Sebastião Rodrigues Ferreira-Filho

Systemic hemodynamic changes in elderly hypertensive patients after ingesting foods with lipid, protein, and carbohydrate contents.

Aging is associated with changes in cardiovascular structure and function, which predisposes elderly people to reduced blood pressure levels after meals. The authors studied cardiac systolic function in elderly hypertensive patients after eating meals with different contents of lipids, proteins, and carbohydrates. Ten elderly male hypertensive patients were studied (mean age, 69 years; range 60–80 years). No patients had a previous history of orthostatic or postprandial hypotension. Patients ate 1 of 3 pre‐prepared meals: lipid meal (LM), protein meal (PM), or carbohydrate meal (CM), on different days. Mean arterial pressure, total peripheral resistance index (TPRi), cardiac index (CI), and stroke index were recorded at the end of the fasting period and then at 5, 15, 30, 45, and 60 minutes after food ingestion. After ingestion of a CM, the CI increased from 2.30±0.21 L/min/m2 to 2.61±0.24 L/min/m2 and the TPRi decreased from 3212±226 dynes/sec2 to 2793±255 dynes/sec2 at 45 minutes (P<.05). After the LM, the CI increased from 2.15±0.15 to 2.84±0.27 L/min/m2 and the TPRi decreased from 3630±274 L/min/m2 to 2666±282 dynes/sec2 at 45 minutes (P<.05). After the PM, no systemic hemodynamic changes were observed. When all 3 meals were compared, the highest values of CI and the lowest values of TPRi were observed for the LM and CM. The authors’ results show that fat‐ and carbohydrate‐rich foods cause changes in the systemic hemodynamic of the elderly hypertensive patients.

Relative and absolute changes in urinary neutrophil gelatinase-associated lipocalin and correlation with small increases in serum creatinine levels after coronary angiography: an observational study.

Introduction/Aims: The Acute Kidney Injury Network classification is based on small increases in serum creatinine (sCr) for stage 1. This study investigated whether changes in the urinary concentration of neutrophil gelatinase-associated lipocalin (uNGAL) could predict small increases in sCr in patients undergoing coronary angiography. Methods: The uNGAL was measured before contrast infusion and 2 and 4 h afterwards. Patients were divided into 2 subgroups: G1 (n = 103), where sCr increased by <0.3 mg/dl, and G2 (n = 22), where sCr increased by ≥0.3 mg/dl 48 h after the angiography. To determine the sensitivity and specificity for the absolute and relative variations of uNGAL, a receiver operating characteristic curve analysis was performed. Results: In G2, the uNGAL concentration increased over baseline values (15.9 vs. 9.2 ng/dl; p < 0.05), and it was also 2-fold higher in G2 versus G1 (15.9 vs. 8.0 ng/dl; p < 0.001). The uNGAL remains an independent predictor of the small increases in sCr, and, for an increase of 50% over baseline levels, it showed 60% sensitivity and 81% specificity. Conclusion: Changes in uNGAL concentration 2 h after the infusion of contrast media showed marginal sensitivity to predict small increases in sCr.

Body Mass Index-Mortality Paradox in Hemodialysis: Can It Be Explained by Blood Pressure?

To the Editor: The recent article by Agarwal,1 which described an investigation of the association of the prevalence and control of blood pressure with obesity, concluded that leaner patients on dialysis had a higher prevalence of hypertension, poorer control of hypertension, a greater left ventricular mass index, and greater evidence of excess extracellular fluid volume. …

Arterial stiffness in elderly patients with normotension and hypertension in Brazil

Data on arterial stiffness in older populations, according to blood pressure (BP) levels, are scarce in Brazil. The objective of this study was to establish reference values for core measures of arterial stiffness, including carotid‐femoral pulse wave velocity (cf‐PWV) and aortic augmentation index (AIx), in a cohort of older individuals with normotension (NT) and hypertension. Cross‐sectional analysis was performed with applanation tonometry data from 1192 patients aged 60 years or older. The authors classified patients according to their BP levels as having NT, controlled hypertension (CH), and uncontrolled hypertension (UH). The cf‐PWV values were 9.11 ± 0.16 m/s (NT), 9.12 ± 0.18 m/s (CH), and 9.42 ± 2.2 m/s (UH) (P < 0.005; UH vs NT and CH). The AIx was 33.3% for the entire cohort and similar across all groups. The cf‐PWV increased with age but reached a ceiling at 75 years. Compared with men, women had a higher AIx but similar cf‐PWV levels. In conclusion, the markers of arterial stiffness were similar among individuals with NT/CH and higher among individuals with UH.

Blood pressure variability in the elderly. Association between postprandial and sleeping periods

INTRODUCTION The variability of arterial blood pressure (BP) is considered an important cardiovascular risk factor. OBJECTIVE To verify the possible associations between the postprandial and the sleeping blood pressure variability. METHODS This study evaluated systolic, diastolic, mean, pulse pressures and heart variability in 69 elderly patients in preprandial, postprandial and sleeping periods. One 24 hours ambulatory blood pressure monitoring was used for measurements and the results were showed in the time-rate index. RESULTS We observed a decrease in the systolic blood pressure values from preprandial to postprandial and to the sleeping periods (124.7 ± 14.6, 113.2 ± 15.3 and 108.5 ± 13.9mmHg, respectively; p = 0.003). Associations between BP variability of the postprandial and sleeping periods were obtained for systolic, diastolic and mean arterial pressure. CONCLUSION The correlation between postprandial and sleeping BP variability has rarely been demonstrated in the literature. These correlations between BP changes after eating and during sleep might suggest that both events could coexist in other clinical situations.

A Specific Angiographic View of Left Coronary Artery Bifurcation in the Left Main Percutaneous Coronary Intervention Era

OBJECTIVES We propose a right lateral (90-120° RAO) with 30° cranial angiographic view to expose the bifurcation of the left main coronary artery (LMCA) when previously used routine projections were inefficient at clearly showing this region. BACKGROUND Little has been published in the medical literature regarding angiographic projections dedicated to special anatomies. METHODS A total of 84 patients were subjected to the proposed projections. A reproducibility study, conducted with the participation of 2 independent observers, judged the effectiveness of the proposed projection. The Prevalence and Bias Adjusted Kappa (PABAK) index, with a 95% confidence interval (CI), was used to demonstrate the intensity of intra/inter-observer agreement. RESULTS The proposed projection was efficient in 79% of the angiograms, with agreement of 0.76 (0.6-0.9; P ≤ 0.001). The origins and the proximal segments of: the anterior descending coronary artery were exposed in 89% of the angiograms, agreement of 0.86 (0.7-1.0; P ≤ 0.001); the circumflex artery were exposed in 83% of the angiograms, with agreement of 0.72 (0.5-1.0; P ≤ 0.001); and the intermediate branch, when present, were exposed in 89% of the angiograms, agreement of 0.79 (0.6-1.0; P ≤ 0.001). CONCLUSION The right lateral (90-120° RAO) with 30° cranial projection is effective, safe, and reproducible. In special situations where routine projections fail, this proposed projection can reveal important details of the anatomy of the bifurcation of the LMCA during conventional coronary angiography or be the working projection during coronary angioplasty. (J Interven Cardiol 2016;29:293-299).

PS 08-77 AGREEMENT AMONG SEQUENTIAL CAROTID-FEMORAL PULSE WAVE VELOCITY (CF-PWV) MEASUREMENTS IN ELDERLY HYPERTENSIVE PATIENTS(*)

Objective: Measurement of cf-PWV using aplanation tonometry requires that patients remain in the supine position for a considerable amount of time to allow multiple measurements that can be averaged. This may pose a problem to elderly patients with difficulty lying supine for prolonged periods. We assessed the agreement among repeated sequential cf-PWV measurements to evaluate the necessity of more than one measurement in clinical practice. Design and Method: We performed cf-PWV in 3 sequential measurements made by the same trained observer in 38 elderly hypertensive patients using the SphygmoCor device (AtCor Medical, Sydney, Australia). Subjects were in the supine position for at least 10 minutes and we performed cf-PWV measurements in 10-minute intervals. Results: Subjects averaged 67± 5.8 years, with average BP 131/75 ± 21/11 mmHg, heart rate 72 ± 11 bpm., and cf-PWV 7.8 ± 2.0 m/s. Three successful measurements were obtained in all subjects. We quantified the limits of agreement among measurements using Bland-Altman plots. The average difference (SD) was 0.09 (1.98) m/s, 0.14 (2.01) m/s and 0.06 (1.98) m/s between the first and second, first and third, and second and third measurements, respectively. Therefore, the 95% limits of agreement were 3.88 m/s, 3.94 m/s and 3.88 m/s, respectively. The range of measurements within individual subjects was 0.39 m/s (range 0 to 1.7 m/s). Only 3 subjects had a range of variation >1 m/s, and 26 subjects had a range < 0.5 m/s. Lin concordance coefficients for the 38 sets of triplicate measurements (114 comparisons) was 0.978 (95% limits 0.968–0.985), indicating “substantial” agreement among measurements (figure). Conclusions: Sequential measurements of cf-PWV showed almost perfect agreement (arbitrarily defined when Lins coefficient is > 0.99) and most measurements were within 0.5–1 m/s of each other. We conclude that a single measurement of cf-PWV provides enough precision in elderly hypertensive patients. This has particular relevance to the practicability of its implementation in clinical practice. *: supported by FAPEMIG

Renal handling of uric acid after kidney donation: a concern for further study

There are many published papers ensuring that kidney donation is a safe procedure. The follow-up studies have focused mainly on glomerular filtration (GFR) and the incidence of proteinuria before and after nephrectomy (Nx). However, the kidney has other functions, such as the excretion of uric acid (Uac), that have been systematically ignored by researchers when analyzing the functionality of the remaining kidney among donors. This avoidance is worrisome because other studies conducted in non-kidney donors revealed that changes in the Uac can be responsible for renal parenchymal lesions (1, 2). Studies evaluating changes in serum uric acid after kidney donation are scarce, and no reports that assess the renal excretion of this organic compound exist. We evaluated 21 kidney donors with average 57 months post-Nx (range: 4–134 months). The serum Uac increased from a baseline value of 4.2 1.1 mg% to 5.4 1.6 mg% post-Nx (p < 0.0001), but five of the 21 donors (24%) presented serum Uac values higher than 6.0 mg% after Nx. We also measured the urinary Uac/creatinine ratio in the urine (Uac/cr) collected over 24 h in all donors post-donation, and the average value was 0.36 0.10 mg/mg. Consequently, we separated the donors with a urinary Uac/cr ratio > 0.36 and those with a value ≤0.36 mg/mg after the donation and verified the clinical and laboratory findings of the individuals in each group (Table 1). Interestingly, the donors who were obese (BMI > 30 kg/m) presented the lowest excretion of uric acid and plasma triglyceride levels higher than those of the leaner donors. In the group with a urinary Uac/cr ratio < 0.36 mg/mg, we found 5 of 12 (42%) with a serum Uac level higher than 6.0 mg%. It is possible that the expected increase in the elimination of Uac by the remaining kidney is unable to occur, and in certain situations, the