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1. Reply to the letter “Understanding lactate and its clearance during extracorporeal membrane oxygenation for supporting refractory cardiogenic shock patients”

Author

Scolari, Fernando Luís, Schneider, Daniel, Fogazzi, Débora Vacaro, Gus, Miguel, Rover, Marciane Maria, Bonatto, Marcely Gimenes, de Araújo, Gustavo Neves, Zimerman, André, Sganzerla, Daniel, Goldraich, Lívia Adams, Teixeira, Cassiano, Friedman, Gilberto, Polanczyk, Carisi Anne, Rohde, Luis Eduardo, Rosa, Regis Goulart, and Wainstein, Rodrigo Vugman

Published
2023
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2. Effectiveness of chlorthalidone/amiloride versus losartan in patients with stage I hypertension and diabetes mellitus: results from the PREVER-treatment randomized controlled trial

Author

Fuchs, Flávio D., Scala, Luiz C. N., Vilela-Martin, José F., Whelton, Paul K., Poli-de-Figueiredo, Carlos E., Pereira E Silva, Ricardo, Gus, Miguel, Bortolotto, Luiz A., Consolim-Colombo, Fernanda M., Schlatter, Rosane P., Cesarino, José E., Castro, Iran, Figueiredo Neto, José A., Chaves, Hilton, Steffens, André A., Alves, João G., Brandão, Andréa A., de Sousa, Marcos R., Jardim, Paulo C., Moreira, Leila B., Franco, Roberto S., Gomes, Marco M., Afiune Neto, Abrahão, Fuchs, Felipe C., Sobral Filho, Dario C., Nóbrega, Antônio C., Nobre, Fernando, Berwanger, Otávio, and Fuchs, Sandra C.

Published
2021
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5. Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

Author

Scolari, Fernando Luís, Schneider, Daniel, Fogazzi, Débora Vacaro, Gus, Miguel, Rover, Marciane Maria, Bonatto, Marcely Gimenes, de Araújo, Gustavo Neves, Zimerman, André, Sganzerla, Daniel, Goldraich, Lívia Adams, Teixeira, Cassiano, Friedman, Gilberto, Polanczyk, Carisi Anne, Rohde, Luis Eduardo, Rosa, Regis Goulart, and Wainstein, Rodrigo Vugman

Published
2020
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9. Correction to: Effectiveness of chlorthalidone/amiloride versus losartan in patients with stage I hypertension and diabetes mellitus: results from the PREVER-treatment randomized controlled trial

Author

Fuchs, Flávio D., Scala, Luiz C. N., Vilela-Martin, José F., Whelton, Paul K., Poli-de-Figueiredo, Carlos E., Pereira E Silva, Ricardo, Gus, Miguel, Bortolotto, Luiz A., Consolim-Colombo, Fernanda M., Schlatter, Rosane P., Cesarino, Evandro J., Castro, Iran, Figueiredo Neto, José A., Chaves, Hilton, Steffens, André A., Alves, João G., Brandão, Andréa A., de Sousa, Marcos R., Jardim, Paulo C., Moreira, Leila B., Franco, Roberto S., Gomes, Marco M., Afiune Neto, Abrahão, Fuchs, Felipe C., Sobral Filho, Dario C., Nóbrega, Antônio C., Nobre, Fernando, Berwanger, Otávio, and Fuchs, Sandra C.

Published
2021
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17. Predictive factors of complications after coronary stent implantation

Author

Quadros Alexandre Schaan de, Gottschall Carlos A. M., Sarmento-Leite Rogério, Gus Miguel, Wainstein Rodrigo, and Bussmann André

Subjects
interventional cardiology, stents, predictive value, complications, Diseases of the circulatory (Cardiovascular) system, RC666-701
Published
2003

25. Hypertension : new guidelines for diagnosis and treatment

Author

Fuchs, Flávio Danni and Gus, Miguel

Subjects
Doenças cardiovasculares, Cardiovascular events, Prevention, eventos cardiovasculares, Hypertension, Hipertensão, prevenção
Abstract

Hipertensão arterial é fator de risco cardiovascular freqüente, muitas vezes despercebido e mal controlado. Evidências recentes de estudos de coorte reforçam a idéia de que é fortemente desejável manter valores muito baixos de pressão arterial ao correr da vida, o que pode ser conseguido com a adoção de estilo de vida saudável. Essas evidências, em conjunto com o resultado de ensaios clínicos, demonstram que, em indivíduos de alto risco, o tratamento medicamentoso antihipertensivo está indicado mesmo em presença de pressão arterial normal. A primeira opção antihipertensiva para a maioria dos pacientes deve recair em diuréticos em baixa dose, como demonstra a análise conjunta de inúmeros ensaios clínicos e os resultados do maior deles, o estudo Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Hypertension, a common cardiovascular risk factor, is frequently underdiagnosed and poorly controlled. Cohort studies have shown that blood pressure levels should be maintained very low along life, a goal that may be accomplished with a healthy lifestyle. Individuals at higher risk for the development of cardiovascular events should undergo antihypertensive treatment even when blood pressure levels are normal (pre-hypertension). Diuretics remain as the first choice in the treatment of most patients with hypertension, a recommendation based on systematic reviews of clinical trials and on the findings of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).

Published
2020

26. HIPERTENSÃO ARTERIAL SISTÊMICA: ESTUDOS DIAGNÓSTICOS

Author

Fuchs, Flávio Danni, Gus, Miguel, Nunes, Gerson, Maestri, Marcelo, Wiehe, Mário, Ferlin, Elton, Fuchs, Sandra Costa, and Moreira, Leila Beltrami

Subjects
hipertensão arterial, temperatura ambiente, epistaxe, alterações fundoscópicas, Pressão arterial, medidas repetidas, cefaléia
Abstract

Confirmação diagnóstica e avaliação de repercussão sobre órgãos-alvo são passos críticos na avaliação de pacientes hipertensos. Demonstramos a importância da aferição repetida da pressão arterial, do tamanho do manguito e da temperatura ambiente para o diagnóstico de hipertensão arterial. Cefaléia tem associação fortuita com pressão arterial, assim como epistaxe. A tradicional classificação de Keith & Wagener (KW) não tem paralelismo com a gravidade da hipertensão arterial. A associação entre anormalidades fundoscópicas isoladas e pressão arterial é fortemente influenciada pela idade dos pacientes. O método microdensitométrico, desenvolvido em nosso serviço em conjunto com a engenharia biomédica, pode aumentar a eficiência da fundoscopia em predizereventos cardiovasculares. Os achados descritos demonstram a importância de se empregar adequadas rotinas diagnósticas de hipertensão arterial e contribuem para o esclarecimento de muitas falsas associações com hipertensão arterial. Unitermos: Pressão arterial, hipertensão arterial, medidas repetidas, temperatura ambiente, cefaléia, epistaxe, alterações fundoscópicas.

Published
2020

27. HIPERTENSÃO ARTERIAL SISTÊMICA: ESTUDOS TERAPÊUTICOS

Author

Fuchs, Flávio Danni, Gus, Miguel, and Moreira, Leila Beltrami

Subjects
Tratamento anti-hipertensivo medicamentoso, tratamento anti-hipertensivo nãomedicamentoso, Resultado do tratamento, Efficacy, Antihypertensive drug treatment, eficácia, Avaliação de medicamentos, Antihypertensive non-drug treatment, Effectiveness, efetividade, Hipertensão
Abstract

O tratamento da hipertensão arterial sistêmica visa à prevenção primária e secundária de doença cardiovascular e renal. Um conjunto extenso de ensaios clínicos randomizados demonstrou que diuréticos em baixa dose consistem na escolha inicial mais eficaz. Contribuições de nosso grupo, neste contexto, têm se dado na revisão crítica da literatura, fortemente influenciada pelo viés corporativo. Algumas medidas não-medicamentosas, como a redução da ingestão salina, aumento da ingestão de potássio e dieta hipocalórica, podem reduzir a pressão arterial, presumindo-se que também reduzam a incidência de eventos clínicos. Em ensaio clínico randomizado e duplo-cego, verificamos não haver diferença de efeito de duas diferentes intensidades de exercício sobre a pressão arterial, podendo ambas serem desprovidas de efeito intrínseco. Em um dos poucos estudos publicados sobre a efetividade de tratamentos antihipertensivos, verificamos que o uso de medicamentos e a adesão parcial à dieta hipocalórica são efetivos a curto prazo, mas que o mesmo não acontece com a dieta hipossódica e com a recomendação de aumentar a atividade física. A extensão dos benefícios dos tratamentos medicamentoso e não-medicamentoso à maioria dos pacientes em condições reais de atendimento requer formas criativas de garantir a adesão contínua às prescrições médicas. The treatment of the systemic hypertension aims at the primary and secondary prevention of cardiovascular and renal events. A long series of randomized clinical trials has demonstrated that low doses of diuretics are the first choice in the management of hypertension. We have repeatedly shown that the design and interpretation of some of those clinical trials have been biased. Some non-drug interventions, such as the reduction in salt intake, increase in potassium intake and hypocaloric diet may reduce blood pressure, as well as the incidence of clinical events. In a randomized, double-blind clinical trial we demonstrated a similar effect of two training intensities on blood pressure, but we could not isolate an intrinsic effect of any of these exercise intensities. Among the few studies evaluating the effectiveness of blood pressure lowering interventions, we verified that the drug treatment and partial compliance with a hypocaloric diet are effective at short term, which does not occur with a low-sodium diet and with the recommendation to increase physical activity. The effectiveness of drug and non-drug treatments of hypertension in clinical practice is far from ideal, and requires creative approaches to improve compliance with medical prescriptions.

Published
2020

30. ASCOT-BPLA

Author

Fuchs, Flavio Danni, Gus, Miguel, Ribeiro, Jorge Pinto, Donzelli, Alberto, Malliani, Alberto, Goldstein, Mark R., Duerden, Martin, Dahlof, Bjorn, Sever, Peter, Poulter, Neil, and Wedel, Hans

Published
2006

31. multi-intervention protocol to improve sleep quality in a coronary care unit.

Author

Beltrami, Flávia Gabe, John, Ângela Beatriz, Macedo, Bruno Rocha de, Júnior, Vicente Corrêa, Nguyen, Xuân Lan, Pichereau, Claire, Maury, Eric, Fleury, Bernard, Gus, Miguel, and Fagondes, Simone Chaves

Subjects
RESEARCH methodology, TERTIARY care, CORONARY care units, MEDICAL protocols, QUESTIONNAIRES
Abstract

Aims Poor sleep is a frequent occurrence in the critical illness. Evaluate sleep quality and test the effect of a multi-intervention sleep care protocol in improving sleep quality in a coronary care unit (CCU). Methods and results Quasi-experimental study, carried out in two phases. During the first phase, the control group (n = 58 patients) received usual care. Baseline sleep data were collected through the Richards-Campbell Sleep Questionnaire (RCSQ) and the Sleep in the Intensive Care Unit Questionnaire (SICUQ). During the second phase (n = 55 patients), a sleep care protocol was implemented. Interventions included actions to promote analgesia, reduce noise, brightness, and other general measures. Sleep data were collected again to assess the impact of these interventions. The intervention group had better scores in overall sleep depth [median (interquartile range)] [81 (65–96.7) vs. 69.7 (50–90); P = 0.046]; sleep fragmentation [90 (65–100) vs. 69 (42.2–92.7); P = 0.011]; return to sleep [90 (69.7–100) vs. 71.2 (40.7–96.5); P = 0.007]; sleep quality [85 (65–100) vs. 71.1 (49–98.1); P = 0.026]; and mean RCSQ score [83 (66–94) vs. 66.5 (45.7–87.2); P = 0.002] than the baseline group. The main barriers to sleep were pain [1 (1.0–5.5)], light [1 (1.0–5.0)], and noise [1 (1.0–5.0)]. The most rated sources of sleep-disturbing noise were heart monitor alarm [3 (1.0–5.25)], intravenous pump alarm [1.5 (1.0–5.00)]. and mechanical ventilator alarm [1 (1.0–5.0)]. All were significantly lower in the intervention group than in the baseline group. Conclusion A multi-intervention protocol was feasible and effective in improving different sleep quality parameters and reducing some barriers to sleep in CCU patients. [ABSTRACT FROM AUTHOR]

Published
2022
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34. Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

Author

Scolari, Fernando, primary, Schneider, Daniel, additional, Fogazzi, Débora Vacaro, additional, Gus, Miguel, additional, Rover, Marciane Maria, additional, Bonatto, Marcely Gimenes, additional, de Araújo, Gustavo Neves, additional, Zimerman, André, additional, Sganzerla, Daniel, additional, Goldraich, Lívia Adams, additional, Teixeira, Cassiano, additional, Friedman, Gilberto, additional, Polanczyk, Carisi Anne, additional, Rohde, Luis Eduardo, additional, Rosa, Regis Goulart, additional, and Wainstein, Rodrigo Vugman, additional

Published
2020
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35. Effectiveness of chlorthalidone/amiloride versus losartan in patients with stage I hypertension and diabetes mellitus: results from the PREVER-treatment randomized controlled trial

Author

Fuchs, Flávio D., primary, Scala, Luiz C. N., additional, Vilela-Martin, José F., additional, Whelton, Paul K., additional, Poli-de-Figueiredo, Carlos E., additional, Pereira E Silva, Ricardo, additional, Gus, Miguel, additional, Bortolotto, Luiz A., additional, Consolim-Colombo, Fernanda M., additional, Schlatter, Rosane P., additional, Cesarino, José E., additional, Castro, Iran, additional, Figueiredo Neto, José A., additional, Chaves, Hilton, additional, Steffens, André A., additional, Alves, João G., additional, Brandão, Andréa A., additional, de Sousa, Marcos R., additional, Jardim, Paulo C., additional, Moreira, Leila B., additional, Franco, Roberto S., additional, Gomes, Marco M., additional, Afiune Neto, Abrahão, additional, Fuchs, Felipe C., additional, Sobral Filho, Dario C., additional, Nóbrega, Antônio C., additional, Nobre, Fernando, additional, Berwanger, Otávio, additional, and Fuchs, Sandra C., additional

Published
2020
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40. Additional file 1 of Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

Author

Scolari, Fernando Luís, Schneider, Daniel, Fogazzi, Débora Vacaro, Gus, Miguel, Marciane Maria Rover, Marcely Gimenes Bonatto, Araújo, Gustavo Neves De, Zimerman, André, Sganzerla, Daniel, Goldraich, Lívia Adams, Teixeira, Cassiano, Friedman, Gilberto, Carisi Anne Polanczyk, Rohde, Luis Eduardo, Rosa, Regis Goulart, and Wainstein, Rodrigo Vugman

Abstract

Additional file 1. Supplementary material.

Published
2020
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46. Posicionamento Brasileiro sobre Hipertensão Arterial Resistente – 2020

Author

Yugar-Toledo, Juan Carlos, primary, Moreno Júnior, Heitor, additional, Gus, Miguel, additional, Rosito, Guido Bernardo Aranha, additional, Scala, Luiz César Nazário, additional, Muxfeldt, Elizabeth Silaid, additional, Alessi, Alexandre, additional, Brandão, Andrea Araújo, additional, Moreira Filho, Osni, additional, Feitosa, Audes Diógenes de Magalhães, additional, Passarelli Júnior, Oswaldo, additional, Souza, Dilma do Socorro Moraes de, additional, Amodeo, Celso, additional, Barroso, Weimar Kunz Sebba, additional, Gomes, Marco Antônio Mota, additional, Paiva, Annelise Machado Gomes de, additional, Barbosa, Eduardo Costa Duarte, additional, Miranda, Roberto Dischinger, additional, Vilela-Martin, José Fernando, additional, Nadruz Júnior, Wilson, additional, Rodrigues, Cibele Isaac Saad, additional, Drager, Luciano Ferreira, additional, Bortolotto, Luiz Aparecido, additional, Consolim-Colombo, Fernanda Marciano, additional, Sousa, Márcio Gonçalves de, additional, Borelli, Flávio Antonio de Oliveira, additional, Kaiser, Sérgio Emanuel, additional, Salles, Gil Fernando, additional, Azevedo, Maria de Fátima de, additional, Magalhães, Lucélia Batista Neves Cunha, additional, Póvoa, Rui Manoel dos Santos, additional, Malachias, Marcus Vinícius Bolívar, additional, Nogueira, Armando da Rocha, additional, Jardim, Paulo César Brandão Veiga, additional, and Jardim, Thiago de Souza Veiga, additional

Published
2020
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48. Prevention of hypertension in patients with pre-hypertension: protocol for the PREVER-prevention trial

Author

Neto José, Pereira e Silva Ricardo, Filho Dario, Alves João, Chaves Hilton, Mota Marco, Scala Luiz, Neto Abrahão, Jardim Paulo, Ribeiro Antônio, de Sousa Marcos R, Brandão Andréa, Franco Roberto, Cesarino Evandro, Moreno Heitor, Vilela-Martin José F, Coelho Eduardo, Nobre Fernando, Consolim-Colombo Fernanda, Bortoloto Luiz, Mion Décio, Poli-de-Figueiredo Carlos E, Nóbrega Antônio C, Gus Miguel, Moreira Leila B, Fuchs Sandra C, Fuchs Flávio D, Irigoyen Maria, Castro Iran, Steffens André, Schlatter Rosane, de Mello Renato, Mosele Francisca, Ghizzoni Flávia, and Berwanger Otávio

Subjects
Medicine (General), R5-920
Abstract

Abstract Background Blood pressure (BP) within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a population-based intervention to prevent the incidence of hypertension and the development of target-organ damage. Methods This is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution. Discussion The early use of blood pressure-lowering drugs, particularly diuretics, which act on the main mechanism of blood pressure rising with age, may prevent cardiovascular events and the incidence of hypertension in individuals with hypertension. If this intervention shows to be effective and safe in a population-based perspective, it could be the basis for an innovative public health program to prevent hypertension in Brazil. Trial Registration Clinical Trials NCT00970931.

Published
2011
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49. A comparison between diuretics and angiotensin-receptor blocker agents in patients with stage I hypertension (PREVER-treatment trial): study protocol for a randomized double-blind controlled trial

Author

Figueiredo Neto José A, e Silva Ricardo, Sobral Filho Dario C, Alves João, Chaves Hilton, Mota Marco, Scala Luiz, Neto Abrahão, Jardim Paulo, Pinho Ribeiro Antônio, de Sousa Marcos R, Brandão Andréa, Franco Roberto, Cesarino Evandro, Moreno Heitor, Vilela-Martin José F, Coelho Eduardo, Nobre Fernando, Consolim-Colombo Fernanda, Bortolotto Luiz, Mion Décio, Poli-de-Figueiredo Carlos E, Nóbrega Antônio C, Gus Miguel, Moreira Leila B, Fuchs Sandra C, Fuchs Flávio D, Irigoyen Maria, Castro Iran, Steffens André, Schlatter Rosane, de Mello Renato, Mosele Francisca, Ghizzoni Flávia, and Berwanger Otávio

Subjects
Medicine (General), R5-920
Abstract

Abstract Background Cardiovascular disease is the leading cause of death in Brazil, and hypertension is its major risk factor. The benefit of its drug treatment to prevent major cardiovascular events was consistently demonstrated. Angiotensin-receptor blockers (ARB) have been the preferential drugs in the management of hypertension worldwide, despite the absence of any consistent evidence of advantage over older agents, and the concern that they may be associated with lower renal protection and risk for cancer. Diuretics are as efficacious as other agents, are well tolerated, have longer duration of action and low cost, but have been scarcely compared with ARBs. A study comparing diuretic and ARB is therefore warranted. Methods/design This is a randomized, double-blind, clinical trial, comparing the association of chlorthalidone and amiloride with losartan as first drug option in patients aged 30 to 70 years, with stage I hypertension. The primary outcomes will be variation of blood pressure by time, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new subclinical atherosclerosis and sudden death. The study will last 18 months. The sample size will be of 1200 participants for group in order to confer enough power to test for all primary outcomes. The project was approved by the Ethics committee of each participating institution. Discussion The putative pleiotropic effects of ARB agents, particularly renal protection, have been disputed, and they have been scarcely compared with diuretics in large clinical trials, despite that they have been at least as efficacious as newer agents in managing hypertension. Even if the null hypothesis is not rejected, the information will be useful for health care policy to treat hypertension in Brazil. Clinical trials registration number ClinicalTrials.gov: NCT00971165

Published
2011
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50. Association between different measurements of blood pressure variability by ABP monitoring and ankle-brachial index

Author

Moreira Leila B, Fuchs Flávio D, Fuchs Sandra C, Wittke Estefânia, Ferlin Elton, Cichelero Fábio T, Moreira Carolina M, Neyeloff Jeruza, Moreira Marina B, and Gus Miguel

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Blood pressure (BP) variability has been associated with cardiovascular outcomes, but there is no consensus about the more effective method to measure it by ambulatory blood pressure monitoring (ABPM). We evaluated the association between three different methods to estimate BP variability by ABPM and the ankle brachial index (ABI). Methods and Results In a cross-sectional study of patients with hypertension, BP variability was estimated by the time rate index (the first derivative of SBP over time), standard deviation (SD) of 24-hour SBP; and coefficient of variability of 24-hour SBP. ABI was measured with a doppler probe. The sample included 425 patients with a mean age of 57 ± 12 years, being 69.2% women, 26.1% current smokers and 22.1% diabetics. Abnormal ABI (≤ 0.90 or ≥ 1.40) was present in 58 patients. The time rate index was 0.516 ± 0.146 mmHg/min in patients with abnormal ABI versus 0.476 ± 0.124 mmHg/min in patients with normal ABI (P = 0.007). In a logistic regression model the time rate index was associated with ABI, regardless of age (OR = 6.9, 95% CI = 1.1- 42.1; P = 0.04). In a multiple linear regression model, adjusting for age, SBP and diabetes, the time rate index was strongly associated with ABI (P < 0.01). None of the other indexes of BP variability were associated with ABI in univariate and multivariate analyses. Conclusion Time rate index is a sensible method to measure BP variability by ABPM. Its performance for risk stratification of patients with hypertension should be explored in longitudinal studies.

Published
2010
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