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1.
Braz J Med Biol Res ; 55: e11821, 2022.
Article in English | MEDLINE | ID: mdl-35239779

ABSTRACT

Evidence has shown that women with type 2 diabetes mellitus (T2DM) have a greater risk of cardiovascular complications compared with men, but this sex difference is not clearly understood. This study assessed the microvascular function and circulatory biomarkers in postmenopausal women (PMW) with T2DM compared with diabetic men and their non-diabetic counterparts. Sixty participants were divided into nondiabetic PMW, PMW with T2DM, non-diabetic men, and diabetic men. Microvascular function was assessed using non-invasive equipment (EndoPAT®) and reported as reactive hyperemia index (RHI). Anthropometric and cardiovascular parameters were also measured. Two-way ANOVA was performed using sex (women or men) and T2DM (non-diabetic and diabetic) as the two factors. RHI impairment (1.97±0.14) was detected in diabetic PMW compared with women without T2DM (2.5±0.13) accompanied by lower adiponectin levels (T2DM: 9.3±1.2 and CTL: 13.8±1.8 ug/mL, P<0.05). An increase in the Nε-carboxymethyllysine (CML), nitrate/nitrite, and C-reactive protein (CRP) levels were observed in diabetic PMW compared to the other groups. Although a poor glycemia control was seen in diabetic men, neither RHI nor circulatory biomarkers were affected by T2DM. Multiple linear regression stratified by sex and T2DM identified some variables with RHI only in PMW with T2DM: HbA1c (P=0.003), body mass index (P=0.029), CML (P=0.032), and CRP (P=0.006). Diabetic PMW were more susceptible to the deleterious effects of hyperglycemia than men, showing microvascular dysfunction with high levels of pro-inflammatory mediators (CML and CRP) and a lower adiponectin concentration.


Subject(s)
Diabetes Mellitus, Type 2 , Anti-Inflammatory Agents , Biomarkers , Body Mass Index , Diabetes Mellitus, Type 2/complications , Female , Humans , Male , Postmenopause
2.
Rev. bras. pesqui. méd. biol ; Braz. j. med. biol. res;55: e11821, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1364561

ABSTRACT

Evidence has shown that women with type 2 diabetes mellitus (T2DM) have a greater risk of cardiovascular complications compared with men, but this sex difference is not clearly understood. This study assessed the microvascular function and circulatory biomarkers in postmenopausal women (PMW) with T2DM compared with diabetic men and their non-diabetic counterparts. Sixty participants were divided into nondiabetic PMW, PMW with T2DM, non-diabetic men, and diabetic men. Microvascular function was assessed using non-invasive equipment (EndoPAT®) and reported as reactive hyperemia index (RHI). Anthropometric and cardiovascular parameters were also measured. Two-way ANOVA was performed using sex (women or men) and T2DM (non-diabetic and diabetic) as the two factors. RHI impairment (1.97±0.14) was detected in diabetic PMW compared with women without T2DM (2.5±0.13) accompanied by lower adiponectin levels (T2DM: 9.3±1.2 and CTL: 13.8±1.8 ug/mL, P<0.05). An increase in the Nε-carboxymethyllysine (CML), nitrate/nitrite, and C-reactive protein (CRP) levels were observed in diabetic PMW compared to the other groups. Although a poor glycemia control was seen in diabetic men, neither RHI nor circulatory biomarkers were affected by T2DM. Multiple linear regression stratified by sex and T2DM identified some variables with RHI only in PMW with T2DM: HbA1c (P=0.003), body mass index (P=0.029), CML (P=0.032), and CRP (P=0.006). Diabetic PMW were more susceptible to the deleterious effects of hyperglycemia than men, showing microvascular dysfunction with high levels of pro-inflammatory mediators (CML and CRP) and a lower adiponectin concentration.

3.
Curr Hypertens Rep ; 20(3): 26, 2018 03 27.
Article in English | MEDLINE | ID: mdl-29589184

ABSTRACT

PURPOSE OF REVIEW: Resistant hypertension (RHTN) is a condition in which besides the antihypertensive therapy using at least three different drugs (including a diuretics), brachial blood pressure does not reach the target (e.g., 140/90 mmHg). RECENT FINDINGS: Despite the diversity of clinical presentations, we divide RHTN in two major groups according to blood pressure and number of drugs taken: controlled (C-RHTN) and uncontrolled (UC-RHTN) resistant hypertension, with refractory hypertension (RfHTN) included in the latter subgroup. Both C-RHTN and UC-RHTN are heterogenic and complex syndromes. To better approach this matter, the some pathophysiological mechanisms (increased volemia, hyperactivity, plasma cortisol, adipocitokines, and other pro-inflammatory factors), have a pivotal clinical role. Some features (African ethnic, obesity, age > 60, LV hypertrophy, and vascular stiffness) increase the risk of refractoriness as well as worst prognosis. Based on increased target organ damage, cardiovascular risk and events will be addressed in this review. Our conclusion is that although both C-RHTN and UC-RHTN are extreme phenotypes of hard-to-control BP, some mechanisms of the disease and clinical expressions are distinct. According to these differences, "UC-RHTN and C-RHTN are not in the same bag."


Subject(s)
Hypertension/physiopathology , Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Humans , Hypertension/diagnosis , Hypertension/drug therapy
4.
J Hum Hypertens ; 25(11): 656-64, 2011 Nov.
Article in English | MEDLINE | ID: mdl-21544090

ABSTRACT

Resistant hypertension (RHTN) includes both patients whose blood pressure (BP) is uncontrolled on three or more medications (uncontrolled RHTN (UCRH)) and patients whose BP is controlled with use of four or more drugs (controlled RHTN (CRH)). It is unknown whether endothelial function and nocturnal drop demonstrate a similar pattern in patients with CRH and UCRH. We examined circadian BP patterns and vascular function in these patients. In all, 40 CRH and 26 UCRH patients, and 25 normotensives underwent biochemical testing, ambulatory BP monitoring, determination of brachial artery responses to endothelial-dependent (flow-mediated; dilation (FMD)) and independent (nitroglycerin mediated) stimuli. The nighttime drop in systolic BP (SBP) and diastolic BP (DBP) was less pronounced in UCRH than in CRH (SBP, 1.9±1.6 versus 4.9±1.7%; DBP, 7.5±1.8 versus 10.9±1.8%, UCRH and CRH, respectively; P<0.05). FMD was greater in control group compared with RHTN patients. Patients with UCRH had significantly impaired FMD compared with CRH (5.9±2.3% versus 7.1±5.1%; P<0.0001). Therefore, UCRH patients have less nocturnal dipping and a more impaired endothelial response compared with CRH patients. These findings suggest that important differences among patients with RHTN may allow identify subgroups with increased cardiovascular risk.


Subject(s)
Blood Pressure , Brachial Artery/physiopathology , Circadian Rhythm , Endothelium, Vascular/physiopathology , Hypertension/physiopathology , Vasodilation , Adult , Analysis of Variance , Antihypertensive Agents/administration & dosage , Blood Pressure/drug effects , Blood Pressure Monitoring, Ambulatory , Brachial Artery/diagnostic imaging , Brachial Artery/drug effects , Brazil , Cardiovascular Diseases/etiology , Cardiovascular Diseases/physiopathology , Drug Resistance , Drug Therapy, Combination , Endothelium, Vascular/diagnostic imaging , Endothelium, Vascular/drug effects , Female , Humans , Hypertension/blood , Hypertension/complications , Hypertension/diagnosis , Hypertension/drug therapy , Linear Models , Male , Middle Aged , Nitroglycerin/administration & dosage , Risk Assessment , Risk Factors , Treatment Failure , Ultrasonography , Vasodilation/drug effects , Vasodilator Agents/administration & dosage
5.
J Hum Hypertens ; 25(9): 532-8, 2011 Sep.
Article in English | MEDLINE | ID: mdl-20927128

ABSTRACT

Resistant hypertension (RHTN) includes patients whose blood pressure (BP) is controlled with the use of four or more antihypertensive medications, and is referred to as 'controlled resistant hypertension' (CRH). While specifically comparing patients with CRH and uncontrolled resistant hypertension (UCRH), we hoped to identify distinguishing characteristics that would provide insight into factors contributing to resistance to antihypertensive therapies. RHTN patients were identified as controlled (CRH, n=43) or uncontrolled (UCRH, n=47). No statistical differences were observed between the CRH and UCRH subgroups with respect to age and gender. The body mass index, aldosterone-renin ratio and pulse wave velocity (PWV) were significantly higher in UCRH patients. Although both subgroups showed increased cardiac mass, left ventricular mass index was significantly higher in UCRH compared with CRH patients. Multivariate linear regression analysis indicated that PWV was significantly dependent on age in both UCRH and CRH patients; however, the influence of ageing was more pronounced in the former subgroup. Older age, greater vascular stiffness, higher aldosterone levels and greater left ventricular hypertrophy were significantly associated with lack of BP control in patients with RHTN. These findings suggest important possibilities in terms of preventing and better treating RHTN.


Subject(s)
Aging/physiology , Body Mass Index , Cardiomegaly/complications , Hyperaldosteronism/complications , Hypertension/drug therapy , Hypertension/etiology , Vascular Stiffness , Aged , Drug Resistance , Female , Humans , Male , Middle Aged , Obesity/complications
6.
Braz J Med Biol Res ; 40(2): 189-97, 2007 Feb.
Article in English | MEDLINE | ID: mdl-17273655

ABSTRACT

Apolipoprotein E (apoE - e2, e3, e4 alleles) plays a role in the regulation of lipid metabolism, with the e4 considered to be a risk factor for coronary artery disease (CAD). We aimed to evaluate the apoE polymorphisms in Brazilians with CAD and their influence on the lipid profile and other risk factors (hypertension, diabetes mellitus, smoking). Two hundred individuals were examined: 100 patients with atherosclerosis confirmed by coronary angiography and 100 controls. Blood samples were drawn to determine apoE polymorphisms and lipid profile. As expected, the e3 allele was prevalent in the CAD (0.87) and non-CAD groups (0.81; P = 0.099), followed by the e4 allele (0.09 and 0.14, respectively; P = 0.158). The e3/3 (76 and 78%) and e3/4 (16 and 23%) were the most common genotypes for patients and controls, respectively. The lipid profile was altered in patients compared to controls (P < 0.05), independently of the e4 allele. However, in the controls this allele was prevalent in individuals with elevated LDL-cholesterol levels only (odds ratio = 2.531; 95% CI = 1.028-6.232). The frequency of risk factors was higher in the CAD group (P < 0.05), but their association with the lipid profile was not demonstrable in e4 carriers. In conclusion, the e4 allele is not associated with CAD or lipid profile in patients with atherosclerosis. However, its frequency in the non-CAD group is associated with increased levels of LDL-cholesterol, suggesting an independent effect of the e4 allele on lipid profile when the low frequency of other risk factors in this group is taken into account.


Subject(s)
Apolipoproteins E/genetics , Coronary Artery Disease/blood , Polymorphism, Genetic , Adult , Aged , Alleles , Case-Control Studies , Coronary Artery Disease/genetics , Female , Genotype , Humans , Lipids/blood , Male , Middle Aged , Risk Factors
7.
Rev. bras. pesqui. méd. biol ; Braz. j. med. biol. res;40(2): 189-197, Feb. 2007. graf, tab
Article in English | LILACS | ID: lil-440489

ABSTRACT

Apolipoprotein E (apoE - e2, e3, e4 alleles) plays a role in the regulation of lipid metabolism, with the e4 considered to be a risk factor for coronary artery disease (CAD). We aimed to evaluate the apoE polymorphisms in Brazilians with CAD and their influence on the lipid profile and other risk factors (hypertension, diabetes mellitus, smoking). Two hundred individuals were examined: 100 patients with atherosclerosis confirmed by coronary angiography and 100 controls. Blood samples were drawn to determine apoE polymorphisms and lipid profile. As expected, the e3 allele was prevalent in the CAD (0.87) and non-CAD groups (0.81; P = 0.099), followed by the e4 allele (0.09 and 0.14, respectively; P = 0.158). The e3/3 (76 and 78 percent) and e3/4 (16 and 23 percent) were the most common genotypes for patients and controls, respectively. The lipid profile was altered in patients compared to controls (P < 0.05), independently of the e4 allele. However, in the controls this allele was prevalent in individuals with elevated LDL-cholesterol levels only (odds ratio = 2.531; 95 percent CI = 1.028-6.232). The frequency of risk factors was higher in the CAD group (P < 0.05), but their association with the lipid profile was not demonstrable in e4 carriers. In conclusion, the e4 allele is not associated with CAD or lipid profile in patients with atherosclerosis. However, its frequency in the non-CAD group is associated with increased levels of LDL-cholesterol, suggesting an independent effect of the e4 allele on lipid profile when the low frequency of other risk factors in this group is taken into account.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Apolipoproteins E/genetics , Coronary Artery Disease/blood , Coronary Artery Disease/genetics , Lipids/blood , Alleles , Case-Control Studies , Genotype , Polymorphism, Genetic , Risk Factors
8.
Biochem Mol Biol Int ; 35(5): 1059-67, 1995 Apr.
Article in English | MEDLINE | ID: mdl-7549924

ABSTRACT

An alpha-amylase gene from Streptomyces sp WL6 was cloned on a 3.1kb DNA fragment, which was completely sequenced. The 3088 nucleotide sequence obtained contains three putative coding regions in the same orientation. The one corresponding to the structural region of the alpha-amylase gene has a deduced amino acid sequence of 459 residues, showing up to 71% identity to other alpha-amylases. An incomplete ORF was identified upstream the alpha-amylase gene, and the deduced product presents some homology to proteins involved in catabolic regulation.


Subject(s)
Genes, Bacterial , Streptomyces/enzymology , Streptomyces/genetics , alpha-Amylases/genetics , Amino Acid Sequence , Base Sequence , Binding Sites , Codon , Hydrolysis , Molecular Sequence Data , Plasmids/chemistry , Plasmids/genetics , Promoter Regions, Genetic , Ribosomes/metabolism , Sequence Alignment , Sequence Analysis, DNA , Sequence Homology, Amino Acid , Sequence Homology, Nucleic Acid , Starch/metabolism
11.
Trop Doct ; 5(2): 84-8, 1975 Apr.
Article in English | MEDLINE | ID: mdl-1129855

ABSTRACT

During his work in a jungle hospital of the Amazonian part of Peru, the author was able to study the health care delivery system in the area. He was impressed by its inadequacy, which seemed to be due less to medical, technological, and manpower deficiencies than to social and economic factors. An attempt is made to identify and classify these constraints. A systems view of the health care insufficiencies is outlined, showing how some barriers prevent the patient from making contact with the health system (input level), how others interfere with its working (processor level), while others limit the efficiency of its actions (output level). Finally, some measures for its improvement are considered.


Subject(s)
Delivery of Health Care , Health Services , Attitude to Health , Culture , Health , Humans , Indians, South American , National Health Programs , Peru , Socioeconomic Factors
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