DECIO MION JUNIOR
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- 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
- 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.
- Poor sleep quality is associated with cardiac autonomic dysfunction in treated hypertensive men(2020) OLIVEIRA-SILVA, Laura; PECANHA, Tiago; FECCHIO, Rafael Y.; REZENDE, Rafael A.; ABREU, Andrea; SILVA, Giovanio; MION-JUNIOR, Decio; CIPOLLA-NETO, Jose; FORJAZ, Claudia L. M.; BRITO, Leandro C.Hypertensives present cardiac autonomic dysfunction. Reduction in sleep quality increases blood pressure (BP) and favors hypertension development. Previous studies suggested a relationship between cardiovascular autonomic dysfunction and sleep quality, but it is unclear whether this association is present in hypertensives. Thus, this study evaluated the relationship between sleep quality and cardiac autonomic modulation in hypertensives. Forty-seven middle-aged hypertensive men under consistent anti-hypertensive treatment were assessed for sleep quality by the Pittsburgh Sleep Quality Index (PSQI-higher score means worse sleep quality). Additionally, their beat-by-beat BP and heart rate (HR) were recorded, and cardiac autonomic modulation was assessed by their variabilities. Mann-Whitney andttests were used to compare different sleep quality groups: poor (PSQI > 5, n = 24) vs good (PSQI <= 5, n = 23), and Spearman's correlations to investigate associations between sleep quality and autonomic markers. Patients with poor sleep quality presented lower cardiac parasympathetic modulation (HR high-frequency band = 26 +/- 13 vs 36 +/- 15 nu,P = .03; HR total variance = 951 +/- 1373 vs 1608 +/- 2272 ms(2),P = .05) and cardiac baroreflex sensitivity (4.5 +/- 2.3 vs 7.1 +/- 3.7 ms/mm Hg,P = .01). Additionally, sleep quality score presented significant positive correlation with HR (r = +0.34,P = .02) and negative correlations with HR high-frequency band (r = -0.34,P = .03), HR total variance (r = -0.35,P = .02), and cardiac baroreflex sensitivity (r = -0.42,P = .01), showing that poor sleep quality is associated with higher HR and lower cardiac parasympathetic modulation and baroreflex sensitivity. In conclusion, in treated hypertensive men, poor sleep quality is associated with cardiac autonomic dysfunction.
- Guidelines on the management of arterial hypertension and related comorbidities in Latin America(2017) BARBOS, Eduardo; COCA, Antonio; LOPEZ-JARAMILLO, Patricio; RAMIREZ, Agustin J.; SANCHEZ, Ramiro A.; ZANCHETTI, Alberto; BURLANDO, Guillermo; GONZALEZ, Claudio; PISKORZ, Daniel; RAMIREZ, Agustin J.; SANCHEZ, Ramiro A.; SIMSOLO, Rosa; VOTO, Liliana; WAISSMAN, Gabriel Dario; ALESSI, Alexandre; AMODEO, Celso; BRANDAO, Andrea Araujo; BAIOCCHI, Sergio; BARBOSA, Eduardo; BARRETO FILHO, Jose Augusto; BORTOLOTTO, Luiz Aparecido; JARDIM, Paulo Cesar Brandao Veiga; BRASIL, David; MIRANDA, Roberto Dischinger; FRITSCH, Mario; KALIL, Marcio; MACHADO, Carlos Alberto; FEITOSA, Audes Magalhaes; MALACHIAS, Marcus Vinicius Bolivar; MALTA, Deborah; MION JR., Decio; MOREIRA FILHO, Osni; MORENO, Heitor; GOMES, Marco Mota; NOBRE, Fernando; NOGUEIRA, Armando; OIGMAN, Wille; PASSARELLI JR., Oswaldo; RIBEIRO, Jose Marcio; POVOA, Rui Manoel Santos; SCHMID, Helena; BARROSO, Weimar Kunz Sebba; JARDIM, Thiago Veiga; VILELA-MARTIN, Jose Fernando; COBOS, Leonardo; LANAS, Fernando; MOYA, Raul Villar; MENDOZA, Jose Luis Accini; GARCIA-ORTIZ, Luis Hernando; LOPEZ-JARAMILLO, Patricio; MOLINA, Dora Ines; SANCHEZ, Gregorio; URINA-TRIANA, Miguel; MORALES-SALINAS, Alberto; LARA, Joffre; WYSS, Fernando Stuardo; ALCOCER, Luis; CAAMANO, Angel Gonzalez; PARRA-CARRILLO, Jose Z.; ORTELLADO, Jose; MONCLOA, Alfonso Bryce; SANTISTEBAN, Segundo Senclen; DIAZ, Margarita E.; HERNANDEZ, Rafael Hernandez; LOPEZ, Jesus; MACHADO, Livia T.; PONTE-NEGRETTI, Carlos
- Can blood pressure decrease after maximal exercise test predict the blood pressure lowering effect of aerobic training in treated hypertensive men?(2023) AZEVEDO, Luan Morais; BRITO, Leandro Campos de; PECANHA, Tiago; FECCHIO, Rafael Yokoyama; REZENDE, Rafael Andrade; SILVA, Giovanio Vieira da; PIO-ABREU, Andrea; MION JUNIOR, Decio; HALLIWILL, John Robert; FORJAZ, Claudia Lucia de MoraesThe acute decrease in blood pressure (BP) observed after a session of exercise (called post-exercise hypotension) has been proposed as a tool to predict the chronic reduction in BP induced by aerobic training. Therefore, this study investigated whether post-exercise hypotension observed after a maximal exercise test is associated to the BP-lowering effect of aerobic training in treated hypertensives. Thirty hypertensive men (50 & PLUSMN; 8 years) who were under consistent anti-hypertensive treatment underwent a maximal exercise test (15 watts/min until exhaustion), and post-exercise hypotension was determined by the difference between BP measured before and at 30 min after the test. Subsequently, the patients underwent 10 weeks of aerobic training (3 times/week, 45 min/session at moderate intensity), and the BP-lowering effect of training was assessed by the difference in BP measured before and after the training period. Pearson correlations were employed to evaluate the associations. Post-maximal exercise test hypotension was observed for systolic and mean BPs (-8 & PLUSMN; 6 and -2 & PLUSMN; 4 mmHg, all P < 0.05). Aerobic training reduced clinic systolic/diastolic BPs (-5 & PLUSMN; 6/-2 & PLUSMN; 3 mmHg, both P < 0.05) as well as awake and 24 h mean BPs (-2 & PLUSMN; 6 and -2 & PLUSMN; 5 mmHg, all P < 0.05). No significant correlation was detected between post-exercise hypotension and the BP-lowering effect of training either for clinic or ambulatory BPs (r values ranging from 0.00 to 0.32, all p > 0.05). Post-exercise hypotension assessed 30 min after a maximal exercise test cannot be used to predict the BP-lowering effect of aerobic training in treated hypertensive men.
- Spironolactone Versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension: The ReHOT Randomized Study (Resistant Hypertension Optimal Treatment)(2018) KRIEGER, Eduardo M.; DRAGER, Luciano F.; GIORGI, Dante M. A.; PEREIRA, Alexandre C.; BARRETO-FILHO, Jose Augusto Soares; NOGUEIRA, Armando R.; MILL, Jose Geraldo; LOTUFO, Paulo A.; AMODEO, Celso; BATISTA, Marcelo C.; BODANESE, Luiz C.; CARVALHO, Antonio C. C.; CASTRO, Iran; CHAVES, Hilton; COSTA, Eduardo A. S.; FEITOSA, Gilson S.; FRANCO, Roberto J. S.; FUCHS, Flavio D.; GUIMARAES, Armenio C.; JARDIM, Paulo C.; MACHADO, Carlos A.; MAGALHAES, Maria E.; MION JR., Decio; NASCIMENTO, Raimundo M.; NOBRE, Fernando; NOBREGA, Antonio C.; RIBEIRO, Antonio L. P.; RODRIGUES-SOBRINHO, Carlos R.; SANJULIANI, Antonio F.; TEIXEIRA, Maria do Carmo B.; KRIEGER, Jose E.The aim of this study is to compare spironolactone versus clonidine as the fourth drug in patients with resistant hypertension in a multicenter, randomized trial. Medical therapy adherence was checked by pill counting. Patients with resistant hypertension (no office and ambulatory blood pressure [BP] monitoring control, despite treatment with 3 drugs, including a diuretic, for 12 weeks) were randomized to an additional 12-week treatment with spironolactone (12.5-50 mg QD) or clonidine (0.1-0.3 mg BID). The primary end point was BP control during office (<140/90 mmHg) and 24-h ambulatory (<130/80 mmHg) BP monitoring. Secondary end points included BP control from each method and absolute BP reduction. From 1597 patients recruited, 11.7% (187 patients) fulfilled the resistant hypertension criteria. Compared with the spironolactone group (n=95), the clonidine group (n=92) presented similar rates of achieving the primary end point (20.5% versus 20.8%, respectively; relative risk, 1.01 [0.55-1.88]; P=1.00). Secondary end point analysis showed similar office BP (33.3% versus 29.3%) and ambulatory BP monitoring (44% versus 46.2%) control for spironolactone and clonidine, respectively. However, spironolactone promoted greater decrease in 24-h systolic and diastolic BP and diastolic daytime ambulatory BP than clonidine. Per-protocol analysis (limited to patients with 80% adherence to spironolactone/clonidine treatment) showed similar results regarding the primary end point. In conclusion, clonidine was not superior to spironolactone in true resistant hypertensive patients, but the overall BP control was low (approximate to 21%). Considering easier posology and greater decrease in secondary end points, spironolactone is preferable for the fourth-drug therapy. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01643434.
- Reduction of Sympathetic Nervous Activity With Device-Guided Breathing(2014) BARROS, Silvana de; SILVA, Giovanio Vieira da; GUSMAO, Josiane Lima de; ARAUJO, Tatiana Goveia de; MION JR., Decio
- Effects of ACEi and ARB on post-exercise hypotension induced by exercises conducted at different times of day in hypertensive men(2020) BRITO, Leandro C.; AZEVEDO, Luan; PECANHA, Tiago; FECCHIO, Rafael Yokoyama; REZENDE, Rafael Andrade; SILVA, Giovanio Vieira da; PIO-ABREU, Andrea; MION, Decio; HALLIWILL, John R.; FORJAZ, Claudia L. M.Background Post-exercise hypotension (PEH) is greater after evening than morning exercise, but antihypertensive drugs may affect the evening potentiation of PEH. Objective: To compare morning and evening PEH in hypertensives receiving angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB). Methods Hypertensive men receiving ACEi (n = 14) or ARB (n = 15) underwent, in a random order, two maximal exercise tests (cycle ergometer, 15 watts/min until exhaustion) with one conducted in the morning (7 and 9 a.m.) and the other in the evening (8 and 10 p.m.). Auscultatory blood pressure (BP) was assessed in triplicate before and 30 min after the exercises. Changes in BP (post-exercise - pre-exercise) were compared between the groups and the sessions using a two-way mixed ANOVA and consideringPResults In the ARB group, systolic BP decrease was greater after the evening than the morning exercise, while in the ACEi group, it was not different after the exercises conducted at the different times of the day. Additionally, after the evening exercise, systolic BP decrease was lower in the ACEi than the ARB group (ARB = -11 +/- 8 vs -6 +/- 6 and ACEi = -6 +/- 7 vs. -8 +/- 5 mmHg, evening vs. morning, respectively, P for interaction = 0.014). Conclusions ACEi, but not ARB use, blunts the greater PEH that occurs after exercise conducted in the evening than in the morning.
- Home and Ambulatory Blood Pressure to Identify White Coat and Masked Hypertension in the Pediatric Patient(2011) FURUSAWA, Erika A.; FILHO, Ulysses D.; MION JUNIOR, Decio; KOCH, Vera H.OBJECTIVE To evaluate the effect of the environment and the observer on the measurement of blood pressure (BP) as well as to compare home BP (HBP) and ambulatory BP (ABP) measurements in the diagnosis of white coat hypertension (WCH) and masked hypertension (MH) in children and adolescents with hypertension (HT). METHODS BP of 40 patients with HT (75% of which had secondary HT and were on antihypertensive medication), mean age 12.1 years was evaluated through casual measurements at the clinic and at the HT unit, HBP for 14 days with the OMRON HEM 705 CP monitor (Omron, Tokyo, Japan) and ABP performed with SPACELABS 90207 (Spacelabs, Redmond, WA), for 24 h. RESULTS HT was diagnosed at the doctor's office by ABP and HBP in 30/40, 27/40, and 31/40 patients, respectively. Based on office BP and ABP, 60% of patients were normotensive, 17.5% HT, 7.5% had WCH, and 15% had MH, whereas based on office BP and HBP 65, 12.5, 10, and 12.5% of patients were classified according to these diagnoses, respectively. There was considerable diagnostic agreement of HT by ABP and HBP (McNemar test, P < 0.01) (kappa = 0.56). CONCLUSION In hypertensive children and adolescents, HBP and ABP present comparable results. HBP appears to be a useful diagnostic test for the detection of MH and WCH in pediatric patients.
- Oral Fludrocortisone Test for Salt-Sensitive Screening in Hypertensive Patients: A Randomized Crossover Trial(2018) PIO-ABREU, Andrea; CASTRO, Isac de; SILVA, Giovanio Vieira da; ORTEGA, Katia Coelho; MION JR., DecioBackground. Salt sensitivity is associated with an increased cardiovascular risk, but the gold standard method (diet cycles) requires 24-h urine samples and has poor patient compliance. Objectives. Test the hypothesis that oral fludrocortisone (0.4 mg per day for 7 days) is a good alternative in identifying salt-sensitive patients. Methodology. We conducted a randomized crossover study with 30 hypertensive individuals comprising the following steps: (1) washout; (2) phase A (low-and high-sodium diet cycles); (3) washout 2; (4) phase B (fludrocortisone test). Phase A and B steps were performed in a random way. Consistent with the literature, we found that 53.3% were salt-sensitive according to the reference test. Using the ROC curve, the fludrocortisone test defined salt sensitivity by a median blood pressure increase of >= 3 mmHg. A good accuracy of fludrocortisone in detecting salt sensitivity was observed (AUC: 0.732 +/- 0.065; p<0.001), with 80% sensitivity and 53% specificity. Conclusion. The fludrocortisone test is a good option for screening salt sensitivity in hypertensive patients. However, the low specificity prevents this test from being an ideal substitute to the labor-intensive diet cycles exam in the definition of salt sensitivity.