Trata-se de um estudo descritivo transversal de abordagem quantitativa, realizado com 48 portadores de hipertensão arterial sistêmica (HAS), internados em alas de internação e UTI cardiológica de um hospital privado do interior paulista, realizado no período de julho a setembro de 2009, tendo por objetivo avaliar os fatores que interferem na adesão à terapêutica. Para coleta de dados, foram utilizados três instrumentos: um relacionado aos dados sociodemográficos, clínicos e relacionados à terapêutica medicamentosa; o Teste de Medida de Adesão ao Tratamento (MAT) para avaliar a adesão ao tratamento medicamentoso e o Instrumento de Avaliação da Atitude Frente à Tomada de Remédio (IAAFTR). Os testes estatísticos foram realizados por meio do software Statistica 8.0 e MedCalc 10.2, e os dados foram considerados significativos quando o nível de significância foi p<0,05 e IC 95%. Os sujeitos possuíam idade entre 19 e 90 anos, com mediana de 70,5 anos, 79,2% eram do sexo masculino, 70,8%, casados, 64,6%, aposentados, 35,4% possuíam ensino médio completo, seguidos por 25% com ensino superior completo, a renda familiar variou de R$900,00 a R$30.000,00, com mediana de R$4.000,00, o número de indivíduos que utilizam a renda familiar variou de 1 a 6, 29,2% eram obesos, 93,8% apresentaram relação cintura-quadril (RCQ) alterada, 35,4% apresentaram valores de pressão arterial (PA) acima de 140X90mmHg, 35,4% faziam uso de diurético, 27,1%, de betabloqueador, 25%, de bloqueador de canais de cálcio, 29,2%, de inibidor da enzima conversora de angiotensina (ECA), 35,4%, de bloqueador do receptor da angiotensina 1 (AT1) e 66,7% utilizam apenas um medicamento para controle da PA. O tempo de diagnóstico da HAS variou de 1 a 40 anos, com mediana de 10 anos. As principais comorbidades encontradas foram: cardiopatias (52,1%), dislipidemia (45,8%) e diabetes mellitus (35,4%). Quando avaliados pelo MAT, 44 (91,7%) apresentaram adesão ao tratamento; pelo IAAFTR 34 (70,8%) mostraram atitude positiva frente à tomada de remédio. Entre aqueles que apresentaram adesão pelo MAT, 33 (75%) também apresentaram atitude positiva frente à tomada de remédio. Não houve diferença estatisticamente significante para idade, sexo, estado civil, ocupação, escolaridade, IMC, RCQ e complicações clínicas, quando aplicados o MAT e o IAAFTR. A prevalência de adesão foi maior entre os indivíduos que acreditavam que sua PA estava controlada (p=0,041), os que não necessitaram de mudanças em sua rotina de vida após o diagnóstico da HAS (p=0,007) e os que nunca recusaram um medicamento prescrito para controle da PA (p<0,001). Diante desse contexto, permanece o desafio quanto à necessidade dos profissionais de saúde buscarem a diminuição das barreiras que interferem na adesão ao tratamento da HAS, favorecendo-a e mostrando seus benefícios, adotando assim uma visão holística do portador de HAS. / This descriptive, quantitative and cross-sectional study was carried out with 48 patients with systemic high blood pressure (SHBP), hospitalized in a cardiologic ICU (Intensive Care Unit) of a private hospital in the interior of the state of São Paulo, between July and September 2009 and aimed to assess the factors that interfere in the adherence to treatment. Three instruments were used for data collection: one related to socioeconomic and clinical data and data related to medication therapy; the Test of Treatment Adherence Measure (TAM) to evaluate the adherence to medication treatment and the Instrument of Evaluation of Attitude regarding Medication Intake (IAAFTR). Statistical tests were carried out using the software Statistica 8.0 and MedCalc 10.2, and data were considered significant for a level of significance p<0.05 and Confidence Interval (CI) 95%. Subjects were aged 19 to 90 years, with median of age of 70.5 years, 79.2% were male, 70.8% married, 64.6% retired, 35.4% had completed high school, followed by 25% with complete higher education, family monthly income varied from R$900.00 (Brazilian reais) to R$30,000.00 (Brazilian reais), with median of R$4,000.00 (Brazilian reais), the number of individuals living with this income varied from 1 to 6, 29.2% were obese, 93.8% presented altered waist-hip ratio (WHR), 35.4% presented values of arterial pressure (AP) above 140X90mmHg, 35.4% used diuretic agents, 27.1% beta-Blockers, 25% blocker of calcium channels, 29.2% Angiotensin-Converting Enzyme Inhibitors (ACE), 35.4% Angiotensin Type 1 Receptor Blockers (AT1) and 66.7% used only one medication for blood pressure control. The time of diagnosis of SHBP varied from 1 to 40 years, with median of 10 years. The main comorbidities were heart diseases (52.1%), dyslipidemias (45.8%) and diabetes mellitus (35.4%). When assessed by TAM, 44 (91.7%) presented adherence to treatment; by IAAFTR 34 (70.8%) showed positive attitude regarding medication intake. Among the ones who presented adherence by TAM, 33 (75%) also presented positive attitude regarding medication intake. There was no statistically significant difference for age, gender, marital status, occupation, schooling, BMI, WHR and clinical complications, for administration of TAM and IAAFTR. The prevalence of adherence was higher among individuals who believed their BP was controlled (p=0.041), the ones who did not need changes in their daily life after the diagnosis of SHBP (p=0.007) and the ones who never refused a prescribed medication for BP control (p<0.001). In this context, remains the challenge of health professionals to decrease the barriers that interfere in the adherence to SHBP treatment, favoring adherence, showing its benefits and thus adopting a holistic view of patients with SHBP.

A prevalência da hipertensão arterial aumenta a cada ano, é uma doença silenciosa, influenciada por fatores de risco, alguns decorrentes de hábitos e estilo de vida. Ao considerar a atual proposta mundial de tornar o paciente agente do seu próprio cuidado, participando a família do seu processo saúde-doença, faz-se necessário considerar esse contexto para propor estratégias de baixo custo, que contribuam para a redução dos valores de pressão arterial. O objetivo deste estudo foi avaliar o efeito da associação entre MRPA e intervenção de ensino (IE) na redução dos valores de pressão arterial. Foi realizado estudo piloto, para identificar as dificuldades e facilitar a operacionalização da coleta de dados, assim como propor estratégias para a melhor execução do planejamento do estudo. Foi realizado estudo clínico randomizado e definiu-se como variáveis a serem estudadas: \"MRPA\", \"IE\" e \"MRPA+IE\". A pressão arterial (PA) foi aferida antes e pós as intervenções. O fato de que todas as comparações realizadas no estudo não apontaram diferenças entre o grupo que participou da pesquisa e o que tendo recusado, teve suas características anotadas, foi o principal resultado. E quando comparou-se a magnitude do efeito da intervenção entre os grupos que receberam a associação das intervenções (grupo 1) e o grupo 2, que recebeu somente a intervenção de ensino, evidenciou-se uma diferença (p = 0,0155) entre eles, o que mostra que o grupo 1 teve uma melhora nos valores de pressão arterial sistólica (PAS) enquanto que no grupo 2 foi observado uma piora nos valores de PAS. O grupo 1 teve uma melhora nos valores de PAS enquanto que no grupo 4, novamente foi observado uma piora nestes valores (p = 0,0040). O grupo 1 foi o único que apresentou redução dos valores de PA tanto na PAS quanto na pressão arterial diastólica (PAD). Assim a associação da MRPA com uma IE sobre a doença hipertensão arterial sistêmica (HAS) é recomendada, pois resultou em consequências positivas na implementação de cuidados de saúde, o que leva a crer ser uma adequada estratégia para redução dos valores de PA em pessoas com HAS em tratamento. Essa sugestão é baseada na análise do efeito e da efetividade das intervenções apresentadas nesse estudo, que evidenciou redução nos valores de PAS e PAD quando aplicada a associação das duas intervenções propostas nesse estudo onde os resultados se diferenciaram significativamente do grupo controle, o qual não sofreu nenhuma intervenção. Tais resultados permitem afirmar que a MRPA associada à IE reduz os valores de PA e que tal associação, poderá contribuir sobremaneira para a melhoria do controle dos valores de PA entre indivíduos com hipertensão arterial em tratamento nas ESF / The prevalence of hypertension is increasing every year , and know that it is a silent disease , influenced by habits and lifestyle . Considering the new global proposal to make the patient agent of their own care, attending to your family health-disease process , it is necessary to propose low-cost strategies that contribute to the reduction of blood pressure values . The aim of this study was to evaluate the association between HBPM and teaching intervention in reducing blood pressure levels . Pilot study , where it was possible to identify the difficulties in the operationalization of data collection and propose strategies for the implementation of the project was conducted . In the methodology it was decided to conduct a randomized clinical trial . We defined the variables to be studied : \" HBP \" , \" EI \" and \" HBP + EI \" , which will be the interventions of the study . The PA variable was measured before and after the interventions . The main result of the fact that all comparisons showed no differences between the group that participated in the survey and who has refused , had noted its features appear . And when we compare the magnitude of the effect of the intervention between the groups who received the combination of interventions (group 1 ) and group 2 , which received only the educational intervention , we observed a difference ( p = 0.0155 ) between them , showing that the group 1 had an improvement in SBP while in group 2 a worsening was observed in these values . When the magnitude of the effect of the intervention compared between groups and 1 control group ( 4 ) evidenced a difference ( p = 0.0040 ) between them , showing that group 1 had an improvement in SBP while in group 4 , was again observed a worsening in these values . Group 1 was the only one that showed a reduction in BP values in both SBP and DBP . Association of HBPM with IE on the disease , its consequences and health care as a strategy for reducing the pressure values is recommended. This suggestion is based on analysis of the effect and effectiveness of interventions presented in this study, which showed a reduction in SBP and DBP when applied to combination of both interventions proposed in this study where the results differed significantly from the control group, which did not suffer no intervention. These results allow us to affirm that HBPM associated with IE reduces the values of PA and that this association may contribute greatly to improving the control of blood pressure values among individuals with hypertension in treatment in the FHS

Neste estudo, foram determinadas as atividades de duas enzimas de membrana: alanina-aminopeptidase (AAP) e Y-glutamil-transpeptidase (YGT) e da enzima lisossomal N-acetil-B-D-glucosaminidase (NAG), bem como os níveis de proteína total (PT), albumina (ALB) e ácido delta-aminolevulínico (ALA) em urinas de indivíduos expostos ocupacionalmente ao chumbo (grupo exposto) e de indivíduos não expostos ao chumbo e nem a outras substâncias químicas (grupo controle). Todos os indivíduos apresentavam creatinina sérica inferior a 1,5 mg/dL. Ao mesmo tempo foram determinados os níveis sangfiíneos de chumbo (Pb-S) e aferidas pressão arterial diastólica (PD) e pressa-o arterial sistólica (PS). O objetivo foi investigar a toxicidade renal crônica do chumbo e sua possível correlação com a pressão arterial em indivíduos com função renal normal. A mediana de chumbo no sangue no grupo controle foi de 11,5 pg/dL contra 36,8 pg/dL no grupo exposto, mostrando-se dependente do tempo de exposição (p < 0,001). O valor mediano da NAG-U corrigido pela creatinina foi mais alto no grupo exposto (31,74 U/g creatinina) e significativamente diferente do grupo controle (25,28 U/g creatinina), p < 0,001. A atividade NAG-U se correlacionou com o Pb-S (p < 0,001), tempo de exposição (p < 0,001) e ALA-U (p < 0,001), mas não houve correlação com a pressão arterial. Os demais indicadores de função renal, Y GT-U, AAP-U, PT-U e ALB-U não se mostraram mais elevados no grupo controle e nem mostraram correlação com o Pb-S, tempo de exposição ou pressão arterial. A pressão arterial diastólica foi maior no grupo exposto (83 mmHg contra 78 mmHg no grupo controle) mas não se observaram diferenças quanto à pressão sistólica. Observaram-se correlações das pressoes arteriais diastólica e sistólica com tempo de exposição (p < 0,001 e p < 0,05 ) e com chumbo no sangue (p < 0,05 e p < 0,05 ) respectivamente, enquanto somente a pressão diastólica se correlacionou com o ALA-U (p < 0,05). / In the present study we determined the activity of two renal tubule membrane enzymes: alanine-aminopeptidase (AAP) and Y-glutamyl-transpeptidase (YGT), and of the renal tubule lysosomal enzyme N-acetyl-B-D-glucosaminidase (NAG), as well as the levels of total protein (TP), albumin (ALB) and delta-aminolevulinic acid (ALA) in the urine of individuais occupationally exposed to lead (exposed group) and in individuais not exposed to lead or to any other chemical substances (control group). All individuais presented serum creatinine levels of less than 1.5 mg%. All subjects were also submitted to measurement of blood lead levels (B-Pb) and of diastolic and systolic arterial pressure. The objective was to investigate the chronic renal toxicity of lead and its possible correlation with arterial pressure in individuais with normal renal function. Median B-Pb levels were 11.5 pg/dL for the controls versus 36.8 Pg/dL for the exposed group, with the level being proportional to time o f exposure (p < 0.001). Median NAG-U values corrected for creatinine were higher in the exposed group (31.74 U/g creatinine) and significantly different from the control (25.28 U/g creatinine), p < 0.001. NAG-U activity was correlated with B-Pb (p < 0.001), time of exposure (p < 0.001) and ALA-U (p < O. 001), but not with arterial pressure. The remaining indicators of renal function, YGT-U, AAP-U, TP-U and ALB-U were not more elevated in the control group and were not correlated with B-Pb, time of exposure or arterial pressure. Diastolic arterial pressure was higher in the exposed group (83 mmHg versus 78 mmHg for the controls), but the two groups did not differ in systolic pressure. Diastolic and systolic pressure values were correlated with time of exposure (p < 0.001 and p < 0.05) and blood lead (p < 0,05 e 0,05) respectively but only diastolic pressure was correlated with ALA-U ( p < 0.05).

Introduction: Magnesium is required by the human body in modest amounts for the maintenance of health and optimal functioning. Objectives: This portfolio of work sets out to investigate whether magnesium supplementation has hypotensive effects and to determine if habitual dietary magnesium intake or loading strategies modulate the effects of magnesium supplementation. The habitual dietary magnesium intake of hypertensive patients was also examined to ascertain adequacy of dietary magnesium in this cohort. A meta-analysis was performed on the effect of magnesium supplementation on blood pressure. Other variables such as dosage, duration and study design were considered and findings from the meta-analysis used to influence future work. A further objective was to examine the effect of supplementation on aerobic and resistance exercise and subsequent recovery. Finally, the efficacy of an alternative means of magnesium delivery in the form of a transdermal magnesium cream was investigated. Methods: A 300 mg.day-1 elemental magnesium aspartate or magnesium citrate was used as a supplementation in studies 1,2,4 and 5. Participants were instructed to continue with their normal diet and for study 6 participants were required to eat the same foods for the 24 hours prior to both laboratory blood taking sessions. With the exception of the meta-analysis, food diaries were kept for various lengths of time, detailed in the publications. Aerobic and resistance exercise protocols were carried out in studies 1,2 and 4, with both performance and cardiovascular parameters investigated for any effect from supplementation. Where supplementation was in the form of a transdermal cream, this was applied to the torso and absorption of the cream was determined by investigating changes in serum and urinary magnesium levels. Summary of results: Blood pressure decreased with magnesium supplementation of 300 mg.day-1 for 7 days with greater reductions in systolic versus diastolic blood pressure consistently evident. Magnesium supplementation of 300 mg.day-1 for 7 and 14 days increased power during resistance exercise but no changes in aerobic exercise performance were observed. A high habitual dietary magnesium intake attenuated the hypotensive effect derived from magnesium supplementation when compared to those on a low habitual dietary intake. The meta-analysis supported these results. A habitually low dietary magnesium intake was observed in a cohort of clinically diagnosed primary hypertensives. Conclusion: These studies show that there is a link between low habitual dietary magnesium intake and elevated blood pressure and that magnesium supplementation appears to be associated with blood pressure. An improvement in resistance exercise performance with magnesium supplementation was also observed. Finally, a transdermal magnesium cream was shown to increase serum magnesium levels and may provide an alternative to oral supplementation.

Background: Essential hypertension is regarded as a complex disease, the phenotype of which results from interactions between numerous genes and environmental factors. Genome-wide association studies of blood pressure (BP) and hypertension have been developed to explore the potential genes involved in blood pressure and identified a number of trait-associated variants. Among those variants, single nucleotide polymorphisms (SNPs) rs1173771 (G/A) and rs1421811 (G/C) are located at the natriuretic peptide receptor C (NPR3) gene locus. Their major alleles are related with blood pressure elevation. Studies have implicated NPR-C in mediating some of the cardio-protective actions of natriuretic peptides and its direct involvement in the pathogenesis of hypertension. However, the precise role of these association between genetic variants at NPR3 and blood pressure control has not been elucidated. Objective: To functionally characterise the effect of BP-associated SNPs at the NPR3 gene locus in the context of BP regulatory pathways. Methods: Primary human umbilical artery smooth muscle (HUASMCs) and vein endothelial (HUVECs) cells were genotyped for BP-associated NPR3 variants. Endogenous mRNA and protein expression levels were assessed by qRT-PCR, allelic expression imbalance assay and western blotting. Open chromatin regions were assayed using formaldehyde-assisted isolation of regulatory elements (FAIRE). Interaction between variants flanking region with nuclear protein was detected by electrophoretic mobility shift assay (EMSA). Cell proliferation and migration were 4 determined by cell counting and scratch assays. Angiotensin II (Ang II)-induced calcium flux was evaluated using the intracellular fluorescent probe. Results: The BP-elevating allele of the NPR3 variants in rs1173771 linkage disequilibrium (LD) block was associated with lower endogenous mRNA and protein levels in HUASMCs. This is consistent with the finding that BP-elevating allele is less located within open chromatin. The decreased NPR3 expression in HUASMCs carrying the BP-elevating allele is associated with increased cell proliferation and intracellular calcium flux in response to Ang II stimulation. No differences in migration rates were detected. No genotype-dependent characteristics were observed in HUVECs NPR3 expression and cell proliferation. Moreover, RT-PCR showed a linkage between of the BP-elevating allele of the NPR3 variants in rs1421811 LD block and lower endogenous mRNA in HUASMCs. Intracellular calcium flux detection also revealed a trend of higher response to Ang II stimulation in BP-elevating allele homozygous HUASMCs. However, No genetic differences were detected in proliferation and migration rates of HUASMCs, and HUVECs NPR3 expression and cell proliferation studies did not present any significant genotype-dependent association. Conclusions: This study has identified a potential mechanism for BP-associated SNPs at NPR3 locus to influence BP predominantly via an effect on vascular smooth muscle cell behaviours.

Magister Artium - MA / Hypertension is estimated to a ect 20 million people in South Africa, with lifestyle factors predisposing certain individuals to this condition disease (Hughes et al., 2013). The prevalence rate of hypertension is higher in areas with low socio-economic status, with women more at risk of developing it than men. Current research suggests that 60-80% of people in South Africa use 'traditional'- most often plant based - medicines at some point for their primary healthcare needs (WHO, 2008; Hughes et al., 2013). In rural and underprivileged areas, such as the community of Nuwerus in the Western Cape Province, the use of herbal medicines and its practices are maintained in an ageing population. This study looks at the ways in which the elderly and the home based care workers of Nuwerus understand hypertension. I focus on the transition from hypertension to high blood pressure and how the two concepts overlap in Nuwerus. I highlight the way the elderly maintain their sense of vitality. I also look at concepts of resilience and vitality to unpack the personal, religious and social dimensions of old age. I focus on the various activities the elderly participate in to unpack the subtle ways with which they push the boundaries of old age consequently challenging conventional notions of health and wellness amongst the aged. The vigour with which the elderly go about their everyday life is what ultimately makes them the pillars and knowledge holders of the community. / National Research Foundation (NRF)

Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 1981. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING. / Bibliography: leaves 125-128. / by Barry Leonard Wyshogrod. / M.S.

Recomenda-se o exercício resistido para hipertensos, entretanto, sua segurança não esta estabelecida. Investigamos o efeito do exercício resistido na pressão arterial (PA) de hipertensos estágio I.Cinco hipertensos (HT) e 6 normotensos (NT) realizaram exercício de extensão de joelhos até a exaustão em 3 intensidades: 1 série em 100% e 3 séries em 80% e 40% de 1 repetição máxima (1RM) com medida intra-arterial da PA. Nos 2 grupos PAS e PAD aumentaram na 1ª série nas 3 intensidades. Nos HT, o aumento da PAS em 40 e 80% 1RM foi maior que em 100% 1RM, mas o da PAD foi semelhante. Durante as 3 séries de exercício em 80 e 40% da 1RM, PAS e PAD aumentaram de forma semelhante nos NT. Nos HT, PAS aumentou mais em 40 que em 80% da 1RM, mas PAD foi semelhante.O exercício resistido de extensão de joelhos até a exaustão promove elevação da PA em HT e, contrariamente ao esperado, esse aumento é maior no exercício de menor intensidade. Esses resultados sugerem que a indicação desse exercício nessa população deve ser feita com cautela / Resistive exercise has been recommended to hypertensives. However, little is known about its safety. This study had investigated the effects on blood pressure of resistive exercise.Five mild hypertensives (HT) and 6 normotensives (NT) performed knee extension exercise to exhaustion in 3 intensities: 100% one maximum repetition (1RM) and 3 series at 80% and 40% 1RM. Blood pressure was obtained by intrarterial measurement.SBP and DBP increased in 100% 1RM and in the 3 series of the 80% and 40% of 1RM in both groups. In HT, SBP increase in 80% and 40% was greater than in 100% 1RM but the DBP rise was similar. During the 3 series of 80% and 40%, SBP and DBP increased similarly in NT. In HT the SBP increase was higher in 40% than in 80% 1RM, but DBP elevation was similar in the 2 intensities.Knee extension resistive exercise performed to exhaustion provokes expressive blood pressure elevation in HT and, unexpectedly, this increase is greater in the low intensity exercise. These results suggest that this exercise should be recommended with caution in hypertensives

Trata-se de um estudo descritivo transversal de abordagem quantitativa, realizado entre 75 portadores de hipertensão arterial (HA) seguidos no ambulatório de um hospital-escola de nível terciário, no interior paulista, realizado no período de setembro de 2008 a abril de 2009, tendo por objetivo avaliar a adesão ao tratamento. Para a coleta de dados foram utilizados três instrumentos: um relativo a dados sociodemográficos, da doença e do tratamento; o Teste de Morisky e Green (TMG) para avaliar a adesão ao tratamento medicamentoso e o Instrumento de Avaliar Atitudes Frente à Tomada de Remédios (IAAFTR). Os testes estatísticos foram realizados por meio do software Statistica 8.0, e os resultados foram considerados significativos quando o nível de significância foi (p <0,05). Os sujeitos possuíam idade média de 61,5 ±10,36 anos, 52,0% eram do sexo feminino, 85,3% brancos, 70,7% casados, 48,0% aposentados e 24,0% do lar, 65,3% possuíam ensino fundamental incompleto, média de 3,08 ±1,99 filho, 94,7% residiam com outros membros da família, 81,3% informaram renda familiar entre um e três salários mínimos; 48,0% apresentaram valores de pressão arterial (PA) maiores que 140X90mmHg, 48,0% eram obesos, 80,6% dos homens e 94,9% das mulheres apresentaram circunferência da cintura com valores alterados. A média do tempo de diagnóstico da hipertensão arterial sistêmica (HAS) foi de 15,57 ±9,61 anos. As principais comorbidades identificadas foram: diabetes mellitus (54,3%) e dislipidemia (46,6%). A média dos medicamentos utilizados foi de 5,1 comprimidos/dia, sendo os mais comumente utilizados os hipoglicemiantes (58,7%) e os antiagregantes plaquetários (54,8%). A média de medicamentos usados para o tratamento da HA foi de 3 comprimidos/dia, sendo que os diuréticos foram os mais usados (84,0%). Quando avaliados pelo TMG, 21 (28,0%) apresentaram adesão ao tratamento; pela utilização do IAAFTR 37 (49,3%) mostraram atitudes positivas frente à tomada dos medicamentos. Entre aqueles que apresentaram adesão pelo TMG, 16 (76,2%) também apresentaram atitudes positivas quando avaliados pelo IAAFTR. A prevalência de controle da PA foi maior para os que tiveram adesão (66,7%) e para aqueles com atitudes positivas (64,9%). Houve significância estatística para o sexo e atitude frente à tomada dos medicamentos em relação ao controle da PA. Os valores de PA foram menores para os que tiveram adesão pelo TMG e que apresentaram atitudes positivas quanto à tomada dos medicamentos (p <0,05). Em relação aos fatores de risco para a HAS, 64,0% não praticavam exercício físico; 9,3% eram fumantes; 17,3% faziam uso de bebida alcoólica e 54,7% diziam ser estressados; 96,0% citaram antecedentes familiares para doenças cardiovasculares. Diante deste contexto permanece um desafio quanto à necessidade de revisão das medidas educativas instituídas no sentido de possibilitar alternativas que possam melhorar, na prática, a adesão dos portadores de HA ao tratamento medicamentoso, o controle da PA e a mudança nos fatores de risco para a HAS. / It is a cross-section descriptive study of quantitative approach, carried out with 75 hypertensive outpatients of tertiary level, in upstate São Paulo, carried out from September 2008 to April 2009, aiming to evaluate adherence to the treatment. Three questionnaires were used to collect the data: one about socio-demographic data regarding the disease and the treatment; the Morisky-Green Test, to assess the adherence to the drug-based treatment and the Questionnaire to Evaluate Attitudes Towards Taking Medicines. The statistical tests were applied by means of the software Statistica 8.0, and the results were considered significant whenever the significance level was (p<0.05). The subjects average age was 61.5 ±10.36 years, 52.0% were women, 85.3% Caucasians, 70.7% married, 48.0% retired and 24.0% housewives, 65.3% did not finish primary education, they had on average 3.08 ±1.99 children, 94.7% lived with other family members, 81.3% stated that their familly income was between one and three minimum wages; 48.0% had blood pressure readings above 140X90 mmHg, 48.0% were overweight, 80.6% of the men and 94.9% of the women had unhealthily large waist circumferences. Average hypertension diagnosis time (HT) was 15.57 ±9.61 years. The most important comorbities identifed were: diabetes mellitus (54.3%) e dyslipidemia (46.6%). The average of the medications used was 5.1 pills/day, and the most commonly used drugs were hypoglycemiants (58.7%) and platelet antiaggregant (54.8%). The average of the medications used for the treatment of HT was 3 pills/day, and the diuretics were the most used ones (84.0%). When evaluated with the Morisky-Green test, 21 (28.0%) showed adherence to the treatment, by means of the Questionnaire to Evaluate Attitudes Towards Taking Medicines, 37 (49.3%) showed positive attitudes towards the taking the medicines. Those that showed adherence through the Morisky-Green test also showed positive attitudes when evaluated by means of the Questionnaire to Evaluate Attitudes Towards Taking Medicines. The prevalence of control of the blood pressure was higher for those who had adherence (66.7%) and for those with positive attitudes (64.9%). Gender and attitude towards taking medicines had statistical significance to the control of blood pressure. Blood pressure readings were lower in hypertensives that had adherence according to the Morisky- Green test and that had positive attitudes toward taking the medicines (p<0.05). Regarding the risk factors for HT, 64.0% did not practice physical exercise; 9.3% were smokers; 17.3% drank alcoholic drinks and 54.7% reported being stressed; 96% cited family antecedents of cardiovascular disease. In face of this context, there remains the challenge of reviewing the current educative measures to enable alternatives that may improve, in practice, the adherence of hypertensives to the drug-based treatment, the control of blood pressure and the change in the risk factors for HT.

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-10-29T19:30:33Z No. of bitstreams: 1 FlaviaMarianaValente_tese.pdf: 815961 bytes, checksum: ea82829ce570996509dd1974cfa9221b (MD5) / Made available in DSpace on 2018-10-29T19:30:33Z (GMT). No. of bitstreams: 1 FlaviaMarianaValente_tese.pdf: 815961 bytes, checksum: ea82829ce570996509dd1974cfa9221b (MD5) Previous issue date: 2017-09-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Prehypertension predisposes individuals to systemic hypertension, which is the main risk factor for the development of cardiovascular diseases (CVD). Ambulatory blood pressure monitoring (ABPM) is an important method to assess blood pressure (BP) as it records levels during 24 hours, as well as changes related to the circadian cycle. In addition to peripheral hemodynamic parameters, 24h ABPM assesses central hemodynamic parameters, such as those linked to arterial stiffness. Thus, this examination presents several variables that correlate with cardiovascular events. Additionally, levels of metalloproteinase-9 (MMP-9), an enzyme involved in the degradation of extracellular matrix components, have been associated with the development of CVD and the arterial stiffness process. Objectives: The aims of the present study were: 1. to compare the peripheral and central hemodynamic variables obtained by ABPM at different BP levels according to the classification of normotension, prehypertension and arterial hypertension and to analyze MMP-9 values in these situations, correlating them with the variables obtained by ABPM. 2. To evaluate MMP-9 levels in acute BP elevations represented by hypertensive crisis. Methods: Participants included normotensive (NT), prehypertensive (PH) and controlled hypertensive (CHT) subjects. Individuals with hypertensive crisis, grouped as hypertensive urgency (HU) and hypertensive emergency (HE) were also included for MMP-9 measurement. Biochemical variables were evaluated for all volunteers. With the exception of hypertensive crisis, peripheral hemodynamic systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), pulse pressure, cardiac output (CO), peripheral vascular resistance (PVR) and central variables as central systolic BP (SBPc), central diastolic BP (DBPc), augmentation index 75% (AI75%) and pulse wave velocity (PWV) were assessed by 24h ABPM. Results: The PH group presented a significant difference when compared to CHT in relation to the peripheral (SBP) and central (SBPc and PWV) variables. There were also differences in these studies between the PH and NT for SBP, SBPc and DBPc. With ABPM, this study also identified significant differences in nocturnal systolic and diastolic dipping between PH and CHT. Regarding the MMP-9 levels, this study showed progressively higher levels between CHT, HU and HE, and that the PH group had higher MMP-9 levels than the CHT group. A positive correlation was identified between MMP-9 levels, CO and PVR. Conclusions: It is suggested that in the PH state there are changes in peripheral and central hemodynamic parameters and, consequently, in functional and structural alterations that predispose subjects to the development of systemic hypertension. Furthermore, MMP-9 levels appear to be influenced by antihypertensive therapy, since controlled hypertensive patients have lower MMP-9 levels than prehypertensive individuals. In the case of hypertensive crisis higher MMP-9 levels may constitute an important biomarker in the acute elevation of blood pressure. / A pré-hipertensão predispõe à hipertensão arterial sistêmica (HAS), que é o principal fator de risco para o desenvolvimento de doenças cardiovasculares (DCV). Dentre os métodos de avaliação dos níveis pressóricos, a monitorização ambulatorial da pressão arterial (MAPA) destaca-se por registrar a pressão arterial (PA) durante 24 horas, bem como alterações em seu ciclo circadiano. Além dos parâmetros hemodinâmicos periféricos, a MAPA 24h também pode mostrar parâmetros hemodinâmicos centrais, como os que avaliam a rigidez arterial. Assim, apresenta variáveis que podem se correlacionar com eventos cardiovasculares. Adicionalmente, os níveis de metaloproteinase-9 (MMP-9), enzima que participa da degradação de componentes da matriz extracelular, também têm sido associados ao desenvolvimento de DCV e no processo de rigidez arterial. Objetivos: Os objetivos do presente estudo foram: 1. Comparar as variáveis hemodinâmicas periféricas e centrais obtidas pela MAPA em diferentes níveis de PA, de acordo com a classificação de normotensão, pré-hipertensão e hipertensão arterial, e verificar a existência de correlação entre as variáveis obtidas pela MAPA e MMP-9. 2. Avaliar os níveis de MMP-9 na elevação aguda da PA, representada pela crise hipertensiva. Métodos: Participaram do presente estudo indivíduos normotensos (NT), pré-hipertensos (PH) e hipertensos controlados (HTC). Na avaliação dos níveis de MMP-9 participaram também indivíduos em crise hipertensiva, divididos em urgência hipertensiva (UH) e emergência hipertensiva (EH). Todos os voluntários foram avaliados quanto às variáveis bioquímicas e, com exceção do estudo na crise hipertensiva, foram monitorados pela MAPA quanto a variáveis hemodinâmicas periféricas, tais como pressão arterial sistólica (PAS), pressão arterial diastólica (PAD), pressão arterial média (PAM), pressão de pulso (PP), débito cardíaco (DC), resistência vascular periférica (RVP); e centrais, como PA sistólica central (PASc), PA diastólica central (PADc), augmentation index 75% (AI75%), e velocidade de onda de pulso (VOP). Resultados: O grupo PH apresentou diferença significativa em dois estudos quando comparados a HTC em relação às variáveis periféricas (PAS) e centrais (PASc e VOP). Também houve diferença nesses estudos entre PH e NT quanto à PAS, PASc e PADc. O uso da MAPA também permitiu identificar diferenças significantes no descenso noturno sistólico e diastólico entre PH e HTC. Em relação aos níveis de MMP-9 observou-se em um dos estudos níveis progressivamente mais elevados entre HTC, UH e EH. Em outro estudo, o grupo PH apresentou níveis de MMP-9 mais elevados que HTC. No estudo de correlação, identificou-se correlação positiva entre MMP-9 com o DC e RVP. Conclusões: Sugere-se que no estado pré-hipertensivo estão presentes alterações de parâmetros hemodinâmicos periféricos e centrais e, consequentemente, alterações funcionais e estruturais que predispõem ao desenvolvimento da hipertensão arterial. Além disso, os níveis de MMP-9 parecem ser influenciados pela terapia anti-hipertensiva, uma vez que hipertensos tratados apresentam menores níveis de MMP-9 do que indivíduos pré-hipertensos. No caso da crise hipertensiva, os níveis de MMP-9 mais elevados podem se constituir em um importante biomarcador na elevação aguda da pressão arterial.