Pulmonary Hypertension Is Associated With Systemic Arterial Hypertension Among Patients With Normal Left Ventricular Diastolic Function

Background The association of pulmonary and systemic arterial hypertension is believed to be mediated through hypertensive left heart disease. The purpose of the current study was to investigate whether pulmonary hypertension (PHT) is associated with systemic arterial hypertension among patients with apparently normal left ventricular diastolic function. Methods and Results Consecutive patients who had echocardiographic evaluation between 2007 and 2019 were enrolled. Patients with disease states that are known to be associated with PHT, including diastolic dysfunction, were excluded from the analysis. Estimated right ventricular systolic pressure was extracted for all patients from the echocardiographic reports. PHT was defined as estimated right ventricular systolic pressure >40 mm Hg. Multivariate logistic regression models were applied. Final study population included 25 916 patients with a median age of 59 (interquartile range, 44–69) years, of whom 12 501 (48%) were men and 13 265 (51%) had systemic arterial hypertension. Compared with normotensive patients, hypertensive patients were 3.2 times more likely to have PHT (95% CI, 2.91–3.53; P <0.001). A multivariate model adjusted for clinical and echocardiographic parameters that are known to be associated with PHT demonstrated that hypertensive patients are almost 3 times more likely to have PHT (95% CI, 2.45–3.15; P <0.001). The association was significant in multiple subgroups but was more significant among women compared with men (odds ratio, 3.1 versus 2.4; P for interaction <0.001). Conclusions PHT is associated with systemic arterial hypertension irrespective of left heart disease. The association is more pronounced among women.

Influenza and morbidity and mortality risk in patients in Mexico with systemic arterial hypertension alone or with comorbidities: a retrospective, observational, cross-sectional study from 2014 to 2020

ObjectivesIn Mexico, patients with systemic arterial hypertension (SAH) are excluded from the influenza vaccination programme despite their risk of cardiovascular events as influenza-related complications. We investigated the impact of influenza on morbidity and mortality in patients with SAH.DesignThis was a retrospective cross-sectional study that analysed data from early 2014 to mid-2020.SettingData were obtained from the Influenza Epidemiological Surveillance System in Mexico database.Participants32 663 cases of influenza in people aged ≥20 years with a confirmed case of influenza-like illness, severe respiratory infection and/or influenza death were investigated.Primary and secondary outcome measuresInfluenza deaths, hospitalisation frequency and the impact on hospitalisation and/or death due to influenza by the SAH variate alone and in combination with diabetes, obesity, chronic obstructive pulmonary disease, cardiovascular disease and/or smoking, and by vaccination status were assessed.ResultsThe hospitalisation frequency increased with age. Notably, 46.0% (15 033/32 663) of confirmed influenza cases had at least one comorbidity, with SAH (19.2%; 6260/32 663) and obesity (18.7%; 6106/32 663) being the most prevalent. Most confirmed SAH cases (80.8%; 5057/6260) were in those who had not been vaccinated against influenza. There were 3496 deaths due to influenza (mortality rate, 0.69×1 00 000 inhabitants), with the highest rates seen in those aged ≥80 years (80–89 years, 2.0%; ≥90 years, 3.6%). The case fatality rate due to influenza and SAH was significantly higher than those due to influenza without SAH in those aged <50 years, but not in the other age groups (20–29 years, 9.8%, p<0.0005; 30–39 years, 8.2%, p<0.035; 40–49 years, 17.8%, p<0.0005; vs 15.1%–20.0%, p=0.31–0.99 for those aged ≥50 years).ConclusionsOur findings support the need to include SAH in public policies of influenza vaccination as a secondary prevention measure to avoid fatal outcomes.

Nursing care to systemic arterial hypertension patients assisted by the e-sus program from the patient's perspective

General objective: To know the nursing care provided to systemic arterial hypertension patients assisted by the e-sus program from the patient's perspective. Methodology: Exploratory research with a quantitative approach. A form was used as an instrument, applied through home visits to 50 elderly people in March 2020. CEP approval opinion no. 3,534,141, on August 27, 2019. Results and Discussion: It was found in the research that 60% of the elderly were between 60 and 75 years old, 70% were female and 60% were illiterate. Regarding quality of life, 64% of the elderly reported physical inactivity, 78% were obese or overweight, and 54% reported having another pathology. In addition, 60% reported not participating in educational activities, hindering health promotion and prevention. As for the use of antihypertensive medications, 94% of the users informed that they were taking them, and 45.3% cited the verification of BP as care taken by the team. Conclusion: Therefore, it becomes relevant the implementation of new strategies and the improvement in the approaches already used by professionals, aiming at a quality of life for the elderly.

Obesity Facts and Their Influence on Renal Function Across the Life Span

Obesity is a chronic disease, with a rapidly increasing prevalence worldwide. Body mass index (BMI) provides the most useful population-level measure of overweight and obesity. For adults, overweight is defined as a BMI (Kg/m2) ≥ 25, and obesity as a BMI ≥ 30, for non-Asians and ≥ 27.5 for Asians. Abdominal obesity can be defined as a waist circumference equal to or higher than 102 cm for men and ≥88 cm for women. The definition of children and adolescents BMI changes with age and sex. Obesity may be exogenous or endogenous obesity, the latter is multifactorial and predominantly manifested during childhood. Presently, overweight and obesity are linked to more deaths worldwide than underweight. The total kidney glomerular filtration rate (GFR) is determined by the sum of nephrons and the GFR within each nephron or single nephron GFR. In clinical practice, GFR is more frequently calculated by GFR estimating equations based upon the plasma levels of creatinine, cystatin C, or both. The measured value of plasma creatinine is strongly influenced by non-GFR factors, by its tubular and gastrointestinal secretion, and by the problems associated with the lack of standardization of creatinine's laboratory assay discrediting it as an ideal GFR biomarker. Unlike creatinine, cystatin C plasma levels are mainly determined by GFR. Obesity may affect the kidney, via development of systemic arterial hypertension and/or diabetes mellitus, or directly, by ectopic accumulation of adipose tissue in the kidney. As obesity is a clinical condition associated with altered body composition, creatinine may not be the ideal biomarker for GFR measurement in obese individuals.

Retrospective Observational Single-Center Study of Complications of Arterial Indwelling Catheters for Invasive Blood Pressure in Intensive Care Unit Patients

This study aimed to analyze the incidence of complications resulting from the use of an indwelling arterial catheter (IAC). We compared the characteristics of the patients with an IAC who developed complications with those who did not present any complications. The study included 1,869 patients with an IAC hospitalized in intensive care units (ICUs) between 2017 and 2018. Most patients were male (58.7%), in the seventh decade of life, and had systemic arterial hypertension. The most common site of IAC implantation was the radial artery. Fifty-four (2.88%) cases of complications related to an IAC were identified including bleeding, hematomas, and thrombosis. Female patients had a higher risk of complications ( P = .030). Comorbidities such as arrhythmias ( P < .001) and peripheral arterial disease ( P = .041) also increased that risk. The use of vasoactive drugs ( P = .001), hemodialysis ( P = .001), and orotracheal intubation (OTI) ( P = .001) was significantly associated with the occurrence of complications as well as length of stay in ICUs ( P < .001) and IAC duration ( P = .001). IACs are safe devices commonly used in ICUs, with an incidence of complications of 2.88%.

COVID-19 E HIPERTENSÃO ARTERIAL SISTÊMICA: FATOR DE RISCO PARA MORBIMORTALIDADE. REVISÃO SISTEMÁTICA

Objetivos: Investigar a relação entre hipertensão arterial sistêmica e morbimortalidade de indivíduos infectados por SARS-CoV-2. Materiais e Métodos: Trata-se de uma revisão sistemática, realizada nas bases de dados do MEDLINE/PubMed®, SciELO/Lilacs, Biblioteca Virtual em Saúde (BVS), EBSCO e Google Acadêmico. Foram utilizados os descritores na língua inglesa: “COVID-19”; “SARS-CoV-2”; “Systemic arterial hypertension”; “Complications”; “Risk factor”. A busca resultou em 1.005 artigos. Entre esses, artigos duplicados foram excluídos, assim como estudos que mostraram inconsistências metodológicas. Ao final, selecionou-se 12 artigos. Resultados: Estudos evidenciaram a elevada prevalência da infecção por SARS-CoV-2 em pacientes portadores de hipertensão arterial sistêmica (HAS). Tais pacientes mostraram resposta inflamatória secundária exacerbada à infecção, compondo parte do grupo de alto risco da doença. Considerando as complicações neste subgrupo específico, uma mudança no estilo de vida e rigorosa adesão a terapêutica medicamentosa se fazem necessárias. Conclusão: A HAS se associa ao pior prognóstico e maior mortalidade de pacientes internados pela COVID-19.