Hypertension arterial sistemica jnc 7 pdf download Download the App today. 7(2) o- agosto Tratamiento farmacológico de la hipertensión arterial La. HIPERTENSION ARTERIAL SISTEMICA JNC 7 PDF DOWNLOAD. The diagnostic evaluation requires. And diabetes mellitus and systemic arterial hypertension. Download JNC 7; JNC-8 RECUERDA: La hipertensión arterial sistémica y la proteinuria destacan como los ores predictores de.
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Stage 2 corresponds to hypertension that has caused detectable damage in a target organ. In Stage 3, the hypertension falls within the clinical context of cardiovascular disease, which is referred to as hypertension with associated clinical disorders. The prognosis in both stages worsens, especially in Stage 3, in which secondary prevention is involved. The kidney is a target organ and is considered to be affected Stage 2 if there is gross proteinuria or a mild increase in creatinine from 1. Chronic renal failure in a year old man represents a fold rise in the risk of death due to vascular disease.
Information on demographic and socioeconomic factors, health-related behaviors, anthropometric measures, morbidities, and self-rated health was collected through household interviews. Systolic and diastolic blood pressure levels were also assessed as well as use of antihypertensive medications and medical diagnosis of hypertension. The dependent variable was categorized as normal blood pressure, prehypertension and hypertension.
Polytomous multiple logistic regression analysis was performed with use of a multinomial logit model.
The polytomous regression analysis showed that prehypertension was significantly associated with males, black skin, years of age, leisure-time physical inactivity, and pre-obesity. Hypertension was associated with males, 40 years of age or more, intermediary tertile of per capita family income, less than 12 years of schooling, leisure-time physical inactivity, pre-obesity, obesity, abdominal obesity, and negative self-rated health.
Descriptors: Hypertension. Risk Factors. Cross-Sectional Studies. Descriptores: Adulto. Factores de Riesgo. Estudios Transversales. PreHT is not an illness; however, those with prehypertension are at greater risk of developing HT and increase their risk of cardiovascular disease compared with normotensive individuals.
HT was more prevalent in older people, those with black skin, those with low socioeconomic status, those with a diet high in salt and those who were overweight.
Diagnosing preHT is important so that campaigns to diminish the damage caused by HT and the cost of hospital admissions due to cardiovascular disease can begin earlier. Only one study on preHT was carried out with adults, and that was in a small town.
We interviewed 32 adults in each of the 63 census districts, increasing the sample size to individuals. Selection of the sample went through two stages.
In the second stage, the sampling units were households. The number of houses in each randomly selected sector was updated by the supervisors of the study, who counted the number of dwellings in each of the selected sectors the number of dwellings ranged from 61 to The result of this process was sixty three census districts, totalling 16, eligible families, of which 1, were systematically selected.
On average, 32 adults were selected from each census district. Adults aged 20 to 59, who resided in the dwellings selected, were eligible for the study. Exclusion criteria were: being bedridden, amputees or those with limbs in plaster, neurological disorders which interfered with understanding of the interview questions.
Pregnant women and those who had had a child in the six months previous to the study did not have their blood pressure or anthropometric measurements taken, as this would affect the values obtained. Face to face interviews were carried out with the adults living in the selected dwellings. There has been the selection of 35 five interviewers who had completed Secondary education and were available for the entire period of the survey in order to carry out this field work. They used a Personal Digital Assistant PDA to record and store the data obtained, eliminating the need for inputting data later.
Key information was verified through telephone contact by the field supervisor. The value of Kappa varied from 0. Comprehension of the questions was tested beforehand by giving the questionnaire to 30 adults resident in an area covered by one of the municipality's health units. A pilot study, with around people from two census districts randomly selected for the purpose, was carried out after the interviewers had received training. The results were not incorporated into the study.
Resting time before and between the two measurements was approximately 15 minutes. Measurements were taken using the right arm, resting on a table at heart height, palm upwards. The individuals were seated, with both feet on the floor.
Normal blood pressure was defined as when the individual reported that they were not taking any medication for high blood pressure, had not been diagnosed with high blood pressure and had SBP lower than mmHg and DBP lower than 80 mmHg.
At time of collection the Brazilian classification of occupations was adopted, which was later adapted to the British classification according to Boing et al. II - administrative and technical, III - specialist professionals.
The last two categories were grouped together. Underweight individuals were excluded from the tables due to low frequency 2. Technical error of measurement TEM inter and intra evaluator was calculated according to the recommendations of Gore et al. The subjects responded to the question of whether they had been diagnosed with diabetes yes; no.
Self-evaluation of health was measured in five categories and dichotomised into positive very good and good and negative regular, bad and very bad self-evaluations of health. Polytomous logistic regression with the multinomial Logit model was carried out to determine factors associated with preHT and HT.
The variables were grouped into a hierarchical model from distal to proximal determinants. The variables were included in the adjusted model, irrespective of the raw analysis p.
The forward and backward methods showed similar results, and we opted for the backward method. The analyses were stratified according to sex due to the nature of the outcome and the different prevalence of HT in men and women.
However, on verifying factors which were associated with preHT and HT in both sexes, we observed that the same factors were repeated irrespective of sex, modifying the magnitude of the correlation, without changing its direction. We opted not to carry out analyses stratified by sex in order to increase the power of the statistical analyses. The analyses were carried out using Stata The subjects were informed of the aims of the study and signed consent forms.
Design effects were, respectively, 1. The majority of the sample were female, with white skin, aged 20 to 29 with more than 12 years in the educational system, with private health plans and non-manual occupation.
Approximately a fifth of the sample reported problems with alcohol and were smokers. More than half did no physical activity in their free time and did not regularly eat fruit and vegetables. The prevalence of obesity, abdominal obesity and diabetes was Almost a fifth of the individuals evaluated their own health negatively Table 1. The prevalence of preHT and HT was The chances of having HT were greater for people over 40, those in the intermediate tercile for income, those who had a manual occupation, those with alcohol abuse issues, those who smoked 10 or more cigarettes a day, those who were physically inactive in their free time, those with unsuitable nutrition, diabetics and those with a negative perception of their own health in the raw analysis Table 3.
The chances of the subjects having preHT, when compared with normotensive individuals, were greater, in the adjusted analysis, in the following groups: male, black skin, over 50s, physically inactive and overweight. Habits affecting health may determine the magnitude with which HT is associated with sex.
PreHT is strongly correlated with having black skin. The authors explain their findings based on social inequalities between the two segments of the population, which hinders access to diagnosis and treatment of HT. Those with black skin make up the segment of the Brazilian population which most feels the impact of social inequalities, a fact which can be explained historically, mainly due to slavery in Brazil in the nineteenth century.
Statistical Analysis The estimation of the year risk for coronary disease for each patient was obtained from the Framingham equation detailed in the appendix to the article by Wilson et al,15 calibrated for Spain according to the appendix of the article by Marrugat et al. The estimation of the year risks for coronary death and vascular death was done from the SCORE equation, described in the appendix of the article by Conroy et al,17 which includes all those risk factors included in the Framingham equation except diabetes.
Models for a low-risk region were followed as well as a model that uses the association between cholesterol and HDL cholesterol HDL-C as a risk factor instead of just total cholesterol. The comparison of renal disease between each regional autonomous community in Spain was done using an analysis of variance ANOVA that included the effects of age, sex, and the autonomous community. The models were analyzed using the statistical package SAS, version 8. Table 1 shows the percentage of patients with the two stages of kidney disease in each regional autonomous community.
With the exception of the Basque Country, the percentage of patients with one or other of the two stages of kidney disease was similar in all the autonomous regions. The rates of kidney disease were similar in both men and women. Kidney disease was more common in older patients with hypertension and in those with a previous diagnosis of hypertension; it was not associated with a family history of cardiovascular disease.
Cardiovascular Risk and Renal Disease Tables 2 and 3 The presence of cardiovascular risk factors was more common in the patients with some degree of kidney disease. The prevalence of diabetes was twice as high in the patients with renal disease, especially in those who already had chronic renal failure; a similar situation was seen with the presence of left ventricular hypertrophy. No significant differences were detected, however, in the diastolic BP DBP or heart rate, nor in obesity, as considered from the body mass index.
No significant differences were noted in the average concentrations of total cholesterol or low density lipoprotein LDL cholesterol LDL-C. Strangely, those patients with some degree of renal disease had a lower prevalence of smoking, which was even less in the patients who had more severe renal disease. The differences were clinically important in both calculations. However, no significant differences were found for the risk of cardiovascular death, either coronary or non-coronary, according to the SCORE project.
Cardiovascular Disease and Renal Disease Table 4 One third of the hypertensive patients with renal disease had another cardiovascular disease; this represented 10 percentage points above the frequency of the association that was found in the other patients with hypertension.
The patients with renal disease more often had angina; they also had twice the rate of myocardial infarction and were more than twice as likely to have undergone coronary revascularization or to have peripheral or cerebral vascular disease.
Heart failure was four times more frequent in the patients with severe renal disease as compared with the hypertensive patients with no signs of renal disease. Symptoms in target organs and the onset of vascular disease associated with hypertension are considered prognostic markers in hypertensive patients.
Not surprisingly, therefore, these patients have a much higher coronary risk than those with hypertension but no associated renal disease, and follow-up studies have shown a greater true mortality in these patients.
As seen in other studies,20 these patients were older, with slightly higher average SBP figures and more often had left ventricular hypertrophy; the control of the hypertension is worse than in patients with no accompanying renal disease.
An interesting point was the notable reduction in smoking in relation to renal disease and its severity. This could reflect a true reduction as a consequence of identifying smoking as a collaborative cause of vascular disease or be the result of a greater mortality in the subgroup of patients with kidney disease who also smoked.
The risk of having a coronary event is raised in primary care patients with kidney disease, both according to the uncorrected Framingham equation and to the equation corrected for the Spanish population. These differences are mainly based on the increased prevalence of diabetes in hypertensive patients with kidney disease.
However, the risk of coronary death and non-coronary cardiovascular death, calculated in accordance with the SCORE project, showed no differences between the groups with and without renal disease. This apparent paradox can be explained by the inability of the SCORE method to detect differences in population risk when these differences are derived from a varying prevalence of diabetes. This point has been the subject of an earlier communication.
In fact, the prevalence of renal disease in groups of persons from the general population without hypertension or diabetes is already estimated to be 6. Consequently, the patients with just microalbuminuria were not considered to have renal disease for the purposes of this study.