DECIO MION JUNIOR
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- 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.
- 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
- Proof of concept study: Improvement of echocardiographic parameters after renal sympathetic denervation in CKD refractory hypertensive patients(2016) KIUCHI, Marcio Galindo; MION JR., Decio; GRACIANO, Miguel Luis; CARREIRA, Maria Angela Magalhaes de Queiroz; KIUCHI, Tetsuaki; CHEN, Shaojie; LUGON, Jocemir RonaldoAim: Evaluation of the effectiveness of the renal sympathetic denervation (RSD) in reducing lesions of target organs such as the heart and kidneys, in resistant hypertensive CKD patients. Methods and results: Forty-five patients were included and treated with an ablation catheter with open irrigated tip. RSD was performed by a single operator following the standard technique. Patients included with CKD were on stages 2 (n = 22), 3 (n 16), and 4 (n = 7). Data were obtained at baseline and monthly until the 6th month of follow-up. Twenty-six out of the 45 patients had LVH and nineteen did not present LVH. The LV mass index decreased from 123.70 +/- 38.44 glm2 at baseline to 106.50 +/- 31.88 g/m(2) at the 6th month after RSD, P < 0.0001. The end-diastolic left ventricular internal dimension (LVIDd) reduced from 53.02 +/- 6.59 mm at baseline to 51.11 +/- 5.85 mm 6 months post procedure, P < 0.0001. The left ventricular end-diastolic posterior wall thickness (PWTd) showed a reduction from 10.58 +/- 139 mm at baseline to 9.82 +/- 1.15 mm at the 6th month of follow-up, P < 0.0001. The end-diastolic interventricular septum thickness (IVSTd) also decreased from 10.58 +/- 1.39 mm at baseline to 9.82 +/- 1.15 mm 6 months post procedure, P < 0.0001. The left ventricular ejection fraction (LVET) improved from 58.90 +/- 10.48% at baseline W 62.24 +/- 10.50 at the 6th month of follow-up, P < 0.0001. When the A between baseline and the 6th month post RSD in LVH patients and non LVH patients were compared to the same parameters no significant difference was found. Conclusions: The RSD seemed to be feasible, effective, and safe resulting in an improvement of echocardiographic parameters in LVH and non LVH CKD refractory hypertensive patients.
- 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.
- 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.