Original Article
Control of Arterial Pressure in Patients undergoing Anti-Hypertensive
Treatment in Brazil - Controlar Brazil
Fernando Nobre1, Artur Beltrame Ribeiro2, Décio Mion Jr.3
Hospital das Clínicas da Faculdade de Medicina da USP1, Ribeirão Preto; Escola Paulista de Medicina - Hospital do Rim e Hipertensão2;
Hospital das Clínicas da Faculdade de Medicina da USP3, São Paulo, SP - Brazil
Abstract
Background: Blood pressure (BP) control is crucial in arterial hypertension (AH).
Objective: To determine the percentage of patients requiring specific BP control goals treated in medical offices
throughout Brazil.
Methods: Each researcher, from a total number of 291, had to evaluate, through conventional BP measurement
performed during five consecutive days, the two first patients treated on that day. We determined the number of
hypertensive patients treated for at least four weeks who presented BP control, according to the goals established for
the risk group they belonged to.
Results: A total of 2,810 patients were assessed in 291 centers. The individuals were divided in groups as follows: A (AH
stages 1 and 2, low and moderate additional risk) = 1,054 (37.51%); B (AH and borderline BP, high additional risk ) =
689 (24.52%); C (AH and borderline BP, very high additional risk, including diabetic patients) = 758 (26.98%) and D
(AH with nephropathy and proteinuria > 1 g/l) = 309 (11%). The BP means in the population were: 138.9 ± 17.1 and
83.1 ± 10.7 mmHg. Factors associated with a worse BP control were: age, abdominal circumference, diabetes, smoking
and coronary disease. The BP control percentages in each of the groups were, respectively: 61.7; 42.5; 41.8 and 32.4%.
Conclusion: The low BP control according to the predefined goals, as demonstrated in the results, reinforces the
necessity to establish measures to promote better control rates. (Arq Bras Cardiol 2007;88(6):624-628)
Key words: Blood pressure/drug effects; antihypertensive agents/therapeutic use.
Introduction
Arterial hypertension (AH) is a disease directly or indirectly
responsible for the high rates of morbidity and mortality
caused by cardiovascular diseases (CVD)1. This is a common
worldwide scenario.
The risk of cardiovascular events due to AH increases from
BP means of 115 x 75 mmHg. For each 20 mmHg added to
the systolic arterial pressure (SAP) or 10 mmHg added to the
diastolic arterial pressure (DAP), there is a 2-fold risk increase,
for both the occurrence of coronary artery disease (CAD) and
cerebrovascular accident (CVA)2.
Therefore, the classifications of the BP behavior have
become more stringent, considering values < 140 x 90
mmHg as necessary for certain groups of patients. Table
1 shows the BP levels for each group, according to the V
Brazilian Hypertension Guidelines (V DBH)3, considering
their degree of risk.
Mailing address: Fernando Nobre •
Av. Independência, 3767 - Jd. Califórnia - 14026-150 - Ribeirão Preto, SP Brazil
E-mail: [email protected], [email protected]
Manuscript received April 08, 2009; revised manuscript received November
05, 2009; accepted November 18, 2009.
623
It is unquestionable that the BP control is directly related
to the decrease in AH complications4. Thus, it is of utmost
importance that patients with high BP be treated, so that they
can benefit from the anti-hypertensive treatment5.
Nevertheless, in spite of the evidence demonstrating
the risk of arterial hypertension, as well as the benefits of
its treatment, the number of diagnosed patients receiving
anti-hypertensive therapy that presents BP control is still
small worldwide6,1,6.
Studies have demonstrated that the benefits of AH treatment
are more significant when the control is more stringent7. In this
context, guidelines that establish the therapy for hypertensive
patients indicate BP goals to be attained with the treatment in
specific groups with arterial hypertension8 (Table 1).
This concern has been seen worldwide and can be
observed in recently published studies9. In Brazil, there are no
data regarding the prevalence of arterial hypertension in the
general population, as well as on the control levels of patients
undergoing therapy, under the same conditions of the studied
population. Similarly, there are no data that express BP control
in specific subgroups.
The present study was designed to evaluate the percentage
of patients undergoing anti-hypertensive treatment that have
Nobre et al
Controlar Brazil
Original Article
Table 1 - BP goals to be attained with treatment for arterial
hypertension, according to the V DBH (V Brazilian Hypertension
Guidelines)3
Categories
Minimum BP goal*
A - AH stage 1 and 2
Low and moderate risk
< 140 x 90 mmHg
B - AH and borderline BP
High risk
< 130 x85 mmHg
C - AH and borderline BP
Very high risk**
< 130 x 80 mmHg
D - AH with nephropathy
and proteinuria > 1g/l
< 120 x 75 mmHg
3. Frequency of the associated clinical conditions in the
assessed patients;
4. Patients undergoing monotherapy;
5. Patients undergoing treatment with an association of
anti-hypertensive drugs.
Inclusion and exclusion criteria
Inclusion criteria
- Age ≥ 21 and < 80 years of either sex;
*If the patient can tolerate it, BP values that are even lower than those indicated
are recommended as treatment, and, if possible, the attainment of optimal
BP values (≤ 120 x 80 mmHg). ** including diabetes mmellitus. AH - arterial
hypertensiona; BP - ablood pressure.
attained the goals established for their specific condition,
having been assigned to four pre-defined categories in medical
offices and clinics throughout Brazil.
Methods
The data collection and assessment were carried out
between February and June 2008, after the Ethics Committee
in Research of HC-FMRP-USP approved the study, to be carried
out in multiple centers as proposed in the presented protocol.
A total of 2,810 individuals were assessed by 291 medical
research physicians, general practitioners, cardiologists or
nephrologists, in medical offices, outpatient clinics or services
of arterial hypertension, distributed throughout the four
macroregions of Brazil as follows: North-Northeast region:
13.5%; Midwest region: 6.5%; Southeast region: 68% and
South region, 12%.
The protocol determined that each researcher should
evaluate, during five consecutive days, the two first patients
treated at the office or clinic that met the study inclusion
criteria. Patients with medical insurance, including the
Brazilian Public Health System (SUS) were assessed, as well
as those who were treated at private medical offices, with or
without free access to medication.
Study characteristic
The present was an observational study and the data
were obtained from patients treated in medical offices and
outpatient clinics throughout Brazil.
The protocol did not foresee therapeutic intervention,
aiming solely at observing, among others, the following
aspects:
1. Relative number of patients undergoing treatment
with SAP and DAP < 140 x 90 mmHg , respectively,
menteregardless of their clinical condition;
2. Relative number of hypertensive patients who had
presented, for at least four weeks, the control of systolic and
diastolic arterial pressure, according to their individual goals,
as established in Table 1;
- Confirmed clinical diagnosis of hypertension and to be
currently undergoing treatment with anti-hypertensive drug
(monotherapy, fixed combination or open combination of
drugs), according to the clinical history;
- Regular use of anti-hypertensive medication for at least
four weeks;
- To be one of the two first patients assessed on the day;
- To accept participating in the study, after being informed
on the study procedures, risks, benefits and rights and reading
and signing the free and informed consent form.
Exclusion criteria
- Secondary arterial hypertension;
- Poor general health due to end-stage diseases;
- Pregnant or breastfeeding women and those who had
given birth less than two months before;
- Regular use of corticósteroies, chemotherapy agenes or
immunosuppressive drugs;
- Chronic use of alcohol (daily or large amounts) or
neuroleptic drugs;
- Participation in another observational study sooner than
three months after their possible inclusion in the present study.
Criteris for data collections
The demographic data were collected by the researchers
and included age (in full years); height (in meters); weight (in
kg); body mass index (BMI = kg/m2), sex, current smoking
status (smoker or nonsmoker); diabetic nephropathy
(present or not); left ventricular hypertrophy, detected
by the electrocardiogram (present or not); coronary and/
or peripheral artery disease (present or not); heart failure
(present or not); previous history of myocardial infarction and/
or cerebrovascular accident, based on patients’ files or their
evaluation during the consultation.
Information on the use of monotherapy or an association
of drugs (fixed or open), as well as the medications being used
for the treatment was also obtained by the researcher during
patient evaluation.
Blood pressure measurement
The BP measurements were obtained according to the
criteria established by the V DBH3.musing an automatic
Microlife sphygmomanometer, model 3 BT0A validated by
the British Hypertension Society, AA qualification, with three
Arq Bras Cardiol 2010;94(5):623-630
624
Nobre et al
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Original Article
different cuff models, according to the patient’s condition:
adult, thin adult and obese adult.
The BP was measured in the sitting position after 5 minutes
of rest and two measurements were obtained consecutively,
with a one-minute interval between them, with the objective
of obtaining the actual BP value through the mean of these
measurements. A third measurement was obtained, equally
one minute after the second measurement, when the
difference between the two first ones was > 5 mmHg.
Statistical analysis
Demographic data, as well as data on physical examination,
associated clinical conditions and current antihypertensive
treatments were descriptively summarized. The classificatory
variables were described through the distribution of
frequencies and percentages. Means, standard deviations,
minimum and maximum values were used to describe
continuous variables.
Exact confidence intervals for the binomial distribution,
with a 95% confidence interval (95%CI) were established
for the proportion of patients that had achieved their goals
for BP control, when considering the total number or the
subgroups of patients. Factors that were predictive of BP
control were explored by adjusting a logistic linear model.
The factors predictive of non-control were also assessed
using the same model.
The SAS system (Statistical Analysis System), release 9.1.3
was used to perform all statistical analyses.
Results
Table 2 - Characteristics of the patients included in the study
Characteristic
Data obtained
Age (years)
60.4 ± 12.4
Height (meters)
1.63 ± 0.9
Gender
Male
1,095 (37.7%)
Female
1,810 (62.3%)
Weight (kg)
75.9 ± 15.4
Abdominal circumference (cm)
96.9 ± 12.5
Body mass index (kg/m )
28.49 ± 4.9
Waist: hip ratio
0.94 ± 0.09
Smoking (number and percentage)
242 (8.4%)
2
Arterial pressure (mmHg)
138.8 ± 17.1 x 83.1 ± 10.7
Diabetes mellitus
563 (20.77%)
Diabetic nephropathy
52 (1.92%)
Obesity
1,049 (38.71%)
Dyslipidemia
1,736 (64.06%)
LV hypertrophy (through ECG)
461 (17.01%)
Coronary artery disease
376 (13.87%)
Peripheral artery disease
135 (4.98%)
Congestive heart failure
67 (2.47%)
Previous history of myocardial infarction
153 (5.65%)
Previous history of cerebrovascular accident
78 (2.88%)
No comorbidity
366 (13.51%)
Other comorbidities
255 (9.41%)
Characteristics of the studied individuals
A total of 2,810 patients from 291 centers were assessed.
The data on the individuals included in the study, as well as
the prevalence of the clinical conditions and the associated
risk factors are shown in Table 2.
As for the risk stratification used to define the four groups,
the distribution was as follows: Group A (hypertension 1
to 2 with low or middle risk): 1,054 (37.51%); Group B
(hypertension or borderline behavior with high risk): 689
(24.52%); Group C (hypertension or borderline behavior
with very high risk): 758 (26.98%) and Group D (arterial
hypertension and kidney disease with protein loss > 1 g/24
h): 309 (10.99%) (Table 3).
Arterial pressure control
In total analysis, regardless of the individual’s condition,
1,497 (53.3%) of them presented BP < 140 x 90 mmHg.
Considering the specific control targets desired for each
of the groups, we obtained the following number of patients
with systolic and diastolic arterial pressure control: Group A:
650 (61.7%); Group B: 293 (42.5%); Group C: 317 (41.8%)
and Group D: 100 (32.4%). These data are shown in Table 4.
Associated clinical conditions
The numbers and percentages of the clinical conditions
625
Arq Bras Cardiol 2010;94(5):623-630
Table 3 - Distribution of the individuals according to the risk
stratification (as established in the V DBH3)
Risk stratification
Number (%)
Group A
1,054 (37.51)
Group B
689 (24.52)
Group C
758 (26.98)
Group D
309 (10.99)
Table 4 - Numbers and percentages of assessed individuals that
presented control of the systolic and diastolic pressure, according
to the goals defined by the DBH V3
Desired level
Number (%)
assessed
Number (%)
controlled
A
<140 x 90 mmHg
1,054 (37.51)
650 (61.7)
B
<130 x 85 mmHg
689 (24.52)
293 (42.5)
C
<130 x 80 mmHg
758 (26.98)
317 (41.8)
D
<120 x 75 mmHg
309 (10.99)
100 (32.4)
2,810 (100)
1,360 (46.5)
Group
Total
Nobre et al
Controlar Brazil
Original Article
associated with arterial hypertension in the studied group can
be seen in Table 2.
goals established for each one of the four risk classes they
were allocated in.
Treatment with monotherapy or with an association of
drugs
Impact of associated factors and blood pressure control
Using a model of logistic regression, it was possible to
establish that for each year of life added to the studied
individual, the probability of BP control was 2% lower. A
similar observation was verified regarding the abdominal
circumference, by verifying that for each centimeter added to
this parameter, the chance of BP control was also 2% lower.
In the four groups with different risk levels, 913 of them
(32.5%) used monotherapy, whereas the other 1,897 (67.5%)
used more than one anti-hypertensive drug. The distribution
of therapeutic classes being used during the study is shown
in Table 5.
Figure 1 shows the percentage of patients that met the
As for the smoking status, the presence or not of diabetes
mellitus and the presence or not of coronary artery disease,
these chances of control were, respectively, 29%, 59% and
17% lower (Figure 2).
Table 5 - Percentage distribution of patients treated with
monotherapy and by classes used in the treatment and number of
associated drugs
Type of treatment
Discussion
Number (%) of individuals
Monotherapy
913 (32.5)
ARB II
369 (40.5)
ACEI
210 (23)
CCA
The evaluation of arterial hypertension prevalence,
awareness, treatment and control has been the object of global
study, due to the importance of the topic104,10,11-12.
The knowledge of BP control in specific groups according
to their risk stratification, however, has not been established in
private medical offices and outpatient clinics (private medical
care system) in Brazil.
210 (23)
Beta-blocker
150 (16.5)
Diuretics
Isolated data obtained from assessed health units
(secondary and tertiary public medical centers and healthcare
facilities) have demonstrated wide-ranging BP control levels.
103 (11.3)
Association
1,897 (67.5)
2 drugs
1,210 (63.8)
3 drugs
502 (26.5)
More than 3 drugs
184 (9.7)
Among the population of the town of Tubarão, state of
Santa Catarina, Brazil, the percentages of BP prevalence,
awareness, treatment and control were, respectively: 40.5%;
55.6%; 46.8% and 21.6%11.
ARB II - angiotensin II receptor blocker; ACEI - angiotensin-converting enzyme
inhibitors; CCA - calcium channel antagonists.
Mion et al12 assessed the BP control in patients treated at
67.6
61.7
58.2
57.5
42.5
38.3
41.8
Controlled
32.4
Noncontrolled
Figure 1 - Percentages of controlled patients in accordance with the goals established for each one of the four risk classes they were allocated in, according to their stratification.
Arq Bras Cardiol 2010;94(5):623-630
626
Nobre et al
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Original Article
Age - 0.989* (p=0.0012)
AC - 0.983** (p<0.001)
Smoker - 0.71*** (p<0.0192)
Diabetes - 0.41*** (p<0.0001)
CAD - 0.83*** (p=0.1247)
0.5
1
Figure 2 - Factors related to a lower BP control in all studied groups. AC - abdominal circumference; CAD - coronary artery disease. Maximal verisimilitude method determination of the logistic regression model - 95%CI. *Chance of BP control decreases 2% with each added year of life. **Chance of BP control decreases 2% with
each cm added to the AC. ***Yes x no.
10 hypertension leagues (São Luis, Maceió, Salvador, Goiania,
Rio de Janeiro, three in São Paulo, Porto Alegre and Sorocaba)
and found that in a total of 1,998 individuals, 56% of them
presented BP < 140 x 90 mmHg12.
Among patients treated at the Hypertension Outpatient
Clinic of HC FMRP USP, in Ribeirao Preto, followed during
the year of 1995, 33.3% of them presented BP <140 x 90
mmHg13.
Mancia et al14 observed that even in large clinical trials,
usually very stringently monitored, the level of BP control did
not show the desired results.
When these assessments favor groups in which the
control goals are necessarily lower, these values tend to be
even lower9.
The main results of the present study indicate a control
rate of systolic and diastolic arterial pressure in the global
analysis of 53.3%, regardless of which subgroup they refer to.
Considering the specific subgroups of patients from medical
offices and outpatient clinics from the different regions of
the country, 61.7% in Group A (AH stages 1 and 2 with low
and moderate risk); 42.5% in Group B (AH and borderline
BP with high risk); 41.8% in Group C (AH and borderline BP
with very high risk, including diabetics) and 32.4% in Group D
(AH with nephropathy and proteinuria > 1 g/l) had achieved
the desired BP goals.
It is worth mentioning that, in the present study, which
focused on a population who had or did not have free access
to medication, these control percentages, apparently high in
comparison to what is observed in the general population,
are still below the expected ones.
Ma and Randall15 evaluated the BP treatment and control
in medical offices in the United States between 2003 and
2004. The mean BP observed by the authors was 141 x 81
mmHg in patients without comorbidities and 143 x 79 mmHg
627
Arq Bras Cardiol 2010;94(5):623-630
in those who presented associated diabetes or nephropathy.
In the present population, the general mean of BP was
138.8 ± 17.1 x 83.1 ± 10.7 mmHg. Whereas in the United
States these authors found 42% of individuals without
comorbidities with BP < 140 x 90 mmHg, in the present
study, among those classified as belonging to Group A (AH
stages 1 and 2 with low and moderate risk), 61.7% presented
BP control. Regarding the group considered by the authors as
presenting the higher risk (patients with associated diabetes
and/or nephropathy), this rate, considering an ideal BP level <
130 x 80 mmHg, was 20%. This rate was approximately 30%
to 40% in a population with a similar profile in the present
study. Interestingly, when assessing the drugs more frequently
used in the United States, it was observed that diuretics were
the first choice (46%), followed by ACEI (37%), beta-blockers
(36%) and ARB II (24%). When assessing the medications
that are generally prescribed in Brazilian medical offices, the
order is different (Table 5), with ARB II being the ones most
frequently prescribed. However, the use of medications in
monotherapy or in association with other drugs exhibits a
very similar situation when comparing the medical practice
in the Unites States with that in Brazil. In that study, 58% of
the patients used a combination of medications, whereas the
present study shows that 67.5% of patients did the same.
Another study, by McInnis et al16, observed that only
49% to 51% of the patients evaluated by them received
monotherapy. This study, which was carried out in Canada,
showed that 62% of the patients used ARB II, similarly to what
was observed in the present study. The percentages of patients
with controlled BP in the present study, according to the gols
defined by the V DB H and also by other similar documents,
are optimistic in comparison to other observations. It is,
however, necessary to mention that for Groups A, B, C and
D we have, respectively, 38.3%; 57.5%; 58.2% and 67.6% of
individuals with noncontrolled BP.
Nobre et al
Controlar Brazil
Original Article
Due to their importance and impact, the associations of
individual variables, which, when present, act as additional risk
factors and can interfere with the desired BP control, were also
assessed. In this sense, we observed that for each centimeter
added to the abdominal circumference or for each year of life
gained, the BP control is reduced by 2%. Similarly, the habit
of smoking, the presence of diabetes mellitus and coronary
artery disease were determinants of a lower chance of blood
pressure control (Figure 2).
New evidence has shown that the abdominal circumference
is an acknowledged risk factor for cardiovascular disease
caused by increased visceral fat19. The present study showed
that this parameter increased the difficulty to control the BP,
even for small variations such as 1 cm.
The more difficult BP control presented by patients with
diabetes and nephropathy, is due, among other factors, to the
fact this population has lower BP goals than those presented
by individuals without these diseases, with the objective
of protecting target organs from vascular injury caused by
hypertension20,21.
A final observation is opportune and necessary. Why is the
blood pressure control so seldom achieved? Perhaps that is
the biggest challenge to be overcome by all professionals who
work with arterial hypertension.
Ogedegbe22 and Nobre et al13, among others, studied the
reasons why patients do not maintain a continuing treatment
and only a small percentage of them achieve BP control. The
factors that contribute to the low rate of BP control are focused
on variables associated with the physician and the patient
and must be considered: low adherence to prescriptions,
medication costs, personal beliefs on the treatment and the
disease itself, low frequency of consultations, adverse effects,
among others.
It is, however, necessary to seek better BP control,
considering the evidence regarding the benefits obtained
with its control.
The present study brings contributions regarding the
identification of the number of individuals undergoing treatment
in medical offices and clinics in Brazil, who present BP control
according to the established goals and their clinical conditions.
It is also useful so that actions can be taken in search of better
control rates, based on the conclusions drawn by the study.
Nevertheless, it has limitations. Among them, we should
mention that the sample is not representative of the population
of patients with arterial hypertension in Brazil, but rather of
those patients treated in private clinics and medical offices (vs.
those treated at the Brazilian Public Health System - SUS). For
this reason, one must state that these data refer to this specific
study population.
Finally, it is worth mentioning that the selection of the
participating centers was not randomly performed, but defined
by the willingness of the individuals invited to participate in
the study.
Researchers participating in the Controlar BRAZIL Study
Abrao Luiz Jablonka, Aderito das Neves Coelho, Adil Abdul
Latif Fares, Adriana Carvalho Ribeiro, Adriano Assis Mendes,
Alberto Pianta Neto, Alcione Maria Simoes, Alcy Maria
Pinheiro, Aldo Odilon Xavier Vitoria, Alessandro F. Chagas,
Alex Gules Mello. Alexandra O. Mesquita, Alexandre E. P. C.
Lucena, Alexandre Jorge Andrade Negri, Alexei A. Der
Bedrossian, Alfredo Jose P. G Leitão, Alice Porfirio Oliveira,
Álvaro Álvares da Silva, Amancio Valois, Ana Valéria S. G.
Ramirez, Andre Luiz S. Ferreira, Angela Cristina Farias, Anibal
Barros Jr., Anibal Prata Barbosa, Antônio Almeida Braga,
Antonio Carlos Lopes, Antonio da Silva Junior, Antonio
Edmond Ghattas, Antonio José L. Jorge, Antônio Mendes P.
Neto, Antonio Ribeiro P. Neto, Ariane L.Chair, Armando C.
Balbinotti, Armando M. Maranhão, Arnaldo Lemos Porto, Ary
Dos Santos Mesquita, Audes D. de M. Feitosa, Augusto O. S.
Coutinho, Augusto Terranova Rocha, Badir Hassan Awad,
Bruno Dumas Galvão, Carlos Alberto Chicca, Carlos Alberto
Oliveira, Carlos Alberto Penna Fernandes, Carlos Alberto Teles
Drews, Carlos Antônio de Souza Andrade, Carlos Cesar da
Silva, Carlos Delmar Ferreira, Carlos E. Dos Santos, Carlos
Eduardo Ornela, Carlos Manoel R. Costa, Carlos Roberto Ito,
Celia Regina Galeotti, Celso Machado Cury, Cesar Augusto de
Carli, Chris Machado Paulini de Andrade, Cicero Emanuel
Barros da Nóbrega, Cícero Roberto Azulay, Claudia B. B.
Alcipret, Claudia Kazuya Yamada, Cláudio David La Terza,
Cláudio Vieira Catharina, Cleiber Antônio dos Santos Teixeira,
Cristiano Jaeger, Cristina Maria Marcolan Quitete, Cristina
Pimentel Seba, Daniel Carvalho Alarcon Gonçalves, Daniel
José da Silva Filho, Daniele Mattos, Daniella Rosano, Darci
Alcoforado Quirino, Dario Cezar Vasconcello, Darlan Carneiro
Silva, Davi Gomes, Davis Taublib, Delma Maria S. H.
Gasparotti, Denise C. G. de Oliveira, Denise L. de Carvalho,
Denise Maria Soares Mohr, Denize Vozniak, Dorival Moraes
Ferreira, Douglas Conrado Schimidt, Dyrlei da Cunha Filho,
Edgar Pessoa de Melo, Edgard Matheus da Silva, Edinaldo
Jorge P. Malheiros, Edson A.Santos Jr., Eduardo Calixto Saliba,
Eduardo Costa Barbosa, Eduardo de Camargo, Eduardo
Rodolpho Ferber, Edvaldo do N. Barbosa, Elaine Brandão
Soares, Eliane Pereira Passos, Elio Lumertz Rolim, Emerson
Clayton Borges, Emerson de Morais Silva, Emerson Costa Porto,
Emmanuel Pires Abreu, Eric Murasca, Ernesto Jose F.Puppi,
Evandro G. de Souza, Evandro Veiler Ferrari, Fabiano de O.
Martins, Fabio Viegas Pimenta, Fátima E. F. de O. Negri, Fausto
Duarte Guimarães, Evandro Veiler Ferrari, Fabiano de O.
Martins, Fabio Viegas Pimenta, Fátima E. F. de O. Negri, Fausto
Duarte Guimarães, Fernanda Baptista Lins, Fernando Antônio
Flores, Fernando Augusto Neiva, Fernando Freire Maia,
Fernando Funari Vivolo, Fernando Lara Roquete, Fernando
Resende, Flávio Brugnara Veloso, Flavio Ferramola Pozzuto,
Flávio Roberto Salatino, Floramil Castilho, Francisco Delano
Macedo, Francisco Jose Godoi, Francisco R. de P. Filho,
Frederico Baumann, Germano M. P. Santos, Gerson N.
Guimarães, Gilberto Gheur Ramos, Gisel Pereira de C. Junior,
Gisely Martinelli Pudo, Gonzalo A.H.Gutierrez, Gustavo Cortez
Vieira, Helcio F. Salmazo, Hélio Cesar Telles Primo, Helio
Rubens Crialezi, Helio Soares, Henrique Miller Balieiro,
Hermilo Borba Carvalho Neto, Hidemburgo de B. Carvalho
Filho, Hugo Pinheiro Faria, Irineu B.Moreno, Ivan Cardoso de
Sá, Ivan Sergio Baddini, Ivna Maria B. de Macedo, Izo Helber,
Jaime Grynberg, Jamil Cherrem Scheneider, Jessica Myriam
A. Garcia, João Alberto R. Oliveira, João Batista de S. E Silva,
João Luiz Figueiredo, João Nei G Fernandes, João Nobrega A.
Arq Bras Cardiol 2010;94(5):623-630
628
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Moraes, Jose Alves Patricio Junior, Jose Augusto Condina, José
Campos Filho, José Carlos Ferreira da Silva Filho, José Carlos
Robalinho, Jose D. C. Solano Aliaga, José Eduardo D’ottaviano,
Jose Ibis Coelho das Neves, José Joaquim F. Raposo Filho, José
Roberto Brito, José Roberto Redini, Jose Wladimir Tambelli
Pires, Karen Oliveira Reis, Keffel Antonio Pereira, Kerginaldo
Paulo Torres, Keyla Alves Ferreira Abdala, Kleber Natal, Lazaro
Fernandes de Miranda, Leandro Espindola Roese, Lenilza
Martins, Loredana Mantovano, Lucélia B.N. C. Magalhães,
Luciana Frison Spiazzi, Luciano Maia de Melo, Luciano
Mauricio de Abreu Filho, Lúcio Lobo Leite Vitarelli, Ludenulfo
Cruz Lacet, Ludmila Daru Rey, Luiz Artur Sutic da Silva Paes,
Luiz Alberto Barreto, Luiz Antonio D. M. Oliveira, Luiz
Benjamin Francisco, Luiz Carlos Pacheco, Luiz Claudio da Silva
Félix, Luiz Claudio Mattos, Luiz Kencis Jr, Luiz Sergio Alves
Silva, Manoel Estrela Obregon Jr, Mara Lia Pereira, Marcel
Vezzaro ®, Marcelo Ferraz Sampaio, Marcelo Lerch Sturmer,
Marcelo Rava Campos, Marcelo Russo, Marcelo Sapucaia,
Marcelo Silva Seixas, Marcelo Xavier, Marcia Santos Guimarães,
Marcio Amuy, Marcio Franceschi Britto, Marco Antonio de M.
Alves, Marco Antonio de V. Barros, Marcos Antonio Lacerda,
Marcos Boechat Lopes, Marcos Cairo Vilela, Marcos Roberto
Volpi, Marcos Vinicios Andrade, Marcus Vinicius P. Matos,
Marcus Vinicíus Sales, Maria Cristina Torres Cardoso, Maria
da C. B. De A. F. Carvalho, Maria de Fátima M. Castro, Maria
do Carmo Maia Reis, Maria do Carmo Orge Rodrigues, Maria
Elizabete Silva Penido, Maria Fatima Oliveira P. Alencar, Maria
Goreth P. Souza, Maria Ivone de C. Abreu, Maria Rita
Veríssimo, Mario Sérgio Julio Cerci, Marlene Nakamura de
Villalon, Martha Demetrio Rustum, Maurício Gonçalves
Zanon, Maurício Tamura Saraiva do Brasil, Max Weyler Nery,
Miraldo Pereira Matos, Miriam de Souza Protásio Mota, Nadja
Sotero, Ned Maciel Oliveira, Neire Niara, Nelson Coifman
Goldemberg, Newton Ferreira Rodrigues, Ney da Silva
Moutinho, Nilton Leme, Olavo de Carvalho Freitas, Olympia
Dias de Azevedo Bastos, Omar Sérgio Lutz, Oscar Yoshinori
Ikari, Otacílio Araujo Silva, Patricia Eunice dos Santos, Paulo
Eduardo Seade Serra, Paulo Miqueloti, Paulo Roberto de
Souza, Paulo Rubens Moreno da Silva, Paulo Sergio de Osório
Almeida, Paulo Sergio Lopes Soares, Paulo Sergio Porto, Pedro
Schimidt, Pedro Vendramini Neto, Peri Sampaio Padua Neto,
Plauto Jose Gouveia, Priscila Cotia Pinheiro, Rachel D. C. Paes
de Aaraujo, Rafael Braga Pimenta, Raimundo Jose Vieira de
Assis, Ramon Farras Lopes, Raphael Damore Zardo, Regina
Celia Villela de Souza, Reinaldo Mattos Hadlich, Renan
Canibal Pires, Renato Fernandes Pinheiro, Renato Schuck
Saraiva, Rene Domingos Castagnino, Reynaldo A. M. da Costa
Miranda, Ricardo Alvarenga, Ricardo Barcia Barbeira, Ricardo
Cairo de Camargo, Ricardo Mendonça Costa, Rita de Cássia
Oliveira, Robert Dancour, Roberto Estrazulas Mayer, Roberto
Sandes Leal, Robson de Castro Ayala, Robson Luiz de Assis,
Rodolfo Ernesto Suriano, Rodolfo Malta Alencar, Rodrigo
629
Arq Bras Cardiol 2010;94(5):623-630
Caetano Pimentel, Rogério Kraukauer, Rogério Martins Ruiz,
Romário Rui de Souza, Rosana Graziane Mendes, Rosana
Stella Grossman, Rute Puiatti Roman, Ruth de Almeida
Medeiros, Ruy Barbosa Jr, Sadi de Carvalho Filho, Samira Kaissa
Nasr, Samuel Ellovitch, Sandra Maria Figueiredo, Sandro Silva
Vilella, Selem Safar T. Pinto, Sergio Baiocchi Carneiro, Sergio
Fajardo Assumpção, Sergio Francisco Ruiz, Sérgio José O. de
A. E Silva, Sérgio Luiz Nascimento, Sergio P. A B. de Camargo,
Sergio Salim Saud, Shirley Mioto, Sidney C. Fernandes,
Siegmar Starke, Silvana Purri B. Hemetério, Silvano Jorge
Pessanha, Silvia Regina V. de Carvalho, Silvio Hock de Paffer
Filho, Silvio Luiz Priori, Sirley da Silva Queiroz, Solange Veiga
F. Faria, Soriano Furtado Neto, Suely Lourdes Pacote, Tatiana
do Carmo Borges, Telemaco Luiz da Silva Jr., Telma Ferrais S.
Machado, Terezinha Mara S. Steele, Théo Fernando Bub,
Thiers Ribeiro Chagas, Tjioe Kok Kie, Tomas D. G. Mesquita,
Valdir Pereira Aires, Victor Luiz Santos Haddad, Victor Neves
da Fonseca, Vilma Cichelli Fernandes, Vilma Helena
Burlamaqui, Vlademir José Lustosa, Walmir Ratier Thomaz,
Walter de Assumpção, Walter Rello de Araujo Filho, Weimar
Kunz Sebba Barros, Wesley Roberto Hossri, Wilson Alvear
Torrano Machado, Wilson Dagone Junior, Wilson Elias Abrão,
Wilson Kioshima, Wilson Koury Filho, Wladimir Magalhães de
Freitas, Wladmyr de Carvalho Machado, Yanko Gonçalves
Melo, Yoshio Asanuma, Zenita Portela Pavani.
Acknowledgments
The authors would like to thank the statistical analysis work
carried out by Statistika Consulting. We also acknowledge
the work of the Clinical Research Team of Sanofi-Aventis
Pharmaceutical, Ltda. in carrying out this project, as well as
of Dr. Maria Eliane Magalhaes (RJ), Dr. Celso Amodeo (SP),
Dr. Francisco H. Fonseca (SP), Dr. Oscar Dutra (RS), Dr. Hilton
Chaves Jr. (PE), Dr. Andrea A. Brandão (RJ), Dr. Paulo C. Jardim
(GO), Dr. Jose Marcio Ribeiro (MG), Dr. Luis Carlos Bodanese
(RS), Dr. Marco A. Mota Gomes (AL), Dr. Edgard Pessoa de
Melo (PE) and Dr. Antonio Carlos Palandri Chagas (SP).
Potential Conflict of Interest
No potential conflict of interest relevant to this article was
reported.
Sources of Funding
This study was funded by Sanofi-Aventis and Sociedade
Brasileira de Hipertensão.
Study Association
This study is not associated with any post-graduation
program.
Nobre et al
Controlar Brazil
Original Article
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