One quarter of any community may have normal (normal/high-normal) as opposed to optimal or hypertensive blood pressures (BP). These individuals may be at risk for a BP-related cardiovascular event, but do not qualify for BP-lowering therapy as those at risk are difficult to identify. In the present thesis I sought to determine whether aspects of non-invasively determined aortic BP may refine BPrelated cardiovascular risk assessment in those with brachial BP values within normotensive ranges. In 1169 participants from a community sample of African ancestry, 319 (27%)

Hypertension is a major cause of morbidity and mortality in communities of African ancestry. The most appropriate method of predicting the risk for blood pressure (BP)-related cardiovascular events is through 24-hour ambulatory BP (ABP) monitoring. Although the cost of monitors precludes the use of 24-hour BP measurement in groups of African descent in Africa, the extent to which BP-related cardiovascular risk may be underestimated by nurse-derived clinic BP measurements, and the current method of BP-related risk assessment in these communities, is uncertain. In this regard, nursederived BP measurement is thought to be superior to other forms of in-office BP measurement. Ambulatory 24-hour, day and night BP (SpaceLabs, model 90207) and nursederived clinic BP (CBP) (mean of 5 values) control rates were determined in 689 randomly selected participants (>16 years) of African ancestry in South Africa. Of the participants 45.7% were hypertensive and 22.6% were receiving antihypertensive medication. More participants had uncontrolled BP at night (34.0%) than during the day (22.6%, p<0.0001). However, uncontrolled CBP was noted in 37.2% of participants, while a much lower proportion had uncontrolled ABP (24.1%)(p<0.0001). These differences were accounted for by a high prevalence of isolated increases in CBP (whitecoat effects)(39.4%). Thus, in communities of African descent, despite a worse BP control at night than during the day, a high prevalence of white-coat effects translates into a striking underestimation of BP control when employing CBP rather than ABP measurements. Nurse-derived BP measurements are often as closely associated with organ damage as ABP. However, the extent to which relationships between nurse-derived BP measurements and organ damage reflect a white-coat effect (isolated increase in inoffice BP) as opposed to the adverse effects of BP per se are unknown. In 750 participants from a community sample, target organ changes were determined from carotid-femoral pulse wave velocity (PWV) (applanation tonometry and SphygmoCor software) (n=662) and left ventricular mass indexed to height2.7 (LVMI) (echocardiography)(n=463). Nurse-derived CBP was associated with organ changes independent of 24-hour BP (LVMI; partial r=0.15, p<0.005, PWV; partial r=0.21, p<0.0001) and day BP. However, in both unadjusted (p<0.0001 for both) and multivariate adjusted models (including adjustments for 24-hour BP)(LVMI; partial r=0.14, p<0.01, PWV; partial r=0.21, p<0.0001) nurse office-day SBP (an index of isolated increases in in-office BP) was associated with target organ changes independent of ambulatory BP and additional confounders. Thus, nurse-elicited whitecoat effects account for a significant proportion of the relationship between nursederived CBP and target organ changes independent of ambulatory BP. Therefore, high quality nurse-derived BP measurements do not approximate the impact of BP effects per se on cardiovascular damage. In 750 participants from a community sample I evaluated whether nurse officeday BP is inversely related to day-night BP (BP dipping) and whether this relationship may in-part explain the independent association between office-day BP and organ damage. Nurse office-day systolic BP (SBP) was correlated with % night/day SBP (r=0.22, p<0.0001) and night SBP (r=0.14, p=0.0001). Although unadjusted and multivariate adjusted (including for day SBP) nurse office-day SBP was associated with LVMI (partial r=0.15, p<0.01) and PWV (partial r=0.22, p<0.0001), neither day-night SBP (LVMI; partial r=-0.01, p=0.88, PWV: partial r=-0.04, p=0.30) nor % night/day SBP (LVMI; partial r=0.01, p=0.91, PWV: partial r=0.04, p=0.37) were independently related to target organ changes. Moreover, the relationships between nurse office-day SBP and target organ changes persisted with adjustments for either day-night SBP (p<0.05- p<0.0001) or night SBP (p<0.01-p=0.0001). Thus, although nurse office-day SBP, an index of an alerting response, is independently associated with an atttenuation of nocturnal decreases in SBP, neither a decreased BP dipping, nor nocturnal BP explain the independent relationship between nurse office-day SBP and target organ changes. Whether nurse office-day BP is affected by antihypertensive therapy, is uncertain. In the present study the effect of antihypertensive therapy on nurse office-day BP was assessed in 173 patients whom, off treatment, had a daytime diastolic BP ranging from 90 to 114 mm Hg. Over the treatment period marked decreases in BP occurred (p<0.0001). However, neither nurse office-day systolic (baseline=16.5±15.8 mm Hg, 4 months=15.3±18.9 mm Hg, p=0.49), nor diastolic (baseline=0.9±9.3 mm Hg, 4 months=4.3±10.7 mm Hg, p<0.005) BP decreased significantly from baseline. Thus, despite producing marked decreases in nurse-derived in-office and out-of-office ambulatory BP, antihypertensive therapy produces no change in nurse-elicited isolated increases in in-office BP (white coat-effects) in a group of African descent. In conclusion, the results of the present thesis indicate that in an urban, developing community of African descent, as compared to 24-hour BP measurements, nurse-derived BP measurements elicit a significant in-office increase in BP which translates into a marked underestimation of BP control at a community level; is strongly associated with organ damage through effects that cannot be attributed to 24-hour BP or to relationships with an attenuated decline in nocturnal BP; and which cannot be treated with antihypertensive therapy. Further work is required to assess the most cost-effective approach to excluding nurse-elicited isolated increases in in-office BP before initiating antihypertensive therapy to groups of African descent.

The purpose of this study was to compare the exercise blood pressure response of subjects with a history of exercise induced hypertension between the submaximal 3-3-3 exercise test and a maximal Bruce treadmill protocol. Seven male and four female subjects with a mean age of 49 ± 2 years were recruited for the study. All subjects were selected based on a previous elevation of exercise diastolic blood pressure >_ 10 mmHg during maximal exercise.The 3-3-3 test is a short, standardized treadmill test protocol that consists of one stage of treadmill walking at a 3% grade, at 3 miles per hour, for 3 minutes. Subjects completed the 3-3-3 test on one day and the Bruce protocol on a different day with 24-48 hours between tests. Test administration order was randomized and all tests were done at the same time of the morning with all blood pressures taken by the same technician with a mercury manometer.The increase in diastolic pressure from rest was significantly lower (p<0.004) during the 3-3-3 protocol compared to the peak of the Bruce protocol. There were no statistical differences between the change in diastolic pressure from rest to peak exercise when the 3-33 protocol was compared to the Bruce Stage I or when the Bruce Stage I was compared to the peak Bruce diastolic measurement. The mean change in diastolic pressure from rest to peak exercise in the3-3-3 protocol was 3.4 ± 2.6 mmHg as compared to 9.9 ± 2.0 mmHg for the Bruce Stage I, and 15.4 ± 2.4 mmHg from rest to peak exercise with the peak Bruce. There were no differences in resting or standing systolic or diastolic blood pressure values between protocols done on separate trial days. The change in systolic response from rest to peak exercise and the peak systolic pressures were significantly different (p<0.001) between the Bruce Stage I and peak Bruce and between the 3-3-3 and peak Bruce. There were no significant differences in the heart rate and rate pressure product between the third minute of the 3-3-3 protocol and the third minute of the Bruce Stage I (p<0.001).The 3-3-3 test was not able to elicit the same rise in diastolic blood pressure as the Bruce treadmill test in this population, although the Bruce Stage I was able to elicit a response that was not statistically different than the response of the peak Bruce protocol. This implies that submaximal treadmill testing may be a feasible method to screen for the presence of an exaggerated diastolic blood pressure response to exercise. / School of Physical Education

Leong Hok Chong. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 87-103). / Abstract also in Chinese. / Chapter 1. --- Abstract --- p.5 / Chapter 2. --- Introduction --- p.8 / Chapter 3. --- Noninvasive Methodology in Pulse Wave Assessment --- p.20 / Chapter 3.1 --- Applanation Tonometry --- p.20 / Chapter 3.2 --- The Instrument: Sphygmocardiograph --- p.20 / Chapter 3.3.0 --- Reproducibility of Sphygmocardiograph --- p.27 / Chapter 3.3.1 --- Background --- p.27 / Chapter 3.3.2 --- Study Aims --- p.28 / Chapter 3.3.3 --- Subjects and Methods --- p.28 / Chapter 3.3.4 --- Statistical Analysis --- p.29 / Chapter 3.3.5 --- Results --- p.31 / Chapter 3.3.6 --- Discussion --- p.35 / Chapter 4. --- Radial Artery-Derived Aortic Augmentation Indexin Normotensive Subjects --- p.36 / Chapter 4.1 --- Background --- p.36 / Chapter 4.2 --- Study Aims --- p.36 / Chapter 4.3 --- Subjects and Methods --- p.38 / Chapter 4.4 --- Statistical Analysis --- p.38 / Chapter 4.5 --- Results --- p.39 / Chapter 4.6 --- Discussion --- p.52 / Chapter 5. --- Changes of Arterial Pulses in Normotensive Subjects with Family History of Hypertension --- p.56 / Chapter 5.1 --- Background --- p.56 / Chapter 5.2 --- Study Aims --- p.58 / Chapter 5.3 --- Subjects and Methods --- p.58 / Chapter 5.4 --- Statistical Analysis --- p.59 / Chapter 5.5 --- Results --- p.59 / Chapter 5.6 --- Discussion --- p.65 / Chapter 6. --- Radial Artery-Derived Aortic Augmentation Indexin Hypertensive Subjects --- p.67 / Chapter 6.1 --- Background --- p.57 / Chapter 6.2 --- Study Aims --- p.68 / Chapter 6.3 --- Subjects and Methods --- p.68 / Chapter 6.4 --- Statistical Analysis --- p.69 / Chapter 6.5 --- Results --- p.69 / Chapter 6.6 --- Discussion --- p.70 / Chapter 7. --- Changes of Arterial Pulses in Antihypertensive Therapies: Comparison between Diuretic and Long-Acting Calcium Antagonist --- p.72 / Chapter 7.1 --- Background --- p.72 / Chapter 7.2 --- Study Aims --- p.73 / Chapter 7.3 --- Subjects and Methods --- p.73 / Chapter 7.4 --- Statistical Analysis --- p.74 / Chapter 7.5 --- Results --- p.74 / Chapter 7.6 --- Discussion --- p.76 / Chapter 8. --- General Remarks and Conclusion --- p.80 / Chapter 9. --- Acknowledgments --- p.86 / Chapter 10. --- References --- p.87

Made available in DSpace on 2014-06-11T19:31:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-04-10Bitstream added on 2014-06-13T19:01:21Z : No. of bitstreams: 1 guandalini_vr_dr_arafcf.pdf: 867277 bytes, checksum: a08a7ab5110fbd3ca2b41b65c69fcacf (MD5) / A hipertensão arterial (HA) e o diabetes mellitus (DM) representam as principais doenças e os principais fatores determinantes do perfil de morbimortalidade no Brasil e no mundo. A Estratégia Saúde da Família (ESF) foi criada com o objetivo de estabelecer ações de promoção em saúde voltadas ao controle e prevenção dos principais fatores de risco para o desenvolvimento de hipertensão e diabetes. O objetivo geral deste trabalho foi avaliar o cuidado em saúde e nutrição dispensado a indivíduos com diabetes mellitus tipo 2 e hipertensão arterial pelas equipes da Saúde da Família (SF), no município de Matão/SP. Foi realizado um estudo do tipo transversal, constituído por análise de prontuário e visita domiciliar para coleta de dados entre usuários por meio da aplicação de questionário. A amostra foi composta por 288 diabéticos e hipertensos atendidos pela ESF, de ambos os sexos, entre 40 e 60 anos de idade. Os resultados mostraram predomínio do sexo feminino (74,0%), idade média de 52,0, cor branca (52,0%), casados ou em união estável (75,0%), com 4 a 7 anos de estudo (38,0%), renda familiar mensal entre 2 a 3 salários mínimos (39,6%), em média com 3 pessoas na casa dependendo desta renda, resultando em renda per capita de 0,66 a 1 salário mínimo. Com relação ao estado nutricional, os homens apresentaram índice de massa corporal (IMC) médio de 29,8 ± 4,70 Kg/m2, no sobrepeso, enquanto as mulheres apresentaram 31,5 ± 6,50 Kg/m2, na obesidade grau I. Ambos os sexos apresentaram aumento da gordura abdominal. A circunferência da cintura (CC) média dos homens foi de 101,7 ± 12,0 cm e 99,5± 14,0 cm das mulheres. A maior prevalência foi de hipertensão arterial (60,0%), com mais de 10 anos de diagnóstico (36,0%). No que se refere às complicações e limitações das atividades de vida diárias, pela presença da... / High blood pressure (H) and diabetes mellitus (DM) are major diseases and the main factors in morbidity and mortality in Brazil and worldwide. The Family Health Strategy (FHS) was created with the goal of establishing health promotion actions aimed at the prevention and control of major risk factors for the development of hypertension and diabetes. The aim of this study was to evaluate the health care and nutrition dispensed to individuals with type 2 diabetes mellitus and hypertension teams of the Family Health (FH) in the municipality of Matão/SP. We conducted a cross-sectional study, consisting of analysis of medical records and home visits to collect data from users through a questionnaire. The sample consisted of 288 diabetic and hypertensive patients by FHS, of both sexes, between 40 and 60 years old. The results showed a predominance of females (74.0%), mean age 52.0, white (52.0%), married or in stable (75.0%), with 4-7 years of study (38.0%), monthly family income between 2-3 minimum wages (39.6%), with an average of 3 people in the house depending on this income, resulting in income per capita from 0.66 to 1 minimum wage. Regarding nutritional status, men were body mass index (BMI) of 29.8 ± 4.70 kg/m2 in overweight, while women had 31.5 ± 6.50 kg/m2, obesity degree I. Both sexes showed increased abdominal fat. Waist circumference (CC) men's average was 101.7 ± 12.0 cm and 99.5 ± 14.0 cm for women. The highest prevalence was hypertension (60.0%), with over 10 years of diagnosis (36.0%). Concerning the complications and limitations of daily living activities, presence of hypertension and/or DM2, the majority said no complications of the disease and / or daily activities have limited by the disease. Considering the dietary intake assessed by the Block Screening Questionnare is Fat and Fruit / Vegetable / Fiber... (Complete abstract click electronic access below)

Orientador: Maria Rita Marques de Oliveira / Banca: Juliana Alvarez Duarte Bonini Campos / Banca: Vera Mariza Henriques de Miranda Costa / Banca: Maria Lucia Teixeira Machado / Banca: Luiza Cristina Godim Domingues Dias / Resumo: A hipertensão arterial (HA) e o diabetes mellitus (DM) representam as principais doenças e os principais fatores determinantes do perfil de morbimortalidade no Brasil e no mundo. A Estratégia Saúde da Família (ESF) foi criada com o objetivo de estabelecer ações de promoção em saúde voltadas ao controle e prevenção dos principais fatores de risco para o desenvolvimento de hipertensão e diabetes. O objetivo geral deste trabalho foi avaliar o cuidado em saúde e nutrição dispensado a indivíduos com diabetes mellitus tipo 2 e hipertensão arterial pelas equipes da Saúde da Família (SF), no município de Matão/SP. Foi realizado um estudo do tipo transversal, constituído por análise de prontuário e visita domiciliar para coleta de dados entre usuários por meio da aplicação de questionário. A amostra foi composta por 288 diabéticos e hipertensos atendidos pela ESF, de ambos os sexos, entre 40 e 60 anos de idade. Os resultados mostraram predomínio do sexo feminino (74,0%), idade média de 52,0, cor branca (52,0%), casados ou em união estável (75,0%), com 4 a 7 anos de estudo (38,0%), renda familiar mensal entre 2 a 3 salários mínimos (39,6%), em média com 3 pessoas na casa dependendo desta renda, resultando em renda per capita de 0,66 a 1 salário mínimo. Com relação ao estado nutricional, os homens apresentaram índice de massa corporal (IMC) médio de 29,8 ± 4,70 Kg/m2, no sobrepeso, enquanto as mulheres apresentaram 31,5 ± 6,50 Kg/m2, na obesidade grau I. Ambos os sexos apresentaram aumento da gordura abdominal. A circunferência da cintura (CC) média dos homens foi de 101,7 ± 12,0 cm e 99,5± 14,0 cm das mulheres. A maior prevalência foi de hipertensão arterial (60,0%), com mais de 10 anos de diagnóstico (36,0%). No que se refere às complicações e limitações das atividades de vida diárias, pela presença da... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: High blood pressure (H) and diabetes mellitus (DM) are major diseases and the main factors in morbidity and mortality in Brazil and worldwide. The Family Health Strategy (FHS) was created with the goal of establishing health promotion actions aimed at the prevention and control of major risk factors for the development of hypertension and diabetes. The aim of this study was to evaluate the health care and nutrition dispensed to individuals with type 2 diabetes mellitus and hypertension teams of the Family Health (FH) in the municipality of Matão/SP. We conducted a cross-sectional study, consisting of analysis of medical records and home visits to collect data from users through a questionnaire. The sample consisted of 288 diabetic and hypertensive patients by FHS, of both sexes, between 40 and 60 years old. The results showed a predominance of females (74.0%), mean age 52.0, white (52.0%), married or in stable (75.0%), with 4-7 years of study (38.0%), monthly family income between 2-3 minimum wages (39.6%), with an average of 3 people in the house depending on this income, resulting in income per capita from 0.66 to 1 minimum wage. Regarding nutritional status, men were body mass index (BMI) of 29.8 ± 4.70 kg/m2 in overweight, while women had 31.5 ± 6.50 kg/m2, obesity degree I. Both sexes showed increased abdominal fat. Waist circumference (CC) men's average was 101.7 ± 12.0 cm and 99.5 ± 14.0 cm for women. The highest prevalence was hypertension (60.0%), with over 10 years of diagnosis (36.0%). Concerning the complications and limitations of daily living activities, presence of hypertension and/or DM2, the majority said no complications of the disease and / or daily activities have limited by the disease. Considering the dietary intake assessed by the Block Screening Questionnare is Fat and Fruit / Vegetable / Fiber... (Complete abstract click electronic access below) / Doutor

A hipertensão arterial é um estado patológico que na maioria das vezes não apresenta sintomas, sendo um mal silencioso que afeta a população e apresenta graves repercussões na saúde pública. Este estudo tem por objetivo avaliar a confiabilidade das medições de pressão arterial e o desempenho do aparelho automático de punho, comparando com o aparelho aneroide. O estudo também fornece subsídios para a correta realização da monitorização residencial da pressão arterial (MRPA), revisando aspectos técnicos e discutindo suas principais indicações clínicas. O estudo de caráter quantitativo, aprovado por comitê de ética, foi realizado em um hospital público na cidade de Curitiba, estado do Paraná. A amostragem constou de 52 voluntários de ambos os sexos, com idade acima de 18 anos. As medições pareadas de pressão arterial sistólica e diastólica foram obtidas com o medidor automático e com o aparelho aneroide. As medições foram avaliadas por análise de variância (ANOVA) e regressão linear. Como resultado obteve-se que a correlação é muito forte entre as medições dos equipamentos, pela análise de variância os equipamentos não são estatisticamente diferentes, mas a análise de regressão apresentou uma grande dispersão de valores. / Hypertension is a health condition which often does not present symptoms. It is a condition that affects the population and is responsible for serious implications that end up affecting public health. This work aims to evaluate the reliability of measurements blood pressure and the performance of the automatic handle device, comparing it with the aneroid's meter. The study also provides information for the correct home blood pressure monitoring, reviewing technical aspects for conducting monitoring, and discussing its main clinical applications. The quantitative study approved by the ethics committee, was conducted in the city of Curitiba, Parana’s state. Samples of 52 adult volunteers of both genders were collected. Paired measurements of systolic and diastolic blood pressure obtained with the automatic measuring device and the aneroid device were analyzed using analysis of variance. Measurement data was interpreted with the analysis of variance (ANOVA) and linear regression. As an obtained result, a strong correlation between equipment measurements was noted. According to results of variance analysis the equipments are not statistically different, although linear regression method presented a visible value dispersion.

A crescente incidência da aterosclerose na população adulta e a obstrução da artéria renal são condições relacionadas à hipertensão renovascular. Independente das comorbidades presentes, a estenose de artéria renal é, por si só, importante causa de mortalidade cardiovascular. Frente a tal realidade, determinar o exame ou exames que possam identificar precocemente esta condição mórbida pode mudar a história natural da doença renovascular. Objetivo: Definir sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo dos exames não invasivos na estenose da artéria renal. Associar estes achados com a análise vascular quantitativa (QVA) das artérias renais. Métodos: Estudo prospectivo com 61 pacientes recrutados entre janeiro de 2008 e agosto de 2011. As características populacionais, os exames de ultrassom Doppler, cintilografia renal com DTPA e a tomografia computadorizada foram selecionados e seus resultados comparados à arteriografia digital das artérias renais e ao QVA. Resultados: A média das idades foi de 65,43 (DP 8,7) anos. Das variáveis relacionadas à população do estudo e comparadas à arteriografia, duas identificaram relação com a estenose da artéria renal, a disfunção renal e os triglicerídeos. A mediana do ritmo de filtração glomerular de 52,8 ml/min/m2 identificou uma razão de chance para estenose de artéria renal de até 10 vezes. Os triglicerídeos associaram-se a uma menor presença de estenose na artéria renal, p < 0,037. A análise da sensibilidade, especificidade, valor preditivo positivo e negativo dos diferentes testes diagnósticos permitiu identificar aquele que melhor detectava a estenose nos suspeitos e afastava nos sadios. O ultrassom doppler com sensibilidade de 82,90%, especificidade 70,00%, valor preditivo positivo 85,00% e preditivo negativo 66,70% e a angiotomografia com sensibilidade de 68,30%, especificidade 80,00%, valor preditivo positivo 87,50% preditivo negativo de 55,20%, foram os exames que permitiram predizer as maiores chances de estenose da artéria renal nos portadores e afastar na população sem estenose. A associação das características populacionais com o QVA, permitiu identificar duas novas variáveis, o sexo e a idade. A média do grau de estenose, 33,47% (DP 29,55) quantificada pelo QVA, identificou menores graus de estenose que na análise visual dos angiogramas. Exames não invasivos positivos em estenoses menores do que 60% da luz do vaso também foram identificados . Os resultados identificados pela curva ROC demonstraram respectivamente a arteriografia, a angiotomografia e o ultrassom Doppler como os exames com melhores chances em predizer estenose significativa da artéria renal. Conclusão: A angiotomografia e o ultrassom Doppler trouxeram qualidade e alta possibilidade no diagnóstico da estenose da artéria renal, com vantagem para o segundo, pois não há necessidade do uso de meio de contraste na avaliação de uma doença que, frequentemente, está acompanhada por portadores de disfunção renal, disfunção ventricular esquerda grave e diabetes melito. A incorporação de uma forma objetiva de medidas das artérias renais aprimora os resultados da angiografia invasiva. / The increasing incidence of atherosclerosis in adults and renal artery stenosis are conditions related to renovascular hypertension. Regardless all risk factors, renovascular stenosis is by itself an important cause of cardiovascular mortality. Choosing appropriate tests that can early identify this morbid condition can change the natural history of renovascular disease. Objective: To define sensitivity, specificity, positive and negative predictive value of non- invasive tests in renal artery stenosis. Associate these findings with the renal arteries quantitative vascular analysis (QVA). Methods: Prospective study with 61 patients selected between January 2008 and August 2011. The population characteristics, Doppler ultrasound scanning, DTPA renal scintigraphy and computed tomography were selected and their results compared with renal arteries digital angiography as well as the comparison to QVA. Results: The mean age was 65.43 (SD 8.7). The risk factors of the study population compared to angiography identified two variables: renal dysfunction and triglycerides. The median glomerular filtration rate of 52.8 ml/min/m2 identified an odds ratio for renal artery stenosis up to 10 times. Triglycerides were associated with lower presence of renal artery stenosis p < 0.037. The analysis of sensitivity, specificity, positive and negative predictive values of different diagnostic tests allowed the identification of the stenosis in the group of suspected patients and this possibility was discarded in the group of healthy patients. Doppler ultrasound scanning with 82.90% sensitivity, 70.00% specificity, 85.00% positive predictive value, 66.70% negative predictive value and computed tomography with 68.30% sensitivity, 80.00% specificity, 87.50% positive predictive value and 55.20% negative predictive value. These were the tests which supplied better chances to predict renal artery stenosis in patients with or without stenosis. The relationship of population characteristics with QVA identified two new variables, gender and age. The mean degree of stenosis 33.47% (SD 29.55) quantified by QVA identified lesser degrees of stenosis than in visual analysis of angiograms. Non- invasive positive stenoses less than 60% of vessel lumen were identified. The results identified by the ROC curve showed respectively angiography, computed tomography, and Doppler ultrasound scanning as better chances for predicting renal artery stenosis. Conclusion: Computed tomography, Doppler ultrasound scanning have brought high quality and ability in the diagnosis of renal artery stenosis, with an advantage to Doppler, which avoids the use of contrast medium in the evaluation of a disease that is often accompanied by patients with renal dysfunction, severe left ventricular dysfunction and diabetes mellitus. The introduction of new methodology to measure renal arteries will certainly improve the angiography results.

The Namibian Treatment Guidelines of 2011 for hypertension management provide evidence-based care protocols for effective management of hypertension. Documentation of health care in clients’ records is important to ensure patient safety and effective continuity of care. Documentation in this study reflected the extent of implementation and compliance with the hypertension management guidelines. The purpose of this study was to examine physicians’ implementation and compliance with hypertension management guidelines, through auditing documentation in health passports of clients diagnosed with hypertension. The guidelines were used as a framework to assess completeness of documentation. The study used a non-experimental, descriptive, retrospective quantitative research to examine the physicians’ implementation and compliance with hypertension management guidelines at the selected hospital outpatient department in Namibia. Non-probability convenience sampling was used to select client records. Data were collected by means of a structured three point Likert scale checklist. Data were analysed using the (SPSS) version 23 for Windows. The findings showed poor documentation of care provided, thus, assuming low compliance with hypertension management guidelines. Major areas of poor documentation were found in monitoring of risks factors, investigations to monitor organ damage, advise on when to seek care and client-centred health education. Based on study results, recommendations were formulated to improve quality of documentation and thus, implementation of and compliance with hypertension management guidelines. / Health Studies / M. P. H. (Health Studies)

A crescente incidência da aterosclerose na população adulta e a obstrução da artéria renal são condições relacionadas à hipertensão renovascular. Independente das comorbidades presentes, a estenose de artéria renal é, por si só, importante causa de mortalidade cardiovascular. Frente a tal realidade, determinar o exame ou exames que possam identificar precocemente esta condição mórbida pode mudar a história natural da doença renovascular. Objetivo: Definir sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo dos exames não invasivos na estenose da artéria renal. Associar estes achados com a análise vascular quantitativa (QVA) das artérias renais. Métodos: Estudo prospectivo com 61 pacientes recrutados entre janeiro de 2008 e agosto de 2011. As características populacionais, os exames de ultrassom Doppler, cintilografia renal com DTPA e a tomografia computadorizada foram selecionados e seus resultados comparados à arteriografia digital das artérias renais e ao QVA. Resultados: A média das idades foi de 65,43 (DP 8,7) anos. Das variáveis relacionadas à população do estudo e comparadas à arteriografia, duas identificaram relação com a estenose da artéria renal, a disfunção renal e os triglicerídeos. A mediana do ritmo de filtração glomerular de 52,8 ml/min/m2 identificou uma razão de chance para estenose de artéria renal de até 10 vezes. Os triglicerídeos associaram-se a uma menor presença de estenose na artéria renal, p < 0,037. A análise da sensibilidade, especificidade, valor preditivo positivo e negativo dos diferentes testes diagnósticos permitiu identificar aquele que melhor detectava a estenose nos suspeitos e afastava nos sadios. O ultrassom doppler com sensibilidade de 82,90%, especificidade 70,00%, valor preditivo positivo 85,00% e preditivo negativo 66,70% e a angiotomografia com sensibilidade de 68,30%, especificidade 80,00%, valor preditivo positivo 87,50% preditivo negativo de 55,20%, foram os exames que permitiram predizer as maiores chances de estenose da artéria renal nos portadores e afastar na população sem estenose. A associação das características populacionais com o QVA, permitiu identificar duas novas variáveis, o sexo e a idade. A média do grau de estenose, 33,47% (DP 29,55) quantificada pelo QVA, identificou menores graus de estenose que na análise visual dos angiogramas. Exames não invasivos positivos em estenoses menores do que 60% da luz do vaso também foram identificados . Os resultados identificados pela curva ROC demonstraram respectivamente a arteriografia, a angiotomografia e o ultrassom Doppler como os exames com melhores chances em predizer estenose significativa da artéria renal. Conclusão: A angiotomografia e o ultrassom Doppler trouxeram qualidade e alta possibilidade no diagnóstico da estenose da artéria renal, com vantagem para o segundo, pois não há necessidade do uso de meio de contraste na avaliação de uma doença que, frequentemente, está acompanhada por portadores de disfunção renal, disfunção ventricular esquerda grave e diabetes melito. A incorporação de uma forma objetiva de medidas das artérias renais aprimora os resultados da angiografia invasiva. / The increasing incidence of atherosclerosis in adults and renal artery stenosis are conditions related to renovascular hypertension. Regardless all risk factors, renovascular stenosis is by itself an important cause of cardiovascular mortality. Choosing appropriate tests that can early identify this morbid condition can change the natural history of renovascular disease. Objective: To define sensitivity, specificity, positive and negative predictive value of non- invasive tests in renal artery stenosis. Associate these findings with the renal arteries quantitative vascular analysis (QVA). Methods: Prospective study with 61 patients selected between January 2008 and August 2011. The population characteristics, Doppler ultrasound scanning, DTPA renal scintigraphy and computed tomography were selected and their results compared with renal arteries digital angiography as well as the comparison to QVA. Results: The mean age was 65.43 (SD 8.7). The risk factors of the study population compared to angiography identified two variables: renal dysfunction and triglycerides. The median glomerular filtration rate of 52.8 ml/min/m2 identified an odds ratio for renal artery stenosis up to 10 times. Triglycerides were associated with lower presence of renal artery stenosis p < 0.037. The analysis of sensitivity, specificity, positive and negative predictive values of different diagnostic tests allowed the identification of the stenosis in the group of suspected patients and this possibility was discarded in the group of healthy patients. Doppler ultrasound scanning with 82.90% sensitivity, 70.00% specificity, 85.00% positive predictive value, 66.70% negative predictive value and computed tomography with 68.30% sensitivity, 80.00% specificity, 87.50% positive predictive value and 55.20% negative predictive value. These were the tests which supplied better chances to predict renal artery stenosis in patients with or without stenosis. The relationship of population characteristics with QVA identified two new variables, gender and age. The mean degree of stenosis 33.47% (SD 29.55) quantified by QVA identified lesser degrees of stenosis than in visual analysis of angiograms. Non- invasive positive stenoses less than 60% of vessel lumen were identified. The results identified by the ROC curve showed respectively angiography, computed tomography, and Doppler ultrasound scanning as better chances for predicting renal artery stenosis. Conclusion: Computed tomography, Doppler ultrasound scanning have brought high quality and ability in the diagnosis of renal artery stenosis, with an advantage to Doppler, which avoids the use of contrast medium in the evaluation of a disease that is often accompanied by patients with renal dysfunction, severe left ventricular dysfunction and diabetes mellitus. The introduction of new methodology to measure renal arteries will certainly improve the angiography results.