Em sintonia com a tendência científica mundial e a orientação da Associação Médica Brasileira, as IV Diretrizes Brasileiras de Hipertensão fundamentam suas orientações segundo Graus de Recomendação baseados em níveis de evidência dos estudos clínicos de referência:Grau A -grandes ensaios clínicos aleatorizados e metanálises. Grau B -estudos clínicos e observacionais bem desenhados. Grau C -relatos e séries de casos. Grau D -publicações baseadas em consensos e opiniões de especialistas.
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She reported that 1 month earlier, these symptoms got worse, coinciding with her job loss and the end of a long-term relationship. She reported being used to moderate and regular physical activity, without problem. Five years earlier, the patient had been diagnosed with mild and labile hypertension, evidenced as occipital headache during physical activity. Since then, she has been on regular use of 25 mg of atenolol and 12.5 mg per day of hydrochlorothiazide, achieving excellent blood pressure control. On the same occasion, a rectification of the mitral valve with escape was diagnosed on the echocardiogram. On her biannual follow-ups, no target-organ lesion was evidenced. She reported smoking since 1999 and also an important familial history of hypertension, including both parents, with a significant "white-coat" effect. On physical examination, her radial pulse (RP) was 64 bpm, regular, and full, and her blood pressure was 154/88 mmHg (mean of 2 measurements). Ambulatory blood pressure monitoring, Holter monitoring, and exercise testing were normal. Her glycemia was 128 mg/dL, and her urinalysis showed 5 pyocytes per field. She was using Tenoretic (25 mg/morning), and atenolol (25 mg every night) was added. The patient improved with an increase in the dosage of atenolol, but, 1 month after the first medical visit, and after her usual physical activity, she experienced intense malaise, accompanied by tachycardia, sweating, pallor, and epigastric pain followed by lipothymia, being then referred to the emergency unit. She began to complain of high abdominal band-like pain, nausea, and frequent vomiting. Her RP was 92 bpm, weak, and her BP was 156/ 75 mmHg. She underwent ultrasonography of the total abdomen, 2 electrocardiographies, and measurement of amylase and cardiac, hepatic, and muscle enzymes, which were within the normal range. Her leukogram showed 28,000 leukocytes, and no eosinophils. The patient was referred to a general hospital, and, at the end of the day, her troponin was 9 ncg/dL, and later, 10. Her leukocyte count remained elevated and the leukogram maintained with the same pattern. She began to have mild hypotension. Two more electrocardiographies were performed, but were normal. The echocardiography revealed chambers of normal dimensions, akinesia of all myocardial segments, except for the apical segments, which were hyperkinetic, important systolic dysfunction, and moderate pulmonary hypertension. Acute heart disease, probably of viral origin, was suspected. Treatment for ventricular dysfunction (25 mg of captopril, BID; and 40 mg/day of furosemide) was initiated, with an excellent response. Gallium-67 myocardial scintigraphy was performed to confirm the diagnosis of viral myocarditis.The complaints disappeared and the hemodynamic findings became stable. On the third day of hospitalization, the patient developed arrhythmias, such as atrial fibrillation, paroxysmal atrial
The metabolic syndrome (MS) is a combination of cardiovascular risk factors, including visceral obesity, low HDL cholesterol level, increased triglycerides, hyperglycemia and high blood pressure. This sequence of risk factors contributes towards the development of atherosclerotic cardiovascular disease (ACVD) and diabetes mellitus. Sedentarism is not widely studied. This habit is a determinant factor for chronic or acute diseases. This study tests the hypothesis of the association between overall sedentarism, including professional work, travel and leisure and the MS, in adult men and women in Salvador, Bahia. A population based cross-sectional study of both genders, ages ≥ 20 years. MS is defi ned by the criteria of the International Diabetes Foundation, characterized as the MS when considering the presence of abdominal obesity (waist ≥84 cm for women and ≥ 88cm for men) plus two of the following criteria: arterial hypertension (≥130/85mmHg) hyperglycemia (≥100mg/dl) hypertriglyceridemia (≥150mg/dl). Hypoalphalipoproteinemia (hdl-cholesterol below 40mg/dl for women and below 50 for men). Sedentarism is defi ned by means of the four criteria of physical inactivity described below. Athletes were excluded. Inactivity in the professional work: lack of physical activity in the professional work or the presence of light physical activity such as: working mostly seated or less than 25% of the time standing or moving around. Inactivity in household work: lack of household work or light work, such as small repairs, light cleaning or preparation of food. Physical inactivity during travel to work: traveling by car or bus, walking less than 30 minutes as well as performing most of the outside activities by car or walking. Physical inactivity during leisure: leisure does not include physical activities. The fi nal sample totaled 1,333 individuals. In logistic regression, the adjusted prevalence ratio (PR) of overall sedentarism and the MS for women was of 1.31 (CI95% 0.86-1.91). For men the adjusted prevalence ratio was of 1.68 (CI95% 1.05-2.53), statistically signifi cant. This paper reveals, in men, that overall sedentarism is associated to the MS. There was no statistically signifi cant association between sedentarism exclusively in leisure and the MS. Marital status was a confounding factor and raises the issue of this variable not being widely studied as a cardiovascular risk factor.
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