Editorial
The freedom of clinicians and the art of the impossible
A liberdade dos clínicos e a arte do impossível
Read
3963
Timeswas read the article
1642
Total PDF
2321
Total HTML
Share statistics
array:25 [ "pii" => "S2174204917302994" "issn" => "21742049" "doi" => "10.1016/j.repce.2017.10.008" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1105" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "edi" "cita" => "Rev Port Cardiol. 2017;36:799-800" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1150 "formatos" => array:3 [ "EPUB" => 134 "HTML" => 747 "PDF" => 269 ] ] "Traduccion" => array:1 [ "pt" => array:20 [ "pii" => "S0870255117307874" "issn" => "08702551" "doi" => "10.1016/j.repc.2017.10.007" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1105" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "edi" "cita" => "Rev Port Cardiol. 2017;36:799-800" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1305 "formatos" => array:3 [ "EPUB" => 150 "HTML" => 848 "PDF" => 307 ] ] "pt" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "A liberdade dos clínicos e a arte do impossível" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "799" "paginaFinal" => "800" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The freedom of clinicians and the art of the impossible" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Hugo Madeira" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Hugo" "apellidos" => "Madeira" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204917302994" "doi" => "10.1016/j.repce.2017.10.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302994?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117307874?idApp=UINPBA00004E" "url" => "/08702551/0000003600000011/v2_201801180628/S0870255117307874/v2_201801180628/pt/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2174204917303240" "issn" => "21742049" "doi" => "10.1016/j.repce.2017.11.003" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1096" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2017;36:801-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1330 "formatos" => array:3 [ "EPUB" => 158 "HTML" => 934 "PDF" => 238 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Early, real-world experience with direct oral anticoagulants in the treatment of intermediate-high risk acute pulmonary embolism" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "801" "paginaFinal" => "806" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Experiência inicial com os anticoagulantes orais diretos no tratamento do tromboembolismo pulmonar agudo de risco intermédio-alto: dados do mundo real" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1064 "Ancho" => 1250 "Tamanyo" => 102637 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Study population flowchart. CONV: conventional anticoagulation; DOAC: direct oral anticoagulant; PE: pulmonary embolism.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sónia Martins Santos, Susana Cunha, Rui Baptista, Sílvia Monteiro, Pedro Monteiro, Francisco Gonçalves, Mariano Pêgo" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Sónia Martins" "apellidos" => "Santos" ] 1 => array:2 [ "nombre" => "Susana" "apellidos" => "Cunha" ] 2 => array:2 [ "nombre" => "Rui" "apellidos" => "Baptista" ] 3 => array:2 [ "nombre" => "Sílvia" "apellidos" => "Monteiro" ] 4 => array:2 [ "nombre" => "Pedro" "apellidos" => "Monteiro" ] 5 => array:2 [ "nombre" => "Francisco" "apellidos" => "Gonçalves" ] 6 => array:2 [ "nombre" => "Mariano" "apellidos" => "Pêgo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S087025511630258X" "doi" => "10.1016/j.repc.2017.01.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511630258X?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917303240?idApp=UINPBA00004E" "url" => "/21742049/0000003600000011/v1_201712190639/S2174204917303240/v1_201712190639/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2174204917302982" "issn" => "21742049" "doi" => "10.1016/j.repce.2017.10.007" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1104" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2017;36:789-98" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2914 "formatos" => array:3 [ "EPUB" => 148 "HTML" => 2241 "PDF" => 525 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "2017 Guidelines for the management of arterial hypertension in primary health care in Portuguese-speaking countries" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "789" "paginaFinal" => "798" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Diretrizes de 2017 em Hipertensão Arterial para Cuidados Primários nos Países de Língua Portuguesa" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1193 "Ancho" => 2083 "Tamanyo" => 149111 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Flowchart for the treatment of arterial hypertension.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">12–14</span></a> ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; BP: blood pressure; CCB: calcium channel blocker; CV: cardiovascular; K: potassium. <span class="elsevierStyleSup">a</span> High doses of chlorthalidone should be used instead of another thiazide unless it has been used previously.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Adapted with permission from Malachias et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a></p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gláucia Maria Moraes de Oliveira, Miguel Mendes, Marcus Vinícius Bolívar Malachias, João Morais, Osni Moreira Filho, Armando Serra Coelho, Daniel Pires Capingana, Vanda Azevedo, Irenita Soares, Alda Menete, Beatriz Ferreira, Miryan Bandeira dos Prazeres Cassandra Soares, Mário Fernandes" "autores" => array:13 [ 0 => array:2 [ "nombre" => "Gláucia Maria Moraes" "apellidos" => "de Oliveira" ] 1 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mendes" ] 2 => array:2 [ "nombre" => "Marcus Vinícius Bolívar" "apellidos" => "Malachias" ] 3 => array:2 [ "nombre" => "João" "apellidos" => "Morais" ] 4 => array:2 [ "nombre" => "Osni Moreira" "apellidos" => "Filho" ] 5 => array:2 [ "nombre" => "Armando Serra" "apellidos" => "Coelho" ] 6 => array:2 [ "nombre" => "Daniel Pires" "apellidos" => "Capingana" ] 7 => array:2 [ "nombre" => "Vanda" "apellidos" => "Azevedo" ] 8 => array:2 [ "nombre" => "Irenita" "apellidos" => "Soares" ] 9 => array:2 [ "nombre" => "Alda" "apellidos" => "Menete" ] 10 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Ferreira" ] 11 => array:2 [ "nombre" => "Miryan Bandeira dos Prazeres Cassandra" "apellidos" => "Soares" ] 12 => array:2 [ "nombre" => "Mário" "apellidos" => "Fernandes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S0870255117307862" "doi" => "10.1016/j.repc.2017.10.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117307862?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302982?idApp=UINPBA00004E" "url" => "/21742049/0000003600000011/v1_201712190639/S2174204917302982/v1_201712190639/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "The freedom of clinicians and the art of the impossible" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "799" "paginaFinal" => "800" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Hugo Madeira" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Hugo" "apellidos" => "Madeira" "email" => array:1 [ 0 => "hcmadeira.fml.ul@sapo.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Ex-presidente da Federação das Sociedades de Cardiologia de Língua Portuguesa, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro Cardiovascular da Universidade de Lisboa, Lisboa, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "A liberdade dos clínicos e a arte do impossível" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Systemic arterial hypertension, generally known nowadays simply as hypertension, is the most important and most common risk factor for death and disability from non-communicable diseases.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> Its prevalence in Europe ranges between 30% and 45%,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> while in the USA two-thirds of adults aged over 60 are hypertensive,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and in south Asia and sub-Saharan Africa, prevalence rates are rising rapidly.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> A recent estimate put the worldwide prevalence of hypertension at 31%.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The last three decades have seen the development of a large number of safe and effective drugs to treat hypertension. However, although lowering blood pressure (BP) by only 10 mmHg is known to reduce cardiovascular death and stroke by 25% and 40%, respectively, over the lifetime of these patients,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> disagreement remains concerning the target BP level to aim for in hypertensive adults in general and the elderly in particular. Furthermore, even when treated, many patients’ hypertension is uncontrolled, failing to reach the target BP levels set by the European Society of Hypertension and the European Society of Cardiology<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> or those recommended on the basis of the SPRINT trial.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Many guidelines and recommendations have been published on the diagnosis and treatment of hypertension by medical societies and other public entities, international and national, but even here there is not complete agreement. Between the target systolic BP level originally proposed in the Fifth Report of the Joint National Committee (<140 mmHg)<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and that based on the results of the SPRINT trial (<120 mmHg),<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> there is a gray area of uncertainty, and although it is believed that lower BP is better for most patients, it is up to clinicians to decide.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Medical guidelines, originally recommendations suggesting approaches to difficult situations in clinical practice, used to allow clinicians the freedom to adjust therapy according to the individual characteristics of the patient. For example, in the case of hypertension, they could decide to adopt a more aggressive approach in younger individuals, even if asymptomatic, and be more conservative – accepting higher systolic BP – in older patients, on the assumption that the latter are more liable to suffer complications from antihypertensive therapy, although this is still the subject of debate.</p><p id="par0025" class="elsevierStylePara elsevierViewall">This therapeutic flexibility is being surreptitiously eroded. Guidelines, produced on the basis of trials and studies that in at times bear little relation to real-world practice, now define what clinicians should do in every situation, or risk their performance being characterized as bad clinical practice. The change in the Portuguese term for guidelines, from <span class="elsevierStyleItalic">Recomendações</span> (‘Recommendations’) to <span class="elsevierStyleItalic">Diretrizes</span> (‘Directives’), says much about this different attitude.</p><p id="par0030" class="elsevierStylePara elsevierViewall">It is therefore not inappropriate to recall that it is the attending physician – who knows the patient's characteristics, including cardiovascular risk, general condition, frailties and options, and taking into consideration any possible adverse effects of therapy – who will make the best decisions.</p><p id="par0035" class="elsevierStylePara elsevierViewall">It is in this context that the guidelines for the management of hypertension in primary health care in Portuguese-speaking countries are published in this issue of the <span class="elsevierStyleItalic">Journal</span>,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> produced under the auspices of the Federation of Cardiology Societies of the Portuguese-Speaking Countries (FSCLP) (<a href="http://www.fsclp.org/">www.fsclp.org</a>), which was established in 2014 with the primary aim of promoting the development of cardiology in countries and territories in which Portuguese is an official language. Before its foundation, Portuguese-Speaking Conferences on Cardiology were held in Cabo Verde in 2009 and in Mozambique in 2011. The first FSCLP Congress took place in Portugal in 2016 and the second will be held in Brazil in November 2017.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The Federation's statutes summarize the ways in which its main objective can be realized, identifying as priorities fostering research into the scientific aspects of cardiovascular disease, analyzing the social aspects of heart disease and its prevention and treatment, and encouraging closer relations between cardiologists in Portuguese-speaking communities. In short, the aim is to develop cardiology in the Portuguese-speaking world.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Producing yet more guidelines for the FSCLP and its geographic areas that do not repeat what has already been published appears an impossible task. And yet, the guidelines published here are valuable. Firstly, they paint an accurate picture of the situation in Portuguese-speaking countries, including their similarities and differences. Secondly, without being excessively detailed, they omit none of the essentials of the subject. Thirdly, and most importantly, they stress the importance of prevention and treatment of hypertension in primary health care, which is after all their purpose. Finally, they take into consideration the medical, social and economic characteristics of the geographic areas for which they are intended.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The guidelines published here<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> have another and very significant merit: they are the first scientific and pedagogic work produced by the FSCLP. They set out to fulfill the aims of the FSCLP by taking an important step toward “a continuous process involving educational actions, lifestyle changes and guaranteed access to pharmacological treatment”, as stated in the document itself.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The authors of these Guidelines have managed the art of the impossible.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Madeira H. A liberdade dos clínicos e a arte do impossível. Rev Port Cardiol. 2017;36:799–800.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.S. Lim" 1 => "T. Vos" 2 => "A.D. Flaxman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(12)61766-8" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2012" "volumen" => "380" "paginaInicial" => "2224" "paginaFinal" => "2260" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23245609" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disability-adjusted life years (DALYs) for 291 diseases in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.J. Murray" 1 => "T. Vos" 2 => "R. Lozano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(12)61689-4" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2012" "volumen" => "380" "paginaInicial" => "2197" "paginaFinal" => "2223" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23245608" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Mancia" 1 => "R. Fagard" 2 => "K. Narkiewicz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/eht151" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2013" "volumen" => "34" "paginaInicial" => "2159" "paginaFinal" => "2219" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23771844" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Erratum in: Circulation. 2013;127:e841" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart disease and stroke statistics – 2013 update: a report from the American Heart Association" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "American Heart Association Statistics Committee and Stroke Statistics Subcommittee" "etal" => true "autores" => array:3 [ 0 => "A.S. Go" 1 => "D. Mozaffarian" 2 => "V.L. Roger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIR.0b013e31828124ad" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2013" "volumen" => "127" "paginaInicial" => "e6" "paginaFinal" => "e245" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23239837" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "NCD Risk Factor Collaboration (NCD-RisC)" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Lancet" "fecha" => "2017" "volumen" => "39" "paginaInicial" => "37" "paginaFinal" => "55" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K.T. Mills" 1 => "J.D. Bundy" 2 => "T.N. Kelly" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.115.018912" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2016" "volumen" => "134" "paginaInicial" => "441" "paginaFinal" => "450" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27502908" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.R. Law" 1 => "J.K. Morris" 2 => "N.J. Wald" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2009" "volumen" => "338" "paginaInicial" => "b1665" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19454737" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized trial of intensive versus standard blood-pressure control" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "SPRINT Research Group" "etal" => true "autores" => array:3 [ 0 => "J.T. Wright Jr." 1 => "J.D. Williamson" 2 => "P.K. Whelton" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Eng J Med" "fecha" => "2015" "volumen" => "373" "paginaInicial" => "2103" "paginaFinal" => "2116" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V)" ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "1993" "volumen" => "153" "paginaInicial" => "154" "paginaFinal" => "183" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8422206" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diretrizes para cuidados primários em hipertensão arterial nos países de Língua Portuguesa" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.M. Oliveira" 1 => "J.C. Morais" 2 => "M.F. Mendes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5935/abc.20170165" "Revista" => array:5 [ "tituloSerie" => "Arq Bras Cardiol" "fecha" => "2017" "volumen" => "109" "paginaInicial" => "389" "paginaFinal" => "396" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003600000011/v1_201712190639/S2174204917302994/v1_201712190639/en/main.assets" "Apartado" => array:4 [ "identificador" => "18163" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003600000011/v1_201712190639/S2174204917302994/v1_201712190639/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302994?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 3 | 9 |
| 2024 October | 30 | 29 | 59 |
| 2024 September | 36 | 27 | 63 |
| 2024 August | 25 | 29 | 54 |
| 2024 July | 27 | 23 | 50 |
| 2024 June | 20 | 23 | 43 |
| 2024 May | 25 | 23 | 48 |
| 2024 April | 21 | 24 | 45 |
| 2024 March | 33 | 25 | 58 |
| 2024 February | 21 | 16 | 37 |
| 2024 January | 21 | 26 | 47 |
| 2023 December | 13 | 30 | 43 |
| 2023 November | 22 | 14 | 36 |
| 2023 October | 18 | 14 | 32 |
| 2023 September | 21 | 22 | 43 |
| 2023 August | 12 | 11 | 23 |
| 2023 July | 26 | 14 | 40 |
| 2023 June | 17 | 11 | 28 |
| 2023 May | 26 | 30 | 56 |
| 2023 April | 16 | 7 | 23 |
| 2023 March | 27 | 25 | 52 |
| 2023 February | 37 | 24 | 61 |
| 2023 January | 29 | 15 | 44 |
| 2022 December | 37 | 29 | 66 |
| 2022 November | 39 | 25 | 64 |
| 2022 October | 36 | 29 | 65 |
| 2022 September | 16 | 38 | 54 |
| 2022 August | 26 | 41 | 67 |
| 2022 July | 29 | 48 | 77 |
| 2022 June | 25 | 34 | 59 |
| 2022 May | 19 | 26 | 45 |
| 2022 April | 24 | 38 | 62 |
| 2022 March | 22 | 51 | 73 |
| 2022 February | 30 | 34 | 64 |
| 2022 January | 42 | 38 | 80 |
| 2021 December | 33 | 28 | 61 |
| 2021 November | 26 | 40 | 66 |
| 2021 October | 54 | 53 | 107 |
| 2021 September | 39 | 27 | 66 |
| 2021 August | 36 | 31 | 67 |
| 2021 July | 25 | 14 | 39 |
| 2021 June | 30 | 24 | 54 |
| 2021 May | 22 | 50 | 72 |
| 2021 April | 27 | 50 | 77 |
| 2021 March | 38 | 9 | 47 |
| 2021 February | 60 | 28 | 88 |
| 2021 January | 23 | 12 | 35 |
| 2020 December | 29 | 13 | 42 |
| 2020 November | 17 | 12 | 29 |
| 2020 October | 12 | 13 | 25 |
| 2020 September | 58 | 11 | 69 |
| 2020 August | 14 | 7 | 21 |
| 2020 July | 34 | 12 | 46 |
| 2020 June | 31 | 10 | 41 |
| 2020 May | 22 | 7 | 29 |
| 2020 April | 26 | 10 | 36 |
| 2020 March | 41 | 12 | 53 |
| 2020 February | 22 | 34 | 56 |
| 2020 January | 22 | 10 | 32 |
| 2019 December | 23 | 4 | 27 |
| 2019 November | 21 | 8 | 29 |
| 2019 October | 42 | 3 | 45 |
| 2019 September | 16 | 6 | 22 |
| 2019 August | 20 | 10 | 30 |
| 2019 July | 31 | 6 | 37 |
| 2019 June | 24 | 15 | 39 |
| 2019 May | 33 | 7 | 40 |
| 2019 April | 26 | 15 | 41 |
| 2019 March | 14 | 11 | 25 |
| 2019 February | 33 | 4 | 37 |
| 2019 January | 8 | 7 | 15 |
| 2018 December | 20 | 11 | 31 |
| 2018 November | 30 | 10 | 40 |
| 2018 October | 22 | 7 | 29 |
| 2018 September | 23 | 16 | 39 |
| 2018 August | 36 | 6 | 42 |
| 2018 July | 16 | 3 | 19 |
| 2018 June | 31 | 7 | 38 |
| 2018 May | 28 | 10 | 38 |
| 2018 April | 32 | 7 | 39 |
| 2018 March | 47 | 5 | 52 |
| 2018 February | 38 | 12 | 50 |
| 2018 January | 37 | 11 | 48 |
| 2017 December | 53 | 21 | 74 |
| 2017 November | 2 | 7 | 9 |
Show all
