Search

Arterial hypertrophy and remodeling are adaptive responses present in SAH that can result in silent ischemia and neurodegeneration, compromising brain connections and cognitive abilities. However, antihypertensives can minimize these histological changes. We try to assess whether cerebrovascular hemodynamic parameters, representative of these histological adaptations, can identify cognitive impairment in a preclinical stage in chronic hypertensive on drug treatment. Three groups of patients without cognitive complaints were prospectively compared: hypertensive under treatment with systolic blood pressure (SBP) < 140 and diastolic blood pressure (DBP) < 90 mmHg (n=54), hypertensive under treatment with SBP > 140 or DBP >90 mmHg (n=31) and volunteers normotensive (n=30). Simultaneous measurements of systemic BP and middle cerebral artery (MCA) blood flow velocity were obtained from digital plethysmography and Transcranial Doppler. For the cognitive assessment, the Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) and a broad neuropsychological battery were applied. In relation to normotensive, uncontrolled hypertensive were older (51 ± 12 years), had greater resistance-area product (RAP 1.7 [±0.7] vs. 1.2 [±0.2], p< 0.001), but did not differ in relation to the pulsatility indices (p=0.361). There was a negative correlation between RAP, episodic memory (r = -0.277, p=0.004) and cognitive processing speed (r = -0.319, p=0.001). In chronic hypertensive using antihypertensive, the RAP is a reliable marker of preclinical cognitive decline in specific domains, as it is less influenced by the direct action of these drugs, and should be further explored as an alternative tool for screening for cognitive impairment in these individuals.

Purpose: To compare augmentation index (AIx) between one Moderate-intensity continuous physical exercise (MICPE) and one High-intensity interval physical exercise (HIIPE) session in normal/high normal blood pressure (BP) (120–140 for systolic and 80–90 mmHg for diastolic). Additionally, to compare two AIx methods (SphygmoCor® and Arteriograph®) [1]. Methods: Exercise intensity and energy expenditure (equalizing) were according to the cardiopulmonary stress test. Individuals were randomized to exercise sessions, performed as cross-over. AIx were analyzed at baseline, immediately after and 24hours after MICPE and HIIPE session and compared among all times. ΔAIxHIIPE (AIxHIIPE - AIxBaseline) and ΔAIxMICPE were calculated. Correlation and agreement analysis was performed between AIx methods. Results: Individuals (n = 23; 78% women; 48 ± 1 years; systolic/diastolicBP = 125 ± 2/84 ± 1 mmHg) had lower AIxSphygmoCor® at MICPE compared to baseline and to 24 hours MICPE (27.2 ± 2.2 vs 32.8 ± 1 and 31.0 ± 2.5%; p < 0.01). AIxSphygmoCor® was lower in HIIPE than other times (23.2 ± 2.4 vs baseline 32.8 ± 1.9 p < 0.01; vs MICPE 27.2 ± 2.2; p = 0.039; vs 24 hours MICPE 31.0 ± 2.5; p < 0.01 and vs 24 hours HIIPE 32.2 ± 2.0%; p < 0.01). AIxArteriograph® was lower in HIIPE (16.0 ± 3.7%) than baseline (28.9 ± 3.4%; p = 0.001), 24 hours MICPE (25.7 ± 4.0%; p = 0.008) and 24 hours HIIPE (29.5 ± 3.9%; p = 0.005). ΔAIxHIIPE was greater than ΔAIxMICPE (−9.37 vs −5.15; p = 0.028). AIxArteriograph® showed a positive correlation with AIxSphygmoCor® (r = 0.793; p < 0.01) and showed agreement. Conclusion: Regardless of intensity, one exercise session improves AIx. The effect seems to be greater after HIIPE than MICPE.

Increased salt consumption is believed to induce high blood pressure (BP)-mediated organ damage, although it is not yet clear whether it reflects a generalized micro- and macrovascular malfunction independent of BP. Exceeding dietary sodium intake is acknowledged to be the main modifiable environmental risk factor for cardiovascular events that accounts for an increase in blood pressure and induces hypertension (HTN)-related target organ damage. Arterial stiffness is well known as an independent cardiovascular risk factor, and sodium intake may be a determinant of arterial stiffness. Even so, the studies that investigated the effect of dietary sodium reduction intake on arterial stiffness in humans provided inconclusive results. Therefore, we aim to perform a review of the available evidence of salt restriction and arterial stiffness and its impact on hypertensive patients.

Introduction: Association between male pattern baldness, also called androgenetic alopecia (AGA) and risk of coronary artery disease has been suggested by several epidemiological studies. Exogenous testosterone (T) therapy in transgender men (TM) promotes the development of alopecia in genetically susceptible individuals, and increases facial and body hair, muscle mass (MM) and visceral fat. The outcome of a long-term androgenic therapy over the functional properties of large arteries and the cardiovascular system of TM are not well stablished. Objective: To investigate the possible association between AGA and arterial stiffness assessed by measurement of carotid-femoral pulse wave velocity (VOPcf) and intima-media thickness carotid artery (cIMT) in TM receiving long-term T therapy. Methods: Forty-six TM (mean age: 43 ± 10 yo) undergoing T therapy (mean time of treatment duration: 13 ± 10 y; mean serum T levels: 611 ± 439 ng/dL) were evaluated in a cross-sectional study. Hair pattern (Ferriman & Gallway scale), grades of male pattern baldness (Hamilton-Norwood scale) and waist-hip ratio (WHR) were analyzed. Subjects were considered to have AGA if they have vertex alopecia (grade ≥ 3). Arterial Hypertension was defined as systolic blood pressure > 140 and/or diastolic blood pressure > 90mmHg or under pharmacological treatment, and dyslipidemia as total cholesterol ≥ 240 mg/dL and/or LDL-c≥ 160 mg/dL and/or HDL-c < 40 mg/dL and/or triglycerides > 200 mg/dL, or under pharmacological treatment. Current smoking has been investigated. The aortic stiffness, assessed by VOPcf and cIMT, was measured using the Complior® device and carotid ultrasound, respectively. Results: TM’s Ferriman degree was 21 ± 6 and AGA was identified in 70% of them. The WHR was 0.9 ± 0.1. TM with AGA showed higher cIMT than TM without AGA (0.66 ± 0.1mm vs. 0.54 ± 0.07mm, p = 0.001), as well as higher WHR (0.93 ± 0.08 vs.0.87 ± 0.04, p = 0.02), higher score in terminal body hair (Ferriman 23 ± 6 vs. 18 ± 6, p = 0.007) and higher frequency of hypertension (94% vs. 6%, p = 0.01). The cIMT positively correlated with age (p = 0.01) and WHR (p = 0.002). The VOPcf was positively correlated with the age (p = 0.0001), androgen treatment duration (p = 0.01) and WHR (p = 0.04). There was a positive correlation between androgen treatment duration and WHR (p = 0.01). There was no difference in the VOPcf values, age, T treatment duration, serum T levels, frequency of dyslipidemia and smoking between the groups. Conclusion: The severe vertex AGA pattern may be considered a possible marker of arterial stiffness in TM undergoing long-term testosterone therapy.

Cerebral autoregulation (AR) keeps cerebral blood flow constant despite fluctuations in systemic arterial pressure. The final common AR pathway is made up of vasomotor adjustments of cerebrovascular resistance mediated by arterioles. Structural and functional changes in the arteriolar wall arise with age and systemic arterial hypertension. This study evaluated whether AR is impaired in hypertensive patients and whether this impairment differs with disease control. Three groups of patients were prospectively compared: hypertensive patients under treatment with systolic blood pressure (SBP) 140 or DBP > 90 mm Hg (n = 31), and normotensive volunteers (n = 30). Simultaneous measurements of cerebral blood flow velocity (CBFV) and BP were obtained by digital plethysmography and transcranial Doppler, and the AR index (ARI) was defined according to the step response to spontaneous fluctuations in BP. Compared to the uncontrolled hypertension, the normotensive individuals were younger (age 43.42 ± 11.14, P

Background: Central nervous system changes associated to systemic arterial hypertension (SAH) are progressive and may cause negative effects on cognitive performance. The objective of this study was to investigate the relation between SAH and the components of executive functions (EF), inhibitory control (IC), updating and shifting, comparing a control group (without SAH) to patients with SAH, in two levels of severity. Methods: The protocol included the following tests to evaluate EF components: T.O.V.A. Test (IC), Backward Digit Span from Wechsler Adults Intelligence Scale (WAIS-III), Phonemic and Semantic Verbal Fluency (updating), and Trail Making Test Part B (shifting). Results: A total of 204 participants was included: 56 from the Control Group (CG), 87 SAH stage 1, and 61 SAH stage 2. The groups were not different for age (52.37±12.29) and education (10.98±4.06). As to controlled blood pressure (BP), duration of hypertension treatment and number of drugs, the SAH 2 group had a worse BP control, longer duration of hypertension treatment and use of more drugs when compared to the SAH 1. The findings revealed that patients with more severe hypertension presented worse performance in updating (Backward Digit Span, phonemic and semantics VF) and shifting (Trail Making Test Part B). Conclusion: The results suggest that patients with SAH have a significant impairment in EF, more specifically in updating and shifting. Besides that, such damage may be directly proportional to the severity of SAH. It is suggested that future studies include neuroimaging exams to exclude possible cerebrovascular diseases. RESUMO Introdução: As alterações do sistema nervoso central associadas à hipertensão arterial sistêmica (HAS) são progressivas e podem ocasionar efeitos negativos no desempenho cognitivo. O objetivo deste estudo foi investigar a relação entre a HAS e os componentes das funções executivas (FE), controle inibitório (CI), atualização e alternância, comparando um grupo controle (sem HAS) a pacientes com HAS, em dois níveis de gravidade. Métodos: O protocolo incluiu os seguintes testes para avaliar os componentes das FE: T.O.V.A. Test (CI), Dígitos Ordem Indireta da Escala de Inteligência Wechsler para Adultos (Wechsler Adults Intelligence Scale - WAIS-III), Fluência Verbal fonêmica e semântica (atualização) e Teste de Trilhas parte B (alternância). Resultados: Foram incluídos 204 participantes, sendo 56 do Grupo Controle (GC), 87 HAS estágio 1 (HAS 1) e 61 de HAS estágio 2 (HAS 2). Os grupos não foram diferentes em relação à idade (52,37±12,29) e escolaridade (10,98±4,06). Em relação à pressão arterial (PA) controlada, tempo de tratamento da HAS e número de medicações, o grupo HAS 2 apresentou pior controle de PA, mais tempo de tratamento da HAS e uso de maior número de medicações quando comparado ao grupo HAS 1. Os achados revelaram que os pacientes com HAS em estágio mais grave apresentaram pior desempenho nos testes de alternância (Teste de Trilhas parte B) e atualização (Dígitos Ordem Indireta, FV fonêmica e semântica). Conclusão: Esses resultados sugerem que pacientes com a HAS possuem prejuízo significativo em FE, especificamente em alternância e atualização, e que esse prejuízo pode ser diretamente proporcional à gravidade da HAS. Sugere-se que, em estudos futuros, incluam-se exames de neuroimagem com o objetivo de excluir possíveis doenças cerebrovasculares.

Obstructive sleep apnea (OSA) is associated with multiple comorbid conditions including cardiovascular diseases and cancer. There is a growing interest in exploring biomarkers to understand the related mechanisms and improve the risk stratification of OSA. Circulating microRNAs (miRNAs) are single noncoding strands of nearly 22 nucleotides that posttranscriptionally regulate target gene expression. Our aim was to identify miRNA profiles associated with OSA. We studied 48 male subjects, mostly Caucasian (63%) and overweight, divided by polysomnography into the no OSA control group (n = 6), mild OSA group (n = 12), moderate OSA group (n = 15), and severe OSA group (n = 15). The study groups were matched for age, body mass index (BMI), and body fat composition. miRNA profiles were measured from peripheral whole blood using two steps: (1) microarray analysis comprising more than 2500 miRNAs in a subsample of 12 subjects (three from each group); and (2) validation phase using real-time quantitative polymerase chain reaction (RTqPCR). The microarray assessment identified 21 differentially expressed miRNAs among the groups. The RT-qPCR assessment showed that miR-1254 and miR-320e presented a gradual increase in expression parallel to OSA severity. Linear regression analysis showed that severe OSA was independently associated with miR-1254 (s = 68.4; EP = 29.8; p = 0.02) and miR-320e (s = 76.1; EP = 31.3; p = 0.02). Severe OSA is independently associated with miRNAs that are involved in heart failure (miR-1254), myocardial ischemia/reperfusion (miR-320e), and cell proliferation in some cancer types (miR-1254 and miR-320e). Future investigations addressing whether these miRs may provide prognostic information in OSA are needed.

The functioning of attention is complex, a primordial function in several cognitive processes and of great interest to neuropsychology. The Test of Variables of Attention (T.O.V.A) is a continuous computerized performance test that evaluates some attention components such as response time to a stimulus and errors due to inattention and impulsivity.1) To evaluate the applicability of T.O.V.A in Brazilian adults; 2) To analyze the differences in performance between genders, age ranges, and levels of education; 3) To examine the association between T.O.V.A variables and other attention and cognitive screening tests.The T.O.V.A was applied to 63 healthy adults (24 to 78 years of age) who also underwent the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Digit Span and Digit Symbol (Wechsler Intelligence Scale for Adults - WAIS-III) and the Trail Making Test.the T.O.V.A was little influenced by age or education, but was influenced by gender. The correlations between some T.O.V.A variables and the Digit Symbol and Trail Making test were weak (r-values between 0.2 and 0.4), but significant (p0.05). There was no correlation with the Digit Span test.The T.O.V.A showed good applicability and proved adequate for evaluating attentional processes in adults.O funcionamento da atenção é complexo, função primordial em diversos processos cognitivos e de grande interesse para a neuropsicologia. O Teste de Variáveis de Atenção (T.O.V.A) é um teste computadorizado de desempenho contínuo que avalia alguns componentes de atenção, como tempo de resposta a um estímulo e erros por desatenção e impulsividade.1) Avaliar a aplicabilidade do T.O.V.A em adultos brasileiros; 2) Analisar as diferenças de desempenho entre os gêneros, faixas etárias e níveis de escolaridade; 3) Examinar a associação entre as variáveis T.O.V.A e outros testes de atenção e triagem cognitiva.O TOVA foi aplicado a 63 adultos saudáveis (24 a 78 anos) submetidos ao Mini-Exame do Estado Mental (MEEM), Montreal Cognitive Assessment (MoCA), Digit Span e Digit Symbol (Wechsler Intelligence Scale for Adults – WAIS-III) e o Trail Making Test.T.O.V.A teve pouca influência da idade e escolaridade, mas foi influenciado pelo gênero. As correlações entre algumas variáveis T.O.V.A e o símbolo Digit e o teste Trail Making foram fracas (valores de r entre 0,2 e 0,4), mas significativas (p0,05). Não houve correlação com o teste Digit Span.T.O.V.A apresentou boa aplicabilidade e foi adequado para avaliar os processos de atenção em adultos.

Metabolic syndrome (MetS) causes autonomic alteration and vascular dysfunction. The authors investigated whether impaired fasting glucose (IFG) is the main cause of vascular dysfunction via elevated sympathetic tone in nondiabetic patients with MetS. Pulse wave velocity, muscle sympathetic nerve activity (MSNA), and forearm vascular resistance was measured in patients with MetS divided according to fasting glucose levels: (1) MetS+IFG (blood glucose ≥100 mg/dL) and (2) MetS-IFG (

Objective To investigate the effects of acute and chronic exercise in female patients with remissive Takayasu arteritis (TAK). Methods This was a 2-part prospective study. In study 1, cytokines and soluble tumor necrosis factor (TNF) receptors were assessed at rest and every 60 minutes during a 3-hour recovery period following an acute exercise session in TAK (n = 11) and heathy control (n = 10) groups. In study 2, a subsample from the TAK group (n = 6) underwent a 12-week exercise training program. Before and after training, the acute session of aerobic exercise was performed and cytokines and soluble TNF receptors were assessed at the same time points described above. Muscle function, strength, aerobic capacity, endothelial function, quality of life, and walking impairment scores were evaluated. Results In study 1, the acute session of aerobic exercise led to overall similar responses on cytokine kinetics in the TAK and heathy control groups. In study 2, the exercise training program did not exacerbate inflammatory cytokines in TAK patients, while the proinflammatory cytokine TNF was diminished both at rest and following the acute session of aerobic exercise. In addition, the exercise training program increased the pro-angiogenic factors vascular endothelial growth factor (at rest) and platelet-derived growth factor AA (at rest and in response to the acute session of aerobic exercise). The exercise training program improved muscle strength and function, whereas aerobic capacity, quality of life, and endothelial function parameters remained unchanged. Conclusion Exercise could be a well-tolerated, safe, and effective intervention able to induce immunomodulatory and pro-angiogenic effects and to increase strength and function in patients with TAK.

Objectives: The aim of this study was to determine if carvedilol improved structural and functional changes in the left ventricle and reduced mortality in patients with hypertensive heart disease. Methods: Blood pressure, heart rate, echocardiographic parameters, and laboratory variables, were assessed pre and post treatment with carvedilol in 98 eligible patients. Results: Carvedilol at a median dose of 50 mg/day during the treatment period in hypertensive heart disease lowered blood pressure 10/10 mmHg, heart rate 10 beats/min, improved left ventricular ejection fraction from baseline to follow-up (median: 6 years) (36%–47%)) and reduced left ventricular end-diastolic and end-systolic dimensions (62 vs 56 mm; 53 vs 42 mm, respectively, all p-values Conclusion: Carvedilol reduced cardiac dimensions and improved left ventricular ejection fraction and cardiac remodeling in patients with hypertensive heart disease. These treatment-related changes had a favorable effect on survival.

Background Evidences suggest that central hemodynamics indexes are independent predictors of future cardiovascular events and all-cause mortality. Multiple factors have been pointed to have potential influence on central aortic function: height, heart rate, left ventricular ejection duration and blood pressure level. Data related to the influence of gender and postmenopausal status on aortic waveform reflection is scarce. We aim to evaluate the impact of gender and menopause on central blood pressure of hypertensive patients. Methods In a cross sectional study 122 hypertensive patients (52 men and 70 women) were studied. Hypertension was defined as blood pressure (BP) levels ≥140/90 mmHg or use of antihypertensive drugs. Central arterial pressure, augmentation index (AIx) and augmentation index normalized to 75 bpm (AIx75) were obtained using applanation tonometry. Menopause and postmenopause history were accessed by a direct series of questions. Postmenopause was defined as at least one year since last menstruation. Patients were paired by age, gender and menopausal status, and the data were compared considering gender and menopausal status. Results Height and weight were significantly lower in women than in men at the same age. Conversely, AIx (32.7 ± 9.8% vs. 20.1 ± 11.7%, p

Flow-mediated dilation (FMD) is a marker of endothelial function and a strong independent predictor of cardiovascular events, constituting a valid prognostic tool beyond traditional cardiovascular risk factors [(1)][1]. Bariatric surgery elicits short-term improvements in FMD [(2)][2], but

Untreated obstructive sleep apnea (OSA) is common in patients with hypertension and may impair blood pressure (BP) and target-organ damage responses to antihypertensive therapy. In this study, we recruited hypertensive patients who underwent treatment with a 30-day regimen of hydrochlorothiazide 25 mg plus enalapril (20 mg BID) or losartan (50 mg BID) and were assessed with a baseline clinical evaluation, polysomnography, 24-hour ambulatory BP monitoring, and carotid-femoral pulse wave velocity. All the examinations except for polysomnography were repeated at 6 and 18 months of follow-up. We studied 94 hypertensive patients (mean age, 55±9 years). The frequency of OSA was 55%. Compared with baseline, we did not observe significant differences between groups in 24-hour BP, daytime systolic and diastolic BPs, or night-time systolic BP at 6 and 18 months. The BP control rate at 24 hours (P =0.027). There were no differences in the number and class of antihypertensive medications prescribed during follow-up. In terms of arterial stiffness, patients with OSA had higher pulse wave velocity than did patients without OSA at baseline (10.3±1.9 versus 9.2±1.7 m/s; P =0.024), but both groups had similar decreases in pulse wave velocity during follow-up. In conclusion, with combined antihypertensive treatment aimed at controlling BP, hypertensive patients with OSA had similar 24-hour BP and arterial stiffness to those without OSA.

In this chapter we describe several techniques to study endothelial function in humans. Specifically, intravascular ultrasound, peripheral arterial tonometry, and blood biomarkers are discussed and illustrated. Technical aspects, limitations, and clinical applicabilities are extensively analyzed. Finally a comparison of advantages and limitations of all methods is presented. These methods allow identification of endothelial dysfunction is several clinical conditions including atherosclerosis, arterial hypertension, and diabetes.

OBJECTIVES: Misuse of anabolic androgenic steroids in athletes is a strategy used to enhance strength and skeletal muscle hypertrophy. However, its abuse leads to an imbalance in muscle sympathetic nerve activity, increased vascular resistance, and increased blood pressure. However, the mechanisms underlying these alterations are still unknown. Therefore, we tested whether anabolic androgenic steroids could impair resting baroreflex sensitivity and cardiac sympathovagal control. In addition, we evaluate pulse wave velocity to ascertain the arterial stiffness of large vessels. METHODS: Fourteen male anabolic androgenic steroid users and 12 nonusers were studied. Heart rate, blood pressure, and respiratory rate were recorded. Baroreflex sensitivity was estimated by the sequence method, and cardiac autonomic control by analysis of the R-R interval. Pulse wave velocity was measured using a noninvasive automatic device. RESULTS: Mean spontaneous baroreflex sensitivity, baroreflex sensitivity to activation of the baroreceptors, and baroreflex sensitivity to deactivation of the baroreceptors were significantly lower in users than in nonusers. In the spectral analysis of heart rate variability, high frequency activity was lower, while low frequency activity was higher in users than in nonusers. Moreover, the sympathovagal balance was higher in users. Users showed higher pulse wave velocity than nonusers showing arterial stiffness of large vessels. Single linear regression analysis showed significant correlations between mean blood pressure and baroreflex sensitivity and pulse wave velocity. CONCLUSIONS: Our results provide evidence for lower baroreflex sensitivity and sympathovagal imbalance in anabolic androgenic steroid users. Moreover, anabolic androgenic steroid users showed arterial stiffness. Together, these alterations might be the mechanisms triggering the increased blood pressure in this population.

Background. Patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (DM) have increased risk of endothelial dysfunction, cardiovascular disease, and mortality. Several studies have separately analyzed endothelial function in these populations. However, data of patients with both CKD and DM are scarce. The aim of this study was to evaluate whether the presence of DM has any additional effect on the endothelial dysfunction of CKD patients.Methods. We measured endothelial progenitor cells (EPCs), stromal-derived factor 1 alpha (SDF-1α), serum and urinary nitric oxide (NO), flow-mediated dilation (FMD), and pulse wave velocity (PWV) in 37 CKD patients with DM (CKD-DM group) and in 37 without DM (CKD group).Results. CKD-DM group had a higher prevalence of obesity (P<0.01), previous myocardial infarction (P=0.02), myocardial revascularization (P=0.04), and a trend for more peripheral artery disease (P=0.07). Additionally, CKD-DM group had higher EPC (P=0.001) and PWV (P<0.001) values. On the other hand, no difference in SDF-1αand serum or urinary NO and FMD was observed between the groups.Conclusions. Endothelial dysfunction is frequent in CKD patients, and an additive effect of diabetes cannot be implicated, suggesting the predominant role of uremia in this condition.

Background: Androgens act directly on the vasculature through your connection to the androgen receptor in the vascular wall, and can promote changes in structural and functional vascular properties. Objective: To evaluate the structural and functional properties of large arteries in TF in prolonged use of testosterone esters and compare them with those of a control group men and women. Patients and methods: 42 patients with diagnosis of TF (42±10 years) in treatment with testosterone esters for at least 1 year (1–38 years) and 147 healthy controls matched for age and BMI were submitted to evaluation of carotid parameters by radiofrequency ultrasound (WTS®): intima media thickness (IMT), diameter and relative distension. The carotid-femoral pulse wave velocity (PWVcf) was measured by Complior® device. Results: The TF showed higher (p < 0.01) PWVcf (7.2±0.8 m/s) than the male controls (6.6±0.9 m/s), but not than female controls (7±1 m/s). When categorized by age, considering median values of age, TF≥42 years showed higher PWVcf than male and female controls, independently of BP values. There is no diferences in carotid parameters between TF and control groups, but obese TF presented higher carotid diameter (6944±527 vs. 6438±555 μm and IMT (691±72 vs. 601±126 μm), and lower carotid distension (4,8±1,5 vs. 6,5±2,1%) than lean TF. The PWVcf was significantly correlated to age (r = 0.63), time of androgenic treatment (r = 0.37) and waist-hip ratio (0.39) in TF. Conclusion: Older TF subjects and TF with prolonged treatment had higher aortic stiffness. Obese TF presented worst carotid structural and functional markers

Background: Changes in the properties of large arteries correlate with higher cardiovascular risk. Recent guidelines have included the assessment of those properties to detect subclinical disease. Establishing reference values for the assessment methods as well as determinants of the arterial parameters and their correlations in healthy individuals is important to stratify patients. Objective: To assess, in healthy adults, the distribution of the values of pulse wave velocity, diameter, intima-media thickness and relative distensibility of the carotid artery, in addition to assessing the demographic and clinical determinants of those parameters and their correlations. Methods: This study evaluated 210 individuals (54% women; mean age, 44 ± 13 years) with no evidence of cardiovascular disease. The carotid-femoral pulse wave velocity was measured with a Complior® device. The functional and structural properties of the carotid artery were assessed by using radiofrequency ultrasound. Results: The means of the following parameters were: pulse wave velocity, 8.7 ± 1.5 m/s; diameter, 6,707.9 ± 861.6 μm; intima-media thickness, 601 ± 131 μm; relative distensibility, 5.3 ± 2.1%. No significant difference related to sex or ethnicity was observed. On multiple linear logistic regression, the factors independently related to the vascular parameters were: pulse wave velocity, to age (p < 0.01) and triglycerides (p = 0.02); intima-media thickness, to age (p < 0.01); diameter, to creatinine (p = 0.03) and age (p = 0.02); relative distensibility, to age (p < 0.01) and systolic and diastolic blood pressures (p = 0.02 and p = 0.01, respectively). Pulse wave velocity showed a positive correlation with intima media thickness (p < 0.01) and with relative distensibility (p < 0.01), while diameter showed a positive correlation with distensibility (p = 0.03). Conclusion: In healthy individuals, age was the major factor related to aortic stiffness, while age and diastolic blood pressure related to the carotid functional measure. The carotid artery structure was directly related to aortic stiffness, which was inversely related to the carotid artery functional property.

Background Metabolic syndrome (MetS) is associated with structural and functional vascular abnormalities, which may lead to increased arterial stiffness, more frequent cardiovascular events and higher mortality. However, the role played by clustering of risk factors and the combining pattern of MetS risk factors and their association with the arterial stiffness have yet to be fully understood. Age, hypertension and diabetes mellitus seem to be strongly associated with increased pulse wave velocity (PWV). This study aimed at determining the clustering and combining pattern of MetS risk factors and their association with the arterial stiffness in non-diabetic and non-hypertensive patients. Methods Recently diagnosed and untreated patients with MetS (n = 64, 49 ± 8 year, 32 ± 4 kg/m2) were selected, according to ATP III criteria and compared to a control group (Control, n = 17, 49 ± 6 year, 27 ± 2 kg/m2). Arterial stiffness was evaluated by PWV in the carotid-femoral segment. Patients were categorized and analyzed according MetS risk factors clustering (3, 4 and 5 factors) and its combinations. Results Patients with MetS had increased PWV when compared to Control (7.8 ± 1.1 vs. 7.0 ± 0.5 m/s, p

Background: Evidences suggest that central hemodynamics indexes are independent predictors of future cardiovascular events and all-cause mortality. Multiple factors have been pointed to have potential influence on central aortic function: height, heart rate, left ventricular ejection duration and blood pressure level. Data related to the influence of gender and postmenopausal status on aortic wave form reflection is scarce. Methods: In a cross sectional study, 122 hypertensive patients (52 men and 70 women) were studied. Hypertension was defined as blood pressure (BP) levels ≥140/90 mmHg or use of antihypertensive drugs. Central arterial pressure, augmentation index (AIx) and augmentation index normalized to 75bpm (Alx75) were obtained using applanation tonometry. Menopause and postmenopause history were accessed by a direct questionnaire. Postmenopause was defined as at least one year since last menstruation. Patients were paired by age, gender and menopausal status and 4 groups were compared: group 1 (young men, ≤ 48y), group 2 (young women, ≤4 8y), group 3 (older men, > 48y) and group 4 (older women, > 48y). Results: Height and weight were significantly lower in women than in men at the same age. Conversely, Alx (32.7±9.8% vs. 20.1±11.7%, p Conclusion: Women patients had both higher reflected aortic pressure wave form and central blood pressure indexes and these findings were worsened by the menopausal status.

Background: Cognitive impairment and elevated arterial stiffness are described in patients with arterial hypertension(AH), but its correlations are not well studied. Objectives: To study the cognitive function at different domains and arterial properties in patients with AH stage 1 to 3 compared to normotensives and to evaluate the correlations between these variables. Methods: We evaluated 221 subjects, 71 normotensives (52±14yrs,47%male,65%white) and 150 patients with stage 1-3 AH (52±12yrs,45%male,70%white) under treatment. The global cognitive function was assessed by Mini Mental State Examination(MMSE) and Montreal Cognitive Assessment(MoCA). There was done a validated comprehensive battery of neuropsychological tests(NPE) assessed the following main cognitive areas: memory, language, visuospatial ability, executive function, attention. Pulse wave velocity(PWV) was measured by Complior® device. Carotid properties were assessed by radiofrequency ultrasound(WTS®). Central arterial pressure and augmentation index (AIx) were obtained using applanation tonometry(Sphygmocor®). Results: Mean BP of the normotensive group (122.1±8/76.7±7mmHg) was significantly lower than hypertensive patients (135.2±13/83.3±10 and 149.9±29/91.5±16mmHg). Severe HTN group had worse performance in cognitive evaluation either by MMSE (26.8±2.1 vs 27.4±2.1 vs. 28.0±2.0, p=0.004) or MoCA test (23.4±3.7 vs. 24.9±2.8 vs. 25.5±3.2, p Conclusions: Cognitive impairment at different domains was more frequent in patients with different stages of AH. Arterial functional and structural properties were diversely associated with cognitive performance at different domains

Cognitive impairment and elevated arterial stiffness have been described in patients with arterial hypertension, but their association has not been well studied. We evaluated the correlation of arterial stiffness and different cognitive domains in patients with hypertension compared with those with normotension. We evaluated 211 patients (69 with normotension and 142 with hypertension). Patients were age matched and distributed according to their blood pressure: normotension, hypertension stage 1, and hypertension stage 2. Cognitive function was assessed using the Mini-Mental State Examination, Montreal Cognitive Assessment, and a battery of neuropsychological evaluations that assessed six main cognitive domains. Pulse wave velocity was measured using a Complior device, and carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. The hypertension stage 2 group had higher arterial stiffness and worse performance either by Mini-Mental State Examination (26.8±2.1 vs 27.3±2.1 vs 28.0±2.0, P=.003) or the Montreal Cognitive Assessment test (23.4±3.5 vs 24.9±2.9 vs 25.6±3.0, P

Aging, hypertension (HTN), and other cardiovascular risk factors contribute to structural and functional changes of the arterial wall. Objective: To evaluate whether arterial stiffness (AS) is related to cerebral blood flow changes and its association with cognitive function in patients with hypertension. Methods: 211 patients (69 normotensive and 142 hypertensive) were included. Patients with hypertension were divided into 2 stages: HTN stage-1 and HTN stage-2. The mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA) and a battery of neuropsychological (NPE) tests were used to determine cognitive function. Pulse wave velocity was measured using the Complior®. Carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. Middle cerebral artery flow velocity was measured by transcranial Doppler ultrasonography. Results: Both arterial stiffness parameters and cerebral vasoreactivity worsened in line with HTN severity. There was a negative correlation between breath holding index (BHI) and arterial stiffness parameters. Cognitive performance worsened in line with HTN severity, with statistical difference occurring mainly between the HTN-2 and normotension groups on both the MMSE and MoCA. The same tendency was observed on the NPE tests. Conclusion: Hypertension severity was associated with higher AS, worse BHI, and lower cognitive performance. RESUMO. A idade, hipertensão arterial (HA), e outros fatores de risco cardiovascular contribuem para as alterações estruturais e funcionais da parede arterial. Objetivo: Avaliar o quanto a rigidez arterial está relacionada com as alterações do fluxo sanguíneo cerebral e sua associação com a função cognitiva em pacientes com hipertensão. Métodos: Foram incluídos 211 pacientes (69 normotensos e 142 hipertensos). Os pacientes com hipertensão foram divididos em dois estágios: HA-1 e HA-2. O mini exame do estado mental (MEEM), Montreal Cognitive Assessment (MoCA) e uma bateria de testes neuropsicológicos foram usados para avaliar a função cognitiva. A velocidade da onda de pulso foi medida usando o Complior®. As propriedades da artéria carótida foram avaliadas usando o ultrassom de radiofrequência. A pressão arterial central e o índice de incremento foram obtidos usando a tonometria de aplanação. A velocidade de fluxo sanguíneo da arterial cerebral média foi medida pelo ultrassom com Doppler Transcraniano. Resultados: Tanto os parâmetros da rigidez arterial quanto a vasorreatividade cerebral foram piores com a gravidade da hipertensão. Houve uma correlação negativa entre o índice de apnéia e os parâmetros da rigidez arterial. O desempenho cognitivo foi pior com a gravidade de hipertensão arterial com diferença estatística ocorrendo principalmente entre os grupos HA-2 e normotensão tanto no MEEM quanto no MoCA. A mesma tendência foi observada em relação aos testes neuropsicológicos. Conclusão: A gravidade de hipertensão arterial foi associada com maior rigidez arterial, pior índice de apneia, e menor desempenho cognitivo.

Background Most evidence of target‐organ damage in hypertension ( HTN ) is related to the kidneys and heart. Cerebrovascular and cognitive impairment are less well studied. Therefore, this study analyzed changes in cognitive function in patients with different stages of hypertension compared to nonhypertensive controls. Methods and Results In a cross‐sectional study, 221 (71 normotensive and 150 hypertensive) patients were compared. Patients with hypertension were divided into 2 stages according to blood pressure ( BP ) levels or medication use ( HTN ‐1: BP, 140–159/90–99 or use of 1 or 2 antihypertensive drugs; HTN ‐2: BP, ≥160/100 or use of ≥3 drugs). Three groups were comparatively analyzed: normotension, HTN stage 1, and HTN stage 2. The Mini–Mental State Examination, Montreal Cognitive Assessment, and a validated comprehensive battery of neuropsychological tests that assessed 6 main cognitive domains were used to determine cognitive function. Compared to the normotension and HTN stage‐1, the severe HTN group had worse cognitive performance based on Mini–Mental State Examination (26.8±2.1 vs 27.4±2.1 vs 28.0±2.0; P =0.004) or Montreal Cognitive Assessment (23.4±3.7 vs 24.9±2.8 vs 25.5±3.2; P Conclusions Cognitive impairment was more frequent in patients with hypertension, and this was related to hypertension severity.

Whether sex influences the association of obstructive sleep apnea (OSA) with markers of cardiovascular risk in patients with hypertension is unknown. In this study, 95 hypertensive participants underwent carotid-femoral pulse wave velocity, 24-hour ambulatory blood pressure monitoring, echocardiogram, and polysomnography after a 30-day standardized treatment with hydrochlorothiazide plus enalapril or losartan. OSA was present in 52 patients. Compared with non-OSA patients, pulse wave velocity values were higher in the OSA group (men: 11.1±2.2 vs 12.7±2.4 m/s, P=.04; women: 11.8±2.4 vs 13.2±2.2 m/s, P=.03). The proportion of diastolic dysfunction was significant in men and women with OSA. Compared with non-OSA patients, nondipping systolic blood pressure in OSA was higher in men (14.3% vs 46.4%) and in women (41.4% vs 65.2%). OSA was independently associated with pulse wave velocity (β=1.050; P=.025) and nondipping systolic blood pressure (odds ratio, 3.03; 95% confidence interval, 1.08-8.55; P=.035) in the regression analysis. In conclusion, OSA is independently associated with arterial stiffness and nondipping blood pressure in patients with hypertension regardless of sex.

Left ventricle remodeling is a common consequence of uncontrolled hypertension. Hypertension treatment including renin-angiotensin-aldosterone system inhibition and beta-blockers offers cardiac protection. Carvedilol uses in cardiomyopathy from different etiology have shown good results in left ventricle reverse remodeling. There is a lack of information regarding carvedilol use in hypertensive cardiomyopathy. The main objective in this study was to evaluate the use of carvedilol in hypertensive patients with reduced left ventricle ejection fraction. We evaluate 98 subjects with reduced left ventricle ejection fraction (55 years age, 59 males, 64 white, 34 nonwhite) before and after at least six months of carvedilol use. Clinical data, laboratory tests, and echocardiogram were evaluated at least 6 months before and after carvedilol was added to the treatment. Other causes of cardiomyopathy, including coronary artery disease, were excluded. A hundred percent of patients was taking diuretic and renin-angiotensin-aldosterone system inhibitors. Twenty eight percent were using statins, 19% were using antidiabetic drugs, and 29% were taking digoxin. Blood pressure and heart rate (144/92 mmHg, 84 bpm) decreased significantly after (130/82 mmHg, 70 bpm) carvedilol treatment. Ejection fraction improved in 68.5% patients. Let ventricle diastolic diameter decreased from 62 to 56 mm, left ventricle systolic diameter decreased from 53 to 42 mm, left ventricle mass index decreased from 145 to 129 g/m 2 , left ventricle relative posterior wall increased from 0.32 to 0.36. Carvedilol, in addition to antihypertensive drugs, showed improvement in hemodynamic parameters, and in echocardiographic structural and functional parameters in hypertensive cardiomyopathy patients.

Introduction: In general population women seems to have greater arterial stiffness and central blood pressure(BP), measured by augmentation index (AIx), than men, but in hypertension this condition is poorly studied. Objectives: To evaluate differences of central BP and arterial stiffness between men and women with arterial hypertension and the influence of postmenopausal status. Methods: We studied 128 subjects with stage 1–3 arterial hypertension, mean age 51.1±11 years, 48% males, BP = 141±24/87±13 mmHg, hypertension duration 10.1±8 years. Noninvasive central aortic BP and wave form characteristics (Alx and AIx corrected by heart rate of 75 bpm – Alx75) were synthesized from radial arterial pressure waves (applanation tonometry) by SphygmoCor®. Brachial BP was obtained by an automatic device(OMRON®). Results: Brachial systolic BP was higher (145±26 vs. 136±20 mmHg, p=0.04) and, weight (76.2±14 vs. 86.4±13.2, p

Introduction: In men with hypertension, obstructive sleep apnea (OSA) is associated with increased arterial stiffness. However, it is not clear if the impact of OSA on patients with hypertension is similar in women. Methods: We recruited consecutive patients with established diagnosis of hypertension under a standardized antihypertensive treatment (hydrochlorothiazide plus enalapril or losartan). All patients were submitted to full polysomnography and carotid-femoral pulse wave velocity (PWV). We performed analysis according to the presence of OSA (defined by an apnea-hypopnea index ≥15 events/hour of sleep) and by gender (male and females). Results: Ninety-five patients were studied (14males without OSA; 28 males with OSA, 29 females without OSA and 24 females with OSA). OSA frequency was 66% in males group versus 45% in females group (p=0.02). The age of female with OSA (59±10yrs) was significantly higher than female without OSA(52±10yrs), while the age did not differ between the male with(58±10yrs) or without OSA(56±8yrs). The BMI was also significantly greater in female with OSA (32.8±5 vs. 28.7±5kg/m2), while was similar in male with(30.5±4.5) or without OSA(29.5±2.5). The blood pressure was not different in the patients with or without OSA. PWV was significantly higher in both male(12.7m/s) and female(13.2m/s) with OSA than the couterparts without OSA(male-11 m/s, female-11.7 m/s) even after adjustments by age. The multivariate linear regression showed that OSA was independently associated with PWV(p=0.008). Conclusions: In patients with hypertension, the presence of OSA is associated with higher PWV regardless of gender.

Objective: To evaluate the determinants of the peripherial wave reflection measured by the second derivative of the fingertip photoplethysmogram (SDPTG) among known cardiovascular (CV) risk factors in a large treated hypertensive population. Population and Methods: We studied prospectively 316 hypertensive patients under treatment (154 male, mean age 54 yrs) by SDPTG automatically recorded from the second digit of the right hand (Fukuda FCP-3166®). The SDPTG waveform consisted of a, b, c and d waves in systole and e wave in diastole. The heights of the a, b and d waves were measured from the baseline, and d/a and b/a ratio were calculated. Augmentation index (AUI) was defined as the ratio of the height of the late systolic peak to that of the early systolic peak; SDPTG aging index (AGI) was calculated as (b-c-d-e)/a. The CV risk factors analized were systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), left ventricule mass index (LVMI), creatinine, glycemia, cholesterol, triglycerides and body mass index (BMI). Results: In the multivariate analysis the most signicative associations were: AGI: age (+, p

Background: Evidences suggest that central hemodynamics indexes are independent predictors of future cardiovascular events and all-cause mortality. Multiple factors have been pointed to have potential influence on central aortic function: height, heart rate, left ventricular ejection duration and blood pressure level. Data related to the influence of gender and postmenopausal status on aortic wave form reflection is scarce. Methods: In a cross sectional study 122 hypertensive patients (52 men and 70 women) were studied. Hypertension was defined as blood pressure (BP) levels ≥140/90 mmHg or use of antihypertensive drugs. Central arterial pressure, augmentation index (AIx) and augmentation index normalized to 75bpm (Alx75) were obtained using applanation tonometry. Menopause and postmenopause history were accessed by a direct questionnaire. Postmenopause was defined as at least one year since last menstruation. Patients were paired by age, gender and menopausal status and 4 groups were compared: group 1 (young men, ≤48y), group 2 (young women, ≤48y), group 3 (older men, >48y) and group 4 (older women, >48y). Results: Height and weight were significantly lower in women than in men at the same age. Conversely, Alx (32.7±9.8% vs. 20.1±11.7%, p < 0.01), Alx75 (29.6±6.7% vs. 18.3±9.4%, p < 0.01) and central systolic blood pressure (136±30 vs. 125±23 mmHg, p = 0.03) were higher in women than men. The menopausal women had the worst indexes of aortic wave reflection. Conclusion: Women patients had both higher reflected aortic pressure wave form and central blood pressure indexes and these findings were worsened by the menopausal status.

Hypertension is the cause of thousands of deaths annually1, and half of the patients treated present controlled blood pressure (BP)2. Resistant hypertension (RH)is defined when the BP remains above the recommended targets with the use of three antihypertensive drugs with synergistic actions at maximum doses recommended and tolerated, preferably one being a diuretic, or when in use of four or more anti-hypertensive drugs, even with controlled BP3. It is estimated that 12%-15% of persons with hypertension are considered resistant, with high risk of cardiovascular morbidity and mortality4. The pathogenesis of hypertension is multifactorial, but the sympathetic activity plays an important role, especially in patients with resistant hypertension2. Efferent renal sympathetic activity stimulates renin release, increases sodium reabsorption and reduces renal blood flow and may be a mechanism for the development and maintenance of hypertension2. Genetic, behavioral and environmental factors influence increased sympathetic activity in persons with hypertension5. New therapies aiming to reduce sympathetic activity have been developed. Renal Sympathetic Denervation (RSD) by radiofrequency catheter ablation of renal arteries has been shown to control BP in resistant hypertension6,7 and in associated clinical conditions such as sleep destructive apnea8 and insulin resistance9. The main RSD clinical studies used a specific catheter not yet available in Brazil, but the radiofrequency ablation of arrhythmias is a procedure that has been performed by electrophysiologists through appropriate catheters for years in our country. Experimental studies of RSD with catheters used for ablation of arrhythmias indicated the possibility of using these to replace those used in international studies, considering the unavailability of those in our reality. Based on this, for the procedure to be reported, the model used for ablation in children (4 mm tip and 5F), which was proven to be more appropriate, was chosen. The objective of the report is to show the result of the first RSD in our community, with the aid of technology used in cardiac arrhythmias.

In hypertensive patients with indication of renal arteriography to investigate renal artery stenosis (RAS) there are no recommendations regarding when to investigate coronary artery disease (CAD). Moreover, the predictors of CAD in patients with RAS are not clear. We aimed to evaluate the frequency and the determinants of CAD in hypertensive patients referred to renal angiography. Eighty-two consecutive patients with high clinical risk suggesting the presence of RAS systematically underwent renal angiography and coronary angiography during the same procedure. Significant arterial stenosis was defined by an obstruction ≥ 70% to both renal and coronary territories. Significant CAD was present in 32/82 (39%) and significant RAS in 32/82 (39%) patients. Both CAD and RAS were present in 25.6% from the 82 patients. Patients with severe CAD were older (63 ± 12 vs. 56 ± 13 years; p = 0.03) and had more angina (41 vs. 16%; p = 0.013) compared to patients without severe CAD. Significant RAS was associated with an increased frequency of severe CAD compared to patients without significant RAS (66% vs. 22%, respectively; p