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1.
J. pediatr. (Rio J.) ; 95(6): 696-704, Nov.-Dec. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1056663

ABSTRACT

ABSTRACT Objective: To assess the carotid intima-media thickness and factors associated with cardiovascular disease in children and adolescents with chronic kidney disease. Material and methods: Observational, cross-sectional study carried out at the Universidade Federal de São Paulo (chronic kidney disease outpatient clinics) with 55 patients (60% males) with a median age of 11.9 years (I25-I75: 9.2-14.8 years). Of the 55 patients, 43 were on conservative treatment and 12 were on dialysis. Serum laboratory parameters (creatinine, uric acid, C-reactive protein, total cholesterol and fractions, and triglycerides), nutritional status (z-score of body mass index, z-score of height/age), body fat (fat percentage and waist circumference), and blood pressure levels were evaluated. The carotid intima-media thickness measure was evaluated by a single ultrasonographer and compared with percentiles established according to gender and height. Data collection was performed between May 2015 and March 2016. Results: Of the children and adolescents with chronic kidney disease, 74.5% (95% CI: 61.0; 85.3) showed an increase (>P95) in carotid intima-media thickness. In patients with stages I and II hypertension, 90.9% had increased carotid intima-media thickness. Nutritional status, body fat and laboratory tests were not associated with increased carotid intima-media thickness. After multivariate adjustment, only puberty (PR = 1.30, p = 0.037) and stages I and II arterial hypertension (PR = 1.42, p = 0.011) were independently associated with carotid intima-media thickness alterations. Conclusion: The prevalence of increased carotid thickness was high in children and adolescents with chronic kidney disease. Puberty and arterial hypertension were independently associated with increased carotid intima-media thickness.


RESUMO Objetivo: Avaliar a espessura médio-intimal da carótida e os fatores associados à doença cardiovascular em crianças e adolescentes com doença renal crônica. Material e métodos: Estudo observacional transversal feito na Universidade Federal de São Paulo (ambulatórios de doença renal crônica) com 55 pacientes (60% do sexo masculino) com mediana de 11,9 anos (I25-I75: 9,2-14,8). Dos 55 pacientes, 43 estavam em tratamento conservador e 12 em terapia dialítica. Foram avaliados os parâmetros laboratoriais séricos (creatinina, ácido úrico, proteína C-reativa, colesterol total e frações e triglicérides), estado nutricional (escore z de índice de massa corpórea, escore z de estatura/idade), gordura corporal (percentual de gordura e circunferência abdominal) e pressão arterial. A medida da espessura médio-intimal da carótida foi avaliada por um único ultrassonografista e comparada com percentis estabelecidos de acordo com o sexo e a estatura. A coleta de dados foi feita entre maio de 2015 e março de 2016. Resultados: Das crianças e adolescentes com doença renal crônica, 74,5% (IC 95%: 61,0; 85,3) apresentaram aumento (> P95) da espessura médio-intimal da carótida. Nos pacientes com hipertensão arterial estágios I e II, 90,9% apresentaram aumento da espessura médio-intimal da carótida. O estado nutricional, a gordura corporal e os exames laboratoriais não apresentaram associação com o aumento da espessura médio-intimal da carótida. Após ajuste multivariado, apenas a puberdade (RP = 1,30; p = 0,037) e a hipertensão arterial estágios I e II (RP = 1,42; p = 0,011) mostraram-se independentemente associados à alteração da espessura médio-intimal da carótida. Conclusão: A prevalência do aumento da espessura da carótida foi elevada em crianças e adolescentes com doença renal crônica. A puberdade e a hipertensão arterial mostraram-se independentemente associadas ao aumento da espessura médio-intimal da carótida.


Subject(s)
Humans , Male , Female , Child , Adolescent , Cardiovascular Diseases/complications , Carotid Arteries/physiopathology , Renal Insufficiency, Chronic/complications , Carotid Intima-Media Thickness , Sexual Maturation , Blood Pressure , Cross-Sectional Studies , Risk Factors , Puberty , Hypertension/complications , Hypertension/physiopathology
2.
J. bras. nefrol ; 41(4): 451-461, Out.-Dec. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1056616

ABSTRACT

ABSTRACT Hypertension and Diabetes mellitus are the two main causes of chronic kidney disease that culminate in the final stage of kidney disease. Since these two risk factors are common and can overlap, new approaches to prevent or treat them are needed. Macitentan (MAC) is a new non-selective antagonist of the endothelin-1 (ET-1) receptor. This study aimed to evaluate the effect of chronic blockade of ET-1 receptor with MAC on the alteration of renal function observed in hypertensive and hyperglycemic animals. Genetically hypertensive rats were divided into control hypertensive (HT-CTL) group, hypertensive and hyperglycemic (HT+DIAB) group, and hypertensive and hyperglycemic group that received 25 mg/kg macitentan (HT-DIAB+MAC25) via gavage for 60 days. Kidney function and parameters associated with oxidative and nitrosative stress were evaluated. Immunohistochemistry for neutrophil gelatinase-associated lipocalin (NGAL), ET-1, and catalase in the renal cortex was performed. The HT+DIAB group showed a decrease in kidney function and an increase in NGAL expression in the renal cortex, as well as an increase in oxidative stress. MAC treatment was associated with attenuated ET-1 and NGAL production and increases in antioxidant defense (catalase expression) and nitric oxide production. In addition, MAC prevented an increase in oxidant injury (as measured by urinary hydroperoxide and lipid peroxidation), thus improving renal function. Our results suggest that the antioxidant effect of the ET-1 receptor antagonist MAC is involved in the improvement of kidney function observed in hypertensive and hyperglycemic rats.


RESUMO Hipertensão e Diabetes Mellitus figuram como as duas principais causas de doença renal crônica que culmina em doença renal terminal. Uma vez que os dois fatores de risco são comuns e podem se sobrepor, novas abordagens preventivas e terapêuticas se fazem necessárias. O macitentan (MAC) é um novo antagonista não-seletivo dos receptores da endotelina-1 (ET-1). O presente estudo teve como objetivo avaliar os efeitos do bloqueio crônico dos receptores da ET-1 com MAC sobre a alteração da função renal em animais hipertensos e hiperglicêmicos. Ratos geneticamente hipertensos foram divididos em grupos com animais hipertensos de controle (HT-CTL), hipertensos e hiperglicêmicos (HT+DIAB) e hipertensos e hiperglicêmicos tratados com 25 mg/kg de macitentan (HT-DIAB+MAC25) via gavagem por 60 dias. Foram avaliados função renal e parâmetros associados ao estresse oxidativo e nitrosativo. Exames de imunoistoquímica foram realizados para lipocalina associada à gelatinase neutrofílica (NGAL), ET-1 e catalase no córtex renal. O grupo HT+DIAB exibiu diminuição da função renal e aumento na expressão de NGAL no córtex renal, bem como estresse oxidativo aumentado. O tratamento com MAC foi associado a atenuação da produção de ET-1 e NGAL e maior ativação das defesas antioxidantes (expressão de catalase) e elevação da produção de óxido nítrico. Além disso, o MAC evitou exacerbação da lesão oxidante (medida por hidroperóxidos urinários e peroxidação lipídica), melhorando assim a função renal. Nossos resultados sugerem que o efeito antioxidante do antagonista dos receptores da ET-1 MAC esteja imbricado no aprimoramento da função renal observada em ratos hipertensos e hiperglicêmicos.


Subject(s)
Humans , Animals , Male , Hyperglycemia/complications , Kidney/drug effects , Antioxidants/pharmacology , Rats/genetics , Risk Factors , Endothelin-1/metabolism , Administration, Intravenous , Endothelin Receptor Antagonists/administration & dosage , Endothelin Receptor Antagonists/therapeutic use , Hyperglycemia/chemically induced , Hypertension/complications , Hypertension/physiopathology , Kidney/physiopathology , Kidney/injuries , Antibiotics, Antineoplastic/administration & dosage
3.
J. bras. nefrol ; 41(3): 400-411, July-Sept. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1040253

ABSTRACT

Abstract Hypertension (blood pressure > 140/90 mm Hg) is very common in patients undergoing regular dialysis, with a prevalence of 70-80%, and only the minority has adequate blood pressure (BP) control. In contrast to the unclear association of predialytic BP recordings with cardiovascular mortality, prospective studies showed that interdialytic BP, recorded as home BP or by ambulatory blood pressure monitoring in hemodialysis patients, associates more closely with mortality and cardiovascular events. Although BP is measured frequently in the dialysis treatment environment, aspects related to the measurement technique traditionally employed may be unsatisfactory. Several other tools are now available and being used in clinical trials and in clinical practice to evaluate and treat elevated BP in chronic kidney disease (CKD) patients. While we wait for the ongoing review of the CKD Blood Pressure KIDGO guidelines, there is no guideline for the dialysis population addressing this important issue. Thus, the objective of this review is to provide a critical analysis of the information available on the epidemiology, pathogenic mechanisms, and the main pillars involved in the management of blood pressure in stage 5-D CKD, based on current knowledge.


Resumo A hipertensão (pressão arterial > 140/90 mmHg) é muito comum em pacientes submetidos à diálise regular, com uma prevalência de 70-80%, e apenas a minoria tem controle adequado da pressão arterial (PA). Em contraste com a associação incerta entre de PA pré-dialítica com mortalidade cardiovascular, estudos prospectivos mostraram que a PA interdialítica, registrada como PA domiciliar ou pela monitorização ambulatorial da pressão arterial em pacientes em hemodiálise, está mais relacionada à mortalidade e eventos cardiovasculares. Embora a PA seja medida com frequência no ambiente de tratamento de diálise, aspectos relacionados à técnica de medição tradicionalmente empregada podem ser insatisfatórios. Várias outras ferramentas estão agora disponíveis, e estão sendo usadas em ensaios clínicos e na prática clínica para avaliar e tratar a PA elevada em pacientes com doença renal crônica (DRC). Enquanto esperamos pela revisão das diretrizes do KIDGO para a pressão sanguíneana DRC, não há nenhuma diretriz para a população em diálise abordando essa importante questão. Assim, o objetivo desta revisão é fornecer uma análise crítica das informações disponíveis sobre a epidemiologia, os mecanismos patogênicos e os principais pilares sustentadores do manejo da pressão arterial no estágio 5-D da DRC, com base no conhecimento atual.


Subject(s)
Humans , Peritoneal Dialysis , Hypertension/therapy , Hypertension/epidemiology , Prevalence , Risk Factors , Blood Pressure Monitoring, Ambulatory , Diet, Sodium-Restricted , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/therapy , Hypertension/diagnosis , Hypertension/physiopathology , Antihypertensive Agents/therapeutic use
4.
J. bras. nefrol ; 41(2): 266-274, Apr.-June 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1012534

ABSTRACT

Abstract Refractory hypertension (RfH) is an extreme phenotype of resistant hypertension (RH), being considered an uncontrolled blood pressure besides the use of 5 or more antihypertensive medications, including a long-acting thiazide diuretic and a mineralocorticoid antagonist. RH is common, with 10-20% of the general hypertensives, and its associated with renin angiotensin aldosterone system hyperactivity and excess fluid retention. RfH comprises 5-8% of the RH and seems to be influenced by increased sympathetic activity. RH patients are older and more obese than general hypertensives. It is strongly associated with diabetes, obstructive sleep apnea, and hyperaldosteronism status. RfH is more frequent in women, younger patients and Afro-americans compared to RFs. Both are associated with increased albuminuria, left ventricular hypertrophy, chronic kidney diseases, stroke, and cardiovascular diseases. The magnitude of the white-coat effect seems to be higher among RH patients. Intensification of diuretic therapy is indicated in RH, while in RfH, therapy failure imposes new treatment alternatives such as the use of sympatholytic therapies. In conclusion, both RH and RfH constitute challenges in clinical practice and should be addressed as distinct clinical entities by trained professionals who are capable to identify comorbidities and provide specific, diversified, and individualized treatment.


Resumo A Hipertensão Arterial Refratária (HARf) representa um fenótipo extremo da hipertensão arterial resistente (HAR), sendo considerada a falência ao tratamento apesar do uso de 5 ou mais classes de anti-hipertensivos, incluindo um diurético tiazídico de longa ação e um antagonista mineralocorticoide. A HAR é comum (10-20%) entre os hipertensos em geral, sendo decorrente de hiperatividade do Sistema Renina Angiotensina Aldosterona e retenção hidrossalina. Aqueles com HARf correspondem a 5-8% dos resistentes e parecem sofrer maior influência catecolaminérgica. Os resistentes tendem a ter maior idade, ao sobrepeso e à obesidade. Comorbidades incluem diabetes, apneia obstrutiva do sono e status de hiperaldosteronismo. Refratários são afro-americanos em maior proporção, mais jovens e, predominantemente, mulheres. Ambos são fortemente associados à elevada albuminúria, HVE, doenças cardio e cerebrovasculares, além da doença renal crônica. O fenômeno do jaleco branco parece ser mais evidente nos resistentes. Quanto ao tratamento, a intensificação da terapia diurética está indicada nos resistentes, enquanto na HARf, a falência à terapia impôs novas alternativas de tratamento ("simpaticolíticas"). Em conclusão, tanto a HAR quanto a HARf constituem-se desafios na prática clínica e devem ser abordadas como entidades clínicas distintas por profissionais especialistas que identifiquem comorbidades e venham a prover um tratamento específico, diversificado e individualizado.


Subject(s)
Humans , Drug Resistance , Hypertension/drug therapy , Hypertension/epidemiology , Phenotype , Sympatholytics/therapeutic use , Blood Pressure/drug effects , Complementary Therapies , Alcohol Drinking/adverse effects , Exercise , Smoking/adverse effects , Prevalence , Blood Pressure Monitoring, Ambulatory , Diet, Sodium-Restricted , Diuretics/pharmacology , Dietary Approaches To Stop Hypertension , Hypertension/diagnosis , Hypertension/physiopathology , Antihypertensive Agents/pharmacology
5.
Int. j. cardiovasc. sci. (Impr.) ; 32(1): 48-54, jan.-fev. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-984518

ABSTRACT

Systemic arterial hypertension (SAH) is one of the main risk factors for heart disease. Among the benefits linked to different modalities of physical exercise, post-exercise hypotension (PEH) is a key point for exercise prescription in this condition. Objective: To investigate and compare PEH in response to continuous aerobic exercise (CONT) and high-intensity interval exercise (HIIE), matched by volume, in sedentary individuals. Methods: A randomized cross-over study, composed of sedentary, healthy male subjects submitted to two acute physical exercise protocols matched by volume, HIIE and CONT, on a treadmill. Hemodynamic measures for the evaluation of PEH were performed pre, immediately after exercise and every five minutes thereafter, during one hour of recovery. Two-way ANOVA with repeated measurements was used for comparisons between groups and Bonferroni post hoc test as appropriate. P < 0.05 was considered significant. Results: Both exercise protocols promoted significant PEH, with reductions in systolic blood pressure (SBP) and mean arterial pressure (MAP). HIIE promoted a reduction of SBP and MAP at the 15th minute, whereas the same effect was observed at the 30th following CONT. Conclusion: Both HIIE and CONT, matched by volume, promote PEH of similar magnitude. However, PEH occurs earlier following HIIE, suggesting a better time / effectiveness ratio, and an additional beneficial effect of this modality


Subject(s)
Humans , Male , Female , Exercise , Sedentary Behavior , Post-Exercise Hypotension , Hypertension/physiopathology , Research Design , Blood Pressure , Body Mass Index , Statistical Analysis , Risk Factors , Analysis of Variance , Cardiomegaly , Guideline Adherence/standards , Exercise Test/methods , Heart Rate
6.
Int. j. cardiovasc. sci. (Impr.) ; 32(1): 61-69, jan.-fev. 2019. tab, ilus
Article in English | LILACS (Americas) | ID: biblio-984522

ABSTRACT

Arterial hypertension is responsible for high morbidity and mortality. Despite increasing awareness of the consequences of uncontrolled hypertension and the publication of several recommendations and guidelines, blood pressure control rates are suboptimal, and approximately half of the patients do not reach the targets. Defined as an increase in blood pressure, hypertension is characterized by hemodynamic abnormalities in cardiac output, systemic vascular resistance, or arterial compliance. Therefore, the approach to arterial hypertension can be improved by the knowledge of the hemodynamics underlying the blood pressure increase. Impedance Cardiography has emerged as a new strategy to customize therapy and monitor patients aiming to improve blood pressure control according to the hemodynamic profile, rather than a blind intensive care approach. This is a review of impedance cardiography evidence, its benefits, actual and future applications in the approach and management of arterial hypertension


Subject(s)
Humans , Male , Female , Cardiography, Impedance , Hypertension/physiopathology , Stroke Volume , Blood Pressure , Cardiovascular Diseases , Risk Factors , Electrocardiography/methods , Heart Failure , Hemodynamics , Antihypertensive Agents/therapeutic use
9.
Int. j. cardiovasc. sci. (Impr.) ; 32(1): 48-54, jan.-fev. 2019. tab
Article in English | LILACS (Americas) | ID: biblio-981576

ABSTRACT

Background: Systemic arterial hypertension (SAH) is one of the main risk factors for heart disease. Among the benefits linked to different modalities of physical exercise, post-exercise hypotension (PEH) is a key point for exercise prescription in this condition. Objective: To investigate and compare PEH in response to continuous aerobic exercise (CONT) and high-intensity interval exercise (HIIE), matched by volume, in sedentary individuals. Methods: A randomized cross-over study, composed of sedentary, healthy male subjects submitted to two acute physical exercise protocols matched by volume, HIIE and CONT, on a treadmill. Hemodynamic measures for the evaluation of PEH were performed pre, immediately after exercise and every five minutes thereafter, during one hour of recovery. Two-way ANOVA with repeated measurements was used for comparisons between groups and Bonferroni post hoc test as appropriate. P < 0.05 was considered significant. Results: Both exercise protocols promoted significant PEH, with reductions in systolic blood pressure (SBP) and mean arterial pressure (MAP). HIIE promoted a reduction of SBP and MAP at the 15th minute, whereas the same effect was observed at the 30th following CONT. Conclusion: Both HIIE and CONT, matched by volume, promote PEH of similar magnitude. However, PEH occurs earlier following HIIE, suggesting a better time /effectiveness ratio, and an additional beneficial effect of this modality


Subject(s)
Humans , Male , Female , Exercise , Sedentary Behavior , Hypertension/physiopathology , Hypotension , Research Design , Blood Pressure , Body Mass Index , Statistical Analysis , Risk Factors , Analysis of Variance , Cardiomegaly , Guideline Adherence/standards , Exercise Test , Heart Rate
10.
Int. j. cardiovasc. sci. (Impr.) ; 32(1): 61-69, jan.-fev. 2019. ilus, tab
Article in English | LILACS (Americas) | ID: biblio-981613

ABSTRACT

Arterial hypertension is responsible for high morbidity and mortality. Despite increasing awareness of the consequences of uncontrolled hypertension and the publication of several recommendations and guidelines, blood pressure control rates are suboptimal, and approximately half of the patients do not reach the targets. Defined as an increase in blood pressure, hypertension is characterized by hemodynamic abnormalities in cardiac output, systemic vascular resistance, or arterial compliance. Therefore, the approach to arterial hypertension can be improved by the knowledge of the hemodynamics underlying the blood pressure increase. Impedance Cardiography has emerged as a new strategy to customize therapy and monitor patients aiming to improve blood pressure control according to the hemodynamic profile, rather than a blind intensive care approach. This is a review of impedance cardiography evidence, its benefits, actual and future applications in the approach and management of arterial hypertension


Subject(s)
Humans , Male , Female , Cardiography, Impedance , Hypertension/physiopathology , Stroke Volume , Blood Pressure , Cardiovascular Diseases , Risk Factors , Electrocardiography/methods , Heart Failure , Hemodynamics , Antihypertensive Agents/therapeutic use
11.
In. Consolim-Colombo, Fernanda M; Saraiva, José Francisco Kerr; Izar, Maria Cristina de Oliveira. Tratado de Cardiologia: SOCESP / Cardiology Treaty: SOCESP. São Paulo, Manole, 4ª; 2019. p.488-495.
Monography in Portuguese | LILACS (Americas) | ID: biblio-1009422
12.
Med. interna (Caracas) ; 35(1): 32-41, 2019. tab
Article in Spanish | LILACS (Americas), LIVECS | ID: biblio-1005804

ABSTRACT

La enfermedad arterial periférica (EAP) es usualmente subdiagnosticada. El índice tobillobrazo (ITB) es un método diagnostico sencillo y no invasivo que permite hacer detección temprana de EAP y de aquellos pacientes con alto riesgo de desarrollar ECV. Objetivo: determinar la relación entre ITB y obesidad visceral mediante la medición de la circunferencia abdominal (CA) en pacientes que acudieron a la consulta externa de Medicina Interna. Otras mediciones: índice de masa corporal (IMC), relación cintura cadera (RCC). Se registró la presencia de hipertensión arterial (HTA), dislipidemia, sedentarismo y tabaquismo. Métodos: Investigación de carácter exploratorio. Muestra no probabilística, intencional de 34 pacientes que acudieron a la consulta de Medicina Interna en tres meses. Se aplicó una encuesta y se realizaron mediciones de los índices antropométricos: CA, RCC, IMC, se calculó el ITB y se determinaron glicemia, colesterol total, HDL, LDL y triglicéridos (TGC). Resultados: El promedio de edad fue 56,14 años ± 11.46. 52,9% mujeres y 47,1% hombres. El 70% tenían IMC elevado, 64,7% dislipidemia, 52,9% HTA, 38.23% sedentarismo y 17,6% fumaban. 5 pacientes masculinos tuvieron un ITB alterado: ITB bajo: 2; ITB elevado: 3. La correlación entre ITB y CA; ITB y RCC e ITB y glicemia, TGC y el LDL fue negativa débil. La correlación entre ITB e IMC, colesterol total y HDL fue positiva. Conclusiones: Una CA y RCC alteradas como marcadores de obesidad visceral se asocian con un ITB bajo(AU)


Peripheral arterial disease (PAD) is associated to high cardiovascular morbidity and mortality. Risk factors related to this pathology do not differ from other cardiovascular diseases (CVD). This disease manifests clinically in advanced stages of the atherothrombotic process, therefore, it is usually underdiagnosed. The ankle-brachial index (ABI) is a simple, inexpensive and non-invasive diagnostic method that allows an early detection of PAD, and, because it is considered atherosclerotic predictor, it helps us detect those patients who have a high risk of developing CVD. Hence, it should be a routine method in clinical practices. Objectives: This study was performed in order to determine the relationship between ABI and visceral obesity by means of waist circumference (WC) measurement and hip to waist ratio (HWR) in patients who attended the internal medicine outpatient clinic. Methods: Exploratory research. Non-probabilistic, intentional sample of 34 patients who attended the Internal Medicine outpatient clinic in three months. A survey was applied and measurements were made of the anthropometric indexes: CA, RCC, BMI, ITB was calculated and glycemia, total cholesterol, HDL, LDL and triglycerides were determined. Results: The average age was 56.14 years ± 11.46. 52.9% women and 47.1% men. 70% had high BMI, 64.7% dyslipidemia, 52.9% HBP, 38.23% sedentary lifestyle and 17.6% smoked. 5 male patients had an altered ABI: low ABI: 2; High ITB: 3. The correlation between ITB and CA; ITB and RCC and ITB and glycemia, TGC and LDL were weak negative. The correlation between ITB and BMI, total cholesterol and HDL was positive. Conclusions: A CA and RCC altered as markers of visceral obesity are associated with a low ABI(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Mid-Upper Arm Circumference , Peripheral Arterial Disease/diagnosis , Hypertension/physiopathology , Obesity/complications , Cardiovascular Diseases , Body Mass Index
13.
ABC., imagem cardiovasc ; 31(4)Out.- Dez. 2018. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-964031

ABSTRACT

Fundamento: Os efeitos da hipertensão arterial sistêmica ainda não foram significativamente correlacionados à hipertrofia do ventrículo direito. Objetivo: Avaliar a correlação entre a presença de hipertensão arterial sistêmica e espessuras, dimensões e função ventriculares direitas. Métodos: Estudo observacional, transversal. Foram selecionados 65 indivíduos que realizaram ecocardiograma com a avaliação do ventrículo direito em cinco aspectos: espessura da parede livre; diâmetros proximal, basal e médio; excursão sistólica do plano do anel tricúspide e onda S´ lateral ao Doppler tecidual da parede livre. Os indivíduos foram divididos em dois grupos: Grupo Controle, sem hipertensão arterial sistêmica, com 24 indivíduos, sendo 17 mulheres, e Grupo Estudo, com hipertensão arterial sistêmica, com 41 indivíduos, sendo 29 mulheres. Resultados: O Grupo Estudo apresentou indivíduos mais idosos em relação ao Controle (67 anos ± 12 anos e 47 anos ± 20 anos; p < 0,001). No Grupo Controle, o sexo masculino apresentou maiores valores em relação ao sexo feminino de diâmetros do ventriculo direito proximal (24,1 mm ± 1,3 mm vs. 20,1 mm ± 2,9 mm; p = 0,002), ventriculo direito basal (32,9 mm ± 2,7 mm vs. 26,5 mm ± 4,2 mm; p = 0,001), ventriculo direito médio (27 mm ± 2,1 mm vs. 21,2 m ; p = 0,005); ventrículo esquerdo diastólico (49,6 mm ± 2,1 mm vs. 45,5 mm ± 4,3 mm; p = 0,028); ventrículo esquerdo sistólico (30,1 mm ± 3,2 mm vs. 27,1 mm ± 2,9 mm; p = 0,034) e S' lateral (14,9 cm/s ± 2,4 cm/s vs. 13 cm/s ± 1,7 cm/s; p = 0,04). Entretanto, no Grupo Estudo não foram encontradas diferenças significativas entre os sexos nas variáveis analisadas, sugerindo maior impacto da hipertensão arterial sistêmica nas mulheres. Conclusão: A presença de hipertensão arterial sistêmica pode causar alterações estruturais diferentes nos padrões geométricos dos ventrículos em homens e mulheres, possivelmente determinando maiores efeitos no sexo feminino. Entretanto, são necessários mais estudos para confirmar estes achados


Background: Systemic arterial hypertension (SAH) has not yet been directly correlated with right ventricular hypertrophy (RV). Objective: To assess the correlation between the presence of systemic arterial hypertension and right ventricular thickness, dimensions and function. Methods: Cross-sectional and observational study. A total of 65 individuals were selected. They underwent echocardiogram with right ventricular evaluation in five aspects: free wall thickness; proximal diameter (RPD), mid diameter (RMD), basal diameter (RBD); tricuspid annular plane systolic excursion; and tissue doppler S' wave. The subjects were divided into two groups: Control Group, without systemic arterial hypertension, with 24 subjects (17 women) and Study Group, with systemic arterial hypertension, with 41 subjects (29 women). Results: Study Group presented older individuals in relation to Control Group (67 years ± 12 years and 47 ± 20 years; p < 0.001). In the Control Group, men presented higher values compared to women: proximal diameter (24.1 mm ± 1.3 mm vs. 20.1 mm ± 2.9 mm; p = 0.002), basal diameter (32.9 mm ± 2.7 mm vs. 26.5 mm ± 4.2 mm; p = 0.001), mid diameter (27 mm ± 2.1 mm vs. 21.2m ; p = 0.005); left ventricle diastolic diameter (49.6 mm ± 2.1 mm vs. 45.5 ± 4.3 mm; p = 0.028); left ventricle systolic diameter (30.1 mm ± 3.2 mm vs. 27.1 mm ± 2.9 mm; p = 0.034); and S' wave (14.9 cm/s ± 2.4 cm/s vs. 13 cm/s ± 1.7 cm/s; p = 0.04). However, in the Study Group there were no significant differences between men and women in the same variables. These findings suggest greater impact of systemic hypertension in women. Conclusion: The presence of systemic hypertension may cause different structural alterations in geometric ventricular patterns in men and women, possibly determining greater effects on the female sex. However, further studies are needed to confirm these finding


Subject(s)
Humans , Male , Female , Aged , Echocardiography/methods , Hypertrophy, Left Ventricular/diagnostic imaging , Heart Ventricles/diagnostic imaging , Hypertension/physiopathology , Body Mass Index , Sex Factors , Age Factors , Observational Study
14.
Int. j. cardiovasc. sci. (Impr.) ; 31(4)jul.-ago. 2018. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-910246

ABSTRACT

A mortalidade por doença cardiovascular entre as mulheres permanece elevada. Estudos observacionais são controversos sobre a participação dos antecedentes de distúrbio hipertensivo gestacional no risco cardiovascular. Verificar a associação entre aterosclerose de carótidas em mulheres no climatério que tiveram hipertensão na gestação. Estudo de caso-controle, sendo os casos compostos por mulheres com aterosclerose de carótida, definida como espessura íntima-média carotídea > 1 mm e/ou presença de placas de carótidas; os controles não apresentavam estas alterações. Adotou-se nível de significância de 95%. Foram avaliadas 504 mulheres sem doença cardiovascular prévia, sendo 126 casos e 378 controles. Eram hipertensas 67% delas; 76% eram dislipidêmicas; e 16%, diabéticas. Cerca de 10% referiram antecedentes de hipertensão na gestação. As mulheres com aterosclerose de carótidas apresentaram valores maiores dos níveis de pressão arterial sistólica (134,18 mmHg vs. 128,59 mmHg; p = 0,008) e de LDL-colesterol (156,52 mg% vs. 139,97 mg%; p = 0,0005). Não foi encontrada diferença estatística em relação à presença de aterosclerose de carótidas e ao antecedente de hipertensão na gestação (OR 1,672; IC 95% 0,893-3,131). O antecedente de hipertensão na gestação não foi associado à aterosclerose subclínica de carótidas em mulheres na pré e pós-menopausa. No entanto, verificou-se a associação entre a aterosclerose de carótida e os fatores de risco clássicos, como pressão arterial sistólica elevada e altos níveis de LDL-colesterol


Cardiovascular disease mortality among women remains high. Observational studies are controversial about the participation of a history of gestational hypertensive disorder in cardiovascular risk. To verify the association between carotid atherosclerosis in menopausal women who had pregnancy-induced hypertension. Case-control study, with cases consisting of women with carotid atherosclerosis, defined as carotid intima-media thickness > 1 mm and/or presence of carotid plaques; the controls did not have these alterations. The significance level was set at 95%. A total of 504 women without previous cardiovascular disease were assessed, 126 cases and 378 controls. Of the total, 67% were hypertensive; 76% were dyslipidemic; and 16% were diabetic. Approximately 10% reported a history of hypertension during pregnancy. Women with carotid atherosclerosis had higher values of systolic blood pressure (134.18 mmHg vs. 128.59 mmHg, p = 0.008) and LDL-cholesterol(156.52 mg% vs. 139.97 mg%; p = 0.0005). No statistical difference was found regarding the presence of carotid atherosclerosis and history of hypertension during pregnancy (OR 1.672, 95% CI: 0.883-3.131). The history of hypertension during pregnancy was not associated with subclinical carotid atherosclerosis in menopausal women. However, an association was observed between carotid atherosclerosis and classic risk factors, such as elevated systolic blood pressure and LDL-cholesterol levels


Subject(s)
Humans , Female , Pregnancy , Middle Aged , Aged , Carotid Artery Diseases/physiopathology , Hypertension/physiopathology , Postmenopause , Pregnancy , Premenopause , Women , Body Mass Index , Cardiovascular Diseases/mortality , Case-Control Studies , Climacteric , Hypertension, Pregnancy-Induced , Review , Risk Factors , Statistical Analysis , Ultrasonography/methods
15.
J. pediatr. (Rio J.) ; 94(2): 184-191, Mar.-Apr. 2018. tab, graf
Article in English | LILACS (Americas) | ID: biblio-894115

ABSTRACT

Abstract Objective The management of children with low birth weight is not the same in countries with different resources. The authors assessed the association of birth weight with blood pressure and nutritional status in a representative sample of adolescents from a Brazilian state, aiming to identify possible consequences of these differences. Methods A cross-sectional school-based study was conducted with adolescents (12-18 years) enrolled in public and private schools. Birth weight, office blood pressure, home blood pressure measurements, and nutritional status (body mass index, height z-score for the age, and waist circumference) were assessed. The association of birth weight with the outcomes (blood pressure, height, body mass index, and waist circumference) was studied through univariate and multivariable linear regression models. Results A total of 829 adolescents with a mean age of 14.6 ± 1.62 years were included; 43.3% were male, and 37.0% from private schools. The prevalence of low birth weight was 8.7%. Mild low height prevalence was higher among those adolescents with low/insufficient birth weight when compared to those with normal/high birth weight (11.7 vs. 4.2%; p < 0.001). In the multiple linear regression analysis, for each increase of 100 g in birth weight, height increased by 0.28 cm (95% CI: 0.18-0.37; p < 0.01). Birth weight did not influence office blood pressure and home blood pressure, body mass index, or waist circumference of adolescents. Conclusions Birth weight was directly associated to height, but not associated to blood pressure, body mass index, and waist circumference in adolescents from an urban area of a developing country.


Resumo Objetivo O manejo de crianças com baixo peso ao nascer não é o mesmo em países com diferentes recursos. Investigamos a associação do peso ao nascer com a pressão arterial e o estado nutricional em uma amostra representativa de adolescentes de uma capital brasileira com o objetivo de identificar possíveis consequências destas diferenças. Métodos Estudo transversal de base escolar conduzido com adolescentes (12-18 anos) matriculados em escolas públicas e privadas. Investigou-se o peso ao nascer, a pressão arterial, e o estado nutricional, por meio do índice de massa corporal, do escore z de estatura para idade e da circunferência da cintura. Resultados Um total de 829 adolescentes com uma idade média 14.6 ± 1.62 anos foram incluídos, 43.3% do sexo feminino e 37.0% de escolas privadas. A prevalência de baixo peso ao nascer foi 8.7%. Baixa estatura leve foi mais prevalente nos adolescentes com peso ao nascer baixo/insuficiente (11.7 × 4.2% - p < 0.001). Na análise de regressão linear múltipla, para cada aumento de 100 g no peso ao nascer, a estatura aumentou em 0.28 cm (IC 95% = 0.18-0.37; p < 0.01). O peso ao nascer não influenciou a pressão arterial (casual e residencial), o índice de massa corporal e a circunferência da cintura dos adolescentes. Conclusões O peso ao nascer esteve diretamente associado à altura, mas não associado à pressão arterial, índice de massa corporal e circunferência da cintura em adolescentes de uma área urbana de um país em desenvolvimento.


Subject(s)
Humans , Male , Female , Child , Adolescent , Birth Weight/physiology , Body Mass Index , Nutritional Status/physiology , Hypertension/physiopathology , Socioeconomic Factors , Blood Pressure/physiology , Cross-Sectional Studies , Waist Circumference , Hypertension/diagnosis
16.
Braz. J. Pharm. Sci. (Online) ; 54(1): e17292, 2018. tab, graf
Article in English | LILACS (Americas) | ID: biblio-951918

ABSTRACT

It is understood that drugs regardless of their order of administration can exhibit drug interactions. Established on the fact that treatment of hypertension may last for decades and prolong usage of multiple drug regimen may induce substantial pathophysiological changes. Hence, This study was designed to evaluate the possible synergistic toxic effects of anti-hypertensive (carvedilol), and anti-inflammatory drug (celecoxib) alone and in combinations. Well-established MTT assay, Single Cell Gel Electrophoresis (SCGE) and Ames assay were employed to evaluate the toxicity at cellular level. Results from MTT assay on Vero cell line revealed that drug combinations have more pronounced anti-proliferative activity with combine IC50 value of 13.7:47.8 µg/mL. Likewise, exposure of peripheral blood mononuclear cells with drug combinations revealed significant (P<0.05) DNA damage (Class 3) in a dose dependent manner at concentrations ≥ 0.78: 2.34 µg/mL. However, carvedilol and celecoxib were non mutagenic against either mutant strain (TA 100 and TA 98) and combinations have also shown mild to moderate mutagenic potential. Nevertheless, upon addition of metabolic activation enzyme, concentration <12.5:37.5 µg/plate exhibited significant (P<0.05) mutagenicity against both tester strains. In conclusion, this study provides additional genotoxicity and mutagenicity data that could be used in considering options for formulating regimens with reduced mutagenic potential


Subject(s)
Celecoxib , Anti-Inflammatory Agents/adverse effects , Mutagenicity Tests/statistics & numerical data , Antihypertensive Agents/adverse effects , Genotoxicity/analysis , Hypertension/physiopathology
17.
Braz. j. med. biol. res ; 51(3): e6601, 2018. tab, graf
Article in English | LILACS (Americas) | ID: biblio-889041

ABSTRACT

The primary aim of this study was to evaluate penile endothelial microvascular function in patients with primary arterial hypertension and age-matched normotensive subjects using laser speckle contrast imaging (LSCI). Additionally, we analyzed the acute penile microvascular effects induced by oral phosphodiesterase type 5 inhibitor (sildenafil; SIL) administration. Endothelium-dependent microvascular reactivity was evaluated in the penises and forearms of hypertensive patients (aged 58.8±6.6 years, n=34) and age-matched healthy volunteers (n=33) at rest and 60 min following oral SIL (100 mg) administration. LSCI was coupled with cutaneous acetylcholine (ACh) iontophoresis using increasing anodal currents. Basal penile cutaneous vascular conductance (CVC) values were not significantly different between control subjects and hypertensive individuals. Penile CVC values increased significantly after SIL administration in control (P<0.0001) and hypertensive (P<0.0001) subjects. Peak CVC values were not different between the two groups during penile ACh iontophoresis before SIL administration (P=0.2052). Peak CVC values were higher in control subjects than in hypertensive subjects after SIL administration (P=0.0427). Penile endothelium-dependent microvascular function is, to some extent, preserved in patients presenting with primary arterial hypertension under effective anti-hypertensive treatment. LSCI may be a valuable non-invasive tool for the evaluation of penile vascular responses to phosphodiesterase type 5 inhibitor.


Subject(s)
Humans , Male , Middle Aged , Aged , Endothelium, Vascular/physiopathology , Hypertension/physiopathology , Penis/blood supply , Phosphodiesterase 5 Inhibitors/administration & dosage , Sildenafil Citrate/administration & dosage , Case-Control Studies , Healthy Volunteers , Laser-Doppler Flowmetry/methods , Microcirculation , Penis/drug effects , Regional Blood Flow , Vasodilation/drug effects
18.
In. Ramires, José Antonio Franchini; Kalil Filho, Roberto; Santos Filho, Raul Dias dos; Casella Filho, Antonio. Dislipidemias e prevenção da Aterosclerose / Dyslipidemias and prevention of Atherosclerosis. Rio de janeiro, Atheneu, 2018. p.69-75.
Monography in Portuguese | LILACS (Americas) | ID: biblio-880894
19.
Med. interna (Caracas) ; 34(4): 224-236, 2018. tab
Article in Spanish | LILACS (Americas), LIVECS | ID: biblio-1005878

ABSTRACT

Analizar las características clínicas y epidemiológicas de los pacientes que presentan insuficiencia cardíaca aguda. Métodos: Se realizó un estudio de casos, transversal, y descriptivo en 400 pacientes que cumplían con criterios de inclusión y con diagnóstico de insuficiencia cardíaca aguda atendidos en el servicio de Medicina Interna del Hospital General del Este Dr. Domingo Luciani, durante el periodo mayo 2016 ­ junio 2017. Resultados: 55 % de la población correspondía al género femenino con un promedio de edad de 64,96 años. La presencia de enfermedades subyacentes se registró en un 77%, la HTA como la más frecuente seguida de diabetes mellitus (28,3%). La principal causa de descompensación fue omisión de tratamiento (52,3%) seguido de etiología infecciosa (33%). Los síntomas más frecuentes fueron disnea (88 %) y edema (85%). El signo clínico más frecuente fueron crepitantes (94%) y Pulso venoso yugular >5cmH2O (73%). Las alteraciones electrocardiográficas más frecuentes fueron: anomalía auricular izquierda (36,25 %), hipertrofia del ventrículo izquierdo (43,1 %) y extrasístoles ventriculares (6,87 %) mientras que las alteraciones ecocardiográficas más frecuentes fueron fracción de eyección <40 % (77,5%) dilatación moderada de cavidades. La mortalidad en las primeras 24 horas fue 9,5% Conclusiones: Predominó el género femenino con edades reportadas en la literatura y la etiología más frecuente la HTA. Los estudios ecocardiográficos coinciden con los descritos en la literatura. La mortalidad a las 24 horas fue alta(AU)


Objectives: to analyze the clinical and epidemiological characteristics of patients with acute heart failure. Methods: this is a descriptive and transversal case study of 400 patients who had criteria for acute heart failure. They were hospitalized at the Hospital Dr. Domingo Luciani, Venezuela from may 2016 to june 2017. Results: 55% of patients were female gender, and the mean age was 64,96 years old. 77% of patients had concomitant illness; arterial hypertension was the most frequent illness followed by diabetes (28,3%). The mean reason for decompensation was medicament´s interruption(52,3%) and infections illness was registered in 33%. The most frequent symptoms were dyspnea (880%), limb edema (85%). The more prominent clinical signs were pulmonary rales (94%) and jugular venous pulse >5cmH2O (73%). Electrocardiographic findings were left atrial enlargement (36,25%), left ventricular hypertrophy (43,12%) and ventricular extrasystolia (6,87%). Echocardiographic findings were ejection fraction <40% (77,5%) and left cavities with moderate dilatation (36,58%).The first 24 hours mortality was 9,5%. Conclusions: Female gender was predominant with a mean age similar to previous studies; the more frequent etiology was arterial hypertension. Echocardiographic findings were similar to those described in the literature. Mortality in the first 24 hours was high(AU)


Subject(s)
Humans , Male , Female , Heart Failure/pathology , Heart Failure/epidemiology , Hypertension/physiopathology , Venezuela/epidemiology , Clinical Laboratory Techniques
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