This study showed that forearm blood pressure measurement overestimates the values of arm blood pressure measurement. In addition, it is possible to correct forearm BPM with an equation.

It is known that slow breathing (o10 breaths min -1 ) reduces blood pressure (BP), but the mechanisms involved in this phenomenon are not completely clear. The aim of this study was to evaluate the acute responses of the muscle sympathetic nerve activity, BP and heart rate (HR), using device-guided slow breathing (breathe with interactive music (BIM)) or calm music. In all, 27 treated mild hypertensives were enrolled. Muscle sympathetic nerve activity, BP and HR were measured for 5 min before the use of the device (n¼14) or while subjects listened to calm music (n¼13), it was measured again for 15 min while in use and finally, 5 min after the interventions. BIM device reduced respiratory rate from 16 ± 3 beats per minute (b.p.m) to 5.5 ± 1.8 b.p.m (Po0.05), calm music did not affect this variable. Both interventions reduced systolic (À6 and À4 mm Hg for both) and diastolic BPs (À4 mm Hg and À3 mm Hg, respectively) and did not affect the HR (À1 and À2 b.p.m respectively). Only the BIM device reduced the sympathetic nerve activity of the sample (À8 bursts min -1 ). In conclusion, both device-guided slow breathing and listening to calm music have decreased BP but only the device-guided slow breathing was able to reduce the peripheral sympathetic nerve activity.

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. Previous exercise attenuates muscle sympathetic activity and increases blood flow during acute euglycemic hyperinsulinemia. J Appl Physiol 98: 866 -871, 2005. First published November 12, 2004 doi:10.1152/japplphysiol.00251.2004.-Insulin infusion causes muscle vasodilation, despite the increase in sympathetic nerve activity. In contrast, a single bout of exercise decreases sympathetic activity and increases muscle blood flow during the postexercise period. We tested the hypothesis that muscle sympathetic activity would be lower and muscle vasodilation would be higher during hyperinsulinemia performed after a single bout of dynamic exercise. Twenty-one healthy young men randomly underwent two hyperinsulinemic euglycemic clamps performed after 45 min of seated rest (control) or bicycle exercise (50% of peak oxygen uptake). Muscle sympathetic nerve activity (MSNA, microneurography), forearm blood flow (FBF, plethysmography), blood pressure (BP, oscillometric method), and heart rate (HR, ECG) were measured at baseline (90 min after exercise or seated rest) and during hyperinsulinemic euglycemic clamps. Baseline glucose and insulin concentrations were similar in the exercise and control sessions. Insulin sensitivity was unchanged by previous exercise. During the clamp, insulin levels increased similarly in both sessions. As expected, insulin infusion increased MSNA, FBF, BP, and HR in both sessions (23 Ϯ 1 vs. 36 Ϯ 2 bursts/min, 1.8 Ϯ 0.1 vs. 2.2 Ϯ 0.2 ml ⅐ min Ϫ1 ⅐ 100 ml Ϫ1 , 89 Ϯ 2 vs. 92 Ϯ 2 mmHg, and 58 Ϯ 1 vs. 62 Ϯ 1 beats/min, respectively, P Ͻ 0.05). BP and HR were similar between sessions. However, MSNA was significantly lower (27 Ϯ 2 vs. 31 Ϯ 2 bursts/min), and FBF was significantly higher (2.2 Ϯ 0.2 vs. 1.8 Ϯ 0.1 ml ⅐ min Ϫ1 ⅐ 100 ml Ϫ1 , P Ͻ 0.05) in the exercise session compared with the control session. In conclusion, in healthy men, a prolonged bout of dynamic exercise decreases MSNA and increases FBF. These effects persist during acute hyperinsulinemia performed after exercise.

INTRODUCTION:The goal of antihypertensive treatment is to reduce blood pressure without interfering in health-related quality of life (HRQL)OBJECTIVE:This study aimed to assess the influence of hypertension control upon HRQL in hypertensive patients with and without complications.MATERIALS AND METHODS:Seventy-seven hypertensive outpatients (71% women, 58% white, 60% with elementary school level education, average age 54 ± 8 years) were observed during a 12-month special care program (phase 1: clinical visits every two months, donation of all antihypertensive medications, meetings with a multidisciplinary team, and active telephone calls) and three years of standard care (phase 2: clinical visits every four months, medication provided by the drugstore of the hospital with a two-hour wait and a possible lack of medication, no meetings with a multidisciplinary team or active telephone calls). The patient HRQL was assessed using Bulpitt and Fletcher’s Specific Questionnaire, as well as the SF-36 scores. Hypertensive patients were divided into “with complications” (n=37, diastolic blood pressure great than 110 mm Hg for patients with or without treatment, with clinically evident target-organ or other associated illness) and “without complications” (n=40). The variables studied were quality of life, blood pressure control, hypertension gravity, and demographic characteristics.RESULTS:In hypertensive patients with and without complications, both the systolic and diastolic blood pressure were significantly higher (p<0.05) in phase 2 of observation (143±18/84±11 and 144±21/93±11 mm Hg for patients with and without complications, respectively) relative to phase 1 (128±17/75±13 and 128±15/83±11mmHg). The proportion of patients with controlled blood pressure (defined as a blood pressure less than 140/90 mm Hg) decreased from 70% to 49% in the “with complications” group and from 78% to 50% in the “without complications” group during phase 2 of observation. The patients with complications showed a decrease in bodily pain, vitality, and mental health component summary scores in both phases. In phase 2, the patients without complications had significantly better HRQL scores compared to complicated patients using both the Bulpitt and Fletcher’s Questionnaire and the SF-36 assessment of physical capacity, bodily pain, and vitality domain summary scores. With regards to hypertension control, there was a significant decrease from phase 1 to phase 2 in the vitality component summary scores and an increase in the emotional aspect component summary scores assessed by the SF-36, whereas Bulpitt and Fletcher’s Questionnaire showed no differences in these scores.CONCLUSION:Special care programs with multidisciplinary activities, individualized and personalized assistance, easy access to pharmacological treatment, frequent meetings, and active telephone calls for hypertensive patients significantly increase blood pressure control but do not interfere with the HRQL.

Objective: To characterize a group of hypertensive patients in relation to beliefs, knowledge, attitudes and factors that could affect treatment compliance. Methods: The data were collected by interviewing hypertensive outpatients. Results: A total of 511 hypertensive patients were studied: most were women, white, with elementary education, and 53±11 years old. The patients had high levels of knowledge about hypertension and treatments. However, they interrupted the treatment due to the expensive medicines and the lack of instructions. Furthermore, they believed they had to take medicines only when they felt unwell, and they did not attend their medical appointment usually due to forgetfulness and personal problems. Regarding the attitudes against the antihypertensive treatment, hypertensive patients forgot to take the medicines, took the medication at different hours, stopped taking the medication on their own account, did not follow instructions, and did not exercise regularly. Conclusion: The profile of the hypertensive patients identified aspects that can hamper treatment compliance. Keywords: Hypertension/prevention & control; Hypertension/therapy; Knowledge, attitudes and health practice; Psychosocial disease effects RESUMO Objetivo: Caracterizar um grupo de hipertensos em relação a crenças, conhecimentos, atitudes e fatores que podem interferir na adesão ao tratamento. Métodos: Os dados foram coletados através de entrevista com hipertensos em seguimento ambulatorial. Resultados: Foram estudados 511 hipertensos: a maioria mulheres, brancas, com escolaridade de nível fundamental, 53,0 ±11,0 anos. Foram verificados índices elevados de conhecimento sobre a doença e tratamento. Porém, o tratamento foi interrompido devido a remédios muito caros e falta de orientação e acreditavam que devem tomar os medicamentos somente quando se sentem mal, além de faltarem à consulta médica, principalmente por esquecimento e problemas particulares. Em relação às atitudes frente ao tratamento, observou-se que esquecem de tomar os remédios, não tomam no mesmo horário, deixam de tomar por conta própria, não seguem as orientações e não praticam exercícios físicos regularmente. Conclusão: A caracterização dos hipertensos identificou aspectos que podem dificultar a adesão ao tratamento. Descritores: Hipertensão/prevenção & controle; Hipertensão/terapia; Conhecimentos, atitudes e prática em saúde; Efeitos psicossociais da doença RESUMENObjetivo: Caracterizar a un grupo de hipertensos en relación a las creencias, conocimientos, actitudes y factores que pueden interferir en la adhesión al tratamiento. Métodos: Los datos fueron recolectados a través de una entrevista a hipertensos con seguimiento en consulta externa. Resultados: Participaron 511 hipertensos: la mayoría mujeres, blancas, con un nivel de escolaridad primario y edad de 53,0 ±11,0 años. Fueron verificados índices elevados de conocimiento sobre la enfermedad y el tratamiento. Sin embargo, el tratamiento fue interrumpido debido a medicamentos muy caros y falta de orie...

Background: This study aimed at evaluating the after effects of a single bout of aerobic exercise on muscle sympathetic nerve activity (MSNA), peripheral vascular resistance and blood pressure (BP) in stages 2-3 chronic kidney disease (CKD) patients. We hypothesized that CKD patients present a greater decline in these variables after the exercise than healthy individuals. Methods: Nine patients with stages 2-3 CKD (50 ± 8 years) and 12 healthy volunteers (50 ± 5 years) underwent 2 sessions, conducted in a random order: exercise (45 min, cycle ergometer, 50% of peak oxygen uptake) and rest (seated, 45 min). Sixty minutes after either intervention, MSNA (by microneurography), BP (by oscillometry), and forearm vascular resistance (FVR) were measured. A 2-way analysis of variance with group (between) and session (within) as main factors was employed, accepting p < 0.05 as significant. Results: Diastolic BP and MSNA were higher in the CKD than the control group in both sessions. Responses after exercise were similar in both groups. Systolic BP, diastolic BP, MSNA and FVR were significantly lower after the exercise than after the rest session in both the CKD and the control groups (162 ± 15 vs. 152 ± 23 and 155 ± 11 vs. 145 ± 16 mm Hg, 91 ± 11 vs. 85 ± 14 and 77 ± 5 vs. 71 ± 10 mm Hg, 38 ± 4 vs. 31 ± 4 and 34 ± 2 vs. 27 ± 4 burst/min, 59 ± 29 vs. 41 ± 29 and 45 ± 20 vs. 31 ± 8 U, respectively, all p < 0.05). Conclusion: These results showed that aerobic exercise may produce hemodynamic and neural responses that can be beneficial to these patients in spite of CKD.

OBJECTIVES:To evaluate the importance of providing guidelines to patients via active telephone calls for blood pressure control and for preventing the discontinuation of treatment among hypertensive patients.INTRODUCTION:Many reasons exist for non-adherence to medical regimens, and one of the strategies employed to improve treatment compliance is the use of active telephone calls.METHODS:Hypertensive patients (n = 354) who could receive telephone calls to remind them of their medical appointments and receive instruction about hypertension were distributed into two groups: a) “uncomplicated” – hypertensive patients with no other concurrent diseases and b) “complicated” - severe hypertensive patients (mean diastolic ≥110 mmHg with or without medication) or patients with comorbidities. All patients, except those excluded (n = 44), were open-block randomized to follow two treatment regimens (“traditional” or “current”) and to receive or not receive telephone calls (“phone calls” and “no phone calls” groups, respectively).RESULTS:Significantly fewer patients in the “phone calls” group discontinued treatment compared to those in the “no phone calls” group (4 vs. 30; p<0.0094). There was no difference in the percentage of patients with controlled blood pressure in the “phone calls” group and “no phone calls” group or in the “traditional” and “current” groups. The percentage of patients with controlled blood pressure (<140/90 mmHg) was increased at the end of the treatment (74%), reaching 80% in the “uncomplicated” group and 67% in the “complicated” group (p<0.000001).CONCLUSION:Guidance to patients via active telephone calls is an efficient strategy for preventing the discontinuation of antihypertensive treatment.