BackgroundDiabetics have increased risks for cardiovascular disease (CVD) and mortality, reducing their life expectancy by up to 15 years. Type 2 diabetes mellitus specifically increases the risk for cardiovascular mortality nearly fivefold. When hypertension is combined with diabetes, the risk of CVD is even greater.ObjectiveIdentify non-fatal cardiovascular outcomes and renal function impairment in a cohort of hypertensive patients in regular treatment in a reference treatment center, over 11 years of follow-up.MethodsHistorical cohort of hypertensive patients in regular treatment for at least 11 years in a specialized service for hypertension treatment. The exposed group was hypertensive diabetic patients at the beginning of the cohort, and the non-exposed group had hypertension without diabetes. The cohort began in 2004, with follow-ups in 2009 and 2015. Variables used: gender, race, age, physical activity, alcohol consumption, smoking, blood pressure, body mass index, glycated hemoglobin, diabetes and hypertension diagnosis times, treatment time in specialized service, non-fatal cardiovascular outcomes, and renal impairment assessed by creatinine clearance.Results139 patients participated in the study (55 diabetic hypertensive; 84 non-diabetic hypertensive), with an initial (2004) mean hypertension treatment time of 5.8 years. Females were the majority (75.5%) in both groups. Groups were similar regarding socio-demographic variables, but the group of hypertensive diabetic patients had higher frequency of obesity and uncontrolled BP, which persisted in all follow-ups. In 11 years of follow-up (2004–2015), the diabetic group had more cardiovascular events, with increased risk of acute myocardial infarction (RR 95% CI 1.6 12.2–95.0), stroke (RR 95% CI 1.3–6.1 27.7) and complications requiring hospitalization (RR 95% CI 1.6 2.2–3.0). Worsened renal function occurred more often in the non-exposed group, but in the end, the proportion of renal function loss was similar between groups.ConclusionsExposure to type 2 diabetes increased the risk of new cardiovascular outcomes over 11 years of follow-up of hypertensive patients. Diabetes by itself increased the risk of cardiovascular outcomes, justifying more intensive actions in this population.
Os autores desta obra: 1. Atestam não possuir qualquer interesse comercial que constitua um conflito de interesses em relação ao artigo científico publicado; 2.Declaram que participaram ativamente da construção dos respectivos manuscritos, preferencialmente na: a) Concepção do estudo, e/ou aquisição de dados, e/ou análise e interpretação de dados; b) Elaboração do artigo ou revisão com vistas a tornar o material intelectualmente relevante; c) Aprovação final do manuscrito para submissão.; 3. Certificam que os artigos científicos publicados estão completamente isentos de dados e/ou resultados fraudulentos; 4. Confirmam a citação e a referência correta de todos os dados e de interpretações de dados de outras pesquisas; 5.Reconhecem terem informado todas as fontes de financiamento recebidas para a consecução da pesquisa; 6. Autorizam a edição da obra, que incluem os registros de ficha catalográfica, ISBN, DOI e demais indexadores, projeto visual e criação de capa, diagramação de miolo, assim como lançamento e divulgação da mesma conforme critérios da Atena Editora. DECLARAÇÃO DA EDITORA A Atena Editora declara, para os devidos fins de direito, que: 1. A presente publicação constitui apenas transferência temporária dos direitos autorais, direito sobre a publicação, inclusive não constitui responsabilidade solidária na criação dos manuscritos publicados, nos termos previstos na Lei sobre direitos autorais (Lei 9610/98), no art. 184 do Código Penal e no art. 927 do Código Civil; 2. Autoriza e incentiva os autores a assinarem contratos com repositórios institucionais, com fins exclusivos de divulgação da obra, desde que com o devido reconhecimento de autoria e edição e sem qualquer finalidade comercial; 3. Todos os e-book são open access, desta forma não os comercializa em seu site, sites parceiros, plataformas de ecommerce, ou qualquer outro meio virtual ou físico, portanto, está isenta de repasses de direitos autorais aos autores; 4. Todos os membros do conselho editorial são doutores e vinculados a instituições de ensino superior públicas, conforme recomendação da CAPES para obtenção do Qualis livro; 5. Não cede, comercializa ou autoriza a utilização dos nomes e e-mails dos autores, bem como nenhum outro dado dos mesmos, para qualquer finalidade que não o escopo da divulgação desta obra. APRESENTAÇÃO A pandemia por COVID-19 mudou a saúde humana global e nos estimulou a pensar sobre novas abordagens de enfrentamento diante de emergências que envolvem a saúde coletiva. Nesse sentido, destacamos a essencial contribuição da ciência em prol da humanidade, que pela primeira vez na história, em tempos recordes, desenvolveu diversas pesquisas e vacinas. Estas, marcaram a redução da mortalidade por COVID-19, o início do controle mundial da pandemia e de seus desfechos na saúde humana. Enquanto a pandemia crescia rapidamente, os pesquisadores, a equipe de saúde e o público em geral enfrentaram, e ainda enfrentam, sofrimento psicológico, incluindo ansiedade, depressão, estresse, angústia, solidão, raiva e suicídio. Esses proble...
Objective: Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension have been previous validated and a P2/P1 ratio over 1,2 shows a good correlation with this damage. 1,2,3 In animal models, with induced hypertension, it has been observed a significative increase in P2/P1 ratio 2 weeks later. 4 Our objective, as a proof of concept, was to observe followed treated hypertensive patients concerning the rate of P2/P1 behavior. Design and method: The evaluation procedure of noninvasive intracranial pressure waveforms have been performed in 62 treated hypertensive patients with 7 minutes length. First and last minutes were discarded as well any test with poor quality wave signal at any moment. Data concerning systolic and diastolic blood pressure (BP) measured with OMRON automatic device HBP 1100 were obtained at the same moment as well the variables of age, body mass index (BMI), anti-hypertensive drugs and a history of diabetes (DM), stroke (ST) or myocardial infarction (MI). Descriptive statistics tests were used through the measurement of central tendency (mean), dispersion (standard deviation) and frequency (percentage). T Student and ANOVA as parametric tests and qui squared for categorical variables. Results: Data from 52 patients were validated. Mean age of 64,6 years, 63,5% female, BMI 28,4 +- 5,4 Kg/m2, 48,1% with diabetes. Mean systolic and diastolic office BP measurements of 141,6 +- 25,4 mmHg and 85,2 +- 14,7 mmHg respectively and 53,8% with controlled hypertension (systolic BP < 140 mmHg and diastolic BP < 90 mmHg). P2/P1 ratio over 1,2 has been found in 75% of the sample and there were no differences concerning controlled and non-controlled hypertension, number of anti-hypertensives drugs, or comorbidities as DM, ST or MI but at this moment we have to consider the small size of the sample to achieve enough power to detect these differences or correlations. Conclusions: The prevalence of 75% of P2/P1 ratio over 1,2 (equivalent to intracranial hypertension) deserves attention from scientific community since it raises a question about blood-brain barrier protection and can help to explain the huge association between hypertension and cerebrovascular diseases.
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