LUCIANO FERREIRA DRAGER
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/63, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/63, Hospital das Clínicas, Faculdade de Medicina - Líder
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- KCNJ5 Somatic Mutation Is a Predictor of Hypertension Remission After Adrenalectomy for Unilateral Primary Aldosteronism(2019) VILELA, Leticia A. P.; RASSI-CRUZ, Marcela; GUIMARAES, Augusto G.; MOISES, Caio C. S.; FREITAS, Thais C.; ALENCAR, Natalia P.; PETENUCI, Janaina; GOLDBAUM, Tatiana S.; MACIEL, Ana Alice W.; PEREIRA, Maria Adelaide A.; V, Giovanio Silva; PIO-ABREU, Andrea; ZERBINI, Maria Claudia N.; CAVALCANTE, Aline C. B. S.; CARNEVALE, Francisco C.; PILAN, Bruna; YAMAUCHI, Fernando; SROUGI, Vitor; TANNO, Fabio Y.; CHAMBO, Jose L.; LATRONICO, Ana Claudia; MENDONCA, Berenice B.; V, Maria Candida B. Fragoso; BORTOLOTTO, Luiz A.; DRAGER, Luciano F.; ALMEIDA, Madson Q.Context: Primary aldosteronism (PA) is the most common cause of endocrine hypertension (HT). HT remission (defined as blood pressure <140/90 mm Hg without antihypertensive drugs) has been reported in approximately 50% of patients with unilateral PA after adrenalectomy. HT duration and severity are predictors of blood pressure response, but the prognostic role of somatic KCNJ5 mutations is unclear. Objective: To determine clinical and molecular features associated with HT remission after adrenalectomy in patients with unilateral PA. Methods: We retrospectively evaluated 100 patients with PA (60 women; median age at diagnosis 48 years with a median follow-up of 26 months). Anatomopathological analysis revealed 90 aldosterone-producing adenomas, 1 carcinoma, and 9 unilateral adrenal hyperplasias. All patients had biochemical cure after unilateral adrenalectomy. KCNJ5 gene was sequenced in 76 cases. Results: KCNJ5 mutations were identified in 33 of 76 (43.4%) tumors: p.Gly151Arg (n = 17), p.Leu168Arg (n = 15), and p.GIu145GIn (n = 1). HT remission was reported in 37 of 100 (37%) patients. Among patients with HT remission, 73% were women (P = 0.04), 48.6% used more than three antihypertensive medications (P= 0.0001), and 64.9% had HT duration <10 years (P= 0.0015) compared with those without HT remission. Somatic KCNJ5 mutations were associated with female sex (P = 0.004), larger nodules (P = 0.001), and HT remission (P = 0.0001). In multivariate analysis, only a somatic KCNJ5 mutation was an independent predictor of HT remission after adrenalectomy (P = 0.004). Conclusion: The presence of a KCNJ5 somatic mutation is an independent predictor of HT remission after unilateral adrenalectomy in patients with unilateral PA.
- 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 IS THERE ANY VALUE FOR HOSPITALIZATION FOR CHECKING MEDICATION ADHERENCE DUE TO RESISTANT AND REFRACTORY HYPERTENSION SUSPICIOUS? IMPLICATIONS FOR MID-TERM FOR BLOOD PRESSURE CONTROL.(2020) ABREU, Andrea Pio de; TRANI, Fernanda; VIEIRA, Giovanio; BORTOLOTTO, Luiz Aparecido; DRAGER, Luciano FerreiraconferenceObject Impact of hospitalization for checking medication adherence due to resistant and refractory hypertension suspicious on short and mid-term blood pressure control(2020) PIO-ABREU, A.; TRANI-FERREIRA, F.; V, G. Silva; BORTOLOTTO, L. A.; DRAGER, L.conferenceObject THE EFFECT OF TEXT MESSAGES BY CELL PHONE IN THE CONTROL OF HYPERTENSION: A RANDOMIZED CLINICAL TRIAL(2023) COELHO, Juliana Chaves; LEE, Renata Jae Won; SILVA, Giovanio Vieira; DRAGER, Luciano Ferreira; PIERIN, Angela Maria Ger- 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
- Adherence to antihypertensive treatment during the COVID-19 pandemic: findings from a cross-sectional study(2022) GUIMARAES, Mayra Cristina da Luz Padua; COELHO, Juliana Chaves; SANTOS, Juliano dos; HIGA, Camila Braga de Oliveira; FLORIDO, Carime Farah; LEE, Renata Jae Won; PAES, Grazielli Soares; SILVA, Giovanio Vieira da; DRAGER, Luciano Ferreira; PIERIN, Angela Maria GeraldoBackground Nonadherence to antihypertensive treatment is one of the main causes of the lack of blood pressure (BP) control. The coronavirus disease (COVID-19) pandemic imposes substantial social restriction impairing the medical care routine, which may influence adherence to the antihypertensive treatment. To assess the rate of nonadherence to antihypertensive drug treatment during the COVID-19 pandemic. Methods This is a cross-sectional study evaluating hypertensive adult patients from a tertiary outpatient clinic. From March to August 2020, patients were interviewed by telephone during the social distancing period of the COVID-19 pandemic. We evaluated biosocial data, habits, attitudes, and treatment adherence using the 4-item Morisky Green Levine Scale during the social distancing. Uncontrolled BP was defined by BP >= 140/90 mmHg. Clinical and prescription variables for drug treatment were obtained from the electronic medical record. We performed a multivariate analysis to determine the predictors of nonadherence to BP treatment. Results We studied 281 patients (age 66 & PLUSMN; 14 years, 60.5% white, 62.3% women, mean education of 9.0 & PLUSMN; 4 years of study). We found that 41.3% of the individuals reported poor adherence to antihypertensive drug treatment and 48.4% had uncontrolled BP. Subsample data identified that adherence was worse during the pandemic than in the previous period. The variables that were independently associated with the nonadherence during the pandemic period were black skin color (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.46-4.68), and intermittent lack of access to antihypertensive medication during the pandemic (OR, 2.56; 95% CI, 1.11-5.89). Conclusions Beyond traditional variables associated with poor adherence, the lack of availability of antihypertensive medications during the study underscore the potential role of pandemic on hypertension burden.
- 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.
- Directly observed therapy for resistant/refractory hypertension diagnosis and blood pressure control(2022) PIO-ABREU, Andrea; TRANI-FERREIRA, Fernanda; SILVA, Giovanio V.; BORTOLOTTO, Luiz A.; DRAGER, Luciano F.Objective To test the impact of directly observed therapy (DOT) at hospital for checking not only adherence/diagnosis in patients with resistant (RHTN) and refractory (RefHTN) hypertension but also blood pressure (BP) control after hospital discharge. Methods During 2 years, Brazilian patients with clinical suspicion of RHTN/RefHTN after several attempts (>= 3) to control BP in the outpatient setting were invited to perform DOT (including low-sodium diet and supervised medications intake) at the hospital. RHTN and RefHTN were categorised using standard definitions. After hospital discharge, we evaluated the BP values and the number of antihypertensive drugs prescribed by physicians who were not involved with the investigation. Results We studied 83 patients clinically suspected for RHTN (31%) and RefHTN (69%) (mean age: 53 years; 76% female; systolic BP 177 +/- 28 mm Hg and diastolic BP 106 +/- 21 mm Hg; number of antihypertensive drugs: 5.3 +/- 1.3). DOT confirmed RHTN in 77%, whereas RefHTN was confirmed in only 32.5%. The number of antihypertensive drugs reduced to 4.5 +/- 1.3 and systolic/ diastolic BP at hospital discharge reduced to 131 +/- 17 mm Hg/80 +/- 12 mm Hg. After hospital discharge, systolic BP remained significantly lower than the last outpatient visit prehospital admission (delta changes (95% CI): 1 month: -25.7 (-33.8 to -17.6) mm Hg; 7 months: -27.3 (-35.5 to -19.1) mm Hg) despite fewer number of antihypertensive classes (1 month: -1.01 (-1.36 to -0.67); 7 months: -0.77 (-1.11 to -0.42)). Similar reductions were observed for diastolic BP. Conclusions DOT at hospital is helpful not only in confirming/excluding RHTN/RefHTN phenotypes, but also in improving BP values and BP control and in reducing the need for antihypertensive drugs after hospital discharge.
conferenceObject EFFECT OF THE PERIOD OF THE COVID-19 PANDEMIC ON HYPERTENSIVE PEOPLE: A PROSPECTIVE COHORT STUDY(2023) GUIMARAES, Mayra Cristina Luz Padua; SANTOS, Juliano; COELHO, Juliana Chaves; CAMPOS, Cassia Lima De; SILVA, Giovanio Vieira da; DRAGER, Luciano Ferreira; PIERIN, Angela Maria Geraldo