LUIZ APARECIDO BORTOLOTTO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
20 resultados
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- Shorter History of Hypertension as a Predictor of Hypertension Remission after 3-years of Bariatric Surgery: Data from the GATEWAY Trial(2023) OLIVEIRA, Juliana D. D.; SCHIAVON, Carlos A. A.; OLIVEIRA, Julia S. S.; SANTOS, Renato N. N.; DAMIANI, Lucas P. P.; IKEOKA, Dimas; SANTUCCI, Eliana V. V.; MACHADO, Rachel Helena V.; BORTOLOTTO, Luiz A. A.; BERWANGER, Otavio; CAVALCANTI, Alexandre B. B.; DRAGER, Luciano F. F.Background Previous evidence explored predictors of hypertension (HTN) remission after bariatric but data are limited to observational studies and lack of ambulatory blood pressure monitoring (ABPM). This study was aimed to evaluate the rate of HTN remission after bariatric surgery using ABPM and to define predictors of mid-term HTN remission. Methods We included patients enrolled in the surgical arm of the GATEWAY randomized trial. HTN remission was defined as controlled blood pressure (< 130 x 80 mmHg) evaluated by 24-h ABPM while no need of anti-hypertensive medications after 36 months. A multivariable logistic regression model was used to assess the predictors of HTN remission after 36 months. Results 46 patients submitted Roux-en-Y gastric bypass (RYGB). HTN remission occurred in 39% (n = 14 out of 36 patients with complete data at 36 months). Patients with HTN remission had shorter HTN history than no remission group (5.9 +/- 5.5 vs. 12.5 +/- 8.1 years; p = 0.01). The baseline insulin levels were lower in patients who presented HTN remission, although not statistically significant (OR: 0.90; CI 95%: 0.80-0.99; p = 0.07). In the multivariate analysis, the HTN history (years) was the only independent predictor of HTN remission (OR: 0.85; 95% CI: 0.70-0.97; p = 0.04). Therefore, for each additional year of HTN history, the chance of HTN remission decreases by approximately 15% after RYGB. Conclusion After 3 years of RYGB, HTN remission defined by ABPM was common and independently associated with a shorter HTN history. These data underscore the need of early effective approach of obesity aiming greater impact in its comorbidities.
- Obstructive sleep apnea and hypertension-mediated organ damage in nonresistant and resistant hypertension(2023) CABRINI, Mayara L.; MACEDO, Thiago A.; CASTRO, Emerson; BARROS, Silvana de; AZAM, Indira; PIO-ABREU, Andrea; SILVA, Giovanio V.; LORENZI-FILHO, Geraldo; BORTOLOTTO, Luiz A.; DRAGER, Luciano F.The potential role of obstructive sleep apnea (OSA) in hypertension-mediated organ damage (HMOD) may be influenced by the presence of resistant hypertension (RH). Herein, we enrolled patients with hypertension from a tertiary center for clinical evaluation and performed a sleep study to identify OSA (apnea-hypopnea index >= 15 events/h) and a blinded analysis of four standard HMOD parameters (left ventricular hypertrophy [LVH], increased arterial stiffness [>= 10 m/s], presence of retinopathy, and nephropathy). RH was diagnosed based on uncontrolled blood pressure (BP) (>= 140/90 mmHg) despite concurrent use of at least three antihypertensive drug classes or controlled BP with concurrent use of >= 4 antihypertensive drug classes at optimal doses. To avoid the white-coat effect, ambulatory BP monitoring was performed to confirm RH diagnosis. One-hundred patients were included in the analysis (mean age: 54 +/- 8 years, 65% females, body mass index: 30.4 +/- 4.5 kg/m(2)). OSA was detected in 52% of patients. Among patients with non-RH (n = 53), the presence of OSA (52.8%) was not associated with an increased frequency of HMOD. Conversely, among patients with RH, OSA (51.1%) was associated with a higher incidence of LVH (RH-OSA,61%; RH + OSA,87%; p = 0.049). Logistic regression analysis using the total sample revealed that RH (OR:7.89; 95% CI:2.18-28.52; p = 0.002), systolic BP (OR:1.04; 95% CI:1.00-1.07; p = 0.042) and OSA (OR:4.31; 95% CI:1.14-16.34; p = 0.032) were independently associated with LVH. No significant association was observed between OSA and arterial stiffness, retinopathy, or nephropathy. In conclusion, OSA is independently associated with LVH in RH, suggesting a potential role of OSA in RH prognosis.
conferenceObject DEVELOPMENT AND IMPLEMENTATION OF THE E-CARE PORTAL HEALTH EDUCATION FOR HYPERTENSION(2017) GUERRA, Grazia Maria; WEN, Chao Lung; MOTTA, Raquel Acciarito; VIEIRA, Margarida M. S.; FISTAROL, Isabela Ribeiro Braga; OLIVEIRA, Jefferson Carlos de; BORTOLOTTO, Luiz AparecidoThe great challenge for the coming decades will be the improvement of therapy adherence for patients with hypertension, diabetes, and chronic diseases. Given the high treatment costs of these diseases for the Brazilian public health system, prevention and adherence become a priority. There are technology tools that can be used to improve communication between the health professional and the patient and thus enhance the effectiveness of the treatment. One of the many types of technology now available is education technology, which is an online repository of data providing a solid basis for health care professional-patient interface. Objective: The aim of this study was to report the building of the Health Education for Hypertension E-Care Portal. Method: This is a descriptive study of the effort that went into investigating adequate technology for an E-Care portal and building it. Three teams collaborated to make the website:the pedagogical team, relying on a research project entitled ""Therapy adherence through education technology applied to hypertensive patients"" carried out at the Heart Institute (InCor), University of Sao Paulo Medical School (FMUSP); the technological team, consulting with the Department of Telemedicine, FMUSP; and the graphic design team from the Distance Learning Nucleus, Sao Camilo University Center. Results: Creation of learning objects and interactions, such as videos with multi-professional interviews (nurse, nutritionist, psychologist, and physical trainer); debates among medical specialists (cardiologist, nephrologist, and neurologist); scripts for automated interactive behavioral situations resulting in an interactive questionnaire with computer-generated imagery; and scripts for three short films to induce behavior changes and therapy adherence by raising awareness: ""Loving others but not taking care of oneself is useless,"" ""Almost means not enough,"" and ""Overcoming obstacles to achieve quality of life."" The underlying technology was that of the virtual man. Also, 3D human body parts (heart, kidneys, and brain) were created to be used in the short films along with explanatory narratives. Conclusion: The use of the technological interactive resources created for the database should provide measurable information on the patients' acquired knowledge and enable the website users to develop enough self-confidence to care for their own health and deal with their problems.- Postural Changes and their Influence on Functional Behavior of the Great Arteries(2019) BORTOLOTTO, Luiz Aparecido
- The effect of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea and uncontrolled hypertension- Study design and challenges during the COVID-19 pandemic(2021) CRUZ, Fernanda C. S. G.; DRAGER, Luciano F.; QUEIROZ, Daniel B. C.; SOUZA, Gabriela A.; PEDROSA, Rodrigo P.; PATRIOTA, Tarcya L. G. Couto; DOREA, Egidio L.; VIEIRA, Marcelo Luiz C.; RIGHI, Camila G.; MARTINEZ, Denis; SILVA, Geruza A. da; V, Giovanio Silva; PIO-ABREU, Andrea; LOTUFO, Paulo A.; BENSEAOR, Isabela M.; BORTOLOTTO, Luiz A.; FUCHS, Flavio D.; LORENZI-FILHO, GeraldoOBJECTIVES: To describe the MORPHEOS (Morbidity in patients with uncontrolled HTN and OSA) trial, and describe the challenges imposed by the COVID-19 pandemic. METHODS: MORPHEOS is a multicenter (n=6) randomized controlled trial designed to evaluate the blood pressure (BP) lowering effects of treatment with continuous positive airway pressure (CPAP) or placebo (nasal strips) for 6 months in adult patients with uncontrolled hypertension (HTN) and moderate-to-severe obstructive sleep apnea (OSA). Patients using at least one antihypertensive medication were included. Uncontrolled HTN was confirmed by at least one abnormal parameter in the 24-hour ABPM and >= 80% medication adherence evaluated by pill counting after the run-in period. OSA was defined by an apnea-hypopnea index >= 15 events/ hours. The co-primary endpoints are brachial BP (office and ambulatory BP monitoring, ABPM) and central BP. Secondary outcomes include hypertension-mediated organ damage (HMOD) to heart, aorta, eye, and kidney. We pre-specified several sub-studies from this investigation. Visits occur once a week in the first month and once a month thereafter. The programmed sample size was 176 patients but the pandemic prevented this final target. A post-hoc power analysis will be calculated from the final sample. RESULTS: The first 100 patients are predominantly males (n=69), age: 52 +/- 10 years, body mass index: 32.7 +/- 3.9 kg/m(2) with frequent co-morbidities. CONCLUSIONS: The MORPHEOS trial has a unique study design inclu ding a run-in period; pill counting, and detailed analysis of hypertension-mediated organ damage in patients with uncontrolled HTN that will allow clarification of the impact of OSA treatment with CPAP.
- Denervação simpática renal percutânea(2013) BERNARDI, Fernando Luiz de Melo; GOMES, Wilton Francisco; SPADARO, André Gasparini; ESTEVES FILHO, Antônio; BORTOLOTTO, Luiz Aparecido; SCANAVACCA, Maurício Ibrahim; LEMOS, Pedro AlvesArterial hypertension is a highly prevalent disease and is associated with increased cardiovascular risk. Despite great advances in drug therapy, a considerable number of patients do not have an effective control of the disease, despite the use of multiple drugs, usually in high doses. Renal sympathetic denervation (RSD) has proved to be a promising therapy, with high safety and efficacy in preliminary studies in patients with resistant hypertension. The role of sympathetic nervous system in the physiopathology of hypertension is well known and is the rationale for the ablation of sympathetic fibers by transluminal delivery of radiofrequency in the renal arteries. In the last few years, results from case series, non-controlled studies and one multicenter randomized trial with a limited number of patients have shown a significant decrease in short and mid-term blood pressure levels. The objective of this review was to gather evidence on the use of RSD in the control of resistant hypertension and describe technical aspects and perspectives of the procedure.
- The Role of Metabolic Surgery on Blood Pressure Control(2016) SCHIAVON, Carlos Aurelio; DRAGER, Luciano F.; BORTOLOTTO, Luiz A.; AMODEO, Celso; IKEOKA, Dimas; BERWANGER, Otavio; COHEN, Ricardo VitorObesity and hypertension are growing epidemics in the modern world. Lifestyle changes and medical treatment for obesity have disappointing long-term results and albeit drugs for hypertension are usually very effective, the necessity of multiple pills and frequent side effects make the adherence to treatment a huge challenge for healthcare systems. Bariatric/metabolic surgery is a very effective treatment and an exponential number of studies have been showing its positive impact beyond weight loss, mainly on type 2 diabetes. There is also growing evidence suggesting that bariatric/metabolic surgery is associated with reduced incidence of cardiovascular events, but the impact on hypertension and other components of metabolic syndrome usually derive from trials' secondary end points. Taking this limitation in mind, bariatric/metabolic surgery action on blood pressure is reaching a significant proportion of hypertension resolution or improvement. In this review, we discussed the current evidence on the impact of bariatric/metabolic surgery on blood pressure control and pointed out perspectives in this research area.
- Systemic arterial hypertension and cognition in adults: effects on executive functioning(2020) MORAES, Natalia Cristina; MUELA, Henrique Cotchi Simbo; MEMORIA, Claudia Maia; COSTA-HONG, Valeria Aparecida da; MACHADO, Michel Ferreira; CECHINHI, Mario Amore; NITRINI, Ricardo; BORTOLOTTO, Luiz Aparecido; YASSUDA, Monica SanchesBackground: Central nervous system changes associated to systemic arterial hypertension (SAH) are progressive and may cause negative effects on cognitive performance. The objective of this study was to investigate the relation between SAH and the components of executive functions (EF), inhibitory control (IC), updating and shifting, comparing a control group (without SAH) to patients with SAH, in two levels of severity. Methods: The protocol included the following tests to evaluate EF components: T.O.V.A. Test (IC), Backward Digit Span from Wechsler Adults Intelligence Scale (VVAIS-III), Phonemic and Semantic Verbal Fluency (updating), and Trail Making Test Part B (shifting). Results: A total of 204 participants was included: 56 from the Control Group (CG), 87 SAH stage 1, and 61 SAH stage 2. The groups were not different for age (52.37 +/- 12.29) and education (10.98 +/- 4.06). As to controlled blood pressure (BP), duration of hypertension treatment and number of drugs, the SAH 2 group had a worse BP control, longer duration of hypertension treatment and use of more drugs when compared to the SAH 1. The findings revealed that patients with more severe hypertension presented worse performance in updating (Backward Digit Span, phonemic and semantics VF) and shifting (Trail Making Test Part B). Conclusion: The results suggest that patients with SAH have a significant impairment in EF, more specifically in updating and shifting. Besides that, such damage may be directly proportional to the severity of SAH. It is suggested that future studies include neuroimaging exams to exclude possible cerebrovascular diseases.
- Interdialytic Blood Pressure and Risk of Cardiovascular Events and Death in Hemodialysis Patients(2023) LIMA, Jose Jayme G. De; GOWDAK, Luis Henrique W.; JR, Jose Otto Reusing; DAVID-NETO, Elias; BORTOLOTTO, Luiz A.IntroductionNormal (120-140 mm Hg) systolic peridialysis blood pressure (BP) is associated with higher mortality in hemodialysis (HD) patients.AimWe explored the relationship between hypertension and BP on outcomes using data collected at the interdialytic period.MethodsThis was a single-center observational cohort study with 2672 HD patients. BP was determined at inception, in mid-week, between 2 consecutive dialysis sessions. Hypertension was defined as systolic BP >= 140 mm Hg and/or diastolic BP >= 90 mm Hg. Endpoints were major CV events and all-cause mortality.ResultsDuring a median follow-up of 31 months, 761 patients (28%) experienced CV events and 1181 (44%) died. Hypertensive patients had lower survival free of CV than normotensive patients (P = 0.031). No difference occurred in the incidence of death between groups. Compared with the reference category of SBP >= 171 mmHg, the incidence of cardiovascular events was reduced in patients with SBP 101-110 (HR 0.647, 95% CI 0.455 to 0.920), 111-120 (HR 0.663, 95%CI 0.492 to 0.894), 121-130 (HR 0.747, 95%CI 0.569 to 0.981), and 131-140 (HR 0.757, 95%CI 0.596 to 0.962). On multivariate analysis, systolic and diastolic BP were not independent predictors of CV events or death. Normal interdialytic BP was not associated with mortality or CV events, and hypertension predicted an increased probability of CV complications.ConclusionsInterdialytic BP may be preferred to guide treatment decisions, and HD patients should be treated according to guidelines for the general population until specific BP targets for this population are identified.
conferenceObject Effects of Bariatric Surgery in Obese Patients With Hypertension: The GATEWAY Randomized Trial(2017) SCHIAVON, Carlos A.; BERSCH-FERREIRA, Angela; SANTUCCI, Eliana; OLIVEIRA, Juliana; TORREGLOSA, Camila; BUENO, Priscila; FRAHYA, Julia; SANTOS, Renato; DAMIANI, Lucas; NOUJAIM, Patricia; HALPERN, Helio; MONTEIRO, Frederico L.; COHEN, Ricardo; UCHOA, Carlos H.; SOUSA, Marcio G.; AMODEO, Celso; BORTOLOTTO, Luiz; IKEOKA, Dimas; DRAGER, Luciano; CAVALCANTI, Alexandre B.; BERWANGER, Otavio