Resistant hypertension (RH) is characterized by the use of three or more antihypertensive drugs without reaching the goal of controlling blood pressure (BP). For a definitive diagnosis of RH, it is ...necessary to exclude causes of pseudoresistance, including the white-coat effect, errors in BP measurement, secondary hypertension, therapeutic inertia, and poor adherence to lifestyle changes and pharmacological treatment. Herein, we report the history of a patient with long-standing uncontrolled BP, even when using seven antihypertensive drugs. Causes of secondary hypertension that justified the high BP levels were investigated, in addition to the other causes of pseudo-RH. In view of the difficult-to-control BP situation, it was decided to hospitalize the patient for better investigation. After 5 days, he had BP control with practically the same medications previously used. Finally, all factors related to the presence of pseudo-RH are discussed, especially poor adherence to treatment. Poor adherence to antihypertensive treatment is common in daily medical practice, and its investigation is of fundamental importance for better management of BP.
SARS-CoV-2, o novo coronavírus, surpreendeu o mundo com a sua capacidade de infecção, causando uma preocupação emergente de saúde pública com mais de 3 milhões de pessoas afetadas em apenas quatro ...meses. A taxa de mortalidade é variável entre os países, considerando as suas estruturas etárias e o percentual de comorbilidades. Os Idosos e as pessoas com doenças subjacentes são mais suscetíveis ao desenvolvimento de casos graves de COVID-19 e têm maior taxa de mortalidade. As doenças cardiovasculares têm uma importância particular, uma vez que a sua prevalência é elevada e considerando a fisiopatologia da infecção. O vírus usa os receptores da enzima de conversão da angiotensina (ECA) 2 para invadir as células humanas. Esses receptores estão principalmente nos pulmões e no coração. Além do dano viral direto, a hipóxia, a tempestade de citocinas e a libertação de catecolaminas também afetam esses órgãos. No coração, estudos mostraram que a COVID-19 pode causar miocardite, arritmias ventriculares, síndrome coronária aguda e insuficiência cardíaca. Além disso, a lesão cardiovascular pode ser a primeira manifestação de infecção viral em alguns casos, motivo de maior preocupação durante esta pandemia. Os inibidores da ECA e os bloqueadores dos receptores da angiotensina (BRA) são medicamentos de suma importância no tratamento de doenças cardiovasculares. No entanto, alguns estudos sugeriram preocupação com esses medicamentos na COVID-19, pois eles poderiam causar um aumento da ECA2 e aumentar a gravidade da infeção. Até onde sabemos, nenhum estudo demonstrou que inibidores da ECA ou ARA são prejudiciais e as principais sociedades cardiovasculares recomendam a continuidade do tratamento.
Background
Systemic arterial hypertension (SAH) is one of the major risk factors related to the development of cardiovascular diseases (CVD). Sodium intake is linked to elevated blood pressure and ...can be estimated by 24-h urinary sodium excretion. The objective of this study was to correlate 24 h urinary sodium excretion, blood pressure and arterial stiffness (AS) parameters in hypertensive individuals.
Methods
We evaluated 53 patients who underwent in-office 24-h blood pressure tests and AS parameters using the Mobil-O-Graph
®
equipment. Te patients were divided into controlled hypertensive and resistant hypertensive. Unpaired
t
-test was performed with significance at
p
< 0.05.
Results
Mean age was 64.32 years; weight 77.56 kg; height 1.61 m; and BMI of 29.68 kg/m
2
. Resistant hypertensive patients (25 subjects) have systolic blood pressure (SBP) (
p
< 0.0001), diastolic blood pressure (DBP) (
p
= 0.004), 24 h SBP (
p
< 0.0001), 24 h DBP (
p
= 0.002), pulse pressure (PP) (
p
< 0.0001), central systolic blood pressure (cSBP) (
p
= 0.0003) and central diastolic blood pressure (cDBP) (
p
= 0.021) higher than controlled hypertensive patients (28 subjects).
Conclusion
Peripheral and central arterial pressures are higher in resistant hypertensive than in controlled hypertensive. Sodium excretion is unrelated to hemodynamic variables. Age is related to the elevation of central pressure and pulse wave velocity.
SARS-CoV-2, the novel coronavirus, surprised the world with its capacity of infection, causing a public health emergency concern with more than 3 million people affected in only four months and ...forcing public institutions to search for ways of obtaining the contention of the virus. The mortality rate is very different among the countries, considering their age structure and the percentage of comorbidities. Elderly and people with underlying diseases are more susceptible to develop severe cases of COVID-19 and have higher case fatality rate. Cardiovascular diseases have a particular importance, given that their prevalence is elevated and considering the infection pathophysiology. Virus uses angiotensin-converting enzyme (ACE) 2 receptors to invade the human cells. These receptors are mainly in the lungs and the heart. Besides the direct viral insult, hypoxia, cytokines storm and catecholamine’s liberation also affect these organs. In the heart, studies have shown that COVID-19 can cause myocarditis, ventricular arrhythmias, acute coronary syndrome and heart failure. Moreover, the cardiovascular insult may be the first manifestation of viral infection in some cases, which is a matter of increased concern during this pandemic. ACE inhibitors and angiotensin receptor blockers (ARB) are drugs of paramount importance in the treatment of cardiovascular diseases. However, studies suggested concern about these medications in COVID-19 because they could cause an ACE2 upregulation and increase the severity of the infection. To the best of our knowledge, no study demonstrated that ACE inhibitors or ARB are harmful and the main cardiovascular societies are recommending the continuity of the treatment.
Resistant hypertension (RH) is characterized by the use of three or more antihypertensive drugs without reaching the goal of controlling blood pressure (BP). For a definitive diagnosis of RH, it is ...necessary to exclude causes of pseudoresistance, including the white-coat effect, errors in BP measurement, secondary hypertension, therapeutic inertia, and poor adherence to lifestyle changes and pharmacological treatment. Herein, we report the history of a patient with long-standing uncontrolled BP, even when using seven antihypertensive drugs. Causes of secondary hypertension that justified the high BP levels were investigated, in addition to the other causes of pseudo-RH. In view of the difficult-to-control BP situation, it was decided to hospitalize the patient for better investigation. After 5 days, he had BP control with practically the same medications previously used. Finally, all factors related to the presence of pseudo-RH are discussed, especially poor adherence to treatment. Poor adherence to antihypertensive treatment is common in daily medical practice, and its investigation is of fundamental importance for better management of BP.
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