Objective: The different classes of drugs routinely used in anti-hypertensive therapy promote different effects on markers of arterial stiffness and, consequently, on the central blood pressure. Arterial stiffness is the main determinant for the increase of the central blood pressure and considered an important predictor for myocardial infarction, stroke and congestive heart failure. Objective: The objective of this study was to compare the effect on the systolic central blood pressure and arterial stiffness in resistant hypertensive patients submitted to sequential nephron blockade (SNB) against double blockade of the renin-angiotensin-aldosterone system (DBRAS) plus Bisoprolol. Design and method: Fifty-five resistant hypertensive patients were recruited in the Hypertension Outpatient Clinic of FAMERP, twenty-nine in the SNB group (18F/11 M) and twenty-six in the DBRAS group (22F/4 M). Central systolic blood pressure (cSBP), incrementing index (AI) and AI75 were measured with Omron HEM9000-A. (Japan). Results: The main result showed significant reduction of the central systolic blood pressure in patients submitted to sequential blockade nephron treatment when compared with the double blockade of the renin-angiotensin system plus Bisoprolol group (128.8 ± 22.1 vs. 117.4 ± 17.9 mmHg - P = 0.03). Figure 1 Conclusions: The sequential nephron blockade group, when compared with the double blockade of the renin-angiotensin-aldosterone system plus Bisoprolol, promotes significant higher reduction of the central systolic blood pressure in resistant hypertensive patients.

Objective: Resistant hypertension (RHTN) is a clinical entity, difficult to manage. To identify the contribution of the volume as well as the renin activity from the maintenance of blood pressure levels could individualize the treatment. Objectives : To demonstrate the efficacy of therapy of sequential nephron blocking (SNB) in relation to the double blockade of the renin-angiotensin system associated with beta-blockers (DBRAS) in patients with RHTN with > 85%-adherence rate after 20 weeks of treatment. Design and method: A prospective study was conducted, open, randomized, parallel comparison between two regimens for RHT: SNB versus DBRAS. SNB consists in a progressive increase of sodium depletion with thiazide, followed by a blockade of mineralocorticoid receptor, followed by progressive doses of loop diuretics and finally blocking sodium channels. DBRAS consists in reinforcing the effect of angiotensin receptor blocker (ARB) with an angiotensin converting enzyme inhibitors (ACEI), followed by betablockers to decrease the renin secretion. Seventy-two patients were randomized (35 to SNB 13 M/22F and 37 to RASDB 14 M/23F) coming from the tertiary outpatient clinic (HB-FAMERP). We used the criteria of the Brazilian VII Guidelines for Hypertension and V Guidelines for ABPM and HBPM. The BP was monitored with the SpaceLabs 90207. Results: Baseline clinical characteristics and laboratory parameters of the 72 RHTM randomized to SNB (n = 35) or DBRAS (n = 37) were similar across both study groups. At the end of the study, a significant reduction of the office pressure was observed (SBP and DBP) in both post-intervention groups (SNB group: initial SBP: 174.5 ± 21.08; final SBP: 127.0 ± 14.74; Initial DBP: 105.3 ± 15.5, final DBP: 78.11 ± 9.28 (p < 0.0001), RAASDB group: initial SBP: 178.4 ± 21.08, final SBP: 134.4 ± 23.25, initial DBP: 102.7 ± 11.07, final DBP: 77.33 ± 13.75 (p < 0.0001). No discontinuation due drug-related adverse events in both study groups. Conclusions: SNB and DBRAS associated with the beta-blocker in RHTN patients with full adherence to the treatment showed excellent therapeutic efficacy. However, the SNB group disclosed a greater absolute reduction of central blood pressure values.

Objective: Obtain an accurate measurement of blood pressure (BP) is of fundamental importance for the diagnosis and follow-up of hypertensive patients. It is known that in some patients, such accuracy is not possible due to the anatomical changes in the musculature of the arm, obesity, and dysmorphisms. Objective: To evaluate and compare blood pressure values using the traditional method of measuring blood pressure in the arm with the values measured in the forearm in hypertensive patients for validation of this technique in obese patients and/or with the arm dysmorphisms. Design and method: Were included 70 patients of both sexes, aged between 30 and 90 years of hypertension outpatient clinic of the State Medical School of São José doRio Preto FAMERP - SP. The BP was measured by the oscillometric method using two electronic devices, with clamp standard for adults with arm circumference between 220 mm and 420 mm and automatic inflation and deflation of air, with pressure variation of 0–280 mmHg (appliance, MICROLIFE BP3AC1–1 model PC) obeying the VII Brazilian Guidelines for the treatment of hypertension. The anthropometric data were obtained at the beginning of the research for sample characterization, as well as information on gender and age. Results: In accordance with the statistical analysis of the data measured blood pressure could observe that the linear correlation values are >80%, which corresponds to an excellent correlation between the measurements of arm and forearm for both systolic and diastolic BP, me, an BP and pulse pressure. Conclusions: Both measurements of systolic and diastolic blood pressure were equivalent in arm and forearm, in such a way that can be considered effective measurement of BP in the forearm in hypertensive patients being of particular usefulness in obese patients or who present arms dysmorphisms.