Mexazolam in a therapeutically effective dosage regimen does not impair psychomotor performance to a clinically relevant extent.

RESUMOIntrodução: A monitorização ambulatorial da pressão arterial é o melhor método de avaliação da pressão arterial e a síndrome da apneia do sono é a principal causa de mau controlo. A oximetria permite rastrear estes indivíduos mas a sua utilidade tem sido pouco explorada em Cuidados de Saúde Primários. O objectivo foi avaliar o controlo da pressão arterial no consultório e na monitorização ambulatorial da pressão arterial, e relacioná-la com a síndrome da apneia do sono. Material e Métodos: Selecionou-se uma amostra de 50 participantes, representativa de 3036 doentes hipertensos. As variáveis avaliadas foram: valor de pressão arterial no consultório e na monitorização ambulatorial da pressão arterial; presença de critérios de síndrome da apneia do sono na oximetria. Resultados: A prevalência de pressão arterial não controlada foi de 56% no consultório e 68% na monitorização ambulatorial da pressão arterial. Encontrou-se: 36% de hipertensão diurna, 52% de hipertensão nocturna, 40% de perfil não-dipper, 16% de hipertensão da bata-branca e 28% de hipertensão mascarada. A prevalência de síndrome da apneia do sono foi 16%. A pressão arterial no consultório e na monitorização ambulatorial da pressão arterial não mostrou associação estatisticamente significativa (p = 0,761). Encontrou-se uma associação estatisticamente significativa entre síndrome de apneia do sono e hipertensão diurna (p = 0,019) e perfil não-dipper (p = 0,005). Discussão e Conclusão: A monitorização ambulatorial da pressão arterial detetou mais 12% de casos de hipertensão não controlada do que o consultório. A síndrome da apneia do sono está fortemente associada a hipertensão não controlada e a oximetria pode ser um bom método de rastreio, mas deve ser mais estudada. Palavras-chave: Hipertensão; Monitorização Ambulatória da Pressão Arterial; Oximetria; Síndromes da Apneia do Sono ABSTRACT Introduction: Ambulatory blood pressure monitoring by automatic device is the best blood pressure evaluation method and sleep apnea syndrome is the leading cause of poor control. Oximetry allows screening these individuals but its usefulness has been poorly explored in Primary Health Care. The aim was to evaluate the blood pressure control at the office and with ambulatory blood pressure monitoring by automatic device and to relate it to sleep apnea syndrome. Material and Methods:We selected a sample of 50 participants, representative of 3036 hypertensive patients. The variables were: blood pressure value at the office and blood pressure with ambulatory blood pressure monitoring by automatic device; presence of criteria of sleep apnea syndrome in oximetry.Results: The prevalence of uncontrolled blood pressure was 56% on office evaluation and 68% on ambulatory blood pressure monitoring by automatic device. It was found: 36% of daytime hypertension, 52% nocturnal hypertension, 40% non-dipper profile, 16% of white coat hypertension and 28% masked hypertension. The prevalence of sleep apnea syndrome was 16%. Blood pressure in ambulatory blood pressure monitoring by...

Objective:This study aims to characterize the distribution of estimated glomerular filtration rate (eGFR) in diabetic patients by association of common cardiovascular risk factors (CVRF) known as alcohol abuse (P15), tobacco abuse (P17), dyslipidemia (T93) and LDL cholesterol value, body mass index (BMI) and systolic blood pressure (sBP).Design/method:Cross-sectional, descriptive and analytical study. Anonymized data were obtained from users of 20 medical files who had at least one medical appointment, with at least one record of sBP, LDL, BMI and creatinine in the last 3 years until the 31st December 2021. The studied variables were sex, age, weight, BMI, creatinine, eGFR(CKD-EPI formula), target organ damage (TOD) identified by the existence of the following ICPC-2 coding: K74, K75, K76, K87 or K89, K90, K91 or K92; hypertension (K86 or K87), diabetes (T89 or T90), P15, P17, T93, at the date of the last record under study. For data collection, it was used MIM@UF®; program and the statistical analysis was performed using the R®3.6.3 program.Cardinality diagrams were created to show the association of CVRF and eGFR, CVRF and sBP, TOD type and sBP. A prediction model for the event of eGFR< 60 mL/min/1.73m2 was also created through a logistic regression model that links the occurrence of chronic kidney disease (CKD) with the predictors HTA, Diabetes, TOD, P15, P17 and T93.Results:The convenience sample consisted of 2396 diabetics, of which 1214 were male, and whose mean age was 70 years (IQR = 17 years). It was found that 70% have coded T93, 79% have hipertension, 38% are obese and 19% have TOD. The most frequent association of CVRF is HTA and T93 with 961 diabetics, followed by HTA with 373 diabetics.The logistic regression model shows that CVRF in diabetic patients in association with CKD, there are two variables that have statistical significance (age and hypertension). So, a constant 1 year increment in age increases the chance of finding a patient with CKD by 10% and the chance of a diabetic patient having CKD while being hypertensive is 2.59 times higher than a normotensive diabetic patient.Conclusions:The presence of several CVRF is frequent in the population that was studied, and the identification and understanding of their distribution is essential for an adequate management of diabetes. CKD is a frequent complication in these patients, and regular evaluation of eGFR and the other CVRF is essential for proper therapeutic management.

Objective: The prognostic value of 24-hour ambulatory monitoring(ABPM) in pregnancy complicated with hypertension remains uncertain Design and method: Observational, 234 pregnant observed in appointment between 2007- July 2019 submitted to ABPM. Mean age 32.1 ± 5.5 years, follow-up 263.9 ± 16.5 days, was defined from gestation to delivery. Event defined: maternal death(MD), fetal or neo natal death(FD), pre-eclampsia (PE) or eclampsia(E), gestational diabetes(DG), prematurity or delayed fetal growth (PF), dystocic delivery(DD).It was observed 118 events((62 PE),32(DG),14 (PF),8(DD),2(FD)) Results: Comparing pregnancies with events versus without, those with event were significantly older, more prevalence of risk factors for BP in PG, shorter follow up / days, higher 24 h Systolic BP(SBP), 24 h Diastolic BP (DBP),day SBP and DBP, night SBP and DBP, lower Systolic and Diastolic Dipping (table 1). In Cox's multivariate analysis for events and adjusted for: age, BMI, number of risk factors for HP in PG - [pre-existing HP, previous gestational HP, previous pre-eclampsia,restriction of previous intrauterine growth, previous membrane detachment, previous fetal death, previous gestational diabetes, smoking history, obesity, family history of preeclampsia, family history of cardiovascular disease, artificial insemination]classified has:(0,1,2,3,> = 4), office SBP, office DBP, gestation n°, give birth n°, were statistically significant for: 24 h SBP, 24 h DBP respectively HR 1.02 (IC1.00-1.03); 1.03 (IC1.01-1.05); Day DBP 1.02 (IC 1.00-1.05); Night SBP, Night DBP, Systolic BP dipping, Diastolic BP dipping respectively HR 1.02(IC1,01-1.03);1.03(IC1.01-1.05);0.96 (IC 0.94-0.98); 0.96 (IC 0.94-0.99) When DBP dipping was adjusted to night DBP, night DBP remains significant and DBP dipping loses respectively HR 1.03(IC 1.00-1.05) and 0.99(IC 0,95- 1.02). When analyzed DBP dipping by the pattern dipping (D)/non dipping (ND, (ND-35 D-198), in a crosstabs analysis, those with event ND pattern was found in 71% and 28,6 % with no event(X2 6.9 p < 0,05). In a survival curve free of events, the presence of the diastolic dipping ND_D pattern, ND was associated to a worst prognosis (log rank 11.2 p < 0.001) Conclusions: Night diastolic values are the best prognosis for prediction of events related to outcomes in pregnant woman's with hypertension, special DBP. Casual BP and even home ambulatory blood pressure are scanty for this period.