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- ItemAcesso aberto (Open Access)Associação entre zumbido e hipertensão arterial(Universidade Federal de São Paulo (UNIFESP), 2015-10-28) Figueiredo, Ricardo Rodrigues [UNIFESP]; Penido, Norma de Oliveira [UNIFESP]; http://lattes.cnpq.br/7060786297081212; http://lattes.cnpq.br/4011513433025198; Universidade Federal de São Paulo (UNIFESP)Introdução: O zumbido, a percepção de um ruído não associado a um estímulo acústico externo, é considerado pela maioria dos autores como um sintoma de origem multifatorial. Uma revisão sistemática sobre a associação entre zumbido e hipertensão arterial sistêmica (HAS) retornou indícios de uma associação positiva, sem que se tenha encontrado uma análise detalhada do tema. Objetivos: Verificar a presença e as características do zumbido nos pacientes hipertensos. Verificar diferenças no impacto causado pelo zumbido, bem como em suas características psicoacústicas, em pacientes normo e hipertensos e avaliar a associação entre a presença de zumbido e as diversas medicações antihipertensivas utilizadas. Método: Estudo caso-controle transversal, comparando dois grupos de indivíduos, com e sem zumbido, em um total de 284 indivíduos (144 no grupo de casos e 140 no grupo-controle). Também foram comparadas características demográficas, clínicas, audiométricas e psicoacústicas do zumbido entre pacientes normo e hipertensos. Resultados: A prevalência encontrada de hipertensão nos pacientes com zumbido foi de 44,4% contra 31,4% em indivíduos sem zumbido (p=0,024). A idade dos pacientes com zumbido e HAS foi significativamente maior do que a idade dos pacientes com zumbido sem HAS (mediana de 66 do grupo com zumbido contra 52,5 do grupo sem zumbido, p=0,0001). Foram encontradas associações positivas com a presença de zumbido nos pacientes em uso de inibidores da enzima de conversão da angiotensina ( p=0,006), diuréticos tiazídicos (p<0,0001), diuréticos poupadores de potássio ( p=0,016) e bloqueadores de canais de cálcio (p=0,004). Conclusões: Existe associação entre hipertensão arterial sistêmica e zumbido. Essa associação é intensificada pelo aumento da idade, sem ser influenciada pelos fatores sexo e raça. Existe tendência estatística de associação entre a presença concomitante de HAS e diabetes mellitus e a presença de zumbido. O consumo de cafeína é maior nos pacientes sem zumbido. O uso de diuréticos, inibidores da enzima de conversão da angiotensina e bloqueadores dos canais de cálcio foi mais prevalente nos pacientes com zumbido. Não há diferenças entre as características audiométricas, psicoacústicas e o incômodo gerado pelo zumbido entre hipertensos e normotensos
- ItemSomente MetadadadosThe association between the Framingham risk score and sleep: A São Paulo epidemiological sleep study(Elsevier B.V., 2012-06-01) Cintra, Fátima Dumas [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Santos-Silva, Rogerio [UNIFESP]; Andersen, Monica Levy [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]; Poyares, Dalva [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Sleep is an important factor in the maintenance of cardiovascular integrity. It seems that cardiovascular injury and sleep impairment is another chicken or egg puzzle and we hypothesized that the higher the cardiovascular risk factors the higher the sleep impairment. Therefore, the goal of this study is to analyze the sleep profile of a general population based on cardiovascular risk stratification.Methods: This population-based survey used a probabilistic three-stage cluster sample of São Paulo inhabitants to represent the population. A sample size of 1056 volunteers was defined in order to allow for prevalence estimates with 3% precision. From the 1101 selected and interviewed participants, a complete full-night polysomnogram (PSG) was performed in 1042 participants as well as clinical evaluation and blood samples analyses to assess Framingham risk score.Results: Nine hundred four subjects were classified according the Framingham score and were included in the analyses. A total of 91.7% were classified as a low risk, 5.8% in the intermediate, and 2.4% in the high risk groups according to Framingham score. All polisomnographic parameters were different between groups, except those related to REM sleep parameters. AHI were greater in the high risk compared to the intermediate and low risk groups (23.9 +/- 2.8; 17.7 +/- 1.8; 7.2 +/- 0.5, respectively, p < 0.001), as well as a lower total sleep time in minutes (295.3 +/- 16.2; 338.4 +/- 10.2; 347.4 +/- 2.6, respectively, p = 0.01). Sleep efficiency in percentage also exhibits a reduction between groups (67.6 +/- 2.5; 78.4 +/- 1.6; 82.9 +/- 0.4, respectively, p < 0.001). After adjustment for confounder factors age (p < 0.001) and sleep efficiency (p = 0.06) remained strongly associated with high risk population.Conclusion: High Framingham risk score was associated with poor sleep efficiency and aging. (C) 2012 Elsevier B.V. All rights reserved.
- ItemAcesso aberto (Open Access)Avaliação da maturidade pulmonar fetal em gestações de alto risco(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 1998-07-01) Taborda, Wladimir [UNIFESP]; Almeida, Maria Fernanda Branco de [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Bertini, Anna Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The objective was to evaluate the accuracy of the foam stability test, lecithin/sphingomyelin (LS) ratio, presence of phosphatidylglycerol (PG) and lung profile (L/S ratio > 1.7 and PG present simultaneously) in 121 consecutive high-risk gestations at the São Paulo Hospital from January 1990 to January 1995. Delivery occurred within 3 days of fetal lung maturation testing. This is a prospective study in which the sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of all the tests were determined. Neonatal respiratory outcome and amniocentesis results were stratified by gestational age for comparison. The distribution of the studied population according to maternal pathology was diabetes mellitus (48), hypertensive disorders (41), Rh isoimmunization (14) and miscellaneous (18). Respiratory distress (RD) was present in 33 infants (27.2%), mainly in the diabetic group. There was no false negative using lung profile (all patients) and foam stability tests among hypertensive pregnancies (specificity 100%), but there were about 20% to 50% false positives in the other tests. Overall, all four tests had a low PPV: 23% for foam test, 51% for L/S ratio, 63% for PG, 61% for lung profile, and high NPV: 92% for foam test, 88% for L/S ratio, 89% for PG and 100% for lung profile. All tests had less accuracy in the diabetic pregnant women. This study shows that the presence of PG and L/S ratio > 1.7 in the amniotic fluid of high-risk pregnancies confirms maturity with a very low risk to develop RD and that the foam stability test was useful as a first-line test to predict the absence of surfactant-deficient respiratory distress syndrome, particularly in hypertensive pregnant women.
- ItemAcesso aberto (Open Access)Efeitos crônicos do Método Pilates sobre as respostas cardiorrespiratórias e metabólicas em mulheres hipertensas controladas(Universidade Federal de São Paulo, 2021-11-24) Barbosa, Rodrigo Fernandes [UNIFESP]; Medeiros, Alessandra [UNIFESP]; Dourado, Victor Zuniga [UNIFESP]; http://lattes.cnpq.br/1919368500743497; http://lattes.cnpq.br/0071198026371230; http://lattes.cnpq.br/2553205841897043; Universidade Federal de São Paulo (UNIFESP)O Método Pilates (MP) tem sido citado como uma modalidade de exercício resistido. Seus benefícios são bem estudados no músculo esquelético, mas sua dinâmica de execução e novos achados, demonstram que ele pode possuir um componente cardiorrespiratório muito importante. O principal objetivo deste estudo foi avaliar o efeito do MP nas variáveis cardiorrespiratórias e metabólicas em hipertensas controladas. Foram avaliadas 22 hipertensas (51,7 ± 5,9 anos) que participaram de um protocolo de intervenção com o MP em solo e aparelhos, sistema básico, durante 15 semanas (42sessões). Todas as voluntárias assinaram o termo de consentimento livre e esclarecido (TCLE) e nosso estudo foi aprovado pelo comitê de ética em pesquisa da UNIFESP (CAEE: 08830819.1.0000.5505). Todas as variáveis foram avaliadas nos momentos pré e pós intervenção. Foi realizado cálculo amostral Post Hoc (poder=0,987). A análise estatística foi realizada através do Modelo de Equações de Estimações Generalizadas (GEE) e magnitude do efeito através do Cohen’s d. Os resultados obtidos, em média e desvio padrão (M±DP pré vs M±DP pós), e se houve diferença estatística (*), foram: estatura (158,90±4,82 vs 160,11 ± 4,73*), massa corporal 69,28±6,94 vs 68,71±6,97), índice de massa corporal (IMC= 27,44±2,24 vs 26,80 ± 2,47*), circunferência da cintura (CC= 85,43±4,93 vs 83,34±5,33*), circunferência do quadril (CQ= 103,86±5,86 vs 102,01±5,43*), relação cintura-quadril (RCQ= 0,82±0,05 vs 0,81±0,04*), relação cintura-estatura (RCEst= 0,537±0,032 vs 0,520±0,036*), flexibilidade (20,86±9,81 vs 28,37±8,95*), força da mão direita (22,65±3,81 vs 26,02±3,84*), força da mão esquerda (21,34±4,32 vs 25,57±3,22*), glicemia de jejum (100,77±11,08 vs 94,77±10,63*), colesterol total (CT= 222,09±36,26 vs 192,81±33,48*), frações HDL (52,59±10,09 vs 55,54±9,68) e LDL (142,95±36,06 vs 117,37±33,89*), triglicérides (TG= 143,09±47,44 vs 118,63±39,76*) e hemoglobina glicada (HbA1c= 5,72±0,41 vs 5,42±0,43*), pressão inspiratória máxima (PIMax= 43,18±15,19 vs 121,36±24,27*), pressão expiratória máxima (PEMax= 71,36±14,86 vs 136,82±26,17*), ventilação pulmonar minuto no pico (VE= 43,82±9,81 vs 52,07±10,01*), no primeiro limiar (VE LT= 20,29±4,05 vs 26,95±5,63*) e no segundo limiar (VE RC= 33,85±6,12 vs 45,21±7,01*), reserva ventilatória (RV= 52,41±13,36 vs 44,00±11,89*), volume corrente (VC= 1,32±0,25 vs 1,49±0,26*), capacidade vital forçada (CVF= 2,92±0,36 vs 3,05±0,35*), volume expiratório forçado no primeiro segundo (VEF1= 2,37±0,40 vs 2,44±0,33), pico de fluxo expiratório (PFE= 5,77±1,13 vs 6,57±0,88*), razão entre o volume expiratório forçado em % da CVF (FEV1/CVF%= 79,11±7,53 vs 82,47±5,04*), fluxo expiratório médio forçado (FEF 25-75%= 2,34±0,84 vs 2,67±0,85*), frequência cardíaca de repouso (FC= 71,77±10,63 vs 67,64±9,74*), no pico do exercício (FC Max= 146,14±21,40 vs 154,50±16,12*), no 1º limiar ventilatório (FC LT=106,18±18,22 vs 115,95±16,87*) e no 2º limiar ventilatório (FC RC= 136,41±21,09 vs 144,50±20,42*) pressão arterial sistólica de 24 horas (PAS= 124,29±10,61 vs 117,18±6,99*), pressão arterial diastólica de 24 horas (PAD= 80,63±7,42) vs 76,74±6,46*), pressão arterial média (PAM= 100,75±8,62 vs 95,95±5,56*), potência no primeiro limiar ventilatório (Power LT= 38,86±12,33 vs 62,95±12,76*) e no segundo limiar ventilatório (Power RC= 80,62±18,27 vs 104,30±13,36*), consumo máximo de O2 absoluto no pico (VO2= 1232,59±285,36 vs 1352,91±219,68*), no primeiro limiar ventilatório (VO2 LT= 764,36±152,96 vs 951,09±169,72*) e no segundo limiar ventilatório (VO2 RC= 1068,45±205,09 vs 1296,05±224,71*), consumo máximo de O2 relativo no pico (VO2/kg= 17,94±3,71 vs 19,76±3,11*), no primeiro limiar ventilatório (VO2/Kg LT= 11,23±2,03 vs 13,89±2,16*) e no segundo limiar (VO2R/Kg RC= 16,00±2,95 vs 19,20±3,01*), pressão expirada de O2 (PetO2= 115,09±3,54 vs 117,91±2,87*), pressão expirada de CO2 (PetCO2= 38,00±3,04 vs 35,64±2,58*), equivalente ventilatório para o O2 (VE/VO2= 35,90±4,80 vs 39,85±4,50*), equivalente ventilatório para o CO2 (VE/VCO2= 31,31±3,00 vs 33,77±2,75*), VE/VCO2 slope (27,50±4,17 vs 25,77±3,63*) e OUES (1518,23±360,22 vs 1690,36±378,90*). Concluímos que 15 semanas do MP em solo e equipamentos foi capaz de melhorar a aptidão cardiorrespiratória e metabólica de hipertensas.
- ItemAcesso aberto (Open Access)Efeitos do treinamento físico resistido nas variáveis psicobiológicas de idosos hipertensos(Universidade Federal de São Paulo (UNIFESP), 2018-12-05) Lima, Luiza Fiorotto [UNIFESP]; Medeiros, Alessandra [UNIFESP]; Montrezol, Fábio Tanil [UNIFESP]; http://lattes.cnpq.br/5501826661634533; http://lattes.cnpq.br/0071198026371230; http://lattes.cnpq.br/9254879907912394; Universidade Federal de São Paulo (UNIFESP)A expectativa de vida da população está em constante ascensão, aumentado assim o número de indivíduos idosos no Brasil e no mundo. O processo de envelhecimento é caracterizado por alterações fisiológicas e psicológicas, acarretando em maior vulnerabilidade para a incidência de doenças crônicas, como a hipertensão arterial. A hipertensão arterial é uma doença multifatorial e silenciosa que consiste na sustentação elevada dos níveis pressóricos, se tornando fator de risco para outros eventos cardiovasculares. Assim, se torna necessário o tratamento anti-hipertensivo, o qual pode ser farmacológico ou não-farmacológico. O exercício físico é um importante componente do tratamento da hipertensão arterial. No entanto, existem poucos estudos demonstrando os efeitos do treinamento resistido sobre a pressão arterial de idosos. Do ponto de vista psicológico, a depressão é o evento psiquiátrico mais comum entre o grupo populacional de idosos, sendo desencadeada por fatores genéticos, eventos vitais, mudança no estilo de vida, doenças incapacitantes e abandono de atividades diárias. Sintomas como variação de humor e má qualidade do sono estão intimamente ligadas a essas alterações psicológicas. Assim, o presente estudo avaliou os efeitos dos exercícios resistidos sobre variáveis psicobiológicas de idosos hipertensos. Ao todo, 20 idosos foram submetidos a uma intervenção de 16 semanas, sendo 3 encontros semanais de 60 minutos de exercício físico resistido e a aplicação pré e pós intervenção dos questionários Escala Geriátrica de Depressão, Variação de Humor de Brunel e Índice de Qualidade de Sono de Pittsbugh. Após desistência, foram analisados os resultados de 10 voluntários sendo 7 do grupo treinado e 3 do grupo controle. Apesar de os resultados demonstrarem melhora estatisticamente significante no ganho de força, não foram encontradas alterações nas demais avaliações. Assim, pode-se concluir que o protocolo de 16 semanas de treinamento físico resistido, apesar de ter promovido aumento de força muscular, não promoveu alterações significantes nas variáveis psicobiológicas estudadas de idosos hipertensos.
- ItemSomente MetadadadosGeometric patterns of left ventricular hypertrophy and electrocardiography(Elsevier B.V., 2011-09-15) Costa, Francisco de Assis [UNIFESP]; Nogueira Bombig, Maria Teresa; Lima, Valter Correia de [UNIFESP]; Souza, Dilma de; Luna Filho, Braulio; Fonseca, Francisco Helfenstein [UNIFESP]; Oliveira Izar, Maria Cristina de; Costa, William da [UNIFESP]; Perez Riera, Andres Ricardo; Povoa, Rui [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
- ItemAcesso aberto (Open Access)Hipertensão arterial na infância(Sociedade Brasileira de Pediatria, 2003-06-01) Salgado, Cláudia Maria [UNIFESP]; Carvalhaes, João Tomás de Abreu [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Goiás Departamento de Pediatria e Puericultura e da Liga de Hipertensão ArterialOBJECTIVE: to critically review recent medical literature, focusing on practical features that are relevant for diagnosis and outpatient treatment of pediatric hypertension. SOURCES OF DATA: classic articles and systematic review of recent literature through electronic search of Medline and Lilacs databases over the last 10 years, using the key words arterial hypertension, newborns, infants, preschool, children and adolescents. Those articles containing relevant information were selected. SUMMARY OF THE FINDINGS: arterial hypertension and obesity are public health problems all over the world. Essential arterial hypertension in adults begins in childhood and can also be secondary to several diseases. Pediatricians must measure the arterial pressure of the patients in a proper manner. When arterial hypertension is detected, it must be investigated in order to be adequately treated. The investigation depends on the age and the rising degree of the arterial pressure, taking into consideration the cause of hypertension, as well as its effects on target organs. CONCLUSIONS: the early recognition of an abnormal arterial pressure followed by adequate investigation and treatment are required to reduce the cardiovascular and renal morbidity/mortality.
- ItemAcesso aberto (Open Access)Imagem corporal, índice de massa corporal, perímetro da cintura, alteração da pressão arterial e intolerância à glicose entre os povos indígenas do Xingu, Brasil(Universidade Federal de São Paulo (UNIFESP), 2016-12-05) Santos, Kennedy Maia dos [UNIFESP]; Gimeno, Suely Godoy Agostinho [UNIFESP]; http://lattes.cnpq.br/9976167885272728; http://lattes.cnpq.br/9976167885272728; Universidade Federal de São Paulo (UNIFESP)Objective: To assess body self-image, nutritional status and the cutoff points of body mass index (BMI) and waist circumference (WC) and the association with alteration in blood pressure (BP) and glucose intolerance (GI) among indigenous peoples of the Xingu, Brazil. Methods: Cross-sectional study that evaluated data from 131 individuals of Khisêdjê ethnicity with twenty years or more and 919 natives in the same age group, belonging to fourteen ethnic groups in the Xingu Indigenous Park (PIX), including Panará, who lived in the PIX up 1997. Data collection was carried out in the indigenous villages by trained professionals at different times: in 1999 (Suyá/Khisêdjê), 2000-2002 (ethnic groups of the Upper Xingu), 2006-2007 (Panará) and 2010 - 2011 (Khisêdjê). We collected data on BMI by weight and height, WC, blood pressure and fasting glucose, body self-image (only Khisêdjê) and physical activity (only Khisêdjê). Data analysis was performed using the chi-square, Student's t test, Kappa statistics, prevalence ratios by Poisson regression. To identify cutoff points of BMI and WC from which there was an increased prevalence of alteration in blood pressure and glucose intolerance was used the logistic regression, calculating the sensitivity, specificity and percentage of individuals correctly classified by BMI and WC according to percentiles 25, 50, 75, 90 and 95 and ROC curve analysis (receiver operating characteristic) to assess the accuracy of tests. Results: Among the Khisêdjê, satisfaction with body image was 61.8%, with no difference between sexes. There was good agreement between real and ideal self-image among men and women (p<0.001) but low correlation between real and ideal self-image and nutritional status. There was higher prevalence of dissatisfaction overweight among individuals with central obesity (PR = 2.76 and 95% CI: 1.10-6.92), overweight (PR = 2.77 and 95% CI: 1.19-6.47), among those with GI (PR = 2.44 and 95% CI: 1.19-5.01) and among subjects with average performance in trunk flexion test (PR = 7.53 95% CI: 1.37-41.31). In the analysis including indigenous PIX, the percentages of overweight and obesity were 39.7% and 7.8% respectively. The prevalences of hypertension and diabetes mellitus were 5.5% and 1.2%, respectively. There has been no trend of increased prevelence of GI and alteration in blood pressure according to the increase in WC values. As for BMI values between 32.0 and 32.9 kg/m2 were associated with higher prevalence of GI (OR = 12.26, 95% CI 2.25-66.65). Also, BMI values from 30.0 to 30.9 kg/m2 (OR = 3.59, 95% CI 1.21-10.61) and from 31.0 to 31.9 kg/m2 (OR = 6. 05, 95% CI 1.53-23.86) were associated with the occurrence of alteration in BP. The values of the X and Y axes regarding the intersection between the sensibility and sensitivity curves in predicting the GI for the WC test were respectively 89 cm and 0.54 for females, and 84.3 cm and 0.54 for males; in prediction of alteration BP values were respectively 85.7 cm and 0.52 for both sexes. As for BMI, the values were 24.9 kg/m2 and 0.53 in prediction of alteration BP and 25 kg/m2 and 0.53 in predicting GI. Conclusions: Despite the high prevalence of overweight identified between men and central obesity among women, satisfaction with body image was high in both sexes. These findings, together with the observed low correlation between nutritional status and real and ideal self-image suggests that it is possible that among the Khisêdjê, the ideal body shape is the one with the larger body size compared to the idealized in Western populations. The best cutoff points for discriminating the presence of GI and alteration BP among PIX Indians were close to recommended for the WC and similar to those recommended for BMI. However, both WC and BMI had low discriminatory power in predicting two outcomes in question.
- ItemSomente MetadadadosMicropartículas e doença cardiovascular hipertensiva: efeitos do tratamento anti-hipertensivo e hipolipemiante em micropartículas circulantes(Universidade Federal de São Paulo (UNIFESP), 2018-04-26) Massunaga, Nayara Dantas [UNIFESP]; Fonseca, Francisco Antonio Helfenstein [UNIFESP]; França, Carolina Nunes; http://lattes.cnpq.br/6580677601405775; http://lattes.cnpq.br/2393476657163442; http://lattes.cnpq.br/1470279541149956; Universidade Federal de São Paulo (UNIFESP)Introduction: Patients with hypertension on stage 2 are usually treated with a combination of two antihypertensive drugs. However, the combination including a diuretic or a calcium channel blocker may determine different effects on vessels, despite similar decrease on blood pressure. Objectives: This study aimed to compare the effects of amlodipinebased treatment with that obtained by hydrochlorothiazide monotherapy or sequentially combined with valsartan and addition and subsequent withdrawal of rosuvastatin on circulating microparticles. An exploratory analysis was also performed on the effects on central blood pressure parameters and vascular compliance. Methods: Prospective, randomized, openlabel with blinded outcomes study included patients of both sexes on stage 2 hypertension who remained for four weeks on the use of amlodipine (n = 24) or hydrochlorothiazide (n = 22) monotherapy. At the end of this period, blood samples were collected for protocol analyses and blood pressure data were obtained. Three sequential fourweek periods were followed at the end of which the mentioned laboratory and blood pressure parameters were obtained. In the second period valsartan 160 mg was added in both arms of the study, in the third rosuvastatin 20 mg and in the last rosuvastatin was suspended, and the antihypertensive treatment was maintained for four weeks. Monocytic, endothelial and platelet microparticles were quantified by flow cytometry and specific antibodies at the end of each intervention period. Results: Biochemical parameters and peripheral blood pressure were similar between the two groups at the end of treatment as monotherapy, as well as throughout the study. However, central pressure parameters were lower in the anlodipine arm from the addition of valsartan (p = 0.002) and did not change in the hydrochlorothiazide arm. The pulse wave velocity was not changed in both treatment groups. Circulating monocytic microparticles remained unchanged in the amlodipine group, but increased in the hydrochlorothiazide group (p = 0.02). For the circulating endothelial microparticles, a reduction with the hydrochlorothiazide group was observed throughout the study. With regard to circulating platelet microparticles, a greater amount was observed after suspension of rosuvastatin in the anlodipine arm. Conclusions: The choice of combination treatment based on amlodipine or hydrochlorothiazide has different effects on both circulating microparticles and synergism with other drugs. In addition, they show important differences in central hemodynamic parameters. These findings suggest differences in cardiovascular protection.
- ItemAcesso aberto (Open Access)Modelos experimentais de resistência à insulina e obesidade: lições aprendidas(Sociedade Brasileira de Endocrinologia e Metabologia, 2006-04-01) Cesaretti, Mario Luís Ribeiro [UNIFESP]; Kohlmann Junior, Osvaldo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)For better understanding the role of each element involved in the physiopathology of obesity and insulin resistance, researchers can use experimental models, which may in controlled manner evaluate the participation of each element on the obesity and insulin resistance and provide information for better understanding the physiopathology and treatment of obesity and insulin resistance. Experimental obesity and insulin resistance can be due to a deficient response to leptin, secondary to hypoleptinemia and/or mutations on leptin receptor, by modifications on insulin receptor, deletion or diminished insulin signal transduction, enhancement of the effects of orexigen peptides and/or diminution of anorexigen peptides actions on hypothalamus, as well as secondary to arterial hypertension, as in the spontaneously hypertension. Obesity and insulin resistance can also be induced by glucocorticoid excess, frutose enriched and cafeteria diet and due to hypothalamus lesions induced by neonatal administration of monossodium glutamate.
- ItemAcesso aberto (Open Access)Obesidade, hipertensão arterial e suas influências sobre a massa e função do ventrículo esquerdo(Sociedade Brasileira de Endocrinologia e Metabologia, 2000-02-01) Ribeiro Filho, Fernando Flexa [UNIFESP]; Rosa, Eduardo Cantoni [UNIFESP]; Faria, Alessandra Nunes [UNIFESP]; Lerário, Daniel D.g. [UNIFESP]; Ferreira, Sandra Roberta Gouvea [UNIFESP]; Kohlmann Junior, Osvaldo [UNIFESP]; Zanella, Maria Teresa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)In order to evaluate the influences of obesity and hypertension on left ventricular mass (LVM), we studied 121 women stratified into 4 groups: normotensive non-obeses (n = 25), hypertensive non-obeses (n = 30), normotensive obeses (n = 24) and hypertensive obeses (n = 42) according to their anthropometric and echocardiographic parameters and ambulatory blood pressure monitoring (ABPM). Hypertensive obeses showed higher LVM than the other groups - normotensive non-obeses, hypertensive non-obeses and normotensive obeses (167 ± 38.8 vs. 113 ± 26.4; vs. 133 ± 26.5; vs. 132 ± 29.2g; respectively, p < 0.05) ond higher diameter of left atrium (LA) as compared to the non-obese groups with or without hypertension (36 ± 4.3 vs. 33 ±5.1; vs. 35 ± 3.9mm; p < 0.05, respectively). Normotensive obese patients showed similar LVM to the hypertensive non-obeses (133 ± 26.5 vs. 132 ± 29.5g; NS) and increased LA as compared to the normotensive non-obeses (35 ± 3.9 vs. 31 ± 4.6mm; p < 0.05). A correlation between the waist circumference and waist-to-hip ratio with the blood pressure levels obtained by the ABPM, as well as between these measurements with the echocardiographic parameters, which reflect cardiac mass; body mass index only showed to be correlated to the LA diameter. The adjustment of LVM by the height instead of body surface resulted in an increase on the prevalence of LV hypertrophy among obese patients (10.6 vs. 36.7%, p < 0.01), but not among non-obeses. Lack of nocturnal blood pressure fall assessed by ABPM (non-dipper) was more prevalent among obese patients with or without hypertension; however, non-dipper hypertensive obese patients did not differ from the dippers according to the LVM. Our data demonstrate that obesity associated to hypertension provoke a more pronounced increase in LVM as compared to the condition separately. We also conclude that obese patients showed increased frequency of abnormal 24-hr blood pressure profile, characterized by decreased tensional drop during sleep.