DECIO MION JUNIOR
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- Aerobic training abolishes ambulatory blood pressure increase induced by estrogen therapy: A double blind randomized clinical trial(2011) CARDOSO JR., Crivaldo Gomes; ROSAS, Fabricio Collares; ONEDA, Bruna; LABES, Eliana; TINUCCI, Tais; ABRAHAO, Sandra Balieiro; FONSECA, Angela Maggio da; MION JR., Decio; FORJAZ, Claudia Lucia de MoraesEmerging data reveal that oral estrogen therapy can increase clinic blood pressure (BP) in postmenopausal women; however, it is important to establish its effects on ambulatory BP, which is a better predictor for target-organ damage. Besides estrogen therapy, aerobic training is widely recommended for post-menopausal women, and it can decrease ambulatory BP levels. This study was designed to evaluate the effect of aerobic training and estrogen therapy on the ambulatory BP of post-menopausal women. Forty seven healthy hysterectomized women were randomly divided (in a double-blind manner) into 4 groups: placebo-control (PLA-CO = 12), estrogen therapy-control (ET-CO = 14), placebo-aerobic training (PLA-AT = 12), and estrogen therapy-aerobic training (ET-AT = 09). The ET groups received estradiol valerate (1 mg/day) and the AT groups performed cycle ergometer, 3x/week at moderate intensity. Hormonal status (blood analysis), maximal cardiopulmonary exercise test (VO(2) peak) and ambulatory BP (24-h, daytime and nighttime) was evaluated before and 6 months after interventions. A significant increase in VO(2) peak was observed only in women who participated in aerobic training groups (+4.6 +/- 1.0 ml kg(-1) min(-1), P=0.00). Follicle-stimulating hormone was a significant decreased in the ET groups (-18.65 +/- 5.19 pg/ml, P=0.00), and it was accompanied by an increase in circulating estrogen (56.1 +/- 6.6 pg/ml). A significant increase was observed in the ET groups for daytime (P=0.01) and nighttime systolic BP (P=0.01), as well as nighttime diastolic BP (P = 0.02). However, daytime diastolic BP was increased only in the ET-CO group (+3.4 +/- 1.2 mmHg, P=0.04), and did not change in any other groups. No significant effect was found in ambulatory heart rate. In conclusion, aerobic training abolished the increase of daytime ambulatory BP induced by estrogen therapy in hysterectomized, healthy, normotensive and postmenopausal women.
- Chronic kidney disease and risk factors responsible for sudden cardiac death: a whiff of hope?(2016) KIUCHI, Marcio G.; MION JR., DecioSeveral studies have shown a strong independent association between chronic kidney disease (CKD) and cardiovascular events, including death, heart failure, and myocardial infarction. Recent clinical trials extend this range of adverse cardiovascular events, also including ventricular arrhythmias and sudden cardiac death. Furthermore, other studies suggest structural remodeling of the heart and electrophysiological alterations in this population. These processes may explain the increased risk of arrhythmia in kidney disease and help to identify patients who are at increased risk of sudden cardiac death. Sympathetic hyperactivity is well known to increase cardiovascular risk in CKD patients and is a hallmark of essential hypertensive state that occurs early in the clinical course of the disease. In CKD, the sympathetic hyperactivity seems to be expressed at the earliest clinical stage of the disease, showing a direct relationship with the severity of the condition of renal failure, being more pronounced in the terminal stage of CKD. The sympathetic efferent and afferent neural activity in kidney failure is a key mediator for the maintenance and progression of the disease. The aim of this review was to show that the feedback loop of this cycle, due to adrenergic hyperactivity, also aggravates many of the risk factors responsible for causing sudden cardiac death and may be a potential target modifiable by percutaneous renal sympathetic denervation. If it is feasible and effective in end-stage renal disease, little is known.
- Betabloqueio com atenolol não reduz potência aeróbia nem muda limiares ventilatórios em hipertensos sedentários(2013) SOUZA, Dinoelia Rosa; GOMIDES, Ricardo Saraceni; COSTA, Luiz Augusto Riani; FERNANDES, Joao Ricardo Cordeiro; ORTEGA, Katia Coelho; MION JR., Decio; TINUCCI, Tais; FORJAZ, Claudia Lucia de MoraesIntroduction: Aerobic exercise is recommended for the treatment of hypertension. Its intensity can be prescribed based on the percentage of maximum heart rate (% MHR) or peak oxygen consumption (VO2peak%) in which the ventilatory thresholds (VT) are achieved. However, some hypertensive patients who begin aerobic training may be receiving beta-blockers, which can influence these parameters. Objective: To investigate the effects of atenolol on VT of sedentary hypertensive patients. Methods: Nine volunteers performed two cardiopulmonary exercise tests until exhaustion after 4 weeks of treatment with atenolol (25 mg orally twice daily) and with placebo, administered in a fixed order and in a blinded manner. During the tests, heart rate (HR), blood pressure (BP), VO2 at rest, anaerobic threshold (AT), respiratory compensation point (RCP) and peak effort were analyzed. Results: VO2 increased progressively throughout the exercise and the values were similar for both treatments. Systolic blood pressure and heart rate also increased progressively during the exercise, but their absolute values were significantly lower with atenolol. However, the increase in systolic BP and HR during exercise was similar in both treatments. Thus, the % of MHR and % VO2peak at which LA and PCR were achieved were not different between placebo and atenolol. Conclusion: Atenolol, at a dosage of 50mg/day, did not affect the % of VO2peak and % of MHR corresponding to the VTs, which confirms that prescription of training intensity based on these percentages is adequate to hypertensive patients receiving beta-blockers.
conferenceObject Influence of Time of Day on Post-Exercise Hypotension Might Be Different in Hypertensives Receiving Different Anti-hypertensive Drugs: An Exploratory Study(2016) BRITO, Leandro; PECANHA, Tiago; FECCHIO, Rafael; SOUSA, Patricia; REZENDE, Rafael; NAVARRO, Manilla; SILVA, Giovanio; ABREU, Andrea; MION-JUNIOR, Decio; FORJAZ, Claudia- Effects of long term device-guided slow breathing on sympathetic nervous activity in hypertensive patients: a randomized open-label clinical trial(2017) BARROS, Silvana de; SILVA, Giovanio Vieira da; GUSMAO, Josiane Lima de; ARAUJO, Tatiana Goveia de; SOUZA, Dinoelia Rosa de; CARDOSO JR., Crivaldo Gomes; ONEDA, Bruna; MION, DecioPurpose: Device-guided slow breathing (DGB) is indicated as nonpharmacological treatment for hypertension. The sympathetic nerve activity (SNA) reduction may be one of the mechanisms involved in blood pressure (BP) decrease. The aim of this study is to evaluate the long-term use of DGB in BP and SNA.Subjects and methods: Hypertensive patients were randomized to listen music (Control Group-CG) or DGB (aim to reduce respiratory rate to less than 10 breaths/minute during 15minutes/day for 8 weeks). Before and after intervention ambulatory blood pressure monitoring (ABPM), catecholamines and muscle sympathetic nerve activity (MSNA) by microneurography were performed.Results: 17 volunteers in the DGB and 15 in the CG completed the study. There was no change in office BP before and after intervention in both groups. There was a reduction in systolic and diastolic BP in the awake period by ABPM only in the CG (13110/929 vs 128 +/- 10/88 +/- 8mmHg, p<0.05). In relation to SNA, no difference in catecholamines was observed. In the volunteers who had a microneurography record, there was no change the MSNA (bursts/minute): DGB (17(15-28) vs 19(13-22), p=0.08) and CG (22(17-23) vs 22(18-24), p=0.52).Conclusion: Long-term DGB did not reduce BP, catecholamines levels or MSNA in hypertensive patients.ClinicalTrials.gov identifier: NCT01390727
- Oral estrogen therapy may mitigate the effects of aerobic training on cardiorespiratory fitness in postmenopausal women: a double-blind, randomized clinical pilot study(2014) CARDOSO JR., Crivaldo Gomes; MEDINA, Fabio Leandro; PINTO, Luiz Gustavo; ONEDA, Bruna; COSTA, Luiz Augusto Riani; LABES, Eliana; ABRAHAO, Sandra Baliero; TINUCCI, Tais; MION JR., Decio; FONSECA, Angela Maggio; FORJAZ, Claudia Luica de MoraesObjective The aim of this study was to evaluate the isolated and associated effects of oral estrogen therapy and aerobic training on cardiorespiratory fitness in postmenopausal women. Methods Forty-two hysterectomized healthy postmenopausal women were randomly divided (in a double-blind manner) into four groups: placebo-control (n = 9), estrogen therapy-control (n = 12), placebo-aerobic training (PLA-AT; n = 11), and estrogen therapy-aerobic training (ET-AT; n = 10). The estrogen therapy groups received estradiol valerate (1 mg/day) and the aerobic training groups trained on a cycle ergometer three times per week at moderate intensity. Before and 6 months after the interventions, all women underwent a maximal cardiopulmonary exercise test on a cycle ergometer. Results Regardless of hormone therapy, aerobic training increased oxygen uptake at anaerobic threshold (P = 0.001), oxygen uptake at respiratory compensation point (P = 0.043), and oxygen uptake at peak exercise (P = 0.020). The increases at respiratory compensation point and peak exercise were significantly greater in the groups receiving placebo than in the groups receiving estrogen (oxygen uptake at respiratory compensation point: PLA-AT +5.3 [2.8] vs ET-AT +3.0 [2.5] mL kg(-1) min(-1), P = 0.04; oxygen uptake at peak exercise: PLA-AT +5.8 [3.4] vs ET-AT +2.8 [1.4] mL kg(-1) min(-1), P = 0.02). Conclusions Oral estrogen therapy may mitigate the cardiorespiratory fitness increase induced by aerobic training in hysterectomized healthy postmenopausal women.
- The impact of changing home blood pressure monitoring cutoff from 135/85 to 130/80 mmHg on hypertension phenotypes(2021) FEITOSA, Audes D. M.; MOTA-GOMES, Marco A.; BARROSO, Weimar S.; MIRANDA, Roberto D.; BARBOSA, Eduardo C. D.; BRANDAO, Andrea A.; NOBRE, Fernando; MION JR., Decio; AMODEO, Celso; LIMA-FILHO, Jose L.; SPOSITO, Andrei C.; NADRUZ JR., WilsonThis study investigated the impact of changing abnormal home blood pressure monitoring (HBPM) cutoff from 135/85 to 130/80 mmHg on the prevalence of hypertension phenotypes, considering an abnormal office blood pressure cutoff of 140/90 mmHg. We evaluated 57 768 individuals (26 876 untreated and 30 892 treated with antihypertensive medications) from 719 Brazilian centers who performed HBPM. Changing the HBPM cutoff was associated with increases in masked (from 10% to 22%) and sustained (from 27% to 35%) hypertension, and decreases in white-coat hypertension (from 16% to 7%) and normotension (from 47% to 36%) among untreated participants, and increases in masked (from 11% to 22%) and sustained (from 29% to 36%) uncontrolled hypertension, and decreases in white-coat uncontrolled hypertension (from 15% to 8%) and controlled hypertension (from 45% to 34%) among treated participants. In conclusion, adoption of an abnormal HBPM cutoff of 130/80 mmHg markedly increased the prevalence of out-of-office hypertension and uncontrolled hypertension phenotypes.
bookPart Caso clínico baseado em diretriz: Hipertensão arterial(2017) MION JR., Décio; PóVOA, Rui; TOLEDO, Juan Carlos Yugar- Home blood pressure (BP) monitoring in kidney transplant recipients is more adequate to monitor BP than office BP(2011) AGENA, Fabiana; PRADO, Elisangela dos Santos; SOUZA, Patricia Soares; SILVA, Giovanio Vieira da; LEMOS, Francine Brambate Carvalhinho; MION JR., Decio; NAHAS, William Carlos; DAVID-NETO, EliasBackground. Hypertension is highly prevalent among kidney transplantation recipients and considered as an important cardiovascular risk factor influencing patient survival and kidney graft survival. Aim. Compare the blood pressure (BP) control in kidney transplant patients through the use of home blood pressure monitoring (HBPM) is more comparable with the results of ambulatory blood pressure monitoring compared to the measurement of office blood pressure. Methods. From March 2008 to April 2009 prospectively were evaluated 183 kidney transplant recipients with time after transplantation between 1 and 10 years. Patients underwent three methods for measuring BP: office blood pressure measurement (oBP), HBPM and ambulatory blood pressure monitoring (ABPM). Results. In total, 183 patients were evaluated, among them 94 were men (54%) and 89 women (46%). The average age was 50 6 11 years. The average time of transplant was 57 6 32 months. Ninety-nine patients received grafts from deceased donors (54%) and 84 were recipients of living donors (46%). When assessed using oBP, 56.3% presented with uncontrolled and 43.7% with adequate control of BP with an average of 138.9/82.3 +/- 17.8/12.1 mmHg. However, when measured by HBPM, 55.2% of subjects were controlled and 44.8% presented with uncontrolled BP with an average of 131.1/78.5 +/- 17.4/8.9 mmHg. Using the ABPM, we observed that 63.9% of subjects were controlled and 36.1% of patients presented uncontrolled BP with an average 128.8/80.5 +/- 12.5/8.1 mmHg. We found that the two methods (oBP and HBPM) have a significant agreement, but the HBPM has a higher agreement that oBP, confirmed P = 0.026. We found that there is no symmetry in the data for both methods with McNemar test. The correlation index of Pearson linear methods for the ABPM with the other two methods were 0.494 for office measurement and 0.768 for HBPM, best value of HBPM with ABPM. Comparing the errors of the two methods by paired t-test, we obtained the descriptive level of 0.837. Looking at the receiver operating characteristic curve for BP measurements in each method, we observed that oBP is lower than those obtained by HBPM in relation to ABPM. Conclusion. We conclude that the results obtained with HBPM were closer to the ABPM results than those obtained with BP obtained at oBP, being more sensitive to detect poor control of hypertension in renal transplant recipients.
- Activation of Mechanoreflex, but not Central Command, Delays Heart Rate Recovery after Exercise in Healthy Men(2021) PECANHA, Tiago; BRITO, Leandro Campos de; FECCHIO, Rafael Yokoyama; SOUSA, Patricia Nascimento de; SILVA, Natan Daniel; COUTO, Patricia Guimaraes; ABREU, Andrea Pio de; SILVA, Giovanio Vieira da; MION, Decio; LOW, David A.; FORJAZ, Claudia Lucia de MoraesThis study tested the hypotheses that activation of central command and muscle mechanoreflex during post-exercise recovery delays fast-phase heart rate recovery with little influence on the slow phase. Twenty-five healthy men underwent three submaximal cycling bouts, each followed by a different 5-min recovery protocol: active (cycling generated by the own subject), passive (cycling generated by external force) and inactive (no-cycling). Heart rate recovery was assessed by the heart rate decay from peak exercise to 30s and 60s of recovery (HRR (30s) , HRR (60s) fast phase) and from 60s-to-300s of recovery (HRR (60-300s) slow phase). The effect of central command was examined by comparing active and passive recoveries (with and without central command activation) and the effect of mechanoreflex was assessed by comparing passive and inactive recoveries (with and without mechanoreflex activation). Heart rate recovery was similar between active and passive recoveries, regardless of the phase. Heart rate recovery was slower in the passive than inactive recovery in the fast phase (HRR (60s) =20 +/- 8vs.27 +/- 10bpm, p<0.01), but not in the slow phase (HRR (60-300s) =13 +/- 8vs.10 +/- 8bpm, p=0.11). In conclusion, activation of mechanoreflex, but not central command, during recovery delays fast-phase heart rate recovery. These results elucidate important neural mechanisms behind heart rate recovery regulation.