Made available in DSpace on 2014-06-11T19:29:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2001Bitstream added on 2014-06-13T18:39:19Z : No. of bitstreams: 1 duarte_mtc_me_botfm.pdf: 367548 bytes, checksum: 0bc9456e76ceee8e0aa601ea2566a701 (MD5) / Objetivou-se, com este trabalho, identificar o abandono do seguimento médico em uma coorte de pacientes inscritos, em 1995, no atendimento ao hipertenso do Centro de Saúde-Escola (CSE) de Botucatu, no período de 1995 a 1999, e analisar os motivos de abandono do tratamento da hipertensão arterial relatados por esses pacientes. Estudaram-se 192 pacientes hipertensos, que compõem a coorte, tendo sido identificados, nesta, três grupos: grupo abandono (GAB), composto por 89 pacientes; grupo abandono-aderente (GAB/AD), composto por 41 pacientes, e grupo aderente (GAD), composto por 62 pacientes. A taxa de abandono observada foi de 46,4% e a de aderência de 53,6%. Os grupos foram caracterizados segundo as variáveis: sociodemográficas, relacionadas ao seguimento e tratamento no serviço de saúde, e doenças crônicas associadas. Na segunda parte do estudo, foram entrevistados 50 pacientes do GAB. A análise temática de conteúdo foi a técnica utilizada para tratamento das respostas dos entrevistados. A pesquisa indicou que a taxa de abandono do seguimento médico no CSE não pode ser generalizada como taxa de abandono de seguimento médico ou, ainda, como de abandono do tratamento da hipertensão, uma vez que se observou que mais da metade dos pacientes entrevistados estavam em acompanhamento médico para tratamento da hipertensão arterial em outros serviços de saúde e relataram diversas formas de cumprimento do tratamento medicamentoso e não-medicamentoso. Os motivos para o abandono do tratamento da hipertensão — considerando em separado os seus componentes... / The aim of this research is to identify the hypertension treatment dropout in a cohort assisted at a School Health Center (SHC), in Botucatu, from 1995 to 1999. This cohort (192 patients) was divided in to three groups: Dropout group – DG – (89 patients), dropout-compliant group – DCG – (41 patients) and compliant group – CG – (62 patients). The dropout rate was 46,4% and the compliance rate was 53,6%. The groups were studied according to these variables: socio-demographic, health service treatment and follow-up and chronic diseases comorbidity. Fifty DG patients were interviewed. Their answer were analyzed by content analysis. As more than half of the patients interviewed were being assisted at other health services the dropout rate at the SHC can not be considered as a treatment dropout. The causes of dropout - patient related problems, lack of symptons, better or normal arterial pressure, alcohol consumption – were the same if one considers each dropout component (medical treatment, changes in life style and health services follow-up) separetely. The lack of information about the medication and its side effects can be regarded as the main dropout causes of medical treatment. Moreover, it was observed that some health service features played an important rule in medical follow-up dropout.

Orientador: Henrique Luiz Monteiro / Banca: Luiz Carlos Marques Vanderlei / Banca: Alberto de Vitta / Resumo: A presente pesquisa destinou-se a investigar as associações entre o nível de atividade física (NAF) de diferentes categorias, de pacientes hipertensos em tratamento farmacológico, com variáveis antropométricas e ocorrência de comorbidades. A pesquisa foi realizada na cidade de Bauru, junto aos Núcleos de Saúde "Otávio Rasi" e "Vila Cardia". Foram avaliados 192 pacientes, com média de idade de 63 ± 11 anos. As medidas de massa corporal total, estatura (cálculo do IMC= Kg/m²) e circunferência de cintura (CC) foram empregadas como indicadores de estado nutricional e risco coronariano. A estimativa do NAF foi realizada aplicando-se questionário de Baecke et al.,(90), e, após computados os escores para cada categoria de atividade física (ocupacional=AFO; tempo livre=AFTL; locomoção=AFL). Utilizando-se o valor médio do escore como ponto de corte para divisão dos grupos (ativo e sedentário) em cada categoria de atividade física. As comorbidades associadas foram identificadas aplicando-se um inquérito fechado de morbidade referida. Para a análise estatística aplicou-se o teste T de Student para dados não pareados nas comparações entre ativos e sedentários; o teste Qui-quadrado para comparação de proporções, e o teste de correlação de Pearson foi empregado para análise entre variáveis contínuas... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This study aimed to investigate the associations of physical activity in different categories of hypertensive patients treated with drug therapy, anthropometric variables and comorbidities. The survey was conducted in Bauru city, in collaboration with the Centers for Health "Otavio Rasi" and "Vila Cardia" that are served by project linked to Unesp. We evaluated 192 patients with a mean age of 63,1 ± 11,05 years. Height and waist circumference were measured for total body mass, and used as indicators of nutritional status and coronary risk. The estimated level of physical activity was performed by applying the Baecke et al.,(90) questionnaire and, after counting the scores for categories of physical activity (OC= occupational; LTPA= Leisure-time; = LPA= locomotion) patients were divided into sedentary (SED) and physically active (PA) in each class studied, using the mean score as the cutoff point to divide the groups. Comorbidities were identified applying the morbidity inquiry. Both surveys were administered through interviews. Statistical analysis was made by Student t-test for unpaired comparisons between active and sedentary; chi-square test was used to compare proportions and to assess the association between the independent variables, one-way ANOVA was used in comparisons between two or more variables. Results show the prevalence of individuals of white, low education and AFLT with the highest score... (Complete abstract click electronic access below) / Mestre

1. In these studies the role of the sympathetic nervous system (SNS) has been investigated in two models of renovascular hypertension in the rat and after surgical reversal. 2. Plasma noradrenaline (NA), heart rate and blood pressure (BP) were measured simultaneously in conscious rats with one-kidney, one-clip (1K1C) (4-6 weeks) and two-kidney, one-clip (2K1C) (4-6 and >16 weeks) hypertension, and parallel loose clip controls, before and 48 hours after unclipping. BP in all hypertensive groups fell to normal after unclipping. 3. Plasma NA was elevated in 1K1C hypertension and fell on unclipping. Conversely, in early 2K1C hypertension plasma NA was unaltered before and rose after unclipping. Plasma NA did not change with unclipping in chronic 2K1C hypertension and was not different from controls. Heart rate showed a similar pattern. Unclipping loose clip control rats produced no change in BP, plasma NA or heart rate. 4. Heart rate was correlated with plasma NA in 1K1C hypertension, and changes in these variables on unclipping were correlated in all three models. BP was only correlated with plasma hypertensive rats. 5. In contrast, renal and cardiac NA levels showed a remarkably similar pattern in 1K1C and 2K1C hypertension of 4-6 weeks duration. Ipsilateral renal NA was reduced in loose clip rats compared to sham-operated controls. This is most likely due to renal denervation during clipping. Hypertension produced a further reduction in ipsilateral renal NA and a reduction in cardiac and contralateral renal (2K1C) NA. 6. It is concluded that the SNS may have a minor role in 1K1C, but not in 2K1C, renovascular hypertension. However, changes in SNS activity upon reversal of hypertension do not explain the BP fall in either model. Changes in renal and cardiac levels of NA in renovascular hypertension are primarily secondary to sustained elevation of BP.

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Orientador: Heitor Moreno Junior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T03:27:07Z (GMT). No. of bitstreams: 1 Barbaro_NataliaRuggeri_M.pdf: 2773445 bytes, checksum: e0d750017009a49d1fe96a9e75554e89 (MD5) Previous issue date: 2013 / Resumo: A inflamação tem sido associada à hipertensão arterial e lesões de órgãos-alvo, sendo que elevados níveis de biomarcadores inflamatórios como a interleucina 6 (IL-6), 10 (IL-10), 1? (IL-1?), fator de necrose tumoral alfa (TNF-?) e a proteína C reativa ultra sensível (PCR-US) têm sido relacionados à doenças cardiovasculares. Estes biomarcadores inflamatórios estão envolvidos na rigidez arterial, um importante fator de risco cardiovascular. De fato, a hipertensão arterial resistente (HAR) possui um prognóstico desfavorável atribuído ao não controle pressórico e a outros fatores de risco associados. Entretanto, ainda não foi estabelecido o perfil dessas citocinas na HAR, também não se conhece o potencial impacto desses biomarcadores inflamatórios na rigidez arterial. Este estudo transversal em 32 pacientes com HAR, 20 com hipertensão de grau leve a moderado (HAS) e 20 normotensos (NT) teve como objetivo avaliar a relação de marcadores inflamatórios com a rigidez arterial em pacientes hipertensos resistentes. Foram avaliadas as medidas de pressão arterial de consultório e rigidez arterial, através da velocidade de onda de pulso (VOP). As concentrações plasmáticas de IL-10, IL-6, IL-1? e TNF-? foram determinadas por ELISA e PCR-US por nefelometria. O teste de Kruskal-Wallis foi utilizado para comparar os níveis de IL-6, TNF- ? e PCR-US, assim como os valores de VOP, enquanto o teste Qui-quadrado foi utilizado para avaliação das variáveis IL-10 (<1,0 and >1,0pg/mL) e IL-1? (<0,012 and >0,012 pg/mL). Análise de regressão linear múltipla foi conduzida para testar se havia associação independente dos marcadores inflamatórios (IL-6, TNF-?, IL-1? e PCR-US) com a VOP. Os grupos não apresentaram diferenças de idade, gênero e IMC. A VOP foi maior nos pacientes HAR (10.5 ± 2.2m/s), seguidos por pacientes HAS (8.7±2.1m/s) e indivíduos NT (7.2± 1.0m/s) (p<0.05). Os níveis de TNF-? (média; (95% CI)) foram significativamente maiores nos grupos HAR: 3,3 (2,19 -4,42pg/mL) e HAS: 3,09 (2,61-3,56) comparados aos NT 1,94 (1,48 - 2,39) (p<0.05), mas não houve diferença entre níveis de IL-6. O grupo de HAR teve maior proporção de sujeitos com níveis elevados de IL-10 (78.1% de IL-10 >1.0 pg/mL) comparados aos HAS (50%) e NT (20%). Além disso, a proporção de pacientes HAR com IL-1? aumentada também foi maior (100%) comparada aos HAS (45%) e NT (25%). Finalmente, apenas a IL-1? foi independentemente associada a VOP (p<0,001; R2= 0,49; ?=0,079). Pacientes HAR apresentaram níveis aumentados de citocinas inflamatórias (TNF-?, IL-1? and IL-10), assim como rigidez arterial. Em adição, a concentração de IL-1? é um fator de risco independente para rigidez arterial / Abstract: Inflammation has been associated with hypertension and target organ damage and increased levels of inflammatory biomarkers such as interleukin-6 (IL-6), 10 (IL-10), 1? (IL-1?), tumor necrosis factor-? (TNF-?) and high sensitive C protein (hs-CRP) have been described in cardiovascular diseases. These inflammatory biomarkers are implicated in arterial stiffness, an important cardiovascular risk factor. Indeed, resistant hypertension (RHTN) leads to unfavorable prognosis attributed to poor blood pressure (BP) control and other cardiovascular risk factors. However, the potential impact of these inflammatory biomarkers on arterial stiffness in RHTN subjects has not been demonstrated. A cross-sectional study was performed in 32 RHTN, 20 mild to moderate hypertensive patients (HTN) and 20 normotensive (NT) subjects. Office BP and arterial stiffness, assessed by pulse wave velocity (PWV) were evaluated. Indeed, IL-10, IL-6, IL-1? and TNF-? were determined by ELISA and hs-CRP by nephelometry. Kruskal-Wallis was used to compare levels of IL-6, TNF- ? and hs-CRP as well as values of PWV, whereas Chi-square was used to evaluated IL-10 (<1.0 and >1.0pg/mL) and IL-1? (<0.012 and >0.012 pg/mL). Multiple linear regression analysis tested the association of inflammatory biomarkers (IL-10, TNF-?, IL-1? and hs-CRP) with PWV. No differences were observed between the 3 groups with respect to age, gender and BMI. PWV was increased in RHTN (10.5 ± 2.2m/s) followed by HTN patients (8.7±2.1m/s) compared to NT individuals (7.2± 1.0m/s) (p<0.05). TNF-? levels (mean; (95% CI)) were significantly higher in RHTN 3.3 (2.19 - 4.42pg/mL) and HTN: 3.09 (2.61-3.56) than NT subjects 1.94 (1.48 - 2.39) (p<0.05) but no differences were observed regarding IL-6 levels. RHTN group had higher frequency of subjects with increased levels of IL-10 (78.1% of IL-10 >1.0 pg/mL) compared with HTN (50%) and NT (20%). Moreover, RHTN had higher frequency of subjects with increased levels of IL-1?(100%) compared to HTN (45% ) and NT (25%). Finally, IL-1? was independently associated to PWV (p<0.001; R2= 0.49; ?=0.079). Taken together, RHTN subjects presented increased levels of inflammatory cytokines (TNF-?, IL-1? and IL-10) as well as of arterial stiffness. In addition, we found that IL-1? levels are an independent risk factor for arterial stiffness / Mestrado / Farmacologia / Mestra em Farmacologia

No description available.

Patient self-monitoring of blood pressure (SMBP) has shown promise in contributing towards improving ongoing management of hypertension, however it has yet to be fully integrated into guidelines or routine general practice in the UK. The aims of this thesis were to investigate the role of SMBP in the management of hypertension to better understand: patient and clinician attitudes to SMBP; what behaviour change SMBP targets in patients to bring about better BP outcomes; to what extent SMBP is utilised as part of routine hypertension management in the UK; and to understand patient preferences for hypertension management in light of effective models of care. A mixed methods approach was used including: systematic reviews of qualitative and quantitative evidence; semi-structured interviews with patients; a cross sectional survey; and a discrete choice experiment. Self-monitoring was associated with better medication adherence, which could have significant impact at a population level given the high proportion of non-adherent hypertensive patients. Use of SMBP should be seen as a continuum from being used solely to inform clinical decisions, through facilitating interaction between patients and clinicians, to empowering patients to be autonomous for example in self-management. SMBP was most effective when patients had the knowledge and skills to make improvements in their lifestyle, and this has been shown in clinical trials and through qualitative investigation. Clinicians recognise the potential benefits of SMBP, but are concerned that patients may become burdened. Clinicians should feel encouraged that patients are supportive of self-monitoring, but they must ensure that patients who wish to self-manage are equipped with the skills to do so. Lack of facility to make positive change may lead some patients to feeling disempowered and clinicians need to be cognisant of this fact.

Dr. J. Torline Dr. S. Sarawan Dr. H. Engelbrecht

M.Tech. / Hypertension or elevated blood pressure is an initiator and promoter of cardiovascular disease and end organ damage. Primary or essential hypertension is an elevated blood pressure due to an unknown or unidentifiable pathology. Secondary hypertension may be caused by underlying pathology or certain medication. Although a number of allopathic drugs are available, hypertension may remain uncontrolled despite lifestyle changes combined with adequate allopathic treatment. This is termed as refractory hypertension. Poor patient compliance, inadequate diuretic therapy, inappropriate drug combinations, and obesity are the leading causes of uncontrolled or refractory hypertension. Crataegus oxyacantha θ is a homoeopathically prepared mother tincture (θ) that has been clinically used to treat hypertension and cardiovascular complaints. However there is insufficient research to confirm its efficacy in the treatment of hypertension. The aim of this study is to ascertain the efficiency of Crataegus oxyacantha θ in the treatment of refractory hypertension in adult males aged between thirty-five and sixty-five years, currently taking allopathic treatment, namely Angiotensin-Converting Enzyme inhibitors combined with a diuretic, and to evaluate the effect of Crataegus oxyacantha Ө on associated symptoms of hypertension. These include headaches; palpitations; vertigo; blurred vision and tinnitus. The study was a placebo controlled double-blinded trial that extended over a period of 12 weeks. Thirty male participants between the ages of thirty-five to sixty-five, that were pre-diagnosed with refractory hypertension for a minimum of two years with a fluctuating blood pressure reading above 150/95 mmHg and currently on allopathic medication i.e. ACE-inhibitor with a combined diuretic were recruited for the study by means of advertisements placed at the University of Johannesburg health clinic, pharmacies and community clinics. Participants were randomly placed in either the experimental or the control group. Participants meeting the inclusion criteria underwent a physical examination and consented to the study (Appendix A). The participants blood pressure was measured on both arms as advised by Milne in the South African hypertensive guidelines 2003 (Annexure A), at the first visit and for two consecutive mornings in order to obtain a baseline reading. He was randomly assigned in either the experimental or the control group. The control group received a 50ml bottle of the 20% alcohol placebo and the experimental group received a 50ml bottle of the homoeopathic remedy, Crataegus oxyacantha θ. He was instructed to take 10 drops in 125ml water twice daily after meals. During the trial period the participant’s blood pressure was assessed every 2 weeks against the measured baseline readings for a period of 12 weeks. The severity of the following symptoms was assessed every 2 weeks, headaches; palpitations; vertigo; blurred vision and tinnitus and other symptoms that he may have experienced. These results were graded and recorded on the progress form (Appendix C). The data obtained from the participants was analysed using descriptive statistics (frequencies and percentages). The blood pressure of the experimental group was compared to the control group as obtained at the first consultation and each of the six follow-up visits. Groups were compared using the Chi-Square test and the Non Parametric Mann Whitney U test. Statistical analysis showed significant differences, P <0.05 for the systolic blood pressure between the experimental and control group. There was a significant decline in the diastolic blood pressure of the experimental and the control group. The diastolic pressure of the control showed a significant decline between day one and week six, however remained constant from week six to week twelve. This implies that the placebo may have provided some benefit towards the lowering of diastolic blood pressure in adult males. The associated symptoms were investigated and the results obtained indicate that headaches and blurred vision remained a constant mild symptom that was experienced throughout the twelve week trial period. Due to the statistical difference between the experimental and the control group in favour of the experimental group, the null hypothesis was rejected. Preliminary findings suggest that Crataegus oxyacantha Ө, is effective in reducing elevated systolic and diastolic blood pressure in adult males with refractory hypertension, however more research over a longer period of time is needed to confirm theses findings.

Class of 2005 Abstract / Objectives: The objectives of this study were to assess the number of antihypertensive prescriptions by therapeutic class including beta-blockers, calcium channel blockers (CCBs), diuretics, angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs), dispensed in the fiscal years 2002 through 2004. Methods: The project was a retrospective analysis of pharmacy data for medications used to treat hypertension from October 2002 through December 2004 (FY02 through the first quarter of FY05). Drug classes used to treat hypertension were obtained from the VA Integrated Service Network 18 (VISN 18). Within the drug classes, only drugs within the class having at least 100 prescriptions were included for the class. Rates of prescriptions dispensed by quarter over the three-year period of interest were obtained. Descriptive statistics were used to compare the before and after ALLHAT and JNC-7 time periods. Results: After the publication of The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), The Australian National Blood Pressure Study 2 (ANBP2), and Joint National Committee (JNC-7) guidelines, dihydropyridine CCB use declined to from 1.80% to 1.65% and non-dihydropyridine CCB use declined from 0.99% to 0.83% of all prescriptions from the first quarter 2002 to the first quarter 2004. In addition, after the publication of ALLHAT, hydrochlorothiazide use increased from 1.42% to 1.83% and ACE-inhibitor use increased from 4.26% to 4.79% of all prescriptions. Implications: The findings have several implications for encouraging our prescribing patterns to follow national guidelines and clinical studies more closely. Health care providers need to accept some responsibility through continuous education to be able to maintain appropriate therapy.