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Palomo-Piñón S, Enciso-Muñoz JM, Meaney E, Díaz-Domínguez E, Cardona-Muller D, Pérez FP, Cantoral-Farfán E, Anda-Garay JC, Mijangos-Chavez J, Antonio-Villa NE. Strategies to prevent, diagnose and treat kidney disease related to systemic arterial hypertension: a narrative review from the Mexican Group of Experts on Arterial Hypertension. BMC Nephrol 2024; 25:24. [PMID: 38238661 PMCID: PMC10797813 DOI: 10.1186/s12882-023-03450-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/27/2023] [Indexed: 01/22/2024] Open
Abstract
This narrative review highlights strategies proposed by the Mexican Group of Experts on Arterial Hypertension endorsed to prevent, diagnose, and treat chronic kidney disease (CKD) related to systemic arterial hypertension (SAH). Given the growing prevalence of CKD in Mexico and Latin America caused by SAH, there is a need for context-specific approaches to address the effects of SAH, given the diverse population and unique challenges faced by the region. This narrative review provides clinical strategies for healthcare providers on preventing, diagnosing, and treating kidney disease related to SAH, focusing on primary prevention, early detection, evidence-based diagnostic approaches, and selecting pharmacological treatments. Key-strategies are focused on six fundamental areas: 1) Strategies to mitigate kidney disease in SAH, 2) early detection of CKD in SAH, 3) diagnosis and monitoring of SAH, 4) blood pressure targets in patients living with CKD, 5) hypertensive treatment in patients with CKD and 6) diuretics and Non-Steroidal Mineralocorticoid Receptor Inhibitors in Patients with CKD. This review aims to provide relevant strategies for the Mexican and Latin American clinical context, highlight the importance of a multidisciplinary approach to managing SAH, and the role of community-based programs in improving the quality of life for affected individuals. This position paper seeks to contribute to reducing the burden of SAH-related CKD and its complications in Mexico and Latin America.
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Affiliation(s)
- Silvia Palomo-Piñón
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México.
- Colaborador Externo, Unidad de Investigación Médica en Enfermedades Nefrológicas Siglo XXI (UIMENSXII), UMAE Hospital de Especialidades "Dr. Bernardo Sepúlveda G" Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
- Grupo Colaborativo en Hipertensión Arterial (GCHTA), Ciudad de México, México.
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Calle Retorno del Escorial #13, Col. El Dorado, Tlanepantla de Baz, Estado de México, 54020, México.
| | - José Manuel Enciso-Muñoz
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones A.C, Ciudad de México, México
| | - Eduardo Meaney
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Escuela Superior de Medicina, Instituto Politecnico Nacional, Ciudad de México, México
| | - Ernesto Díaz-Domínguez
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - David Cardona-Muller
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Fabiola Pazos Pérez
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- UMAE Hospital de Especialidades "Dr. Bernardo Sepúlveda G" Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Emilia Cantoral-Farfán
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Jefatura de Nefrología, Hospital General De Zona Médico Familiar No. 8 Gilberto Flores Izquierdo, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Juan Carlos Anda-Garay
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- UMAE Hospital de Especialidades "Dr. Bernardo Sepúlveda G" Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Janet Mijangos-Chavez
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Jefatura de Cardiología, UMAE Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Neftali Eduardo Antonio-Villa
- Grupo de Expertos en Hipertensión Arterial México (GREHTA), Ciudad de México, México
- Departamento de Endocrinologia, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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Bittencourt JC, Scheinbein GHA, de Oliveira Junior WC, Bassi RL, Moura LB, Correa ALD, de Lima Bernardes RG, Freitas LS, Lemos JC, Gonçalves GKN, Rodrigues-Machado MDG. Arterial stiffness indices, pulse wave velocity and central systolic blood pressure, are able to discriminate between obese and non-obese children. Eur J Pediatr 2023; 182:1403-1415. [PMID: 36680578 PMCID: PMC9862226 DOI: 10.1007/s00431-023-04807-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/09/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023]
Abstract
The objectives of this study were to verify, first, if arterial stiffness indices can discriminate between obese and healthy children. Second, to evaluate arterial stiffness index predictors and hemodynamic parameters in obese children. Arterial stiffness indices evaluated were pulse wave velocity (PWV), central systolic blood pressure (SBPc), and central pulse pressure (PPc). A cross-sectional, descriptive, comparative study design was used. The sample consisted of 78 normal-weight children (8.1 ± 1.96 years) and 58 obese children (9.0 ± 1.87 years). PWV, PPc, and SBPc were significantly higher in the group of obese children than in the control group. The ROC curve analysis showed that maximum PWV and SBPc sensitivity and specificity in differentiating obese from non-obese children occurred at 4.09 m/s and 86.17 mmHg, respectively. PPc did not exhibit a discriminatory capacity between the two groups. Peripheral systolic blood pressure (SBPp), peripheral pulse pressure (PPp), and PPc (R2 = 0.98) were predictors of increased PWV. Augmentation pressure, PPp, and reflection coefficient (R2 = 0.873) were predictors of PPc. Age, augmentation index, total vascular resistance, cardiac index, and mean fat percentage (R2 = 0.801) were predictors of SBPc. CONCLUSION This study shows for the first time that PWV > 4.09 m/s and SBPc > 86.17 mmHg are cut-off points associated with a higher risk of obesity. These results indicate that the simple, rapid, and noninvasive measurement of arterial stiffness adds prognostic information regarding cardiovascular risk, in addition to increased body mass index. WHAT IS KNOWN • Overweight and obesity are strongly associated with comorbidities que contribute to the development of cardiovascular diseases. WHAT IS NEW • This is the first study to show that PWV and SBPc can discriminate obese from non-obese children. These results show that, in addition to an increased BMI, a simple, rapid, and noninvasive measurement of arterial stiffness adds prognostic information on cardiovascular risk.
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Affiliation(s)
- Juliana Cabral Bittencourt
- Faculty of Medical Sciences of Minas Gerais (FCM-MG), Post-Graduate Program in Health Sciences, Belo Horizonte, MG Brazil
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Gonçalves CV, Ribeiro IS, Galantini MPL, Muniz IPR, Lima PHB, Santos GS, da Silva RAA. Inflammaging and body composition: New insights in diabetic and hypertensive elderly men. Exp Gerontol 2022; 170:112005. [PMID: 36341786 DOI: 10.1016/j.exger.2022.112005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 12/29/2022]
Abstract
Age-related changes in the body's physiological responses play a critical role in systemic arterial hypertension (SAH) and type 2 Diabetes mellitus (T2DM). SAH and T2DM have clinically silent low-grade inflammation as a common risk factor. This inflammation has a relevant element, the excess of fatty tissue. In this scenario, little is known about how inflammatory markers interact with each other. Therefore, this work evaluated the interplay among anthropometric, biochemical, and inflammatory markers in the elderly with SAH and T2DM. Men aged 60-80 years old with SAH and T2DM were classified by body mass index (BMI) as eutrophic elderly (EE, 24 individuals) or overweight elderly (OE, 25 individuals). Body composition analysis was performed using bioimpedance. Blood samples were collected to perform inflammatory and biochemical evaluations. The cytokines IL-17A, IL-1β, IFN-y, TNF-α, and IL-10, were evaluated by ELISA. Triglycerides, total and fractions of cholesterol, and glucose were measured by spectrophotometry. Overweight elderly men had a higher glycemic index and an increase in most anthropometric markers, as well as higher means for all pro-inflammatory cytokines analyzed (IL-17A, IL-1β, IFN-y, and TNF-α) in comparison to their eutrophic elderly counterparts. However, there was a decrease in IL-10 anti-inflammatory cytokine and IL-10/IL-17A ratio compared to their eutrophic elderly counterparts. Although overweight elderly men have worsening inflammatory parameters, the magnitude of their correlations with anthropometric and biochemical parameters becomes less evident. The Bayesian networks highlight that in the eutrophic elderly, IL-17A and TNF-α are the cytokines most associated with interactions, and most of these interactions occur with biochemical parameters. It is worth highlighting the role of IFN-y in overweight elderly men. This cytokine influences IL-10 and TNF-α production, contributing to the inflammatory profile exacerbated in this group.
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de Souza AMF, Macola A, Gumieiro DN, Nicolodi GA, Lima RME, Minicucci MF, Azevedo PS, Sahota O, Lima LHNE. Association between pre-operative complications, comorbidities, and in-hospital mortality in a hip fracture cohort: a register study in a tertiary hospital in Brazil. Int Orthop 2022. [PMID: 35608676 DOI: 10.1007/s00264-022-05443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The incidence of hip fractures is increasing exponentially due to an aging Brazilian population. Older people had significant comorbidities which increases the risk of post-operative mortality. Our purpose was to examine the association between pre-operative infections and comorbidities on the risk of post-operative in-hospital mortality after proximal femur fracture surgery's, beyond that, to evaluate the association between comorbidities and time to surgery. METHODS This is a population-based cohort retrospective study, using medical records of all six year consecutive surgical procedures for correction of hip fracture in a tertiary teaching Hospital in Brazil. The exclusion criteria aimed to exclusively allocate patients who had their first hip fracture secondary to low-energy trauma. Multivariate logistical regression was performed and receiver operating characteristic (ROC) curve with area under curve (AUC) to evaluate the sensitivity and specificity of the model. p-value < 0.05 was considered significant. RESULTS Final sample was composed by 856 consecutive patients with 81 years of median and 164 patients were excluded. The median length of hospital say was five days with - l mortality at 3.6%. Significant variables for increased mortality included the presence of pre-operative infection (odds ratio (OR): 3.9(1.12-8.54), chronic obstructive pulmonary disease (COPD) (OR: 3.83(1.36-10.82)), and systemic arterial hypertension (SAH) (OR: 4.1(1.18-14.25)). Development of pre-operative infection was associated with a delay to surgery (OR: 1.1 (1.08-1.13)). CONCLUSIONS In older people with proximal femur fracture, the presence of pre-operative infection, COPD and SAH were the strongest risk factor for post-operative in-hospital mortality. Pre-operative infection was associated with statistically significant delay to surgery.
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Faria-Neto JR, Yarleque C, Vieira LF, Sakane EN, Santos RD. Challenges faced by patients with dyslipidemia and systemic arterial hypertension in Brazil: a design of the patient journey. BMC Cardiovasc Disord 2022; 22:237. [PMID: 35597901 PMCID: PMC9124411 DOI: 10.1186/s12872-022-02669-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Non-communicable diseases like systemic arterial hypertension (SAH) and dyslipidemia are poorly studied in terms of patient journey aspects. This semi-systematic review provides evidence synthesis for the management of SAH and dyslipidemia in Brazil and also discusses challenges faced by patients at the local level along with a suggested care approach by local experts. METHODS A semi-systematic review using both structured literature databases (Embase and Medline) and unstructured scientific records (WHO, IPD, MOH and Google) on hypertension and dyslipidemia in the English language from 2010 to 2019 was performed by reviewers. After two-level screening based on pre-defined criteria, patient journey touchpoints and prevalence information were extracted from the included articles. Data gaps were bridged through the insights of local experts. RESULTS Prevalence of hypertension and dyslipidemia in Brazil were 23% and 40.8%, respectively. Awareness of dyslipidemia was found in a larger proportion (58.1%) than in SAH (22.2%). Similarly, screening for hypertension (97%) and dyslipidemia (55.4%) were found to be effective, while treatment was (62.9%) and (30.0%) for hypertension and dyslipidemia, respectively. CONCLUSION There were important gaps on patient awareness and treatment of dyslipidemia and hypertension. Limited patient education, regional disease distribution, and treatment allocation, along with limited resources for diagnosis and treatment are the key challenges.
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Affiliation(s)
- Jose Rocha Faria-Neto
- School of Medicine, Pontificial Catholic University of Parana (PUCPR), Curitiba, Brazil
| | - Carlos Yarleque
- Research, Development and Medical, Upjohn - A Division of Pfizer, Lima, Peru
| | | | | | - Raul D Santos
- Heart Institute (InCor) University of Sao Paulo Medical School Hospital, São Paulo, Brazil.
- Academic Research Organization, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Gramegna A, De Petro C, Leonardi G, Contarini M, Amati F, Meazza R, Carugo S, Blasi F. Onset of systemic arterial hypertension after initiation of elexacaftor/tezacaftor/ivacaftor in adults with cystic fibrosis: A case series. J Cyst Fibros 2022:S1569-1993(22)00099-6. [PMID: 35450770 DOI: 10.1016/j.jcf.2022.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 01/17/2023]
Abstract
Elexacaftor/tezacaftor/ivacaftor (ETI) is associated with major improvements in respiratory outcomes of individuals with cystic fibrosis (CF) and at least one Phe508del mutation. Although ETI was well tolerated in registration studies, the attention on adverse events not previously described is very high in the post-marketing phase. In this case series we report the onset of systemic arterial hypertension in 4 individuals with CF within the first weeks of starting therapy. All patients needed cardiac evaluation and started chronic anti-hypertensive therapy. Until more data is available, this report could foster the attention of CF physicians towards careful monitoring of cardiovascular parameters in patients starting ETI.
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Ribeiro IS, Pereira ÍS, Galantini MPL, Santos DP, Teles MF, Muniz IPR, Santos GS, Silva RAA. Regular physical activity reduces the effects of inflammaging in diabetic and hypertensive men. Exp Gerontol 2021; 155:111558. [PMID: 34547405 DOI: 10.1016/j.exger.2021.111558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
The aim of this study was to assess the influence of physical activity in inflammatory, biochemical and endocrine parameters of middle-aged and elderly men with Systemic Arterial Hypertension (SAH) and Type 2 Diabetes Mellitus (T2DM). The assessment was comprised by 77 male volunteers aged between 45 and 59 years old (middle-aged men) or 60 to 86 years old (elderly men), diagnosed with SAH and T2DM, assisted by Family Health Units in Vitória da Conquista, Bahia, Brazil. According to age and lifestyle (sedentary or practicing physical activity), these men were classified as middle-aged sedentary men, middle-aged physically active men, elderly sedentary men, or elderly physically active men. It was noticed that active elderly people with SAH and T2DM had a better inflammatory balance than sedentary middle-aged men, through the evaluation of the relationship between the cytokines IL-10/TNF-α, IL-10/IL-17A and IL-10/IFN-γ. Moreover, in the extended correlation analysis, a greater global balance was observed among anthropometric, blood pressure, biochemical and cytokine parameters. Physical activity beneficially modulates aging-related disease risk factors even in elderly individuals.
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Affiliation(s)
- Israel S Ribeiro
- Multidisciplinary Institute of Health, Anísio Teixeira Campus - Federal University of Bahia, 58 Hormindo Barros Street - 17 Block - 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil; Paulo Freire Campus - Federal University of Southern Bahia, 250 Joana Angélica Square, São José, 45.988-058 Teixeira de Freitas, Bahia, Brazil
| | - Ítalo S Pereira
- Multidisciplinary Institute of Health, Anísio Teixeira Campus - Federal University of Bahia, 58 Hormindo Barros Street - 17 Block - 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil
| | - Maria P L Galantini
- Multidisciplinary Institute of Health, Anísio Teixeira Campus - Federal University of Bahia, 58 Hormindo Barros Street - 17 Block - 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil
| | - Denisar P Santos
- Multidisciplinary Institute of Health, Anísio Teixeira Campus - Federal University of Bahia, 58 Hormindo Barros Street - 17 Block - 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil; FG Universitary Center - UniFG, 459 Barão do Rio Branco Avenue, Zip code: 46430-000 Guanambi, Bahia, Brazil
| | - Mauro F Teles
- Multidisciplinary Institute of Health, Anísio Teixeira Campus - Federal University of Bahia, 58 Hormindo Barros Street - 17 Block - 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil
| | - Igor P R Muniz
- Multidisciplinary Institute of Health, Anísio Teixeira Campus - Federal University of Bahia, 58 Hormindo Barros Street - 17 Block - 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil
| | - Gilvanéia S Santos
- Multidisciplinary Institute of Health, Anísio Teixeira Campus - Federal University of Bahia, 58 Hormindo Barros Street - 17 Block - 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil
| | - Robson A A Silva
- Multidisciplinary Institute of Health, Anísio Teixeira Campus - Federal University of Bahia, 58 Hormindo Barros Street - 17 Block - 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil.
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Waclawovsky G, Boll LFC, Neto SG, Irigoyen MCC, Lehnen AM. Effects of autonomic nervous system activation on endothelial function in response to acute exercise in hypertensive individuals: study protocol for a randomized double-blind study. Trials 2021; 22:548. [PMID: 34412668 PMCID: PMC8374129 DOI: 10.1186/s13063-021-05516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/06/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Arterial hypertension has a direct association with endothelial dysfunction and major cardiovascular events. There is evidence showing the benefits of aerobic exercise on flow-mediated dilation (FMD) in hypertensive individuals but little is known about the effect of autonomic nervous system (ANS) activation on FMD of the brachial artery in response to different types of exercise in this specific population. This study aims to examine the effects of ANS activation on FMD of the brachial artery in response to exercise in hypertensive individuals following a session of different types of exercise including aerobic exercise (AE), resistance exercise (RE), or combined exercise (CE). METHODS Thirty-nine hypertensive volunteers aged 35 to 55 years will be randomly assigned to two exercise sessions: AE (40 min on a cycle ergometer at 60% of HR reserve), RE (4 lower limb sets with 12 repetitions at 60% 1-RM for 40 min), or CE (RE for 20 min + AE for 20 min). Each exercise group will be randomized to receive either an α1-adrenergic blocker (doxazosin 0.05 mg/kg-1) or placebo. Ultrasound measurement of FMD is performed 10 min before and 10, 40, and 70 min after exercise. ANS activation is monitored using a Finometer and measurements are taken during 10 min before each FMD assessment. Arterial stiffness is assessed by pulse wave velocity (PWV) analysis using a Complior device. DISCUSSION We expect to demonstrate the effect of ANS activation on FMD of the brachial artery in hypertensive individuals in response to different types of exercise. This study may give some insight on how to improve exercise prescription for hypertension management. TRIAL REGISTRATION https://clinicaltrials.gov and ID "NCT04371757". Registered on May 1, 2020.
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Affiliation(s)
- Gustavo Waclawovsky
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, Brazil
| | | | - Salvador Gomes Neto
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, Brazil
| | - Maria Claudia Costa Irigoyen
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, Brazil
- Unidade de Hipertensão, Instituto do Coração de São Paulo, Universidade do Estado de São Paulo, São Paulo, Brazil
| | - Alexandre M Lehnen
- Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, Brazil.
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Lopes DPS, Ribeiro IS, Santos DC, Lima FMS, Santos AA, Souza DSP, Lopes DN, Prado AO, Pereira ÍS, Santos DP, Santos GS, Silva RAA. Regular physical activity reduces the proinflammatory response in older women with diabetes and hypertension in the postmenopausal phase. Exp Gerontol 2021; 152:111449. [PMID: 34126225 DOI: 10.1016/j.exger.2021.111449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
Aging in women is characterized by extreme hormonal changes leading them to develop a chronic low-grade inflammation that is linked to the development of systemic arterial hypertension (SAH) and type 2 diabetes mellitus (T2DM). In this scenario, physical activity emerges as an interesting methodology, since it seems to be connected to a decrease in serum levels of some pro-inflammatory cytokines. Nevertheless, most studies evaluate these cytokines in an isolated manner not considering the influence of comorbidities on the responsiveness of participants to the benefits of physical activity. So, this study aimed to assess the influence of physical activity on body composition, anthropometric parameters, lipid profile, and inflammatory markers of diabetic and hypertensive older postmenopausal women. We evaluated 163 women aged from 60 to 80 years, diagnosed with T2DM and SAH that were assisted by the Family Health Units in Vitória da Conquista, Bahia, Brazil. The pratice of physical activity was measured by the International Physical Activity Questionnaire with the participants being classified as active or sedentary individuals. Active older women presented better body composition, lipid profile and inflammatory balance. This was connected to a better correlation profile between these factors in active older women, characteristics that were not noticed in sedentary older women. Moreover, IL-17A and the relationship between IL-10 and the other pro-inflammatory cytokines examined was greatly influenced by physical activity. Consequently, physical activity is linked to a global improvement in T2DM and SAH risk factors and with a positive inflammatory modulation in diabetic and hypertensive older women.
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Affiliation(s)
- Diego P S Lopes
- Multidisciplinary Institute of Health, Anísio Teixeira Campus, Federal University of Bahia, 58 Hormindo Barros Street, 17 Block, 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil
| | - Israel S Ribeiro
- Multidisciplinary Institute of Health, Anísio Teixeira Campus, Federal University of Bahia, 58 Hormindo Barros Street, 17 Block, 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil; Paulo Freire Campus, Federal University of Southern Bahia, 250 Joana Angélica Square, São José, 45.988-058 Teixeira de Freitas, Bahia, Brazil
| | - Deborah C Santos
- Multidisciplinary Institute of Health, Anísio Teixeira Campus, Federal University of Bahia, 58 Hormindo Barros Street, 17 Block, 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil
| | - Fernanda M S Lima
- Multidisciplinary Institute of Health, Anísio Teixeira Campus, Federal University of Bahia, 58 Hormindo Barros Street, 17 Block, 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil
| | - Andressa A Santos
- Multidisciplinary Institute of Health, Anísio Teixeira Campus, Federal University of Bahia, 58 Hormindo Barros Street, 17 Block, 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil
| | - Daniela S P Souza
- Multidisciplinary Institute of Health, Anísio Teixeira Campus, Federal University of Bahia, 58 Hormindo Barros Street, 17 Block, 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil
| | - Danilo N Lopes
- Multidisciplinary Institute of Health, Anísio Teixeira Campus, Federal University of Bahia, 58 Hormindo Barros Street, 17 Block, 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil
| | - Alice O Prado
- Multidisciplinary Institute of Health, Anísio Teixeira Campus, Federal University of Bahia, 58 Hormindo Barros Street, 17 Block, 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil
| | - Ítalo S Pereira
- Multidisciplinary Institute of Health, Anísio Teixeira Campus, Federal University of Bahia, 58 Hormindo Barros Street, 17 Block, 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil
| | - Denisar P Santos
- Multidisciplinary Institute of Health, Anísio Teixeira Campus, Federal University of Bahia, 58 Hormindo Barros Street, 17 Block, 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil; FG Universitary Center, UniFG, 459 Barão do Rio Branco Avenue, Downtown, 46430-000 Guanambi, Bahia, Brazil
| | - Gilvanéia S Santos
- Multidisciplinary Institute of Health, Anísio Teixeira Campus, Federal University of Bahia, 58 Hormindo Barros Street, 17 Block, 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil
| | - Robson A A Silva
- Multidisciplinary Institute of Health, Anísio Teixeira Campus, Federal University of Bahia, 58 Hormindo Barros Street, 17 Block, 58 Lot, Candeias, 45.029-094 Vitória da Conquista, Bahia, Brazil.
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Vitarelli A. Myocardial strain impairment, heterozygous familial hypercholesterolemia and systemic arterial hypertension: Is there a link? Int J Cardiol Hypertens 2021; 9:100086. [PMID: 34095812 PMCID: PMC8167278 DOI: 10.1016/j.ijchy.2021.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/08/2022] Open
Abstract
Dyslipidemia is known as a strong risk factor for premature atherosclerotic cardiovascular disease and increased morbidity and mortality and can have an adverse effect on left ventricular function due to direct or indirect macrovascular and/or microvascular damage. Speckle-tracking echocardiography allows the assessment of subclinical cardiac dysfunction in different diseases on the basis of myocardial deformation indices, and decrease in longitudinal and circumferential strain was shown in patients with heterozygous familial hypercholesterolemia (heFH) without comorbidities. In this issue of the journal a new study presents the results in a well-defined population which included asymptomatic treatment-naive heFH individuals without known coronary/peripheral arterial disease, with normal left ventricular ejection fraction and no other risk factors as formal arterial hypertension or diabetes mellitus. A slight impairment of global longitudinal strain was present, despite normal standard echocardiographic parameters. Also, the higher rise in systolic and diastolic blood pressure of heHF patients during exercise treadmill test might reflect early preclinical hypertension. High cholesterol level may have produced endothelial dysfunction, which has been shown to be related to the extent of atherosclerotic process and cardiovascular damage. Relevant findings are reported on left ventricular strain reduction and increase in systolic/diastolic blood pressure in asymptomatic heFH males. The relationship between myocardial strain impairment and developing systemic arterial hypertension in hypercholesterolemic patients could be the subject of further subsequent investigation.
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Affiliation(s)
- Antonio Vitarelli
- Sapienza University, Dept. of Medicine and Cardiology, Via Lima 35, Rome, 00198, Italy
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Ferreira da Mata G, Mansur JB, Riguetti MTP, Rezende GF, Osmar de Medina Pestana J, Mastroianni Kirsztajn G. A Single-center, Retrospective Study of Focal Segmental Glomerulosclerosis after Kidney Transplantation: Evolutive Analysis. Int J Organ Transplant Med 2021; 12:1-10. [PMID: 35509723 PMCID: PMC9013500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Focal segmental glomerulosclerosis (FSGS) has a high recurrence rate after renal transplantation, which significantly impacts renal graft survival. However, the factors related to recurrence remain unclear. OBJECTIVE This study aimed to analyze focal segmental recurrence and evolution of glomerulosclerosis after renal transplantation. METHODS This was a descriptive, retrospective study involving 88 adults who underwent renal transplantation within a 15-year period. Demographic and clinical characteristics, as well as the occurrence of graft loss, were analyzed. Over the study period, 88 patients with a diagnosis of FSGS after transplantation were identified. RESULTS The mean age of the patients (n=54, males) was 29.1 years. Transplants with deceased donors predominated (60.9%). Calcineurin and prednisone inhibitors were present in 96.4% of the initial immunosuppression regimens. The mean time of onset of proteinuria greater than 0.5 g/g was 20.51 days. At 60 months after transplantation, 44.16% of the patients had partial remission, 25.97% had complete remission, and 29.87% had no remission. However, 50.60% of the patients developed graft loss throughout the analyzed period. Eight patients (9.4%) died within 60 months, of which five (62.5%) were attributed to infection. CONCLUSION Our results indicate that FSGS after renal transplantation is a disease of high recurrence that is commonly precocious, and the histological alterations in light microscopy are not simultaneous to the appearance of proteinuria. Hypertension is considered a risk factor causing progression and recurrence. Thus, prospective studies are required to better evaluate progression and recurrence factors.
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Affiliation(s)
- G. Ferreira da Mata
- Department of Medicine (Nephrology), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - J. B. Mansur
- Department of Medicine (Nephrology), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - M. T. P. Riguetti
- Department of Medicine (Nephrology), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - G. F. Rezende
- Faculty of Medicine, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | | | - G. Mastroianni Kirsztajn
- Department of Medicine (Nephrology), Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Dellalibera-Joviliano R, Bestetti RB, Lopes GS, Furlan-Daniel R, Lopes KC, Faria-Junior M, Junior NI. Kinins and nitric oxide in patients with chronic chagas disease and systemic arterial hypertension. Cardiovasc Pathol 2020; 49:107257. [PMID: 32674046 DOI: 10.1016/j.carpath.2020.107257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/31/2020] [Accepted: 06/15/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Chronic Chagas disease (CCHD) associated with Systemic Arterial Hypertension (SAH) is frequently found in areas where the disease is endemic. The pathogenesis of patients with both pathologies (CCHD-SAH) is unsettled. Nitric Oxide (NO) and Kinins are important players in the myocardial inflammation process in experimental CCHD. No previous study has addressed this question in patients with CCHD, particularly in those with CCHD-SAH. Accordingly, this study was undertaken in an attempt to contribute to the understanding of the pathogenesis of patients with CCHD-SAH. METHODS Thirty-seven patients with a positive serology for Chagas disease were enrolled; 15 had CCHD alone, 22 had CCHD-SAH (abnormal ECG/Doppler echocardiogram plus a systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg on admission), and 11 had SAH alone. Thirty healthy individuals matched by age and sex served as controls. Plasma High-molecular (Hkg) and low-molecular weight (LKg) kininogens, plasma kallikrein levels (Pkal and Tcal), Kininase II, and plasma NO were measured. RESULTS HKg and LKg were lower in CCHD-SAH patients in comparison with other groups (P < .0001). Pkal and Tcal were higher in CCHD-SAH patients in comparison with the other groups (P< .0001). Kininase II levels were similar in SAH, CCHD, and CCHD-SAH patients, but lower in comparison with controls (P< .0001). NO levels were similar in CCHD and CCHD-SAH patients, but higher in comparison with SAH patients and controls (P > .0001). CONCLUSION Such findings suggest increased Kinin and NO activity in patients with CCHD-SAH, thus contributing to the understanding of the pathogenesis of this condition.
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Balderas-Vargas NA, Legorreta-Soberanis J, Paredes-Solís S, Flores-Moreno M, Santos FRSDL, Andersson N. Occult renal failure and associated factors in patients with chronic conditions. GAC MED MEX 2020; 156:11-16. [PMID: 32026875 DOI: 10.24875/gmm.19005292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Timely diagnosis and early therapeutic intervention reduce premature mortality associated with chronic renal failure. Objective To identify the prevalence and factors associated with occult renal failure in patients with chronic diseases. Method Cross-sectional study of 1268 patients with type 2 diabetes mellitus and systemic arterial hypertension. A measuring instrument with questions about associated factors such as osteoarthritis, treatment of chronic conditions, smoking, analgesic consumption, alcoholism, body mass index, physical activity and serum glucose, cholesterol and triglyceride levels was used. Results The prevalence of occult renal failure was 13.2 % (167/1,268), 13.4 % in diabetic patients (117/876) and 14.9 % in hypertensive patients (150/1,010). In the multivariate analysis, the factors associated with occult renal failure were being older than 60 years (aOR = 1.96, 95 % CI = 1.22-2.49), belonging to the female gender (aOR = 2.17, 95 % CI = 1.30-2.82), suffering from systemic arterial hypertension (aOR = 1.96, 95% CI = 1.22-2.50) and not having overweight/obesity (aOR = 0.49, 95 % CI = 0.41-0.8). Conclusions The prevalence of occult renal failure was 13 %. Female patients older than 60 years with overweight/obesity and systemic arterial hypertension should be examined in detail by the family doctor for occult renal failure early detection.
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Affiliation(s)
| | - José Legorreta-Soberanis
- Universidad Autónoma de Guerrero, Centro de Investigación de Enfermedades Tropicales. Guerrero, México
| | - Sergio Paredes-Solís
- Universidad Autónoma de Guerrero, Centro de Investigación de Enfermedades Tropicales. Guerrero, México
| | - Miguel Flores-Moreno
- Universidad Autónoma de Guerrero, Centro de Investigación de Enfermedades Tropicales. Guerrero, México
| | | | - Neil Andersson
- Universidad Autónoma de Guerrero, Centro de Investigación de Enfermedades Tropicales. Guerrero, México
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Di Francesco S, Caruso M, Robuffo I, Militello A, Toniato E. The Impact of Metabolic Syndrome and Its Components on Female Sexual Dysfunction: A Narrative Mini-Review. Curr Urol 2019; 12:57-63. [PMID: 31114461 DOI: 10.1159/000489420] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/09/2018] [Indexed: 02/06/2023] Open
Abstract
Background The impact of metabolic syndrome on female sexual dysfunction received modest consideration in clinical practice. The aim of the research was to analyze the international literature to determine the relationship between the metabolic syndrome, its components and female sexual disorders. Methods We identified relevant full-length papers by electronic databases as Index Medicus/Medline, Scopus, Life Science Journals, from 2005 to the present. Studies were searched using the following as search query: metabolic syndrome, female sexual dysfunction, obesity, systemic arterial hypertension, diabetes mellitus, dyslipidemia. Results Women with metabolic syndrome showed higher prevalence of sexual inactivity and low sexual desire, orgasm and satisfaction respect to women without metabolic syndrome. Particularly metabolic components as diabetes mellitus, dy-slipidemia, systemic arterial hypertension were strongly associated with lower sexual desire, activity and Female Sexual Function Index total score. In contrast, other studies showed no relationship. Conclusion Our study showed that in the clinical evaluation of women with metabolic syndrome routine inquiring about female sexual dysfunction should be recommended to ameliorate sexual function and quality of life. However more prospective and longitudinal studies on the sexual effects of metabolic syndrome should also be suggested to know the factors related to women's sexuality better.
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Affiliation(s)
- Simona Di Francesco
- Department of Medical and Oral Sciences and Biotechnologies, G. D'Annunzio University of Chieti-Pescara, Chieti
| | - Marika Caruso
- Department of Medical and Oral Sciences and Biotechnologies, G. D'Annunzio University of Chieti-Pescara, Chieti
| | - Iole Robuffo
- Institute of Molecular Genetics, National Research Council, Section of Chieti, Chieti
| | - Andrea Militello
- Urology and Andrology Section, Villa Immacolata Hospital, Viterbo, Italy
| | - Elena Toniato
- Department of Medical and Oral Sciences and Biotechnologies, G. D'Annunzio University of Chieti-Pescara, Chieti
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Schuh DS, Piccoli ÂB, Paiani RL, Maciel CR, Pellanda LC, Vilela MA. Ocular Signs Related to Overweight and Arterial Hypertension in Children: A Systematic Review. Open Ophthalmol J 2017; 11:273-285. [PMID: 29081867 PMCID: PMC5633707 DOI: 10.2174/1874364101711010273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/20/2017] [Accepted: 06/18/2017] [Indexed: 12/18/2022] Open
Abstract
Background: The ocular effects of obesity and hypertension need to be established and can be used as prognostic markers. Objective: To estimate the prevalence of ophthalmological alterations in children and adolescents who are overweight and/or have SAH. Methods: The database for this study included all observational studies (CS, cohort, case-control and “baseline” description of randomized clinical trials) with children and/or adolescents who were overweight, obese or had SAH and that measured ophthalmological alterations. Results: Comparative studies with healthy children demonstrated positive association between body adiposity with retinal venular dilation, and SAH with retinal arteriolar narrowing. Different retinal fundus cameras and computer-assisted programs to evaluate the retinal vessels, variations in the methods of analysis, adjustments, populations, were the main arguments against formal meta-analysis. The heterogeneity was too high (I2 >90%, in fixed or randomized effects), and the lack of linearity, normal distribution and homoscedasticity did not recommend meta-regression. Conclusion: Obesity and SAH show associations with ophthalmological alterations, especially with retinal vessel diameter. Lack of standardization does not allow a quantitative evaluation.
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Affiliation(s)
- Daniela S Schuh
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Ângela B Piccoli
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Raquel L Paiani
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Cristiane R Maciel
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Lucia C Pellanda
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Manuel Ap Vilela
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Azpiri-López JR, Assad-Morell JL, Ponce de León-Martínez E, Monreal-Puente R, Dávila-Bortoni A, Vázquez-Díaz LA, Treviño-Frutos RJ, Barrera-Oranday F, Del Angel-Soto JG, Martínez JG, Arellano-Torres M. [Position paper on the results of Symplicity HTN-3 trial. Grupo de estudio de la hipertensión arterial resistente]. Arch Cardiol Mex 2015; 85:154-7. [PMID: 25700579 DOI: 10.1016/j.acmx.2014.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 11/27/2014] [Accepted: 11/27/2014] [Indexed: 11/23/2022] Open
Abstract
Renal artery denervation has shown to be an effective treatment for resistant hypertension. Symplicity HTN 1 and 2 trials showed in small and uncontrolled groups, significant systolic blood pressure reductions down to 30 mm Hg. Symplicity HTN-3, a double blind, randomized, placebo controlled clinical trial shaded this initial enthusiasm. Surprisingly, their results showed that renal denervation has a similar effect to placebo. Pre-specified subgroup analysis showed that non-black race individuals, younger than 65 years and with normal renal function, had a statistically significant systolic blood pressure decrease. This manuscript critically appraises the Symplicity HTN-3 trial, proposing possible explanations for the results. Also declares our group position and future actions regarding renal denervation.
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Prada-Delgado O, Barge-Caballero E, Peteiro J, Bouzas-Mosquera A, Estévez-Loureiro R, Barge-Caballero G, López-Pérez M, Vázquez-González N, Castro-Beiras A. Prognostic value of exercise-induced left ventricular systolic dysfunction in hypertensive patients without coronary artery disease. Rev Esp Cardiol (Engl Ed) 2015; 68:107-114. [PMID: 25499955 DOI: 10.1016/j.rec.2014.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/06/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES We sought to assess the prognostic value of exercise-induced left ventricular systolic dysfunction in hypertensive patients with normal resting echocardiography and absence of coronary artery disease. METHODS From our database of patients referred for treadmill exercise echocardiography, we identified 93 hypertensive patients with preserved resting left ventricular ejection fraction (≥ 50%), no evidence of structural heart disease, and absence of coronary artery disease on angiography. Overall, 39 patients developed exercise-induced left ventricular systolic dysfunction (defined as a decrease in left ventricular ejection fraction below 50% at peak exercise) and 54 exhibited a normal left ventricular ejection fraction response to exercise. The mean follow-up was 6.1 (3.7) years. End points were all-cause mortality, cardiac death, heart failure, and the composite event of cardiac death or heart failure. RESULTS Patients who developed exercise-induced left ventricular systolic dysfunction were at higher risk of death from any cause (hazard ratio=3.4; 95% confidence interval, 1.1-10.3), cardiac death (hazard ratio=5.6; 95%CI, 1.1-29.4), heart failure (hazard ratio=8.9; 95% confidence interval, 1.8-44.2), and the composite end point (hazard ratio=5.7; 95% confidence interval, 1.7-19.0). In the multivariate analysis, exercise-induced left ventricular systolic dysfunction remained an independent predictor of both heart failure (hazard ratio=6.9; 95% CI, 1.3-37.4) and the composite event of cardiac death or heart failure (hazard ratio=4.5; 95% confidence interval, 1.2-16.0). CONCLUSIONS In hypertensive patients with preserved resting left ventricular ejection fraction and absence of coronary artery disease, exercise-induced left ventricular systolic dysfunction is a strong predictor of cardiac events and may represent early hypertensive heart disease.
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Affiliation(s)
- Oscar Prada-Delgado
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain.
| | - Eduardo Barge-Caballero
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Jesús Peteiro
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Alberto Bouzas-Mosquera
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | | | - Gonzalo Barge-Caballero
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - Manuel López-Pérez
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | | | - Alfonso Castro-Beiras
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
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Karoline de Morais P, Sales MM, Alves de Almeida J, Motta-Santos D, Victor de Sousa C, Simões HG. Effects of aerobic exercise intensity on 24-h ambulatory blood pressure in individuals with type 2 diabetes and prehypertension. J Phys Ther Sci 2015; 27:51-6. [PMID: 25642036 PMCID: PMC4305596 DOI: 10.1589/jpts.27.51] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 07/04/2014] [Indexed: 01/24/2023] Open
Abstract
[Purpose] To verify the effects of different intensities of aerobic exercise on 24-hour
ambulatory blood pressure (BP) responses in individuals with type 2 diabetes mellitus
(T2D) and prehypertension. [Subjects and Methods] Ten individuals with T2D and
prehypertension (55.8 ± 7.7 years old; blood glucose 133.0 ± 36.7 mg·dL−1 and
awake BP 130.6 ± 1.6/ 80.5 ± 1.8 mmHg) completed three randomly assigned experiments:
non-exercise control (CON) and exercise at moderate (MOD) and maximal (MAX) intensities.
Heart rate (HR), BP, blood lactate concentrations ([Lac]), oxygen uptake (VO2),
and rate of perceived exertion (RPE) were measured at rest, during the experimental
sessions, and during the 60 min recovery period. After this period, ambulatory blood
pressure was monitored for 24 h. [Results] The results indicate that [Lac] (MAX: 6.7±2.0
vs. MOD: 3.8±1.2 mM), RPE (MAX: 19±1.3 vs. MOD: 11±2.3) and VO2peak (MAX:
20.2±4.1 vs. MOD: 14.0±3.0 mL·kg−1·min−1) were highest following the
MAX session. Compared with CON, only MAX elicited post-exercise BP reduction that lasted
for 8 h after exercise and during sleep. [Conclusion] A single session of aerobic exercise
resulted in 24 h BP reductions in individuals with T2D, especially while sleeping, and
this reduction seems to be dependent on the intensity of the exercise performed.
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Affiliation(s)
- Pâmella Karoline de Morais
- Universidade Católica de Brasília: EPTC, QS07, LT1 s/n. Bloco G Sala 15, CEP 72030-170 Águas Claras, Taguatinga/DF, Brazil
| | - Marcelo Magalhães Sales
- Universidade Católica de Brasília: EPTC, QS07, LT1 s/n. Bloco G Sala 15, CEP 72030-170 Águas Claras, Taguatinga/DF, Brazil
| | | | | | - Caio Victor de Sousa
- Universidade Católica de Brasília: EPTC, QS07, LT1 s/n. Bloco G Sala 15, CEP 72030-170 Águas Claras, Taguatinga/DF, Brazil
| | - Herbert Gustavo Simões
- Universidade Católica de Brasília: EPTC, QS07, LT1 s/n. Bloco G Sala 15, CEP 72030-170 Águas Claras, Taguatinga/DF, Brazil
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Morillas P, Pallarés V, Fácila L, Llisterri JL, Sebastián ME, Gómez M, Castilla E, Camarasa R, Sandin M, García-Honrubia A; FAPRES registry investigators. The CHADS2 Score to Predict Stroke Risk in the Absence of Atrial Fibrillation in Hypertensive Patients Aged 65 Years or Older. ACTA ACUST UNITED AC 2015; 68:485-91. [PMID: 25487320 DOI: 10.1016/j.rec.2014.06.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/30/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES The CHADS2 score is a proven, essential tool for estimating cardioembolic risk (mainly stroke) in patients with nonvalvular atrial fibrillation, with the purpose of determining the indication for anticoagulant therapy. In this study we analyzed the use of CHADS2 in hypertensive patients without known atrial fibrillation in a Mediterranean population. METHODS The study included 887 hypertensive patients aged 65 years or older without atrial fibrillation or anticoagulant therapy, who attended a medical consultation. Data on the patients' main risk factors, cardiovascular history, and medication were collected, basic laboratory analyses and electrocardiography were performed, and the CHADS2 score (heart failure, hypertension, age ≥ 75 years, diabetes mellitus, and previous stroke or transient ischemic attack) was calculated. A clinical follow-up was carried out, recording hospital admissions for a stroke or transient ischemic attack. The median duration of follow-up was 804 days. RESULTS Mean age was 72.5 (SD,5.7) years, 46.6% were men, 27.8% had diabetes, and 8.6% were smokers. During follow-up, 40 patients were hospitalized for a stroke or transient ischemic attack (4.5%). The event-free survival analysis showed significant differences according to the CHADS2 score (log rank test, P < .001). On multivariate analysis, smoking and CHADS2 ≥3 were independent predictors of stroke or transient ischemic attack. CONCLUSIONS The CHADS2 may be useful for estimating the risk of stroke or transient ischemic attack in hypertensive patients without known atrial fibrillation.
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Veloso HH. Incidence of sudden cardiac death in congestive heart failure: Chagas disease versus systemic arterial hypertension. Int J Cardiol 2014; 175:175-6. [PMID: 24852839 DOI: 10.1016/j.ijcard.2014.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
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Bestetti RB, Otaviano AP, Fantini JP, Cardinalli-Neto A, Nakazone MA, Nogueira PR. Mode of death in chronic systolic heart failure: Chagas cardiomyopathy versus systemic arterial hypertension. Int J Cardiol 2014; 174:818-9. [PMID: 24794968 DOI: 10.1016/j.ijcard.2014.04.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/12/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Reinaldo B Bestetti
- Department of Cardiology and Cardiovascular Surgery, Hospital de Base, São José do Rio Preto City, Brazil.
| | - Ana Paula Otaviano
- Department of Cardiology and Cardiovascular Surgery, Hospital de Base, São José do Rio Preto City, Brazil
| | - João Paulo Fantini
- Department of Cardiology and Cardiovascular Surgery, Hospital de Base, São José do Rio Preto City, Brazil
| | - Augusto Cardinalli-Neto
- Department of Cardiology and Cardiovascular Surgery, Hospital de Base, São José do Rio Preto City, Brazil
| | - Marcelo A Nakazone
- Department of Cardiology and Cardiovascular Surgery, Hospital de Base, São José do Rio Preto City, Brazil
| | - Paulo R Nogueira
- Department of Cardiology and Cardiovascular Surgery, Hospital de Base, São José do Rio Preto City, Brazil
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Bestetti RB, Otaviano AP, Fantini JP, Cardinalli-Neto A, Nakazone MA, Nogueira PR. Prognosis of patients with chronic systolic heart failure: Chagas disease versus systemic arterial hypertension. Int J Cardiol 2013; 168:2990-1. [PMID: 23642596 DOI: 10.1016/j.ijcard.2013.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 04/04/2013] [Indexed: 01/08/2023]
Affiliation(s)
- Reinaldo B Bestetti
- Post-Graduate Division of São José do Rio Preto Medical School, Hospital de Base, São José do Rio Preto, Brazil.
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Cioffi G, Mureddu GF, Stefenelli C. Influence of age on the relationship between left atrial performance and left ventricular systolic and diastolic function in systemic arterial hypertension. Exp Clin Cardiol 2006; 11:305-310. [PMID: 18651023 PMCID: PMC2274841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Changes in left ventricular (LV) systolic and diastolic properties may generate variations in left atrial (LA) size and function in many pathophysiological models of LV overload. Besides these states, increasing age may independently influence and magnify LA changes. OBJECTIVE To investigate the relation of LA size and function to increasing age in hypertensive patients, and to evaluate whether this relationship is influenced by LV function. METHODS Three hundred thirty-six patients were evaluated using Doppler echocardiography. Maximal LA volume and ejection force were used as indexes of LA size and performance, respectively. RESULTS Age was positively associated with LA ejection force (r=0.34, P<0.001) and maximal volume (r=0.25, P<0.001). The effect of age was independent of LV mass and LV concentric geometry, which independently influenced LA parameters. The relationship between age and LA ejection force was maintained in patients with and without LV systolic dysfunction, and in those with normal diastolic function, whereas it was lost in those with LV diastolic dysfunction. The relationship between age and LA size was not influenced by either LV systolic or diastolic function. LA ejection force was associated with LV mass and LV concentric geometry in all groups of patients 56 years or older, while no association was found between these variables in patients younger than 56 years. LV mass was systematically linked to maximal LA volume in all classes of age, together with LV end-diastolic volume in all groups of patients 56 years of age or older, and LV concentric geometry in patients 68 years of age or older. CONCLUSIONS There is a positive relationship between age and LA size and performance in hypertensive patients, which is independent of LV mass and geometry. The effect of age on LA performance is insignificant when diastolic dysfunction occurs.
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