SummaryObjective: To evaluate the efficacy of a program of lifestyle change through psychological intervention, combined with pharmacological therapy, for coronary risk reduction in uncontrolled hypertensive patients with overweight and dyslipidemia over 11 months of follow-up. Methods

Objective -To assess hypertension control rates in a specialized university-affiliated medical department, the influence of sex, diabetes, and obesity on that control, and the strategies for the treatment of hypertension. The estimated prevalence of arterial hypertension in Brazil is 15% to 20% 1 . According to official data from 1996, cardiovascular diseases are the major cause of morbidity and mortality in our country 2 . Even though arterial hypertension is the major risk factor for such diseases, little is known about its control in Brazil. The number of controlled hypertensive patients varies from 4% to 12% depending on the criteria used 3 . Among the patients under pharmacological treatment, however, the percentage of control varies from 20% to 50% [3][4][5][6] . These data are not in accordance with the international literature that reports lower control rates for patients on treatment. According to the last NIH report 7 , of the developed countries, the USA has the greatest rate of control of high blood pressure (27.4%), while England has the lowest (5.9%) 8 . Among the developing countries, India and Zaire have control rates as low as 9% and 2.5%, respectively 8 . For these reasons, we aimed to assess blood pressure control rates in patients pharmacologically treated at the Clinic of Arterial Hypertension of the Discipline of Nephrology of the Escola Paulista de Medicina -UNIFESP. We also assessed the influence of sex, obesity, and diabetes, and the pharmacological strategy used to control high blood pressure. Methods - MethodsWe carried out a cross-sectional study on blood pressure control in patients older than 18 years and registered at the Clinic of Arterial Hypertension of the Discipline of Nephrology at the Hospital do Rim e Hipertensão, who received medical assistance through the Integrated Health System (Sistema Único de Saúde -SUS). The inclusion criteria were regular follow-up for at least 6 months and primary arterial hypertension. We excluded the patients who were participating in a clinical protocol and those with secondary arterial hypertension. Data were collected directly from the medical and nursing records on the day of the medical visit

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Objective: Blood pressure(BP) and target organ responses to antihypertensive drugs are not well established in hypertensive obese patients. This study is aimed at evaluating the effects of obesity and adiposity distribution patterns on these responses. Methods: 49 hypertensive obese women were designated to different groups according to waist to hip ratio measurements -37 with troncular and 12 with peripheral obesity. Patients were treated for 24-weeks on a stepwise regimen with cilazapril alone or a cilazapril/hydrochlorothiazide/amlodipine combination therapy to achieve a BP lower than 140/90mmHg. Ambulatory blood pressure monitoring (ABPM), echocardiography, and albuminuria were assessed before and after the intervention. Results: After 24 weeks, weight loss was less than 2% in both groups. ABPM targets were achieved in 81.5% of patients upon a combination of 2(26.5%) or 3(55.1%) drugs. Similar reductions in daytime-SBP/DBP: -22.5/-14.1(troncular obesity) / -23.6/-14.9mmHg (peripheral obesity) were obtained. Decrease in nocturnal-SBP was greater in troncular obesity patients. Upon BP control, microalbuminuria was markedly decreased, while only slight decrease in left ventricular mass was observed for both groups. Conclusions: In the absence of weight loss, most patients required combined antihypertensive therapy to control their BP, regardless of their body fat distribution pattern. Optimal target BP and normal albuminuria were achieved in the group as a whole and in both obese patient groups, while benefits to cardiac structure were of a smaller magnitude. RESUMORespostas Pressórica e Cardiorrenal à Terapia Anti-hipertensiva em Mulheres Obesas. As respostas pressórica e de órgãos-alvo mediante o tratamento anti-hipertensivo medicamentoso, não estão bem estabelecidas em pacientes obesos hipertensos. O presente estudo tem por objetivo avaliar as repercussões da obesidade e da distribuição de gordura corporal sobre estas respostas. Métodos: Foram avaliadas 49 mulheres obesas hipertensas, separadas em subgrupos com distribuição troncular (n = 37) e periférica (n = 12) de gordura, de acordo com a distribuição cintura/quadril. As pacientes foram tratadas por 24 semanas com um regime anti-hipertensivo escalonado, iniciando-se com cilazapril e adicionando-se na seqüência, hidroclortiazida e amlodipina, com alvo pressórico inferior a 140 x 90 mmHg. Foram realizados MAPA, ecocardiograma e microalbuminuria antes e após o tratamento. Resultados: Depois de 24 semanas observou-se perda de peso inferior a 2% em ambos os subgrupos. O controle pressórico à MAPA pode ser observado em 81,5% das pacientes mediante a combinação de duas (26,5%) ou três (55,1%) Previous research from our group has previously demonstrated the influence of obesity, and specifically visceral obesity, on the prevalence of hypertension, cardiovascular risk factors and target organ damage (3,9). Moreover, clinical data obtained from our outpatients showed the benefits of specific antihypertensive drugs and the independent influence of weight ...

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