Arquivos brasileiros de cardiologia最新文献

{"title":"Cardiovascular Telerehabilitation: An Alternative for Greater Availability of Cardiovascular and Metabolic Rehabilitation in Brazil.","authors":"Artur Haddad Herdy, Ariella Sebastião Mangia, Magnus Benetti","doi":"10.36660/abc.20240570","DOIUrl":"10.36660/abc.20240570","url":null,"abstract":"<p><p>Central Illustration: Cardiac Telerehabilitation - An alternative for patients with difficulty attending rehabilitation centers.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 3","pages":"e20240570"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uptake of Influenza Vaccine among Older Adults with Cardiovascular Comorbidities.","authors":"Rodrigo S Aguilar, Ana Paula Rosim Giraldes, Maria Paula Barbieri Delia, Meliza Goi Roscani, Henrique Pott","doi":"10.36660/abc.20240537","DOIUrl":"10.36660/abc.20240537","url":null,"abstract":"<p><strong>Background: </strong>Influenza vaccination reduces illness and fatality in older adults, especially those with cardiovascular comorbidities.</p><p><strong>Objective: </strong>To investigate influenza vaccination uptake among community-dwelling older Brazilian patients with cardiovascular comorbidities.</p><p><strong>Methods: </strong>This cross-sectional study analyzed data from the ELSI-Brazil Second wave (2019-2021), involving 9,949 older adults. Participants with cardiovascular conditions provided data on influenza vaccination from the previous year. Vaccination-associated factors were identified, with subgroup analyses for each cardiovascular comorbidity. An exploratory analysis investigated the primary reasons for non-vaccination. Statistical significance was determined with a two-sided P-value < 0.05.</p><p><strong>Results: </strong>This study included 5,296 individuals. Of these, 76.6% reported receiving the influenza vaccine within the year before data collection. Vaccinated individuals were generally older females, widowed, and non-smokers with healthier habits and private healthcare access, although they had higher frailty and cardiovascular comorbidities. Age significantly influenced the likelihood of vaccination across subgroups. In hypertension, private healthcare and good health status increased the odds, while smoking and alcohol consumption reduced them. The most common reasons for not receiving the influenza vaccine were fear of adverse reactions (18.2%), belief in a low-risk infection (14.9%), vaccine unavailability (13.9%), and lack of confidence in its effectiveness (12%).</p><p><strong>Conclusion: </strong>About 24% of older Brazilian adults with cardiovascular conditions remain unvaccinated against influenza, posing severe health risks. Strategies addressing personal beliefs, improving access, and enhancing healthcare provider engagement are crucial. Tailored interventions should align with the population's demographic and health characteristics to overcome these barriers effectively.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 3","pages":"e20240537"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fabry Disease and Its Different Phenotypes.","authors":"Murillo Oliveira Antunes, Rafael Ruas Nastari, Edmundo Arteaga-Fernandez, Marcelle G Henriques Lizandro, William Batah El-Feghaly, Guilherme José Dos Santos Ferreira, Alan Silva Martins, Juliana Alzira Gonzales Oliveira Leguizamon, Vinicius Machado Correia, Vagner Madrini Junior, Fábio Fernandes","doi":"10.36660/abc.20240535","DOIUrl":"10.36660/abc.20240535","url":null,"abstract":"<p><p>Fabry disease (FD) is an X-linked genetic condition caused by variants in the GLA gene causing enzyme α-galactosidase A deficiency and accumulation of globotriaosylceramide (Gb3) in tissues such as the heart, kidneys, and the nervous system. This study reports a case series of patients with FD, highlighting the phenotypic diversity of the disease, which can be confused with other cardiological conditions. When properly indicated, genetic evaluation, combined with biomarker dosage and α-galactosidase enzymatic activity, is key for an accurate diagnosis. Early diagnosis of FD is fundamental for initiating treatments that can slow disease progression and prevent serious complications, reinforcing the need for greater awareness about this condition among cardiologists.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 2","pages":"e20240535"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cascade Screening in Adolescents with Lipid Disorders Suggestive of Familial Hypercholesterolemia: Findings from the ERICA Study in Curitiba.","authors":"Vivian Freitas Rezende Bento, Tatiana Lorena da Luz Kaestner, Amauri de Vargas Junior, Renan Barbosa Lopes, Fernando Pinotti Scariot, Leiza Loiane Hollas, Marcia Olandoski, Cristina Pellegrino Baena, Katia Vergetti Bloch, José Rocha Faria Neto","doi":"10.36660/abc.20240468","DOIUrl":"10.36660/abc.20240468","url":null,"abstract":"<p><strong>Background: </strong>Familial hypercholesterolemia (FH) is a common genetic cause of premature coronary heart disease due to prolonged exposure to high levels of LDL cholesterol (LDL-C). Its prevalence in the heterozygous form ranges from 1:200 to 1:500, and early diagnosis is fundamental for treatment and risk reduction. Cascade screening is recommended upon the identification of index cases.</p><p><strong>Objectives: </strong>To assess the prevalence of lipid disorders suggestive of FH in students aged 12 to 17 years participating in the ERICA study in Curitiba and to determine the prevalence of FH based on clinical and laboratory criteria in these adolescents and their first-degree relatives undergoing cascade screening.</p><p><strong>Methods: </strong>Using data from the ERICA study, adolescents with LDL-C levels > 160 mg/dL or non-HDL cholesterol > 190 mg/dL were identified, along with their first-degree relatives. The clinical diagnosis of the study participants was based on the DUTCH MedPed criteria. Statistical significance was defined as P < 0.05.</p><p><strong>Results: </strong>Eleven adolescents with lipid disorders suggestive of FH were identified among the 2,383 evaluated (1:216). Of these, 7 students and 15 first-degree relatives were assessed. None of the adolescents had a diagnosis of possible FH confirmed by the clinical score. However, 3 family members (20%) were diagnosed with possible/probable FH.</p><p><strong>Conclusion: </strong>Although the clinical score application did not confirm any cases among adolescents with lipid disorders suggestive of FH, indicating a limitation of the diagnostic method in this population, cascade screening identified potential cases in first-degree relatives.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 3","pages":"e20240468"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patisiran Treatment in the Brazilian Subpopulation of the Phase 3 APOLLO-B Study in Transthyretin Amyloidosis with Cardiomyopathy: Post Hoc Analysis.","authors":"Claudio Tinoco Mesquita, Pedro Schwartzmann, Edileide Barros Correia, Marcus V Simões, Andreia Biolo, Daniel Rodriguez Duque, Patrick Y Jay, Fábio Fernandes","doi":"10.36660/abc.20240568","DOIUrl":"10.36660/abc.20240568","url":null,"abstract":"<p><strong>Background: </strong>Patisiran rapidly knocked down transthyretin and preserved functional capacity in patients with transthyretin amyloidosis with cardiomyopathy (ATTR-CM) in the global Phase 3 APOLLO-B study (NCT03997383).</p><p><strong>Objectives: </strong>To evaluate patisiran efficacy and safety in post hoc analysis of the Brazilian subpopulation of APOLLO-B.</p><p><strong>Methods: </strong>Patients were randomized 1:1 to patisiran 0.3 mg/kg or placebo every 3 weeks for 12 months. The primary endpoint was the change from baseline (CFB) in functional capacity (6-minute walk test [6MWT]) at Month 12. Secondary endpoints included CFB to Month 12 in the Kansas City Cardiomyopathy Questionnaire-Overall Summary (KCCQ-OS) score. Exploratory endpoints included CFB in cardiac biomarkers and Perugini grade of cardiac uptake during technetium-99m scintigraphy.</p><p><strong>Results: </strong>Forty-two patients enrolled in Brazil (patisiran, n=20; placebo, n=22). Patisiran showed benefit in 6MWT and KCCQ-OS scores vs. placebo; CFB (95% confidence interval [CI]) in 6MWT (median) and KCCQ-OS scores (least squares mean) was -2.0 m (-58.5, 42.9) and 9.37 (1.93, 16.81) points with patisiran vs. -30.1 m (-72.2, 3.5) and 2.62 (-4.68, 9.92) points for placebo. For cardiac biomarkers, the mean fold-change from baseline (95% CI) for N-terminal prohormone B-type natriuretic peptide and troponin I was 1.31 (1.06, 1.61) and 1.12 (0.94, 1.34) for patisiran, and 1.71 (1.39, 2.10) and 1.28 (1.08, 1.53) for placebo, respectively. Perugini grade improved in 11/18 (61.1%) and 0/10 evaluable patients with patisiran and placebo, respectively. There were no deaths in the patisiran group vs. 3 in the placebo group.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 4","pages":"e20240568"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Complex Puzzle of Hypertrophic Phenotype: A Practical Approach for the Clinician.","authors":"Alex Dos Santos Felix, Silvio Henrique Barberato, Marcelo Dantas Tavares de Melo, Sílvia Aguiar Rosa, Nuno Cardim","doi":"10.36660/abc.20240529","DOIUrl":"10.36660/abc.20240529","url":null,"abstract":"<p><p>Left ventricular hypertrophy (LVH) represents a frequent observation in clinical practice. Nonetheless, the hypertrophic phenotype emerges as a common manifestation of diverse conditions, thereby presenting a diagnostic conundrum for clinicians. Differentiation among the etiologies of LVH is imperative for therapy decision-making, as different approaches must be implemented for distinct conditions, such as LVH secondary to loading changes, hypertrophic cardiomyopathy (HCM), or HCM mimics. In some instances, an erroneous or late diagnosis may lead to a progression of the underlying disease with worsening functional capacity, high morbidity and mortality. The rational use of cardiovascular multimodality imaging is of great importance when carried out in addition to a thorough clinical assessment and correlated with electrocardiographic findings, providing clues to fill the gaps, being, most of the time, the missing piece to solve this challenging puzzle. An integrative approach is of paramount importance for the evaluation of these patients, as they are often followed by several specialties, with varied systemic manifestations. Although a multidisciplinary team is needed for an optimized follow-up of these patients, the most important player in this journey is the clinician, whose mission is to bring together all the red flags and coordinate all the data for an assertive diagnosis. The objective of this review is to provide a pragmatic methodology, highlighting important clues for discriminating among the diverse conditions that result in LVH.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 1","pages":"e20240529"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Growth Differentiation Factor 15 is Correlated With Urinary Markers in Patients with Chronic Heart Failure.","authors":"Gustavo Rodolfo Moreira, Diane Xavier Ávila, Angelo Michele Di Candia, Victoria Depes Scaramussa, Humberto Villacorta","doi":"10.36660/abc.20240153","DOIUrl":"10.36660/abc.20240153","url":null,"abstract":"<p><strong>Background: </strong>There is a lack in identifying heart failure (HF) patients with an increased risk of hospitalization and death. Growth differentiation factor 15 (GDF-15), a biomarker associated with inflammation and oxidative stress, emerges as a candidate associated with cardiovascular and renal disease. The low estimated glomerular filter rate (eGFR), low urinary sodium (UNa), and the high ratio of albumin to creatinine are renal markers already associated with a high risk of hospitalization and mortality.</p><p><strong>Objective: </strong>To evaluate the relationship between GDF-15 and renal markers in patients with chronic HF.</p><p><strong>Method: </strong>We enrolled 87 consecutive patients with symptomatic HF with reduced left ventricular ejection fraction (LVEF < 40%), mildly reduced LVEF (40-49%) or an improved LVEF (50% but previously < 50%) in a university hospital. We compared the associations of GDF-15 and NT-proBNP with renal markers using correlation tests and multiple regression analysis at the significance level of 5%.</p><p><strong>Results: </strong>GDF-15 and NT-proBNP had weak to moderate negative correlations with UNa (r=-0.362, p=0.007; r=-0.334, p=0.014, respectively) and eGFR (r=-0.385, p=0.0002; r=-0.346, p=0.001, respectively). GDF-15, age, hypertension and NT-proBNP were independently associated with eGFR in multiple regression analysis (overall R2=0.32). GDF-15 (positive) and age (negative) were independently associated with UAC (overall, R2=0.30). Only GDF-15 was independently associated with UNa (R2=0.45).</p><p><strong>Conclusions: </strong>In these chronic patients with HF, GDF-15 is better correlated with markers of renal dysfunction than NT-proBNP. Since the prognostic value of renal markers is well established, these findings reinforce the prognostic role of GDF-15 in chronic HF.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 3","pages":"e20240153"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subclinical Atrial Fibrillation Screening in Dialytic Chronic Kidney Disease Patients Using Portable Device.","authors":"Adson Patrik Vieira Carvalho, Gabriel Assis Lopes do Carmo, Cassia Aparecida Silva, Ana Cecília Oliveira, Lucas Giandoni Perez, Lilian Pires de Freitas do Carmo, Antonio L Ribeiro","doi":"10.36660/abc.20240450","DOIUrl":"10.36660/abc.20240450","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular morbidity and mortality rates are higher in hemodialysis (HD) patients, with an increased prevalence of arrhythmias. Atrial fibrillation (AF) is an independent risk factor for mortality and thromboembolic events in dialysis patients. For a better understanding and management of AF in these patients, it is important to know its prevalence. The use of a portable device would be pioneering for this group of patients.</p><p><strong>Objective: </strong>To screen HD patients for AF using a portable gadget and evaluate the device's diagnostic performance.</p><p><strong>Methods: </strong>HD patients at a tertiary hospital underwent AF screening during HD sessions using MyDiagnostick® (Applied Biomedical Systems). Multiple data were collected to evaluate potential associations. Statistical significance was defined as p < 0.05.</p><p><strong>Results: </strong>388 patients were evaluated (female, 40.7%; mean age of 56.8 years old, SD ± 14.7; and HD time of 27 months, 10-57). Screening was positive in 16 (4.1%) patients. AF was confirmed by electrocardiogram in 7 (1.8%) patients. Male sex (p = 0.019), older age (p = 0.007), altered baseline electrocardiogram (p < 0.001), increased serum potassium (p = 0.021), reduced systolic blood pressure at the beginning of dialysis (p = 0.007), and stable angina (0.011) were associated with positive screening for AF. The device presented a 91.74% specificity (95% CI, 86.65% to 96.91%) and 100% sensitivity (95% CI, 100% to 100%), with a negative predictive value of 100% (95% CI, 100% to 100%) for AF screening.</p><p><strong>Conclusion: </strong>The use of this device proved to be practical, with high sensitivity and excellent negative predictive value. Subclinical AF has a high prevalence and may be underestimated in this population.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 3","pages":"e20240450"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophageal Protection Strategies for Ablation of Atrial Fibrillation: Comparative Results of Consecutive Endoscopic Evaluation.","authors":"Alberto Pereira Ferraz, Cristiano Faria Pisani, Esteban Wisnivesky Rocca Rivarola, Tan Chen Wu, Francisco Carlos da Costa Darrieux, Rafael Alvarenga Scanavacca, Muhieddine Omar Chokr, Carina Abigail Hardy, Sissy Lara de Melo, Denise Tessariol Hachul, Beatriz Hachul de Campos, Mauricio Ibrahim Scanavacca","doi":"10.36660/abc.20230913","DOIUrl":"10.36660/abc.20230913","url":null,"abstract":"<p><strong>Background: </strong>Atrial-esophageal fistula following AF ablation remains a concern. There is no standardized approach to minimize its risk and morbidity.</p><p><strong>Objective: </strong>To present the seven-year experience of a systematic endoscopic surveillance of esophageal injury after AF catheter ablation.</p><p><strong>Methods: </strong>This is a retrospective single center registry of systematic endoscopic evaluation after AF ablation in consecutive procedures performed from 2016 to 2022. A p-value of <0.05 was considered statistically significant.</p><p><strong>Results: </strong>823 AF ablation with controlled esophagogastroduodenoscopy (EGD) were analyzed. Most patients (n=588, 71.4%) were male, 575 (69.9%) had paroxysmal AF. Esophageal temperature monitoring was performed using a single sensor in 310 patients (40.3%) and a multi-sensor probe in 306 (39.8%). Lesions were presented in 217 EGD (26.5%): hematoma-ecchymosis in 27 (3.3%), erythema in 14 (1.7%), erosion in 78 (9.5%) and ulcer in 67 (8.2%) patients. No esophageal protective strategy was associated with more ulcers, except the use of 8mm tip-catheter (14.7% of ulcers with 8mm tip catheter vs 6.7% with other catheters, p = 0.001). Thermal lesions were early detected and treated. Most lesions were considered healed at endoscopy, but one patient who underwent pulmonary vein isolation with an 8m tip catheter had esophageal fistula, treated successfully with endoscopic metal clip and endoloop technique.</p><p><strong>Conclusion: </strong>The incidence of esophageal lesions at routine EGD following AF ablation is high, although in most of the cases they heal spontaneously. Patients who underwent ablation with the 8mm tip catheter had more severe thermal lesions. Early esophagus endoscopy may help the diagnosis of early-stage lesions and the prevention of fistula formation after AF ablation.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 3","pages":"e20230913"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review of the Effectiveness of Intensive Antihypertensive Treatment Goals: Brazilian Society of Cardiology (SBC) Recommendation.","authors":"Andréa Araujo Brandão, Cibele Isaac Saad Rodrigues, Luiz Aparecido Bortolotto, Leonardo Castro Luna, Bruno Monteiro Barros, Mario Fritsch Toros Neves, Ana Flávia de Souza Moura, Frida Liane Plavnik, Luciano Ferreira Drager, Osni Moreira Filho, Weimar Kunz Sebba Barroso de Souza, Wilson Nadruz","doi":"10.36660/abc.20240761","DOIUrl":"10.36660/abc.20240761","url":null,"abstract":"<p><strong>Background: </strong>Strict blood pressure control has been investigated as a strategy to reduce severe cardiovascular events in patients with hypertension. However, there are still doubts about the impact of intensive antihypertensive treatment goals (< 130/80 mmHg) compared to conventional goals (≥ 130/80 mmHg) in preventing myocardial infarction, stroke, mortality, and possible treatment-related adverse effects.</p><p><strong>Objective: </strong>To evaluate the effectiveness of intensive antihypertensive treatment goals in reducing critical cardiovascular events compared to usual goals.</p><p><strong>Methods: </strong>This systematic review included randomized controlled trials (RCTs) that compared intensive blood pressure control goals with conventional goals in adults aged 18 years or older. Studies with at least one of the following outcomes were included: mortality, myocardial infarction, stroke, progression to stage 4 or 5 chronic kidney disease, need for dialysis, or kidney transplantation. Medline, Embase, and Cochrane Library databases were searched up to May 2024. Risk of bias assessment was performed by two independent reviewers using the Cochrane Collaboration's Risk of Bias 2 (RoB 2) tool. Synthesis of results was conducted through meta-analysis for the composite outcome of myocardial infarction, stroke, and all-cause mortality. The certainty of scientific evidence and strength of recommendation followed the methods proposed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.</p><p><strong>Results: </strong>Nine RCTs with more than 34,000 participants were included. Intensive treatment was associated with a 13% reduction in cardiovascular events. In the studies with low risk of bias, the reduction was 17%, with high certainty of evidence. Separately, a significant reduction was observed in the outcomes of myocardial infarction and stroke, but not in all-cause mortality. Limited data were found on the progression of kidney disease and the need for dialysis or kidney transplantation.</p><p><strong>Conclusion: </strong>High-quality evidence suggests that more intensive antihypertensive treatment goals significantly reduce cardiovascular events. However, the choice of treatment goals should be individualized, considering factors such as age, frailty, individual cardiovascular risk, and the possibility of adverse events. Adherence to treatment is essential to therapeutic success.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 3","pages":"e20240761"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}