Left Ventricular Diastolic Function in Essential Hypertensive Patients: Influence of Age and Left Ventricular Geometry

PURPOSE - To evaluate diastolic dysfunction (DD) in essential hypertension and the influence of age and cardiac geometry on this parameter. METHODS - Four hundred sixty essential hypertensive patients (HT) underwent Doppler echocardiography to obtain E/A wave ratio (E/A), atrial deceleration time (ADT), and isovolumetric relaxation time (IRT). All patients were grouped according to cardiac geometric patterns (NG - normal geometry; CR - concentric remodeling; CH- concentric hypertrophy; EH - eccentric hypertrophy) and to age (60 years). One hundred six normotensives (NT) persons were also evaluated. RESULTS - A worsening of diastolic function in the HT compared with the NT, including HT with NG (E/A: NT - 1.38±0.03 vs HT - 1.27±0.02, p<0.01), was observed. A higher prevalence of DD occurred parallel to age and cardiac geometry also in the prehypertrophic groups (CR). Multiple regression analysis identified age as the most important predictor of DD (r²=0.30, p<0.01). CONCLUSION - DD was prevalent in this hypertensive population, being highly affected by age and less by heart structural parameters. DD is observed in incipient stages of hypertensive heart disease, and thus its early detection may help in the risk stratification of hypertensive patients.Universidade Federal de São Paulo (UNIFESP) Kidney and Hypertension Hospital Division of NephrologyUNIFESP, Kidney and Hypertension Hospital Division of NephrologySciEL

Estratégias de aquisição da casa própria: a trajetória de algumas famílias negras paulistanas nas décadas de 1920 a 1940

In Brazil, there is a cultural belief that property acquisition is the wisest attitude to ensure a safe and stable economy. For generations, the "dream of property ownership" has been cultivated as a horizon to be achieved. Confirming this tendency, since the 1920s, "casa propria" (home ownership) became a notion mobilized in the black press periodicals, circulating as a desirable aspiration and an orientation to the journals public. Between 1924 and 1937, two of the main newspapers of São Paulo black press, O Clarim da Alvorada and A Voz da Raça, carried out a campaign in favor of property ownership, spreading among paulista black families the importance of property acquisition. These campaigns are an important sign for the relevance of buying a property for black families at that time. In this paper, we seek to analyze it as an intergenerational social security strategy, through the presentation of three cases of black families that accomplished this goal between 1920s and 1940s. The black families testimonies reported here indicate precocity, specificities and strategies that represent new challenges for the formulation of property ownership problem, from a racial point of view.No Brasil, há uma crença cultural de que a atitude mais sábia para garantir uma economia doméstica segura e estável é a aquisição da casa própria. Por gerações, o “sonho da casa própria” tem sido cultivado como um horizonte a se atingir. Confirmando essa tendência, desde a década de 1920, a “casa própria” torna-se uma noção mobilizada nos periódicos da imprensa negra, circulando em diversos artigos como uma aspiração desejável e uma orientação ao público dos jornais. Entre 1924 e 1937, dois dos principais jornais da imprensa negra paulista, O Clarim da Alvorada e A Voz da Raça, realizaram uma campanha em favor da casa própria, difundindo entre as famílias negras paulistanas a ideia da importância da aquisição imobiliária. Essas campanhas constituem um indício importante da relevância da aquisição residencial para as famílias negras do período. Neste trabalho, procuramos analisar essa importância como estratégia de seguridade social intergeracional, por meio da apresentação de três casos de famílias negras que realizaram esse objetivo entre as décadas de 1920 e 1940. Os depoimentos das famílias negras aqui reportados indicamprecocidade, especificidades e estratégias que representam novos desafios para a reflexão sobre a formulação do problema da casa própria, a partir do ponto de vista racial

Left Ventricular Diastolic Function in Essential Hypertensive Patients: Influence of Age and Left Ventricular Geometry

PURPOSE - To evaluate diastolic dysfunction (DD) in essential hypertension and the influence of age and cardiac geometry on this parameter. METHODS - Four hundred sixty essential hypertensive patients (HT) underwent Doppler echocardiography to obtain E/A wave ratio (E/A), atrial deceleration time (ADT), and isovolumetric relaxation time (IRT). All patients were grouped according to cardiac geometric patterns (NG - normal geometry; CR - concentric remodeling; CH- concentric hypertrophy; EH - eccentric hypertrophy) and to age (<40; 40 - 60; >60 years). One hundred six normotensives (NT) persons were also evaluated. RESULTS - A worsening of diastolic function in the HT compared with the NT, including HT with NG (E/A: NT - 1.38±0.03 vs HT - 1.27±0.02, p<0.01), was observed. A higher prevalence of DD occurred parallel to age and cardiac geometry also in the prehypertrophic groups (CR). Multiple regression analysis identified age as the most important predictor of DD (r²=0.30, p<0.01). CONCLUSION - DD was prevalent in this hypertensive population, being highly affected by age and less by heart structural parameters. DD is observed in incipient stages of hypertensive heart disease, and thus its early detection may help in the risk stratification of hypertensive patients

Granuloma faciale and eosinophilic angiocentric fibrosis: similar entities in different anatomic sites

Eosinophilic angiocentric fibrosis (EAF) and granuloma faciale (GF) share several histopathologic features, including eosinophil-rich inflammation, microangiitis, and progressive fibrosis. Concurrent presentation of EAF and GF suggests a pathogenetic link between them. To identify histologic findings that tell them apart and construe the pathogenetic mechanisms behind each morphologic variable, 14 immunohistochemical markers were used to study the cells subpopulations in 14 cases of GF and 3 cases of EAF. The lesions were classified according to their stage of development. The antibodies studied were: CD4, Foxp3, CD8, granzymes A and B, perforin, granulysin, CD20, CD56, CD68, ICAM-1, CD34, CD105, and 1A4. The intensity of the sclerotic response and the density of 1A4-immunostained cells were significantly higher in EAF. In both diseases, CD68 cells were the most numerous, followed by CD20, CD8, and CD4 cells. About 30% of cells expressed ICAM-1. Among cells with cytotoxic granules, granulysin-positive cells were the most frequent. Differences between GF and EAF were found to be mostly like due to anatomic site (usually skin of the face vs. sinonasal cavity) and stage of the disease development (usually earlier in cutaneous lesions because of their visibility). Innate and adaptive immunity, including B cells, T cells, and cytotoxic granules have a role in their pathogenesis.Eosinophilic angiocentric fibrosis (EAF) and granuloma faciale (GF) share several histopathologic features, including eosinophil-rich inflammation, microangiitis, and progressive fibrosis. Concurrent presentation of EAF and GF suggests a pathogenetic link253213220FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOSEM INFORMAÇÃ

Left Ventricular Hypertrophy Evaluation in Obese Hypertensive Patients: Effect of Left Ventricular Mass Index Criteria

PURPOSE: To evaluate left ventricular mass (LVM) index in hypertensive and normotensive obese individuals. METHODS: Using M mode echocardiography, 544 essential hypertensive and 106 normotensive patients were evaluated, and LVM was indexed for body surface area (LVM/BSA) and for height² (LVM/h²). The 2 indexes were then compared in both populations, in subgroups stratified according to body mass index (BMI): <27; 27-30; > or = 30kg/m². RESULTS: The BSA index does not allow identification of significant differences between BMI subgroups. Indexing by height² provides significantly increased values for high BMI subgroups in normotensive and hypertensive populations. CONCLUSION: Left ventricular hypertrophy (LVH) has been underestimated in the obese with the use of LVM/BSA because this index considers obesity as a physiological variable. Indexing by height² allows differences between BMI subgroups to become apparent and seems to be more appropriate for detecting LVH in obese populations