DECIO MION JUNIOR
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- 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.
- 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.
- Brazilian Guidelines of Hypertension-2020(2021) BARROSO, Weimar Kunz Sebba; RODRIGUES, Cibele Isaac Saad; BORTOLOTTO, Luiz Aparecido; MOTA-GOMES, Marco Antonio; BRANDAO, Andrea Araujo; FEITOSA, Audes Diogenes de Magalhaes; MACHADO, Carlos Alberto; POLI-DE-FIGUEIREDO, Carlos Eduardo; AMODEO, Celso; MION JUNIOR, Decio; BARBOSA, Eduardo Costa Duarte; NOBRE, Fernando; GUIMARAES, Isabel Cristina Britto; VILELA-MARTIN, Jose Fernando; YUGAR-TOLEDO, Juan Carlos; MAGALHAES, Maria Eliane Campos; NEVES, Mario Fritsch Toros; JARDIM, Paulo Cesar Brandao Veiga; MIRANDA, Roberto Dischinger; POVOA, Rui Manuel dos Santos; FUCHS, Sandra C.; ALESSI, Alexandre; LUCENA, Alexandre Jorge Gomes de; AVEZUM, Alvaro; SOUSA, Ana Luiza Lima; PIO-ABREU, Andrea; SPOSITO, Andrei Carvalho; PIERIN, Angela Maria Geraldo; PAIVA, Annelise Machado Gomes de; SPINELLI, Antonio Carlos de Souza; NOGUEIRA, Armando da Rocha; DINAMARCO, Nelson; EIBEL, Bruna; FORJAZ, Claudia Lucia de Moraes; ZANINI, Claudia Regina de Oliveira; SOUZA, Cristiane Bueno de; SOUZA, Dilma do Socorro Moraes de; NILSON, Eduardo Augusto Fernandes; COSTA, Elisa Franco de Assis; FREITAS, Elizabete Viana de; DUARTE, Elizabeth da Rosa; MUXFELDT, Elizabeth Silaid; LIMA JUNIOR, Emilton; CAMPANA, Erika Maria Goncalves; CESARINO, Evandro Jose; MARQUES, Fabiana; ARGENTA, Fabio; CONSOLIM-COLOMBO, Fernanda Marciano; BAPTISTA, Fernanda Spadotto; ALMEIDA, Fernando Antonio de; BORELLI, Flavio Antonio de Oliveira; FUCHS, Flavio Danni; PLAVNIK, Frida Liane; SALLES, Gil Fernando; FEITOSA, Gilson Soares; SILVA, Giovanio Vieira da; GUERRA, Grazia Maria; MORENO JUNIOR, Heitor; FINIMUNDI, Helius Carlos; BACK, Isabela de Carlos; OLIVEIRA FILHO, Joao Bosco de; GEMELLI, Joao Roberto; MILL, Jose Geraldo; RIBEIRO, Jose Marcio; LOTAIF, Leda A. Daud; COSTA, Lilian Soares da; MAGALHAES, Lucelia Batista Neves Cunha; DRAGER, Luciano Ferreira; MARTIN, Luis Cuadrado; SCALA, Luiz Cesar Nazario; ALMEIDA, Madson Q.; GOWDAK, Marcia Maria Godoy; KLEIN, Marcia Regina Simas Torres; MALACHIAS, Marcus Vinicius Bolivar; KUSCHNIR, Maria Cristina Caetano; PINHEIRO, Maria Eliete; BORBA, Mario Henrique Elesbao de; MOREIRA FILHO, Osni; PASSARELLI JUNIOR, Oswaldo; COELHO, Otavio Rizzi; VITORINO, Priscila Valverde de Oliveira; RIBEIRO JUNIOR, Renault Mattos; ESPORCATTE, Roberto; FRANCO, Roberto; PEDROSA, Rodrigo; MULINARI, Rogerio Andrade; PAULA, Rogerio Baumgratz de; OKAWA, Rogerio Toshiro Passos; ROSA, Ronaldo Fernandes; AMARAL, Sandra Lia do; FERREIRA-FILHO, Sebastiao R.; KAISER, Sergio Emanuel; JARDIM, Thiago de Souza Veiga; GUIMARAES, Vanildo; KOCH, Vera H.; OIGMAN, Wille; NADRUZ, Wilson
- A comparison between diuretics and angiotensin-receptor blocker agents in patients with stage I hypertension (PREVER-treatment trial): study protocol for a randomized double-blind controlled trial(2011) FUCHS, Flavio D.; FUCHS, Sandra C.; MOREIRA, Leila B.; GUS, Miguel; NOBREGA, Antonio C.; POLI-DE-FIGUEIREDO, Carlos E.; MION, Decio; BORTOLOTTO, Luiz; CONSOLIM-COLOMBO, Fernanda; NOBRE, Fernando; COELHO, Eduardo Barbosa; VILELA-MARTIN, Jose F.; MORENO JR., Heitor; CESARINO, Evandro Jose; FRANCO, Roberto; BRANDAO, Andrea Araujo; SOUSA, Marcos R. de; RIBEIRO, Antonio Luiz Pinho; JARDIM, Paulo Cesar; AFIUNE NETO, Abrahao; SCALA, Luiz Cesar N.; MOTA, Marco; CHAVES, Hilton; ALVES, Joao Guilherme; SOBRAL FILHO, Dario C.; SILVA, Ricardo Pereira e; FIGUEIREDO NETO, Jose A.; IRIGOYEN, Maria Claudia; CASTRO, Iran; STEFFENS, Andre Avelino; SCHLATTER, Rosane; MELLO, Renato Bandeira de; MOSELE, Francisca; GHIZZONI, Flavia; BERWANGER, OtavioBackground: Cardiovascular disease is the leading cause of death in Brazil, and hypertension is its major risk factor. The benefit of its drug treatment to prevent major cardiovascular events was consistently demonstrated. Angiotensin-receptor blockers (ARB) have been the preferential drugs in the management of hypertension worldwide, despite the absence of any consistent evidence of advantage over older agents, and the concern that they may be associated with lower renal protection and risk for cancer. Diuretics are as efficacious as other agents, are well tolerated, have longer duration of action and low cost, but have been scarcely compared with ARBs. A study comparing diuretic and ARB is therefore warranted. Methods/design: This is a randomized, double-blind, clinical trial, comparing the association of chlorthalidone and amiloride with losartan as first drug option in patients aged 30 to 70 years, with stage I hypertension. The primary outcomes will be variation of blood pressure by time, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new subclinical atherosclerosis and sudden death. The study will last 18 months. The sample size will be of 1200 participants for group in order to confer enough power to test for all primary outcomes. The project was approved by the Ethics committee of each participating institution. Discussion: The putative pleiotropic effects of ARB agents, particularly renal protection, have been disputed, and they have been scarcely compared with diuretics in large clinical trials, despite that they have been at least as efficacious as newer agents in managing hypertension. Even if the null hypothesis is not rejected, the information will be useful for health care policy to treat hypertension in Brazil.
- Yoga Relaxation (savasana) decreases cardiac sympathovagal balance in hypertensive patients(2014) SANTAELLA, Danilo F; LORENZI-FILHO, Geraldo; RODRIGUES, Marcos R; TINUCCI, Taís; MALINAUSKAS, Ana Paula; MION-JÚNIOR, Décio; MONTANO, Nicola; FORJAZ, Cláudia LMOBJECTIVE: Although relaxation is recommended as complementary therapy for hypertension, its post-intervention cardiovascular autonomic effects are unclear. The objective of this research was to investigate the effects of savasana relaxation on cardiovascular autonomic modulation in hypertensive patients. METHODS: This randomized controlled trial was performed at the Hemodynamic Laboratory of the Physical Education School of the University of São Paulo/Brazil. Sixteen hypertensive (6-women) and 14 normotensive patients (6-women) non-obese subjects participated in 2 random sessions: savasana relaxation and control. Patients remained supine for 55 min after interventions. Electrocardiogram, beat-to-beat blood pressure and respiration were acquired during and after interventions for posterior autoregressive spectral analysis of the R-R interval and blood pressure variability. RESULTS: Hypertensive and normotensive patients presented similar cardiac autonomic modulation responses during and after experimental sessions. During relaxation, low frequency and sympathovagal balance were significantly lower in the Relaxation sessions than during supine rest in the Control sessions. Fifteen minutes after interventions, low frequency and sympathovagal balance were still lower in Relaxation than in Control, and remained lower for 35 min; at 55 min, the variables were similar between sessions. Systolic blood pressure variability did not differ among sessions. CONCLUSIONS: Savasana Relaxation decreases cardiac sympathetic autonomic modulation after its performance in hypertensive patients; this reduction lasts at least 35 minutes and is not blunted in hypertensive patients when compared to normotensive controls. Thus, savasana relaxation has positive effects on cardiac autonomic modulation of hypertensive patients, and may be included as a strategy for the non-drug treatment of hypertension.
- Felypressin Increases Blood Pressure During Dental Procedures in Hypertensive Patients(2012) BRONZO, Ana Lucia Aparecida; CARDOSO JR., Crivaldo Gomes; ORTEGA, Katia Coelho; MION JR., DecioBackground: Felypressin has been added to local anesthetic to increase the length of the anesthetic effect and reduce toxicity during dental procedures. However, the effect on blood pressure remains uncertain, and this may be highly relevant in the dental treatment of hypertensive patients. Objective: To investigate the effect of felypressin on blood pressure in hypertensive patients with controlled BP. Methods: 71 subjects with these characteristics and in need of periodontal treatment were studied. After 10 minutes of rest, local anesthesia (prilocaine) was infiltrated with and without addition of felypressin. Then, a deep subgingival scaling was performed. Blood pressure was measured by an automated oscillometric device (DIXTAL DX2010). Ten minutes after the administration of the anesthetic, peak anesthetic action was recorded. The State-Trait Anxiety Inventory (STAI) was used to assess the patients' trait anxiety. Results: Systolic blood pressure increased after anesthesia, regardless of association with felypressin, throughout the dental procedure (p<0.05) and this response can be explained, at least in part, by the trait anxiety levels of the subjects. However, a further increase in diastolic blood pressure was observed when prilocaine was associated with felypressin (p<0.05), but this response did not change with trait anxiety levels. Conclusion: Felypressin increased the diastolic blood pressure of hypertensive patients with controlled blood pressure. Patients with high trait anxiety presented increases in systolic blood pressure upon some procedures, suggesting that an increase in blood pressure might also be related to fear or anxiety. (Arq Bras Cardiol 2012;99(2):724-731)
article 7TH BRAZILIAN GUIDELINE OF ARTERIAL HYPERTENSION(2016) MALACHIAS, Marcus Vinicius Bolivar; SOUZA, Weimar Kunz Sebba Barroso de; PLAVNIK, Frida Liane; RODRIGUES, Cibele Isaac Saad; BRANDAO, Andrea Araujo; NEVES, Mario Fritsch Toros; BORTOLOTTO, Luiz Aparecido; FRANCO, Roberto Jorge da Silva; FIGUEIREDO, Carlos Eduardo Poli de; JARDIM, Paulo Cesar Brandao Veiga; AMODEO, Celso; BARBOSA, Eduardo Costa Duarte; KOCH, Vera; GOMES, Marco Antonio Mota; PAULA, Rogerio Baumgratz de; PAVOA, Rui Manuel dos Santos; COLOMBO, Fernanda Consolim; FERREIRA FILHO, Sebastiao; MIRANDA, Roberto Dischinger; MACHADO, Carlos Alberto; NOBRE, Fernando; NOGUEIRA, Armando da Rocha; MION JUNIOR, Decio; KAISER, Sergio; FORJAZ, Claudia Lucia de Moraes; ALMEIDA, Fernando Antonio; MARTIM, Jose Fernando Vilela; SASS, Nelson; DRAGER, Luciano Ferreira; MUXFELDT, Elizabeth; BODANESE, Luiz Carlos; FEITOSA, Audes Diogenes; MALTA, Deborah; FUCHS, Sandra; MAGALHAES, Maria Eliane; OIGMAN, Wille; MOREIRA FILHO, Osni; PIERIN, Angela Maria Geraldo; FEITOSA, Gilson Soares; BORTOLOTTO, Maria Rita de Figueiredo Lemos; MAGALHAES, Lucelia Batista Neves Cunha; SILVA, Ana Cristina Simoes e; RIBEIRO, Jose Marcio; BORELLI, Flavio Antonio de Oliveira; GUS, Miguel; PASSARELLI JUNIOR, Oswaldo; TOLEDO, Juan Yugar; SALLES, Gil Fernando; MARTINS, Luis Cuadrado; JARDIM, Thiago de Souza Veiga; GUIMARAES, Isabel Cristina Britto; ANTONELLO, Ivan Carlos; LIMA JUNIOR, Emilton; MATSUDO, Victor; SILVA, Giovanio Vieira da; COSTA, Lilian Soares da; ALESSI, Alexandre; SCALA, Luiz Cezar Nazario; COELHO, Eduardo Barbosa; SOUZA, Dilma de; LOPES, Heno Ferreira; GOWDAK, Marcia Maria Godoy; CORDEIRO JUNIOR, Antonio Carlos; TORLONI, Maria Regina; KLEIN, Marcia Regina Simas Torres; NOGUEIRA, Paulo Koch; LOTAIF, Leda Aparecida Daud; ROSITO, Guido Bernardo Aranha; MORENO JUNIOR, Heitor- Ambulatory Blood Pressure Monitoring: Five Decades of More Light and Less Shadows(2016) NOBRE, Fernando; MION JUNIOR, DecioCasual blood pressure measurements have been extensively questioned over the last five decades. A significant percentage of patients have different blood pressure readings when examined in the office or outside it. For this reason, a change in the paradigm of the best manner to assess blood pressure has been observed. The method that has been most widely used is the Ambulatory Blood Pressure Monitoring - ABPM. The method allows recording blood pressure measures in 24 hours and evaluating various parameters such as mean BP, pressure loads, areas under the curve, variations between daytime and nighttime, pulse pressure variability etc. Blood pressure measurements obtained by ABPM are better correlated, for example, with the risks of hypertension. The main indications for ABPM are: suspected white coat hypertension and masked hypertension, evaluation of the efficacy of the antihypertensive therapy in 24 hours, and evaluation of symptoms. There is increasing evidence that the use of ABPM has contributed to the assessment of blood pressure behaviors, establishment of diagnoses, prognosis and the efficacy of antihypertensive therapy. There is no doubt that the study of 24-hour blood pressure behavior and its variations by ABPM has brought more light and less darkness to the field, which justifies the title of this review.
- Prevention of hypertension in patients with pre-hypertension: protocol for the PREVER-prevention trial(2011) FUCHS, Flavio D.; FUCHS, Sandra C.; MOREIRA, Leila B.; GUS, Miguel; NOBREGA, Antonio C.; POLI-DE-FIGUEIREDO, Carlos E.; MION, Decio; BORTOLOTO, Luiz; CONSOLIM-COLOMBO, Fernanda; NOBRE, Fernando; COELHO, Eduardo Barbosa; VILELA-MARTIN, Jose F.; MORENO JR., Heitor; CESARINO, Evandro Jose; FRANCO, Roberto; BRANDAO, Andrea Araujo; SOUSA, Marcos R. de; RIBEIRO, Antonio Luiz Pinho; JARDIM, Paulo Cesar; AFIUNE NETO, Abrahao; SCALA, Luiz Cesar N.; MOTA, Marco; CHAVES, Hilton; ALVES, Joao Guilherme; SOBRAL FILHO, Dario C.; SILVA, Ricardo Pereira e; FIGUEIREDO NETO, Jose A.; IRIGOYEN, Maria Claudia; CASTRO, Iran; STEFFENS, Andre Avelino; SCHLATTER, Rosane; MELLO, Renato Bandeira de; MOSELE, Francisca; GHIZZONI, Flavia; BERWANGER, OtavioBackground: Blood pressure (BP) within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a population-based intervention to prevent the incidence of hypertension and the development of target-organ damage. Methods: This is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution. Discussion: The early use of blood pressure-lowering drugs, particularly diuretics, which act on the main mechanism of blood pressure rising with age, may prevent cardiovascular events and the incidence of hypertension in individuals with hypertension. If this intervention shows to be effective and safe in a population-based perspective, it could be the basis for an innovative public health program to prevent hypertension in Brazil.
- An economic evaluation of antihypertensive therapies based on clinical trials(2012) TSUJI, Rosana Lima Garcia; SILVA, Giovanio Vieira da; ORTEGA, Katia Coelho; BERWANGER, Otavio; MION JUNIOR, DecioOBJECTIVE: Hypertension is a major issue in public health, and the financial costs associated with hypertension continue to increase. Cost-effectiveness studies focusing on antihypertensive drug combinations, however, have been scarce. The cost-effectiveness ratios of the traditional treatment (hydrochlorothiazide and atenolol) and the current treatment (losartan and amlodipine) were evaluated in patients with grade 1 or 2 hypertension (HT1-2). For patients with grade 3 hypertension (HT3), a third drug was added to the treatment combinations: enalapril was added to the traditional treatment, and hydrochlorothiazide was added to the current treatment. METHODS: Hypertension treatment costs were estimated on the basis of the purchase prices of the antihypertensive medications, and effectiveness was measured as the reduction in systolic blood pressure and diastolic blood pressure (in mm Hg) at the end of a 12-month study period. RESULTS: When the purchase price of the brand-name medication was used to calculate the cost, the traditional treatment presented a lower cost-effectiveness ratio [US$/mm Hg] than the current treatment in the HT1-2 group. In the HT3 group, however, there was no difference in cost-effectiveness ratio between the traditional treatment and the current treatment. The cost-effectiveness ratio differences between the treatment regimens maintained the same pattern when the purchase price of the lower-cost medication was used. CONCLUSIONS: We conclude that the traditional treatment is more cost-effective (US$/mm Hg) than the current treatment in the HT1-2 group. There was no difference in cost-effectiveness between the traditional treatment and the current treatment for the HT3 group.