7 4 6 5 9- 5 3 2 e n nli EDITORIAL Green Tea Attenuates Hypotension Induced by o Physical Exercise: A Randomized, Placebo Controlled SN Cardiology Journals from Portuguese-Speaking Study 2 | IS Countries: Challenges and Opportunities Study of Dabigatran Use in a Brazilian Public Hospital 0 8 Specialized in Cardiology 4 9- ORIGINAL ARTICLES 5 3 nt 2 2Pr4e-dHicotusr OAumtcboumlaetosr oy fB Hloyopde rPterensssivuere P Matoiennittso riinn g REVIEW ARTICLE pri Primary Care: A Cohort Study Predictors of Metabolic Syndrome in the Elderly: A N Review S st | IS AMreea Psuartieedn tisn’ MBleodoidc aPl rOesffisuceres ?Levels Being Routinely u VIEWPOINT g Au 12-Month Clinical Follow-Up of Patients Undergoing y / Early Invasive Strategy by the Transradial or Detailing Peripheral Arterial Tonometry in Heart ul Transfemoral Approach with Vascular Closure Device Failure. An Endothelial Function Evaluation J 4 | ber PMryoobcaabridlisiatilc R Mevoadseclu floarr izParetiodnic:t iCoonm opf lPicraotgionnoss tiinc s in CASE REPORTS m u Coronary Surgery N Cardiac Memory, an Underdiagnosed Condition 0 - 3 Are Body Fat and Uric Acid associated with e Cardiovascular Risk Scores? Cross-Sectional Analysis A Transcatheter Aortic Valve Implantation Without m Aortography Guidance Due To Vascular Access u in the PROCARDIO-UFV Trial ol Constraints Or Limitations V SUMMARY • Editorial Cardiology Journals from Portuguese-Speaking Countries: Challenges and Opportunities ......................................... 283 Luiz Felipe P. Moreira • Original Articles 24-Hour Ambulatory Blood Pressure Monitoring Predicts Outcomes of Hypertensive Patients in Primary Care: A Cohort Study ................................................................................................................................................................................ 285 Guilherme Brasil Grezzana, Airton Tetelbon Stein, Lucia Campos Pellanda Are Patients’ Blood Pressure Levels Being Routinely Measured in Medical Offices? ................................................... 293 Israel Guilharde Maynarde, Thiago Veiga Jardim, Weimar Kunz Sebba Barroso de Souza, Ana Luiza Lima Sousa, Andrey Rocha Rocca, Bruna Yana de Carvalho Lin, Natália Mirelle Carrijo dos Santos, Diogo Pereira Santos Sampaio, Xênia Larissa Motta Serafim, Paulo Cesar Brandao Veiga Jardim 12-Month Clinical Follow-Up of Patients Undergoing Early Invasive Strategy by the Transradial or Transfemoral Approach with Vascular Closure Device ................................................................................................................................ 299 Pedro Beraldo de Andrade, Luiz Alberto Piva e Mattos, Fabio Salerno Rinaldi, Igor Ribeiro de Castro Bienert, Robson Alves Barbosa, Sérgio Kreimer, Vinícius Cardoso Esteves, Marden André Tebet, André Labrunie, Amanda Guerra de Moraes Rego Sousa Probabilistic Model for Prediction of Prognostics in Myocardial Revascularization: Complications in Coronary Surgery .......................................................................................................................................................................................... 307 Valcellos José da Cruz Viana, Felipe Coelho Argolo, Nilzo Augusto Mendes Ribeiro, Augusto Ferreira da Silva Junior, Luis Claudio Lemos Correia Are Body Fat and Uric Acid associated with Cardiovascular Risk Scores? Cross-Sectional Analysis in the PROCARDIO-UFV Trial ........................................................................................................................................................... 313 Juliane Soares Rodrigues, Alinne Paula de Almeida, Carla de Oliveira Barbosa Rosa, Helen Hermana Miranda Hermsdorff Green Tea Attenuates Hypotension Induced by Physical Exercise: A Randomized, Placebo Controlled Study ............. 325 Manoel Miranda Neto, Raquel Suelen Brito da Silva, Taís Feitosa da Silva, Fabiano Ferreira de Lima, Alexandre Sérgio Silva Study of Dabigatran Use in a Brazilian Public Hospital Specialized in Cardiology ....................................................... 334 Luise Barros Martins, Ivis Levy Fernandes Martins, Raíssa Miranda Silva, Flávia Valéria dos Santos Almeida, Christianne Bretas Vieira Scaramello • Review Article Predictors of Metabolic Syndrome in the Elderly: A Review ............................................................................................... 343 Carolina Cunha de Oliveira, Emanuelle Dias da Costa, Anna Karla Carneiro Roriz, Lilian Barbosa Ramos, Mansueto Gomes Neto • Viewpoint Detailing Peripheral Arterial Tonometry in Heart Failure. An Endothelial Function Evaluation ................................. 354 Aline Cristina Tavares, Edimar Alcides Bocchi, Guilherme Veiga Guimarães • Case Reports Cardiac Memory, an Underdiagnosed Condition ................................................................................................................ 359 Margarida Oliveira, Olga Azevedo, Lucy Calvo, Bebiana Faria, Sílvia Ribeiro, António Lourenço A Transcatheter Aortic Valve Implantation Without Aortography Guidance Due To Vascular Access Constraints Or Limitations ..................................................................................................................................................................................... 363 Oktay Ergene, Hamza Duygu, Volkan Emren, Ugur Kocabas, Levent Cerit ISSN 2359-4802 / IJCS ONLINE: ISSN 2359-5647 Editor Guilherme Vianna e Silva (Interventionist Cardiology Area) – Texas Heart Institute, USA Cláudio Tinoco Mesquita – Hospital Universitário Antônio Pedro (HUAP), Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, RJ – Brazil João Augusto Costa Lima (Integrative Imaging Area) – Johns Hopkins Hospital – Baltimore, USA Lauro Casqueiro Vianna (Multiprofessional Area) – Faculdade de Educação Associated Editors Física, Universidade de Brasília (UnB), Brasília, DF – Brazil Clério Francisco Azevedo Filho (Cardiovascular Imaging Area) – Miguel Mendes (Ergometric and Cardiac Rehabilitation Area) – Sociedade Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil Portuguesa de Cardiologia, Portugal Gláucia Maria Moraes de Oliveira (Clinical Cardiology Area) – Departamento Ricardo Mourilhe-Rocha (Heart Failure and Myocardiopathy Area) – de Clínica Médica, Faculdade de Medicina (FM), Universidade Federal do Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil Janeiro (UERJ), Rio de Janeiro, RJ - Brazil EDITORIAL BOARD Leonardo Silva Roever Borges – Departamento de Pesquisa Clínica, Universidade Federal de Uberlândia (UFU), MG – Brazil Brazil Leopoldo Soares Piegas – Fundação Adib Jatene, Instituto Dante Pazzanese de Cardiologia (IDPC/FAJ), São Paulo, SP - Brazil Andréia Biolo – Faculdade de Medicina, Universidade Federal do Rio Grande Luís Alberto Oliveira Dallan – Serviço Coronariopatias, Instituto do Coração do Sul (UFRGS), Porto Alegre, RS – Brazil (INCOR), São Paulo, SP - Brazil Angelo Amato Vincenzo de Paola – Escola Paulista de Medicina (EPM), Marcelo Iorio Garcia – Clínica de Insuficiência Cardíaca, Universidade Federal Universidade Federal de São Paulo (UNIFESP), São Paulo, SP – Brazil do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ – Brazil Antonio Cláudio Lucas da Nóbrega – Centro de Ciências Médicas, Marcelo Westerlund Montera – Centro de Insuficiência Cardíaca, Hospital Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, RJ – Brazil Pró Cardíaco (PROCARDIACO), Rio de Janeiro, RJ – Brazil Ari Timerman – Unidades de Internação, Instituto Dante Pazzanese de Marcio Luiz Alves Fagundes – Divisão de Arritmia e Eletrofisiologia, Instituto Cardiologia (IDPC), São Paulo, SP - Brazil Nacional de Cardiologia Laranjeiras (INCL), Rio de Janeiro, RJ – Brazil Armando da Rocha Nogueira – Departamento de Clínica Médica, Marco Antonio Mota Gomes - Fundação Universitária de Ciências da Saúde Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil Governador Lamenha Filho (UNCISAL), Maceió, AL - Brazil Carísi Anne Polanczyk – Hospital de Clínicas de Porto Alegre, Universidade Marco Antonio Rodrigues Torres – Departamento de Medicina Interna, Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS – Brazil Hospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brazil Carlos Eduardo Rochitte – Departamento de Cardiopneumologia, Hospital Marcus Vinicius Bolivar Malachias – Instituto de Pesquisas e Pós- das Clínicas da Faculdade de Medicina da Universidade de São Paulo graduação (IPG), Faculdade de Ciências Médicas de Minas Gerais (HCFMUSP), São Paulo, SP – Brazil (FCMMG), Belo Horizonte, MG – Brazil Carlos Vicente Serrano Júnior – Faculdade de Medicina da Universidade de Maria Eliane Campos Magalhães – Departamento de Especialidades Médicas, São Paulo, Instituto do Coração (InCor), São Paulo, SP – Brazil Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ – Brazil Cláudio Gil Soares de Araújo – Instituto do Coração Edson Saad, Universidade Mário de Seixas Rocha – Unidade Coronariana, Hospital Português, Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil Salvador, BA – Brazil Cláudio Pereira da Cunha – Departamento de Clínica Médica, Universidade Maurício Ibrahim Scanavacca – Unidade Clínica de Arritmia, Instituto do Federal do Paraná (UFPR), Paraná, PR – Brazil Coração do Hospital das Clínicas da FMUSP, São Paulo, SP – Brazil Cláudio Tinoco Mesquita – Hospital Universitário Antônio Pedro (HUAP), Nadine Oliveira Clausell – Faculdade de Medicina, Universidade Federal do Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, RJ – Brazil Rio Grande do Sul (UFRGS), Porto Alegre, RS – Brazil Denílson Campos de Albuquerque – Faculdade de Ciências Médicas, Nazareth de Novaes Rocha – Centro de Ciências Médicas, Universidade Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ – Brazil Federal Fluminense, UFF - Rio de Janeiro, RJ – Brazil Denizar Vianna Araujo – Departamento de Clínica Médica, Universidade do Nelson Albuquerque de Souza e Silva – Departamento de Clínica Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ – Brazil Médica, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ – Brazil Esmeralci Ferreira – Hospital Universitário Pedro Ernesto (HUPE), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brazil Paola Emanuela Poggio Smanio – Seção Médica de Medicina Nuclear, Instituto Dante Pazzanese de Cardiologia (IDPC) São Paulo, SP - Brazil Evandro Tinoco Mesquita – Hospital Universitário Antônio Pedro (HUAP), Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, RJ – Brazil Paulo Cesar Brandão Veiga Jardim – Liga de Hipertensão Arterial, Universidade Federal de Goiás (UFGO), Goiânia, GO – Brazil Fernando Nobre – Faculdade de Medicina de Ribeirão Preto (FMRP), Ronaldo de Souza Leão Lima – Pós-Graduação em Cardiologia, Universidade Universidade de São Paulo, São Paulo, SP – Brazil Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ – Brazil Gabriel Blacher Grossman – Serviço de Medicina Nuclear, Hospital Moinhos Salvador Manoel Serra – Setor de Pesquisa Clínica, Instituto Estadual de de Vento, Porto Alegre, RS – Brazil Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro, RJ – Brazil Henrique César de Almeida Maia – Governo do Distrito Federal (GDF), Sandra Cristina Pereira Costa Fuchs – Departamento de Medicina Social, Brasília, DF - Brazil Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Humberto Villacorta Júnior – Hospital Universitário Antônio Pedro (HUAP), RS – Brazil Universidade Federal Fluminense (UFF), Niterói, Rio de Janeiro, RJ – Brazil Tiago Augusto Magalhães – Ressonância Magnética e Tomografia Cardíaca, Iran Castro – Fundação Universitária de Cardiologia (FUC), Instituto de Hospital do Coração (HCor), São Paulo, SP – Brazil Cardiologia do Rio Grande do Sul (IC), Porto Alegre, RS – Brazil Walter José Gomes – Departamento de Cirurgia, Universidade Federal de João Vicente Vitola – Quanta Diagnóstico e Terapia (QDT), Curitiba, PR – Brazil São Paulo (UFESP), São Paulo, SP – Brazil José Geraldo de Castro Amino – Sessão Clínica, Instituto Nacional de Washington Andrade Maciel – Serviço de Arritmias Cardíacas, Instituto Cardiologia (INC), Rio de Janeiro, RJ – Brazil Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro, RJ – Brazil José Márcio Ribeiro – Clínica Médica (Ambulatório), União Educacional Vale Wolney de Andrade Martins – Centro de Ciências Médicas, Universidade do Aço (UNIVAÇO), Ipatinga, MG - Brazil Federal Fluminense (UFF), Niterói, Rio de Janeiro, RJ – Brazil Exterior Guilherme Vianna e Silva – Texas Heart Institute, Texas – USA Amalia Peix – Instituto de Cardiología y Cirugía Cardiovascular, Havana – Cuba Horacio José Faella – Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Amelia Jiménez-Heffernan – Hospital Juan Ramón Jiménez, Huelva – Spain Garrahan”, Caba – Argentina Charalampos Tsoumpas – University of Leeds, Leeds – England James A. Lang – Des Moines University, Des Moines – USA Chetal Patel – All India Institute of Medical Sciences, Delhi – Indian James P. Fisher – University of Birmingham, Birmingham – England Edgardo Escobar – Universidad de Chile, Santiago – Chile João Augusto Costa Lima – Johns Hopkins Medicine, Baltimore – USA Enrique Estrada-Lobato – International Atomic Energy Agency, Vienna – Austria Massimo Francesco Piepoli – Ospedale “Guglielmo da Saliceto”, Erick Alexanderson – Instituto Nacional de Cardiología - Ignacio Chávez, Piacenza – Italy Ciudad de México – México Raffaele Giubbini – Università degli Studi di Brescia, Brescia – Italy Fausto Pinto – Universidade de Lisboa, Lisboa - Portugal Ravi Kashyap – International Atomic Energy Agency, Vienna – Austria Ganesan Karthikeyan – All India Institute of Medical Sciences, Delhi – Indian Shekhar H. Deo – University of Missouri, Columbia - USA BIENNIUM BOARD 2016/2017 SOCIEDADE BRAZILEIRA DE Chief Editor of the Brazilian Archives of SBC/MA – Márcio Mesquita Barbosa CARDIOLOGIA/ BRAZILIAN Cardiology SBC/MG – José Carlos da Costa Zanon SOCIETY OF CARDIOLOGY Luiz Felipe Pinho Moreira SBC/MS – Delcio Gonçalves da Silva Junior SBC/MT – Max Wagner de Lima Governador - ACC Brazil Chapter SBC/NNE – Claudine Maria Alves Feio President Roberto Kalil Filho SBC/PA – Sônia Conde Cristino Marcus Vinícius Bolívar Malachias SBC/PE – Paulo Sérgio Rodrigues Oliveira SBC/PB – Miguel Pereira Ribeiro ADJUNCT COORDINATION Vice-President SBC/PI – Wildson de Castro Gonçalves Filho Eduardo Nagib Gaui SBC/PR – Gerson Luiz Bredt Júnior International Relations Coordinator SBC/RJ (SOCERJ) – Ricardo Mourilhe Rocha President-Elect David de Pádua Brazil SBC/RN – Maria de Fátima Azevedo Oscar Pereira Dutra SBC/RO (SOCERON) – João Roberto Gemelli Universidade Corporativa Coordinator SBC/RS (SOCERGS) – Gustavo Glotz de Lima Scientific Director Gilson Soares Feitosa Filho SBC/SC – Maria Emilia Lueneberg SBC/SE – Sergio Costa Tavares Filho Raul Dias dos Santos Filho Standards and Guidelines Coordinator SBC/SP (SOCESP) – Ibraim Masciarelli José Francisco Kerr Saraiva Francisco Pinto Financial Director SBC/TO – Andrés Gustavo Sánchez Gláucia Maria Moraes Oliveira Cardiovascular Records Coordinator DEPARTAMENTS AND STUDY GROUPS Otávio Rizzi Coelho Administrative Director Denilson Campos de Albuquerque Professional Valuation Coordinator SBC/DA – André Arpad Faludi Carlos Japhet da Matta Albuquerque SBC/DCC – José Carlos Nicolau Government Liaison Director SBC/DCC/CP – Maria Angélica Binotto Renault Mattos Ribeiro Júnior New Projects Coordinator SBC/DCM – Elizabeth Regina Giunco Alexandre Fernando Augusto Alves da Costa SBC/DECAGE – José Maria Peixoto Information Technology Director SBC/DEIC – Luis Eduardo Paim Rohde Osni Moreira Filho SBC/DERC – Salvador Manoel Serra Continuing Education Coordinator SBC/DFCVR – João Jackson Duarte Marcelo Westerlund Montera e Rui Manuel dos Communication Director SBC/DHA – Eduardo Costa Duarte Barbosa Santos Póvoa Celso Amodeo SBC/DIC – Samira Saady Morhy SBCCV – Fabio Biscegli Jatene Strategic Planning Concil Research Director SBHCI – Marcelo José de Carvalho Cantarelli Andrea Araújo Brandão, Ari Timeman, Dalton Leandro Ioshpe Zimerman SOBRAC – Denise Tessariol Hachul Bertolin Precoma, Fábio Biscegli Jatene GAPO – Bruno Caramelli Assistance Quality Director GECC – Mauricio Wajngarten Walter José Gomes SBC Newsletter Editor GECESP – Daniel Jogaib Daher Carlos Eduardo Suaide Silva GECETI – Gilson Soares Feitosa Filho GECHOSP – Evandro Tinoco Mesquita Specialized Departments Director PRESIDENTS OF STATE AND GECIP – Gisela Martina Bohns Meyer João David de Sousa Neto REGIONAL BRAZILIAN SOCIETIES GECN – Andréa Maria Gomes Marinho Falcão State and Regional Relations Director OF CARDIOLOGY GECO – Roberto Kalil Filho GEECABE – José Antônio Marin Neto José Luis Aziz GEECG – Nelson Samesima SBC/AL – Pedro Ferreira de Albuquerque GEICPED – Estela Azeka Cardiovascular Health Promotion Director - SBC/BA – Nivaldo Menezes Filgueiras Filho GEMCA – Álvaro Avezum Junior SBC/Funcor SBC/CE – Sandro Salgueiro Rodrigues GEMIC – Felix Jose Alvarez Ramires Weimar Kunz Sebba Barroso de Souza SBC/CO – Danilo Oliveira de Arruda GERCPM – Tales de Carvalho SBC/DF – José Roberto de Mello Barreto Filho GERTC – Marcello Zapparoli General Ombudsman SBC/ES – Bruno Moulin Machado GETAC – João David de Souza Neto Lázaro Fernandes de Miranda SBC/GO – Aguinaldo Figueiredo Freitas Jr. GEVAL – Luiz Francisco Cardoso INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES This work is available per guidelines from the Creative Volume 30, Number 4, July/August 2017 Commons License. Attribution Indexing: Index Medicus Latino-Americano – LILACS and Scientific Electronic Library Online - SciELO 4.0 International. Partial or total reproduction of this work is permitted upon citation. Commercial Department Telephone Number: (11) 3411-5500 e-mail: [email protected] Editorial Production SBC - Gerência Científica - Núcleo de Publicações Desktop Publishing and Graphic Design SBC - Gerência Científica - Núcleo de Publicações MMM Design & Editoração Former SOCERJ Magazine (ISSN 0104-0758) up to December 2009; Revista Brazileira de Cardiologia (print ISSN 2177-6024 and online ISSN 2177-7772) from January 2010 up to December 2014. International Journal of Cardiovascular Sciences (print ISSN 2359-4802 and online ISSN 2359-5647) from January 2015. ÓRGÃO OFICIAL DA SOCIEDADE BrazilEIRA DE CARDIOLOGIA - SBC PUBLICAÇÃO BIMESTRAL / PUBLISHED BIMONTHLY INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES (INT J CARDIOVASC SCI) The International Journal of Cardiovascular Sciences (ISSN 2359-4802) bi-monthly edited by SBC: Av. Marechal Câmara, 160 - 3º andar - Sala 330 20020-907 • Centro • Rio de Janeiro, RJ • Brazil Telephone number: (21) 3478-2700 e-mail: [email protected] <www.onlineijcs.org> International Journal of Cardiovascular Sciences. 2017;30(4):283-284 283 EDITORIAL Cardiology Journals from Portuguese-Speaking Countries: Challenges and Opportunities Luiz Felipe P. Moreira Instituto do Coração, Hospital das Clínicas FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP – Brazil Scientific development is currently happening at an consistently ranked among the 30 most important in increasingly faster pace. With this situation, the scientific the production of knowledge in health sciences over journals are required to commit to disseminating new the past two decades. Among the publications from knowledge with greater agility and broad propagation by Portuguese-speaking countries, there is a predominance the main international indexers. On the other hand, the of publications in journals with international circulation, mission of the scientific journals is also to encourage the written in English, which have a greater potential for propagation and discussion of new subjects in scientific knowledge dissemination. However, about 42% of the communities, a situation of great importance mainly for studies from Brazilian or Portuguese researchers have been only published in Portuguese or in both languages, those journals associated with medical societies and with English and Portuguese, emphasizing the relevance of a predominantly national circulation. these publications for countries of Lusitanian culture. With respect to scientific propagation at an According to the SciELO portal, the number of views international level, the use of the English language has of articles published in Portuguese in the Arquivos been well defined as being universal, leaving those Brasileiros de Cardiologia, a journal with articles indexed publications in other languages to the background. in the portal in both Portuguese and English, totaled Only articles published in English in broadly indexed more than 4.6 million downloads in 2016, while the journals achieve a greater number of citations, number of downloads of publications in English of collaborating effectively in consolidating the involved these same studies were slightly more than 2.9 million.3 research groups and elevating the impact of the The greater number of views of articles in Portuguese both periodicals in which they were published.1 On the for original articles and articles focused on knowledge other hand, health professionals in several countries dissemination and discussion, clearly demonstrate still encounter difficulties in accessing the international the importance of maintaining the publications in our scientific literature and find in their local language the language for better access by our professionals. primary means to keep up with new knowledge. Another important fact refers to the observation that According to the indexer SCImago, from the company the journals published by national societies concentrate Elsevier, Portuguese-speaking countries were responsible mainly publications originating in their own countries, for more than 20 thousand scientific publications indexed representing the main vehicle for the international in the health-related area in 2015.2 Of these, 1130 were dissemination of internally conducted research. In this published in the areas of cardiology or cardiovascular sense, the Arquivos Brasileiros de Cardiologia continues sciences, representing 2.1% of all the publications to be the journal responsible for dissemination of in these areas of knowledge.2 Most of these studies approximately 25% of the Brazilian publications indexed originated from Brazil or Portugal, countries that have in cardiology or cardiovascular sciences,4 the same happening with the Revista Portuguesa de Cardiologia with regard to almost 30% of the publications from Portugal Keywords in these areas of knowledge. On the other hand, these Cardiovascular Diseases; Periodicals as Topic; journals are able to publish less than half of the currently submitted articles, limiting the appropriate dissemination Bibliometrics; Bilinguism. Mailing Address: Luiz Felipe P. Moreira Av. Dr. Enéas Carvalho Aguiar, 44, 2º andar, bloco 2, sala 13, Cerqueira César. Postal Code: 05403-000, São Paulo, SP – Brazil E-mail: [email protected] DOI: 10.5935/2359-4802.20170050 Int J Cardiovasc Sci. 2017;30(4):283-284 Luiz Felipe P. Moreira Editorial Cardiology journals from portuguese-speaking countries: challenges and opportunities 284 of studies by many researchers who find difficulties in cardiovascular sciences in Portuguese-speaking countries accessing other means of publication.4 in recent years, new opportunities have opened up for Based on these facts, scientific publications from the expansion of our editorial activity. In this sense, the countries with specific cultural characteristics, such incorporation of the International Journal of Cardiovascular as Portuguese-speaking ones, must be guided by Sciences by the Brazilian Society of Cardiology, a journal policies that take into account both the need for wide published in English and Portuguese with a similar dissemination of their contents at the international editorial quality as the Arquivos Brasileiros de Cardiologia, level, as well as their appropriate dissemination meets the conditions suitable for a greater international among members of their own professional community. reach for the Brazilian cardiology science without With the increasing scientific research in cardiology and neglecting a wide dissemination at the national level.4 References 1. Moreira LF. Impact of Brazilian papers in cardiology and cardiovascular 3. Scielo. Métricas dos Arquivos Brasileiros de Cardiologia [Accessed sciences in the last decade. Arq Bras Cardiol. 2017;108(1):1-2. in 2017 Apr 10]. Available from: http://www.scielo.br/statjournal. php?lang=pt&issn=0066-782X&collection= 2. SCImago. SJR - SCImago Journal & Country Rank. 2015. [Accessed in 4. Moreira LF. Role of the International Journal of Cardiovascular 2017 Apr 10]. Available from: http://www.scimagojr.com/countryrank. Sciences in the increase of Brazilian publications in Cardiology and php?category=2705&area=2700&year=2015 Cardiovascular Sciences. Arq Bras Cardiol. 2016;107(1):1. International Journal of Cardiovascular Sciences. 2017;30(4):285-292 285 ORIGINAL ARTICLE 24-Hour Ambulatory Blood Pressure Monitoring Predicts Outcomes of Hypertensive Patients in Primary Care: A Cohort Study Guilherme Brasil Grezzana, Airton Tetelbon Stein, Lucia Campos Pellanda Instituto de Cardiologia, Fundação Universitária de Cardiologia, Porto Alegre, RS – Brazil Abstract Background: Arterial hypertension is an important risk factor for cardiovascular outcomes. However, in most Primary Health Care centers, blood pressure remains at inadequate control levels. Ambulatory Blood Pressure Monitoring (ABPM) is a useful tool in predicting cardiovascular morbidity and mortality. The implementation of 24-hour ABPM and evaluation of cardiovascular outcomes in Primary Health Care may be effective in improving strategies for monitoring hypertensive patients in this setting. Objective: To evaluate uncontrolled arterial hypertension detected by 24-hour ABPM as a predictor of cardiovascular outcomes in hypertensive patients from Primary Health Care in a low-resource environment. Methods: Cohort study based on primary health care centers. The study was carried out with 143 hypertensive patients, who underwent 24-hour ABPM at baseline. Therapeutic targets were based on the Eighth Joint National Committee, the Brazilian Hypertension Guideline, and the European Hypertension Guideline. Medical records of emergency care, hospital admissions, and death certificates were reviewed. Results: The sample consisted of 143 patients who met the inclusion criteria. After 4 years of follow-up, there were 17 deaths, 12 new cases of atrial fibrillation and 37 hospital admissions related to cardiovascular outcomes. During the follow-up period, the 24-hour ABPM showed a predictive result for new cases of atrial fibrillation (p = 0.015) and a combination of cardiovascular outcomes, mortality, and hospital admissions (p = 0.012). Conclusion: The 24-hour ABPM was an important predictor of cardiovascular outcomes in a hypertensive population that seeks assistance in Primary Health Care centers. (Int J Cardiovasc Sci. 2017;30(4):285-292) Keywords: Blood Pressure Monitoring, Ambulatory; Hypertension/ complications; Public Health; Cardiovascular Diseases. Introduction BP ≥ 90 mmHg) increased from 605 to 978 million, among other causes, influenced by population aging.4 Arterial hypertension is a major risk factor for The absolute increase of the hypertensive population cardiovascular disease.1 Epidemiological studies have should lead to an increase in the use of health services, provided unequivocal evidence for the association which increases the need to identify and treat hypertension between arterial hypertension and mortality from to prevent having to manage the costs of complications ischemic heart disease, cerebrovascular accident (CVA), associated with the disease.5 and vascular diseases.2 Additionally, there is a strong The 24-hour ambulatory blood pressure monitoring association between blood pressure (BP) reduction and (ABPM) is the most accurate tool to assess BP as a prevention of coronary artery disease (CAD) and CVA.3 predictor of cardiovascular events, when compared The number of individuals with uncontrolled to other methods, such as home and conventional BP hypertension (systolic BP ≥ 140 mmHg or diastolic measurements.6 However, in the primary health care Mailing Address: Guilherme Brasil Grezzana Rua Oswaldo Hampe, 258. Postal Code: 95250-000, Centro, Antônio Prado, RS − Brazil E-mail: [email protected], [email protected] DOI: 10.5935/2359-4802.20170061 Manuscript received November 01, 2016, revised manuscript February 01, 2017, accepted April 05, 2017. Int J Cardiovasc Sci. 2017;30(4):285-292 Grezzana et al. Original Article Hypertension in primary health care 286 (PHC) setting the availability and use of ABPM are below Between January 2013 and October 2014, patients their indications, and general practitioners play a critical were invited to participate in the second phase of the role in controlling hypertension.7 study by telephone and/or by letter. Before being Several prospective studies have evaluated the enrolled in this study phase, patients were reassessed predictive value of ABPM in relation to conventional BP by their PHC physicians. Patients who were not able to measurement, such as the Dublin Outcome Study8 and answer the questionnaire, pregnant women, those with the International Database of Ambulatory Blood Pressure electrocardiograms showing non-sinus rhythm, those in relation to Cardiovascular Outcome (IDACO)9, both who lived outside the coverage area of the PHC centers, with a significant follow-up time (8.4 and 9.5 years, those who moved to another city or were not contacted, respectively). Additionally, the CARDIORISC study,10 and/or did not tolerate the use of ABPM, or had technical with a sample size of 2,115 treated hypertensive patients, difficulty during the method application were excluded and a follow-up of 4 years, which included patients from the study.13 from the PHC setting, and national guidelines such as All patients who agreed to participate in the study NICE11 and CHEP,12 recommend the ABPM method as signed the Free and Informed Consent form. The results a diagnostic tool for hypertension. obtained from the biochemical analyses and ABPM However, the diagnostic accuracy of hypertension assessment during the study were delivered to the based on conventional BP measurements is low,13 and patients. The study was approved by the Research Ethics there is a scarcity in prospective studies evaluating Committee of Instituto de Cardiologia do Rio Grande do the impact of 24-hour ABPM on hypertension control Sul (protocol n. 4278.08). in PHC. In most PHC settings, 24-hour ABPM is still a scarcely used tool, and additional studies are needed to Measurements increase its implementation. The aim of the present study BP measurements were performed by the physicians of was to evaluate uncontrolled hypertension detected by the PHC units. Three BP measurements were performed 24-hour ABPM as a predictor of cardiovascular outcomes using a mercury sphygmomanometer – the use of the in hypertensive PHC patients in a low-resource setting. mercury sphygmomanometer is allowed in the State of Rio Grande do Sul, which follows the guidelines of the Methods Collegiate Board Resolution n. 63-2011, Art. 23 – after being instructed to use appropriate-size cuffs. Patients were in the sitting position, with their feet Participants flat on the floor, and measurements were taken after at This cohort study was based on PHC centers, least 5 minutes of rest. PHC physicians were instructed including hypertensive patients from Antônio Prado to perform BP measurements on both arms, using as (RS), a municipality in the Southern Region of Brazil, with reference the highest BP value obtained after an interval a population of 12,883 inhabitants.14 The samples were of approximately 3 minutes. The first measurement representative of the hypertensive patients who sought was discarded, and the mean of the two subsequent care at PHC centers in the municipality, being selected measurements was considered and recorded in the from a total of 646 patients registered in the system. patient’s medical record.7 The inclusion criteria of the study were hypertensive After this procedure, the patients were referred to patients, registered at the public health system the care of a nurse trained for the study for the 24-hour participating in the hypertensive patient program ABPM device placement, questionnaire application and and receiving regular pharmacological treatment in anthropometric measurements. The collected data also one of the two PHC centers of the municipality for at included analysis of patients’ medical records, request least 6 months. for biochemical exams, and assessment of ABPM data From January 2009 to December 2010, the random by the first author of the study, who was blinded to sample of hypertensive patients was selected from the the BP assessment performed by the PHC physicians. total set of hypertensive patients enrolled in two Basic The ABPM was performed during the patient’s normal Health Units, through the generation of random numbers workday, with weekends and holidays being excluded using the program Microsoft Excel 2008. from the analysis.