Adipokines: Another Link Between Obesity And Hypertension

[No abstract available

Phenotypic Characteristics Of Resistant Hypertension In The Brazilian Population [características Fenotípicas Da Hipertensão Arterial Resistente Na População Brasileira]

Resistant hypertension (RH) is defined as blood pressure that remains above target in spite of the concurrent use of three or more classes of antihypertensive drugs at optimized doses (UCRH), with one of them being a diuretic. Moreover, patients whose blood pressure is controlled while using four or more antihypertensive medications are also considered controlled resistant hypertensive (CRH) subjects. Although this definition may be useful in terms of categorizing a larger group of resistant hypertensive individuals, as these two subgroups share high cardiovascular risk, some important clinical and pathophysiologic particularities need to be better evaluated, before considering resistant controlled and uncontrolled patients as part of the same group. We compared cardiovascular characteristics of these two subgroups with resistant hypertension. In spite of some similar features, the UCRH subgroup has cardiovascular phenotypes with worse prognosis, such as increased vascular stiffness and left ventricular hypertrophy, as well as more impaired endothelial function and lower nocturnal blood pressure dipping, among others. Considering these differences, the UCRH subgroup is associated with greater cardiovascular risk and may be considered as more resistant to antihypertensive treatment. In addition to the importance of better prevention and treatment of resistant hypertension by identifying early risk factors and optimizing drug therapy, some clinical implications must be considered when managing controlled and uncontrolled patients as similar to the resistant hypertension group.1006579582Calhoun, D.A., Jones, D., Textor, S., Goff, D.C., Murphy, T.P., Toto, R.D., Resistant hypertension: Diagnosis, evaluation, and treatment: A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research (2008) Circulation., 117 (25), pp. e510-e526Calhoun, D.A., Jones, D., Textor, S., Goff, D.C., Murphy, T.P., Toto, R.D., Resistant hypertension: Diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research (2008) Hypertension., 51 (6), pp. 1403-1419Lloyd-Jones, D.M., Evans, J.C., Larson, M.G., O'Donnell, C.J., Roccella, E.J., Levy, D., Differential control of systolic and diastolic blood pressure: Factors associated with lack of blood pressure control in the community (2000) Hypertension., 36 (4), pp. 594-599Cushman, W.C., Ford, C.E., Cutler, J.A., Margolis, K.L., Davis, B.R., Grimm, R.H., Success and predictors of blood pressure control in diverse North American settings: The antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT) (2002) J Clin Hypertens (Greenwich)., 4 (6), pp. 393-404Pimenta, E., Gaddam, K.K., Oparil, S., Aban, I., Husain, S., Dell'Italia, L.J., Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension: Results from a randomized trial (2009) Hypertension., 54 (3), pp. 475-481Cuspidi, C., Macca, G., Sampieri, L., Michev, I., Salerno, M., Fusi, V., High prevalence of cardiac and extracardiac target organ damage in refractory hypertension (2001) J Hypertens., 19 (11), pp. 2063-2070Salles, G.F., Cardoso, C.R., Pereira, V.S., Fiszman, R., Muxfeldt, E.S., Prognostic significance of a reduced glomerular filtration rate and interaction with microalbuminuria in resistant hypertension: A cohort study (2011) J Hypertens., 29 (10), pp. 2014-2023Salles, G.F., Fiszman, R., Cardoso, C.R., Muxfeldt, E.S., Relation of left ventricular hypertrophy with systemic inflammation and endothelial damage in resistant hypertension (2007) Hypertension., 50 (4), pp. 723-728Salles, G.F., Cardoso, C.R., Fiszman, R., Muxfeldt, E.S., Prognostic impact of baseline and serial changes in electrocardiographic left ventricular hypertrophy in resistant hypertension (2010) Am Heart J., 159 (5), pp. 833-840Gus, M., Silva, D.N., Fernandes, J., Cunha, C.P., Sant'Anna, G.D., Epworth's sleepiness scale in outpatients with different values of arterial blood pressure (2002) Arq Bras Cardiol., 78 (1), pp. 17-24Gus, M., Goncalves, S.C., Martinez, D., de Abreu Silva, E.O., Moreira, L.B., Fuchs, S.C., Risk for Obstructive Sleep Apnea by Berlin Questionnaire, but not daytime sleepiness, is associated with resistant hypertension: A case-control study (2008) Am J Hypertens., 21 (7), pp. 832-835Pedrosa, R.P., Krieger, E.M., Lorenzi-Filho, G., Drager, L.F., Recent advances of the impact of obstructive sleep apnea on systemic hypertension (2011) Arq Bras Cardiol., 97 (2), pp. e40-e47Pedrosa, R.P., Drager, L.F., Gonzaga, C.C., Sousa, M.G., de Paula, L.K., Amaro, A.C., Obstructive sleep apnea: The most common secondary cause of hypertension associated with resistant hypertension (2011) Hypertension., 58 (5), pp. 811-817Whaley-Connell, A., Johnson, M.S., Sowers, J.R., Aldosterone: Role in the cardiometabolic syndrome and resistant hypertension (2010) Prog Cardiovasc Dis., 52 (5), pp. 401-409Sowers, J.R., Whaley-Connell, A., Epstein, M., Narrative review: The emerging clinical implications of the role of aldosterone in the metabolic syndrome and resistant hypertension (2009) Ann Intern Med., 150 (11), pp. 776-783Drager, L.F., Queiroz, E.L., Lopes, H.F., Genta, P.R., Krieger, E.M., Lorenzi-Filho, G., Obstructive sleep apnea is highly prevalent and correlates with impaired glycemic control in consecutive patients with the metabolic syndrome (2009) J Cardiometab Syndr., 4 (2), pp. 89-95Martins, L.C., Conceicao, F.L., Muxfeldt, E.S., Salles, G.F., Prevalence and associated factors of subclinical hypercortisolism in patients with resistant hypertension (2012) J Hypertens., 30 (5), pp. 967-973Boer-Martins, L., Figueiredo, V.N., Demacq, C., Martins, L.C., Consolin-Colombo, F., Figueiredo, M.J., Relationship of autonomic imbalance and circadian disruption with obesity and type 2 diabetes in resistant hypertensive patients (2011) Cardiovasc Diabetol., 10, p. 24Ubaid-Girioli, S., Souza, A.L., Yugar-Toledo, J.C., Martins, L.C., Ferreira-Melo, S., Coelho, O.R., Aldosterone excess or escape: Treating resistant hypertension (2009) J Clin Hypertens (Greenwich)., 11 (5), pp. 245-252Boer-Martins, L., Figueiredo, V.N., Demacq, C., Martins, L.C., Faria, A.P., Moraes, C.D., Leptin and aldosterone in sympathetic activity in resistant hypertension with or without type 2 diabetes (2012) Arq Bras Cardiol., 99 (1), pp. 642-648de Souza, F., Muxfeldt, E., Fiszman, R., Salles, G., Efficacy of spironolactone therapy in patients with true resistant hypertension (2010) Hypertension., 55 (1), pp. 147-152Acelajado, M.C., Pisoni, R., Dudenbostel, T., Dell'Italia, L.J., Cartmill, F., Zhang, B., Refractory hypertension: Definition, prevalence, and patient characteristics (2012) J Clin Hypertens (Greenwich)., 14 (1), pp. 7-12Moreno Jr., H., Coca, A., Resistant and refractory hypertension: Reflections on pathophysiology and terminology (2012) Blood pressure., 21 (4), pp. 209-210Martins, L.C., Figueiredo, V.N., Quinaglia, T., Boer-Martins, L., Yugar-Toledo, J.C., Martin, J.F., Characteristics of resistant hypertension: Ageing, body mass index, hyperaldosteronism, cardiac hypertrophy and vascular stiffness (2011) J Hum Hypertens., 25 (9), pp. 532-538Figueiredo, V.N., Yugar-Toledo, J.C., Martins, L.C., Martins, L.B., de Faria, A.P., de Haro Moraes, C., Vascular stiffness and endothelial dysfunction: Correlations at different levels of blood pressure (2012) Blood Press, 21 (1), pp. 31-38Quinaglia, T., Martins, L.C., Figueiredo, V.N., Santos, R.C., Yugar-Toledo, J.C., Martin, J.F., Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension (2011) J Hum Hypertens., 25 (11), pp. 656-664de Haro Moraes, C., Figueiredo, V.N., de Faria, A.P., Barbaro, N.R., Sabbatini, A.R., Quinaglia, T., High-circulating leptin levels are associated with increased blood pressure in uncontrolled resistant hypertension (2012) J Hum Hypertens, , Jul 19[epub ahead of print

Tadalafil-induced Improvement In Left Ventricular Diastolic Function In Resistant Hypertension

Purpose: Left ventricular hypertrophy and diastolic dysfunction (LVDD) remain highly frequent markers of cardiac damage and risk of progression to symptomatic heart failure, especially in resistant hypertension (RHTN). We have previously demonstrated that administration of sildenafil in hypertensive rats improves LVDD, restoring phosphodiesterase type 5 (PDE-5) inhibition in cardiac myocytes. Methods: We hypothesized that the long-acting PDE-5 inhibitor tadalafil may be clinically useful in improving LVDD in RHTN independently of blood pressure (BP) reduction. A single blinded, placebo-controlled, crossover study enrolled 19 patients with both RHTN and LVDD. Firstly, subjects received tadalafil (20 mg) for 14 days and after a 2-week washout period, they received placebo orally for 14 days. Patients were evaluated by office BP and ambulatory BP monitoring (ABPM), endothelial function (FMD), echocardiography, plasma brain natriuretic peptide (BNP-32), cyclic guanosine monophosphate (cGMP) and nitrite levels. Results: No significant differences were detected in BP measurements. Remarkably, at least four echocardiographic parameters related with diastolic function improved accompanied by decrease in BNP-32 in tadalafil use. Although increasing cGMP, tadalafil did not change endothelial function or nitrites. There were no changes in those parameters after placebo. Conclusion: The current findings suggest that tadalafil improves LV relaxation through direct effects PDE-5-mediated in the cardiomyocytes with potential benefit as an adjunct to treat symptomatic subjects with LVDD such as RHTN patients. © 2013 Springer-Verlag Berlin Heidelberg.702147154Calhoun, D.A., Jones, D., Textor, S., Goff, D.C., Murphy, T.P., Toto, R.D., White, A., Carey, R.M., Resistant hypertension: Diagnosis, evaluation, and treatment: A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research (2008) Circulation, 117, pp. 510-e526. , 18574054 10.1161/CIRCULATIONAHA.108.189141Salles, G.F., Cardoso, C.R., Fiszman, R., Muxfeldt, E.S., Prognostic impact of baseline and serial changes in electrocardiographic left ventricular hypertrophy in resistant hypertension (2010) Am Heart J, 159, pp. 833-840. , 20435193 10.1016/j.ahj.2010.02.012Redfield, M.M., Jacobsen, S.J., Burnett, Jr.J.C., Mahoney, D.W., Bailey, K.R., Rodeheffer, R.J., Burden of systolic and diastolic ventricular dysfunction in the community: Appreciating the scope of the heart failure epidemic (2003) JAMA, 289, pp. 194-202. , 12517230 10.1001/jama.289.2.194Kohno, M., Horio, T., Yokokawa, K., Murakawa, K., Yasunari, K., Akioka, K., Tahara, A., Kurihara, N., Brain natriuretic peptide as a cardiac hormone in essential hypertension (1992) Am J Med, 92, pp. 29-34. , 1:STN:280:DyaK387hslSmtw%3D%3D 1530996 10.1016/0002-9343(92)90011-YUbaid-Girioli, S., Adriana De Souza, L., Yugar-Toledo, J.C., Martins, L.C., Ferreira-Melo, S., Coelho, O.R., Sierra, C., Moreno, H., Aldosterone excess or escape: Treating resistant hypertension (2009) J Clin Hypertens (Greenwich), 11, pp. 245-252. , 1:CAS:528:DC%2BD1MXosVaksrg%3D 10.1111/j.1751-7176.2009.00110.xSchwartz, B.G., Levine, L.A., Comstock, G., Stecher, V.J., Kloner, R.A., Cardiac uses of phosphodiesterase-5 inhibitors (2012) J Am Coll Cardiol, 59, pp. 9-15. , 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Lenaerts, I., Busch, C., Marsboom, G., Janssens, S.P., Ventricular phosphodiesterase-5 expression is increased in patients with advanced heart failure and contributes to adverse ventricular remodeling after myocardial infarction in mice (2009) Circulation, 119, pp. 408-416. , 1:CAS:528:DC%2BD1MXpt1Cmsw%3D%3D 3791110 19139381 10.1161/CIRCULATIONAHA. 108.822072Zhang, M., Koitabashi, N., Nagayama, T., Rambaran, R., Feng, N., Takimoto, E., Koenke, T., Kass, D.A., Expression, activity, and pro-hypertrophic effects of PDE5A in cardiac myocytes (2008) Cell Signal, 20, pp. 2231-2236. , 1:CAS:528:DC%2BD1cXhtlCru7vL 2601628 18790048 10.1016/j.cellsig.2008.08. 012Ferreira-Melo, S.E., Demacq, C., Lacchini, S., Krieger, J.E., Irigoyen, M.C., Moreno, H., Sildenafil preserves diastolic relaxation after reduction by L-NAME and increases phosphodiesterase-5 in the intercalated discs of cardiac myocytes and arterioles (2011) Clinics (Sao Paulo), 66, pp. 1253-1258. , 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blood pressure (2012) Blood Press, 21, pp. 31-38. , 1:CAS:528:DC%2BC38XhtlKnsrg%3D 22029740 10.3109/08037051.2011.61704

Adductor pollicis muscle thickness in Brazilian adolescents and associations with nutritional status, sexual maturation and physical activity (EVA-JF Study)

Objective: The present study aims to assess the associations of adductor pollicis muscle thickness (APMT) with age, skin color, sexual maturation, anthropometric indicators and physical activity in Brazilian adolescents. Materials and methods: Cross-sectional study of adolescents aged 14-19 years. Weight, height, body mass index (BMI), arm circumference (AC), APMT, body fat, fat-free mass (FFM), fat-free mass index (FFMI), sexual maturation, time of physical activity and skin color were evaluated. APMT was associated with categorical variables using Mann-Whitney or Kruskal-Wallis tests and correlated with anthropometric variables using Spearman’s correlation. Linear regression was used with APMT as a dependent and the other variables as predictors. Data analysis was carried out in SPSS® software (version 17.0) with a 5% significance level. Results: 828 adolescents were evaluated, 57.6% female, with a mean age of 16.13 ± 1.20 years. APMT had an average value of 18.0 mm in females and 21.0 mm in males. The measure was greater in males, in more advanced stages of sexual maturation, overweight and physical activity. It presented a moderate correlation with FFM, FFMI, body fat and AC. In the final model of multiple linear regression for females, the variables AC and body fat explain 20.1% of the APMT variability. For men, the variables AC and FFMI explain 30.5% of the APMT variability. Conclusion: It is recommended that APMT be used in a complementary manner in the nutritional assessment of adolescents.Objetivo: El presente estudio tiene como objetivo evaluar las asociaciones del grosor del músculo aductor del pulgar (EMAP) con la edad, el color de la piel, la maduración sexual, los indicadores antropométricos y la actividad física en adolescentes brasileños. Material y métodos: estudio transversal con adolescentes de 14 a 19 años. Peso, talla, índice de masa corporal (IMC), circunferencia del brazo (CB), EMAP, grasa corporal, masa libre de grasa (MLG), índice de masa libre de grasa (IMLG), maduración sexual, tiempo de actividad física y color de piel fueron juzgado. EMAP se asoció con variables categóricas mediante pruebas de Mann-Whitney o Kruskal-Wallis y se correlacionó con variables antropométricas mediante la correlación de Spearman. Se utilizó regresión lineal con EMAP como variable dependiente y el resto de variables como predictores. El análisis de los datos se realizó mediante el software SPSS® (versión 17.0) con un nivel de significancia del 5%. Resultados: se evaluaron 828 adolescentes, 57,6% mujeres, con una edad media de 16,13 ± 1,20 años. EMAP tuvo un valor promedio de 18.0 mm en mujeres y 21.0 mm en hombres. La medida fue mayor en varones, en estadios más avanzados de maduración sexual, sobrepeso y practicantes de actividad física. Presentó una correlación moderada con MLG, IMLG, grasa corporal y CB. En el modelo final de regresión lineal múltiple para mujeres, las variables CB y grasa corporal explican el 20,1%; para los hombres, las variables CB y MLG explican el 30,5% de la variabilidad EMAP. Conclusión: Se recomienda que EMAP se utilice de forma complementaria en la valoración nutricional de adolescentes

Estabelecimento in vitro e micropropagação de maracujá silvestre (Passiflora foetida L.) In vitro establishment and micropropagation of Passiflora foetida L.

Entre as espécies do gênero Passiflora, a P. foetida L. apresenta a maior variabilidade genética e tem grande importância medicinal, pois é usada no tratamento de doenças como asma, icterícia, e na forma de emplastros, para as erisipelas e doenças de pele com inflamação. Portanto, são necessários estudos que visem a micropropagação e conservação. As sementes de P. foetida L. apresentam dormência e muitas vezes, levam alguns meses para germinar, produzindo mudas desuniformes e de baixo vigor. Neste sentido, a cultura de tecidos apresenta-se como uma forma alternativa a propagação. Assim, o objetivo do trabalho foi estabelecer e micropropagar P. foetida L., para formação de um banco de germoplasma. Para tanto, sementes foram escarificadas, desinfestadas e inoculadas em meio MS(½) sem reguladores de crescimento e cultivados por 66 dias. Explantes de hipocótilos obtidos de plantas germinadas in vitro, foram cultivados no mesmo meio suplementado com 1,0 mg L-1 de BAP. Na fase de estabelecimento, 45% dos explantes brotaram e formaram gemas axilares. 88,9% dos explantes de hipocótilo induziram brotação e 11,1% produziram calos. Plântulas regeneradas com 1,82 cm de altura, com raízes foram aclimatadas.<br>Among the species of the genus Passiflora, P. foetida L. presents highest genetic variability and also great medicinal importance. This species is used in the treatment of diseases such as asthma, jaundice, and in the form of poultices for erysipelas and skin diseases with inflammation. Therefore, studies are needed to preserve them. Its seeds present dormancy and often take several months to germinate. The tissue culture is a alternative form to propagate species. The objective was to establish and micropropagation P. foetida L., and create a germplasm bank. Seeds were scarified, disinfected, and inoculated on MS medium (½) without regulators for 66 days. Hypocotyls explants obtained of seedlings in vitro germinated were transferred and placed in the same medium supplemented with BAP (1,0 mg L-1). In the establishment phase of 45% of the explants sprouted and formed axillary buds. 88,9% of hypocotyl explants induced shoots and 11,1% produced callus. Seedling measuring 1,82 cm length and rooted were acclimatized