Sergio Emanuel Kaiser

Antihypertensive Treatment Improves Microvascular Rarefaction and Reactivity in Low-Risk Hypertensive Individuals

To test whether long‐term antihypertensive treatment with metoprolol succinate (a β1‐adrenoceptor blocker) or olmesartan medoxomil (an angiotensin II AT1‐receptor blocker) reverses microvascular dysfunction in hypertensive patients.

The effects of moderate energy restriction on apnoea severity and CVD risk factors in obese patients with obstructive sleep apnoea.

Nutritional intervention for weight loss is one of the treatment options for obstructive sleep apnoea (OSA) in patients with overweight or obesity. However, the effects of moderate energy restriction on OSA severity are not yet known. The present study aimed to evaluate the effects of moderate energy restriction on OSA severity and CVD risk factors in obese patients with OSA. In this 16-week randomised clinical trial, twenty-one obese subjects aged 20-55 years and presenting an apnoea/hypopnoea index (AHI)≥5 events/h were randomised into two groups: the energy restriction group (ERG) and the control group (CG). The ERG was instructed to follow an energy-restricted diet -3347·2 kJ/d (-800 kcal/d) and the CG was advised not to change their food intake. At the beginning and at the end of the study, participants underwent evaluation of the following: OSA (Watch-PAT200®), nutritional parameters, blood pressure, sympathetic activity, inflammatory biomarkers, metabolic profile and endothelial function. The ERG (n 11), compared with the CG (n 10), had a significantly greater reduction in body weight (Cohens d=-1·19; P<0·001), in AHI (Cohens d=-0·95; P=0·04) and in plasma concentrations of adrenaline (Cohens d=-1·02; P=0·04) as well as a significantly greater increase in minimum O2 saturation (Cohens d=1·08; P=0·03). Although energy restriction was not associated with significant improvements in CVD risk factors, medium-to-large effect sizes were observed, suggesting that the statistically non-significant difference between groups may be due to the small sample size. This study suggests that in obese patients with OSA, moderate energy restriction is able to reduce the parameters of OSA severity and sympathetic activity.

Obstructive sleep apnea in non-dialyzed chronic kidney disease patients: Association with body adiposity and sarcopenia

OBJECTIVES Obstructive sleep apnea (OSA) is a risk factor for cardiovascular disease (CVD), the main cause of mortality in chronic kidney disease (CKD). Although the prevalence of OSA in patients with CKD has not been established, a few studies suggest that it is higher than in the general population, potentially increasing the risk for CVD. Obesity increases the risk, whereas sarcopenia has been suggested as a consequence of OSA in the general population. To our knowledge, these associations have not been adequately evaluated in patients with CKD. The aim of this study was to evaluate OSA frequency and its association with total and upper body adiposity and sarcopenia in non-dialyzed CKD patients. METHODS This cross-sectional study included 73 patients with stages 3b-4 CKD (42 men, 62.9 ± 1.1 y of age). Glomerular filtration rate was estimated by the CKD-Epidemiology Collaboration equation. Patients were assessed for OSA by Watch-PAT200 (apnea-hypopnea index ≥5 events hourly; Itamar Medical), total body adiposity by dual-energy x-ray absorptiometry (DXA) and body mass index (BMI), upper body adiposity by anthropometric parameters and by trunk and visceral fat by DXA, and sarcopenia. RESULTS OSA frequency was 67% (N = 49). Both total and upper body adiposity were associated with the presence and severity of OSA. In non-obese patients (BMI <30 kg/m2), upper body obesity increased significantly the frequency of OSA. OSA association with sarcopenia was blunted when BMI was included in regression model. CONCLUSIONS Results from the present study suggest that in non-dialyzed CKD patients OSA is very common and associated with total and upper body obesity, but not with sarcopenia.

Internationalization is Necessary, But is it Enough?

Internationalization is Necessary, But is it Enough? Gláucia Maria Moraes de Oliveira,1 Andrea De Lorenzo,2 Fernanda Marciano Consolim Colombo,3 Eduardo Back Sternick,4 Andréa Araujo Brandão,5 Sergio Emanuel Kaiser,6 Alexandre Schaan de Quadros,7 Renato Abdala Karam Kalil,7 Christianne Brêtas Vieira Scaramello,9 Francisco Rafael Martins Laurindo,8 Ludhmila Abrahão Hajjar8 Programa de Pós-Graduação em Cardiologia da Universidade Federal do Rio De Janeiro (UFRJ),1 Rio de Janeiro, RJ – Brazil Programa de Pós-Graduação em Ciências Cardiovasculares do Instituto Nacional de Cardiologia (INC),2 Rio de Janeiro, RJ – Brazil Programa de Pós-Graduação em Medicina da Universidade Nove de Julho (UNINOVE),3 São Paulo, SP – Brazil Programa de Pós-Graduação em Ciências da Saúde da Faculdade Ciências Médicas de Minas Gerais,4 Belo Horizonte, MG – Brazil Programa de Pós-Graduação em Ciências Médicas Universidade do Estado do Rio de Janeiro (UERJ),5 Rio de Janeiro, RJ – Brazil Programa de Pós-Graduação em Fisiopatologia Clínica e Experimental da Universidade Estadual do Rio de Janeiro (UERJ),6 Rio de Janeiro, RJ – Brazil Programa de Pós-Graduação do Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia (IC/FUC),7 Porto Alegre, RS – Brazil Programa de Pós-Graduação em Cardiologia da Universidade de São Paulo (USP),8 São Paulo, SP – Brazil Programa de Pós-Graduação em Ciências Cardiovasculares da Universidade Federal Fluminense (UFF),9 Rio de Janeiro, RJ – Brazil

Serum Uric Acid Levels are Associated with Cardiometabolic Risk Factors in Healthy Young and Middle-Aged Adults

Background Observational studies have highlighted an association between serum uric acid (SUA) levels and cardiovascular risk factors. Despite the growing body of evidences, several studies were conducted in older individuals or in carriers of diseases susceptible to affect SUA levels and cardiometabolic risk markers. Objective To evaluate the relationship of SUA with body adiposity, metabolic profile, oxidative stress, inflammatory biomarkers, blood pressure and endothelial function in healthy young and middle-aged adults. Methods 149 Brazilian adults aged 20-55 years, both sexes, underwent evaluation of body adiposity, SUA, fasting glucose and insulin, lipid profile, malondialdehyde (MDA), high sensitivity C-reactive protein (hs-CRP), adiponectin, blood pressure and endothelial function. Endothelial function was assessed by the reactive hyperemia index (RHI) derived from peripheral arterial tonometry method. Participants were allocated in two groups according to SUA levels: control group (CG; n = 130; men ≤ 7 mg/dL, women ≤ 6 mg/dL) and hyperuricemia group (HG; n = 19; men > 7 mg/dL, women > 6 mg/dL). A P-value < 0.05 was considered statistically significant. Results After adjustment for confounders, participants in HG compared with those in CG displayed higher body mass index (BMI): 34.15(33.36-37.19) vs.31.80 (26.26-34.42) kg/m2,p = 0.008, higher MDA: 4.67(4.03-5.30) vs. 3.53(3.10-4.07) ng/mL, p < 0.0001 and lower RHI: 1.68 ± 0.30 vs. 2.05 ± 0.46, p = 0.03). In correlation analysis adjusted for confounders, SUA was positively associated (p < 0.05) with BMI, waist circumference, LDL-cholesterol, triglycerides and MDA, and negatively associated (p < 0.05) with HDL-cholesterol, adiponectin and RHI. Conclusions This study suggests that in healthy young and middle-aged adults higher SUA levels are associated with higher body adiposity, unfavorable lipid and inflammatory phenotype, higher oxidative stress and impaired endothelial function.

Positions, Guidelines and Standardizations. Vehicles of Assistance to Medical Practice

Positions, Guidelines and Standardizations. Vehicles of Assistance to Medical Practice Antônio Carlos Sobral Sousa,1,2 Claudio Pereira da Cunha,3 Lucélia Batista Neves Cunha Magalhães,4 Sergio Emanuel Kaiser,5 José Francisco Kerr Saraiva6 Departamento de Medicina e Núcleo de Pós graduação em medicina da Universidade Federal de Sergipe;1 Centro de Ensino e Pesquisa da Fundação São Lucas,2 Aracaju, SE; Universidade Federal do Paraná,3 Curitiba, PR; Universidade Federal da Bahia,4 Slavador, BA; Universidade do Estado do Rio de Janeiro,5 Rio de Janeiro, RJ; Pontifícia Universidade Católica de Campinas (PUC-Camp),6 São Paulo, SP – Brazil

7th Brazilian Guideline of Arterial Hypertension: Chapter 5 - Therapeutic Decision and Targets

The therapeutic management of elevated BP includes nonpharmacological measures and the use of antihypertensive drugs to reduce BP, protect target organs and prevent CV and renal outcomes.1-3 Non-pharmacological measures have proven efficient to reduce BP, although limited by mediumand long-term lack of adherence to treatment. A systematic review4 of studies with a minimum duration of 12-24 months, combining dietary interventions and moderate-to-highintensity physical activity in patients using or not medications, has revealed a reduction in SBP and DBP for < 12 months of -4.47 (-7.91 to -1.04) mm Hg and -1.10 (-2.39 to 0.19) mm Hg, respectively. For 12 to 24 months, the reductions were -2.29 (-3.81 to -0.76) mm Hg and -1.00 (-3.22 to 1.22) mm Hg in SBP and DBP, respectively. The direct impact of those measures on the risk of CV outcomes is uncertain, the studies are small and short, and the effects on other RF could contribute to CV protection.

968 EFFECTS OF A SIX-MONTH ANTI-HYPERTENSIVE TREATMENT ON MICROVASCULAR ENDOTHELIAL FUNCTION OF PATIENTS WITH STAGE I AND II HYPERTENSION

Objectives: To assess the effects of six-month treatment with a beta-blocker or an antagonist of the AT1 receptor on microvascular endothelial function of hypertensive patients. Methods: Prospective, randomized, open-label study, blind endpoint assessment. Newly diagnosed stage I or II hypertensives were treated either with metoprolol (METO, 100 mg/day, n = 20) or olmesartan medoxomil (OLME, 40 mg/day, n = 24). Twenty normotensive subjects matched for age, sex and body mass index were used as controls. Microvascular endothelial function was evaluated using skin laser Doppler flowmetry during post-occlusive reactive hyperemia (PORH) and thermal hyperemia (TH). Values are expressed as median (25th-75thpercentile) or mean ± SD. Results: We studied forty-four patients (23 men) aged 46.7 ± 1.3 years. Mean systolic and diastolic blood pressure decreased to the same extent in both groups. Maximal cutaneous vascular conductance (CVC, arbitrary units of flow/mean arterial pressure) during PORH was significantly lower in the pool of patients [0.29 (0.22 - 0.38)] when compared to controls [0.39 (0.31 - 0.49); P < 0.001)], and increased to 0.41 (0.29 - 0.51); P < 0.001) after treatment. CVC during PORH increased after OLME treatment [from 0.29 ± 0.02 to 0.42 ± 0.04; P < 0.001] but not after METO treatment [from 0.31 (0.21 - 0.46) to 0.37 (0.25 - 0.52); P = 0.26]. CVC during TH in the pool of patients was [1.59 (1.16 - 1.90)] and increased to 1.82 (1.29 - 2.20; P < 0.001) after treatment. CVC during TH increased both after OLME treatment [from 1.50 ± 0.10 to 1.87 ± 0.15; P < 0.0001] and METO treatment (from 1.74 ± 0.17 to 1.90 ± 0.17; P = 0.001). Conclusions: Anti-hypertensive treatment with OLME or METO improves systemic microvascular endothelial function.

967 ANTI-HYPERTENSIVE TREATMENT REVERSES SYSTEMIC MICROVASCULAR RAREFACTION IN PATIENTS WITH STAGE I AND II HYPERTENSION

Background: Capillary rarefaction and reduced capillary recruitment are hallmarks of arterial hypertension and reflect systemic microvascular endothelial dysfunction. Objectives: To assess the effects of six-month treatment with a beta-blocker or an antagonist of the AT1 receptor on systemic microvascular density of hypertensive patients. Methods: Prospective, randomized, open-label study, blind endpoint assessment. Newly diagnosed stage I or II hypertensives were treated either with metoprolol (METO, 100 mg/day, n = 20) or olmesartan medoxomil (OLME, 40 mg/day, n = 24). Twenty normotensive subjects matched for age, sex and body mass index were used as controls. Skin capillary density was evaluated using videocapillaroscopy before and during post-occlusive reactive hyperemia (PORH). Values are expressed as mean ± SD. Results: We studied forty-four patients (23 men) aged 46.7 ± 1.3 years. Mean systolic and diastolic blood pressure decreased to the same extent in both groups. Capillary density (CD, capillaries/mm2) was significantly lower in the pool of patients in resting conditions (71.3 ± 1.5) and during PORH (71.7 ± 1.5) when compared to controls (80.6 ± 1.8, P < 0.001 and 79.5 ± 2.6, P < 0.05, respectively), and increased to 75.4 ± 1.1 (P < 0.001) and 76.8 ± 1.1 (P < 0.05) after treatment, respectively. Basal CD increased after METO treatment (from 70.0 ± 1.9 to 75.9 ± 1.7; P < 0.05) but not after OLME treatment (from 72.3 ± 2.2 to 75.0 ± 1.6; P > 0.05); CD during PORH also increased after METO treatment (from 69.8 ± 1.8 to 76.3 ± 1.7; P < 0.001) but not after OLME treatment (from 73.3 ± 2.4 to 77.2 ± 1.6; P > 0.05). Conclusions: Anti-hypertensive treatment reverses capillary rarefaction and increases capillary recruitment, which is consistent with improved microvascular endothelial function. The differences between effects of both agents should be confirmed in studies with larger samples.

O impacto dos inibidores da HMG-CoA redutase na modificação da história natural da doença coronária

,em 1997, foram divulgados os resultados de dois estudosprospectivos multicentricos de prevencao primaria e secun-daria de eventos cardiovasculares atraves do uso a longoprazo de drogas inibidoras da HMG-CoA redutase, respec-tivamente, o estudo AF/Texcaps, comparando lovastatina eplacebo em pacientes aparentemente saudaveis e o estudoLIPID, avaliando a eficacia da pravastatina frente aoplacebo em pacientes com episodios anteriores de infartodo miocardio (IM) ou angina instavel.As conclusoes preliminares geradas por esses doisimportantes estudos, somadas aos resultados amplamenteconhecidos dos tres ensaios clinicos precedentes