Navegando por Palavras-chave "Disfunção Endotelial"
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- ItemSomente MetadadadosAvaliação da vasodilatação mediada por fluxo artéria braquial e dos fatores de risco cardiovascular em crianças e adolescentes com doença renal crônica(Universidade Federal de São Paulo (UNIFESP), 2019-04-04) Bocaletti, Ana Paula [UNIFESP]; Ajzen, Sergio Aron [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Cardiovascular morbidity and mortality are the leading causes of death in children and young adults with advanced chronic kidney disease (CKD) diagnosed in childhood. Individuals with impairment of endothelial function and carotid intima-media thickness have an increased cardiovascular risk in the future. High resolution ultrasonography is a useful noninvasive method to investigate subclinical atherosclerosis by measuring the intima-media thickness of carotid artery and evaluating the brachial flow-mediated vasodilation (FMD). Objectives: Estimate the prevalence of FMD reduction in pediatric patients with advanced chronic kidney disease and verify the association between FMD reduction, clinical, anthropometric, laboratory parameters and intima-media thickness. Methods: In this cross-sectional study 55 patients (60% male), age 6.2-17.4 years, 43 with non-dialysis CKD and 12 on chronic dialysis were included in the analysis. FMD was evaluated 60 seconds after cuff release and was reduced when less or equal to 5%, compared with the baseline parameters. Intima-media thickness of carotid artery complex was performed on the posterior wall, on the longitudinal axis. Results: The prevalence of FMD reduction (≤ 5%) at 60 seconds was 41.8% (95% CI). Systemic arterial pressure (p = 0.041) and hemodialysis treatment (p<0,001) was significant correlated was with FMD reduction, as the glomerular filtration rate (p = 0.001) in patients on conservative treatment. The correlation between FMD reduction and carotid ECMI were not statistically significant. No statistical significance was observed between reduction of vasodilatation with sex, age, etiology of renal disease, time of diagnosis of renal disease, conservative or dialytic treatment, use of medications and changes in the serum biochemical levels studied. Conclusions: The prevalence of endothelial disfunction due to brachial FMD reduction was 41.8% in pediatric patients with chronic kidney disease. There was significant correlation between FMD reduction and glomerular filtration rate, blood pressure (BP) and hemodialysis. BP and hemodialysis were independently associated with FMD reduction. There was no significant correlation between carotid ECMI (morphological parameter) and FMD reduction (functional parameter). No statistical significance was observed between FMD reduction and renal disease etiology, time of diagnosis of renal disease, conservative or dialytic treatment, use of drugs and serum biochemical levels studied.
- ItemAcesso aberto (Open Access)Estudo da associação da vitamina D e do inibidor da 3- hidroximetilglutaril coa redutase na função endotelial em portadores de hipertensão arterial: um estudo duplo-cego, placebo-controlado(Universidade Federal de São Paulo (UNIFESP), 2020-01-30) Kohatsu, Anderson Simabuco [UNIFESP]; Batista, Marcelo Costa [UNIFESP]; http://lattes.cnpq.br/0614350233628814; http://lattes.cnpq.br/6572506670639242; Universidade Federal de São PauloHypertension is considered a substantial trouble in public health. Because it is an easily diagnosed disease, but difficult to control and follow up, it needs special attention especially due to its association with cardiovascular outcomes and the great impact on morbidity and mortality of the population. The biological vulnerability of an inflammatory vascular environment can lead to impaired vascular regulation linked to a process of endothelial dysfunction and, consequently, a higher risk of developing hypertension. In this scenario, there is growing evidence of the benefits of Vitamin D and the 3- Hydroxymethylglutaryl CoA Reductase Inhibitor (Statin) in reducing inflammation and improving endothelial function through pleiotropic effects. However, the number of intervention studies is limited and raises questions about causal relationship, long-term interaction and benefits of these drugs in blood pressure control. The present double-blind, placebo-controlled study using a 2x2 factorial design proposals to evaluate the effect of the association between Vitamin D and Statin, compared with their respective placebos, on blood pressure, mensuration of dimethyl arginine-asymmetric endothelial function (ADMA) and inflammatory profile in patients with hypertension. Sixty eligible subjects were randomized to 4 groups of 15 patients at a 1: 1: 1: 1 ratio to receive simvastatin 40mg/day or vitamin D 200,000Ui starting dose followed by 100,000Ui/month (4 doses) alone or simvastatin with vitamin D or placebos treatment over 22 weeks. Throughout the period, monthly consultations were performed with monitoring of clinical parameters including blood pressure and antihypertensive adjustments in a stepwise manner according to protocol. Additionally before the intervention and at the end of the study, blood pressure was also measured by ambulatory blood pressure monitoring (ABPM) and laboratory tests including serum ADMA and C-reactive protein measurements from all participants. The results obtained with the intervention did not determine changes in systemic blood pressure levels at the end of follow-up, either by ABPM or office blood pressure, nor did it change the values of asymmetric dimethylarginine and C-reactive protein. Thus, we demonstrated that vitamin D supplementation and simvastatin treatment, alone or in combination, over 22 weeks in hypertensive patients with low cardiovascular risk did not lead to a reduction in blood pressure or changes in variables related to endothelial function and inflammation.
- ItemSomente MetadadadosEstudo da função endotelial pela Dimetil Arginina assimétrica em portadores de hipertensão arterial resistente(Universidade Federal de São Paulo (UNIFESP), 2019-05-30) Beraldo, Daniel De Oliveira [UNIFESP]; Batista, Marcelo Costa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: We conducted a subanalysis of the ReHOT (Resistant Hypertension Optimal Treatment) study to evaluate the association between endothelial dysfunction and resistant hypertension in a population of patients treated in a staged fashion for hypertension. Methods: One hundred and three hypertensive patients were followed for 6 months and participated in 7 visits (V0-V6) 28 days apart. There was a first phase (V0-V3) of antihypertensive adjustment with 3 drugs and determination of resistant hypertension and a second randomized phase (V3-V6) of treatment with a fourth drug (clonidine or spironolactone) in the hypertensive patients characterized as resistant. Results: Of the 103 patients included, 86 (83.5%) underwent the randomization visit (V3), 71 were characterized as non-resistant hypertensives (82.5%) and 15 as resistant hypertensives (17.5%). Serum asymmetric dimethylarginine was shown to be an independent predictor of resistant hypertension after adjustment for multiple variables (OR: 11.42, 95% CI: 1.02 - 127.71, p = 0.048) and, in addition, there was a reduction in blood pressure levels and asymmetric dimethylarginine values during follow-up with a positive correlation in both groups and a greater reduction in the group of resistant hypertensives. Conclusion: We demonstrated that asymmetric dimethylarginine was an independent predictor of resistant hypertension, and we observed that the improvement in blood pressure levels obtained with the treatment was proportional to the reduction in asymmetric dimethylarginine values, suggesting a complementary role of asymmetric dimethylarginine not only as a stratification tool for the occurrence of resistant hypertension, but also as a possible therapeutic target in this population.