Aumento de distensibilidade arterial e hipertensão renovascular na Sindrome de Goldenhar

This is a report of the successful angioplastic treatment of an association of renovascular hypertension with renal artery stenosis and the Goldenhar syndrome (a variant of oculoauriculovertebral dysplasia). For the first time to date, this association, which occurred in a 13-year-old girl, is reported. Additionally, increased arterial distensibility in spite of arterial hypertension was detected by noninvasive methods. The similarity of this finding and in those for other genetic diseases, suggests that the vascular lesions could be linked to the Goldenhar syndrome.Relatamos a associação de hipertensão renovascular por estenose de artéria renal e a Sindrome de Goldenhar (variante da displasia oculoauriculovertebral) em uma paciente do sexo feminino de 13 anos de idade. Este é o primeiro relato de tratamento por angioplastia. Além disso, detectamos por métodos não invasivos um aumento da distensibilidade arterial, a despeito da hipertensão arterial. A similaridade destes achados com outras doenças genéticas sugere que as alterações vasculares presentes podem estar relacionadas à Síndrome de Goldenhar

Arterial stiffness and atrial fibrillation: A review

Arterial stiffness has been investigated as part of the physiopathology of arterial hypertension since the 1970s. Its role in increasing the “pulsatile load” imposed over the Left Ventricle (LV) has been intensely studied recently and has helped in understanding the mechanisms of Atrial Fibrillation (AF) in hypertensive patients. This paper aims to review the main evidence on this issue and establish possible mechanisms involved in the development of AF in patients with arterial stiffness. A PubMed search was performed, and selected articles were searched for references focusing on this topic. In the long term, lower blood pressure levels allow for arterial wall remodeling, leading to a lower stiffness index. To this day, however, there are no available treatments that directly promote the lowering of arterial wall stiffness. Most classes of anti-hypertensive drugs ‒ with stronger evidence for beta-blockers and diuretics ‒ could be effective in reducing arterial stiffness. There is strong evidence demonstrating an association between arterial stiffness and AF. New studies focusing on arterial stiffness and pre-fibrillatory stages would strengthen this causality relation

Structural remodeling of large arteries in patients with hypertensive myocardiopathy is correlated to the ventricular geometry and renal dysfunction

Objectives: To study structural and functional parameters of large arteries in hypertensive subjects (sbjs) with different patterns of hypertensive myocardiopathy. Material and Methods: 45 hypertensive sbjs (PA > 140/90 mmHg or under treatment) were evaluated and hypertensive myocardiopathy was defined by left ventricular hypertrophy (LVH) (LVMi >125 g/m²) and/or systolic dysfunction (SD) (FE < 0.50) at the echocardiogram and divided into2 groups: 1) LVH without SD, 16 sbjs; 2) LVH with DS, 18 sbjs. Data was compared to 11 hypertensive sbjs without LVH or SD. Arterial parameters (intimal-medial thickness-IMT, internaldiameter, distensibility) were assessed at the right carotid by a high-resolution “echo-tracking”equipment and the aortic stiffness was assessed through carotid-femoral pulse wave velocity(PWV) by Complior method. Results: The patients of the group LVH with SD showed a larger carotid diameter (8,02 ± 0,88mm) and a larger IMT (0,88 ± 0,21mm) than those from the control group (7,04 ± 0,73mm e 0,68 ± 0,13mm)(p < 0.01). The sbjs from the LVH without SDgroup showed no differences among the other groups. The PWV and the carotid distensibility were similar among the 3 groups. At multivariate analysis, the IMT was significatively correlated to the LVMi (r = 0,44, p < 0,005), while the carotid diameter was correlated to age and serumcreatinine (r = 0.54). Conclusion: In hypertensive subjects with LVH and systolic dysfunction there is a structural remodeling in large arteries. This remodeling is correlated to ventricular geometry and renal failure, without alterations in vascular function.Objetivo: Estudar parâmetros funcionais e estruturais de grandes artérias em pacientes hipertensos com diferentes graus de miocardiopatia hipertensiva. Material e métodos:Foram estudados 45 pacientes hipertensos (PA > 140/90mmHg ou em tratamento) e miocardiopatia hipertensiva definida por hipertrofia ventricular esquerda (HVE) (IMVE > 125g/m²) e/ou disfunção sistólica (DS) (FE < 0,50) ao ecocardiograma divididos em 2 grupos: 1)HVE sem DS, 16 pacientes; 2) HVE com DS, 18 pacientes. Dados foram comparados a 11pacientes hipertensos sem HVE ou DS. Parâmetros arteriais (espessura intima-medial-EIM,diâmetro interno, distensibilidade) foram avaliados em artéria carótida direita por equipamento“echo-tracking” e a rigidez aórtica pela medida da velocidade de onda de pulso (VOP) carótidofemoral pelo Complior. Resultados: Os pacientes do grupo HVE com DS apresentaram maior diâmetro de carótida (8,02 ± 0,88mm) e maior EIM (0,88 ± 0,21mm) que os pacientes do grupo controle (7,04 ± 0,73mm e 6,8 ± 0,13mm, p < 0.01), e os pacientes do grupo HVE semDS não apresentaram diferenças em relação aos demais grupos. A VOP e a distensibilidade de carótida foram similares nos 3 grupos de pacientes. Na análise multivariada, a EIM secorrelacionou significativamente com o IMVE (r = 0,44, p < 0,005), enquanto o diâmetro de carótida se correlacionou com a idade e à creatinina sérica (r = 0.54). Conclusão: Em hipertensos com hipertrofia ventricular e disfunção ventricular sistólica há um remodelamento estrutural de grandes artérias. Este remodelamento é relacionado à geometria ventricular e à disfunção renal, sem modificações da função vascular

Intermittent claudication and severe renal artery stenosis are independently associated in hypertensive patients referred for renal arteriography

OBJECTIVE: The purpose of this study was to evaluate the association between the presence of clinical symptoms of peripheral artery disease and severe renal artery stenosis in patients referred for renal angiography. METHOD: We included 82 patients with clinical suspicion of renovascular hypertension and performed an imaging investigation (renal Doppler ultrasound and/or renal scintigraphy) for possible renal artery stenosis. All patients underwent renal arteriography and were examined for peripheral artery disease based on the presence of intermittent claudication and ankle-brachial index test results. Severe renal artery stenosis was defined as a lesion causing 70% obstruction. RESULTS: Severe renal artery stenosis was present in 32 of 82 (39%) patients. Patients with severe renal artery stenosis were older (63±12 vs 56±12 years, p=0.006), had more intermittent claudication (55 vs 45%, p=0.027), and had a greater prevalence of an ankle-brachial inde

Aortic distensibility measured by pulse-wave velocity is not modified in patients with Chagas' disease

Abstract\ud \ud \ud \ud Background\ud \ud Experimental studies demonstrate that infection with trypanosoma cruzi causes vasculitis. The inflammatory lesion process could hypothetically lead to decreased distensibility of large and small arteries in advanced Chagas' disease. We tested this hypothesis.\ud \ud \ud \ud Methods and results\ud \ud We evaluated carotid-femoral pulse-wave velocity (PWV) in 53 Chagas' disease patients compared with 31 healthy volunteers (control group). The 53 patients were classified into 3 groups: 1) 16 with indeterminate form of Chagas' disease; 2) 18 with Chagas' disease, electrocardiographic abnormalities, and normal systolic function; 3) 19 with Chagas' disease, systolic dysfunction, and mild-to-moderate congestive heart failure. No difference was noted between the 4 groups regarding carotid-femoral PWV (8.4 ± 1.1 vs 8.2 ± 1.5 vs 8.2 ± 1.4 vs 8.7 ± 1.6 m/s, P = 0.6) or pulse pressure (39.5 ± 7.6 vs 39.3 ± 8.1 vs 39.5 ± 7.4 vs 39.7 ± 6.9 mm Hg, P = 0.9). A positive, significant, similar correlation occurred between PWV and age in patients with Chagas' disease (r = 0.42, P = 0.002), in controls (r = 0.48, P = 0.006), and also between PWV and systolic blood pressure in both groups (patients with Chagas' disease, r = 0.38, P = 0.005; healthy subjects, r = 0.36, P = 0.043).\ud \ud \ud \ud Conclusion\ud \ud Carotid femoral pulse-wave velocity is not modified in patients with Chagas' disease, suggesting that elastic properties of large arteries are not affected in this disorder.The authors thank Professor Kathleen A. Dracup, University of California, San Francisco, for reviewing the manuscript.The authors thank Professor Kathleen A. Dracup, University of California, San Francisco, for reviewing the manuscript

Glomerular Filtration Rate Measured by 51Cr-EDTA Clearance: Evaluation of Captopril-Induced Changes in Hypertensive Patients with and without Renal Artery Stenosis

INTRODUCTION: Renal artery stenosis can lead to renovascular hypertension; however, the detection of stenosis alone does not guarantee the presence of renovascular hypertension. Renovascular hypertension depends on activation of the renin-angiotensin system, which can be detected by functional tests such as captopril renal scintigraphy. A method that allows direct measurement of the baseline and post-captopril glomerular filtration rate using chromium-51 labeled ethylenediamine tetraacetic acid (51Cr-EDTA) could add valuable information to the investigation of hypertensive patients with renal artery stenosis. The purposes of this study were to create a protocol to measure the baseline and post-captopril glomerular filtration rate using 51Cr-EDTA, and to verify whether changes in the glomerular filtration rate permit differentiation between hypertensive patients with and without renal artery stenosis. METHODS: This prospective study included 41 consecutive patients with poorly controlled severe hypertension. All patients had undergone a radiological investigation of renal artery stenosis within the month prior to their inclusion. The patients were divided into two groups: patients with (n=21) and without renal artery stenosis, (n=20). In vitro glomerular filtration rate analysis (51Cr-EDTA) and 99mTc-DMSA scintigraphy were performed before and after captopril administration in all patients. RESULTS: The mean baseline glomerular filtration rate was 48.6±21.8 ml/kg/1.73 m² in the group wuth renal artery stenosis, which was significantly lower than the GFR of 65.1±28.7 ml/kg/1.73m² in the group without renal artery stenosis (p=0.04). Captopril induced a significant reduction of the glomerular filtration rate in the group with renal artery stenosis (to 32.6±14.8 ml/kg/1.73m², p=0.001) and an insignificant change in the group without RAS (to 62.2±23.6 ml/kg/1.73m², p=0.68). Scintigraphy with technetium-99m dimercapto-succinic acid (DMSA) did not show significant differences in differential renal function from baseline to post-captopril images in either group. CONCLUSIONS: Captopril induced a decrease in the GFR that could be quantitatively measured with 51Cr-EDTA. The reduction is more pronounced in hypertensive patients with RAS

Os principais tipos de rochas vulcânicas da bacia do Paraná no planalto de Santa Catarina

The volcanic rocks of the Plateau of Santa Catarina, Southern Brazil, are composed, predominantly, by lava flows of basaltic to basaltic-andesite composition. Rocks of intermediate composition occur in the centro-west region and correspond to ranophyric trahyandesite. Acid rocks are represented by granophyric hemicristalline dacites in the South-east region and by granophyric riolites in the centro-west region, immediate to Paraná State.Magmatic activity in the Upper Mantle and in the Lower Crust, during Cretaceous, indued the diversity of petrographic types.The density of rocks provide different values and, by this reason, it is a good parameter to established the distinction among themselves.As rochas vulcânicas do Planalto de Santa Catarina são constituídas, predominantemente, por derrames de composição basáltica e andesito-basáltica. Rochas de composição intermediária ocorrem na região centro-oeste e foram classificadas como traquiandesito porfirítico granofírico. Rochas ácidas estão representadas por dacitos hemicristalinos granofíricos na região sudeste e por riólitos granofílicos na região centro-oeste, em direção ao Estado do Paraná.A atividade magmática no Manto Superior e na Crosta Inferior, durante o Cretáceo, foi responsável por essa diversidade de tipos petrográficos.A determinação da densidade das rochas forneceu valores significativamente diferentes, constituindo-se num parâmetro sensível para a distinção entre elas

Acute Aerobic Exercise Reduces 24-H Ambulatory Blood Pressure Levels in Long-Term-Treated Hypertensive Patients

BACKGROUND: Even with anti-hypertensive therapy, it is difficult to maintain optimal systemic blood pressure values in hypertensive patients. Exercise may reduce blood pressure in untreated hypertensive, but its effect when combined with long-term anti-hypertensive therapy remains unclear. Our purpose was to evaluate the acute effects of a single session of aerobic exercise on the blood pressure of long-term-treated hypertensive patients. METHODS: Fifty treated hypertensive patients (18/32 male/female; 46.5±8.2 years; Body mass index: 27.8±4.7 kg/m²) were monitored for 24 h with respect to ambulatory (A) blood pressure after an aerobic exercise session (post-exercise) and a control period (control) in random order. Aerobic exercise consisted of 40 minutes on a cycle-ergometer, with the mean exercise intensity at 60% of the patient's reserve heart rate. RESULTS: Post-exercise ambulatory blood pressure was reduced for 24 h systolic (126±8.6 vs. 123.1±8.7 mmHg, p=0.004) and diastolic blood pressure (81.9±8 vs. 79.8±8.5 mmHg, p=0.004), daytime diastolic blood pressure (85.5±8.5 vs. 83.9±8.8 mmHg, p=0.04), and nighttime S (116.8±9.9 vs. 112.5±9.2 mmHg, p<0.001) and diastolic blood pressure (73.5±8.8 vs. 70.1±8.4 mmHg, p<0.001). Post-exercise daytime systolic blood pressure also tended to be reduced (129.8±9.3 vs. 127.8±9.4 mmHg, p=0.06). These post-exercise decreases in ambulatory blood pressure increased the percentage of patients displaying normal 24h systolic blood pressure (58% vs. 76%, p=0.007), daytime systolic blood pressure (68% vs. 82%, p=0.02), and nighttime diastolic blood pressure (56% vs. 72%, p=0.02). Nighttime systolic blood pressure also tended to increase (58% vs. 80%, p=0.058). CONCLUSION: A single bout of aerobic exercise reduced 24h ambulatory blood pressure levels in long-term-treated hypertensive patients and increased the percentage of patients reaching normal ambulatory blood pressure values. These effects suggest that aerobic exercise may have a potential role in blood pressure management of long-term-treated hypertensive

EFEITOS DO ALONGAMENTO ATIVO SOBRE O DESEMPENHO DA FORÇA MUSCULAR EM UMA MULHER JOVEM: UM ESTUDO DE CASO DE EFEITOS CRÔNICOS

O alongamento realizado pré exercício de força muscular tem despertado muita polêmica entre os profissionais de fisiologia do exercício, pois ainda existem controversas se o alongamento pode prejudicar o treino de força ou não. O objetivo geral deste estudo foi avaliar se o alongamento ativo realizado antes da sessão de treinamento resistido prejudica o desempenho de força em uma mulher jovem após 2 meses de treinamento. Participou do estudo uma mulher jovem de 21 anos que tinha experiência com treinamento resistido, mas estava inativa a 5 meses. Para avaliação antes e após o programa de exercícios foram utilizados peso, altura, protocolo de Jackson e Pollock 7 dobras, circunferências anatômicas, teste de 1RM, tabela de percepção subjetiva de esforço, protocolo de flexibilidade

Acute aerobic exercise reduces 24-h ambulatory blood pressure levels in long-term-treated hypertensive patients

BACKGROUND: Even with anti-hypertensive therapy, it is difficult to maintain optimal systemic blood pressure values in hypertensive patients. Exercise may reduce blood pressure in untreated hypertensive, but its effect when combined with long-term anti-hypertensive therapy remains unclear. Our purpose was to evaluate the acute effects of a single session of aerobic exercise on the blood pressure of long-term-treated hypertensive patients. METHODS: Fifty treated hypertensive patients (18/32 male/female; 46.5±8.2 years; Body mass index: 27.8±4.7 kg/m²) were monitored for 24 h with respect to ambulatory (A) blood pressure after an aerobic exercise session (post-exercise) and a control period (control) in random order. Aerobic exercise consisted of 40 minutes on a cycle-ergometer, with the mean exercise intensity at 60% of the patient's reserve heart rate. RESULTS: Post-exercise ambulatory blood pressure was reduced for 24 h systolic (126±8.6 vs. 123.1±8.7 mmHg, p=0.004) and diastolic blood pressure (81.9±8 vs. 79.8±8.5 mmHg, p=0.004), daytime diastolic blood pressure (85.5±8.5 vs. 83.9±8.8 mmHg, p=0.04), and nighttime S (116.8±9.9 vs. 112.5±9.2 mmHg,