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OBJECTIVE: To determine reference intervals (RI) for fasting blood insulin (FBI) in Brazilian adolescents, 12 to 17 years old, by direct and indirect approaches, and to validate indirectly determined RI. METHODS: Two databases were used for RI determination. Database 1 (DB1), used to obtain RI through a posteriori direct method, consisted of prospectively selected healthy individuals. Database 2 (DB2) was retrospectively mined from an outpatient laboratory information system (LIS) used for the indirect method (Bhattacharya method). RESULTS: From DB1, 29345 individuals were enrolled (57.65 % female) and seven age ranges and sex partitions were statistically determined according to mean FBI values: females: 12 and 13 years-old, 14 years-old, 15 years-old, 16 and 17 years-old; and males: 12, 13 and 14 years-old, 15 years-old, 16 and 17 years-old. From DB2, 5465 adolescents (67.5 % female) were selected and grouped according to DB1 partitions. The mean FBI level was significantly higher in DB2, on all groups. The RI upper limit (URL) determined by Bhattacharya method was slightly lower than the 90 % CI URL directly obtained on DB1, except for group female 12 and 13 years old. High agreement rates for diagnosing elevated FBI in all groups on DB1 validated indirect RI presented. CONCLUSION: The present study demonstrates that Bhattacharya indirect method to determine FBI RI in adolescents can overcome some of the difficulties and challenges of the direct approach.
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Mineração de Dados , Jejum , Insulina , Humanos , Adolescente , Feminino , Masculino , Valores de Referência , Brasil , Criança , Insulina/sangue , Jejum/sangue , Mineração de Dados/métodos , Estudos Retrospectivos , Bases de Dados FactuaisRESUMO
INTRODUCTION: Obstructive Sleep Apnea (OSA) is a chronic disorder associated with several risk factors, and increased Body Mass Index (BMI) and waist circumference are correlated with it is severity. AIM: To evaluate vascular function, central hemodynamics, and autonomic modulation in obese individuals with moderate and severe OSA. METHODS: Individuals of both sexes, aged 40-70 years and BMI ≥ 30 and < 40 kg/m2, were submitted to assessment of heart rate variability, endothelial function by flow-mediated dilatation, central parameters by oscillometry and carotid ultrasound. The sleep study was performed through a portable home sleep test device (WatchPAT). RESULTS: Patients (n = 76) were divided according to Apnea-Hypopnea Index (AHI): absent-mild group (AHI < 15 events/h, n = 30) and Moderate-Severe (MS) group (AHI ≥ 15 events/h, n = 46). The Low/High Frequency (LF/HF) ratio (0.81 ± 0.48 vs 1.39 ± 1.08 ms2, p = 0.035), Pulse Wave Velocity (PWV; 6.9 ± 0.7 vs 7.7 ± 1.6m/s, p = 0.004), vascular age (48 ± 6 vs 53 ± 9 years, p = 0.05) and mean intima-media thickness (0.59 ± 0.08 vs 0.66 ± 0.13 mm, p = 0.011) were significantly higher in the MS group. AHI was significantly correlated with PWV (r = 0.26, p = 0.024) and LF/HF ratio (r = 0.40, p < 0.001). Only in the MS group, PWV was significantly correlated with SD2/SD1 ratio (r = 0.611, p ≤ 0.001), and flow-mediated dilation with central systolic blood pressure (r = 0.364, p = 0.018), even after adjustment for age and sex. CONCLUSION: In this sample of obese individuals, moderate to severe OSA was associated with sympathetic hyperactivity and evidence of accelerated vascular aging with arterial stiffness and subclinical atherosclerosis.
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Apneia Obstrutiva do Sono , Rigidez Vascular , Masculino , Feminino , Humanos , Espessura Intima-Media Carotídea , Análise de Onda de Pulso , Obesidade/complicações , Obesidade/diagnóstico , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnósticoRESUMO
The acute effects of exercise modes on pulse wave reflection (PWR) and their relationship with autonomic control remain undefined, particularly in individuals with elevated blood pressure (BP). We compared PWR and autonomic modulation after acute aerobic (AE), resistance (RE), and concurrent exercise (CE) in 15 men with stage-1 hypertension (mean ± SE: 34.7 ± 2.5 years, 28.4 ± 0.6 kg/m2, 133 ± 1/82 ± 2 mmHg). Participants underwent AE, RE, and CE on different days in counterbalanced order. Applanation tonometry and heart rate variability assessments were performed before and 30-min postexercise. Aortic pressure decreased after AE (- 2.4 ± 0.7 mmHg; P = 0.01), RE (- 2.2 ± 0.6 mmHg; P = 0.03), and CE (- 3.1 ± 0.5 mmHg; P = 0.003). Augmentation index remained stable after RE, but lowered after AE (- 5.1 ± 1.7%; P = 0.03) and CE (- 7.6 ± 2.4% P = 0.002). Systolic BP reduction occurred after CE (- 5.3 ± 1.9 mmHg). RR-intervals and parasympathetic modulation lowered after all conditions (~ 30-40%; P < 0.05), while the sympathovagal balance increased after RE (1.2 ± 0.3-1.3 ± 0.3 n.u., P < 0.05). Changes in PWR correlated inversely with sympathetic and directly with vagal modulation in CE. In conclusion, AE, RE, and CE lowered central aortic pressure, but only AE and CE reduced PWR. Overall, those reductions related to decreased parasympathetic and increased sympathetic outflows. Autonomic fluctuations seemed to represent more a consequence than a cause of reduced PWR.
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Sistema Nervoso Autônomo/fisiopatologia , Terapia por Exercício/métodos , Hipertensão/terapia , Treinamento Resistido/métodos , Nervo Vago/fisiopatologia , Adulto , Pressão Arterial/fisiologia , Frequência Cardíaca/fisiologia , Humanos , Hipertensão/fisiopatologia , Masculino , Análise de Onda de Pulso , Sinais VitaisRESUMO
Hypertension is a pathology of high prevalence in the world. In Brazil, it is the main risk factor for the major cause of death in the country, coronary heart disease. The May Measurement Month Campaign in 2018 (MMM18) included a population with representation from all Brazilian states and reflects some of the characteristics of hypertension in Brazil. Questionnaire data were collected and three measures of blood pressure (BP) were performed. The sample consisted of 12 413 individuals, 59.1% were white, 51.3% were women. The average age was 54. ± 16.0 years. Diabetes was present in 11.6%, previous myocardial infarction in 5.9%, and previous stroke in 2.7%. Current smokers were 9.3% and 12.4% were regular drinkers. The average body mass index was 27.3 ± 4.5 kg/m2. After multiple imputations, 67.9% were hypertensive (>140/90 mmHg). Of the individuals who were not taking antihypertensive medication, 27.9% were hypertensive and of those taking antihypertensive medication, 40.3% were uncontrolled. Systolic BP increased with age. The MMM18 campaign demonstrated a large number of unknown hypertensives and a high rate of uncontrolled hypertension in Brazil, unfortunately in keeping with 2017 findings.
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Studies aiming to associate the sodium/potassium (Na/K) ratio with hypertension use 24-hour urinary excretion as a daily marker of ingestion. The objective of this study was to evaluate the association between urinary Na/K ratio and structural and functional vascular alterations in non-diabetic hypertensive patients. In hypertensive patients (n = 72), aged between 40 and 70 years, both sexes (61% women), in use of hydrochlorothiazide, we measured blood pressure, 24-hour urine sample collection, assessment of carotid-femoral pulse wave velocity (cf-PWV, Complior), central hemodynamic parameters (SphygmoCor), and post-occlusive reactive hyperemia (PORH). The participants were divided according to the tertile of 24-hour urinary Na/K ratio. Each group contained 24 patients. Systolic blood pressure was higher in T2 (133 ± 9 vs 140 ± 9 mmHg, P = .029). C-reactive protein (CRP) presented higher values in T3 as compared to T1 [0.20(0.10-0.34) vs 1.19 (0.96-1.42) mg/dL, P < .001]. Higher values in T3 were also observed for aortic systolic pressure (aoSP) [119(114-130) vs 135(125-147) mmHg, P = .002] and cf-PWV (9.2 ± 1.6 vs 11.1 ± 1.5 m/s, P < .001). The urinary Na/K ratio presented significant correlations with proteinuria (r = .27, P = .023), CRP (r = .77, P < .001), cf-PWV (r = .41, P < .001), and post-occlusive reactive hyperemia on cutaneous vascular conductance (PORH CVC) (r = -.23, P = .047). By multivariate linear regression, it was detected an independent and significant association of cf-PWV with urinary Na/K ratio (R2 = 0.17, P < .001) and PORH CVC with CRP (R2 = 0.30, P = .010). Our data indicated that increased urinary Na/K ratio in non-diabetic hypertensive patients was associated with higher degree of inflammation, raised peripheral and central pressure levels, and changes suggestive of endothelial dysfunction and arterial stiffness.
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Hipertensão/metabolismo , Hipertensão/fisiopatologia , Potássio/urina , Sódio/urina , Adulto , Idoso , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Proteína C-Reativa/análise , Velocidade da Onda de Pulso Carótido-Femoral/métodos , Estudos Transversais , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Hidroclorotiazida/uso terapêutico , Hiperemia/epidemiologia , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Proteinúria/epidemiologia , Inibidores de Simportadores de Cloreto de Sódio/uso terapêutico , Coleta de Urina/métodos , Rigidez Vascular/fisiologiaRESUMO
de Paula, T, Neves, MF, da Silva Itaborahy, A, Monteiro, W, Farinatti, P, and Cunha, FA. Recovery pattern of cardiac autonomic control after aerobic and strength exercises in overweight prehypertensive men. J Strength Cond Res 33(10): 2743-2752, 2019-The extent to which postexercise cardiac autonomic control depends on exercise modality remains unclear, particularly among individuals with autonomic dysfunction (cardiac autonomic dysfunction [CADysf]). This study compared heart rate variability (HRV) and baroreflex sensitivity (BRS) responses to acute aerobic exercise (AE) and strength exercise (SE) in men with CADysf. Twenty men were assigned into control (n = 10: 33.8 ± 3.0 years; 23.7 ± 1.5 kg·m) and CADysf (n = 10: 36.2 ± 9.8 years; 28.4 ± 2.6 kg·m) groups. Cardiac autonomic dysfunction underwent AE, SE, and a nonexercise control day (control session [CTL]) in a randomized, counter-balanced order. Heart rate variability and BRS were assessed in a supine position during 25 minutes of recovery after AE, SE, and CTL. Both HRV indices (p ≤ 0.05; effect size [Cohen's d]: >1.4) and BRS at rest were significantly lower in CADysf than those in controls (p < 0.01; effect size [Cohen's d]: ≥1.36). In CADysf, postexercise increases in heart rate, sympathetic activity (low-frequency [LF] band), and sympathovagal balance (LF:high-frequency [HF] ratio), as well as decreases in R-R interval, parasympathetic activity (HF band), and BRS were observed in AE (p ≤ 0.05; effect size [Cohen's d]: ≥1.31) and SE (p ≤ 0.05; effect size [Cohen's d]: ≥0.79) vs. CTL, but changes were larger after AE than SE (p ≤ 0.05; effect size [Cohen's d]: ≥0.73). In conclusion, both AE and SE elicited postexercise changes in HRV and BRS among CADysf men, primarily reflected by lowered vagal modulation, increased sympathovagal balance, and a delayed BRS recovery pattern. However, those changes seem to be more likely to occur after AE than SE.
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Doenças do Sistema Nervoso Autônomo/fisiopatologia , Barorreflexo , Exercício Físico/fisiologia , Cardiopatias/fisiopatologia , Frequência Cardíaca , Adulto , Pressão Sanguínea/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Treinamento Resistido , Nervo VagoRESUMO
The aim of the study was to assess the acute effect of whole-body vibration (WBV) exercise, with low frequency (5 Hz), on the pain level (PL), trunk flexibility, and cardiovascular responses (blood pressure [BP] and heart rate [HR]) in individuals with metabolic syndrome (MetS). Forty-four individuals were included in the study (control: 15) or in (WBV exercise: 29) groups. They were submitted to 3 bouts (1 minute each) of WBV exercise (5 Hz and peak-to-peak displacements of 2.5, 5.0, and 7.5 mm, corresponding to peak accelerations of 0.12, 0.25, and 0.35 g, respectively, sitting in a chair with the feet on the platform with knees flexed, followed by 1 minute of interset rest. The Control Group performed the same protocol, but the platform was turned off. The PL was measured through the visual analog pain scale, and the flexibility was measured through the anterior trunk flexion test. Significant improvements on PL (P = .031) and flexibility (P = .004) were found only in the WBV exercise group. The BP and HR remained at physiological levels. In conclusion, the WBV exercise would lead to physiological response decreasing PL and increasing flexibility as well as maintaining the cardiovascular responses in individuals with MetS.
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BACKGROUND: In recent years, it has become more evident that oxidative stress is involved in the development of cardiovascular disease. Indeed, reactive oxygen species seems to be the common mechanism for endothelial dysfunction, vascular inflammation and arterial stiffness, resulting in a blood pressure increase and early vascular aging. METHODS: This review presents the potential role of antioxidant nutrients and exercise for cardiovascular protection. RESULTS: Flavonoids, vitamins and minerals present in some fruits and foliage are considered natural antioxidants. In fact, fruits and vegetables contain large amounts of antioxidants. Several clinical trials have extensively studied vitamin E, beta-carotene, vitamin C, polyphenols, plus selenium and zinc. In addition, many authors have been carried out clinical trials to evaluate the mechanisms of oxidative stress attenuation after exercise. Exercise responses may vary according to the Frequency, Intensity, Time and Type (FITT) principle, making it difficult to obtain a consensus concerning the exercise properties and redox status. High-intensity interval training (HIIT) has been reported as an efficient option for metabolic adaptations in a short time. Aerobic exercises must be performed at least three times a week, for two months or more, using moderate to vigorous intensity to promote a positive effect on oxidative stress and vascular function. CONCLUSION: The recognition of appropriate nutrients and exercise with antioxidant properties may be an important supportive approach to impair early vascular aging and to prevent cardiovascular disease.
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Antioxidantes/farmacologia , Doenças Cardiovasculares/terapia , Terapia por Exercício , Exercício Físico , Nutrientes/farmacologia , Estresse Oxidativo/efeitos dos fármacos , Animais , Antioxidantes/química , Humanos , Nutrientes/químicaRESUMO
Abstract Background: Obesity, systemic arterial hypertension (SAH) and obstructive sleep apnea (OSA) are closely related. Up to 70% of patients with OSA may be asymptomatic, and there is evidence that these patients have cardiovascular disease, especially nocturnal SAH. Objectives: The aim of this study was to evaluate 24-hour blood pressure circadian variation in asymptomatic, obese individuals with moderate-to-severe OSA and compare it with that in individuals with mild OSA or without OSA. Methods: Eighty-six obese subjects aged between 30 and 55 years (BMI 30-39 kg/m2), with casual blood pressure < 140/90 mmHg and without comorbidities were recruited. Eighty-one patients underwent clinical and anthropometric assessment, ambulatory blood pressure monitoring (ABPM), and Watch-PAT. Participants were divided into two groups, based on the apnea-hypopnea index (AHI): group 1, with AHI < 15 events/hour, and group 2 with AHI ≥ 15 events/hour. Results: Compared with group 1, group 2 had higher neck circumference and waist-hip circumference (40.5 ± 3.2 cm vs. 38.0 ± 3.7 cm, p = 0.002, and 0.94 ± 0.05 vs. 0.89 ± 0.05, p = 0.001, respectively), higher systolic and diastolic blood pressure measured by the 24-h ABPM (122 ± 6 vs 118 ± 8 mmHg, p = 0.014, and 78 ± 6 vs 73 ± 7 mmHg, p = 0.008, respectively), and higher nocturnal diastolic pressure load (44,6 ± 25,9% vs 31,3 ± 27,3%, p = 0,041). Moreover, there was a positive correlation between nocturnal diastolic blood pressure and AHI (r = 0.43, p < 0.05). Conclusions: Asymptomatic obese subjects with moderate-to-severe OSA have higher systolic and diastolic blood pressure at 24 hours compared with those with absent / mild OSA, despite normal casual blood pressure between the groups. These results indicate that ABPM may be useful in the evaluation of asymptomatic obese patients with moderate-to-severe OSA.
Resumo Fundamentos: Obesidade, hipertensão arterial sistêmica (HAS) e apneia obstrutiva do sono (AOS) estão intimamente relacionados. Até 70% dos pacientes com AOS podem ser assintomáticos e há evidências que eles apresentam alterações cardiovasculares, em especial HAS noturna. Objetivos: O objetivo deste estudo foi avaliar o comportamento da pressão arterial nas 24 horas em indivíduos obesos assintomáticos com AOS moderada/grave comparando àqueles com AOS leve/ausente. Métodos: Foram selecionados 86 pacientes entre 30 e 55 anos, obesos (IMC 30-39,9 kg/m2), com pressão arterial casual < 140/90 mmHg e sem comorbidades, dos quais 81 foram submetidos à avaliação clínica, medidas antropométricas, monitorização ambulatorial da pressão arterial (MAPA) e Watch-PAT. Os participantes do estudo foram divididos em dois grupos com base no índice de apneia-hipopneia (IAH): grupo 1 com IAH < 15 eventos/h e grupo 2 com IAH ≥ 15 eventos/h. Resultados: Em comparação ao grupo 1, o grupo 2 apresentou maior circunferência de pescoço e maior relação cintura-quadril (40,5 ± 3,2 vs 38,0 ± 3,7 cm, p = 0,002, e 0,94 ± 0,05 vs 0,89±0,05cm, p = 0,001, respectivamente), maiores pressões arteriais sistólica e diastólica na MAPA-24h (122 ± 6 vs 117 ± 8 mmHg, p = 0,014, e 78 ± 6 vs 73 ± 7 mmHg, p = 0,008, respectivamente), bem como maior carga pressórica diastólica noturna (44,6 ± 25,9% vs 31,3 ± 27,3%, p = 0,041). Além disso, houve correlação positiva entre pressão arterial diastólica noturna e IAH (r = 0,43, p < 0,05). Conclusões: Indivíduos obesos assintomáticos com AOS de moderada a grave apresentam maiores valores de PA sistólica e diastólica nas 24 horas em comparação àqueles com AOS ausente/leve, apesar da PA casual normal. Esses resultados indicam que a MAPA pode ser útil na avaliação de pacientes obesos assintomáticos com AOS de moderada à grave.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Pressão Sanguínea/fisiologia , Apneia Obstrutiva do Sono/fisiopatologia , Hipertensão/fisiopatologia , Obesidade/fisiopatologia , Valores de Referência , Fatores de Tempo , Índice de Gravidade de Doença , Antropometria , Estudos Transversais , Fatores de Risco , Ritmo Circadiano/fisiologia , Estatísticas não Paramétricas , Monitorização Ambulatorial da Pressão Arterial/métodos , Apneia Obstrutiva do Sono/complicações , Hipertensão/etiologia , Obesidade/complicaçõesRESUMO
BACKGROUND: Obesity, systemic arterial hypertension (SAH) and obstructive sleep apnea (OSA) are closely related. Up to 70% of patients with OSA may be asymptomatic, and there is evidence that these patients have cardiovascular disease, especially nocturnal SAH. OBJECTIVES: The aim of this study was to evaluate 24-hour blood pressure circadian variation in asymptomatic, obese individuals with moderate-to-severe OSA and compare it with that in individuals with mild OSA or without OSA. METHODS: Eighty-six obese subjects aged between 30 and 55 years (BMI 30-39 kg/m2), with casual blood pressure < 140/90 mmHg and without comorbidities were recruited. Eighty-one patients underwent clinical and anthropometric assessment, ambulatory blood pressure monitoring (ABPM), and Watch-PAT. Participants were divided into two groups, based on the apnea-hypopnea index (AHI): group 1, with AHI < 15 events/hour, and group 2 with AHI ≥ 15 events/hour. RESULTS: Compared with group 1, group 2 had higher neck circumference and waist-hip circumference (40.5 ± 3.2 cm vs. 38.0 ± 3.7 cm, p = 0.002, and 0.94 ± 0.05 vs. 0.89 ± 0.05, p = 0.001, respectively), higher systolic and diastolic blood pressure measured by the 24-h ABPM (122 ± 6 vs 118 ± 8 mmHg, p = 0.014, and 78 ± 6 vs 73 ± 7 mmHg, p = 0.008, respectively), and higher nocturnal diastolic pressure load (44,6 ± 25,9% vs 31,3 ± 27,3%, p = 0,041). Moreover, there was a positive correlation between nocturnal diastolic blood pressure and AHI (r = 0.43, p < 0.05). CONCLUSIONS: Asymptomatic obese subjects with moderate-to-severe OSA have higher systolic and diastolic blood pressure at 24 hours compared with those with absent / mild OSA, despite normal casual blood pressure between the groups. These results indicate that ABPM may be useful in the evaluation of asymptomatic obese patients with moderate-to-severe OSA.
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Pressão Sanguínea/fisiologia , Hipertensão/fisiopatologia , Obesidade/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Adulto , Antropometria , Monitorização Ambulatorial da Pressão Arterial/métodos , Ritmo Circadiano/fisiologia , Estudos Transversais , Feminino , Humanos , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Valores de Referência , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/complicações , Estatísticas não Paramétricas , Fatores de TempoRESUMO
BACKGROUND: Whole body vibration exercises (WBVE) improve the quality of life (QoL) of different populations. Metabolic syndrome patients (MetS) may be favored by physical activity. Questionnaires are used to assess the QoL. The aim was to evaluate the QoL of patients with MetS that have undergone WBVE with a brief WHOQOL (WHOQOL-BREF). MATERIAL AND METHODS: MetS patients were randomly divided into three groups: (i) control group (CG), (ii) treated with WBVE once per week (WBVE1) and (iii) treated with WBVE twice per week (WBVE2). In the first session, the patient was sat in a chair in front of the platform with the feet on its base in 3 peak to peak displacements (2.5, 5.0 and 7.5 mm) and frequency of 5 Hz was used. From the second to the last session, patients were subjected to the same protocol, however they were standing on the base of the platform and the frequency was increased up to 14 Hz. The patients fulfilled the WHOQOL-BREF before the first and after the last sessions. Cronbach coefficients were determined to each domain of the WHOQOL-BREF and test Wilcoxon (p<0.05) was used. RESULTS: The patients of the WBVE1 group had improvements in the physical, psychological and environment domains while in the WBVE2, the improvements were in the physical and social relationships domain of the WHOQOL-BREF. CONCLUSION: It was observed that the WBVE in a protocol (one or two times per week) with a progressive and increased frequency improves the QoL of patients with MetS in different domains of the WHOQOL-BREF.
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Terapia por Exercício/métodos , Síndrome Metabólica/terapia , Qualidade de Vida , Vibração , Adulto , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
INTRODUCTION: The purpose of this study was to compare the effects of benazepril and losartan on endothelial function and vascular stiffness, in patients with diabetes mellitus and hypertension. MATERIALS AND METHODS: We included hypertensive diabetic patients with an office systolic blood pressure (BP) ⩾ 130 mmHg and/or diastolic BP ⩾ 80 mmHg. Patients were rolled over to amlodipine for 6 weeks, then we performed C-reactive protein assays, BP measurement and vascular tests; next, patients were randomized to benazepril or losartan. The tests were repeated after 12 weeks. RESULTS: We randomized 14 patients to benazepril and 16 to losartan. There were no differences in systolic (139 versus 134 mmHg, p = 0.618) and diastolic (82 versus 80 mmHg, p = 0.950) BP at the end of the study. C-reactive protein values were lower in the benazepril group (0.38 versus 0.42 mg/dl, p = 0.020). There was a slightly higher flow-mediated vasodilation (FMD) response in the benazepril group (45% increase, p = 0.057) than in the losartan group (19% increase, p = 0.132). Both central systolic BP (129 versus 123 mmHg, p = 0.934) and carotid-femoral pulse wave velocity (cfPWV) (8.5 versus 8.5 m/s, p = 0.280) were the same between groups. CONCLUSIONS: Hypertensive diabetic patients using benazepril had a greater reduction in C-reactive protein, and a slight improvement in FMD, than those taking losartan.
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Benzazepinas/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Endotélio Vascular/fisiopatologia , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Losartan/uso terapêutico , Rigidez Vascular/efeitos dos fármacos , Aorta/efeitos dos fármacos , Aorta/fisiopatologia , Benzazepinas/efeitos adversos , Benzazepinas/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Proteína C-Reativa , Estudos de Coortes , Diabetes Mellitus Tipo 2/fisiopatologia , Endotélio Vascular/efeitos dos fármacos , Feminino , Humanos , Losartan/efeitos adversos , Losartan/farmacologia , Masculino , Pessoa de Meia-Idade , Análise de Onda de PulsoRESUMO
Magnesium has been implicated in the pathogenesis of hypertension, but the role of its intracellular levels in cardiovascular diseases is not clear yet. We investigated the relationships of low concentrations of serum magnesium (sMg) and intracellular Mg (iMg) with clinical and vascular parameters. Thiazide-treated hypertensive women were separated into two groups according to lower (<2.0 mg/dL) or normal (≥2.0 mg/dL) sMg concentrations. The same patients were later divided according to lower (<3.75 mg/dL erythrocytes) and normal (≥3.75 mg/dL erythrocytes) iMg concentrations. Carotid ultrasound, radial applanation, and peripheral arterial tonometry were performed in all patients. Low sMg levels were associated with increased Framingham Risk Score (16% ± 3% vs 11% ± 1%; P = .024), higher systolic (148 ± 7 vs 135 ± 3 mm Hg; P = .049) and diastolic (91 ± 3 vs 84 ± 2 mm Hg; P = .042) blood pressure, and carotid intima-media thickness (0.92 ± 0.09 vs 0.76 ± 0.02 mm; P = .023). Low concentrations of iMg were related to wave reflection parameters such as increased augmentation pressure (20 ± 2 vs 15 ± 1 mm Hg; P = .032) and augmentation index (43% ± 2% vs 33% ± 2%; P = .004). In conclusion, in these diuretic-treated hypertensive women, low sMg was associated with higher blood pressure values, and more intense wave reflection were closely linked to iMg depletion, processes that might contribute to hypertension and other cardiovascular risk factors.
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Hipertensão/tratamento farmacológico , Deficiência de Magnésio/tratamento farmacológico , Magnésio/uso terapêutico , Inibidores de Simportadores de Cloreto de Sódio/uso terapêutico , Doenças Vasculares/tratamento farmacológico , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/fisiologia , Estudos Transversais , Método Duplo-Cego , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/metabolismo , Magnésio/sangue , Deficiência de Magnésio/sangue , Deficiência de Magnésio/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Doenças Vasculares/epidemiologia , Doenças Vasculares/metabolismo , Rigidez Vascular/fisiologiaRESUMO
OBJECTIVES: To investigate whether vasculogenic erectile dysfunction (ED) severity and the clinical response to vardenafil were associated with structural and functional vascular changes in patients with uncomplicated hypertension. METHODS: Sexually active hypertensive men (n = 100), aged 50-70 years, completed the International Index of Erectile Function, Erection Function Domain (IIEF-EF) and were divided into 2 groups: 74 men with mild to moderate, moderate, or severe ED (IIEF-EF score ≤18) and without major cardiovascular disease and 26 controls (IIEF-EF score ≥25). Clinical and laboratory evaluations were performed, followed by measurement of the carotid intima-media thickness (IMT) and brachial flow-mediated dilation (FMD) before 4 attempts with 20 mg of vardenafil. The responders had ≥50% positive answers on sexual encounter profile question 3. RESULTS: The carotid IMT was significantly greater and the FMD was significantly lower in patients with ED than in the control patients. The baseline IIEF-EF score correlated negatively with the carotid IMT (r = -0.48, P < .001) and with the Framingham score (r = -0.41, P < .001) among those with ED. After multivariate logistic regression analysis, the baseline IIEF score was independently and only associated with the carotid IMT (ß = 6.105, P = .019). Responders were younger, had a lower cardiovascular risk profile and carotid IMT, and greater baseline IIEF-EF score and FMD than did the nonresponders. On logistic regression analysis, the response to vardenafil was independently associated with the brachial FMD (ß = 1.085, P = .002). CONCLUSIONS: In hypertensive men with vasculogenic ED and no other clinical evidence of arteriosclerosis, the ED severity correlated with the carotid IMT, and phosphodiesterase-5 effectiveness correlated with brachial FMD.
Assuntos
Artéria Braquial/fisiopatologia , Hipertensão/complicações , Imidazóis/uso terapêutico , Impotência Vasculogênica/tratamento farmacológico , Impotência Vasculogênica/fisiopatologia , Inibidores da Fosfodiesterase 5/uso terapêutico , Piperazinas/uso terapêutico , Dilatação Patológica , Humanos , Impotência Vasculogênica/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fluxo Sanguíneo Regional , Índice de Gravidade de Doença , Sulfonas/uso terapêutico , Triazinas/uso terapêutico , Dicloridrato de VardenafilaRESUMO
OBJECTIVE: Low birth weight contributes to the early onset of end-stage renal disease. Therefore, this study was undertaken to investigate early and late glomerular structural alterations in both sexes of Wistar rat offspring from dams submitted to severe low protein intake during gestation. METHODS: Offspring from dams fed normal protein (19% of protein) or low protein (5% of protein) were studied at days 0, 10, 90 and 180 of age. RESULTS: Inner cortical structure showed immature (comma-shaped and S-shaped forms) and mature corpuscles in different proportions in low protein offspring (less maturity) and normal protein offspring (more maturity). At day 10 (end of the nephrogenesis period), immature corpuscles were observed only in low protein offspring. In adulthood, low protein offspring had higher blood pressure, and showed thicker glomerular basement membrane (GBM) with effacement of the pedicles, and slit diaphragm absent with some podocytes directly adhering to the basal membrane with pedicles absent. The number of renal corpuscles was lower in low protein offspring than in normal protein offspring of the same sex, all age groups (P < 0.001). No interaction was observed between sex and maternal nutrition for the same sex and all age groups. CONCLUSION: Gestational low protein leads to glomerulogenesis retardation and consequently a lower nephron number with thick GBM and structural alterations in the pedicles of podocytes.