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Clinical Characteristics of Resistant vs. Refractory Hypertension in a Population of Hypertensive Afrodescendants.

高血压后代人群中难治性与难治性高血压的临床特征。

  • 影响因子:1.00
  • DOI:10.36660/abc.20190218
  • 作者列表:"Macedo C","Aras Junior R","Macedo IS
  • 发表时间:2020-03-30
Abstract

BACKGROUND:Afrodescendants have been associated with a greater severity of arterial hypertension and a higher incidence of cardiovascular complications. Characteristics in the presentation of resistant hypertension (RH) or refractory hypertension (RfH), specifically in this ethnic group, have not been properly studied. OBJECTIVES:The study compares clinical and epidemiological characteristics and prevalence of cardiovascular events in people of African descent diagnosed with RH or RfH. METHODS:Cross-sectional study carried out in a referral clinic for patients with severe hypertension. The level of significance was 5%. RESULTS:146 consecutive patients were evaluated, of which 68.7% were female. The average age was 61.8 years, with 88.4% of Afrodescendants (mixed race or black). 51% had RfH. There was a high prevalence of cardiovascular risk factors: 34.2% of subjects had diabetes, 69.4% dyslipidemia, 36.1% obesity, and 38.3% history of smoking. Reduced renal function was seen in 34.2%. Previous cardiovascular events occurred in 21.8% for myocardial infarction and in 19.9% for stroke. The Framingham's risk score was moderate/high at 61%. RfH patients were younger (mean age 59.38±11.69 years versus 64.10±12.23 years, p=0.02), had more dyslipidemia (83.8 versus 66.7%, p=0.021), and stroke (30.4 versus 12.3%, p=0.011) when compared to those with RH. The use of a combination of ACEi/ARB+CCB+Diuretic, chlortalidone and spironolactone was also more frequent in individuals with RfH. CONCLUSION:Africandescendant people with RH had a high cardiovascular risk, a high prevalence of RfH, a higher frequency of dyslipidemia and stroke, compatible with a high incidence of injury to target organs. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0). FUNDAMENTOS:Afrodescendentes têm sido associados a uma maior gravidade da hipertensão arterial e maior incidência de complicações cardiovasculares. Características na apresentação da hipertensão resistente (HR) ou hipertensão refratária (HRf), especificamente nessa etnia, não têm sido devidamente estudadas. OBJETIVOS:O estudo compara características clínicas e epidemiológicas e prevalência de eventos cardiovasculares em afrodescendentes com diagnóstico de HR ou de HRf. MÉTODOS:Estudo transversal realizado em ambulatório de referência para pacientes com Hipertensão Grave. O nível de significância foi de 5%. RESULTADOS:Avaliados 146 pacientes consecutivos, dos quais 68,7% eram do sexo feminino. A média de idade foi de 61,8 anos, sendo 88,4% afrodescendentes (pardos ou negros). 51% apresentavam HRf. Houve alta prevalência de fatores de risco cardiovascular: 34,2% tinham diabetes, 69,4% dislipidemia, 36,1% obesidade e 38,3% história de tabagismo. Função renal reduzida foi observada em 34,2%. Eventos cardiovasculares prévios ocorreram em 21,8% para infarto do miocárdio e em 19,9% para acidente vascular cerebral. O escore de risco de Framingham foi moderado/alto em 61%. Os pacientes com HRf eram mais jovens (média de idade de 59,38±11,69 anos versus 64,10±12,23 anos, p=0,02), tinham mais dislipidemia (83,8 versus 66,7%, p=0,021) e acidente vascular cerebral (30,4 versus 12,3%, p=0,011) quando comparados aos com HR. O uso de combinação de ACEi/BRA+CCB+Diurético, clortalidona e espironolactona também foi mais frequente em indivíduos com HRf. CONCLUSÃO:Afrodescendentes com HR apresentaram alto risco cardiovascular, alta prevalência de HRf, maior frequência de dislipidemia e de acidente vascular cerebral, compatível com alta incidência de lesão a órgãos-alvo. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

摘要

背景:非洲裔一直与更严重的动脉高血压和更高的心血管并发症发生率有关。难治性高血压(RH)或难治性高血压(RfH)的表现特征,特别是在这个民族,尚未得到适当的研究。 目的:研究比较诊断为RH或RfH的非洲人的临床和流行病学特征以及心血管事件的患病率。 方法:在一所转诊的重症高血压患者中进行横断面研究。显著性水平为5%。 结果:连续评估146例患者,其中68.7%为女性。平均年龄为61.8岁,其中88.4%为非洲后裔(混血儿或黑人)。51%有RfH。心血管危险因素的患病率较高:34.2%的受试者有糖尿病、69.4%的血脂异常、36.1%的肥胖和38.3%的吸烟史。34.2%的患者肾功能下降。21.8%为心肌梗死,19.9%为中风。弗雷明汉的风险评分为中等/高,为61%。RfH患者更年轻(平均年龄59.38±11.69岁vs 64.10±12.23岁,p=0.02),血脂异常(83.8 vs 66.7%, p=0.021),中风(30.4 vs 12.3%, p=0.011)。联合使用ACEi/ARB+CCB+利尿剂、氯他酮和螺内酯在RfH患者中也更为常见。 结论:非洲晚期RH患者心血管风险高,RfH患病率高,血脂异常和中风发生率高,靶器官损伤发生率高。(Arq Bras Cardiol. 2020;(在线)。提前打印,PP.0-0)。 基本情况:这类患者主要是患有心血管并发症的孕妇。如果你喜欢一个人的抵抗力(HR)或者一个人的想象力(HRf),特别是当你喜欢一个人的时候,当你学习的时候。 目的:研究心血管疾病的临床和流行病学以及心血管疾病的诊断。 我的意思是:这是一个在坟墓里的参考资料。没有5%的显著性。 结果:一共有146个和平区,平均为68个,7%的女性和平区。有61人,8人,88人,4%是黑人。51% apresentavam HRf。心血管疾病:34,2%糖尿病,69,4%血脂,36,1%肥胖,38,3%吸烟史。根据观察,Funcao肾热为34,2%。心血管疾病的发病率为21,8%的心血管疾病发病率为19,9%的脑血管疾病发病率。在弗雷明汉的市场份额为61%。与对照组相比,前者的平均心率为59,38±11,69 anos vs 64,10±12,23 anos, p=0,02),后者的血脂(83,8 vs 66,7%, p=0,021),而后者的血管性脑损伤(30,4 vs 12.3%, p=0,011)。如果您能将ACEi/BRA+CCB+利尿剂结合起来,那么您就可以在每个人的HRf中得到您想要的。 结论:降血脂主要发生在心血管疾病、脑血管疾病、脑血管酸血症和脑血管疾病,并伴有更严重的疾病。(Arq Bras Cardiol. 2020;(在线)。提前打印,PP.0-0)。

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