Population assessment of effective blood pressure (BP) control is fundamental for reducing the global burden of hypertension, especially in low-and middle-income countries. The authors evaluated the effectiveness of BP control and determined independent predictors associated with effective control among patients with hypertension on drug treatment in a large cross-sectional study performed in two metropolitan areas in Brazil's southeast region. A total of 43 647 patients taking antihypertensive treatment were identified. Less than half of the patients (40.9%) had controlled BP (systolic BP <140 mm Hg and diastolic BP <90 mm Hg). Independent predictors of BP control were age, eating fruit daily, physical activity, previous cardiovascular disease, male sex, diabetes mellitus, ethnicity, and obesity. Simple variables associated with BP control may be utilized for knowledge translation strategies aiming to reduce the burden of hypertension. | INTRODUCTIONCardiovascular disease (CVD) is the leading cause of mortality worldwide.1 About 80% of the global burden of CVD death occurs in lowand middle-income countries. 2 Therefore, primary and secondary CVD prevention is of increasing priority for these countries.Primary risk factors for a first cardiovascular event include age, sex, tobacco use, arterial hypertension, dyslipidemia, diabetes mellitus, obesity, and physical inactivity.3 Hypertension is one of the leading preventable causes of cardiovascular morbidity and mortality. The aim of the current analysis was to evaluate BP control rates and to identify independent predictors associated with effective BP control among patients with hypertension under pharmacological therapy.

BackgroundGuidelines recommend that in suspected stable coronary artery disease (CAD), a clinical (non-invasive) evaluation should be performed before coronary angiography.ObjectiveWe assessed the efficacy of patient selection for coronary angiography in suspected stable CAD.MethodsWe prospectively selected consecutive patients without known CAD, referred to a high-volume tertiary center. Demographic characteristics, risk factors, symptoms and non-invasive test results were correlated to the presence of obstructive CAD. We estimated the CAD probability based on available clinical data and the incremental diagnostic value of previous non-invasive tests.ResultsA total of 830 patients were included; median age was 61 years, 49.3% were males, 81% had hypertension and 35.5% were diabetics. Non-invasive tests were performed in 64.8% of the patients. At coronary angiography, 23.8% of the patients had obstructive CAD. The independent predictors for obstructive CAD were: male gender (odds ratio [OR], 3.95; confidence interval [CI] 95%, 2.70 - 5.77), age (OR for 5 years increment, 1.15; CI 95%, 1.06 - 1.26), diabetes (OR, 2.01; CI 95%, 1.40 - 2.90), dyslipidemia (OR, 2.02; CI 95%, 1.32 - 3.07), typical angina (OR, 2.92; CI 95%, 1.77 - 4.83) and previous non-invasive test (OR 1.54; CI 95% 1.05 - 2.27).ConclusionsIn this study, less than a quarter of the patients referred for coronary angiography with suspected CAD had the diagnosis confirmed. A better clinical and non-invasive assessment is necessary, to improve the efficacy of patient selection for coronary angiography.

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Paciente masculino de 85 años de edad, nacionalidad Japonesa, ingresa al servicio de urgencias del Hospital Dante Pazzanese de Cardiologia con cuadro clínico de 12 horas de evolución consistente en dolor torácico opresivo, inicio gradual, intensidad moderada, duración mayor de 30 minutos, no irradiado, no mejora con el reposo o con el uso de nitratos asociado a disnea de medianos esfuerzos, niega síntomas neurovegetativos. Antecedentes de importancia Hipertensión arterial, Enfermedad renal crónica estadio 4 (TFG 22 ml/min/1.73m2 por CKD EPI), Insuficiencia cardiaca con fracción de eyección reducida (FE 22%). Al examen físico paciente normotenso, bradicárdico, ausculta con soplo sistólico en foco Mitral grado 3/6, sin frémito; sin signos de bajo gasto cardiaco. Realizada impresión diagnostica de Síndrome coronario agudo por lo cual fue solicitado EKG de 12 derivaciones, marcadores de necrosis miocárdicas y Radiografía de tórax. El EKG revela bradicardia sinusal, hemibloqueo anterior izquierdo, sin signos de lesión o isquemia aguda, marcadores negativos y radiografía de tórax muestra ensanchamiento mediastinal y signo del calcio positivo por lo que sospechamos en Síndrome aórtico agudo y es solicitado Eco transesofágico mostrando dilatación discreta de la aorta ascendente 40 mm, arco aórtico de difícil visualización, dilatación moderada de la aorta descendente 44 mm, imagen sugestiva de hematoma intramural aórtico iniciando después del nacimiento de la arteria subclavia izquierda y extendiéndose hasta el tercio proximal de la aorta torácica descendente, midiendo 11 mm de espesor. El paciente posteriormente es sometido a Angiotomografia de tórax con medidas de prevención de nefrotoxicidad inducida por contraste y es evidenciado presencia de hematoma en la pared de la aórta torácica descendente que inicia después de la emergencia de la arteria subclavia izquierda hasta la emergencia de las arterias renales. Fue solicitada valoración por cirugía vascular y optado por tratamiento clínico dada la fase etaria del paciente y la presencia de comorbilidades. Actualmente continúa en seguimiento con Cardiologia, Nefrologia y Cirugía vascular.

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