in the 6-month postoperative period.

CONCLUSION

There was an increase in vitamin D levels in the postoperative period. BMI proved to be a negative factor for obtaining adequate levels of vitamin D in the preoperative period and in the 6-month postoperative period.

Acute effects of body-weight resistance exercises on blood pressure and glycemia in middle-aged adults with hypertension

OBJECTIVE

The purpose of the present study was to evaluate the acute effects of single session of body-weight resistance exercises on blood pressure (BP) and glycemia in middle-aged adults with hypertension.

METHODS

Twenty-three participants took part in this trial with crossover design and performed two experimental sessions in a random order: Body-weight resistance exercise session (BWR) and a control session without exercise. BWR was composed of four exercises: inverted row, squat, , and sit-ups. The participants performed 3 sets of 30 s, in which they were instructed to perform as much repetitions as possible and as fast as possible. After each session, BP and glycemia were measured continuously for 60 min.

RESULTS

Systolic BP decreased after BWR when compared with control at post 45': -7 (95%CI:-11 to -2) mmHg, p = .003 and post60': -7 (95%CI:-12 to -3) mmHg, p = .003. Diastolic BP decreased after BWR when compared with control at post 15': -6 (95%CI:-9 to -3) mmHg, p < .001; post 30': -6 (95%CI:-9 to -2) mmHg, p = .001; post45': -5 (95%CI:-9 to -2) mmHg, p = .005; and post60': -6 (95%CI: -8 to -3) mmHg, p < .001. No significant difference was found in glycemia between BWR and control sessions.

CONCLUSION

BWR acutely reduces BP in middle-aged adults with hypertension without effects on usual glycemia responses. This alternative form of resistance training could facilitate access, adherence, and reduce health costs related to exercise programs.

Renal sympathetic denervation for resistant hypertension: where do we stand after more than a decade

Despite the current availability of safe and efficient drugs for treating hypertension, a substantial number of patients are drug-resistant hypertensives. Aiming this condition, a relatively new approach named catheter-based renal denervation was developed. We have now a clinically relevant time window to review the efficacy of renal denervation for treating this form of hypertension. This short review addresses the physiological contribution of renal sympathetic nerves for blood pressure control and discusses the pros and cons of renal denervation procedure for the treatment of resistant hypertension.

Early consumption of high-fat diet worsens renal damage in spontaneously hypertensive rats in adulthood

The association between hypertension and obesity has been shown to be an important cause of kidney disease. We aimed to investigate the impact of a high-fat diet (HFD) administered in spontaneously hypertensive rats (SHR) after weaning in renal morphology and functional parameters. Male post-weaned SHR were divided into two groups: standard control diet (CD) (3% lipids; n = 8) or HFD (30% lipids; n = 8) during 8 weeks. The group HFD showed an increase in serum triglycerides (HFD: 96 ± 7 vs. CD: 33 ± 2 mg/dL) and glucose intolerance (HFD: 185 ± 7 vs. CD: 149 ± 4 mg/dL/min). Moreover, the HFD also showed an increase in almost 90% of the periepididymal and retroperitoneal adiposity. There was no difference in arterial blood pressure between groups. Renal morphofunctional parameters were decreased in HFD group for glomerular tuft area and diameter (4733 ± 65 µm² and 82 ± 1 µm, respectively) when compared with CD group (5289 ± 171 µm² and 88 ± 2 µm, respectively). HFD also showed a decrease of 50% of the renal function, which was associated with higher renal extracellular matrix and lipid deposition. Therefore, our data suggest that HFD since early period of life may contribute to renal damage in adults with hypertension, and this impairment can be associated with increased renal lipid accumulation.

Evaluating the performance of automated sphygmomanometers using a patient simulator

BACKGROUND AND OBJECTIVE

Automated sphygmomanometers use the oscillometric method to measure blood pressure, which is based on an algorithm that relates the amplitude of the oscillometric waveform pulses and the pressure inside the cuff. Validation uses empirical information from clinical trials conducted by each manufacturer. Consequently, measurement algorithms are not harmonized, being based on distinct arterial waveforms, according to each group of volunteers of the clinical test. In the present study, a patient simulator was used to generate standardized, consistent oscillometric waveform pulses to test the algorithms used in six sphygmomanometers.

MATERIALS AND METHODS

Six different upper arm and wrist-based automated sphygmomanometers were tested using a patient simulator comprising four different blood pressure levels, Psys/dia (mmHg): 80/50; 120/80; 150/100; 200/150. The devices were also submitted to conformity assessment. The variance of repeatable measurements was also analyzed.

RESULTS

All tested automated sphygmomanometers complied with metrological requirements, presenting results within the range of ±2 mmHg for static calibration. Systematic discrepancies, greater than 20 mmHg, were observed between sphygmomanometers' results from upper arm and wrist-based models. Differences reaching 12.8 mmHg in diastolic pressure results were observed among upper arm devices.

CONCLUSION

These results may have a clinical impact and indicate the need for a standardized algorithm, with a harmonized approach for validation. Moreover, the algorithm of the wrist-based devices is being affected by the use of the brachial artery waveform as reference for its validation, which also reveals that the current approach needs standardization, especially regarding the use of patient simulators.24299305.

Effects of the Order of Physical Exercises on Body Composition, Physical Fitness, and Cardiometabolic Risk in Adolescents Participating in an Interdisciplinary Program Focusing on the Treatment of Obesity

The main objective of this study was to investigate the effects of the order of physical exercises on body composition, physical fitness, and cardiometabolic risk in adolescents participating in an interdisciplinary program focusing on the treatment of obesity. The final 12-week analyses involved 33 female adolescents who were split into two groups of concurrent training (CT): resistance plus aerobic training and aerobic plus resistance training, with equalization performed in all physical exercises. The only difference between the two groups was the order in which the exercises were performed. The results showed reductions in fat mass, body fat, and waist circumference, as well as increases in musculoskeletal mass and resting metabolic rate (p < 0.05) following the multiprofessional intervention period. However, no significant differences were observed in regard to body mass, body mass index, neck circumference, or arm circumference (p > 0.05). Maximal isometric strength and maximal oxygen consumption showed significant increases after the intervention period (p < 0.05). There were reductions in insulin, HOMA-IR, total cholesterol, triglycerides, and low-density lipoproteins (p < 0.05), and an interaction within the resistance plus aerobic training group showed lower values for triglycerides when compared to itself (p = 0.002). No difference was found in fasting glycemia for either group (p > 0.05). It is worth noting that the equalization training variables presented no differences between the two groups (p > 0.05). Based on these results, both CT methods were found to be effective in promoting health parameters in overweight and obese female adolescents, and triglyceride values decreased more in the resistance plus aerobic group. Future studies with larger samples and feeding control should be conducted to confirm or refute our findings.