The impact of metabolic syndrome on metabolic, pro-inflammatory and prothrombotic markers according to the presence of high blood pressure criterion

OBJECTIVES: We explored whether high blood pressure is associated with metabolic, inflammatory and prothrombotic dysregulation in patients with metabolic syndrome. METHODS: We evaluated 135 consecutive overweight/obese patients. From this group, we selected 75 patients who were not under the regular use of medications for metabolic syndrome as defined by the current Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults criteria. The patients were divided into metabolic syndrome with and without high blood pressure criteria (≥130/≥85 mmHg). RESULTS: Compared to the 45 metabolic syndrome patients without high blood pressure, the 30 patients with metabolic syndrome and high blood pressure had significantly higher glucose, insulin, homeostasis model assessment insulin resistance index, total cholesterol, low-density lipoprotein-cholesterol, triglycerides, uric acid and creatinine values; in contrast, these patients had significantly lower high-density lipoprotein-cholesterol values. Metabolic syndrome patients with high blood pressure also had significantly higher levels of retinol-binding protein 4, plasminogen activator inhibitor 1, interleukin 6 and monocyte chemoattractant protein 1 and lower levels of adiponectin. Moreover, patients with metabolic syndrome and high blood pressure had increased surrogate markers of sympathetic activity and decreased baroreflex sensitivity. Logistic regression analysis showed that high-density lipoprotein, retinol-binding protein 4 and plasminogen activator inhibitor-1 levels were independently associated with metabolic syndrome patients with high blood pressure. There is a strong trend for an independent association between metabolic syndrome patients with high blood pressure and glucose levels. CONCLUSIONS: High blood pressure, which may be related to the autonomic dysfunction, is associated with metabolic, inflammatory and prothrombotic dysregulation ...

Exercise training program based on minimum weekly frequencies: effects on blood pressure and physical fitness in elderly hypertensive patients / Programa de exercícios físicos baseado em frequência semanal mínima: efeitos na pressão arterial e aptidão física em idosos hipertensos

BACKGROUND: Exercise training (ET) can reduce blood pressure (BP) and prevent functional disability. However, the effects of low volumes of training have been poorly studied, especially in elderly hypertensive patients. OBJECTIVES: To investigate the effects of a multi-component ET program (aerobic training, strength, flexibility, and balance) on BP, physical fitness, and functional ability of elderly hypertensive patients. METHODS: Thirty-six elderly hypertensive patients with optimal clinical treatment underwent a multi-component ET program: two 60-minute sessions a week for 12 weeks at a Basic Health Unit. RESULTS: Compared to pre-training values, systolic and diastolic BP were reduced by 3.6% and 1.2%, respectively (p<0.001), body mass index was reduced by 1.1% (p<0.001), and peripheral blood glucose was reduced by 2.5% (p=0.002). There were improvements in all physical fitness domains: muscle strength (chair-stand test and elbow flexor test; p<0.001), static balance test (unipedal stance test; p<0.029), aerobic capacity (stationary gait test; p<0.001), except for flexibility (sit and reach test). Moreover, there was a reduction in the time required to perform two functional ability tests: "put on sock" and "sit down, stand up, and move around the house" (p<0.001). CONCLUSIONS: Lower volumes of ET improved BP, metabolic parameters, and physical fitness and reflected in the functional ability of elderly hypertensive patients. Trial Registration RBR-2xgjh3.

CONTEXTUALIZAÇÃO: O treinamento físico (TF) é capaz de reduzir a pressão arterial (PA) e prevenir o declínio da capacidade funcional. Entretanto, pouco tem sido estudado sobre os efeitos de menores volumes de treinamento em idosos com hipertensão arterial (HA). OBJETIVOS: Investigar os efeitos de um programa de TF multicomponente (treinamento aeróbico, força, flexibilidade e equilíbrio) na PA, aptidão física e capacidade funcional de idosos com HA. MÉTODOS: Trinta e seis idosos com HA e tratamento clínico otimizado foram submetidos a um programa de exercícios físicos multicomponente, com duas sessões semanais de 60 minutos cada, durante 12 semanas, em uma Unidade Básica de Saúde (UBS). RESULTADOS: Comparados aos valores antes do TF, observou-se redução de 3,6% da PA sistólica (p<0,001), de 1,2% da PA diastólica (p<0,001), de 1,1% do índice de massa corporal (IMC) (p<0,001) e de 2,5% da glicemia periférica em jejum (p=0,002). Observou-se melhora em todos os domínios da aptidão física, como força muscular (testes de levantar da cadeira e flexão de cotovelos, p<0,001); equilíbrio estático (teste de apoio unipodal, p=0,029), capacidade aeróbica (teste de marcha estacionária, p<0,001), com exceção da flexibilidade (teste de sentar e alcançar). Além disso, houve redução no tempo utilizado para realização de dois testes de avaliação da capacidade funcional, o de "calçar meias" e o de "sentar, levantar-se da cadeira e locomover-se pela casa" (p<0,001). CONCLUSÕES: O TF com duas sessões semanais em idosos hipertensos repercutiu na melhora dos indicadores metabólicos, da aptidão física e da capacidade funcional e atuou como auxiliar no controle da PA. Registro de Ensaios Clínicos RBR-2xgjh3.

Efeitos fisiológicos do treinamento físico em pacientes portadores de diabetes tipo 1 / Physiological effects of exercise training in patients with type 1 diabetes / Physiological effects of exercise training in patients with type 1 diabetes

Insulinoterapia, atividade física regular e planejamento alimentar, em conjunto, consistem na abordagem mais completa no tratamento de portadores de diabetes mellitus tipo 1 (DM1). Estudos clínicos e experimentais têm evidenciado os benefícios do treinamento físico em indivíduos com DM1, tais como melhora na sensibilidade à insulina, redução das doses de insulina e atenuação das disfunções autonômicas e cardiovasculares. Essa revisão aborda as adaptações fisiológicas ao treinamento físico no indivíduo com DM1 e discute as recomendações e prescrição de atividade física para esta população.

Insulin therapy, regular physical activity and an individualized dietary plan are considered to be the ideal approach for the treatment plan of type 1 diabetes mellitus (T1DM) patients. Clinical and experimental studies have shown the benefits of exercise training in T1DM, as demonstrated by insulin sensitivity improvement, reduction in insulin requirement and an attenuation of autonomic and cardiovascular dysfunction. This review explores the physiological adaptations to exercise training in T1DM, and discuss the guidelines for physical activity recommendations and prescription in this setting.

Hydrogen peroxide as a tool for studying oxidative stress in the heart

Hydrogen peroxide (H2O2) was observed to depolarize the frog sartorius muscle and promote rhythmic contraction of frog cardiac ventricular rings or their contracture. This last effect was sodium-dependent. H2O2 perfused or injected into the aorta of the isolated rat heart induces a positive inotropic effect (with cardiac arrhythmias such as extrasystolic potentiations) followed by deoression of contractility or cardiac contractures, according to the dose employed. The last effects is similar to the "stone heart"observed in the reperfusion injury and may be ascribed to lipoperoxidation (LPO) of the membrane lipids, to protein damage, to reduction in the ATP level and/or to cardioactive compounds liberated by LPO. Besides its direct effect on the ATP level, H2O2 would react with iron ions to produce hydroxyl radicals that attack the cellular membranes. Deferoxamine, an iron chelator and scavenger of hydroxyl radicals, reduced the contractures induced by H2O2. Perfusion with H2O2 increased the LPO of cardiac homogenates measured by chemiluminescence, oxygen uptake and malonaldehyde formation. The fall in ATP levels and the LPO would result in calcium overload of the cardiac fibers and contracture ("stone heart"). The 45Ca uptake was increased by incubation of cardiac strips with H2O2. Previous perfusion of the isolated rat heart with nifedipine or indomethacin reduced the H2O2 cardiac contracture. Vitamin A, a quencher of singlet oxygen liberated during LPO, reduces the H2O2 cardiac contractures and also LPO. Gradual physical exercises, besides increasing the oxygen consumption, protected the heart from oxidative stress. The experimental production of hypothyroidism protected the heart against the H2O2 oxidative stress. The hearts of rats submitted to hypertension with high renin levels showed increased LPO, measured by chemiluminescence and oxygen uptake, indicating that this condition may be produced by oxygen species or causes their production. All these findings give support to the idea that the ischemia-reperfusion injury is an active oxygen species associated disorder that induces cardiac stiffness or contractures that would be produced by calcium overload. Thus, H2O2 may be useful for inducing experimental oxidative stress in the heart and for studying its oxidative status in physiological and pathological situations.