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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article Does Obstructive Sleep Apnea Treatment Influence Lipoprotein (a) Concentrations? Data from the TREATOSA-MS Clinical Trial(2023) GIAMPA, Sara Q. C.; VIANA, Luciana G.; CARDOZO, Karina H. M.; MACEDO, Thiago A.; FURLAN, Sofia F.; FREITAS, Lunara S.; BORTOLOTTO, Luiz A.; LORENZI-FILHO, Geraldo; DRAGER, Luciano F.- Effects of continuous positive airway pressure on depression and anxiety symptoms in patients with obstructive sleep apnoea: results from the sleep apnoea cardiovascular Endpoint randomised trial and meta-analysis(2019) ZHENG, Danni; XU, Ying; YOU, Shoujiang; HACKETT, Maree L.; WOODMAN, Richard J.; LI, Qiang; WOODWARD, Mark; LOFFLER, Kelly A.; RODGERS, Anthony; DRAGER, Luciano F.; LORENZI-FILHO, Geraldo; WANG, Xia; QUAN, Wei Wei; TRIPATHI, Manjari; MEDIANO, Olga; OU, Qiong; CHEN, Rui; LIU, Zhihong; ZHANG, Xilong; LUO, Yuanming; MCARDLE, Nigel; MUKHERJEE, Sutapa; MCEVOY, R. Douglas; ANDERSON, Craig S.Background: Whether continuous positive airway pressure (CPAP) treatment can improve depression or anxiety symptoms in obstructive sleep apnoea (OSA) patients remains uncertain. Methods: Secondary analysis of the Sleep Apnea Cardiovascular Endpoints (SAVE) trial, combined with a systematic review of randomised evidence. The SAVE secondary analyses involved 2410 patients with co-existing moderate-severe OSA and established cardiovascular disease randomly allocated to CPAP treatment plus usual care or usual care alone and followed up for 3.7 (SD 1.6) years. We evaluated the effect of CPAP treatment on depression and anxiety caseness (scores >= 8 on the Hospital Anxiety and Depression Scale depression and anxiety subscales [HADS-D and HADS-A]) for OSA patients. Findings: CPAP treatment was associated with reduced odds of depression caseness (adjusted odds ratio [OR] 0.80, 95% confidence interval [CI] 0.65-0.98, P=0.031) compared to usual care in the SAVE trial and the treatment effect was greater in those with pre-existing depression symptoms. A systematic review of 20 randomised trials including 4255 participants confirmed a benefit of CPAP in reducing depression symptoms in OSA patients: the overall effect (standardised mean difference) was -0.18 (95% CI -0.24 to -0.12). No effect of CPAP treatment on anxiety caseness was found both in patients of the SAVE study (adjusted OR 0.98, 95% CI 0.78-1.24, P = 0.89) and the systematic review. Interpretation: CPAP reduces depression symptoms in patients with co-existing OSA and CVD independently of improvements in sleepiness. (C) 2019 Published by Elsevier Ltd.
conferenceObject GENDER-RELATED DIFFERENCES IN CORONARY ARTERY DISEASE IN PATIENTS WITH RESISTANT HYPERTENSION(2022) SOLIMENE, Maria Cecilia; DRAGER, Luciano; BORTOLOTTO, Luiz- Primary Prevention of Cardiovascular Disease at Community Clinics in the State of Sao Paulo, Brazil: Results from the Epidemiological Information Study of Communities(2023) FONSECA, Henrique Andrade R.; IZAR, Maria cristina O.; DRAGER, Luciano F.; PINTO, Ibraim M.; SARAIVA, Jose Francisco K.; FERREIRA, Joao Fernando Monteiro; AVEZUM, Alvaro; FONSECA, Francisco Antonio; BERWANGER, OtavioBackground: Primary prevention of cardiovascular disease (CVD) remains a major challenge, especially in communities of low-and middle-income countries with poor medical assistance influenced by distinct local, financial, infrastructural, and resource -related factors. Objective: This a community-based study aimed to determine the proportion and prevalence of uncontrolled cardiovascular risk factors (CRF) in Brazilian communities. Methods: The EPICO study was an observational, cross-sectional, and community clinic-based study. Subjects were living in Brazilian communities and were of both sexes and & GE;18 years old, without a history of a stroke or myocardial infarction but presenting at least one of the following cardiovascular risk factors: hypertension, diabetes mellitus and hypercholesterolemia. The study was carried out in Brazil, including 322 basic health units (BHU) in 32 cities. Results: A total of 7,724 subjects with at least one CRF were evaluated, and one clinical visit was performed. Mean age was 59.2 years-old (53.7% were >60 years old). A total of 66.7% were women. Of the total, 96.2% had hypertension, 78.8% had diabetes mellitus type II, 71.1% had dyslipidemia, and 76.6% of patients were overweight/obese. Controlled hypertension (defined by <130/80 mmHg or <140/90 mmHg) was observed in 34.9% and 55.5% patients among respective criteria, the rates of controlled blood glucose in patients taking antidiabetic medications was 29.5%, and among those with documented dyslipidemia who received any lipid-lowering medication, only 13.9% had LDL-c on target. For patients presenting three CRF less than 1.9% had LDL-c < 100 mg/dL once their BP and blood glucose were on target. High education level as associated with blood pressure (BP) target of less than 130 / 80mm Hg. The glucose and LDL-c levels on target were associated with the presence of hypertension and diabetes mellitus. Conclusion: In Brazilian community clinics, regarding most patients in primary prevention, the CRF such as BP, blood glucose, and lipid levels are poorly controlled, with a majority of patients not achieving guidelines/recommendations.
- Shorter History of Hypertension as a Predictor of Hypertension Remission after 3-years of Bariatric Surgery: Data from the GATEWAY Trial(2023) OLIVEIRA, Juliana D. D.; SCHIAVON, Carlos A. A.; OLIVEIRA, Julia S. S.; SANTOS, Renato N. N.; DAMIANI, Lucas P. P.; IKEOKA, Dimas; SANTUCCI, Eliana V. V.; MACHADO, Rachel Helena V.; BORTOLOTTO, Luiz A. A.; BERWANGER, Otavio; CAVALCANTI, Alexandre B. B.; DRAGER, Luciano F. F.Background Previous evidence explored predictors of hypertension (HTN) remission after bariatric but data are limited to observational studies and lack of ambulatory blood pressure monitoring (ABPM). This study was aimed to evaluate the rate of HTN remission after bariatric surgery using ABPM and to define predictors of mid-term HTN remission. Methods We included patients enrolled in the surgical arm of the GATEWAY randomized trial. HTN remission was defined as controlled blood pressure (< 130 x 80 mmHg) evaluated by 24-h ABPM while no need of anti-hypertensive medications after 36 months. A multivariable logistic regression model was used to assess the predictors of HTN remission after 36 months. Results 46 patients submitted Roux-en-Y gastric bypass (RYGB). HTN remission occurred in 39% (n = 14 out of 36 patients with complete data at 36 months). Patients with HTN remission had shorter HTN history than no remission group (5.9 +/- 5.5 vs. 12.5 +/- 8.1 years; p = 0.01). The baseline insulin levels were lower in patients who presented HTN remission, although not statistically significant (OR: 0.90; CI 95%: 0.80-0.99; p = 0.07). In the multivariate analysis, the HTN history (years) was the only independent predictor of HTN remission (OR: 0.85; 95% CI: 0.70-0.97; p = 0.04). Therefore, for each additional year of HTN history, the chance of HTN remission decreases by approximately 15% after RYGB. Conclusion After 3 years of RYGB, HTN remission defined by ABPM was common and independently associated with a shorter HTN history. These data underscore the need of early effective approach of obesity aiming greater impact in its comorbidities.
- 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.
- Pharmacological treatment for central sleep apnoea in adults(2023) ROCHA, Aline; PINTO, Ana Carolina Pereira Nunes; V, Daniela Pachito; DRAGER, Luciano F.; LORENZI-FILHO, Geraldo; ATALLAH, Alvaro N.Background The term central sleep apnoea (CSA) encompasses diverse clinical situations where a dysfunctional drive to breathe leads to recurrent respiratory events, namely apnoea (complete absence of ventilation) and hypopnoea sleep (insuOicient ventilation) during sleep. Studies have demonstrated that CSA responds to some extent to pharmacological agents with distinct mechanisms, such as sleep stabilisation and respiratory stimulation. Some therapies for CSA are associated with improved quality of life, although the evidence on this association is uncertain. Moreover, treatment of CSA with non-invasive positive pressure ventilation is not always eOective or safe and may result in a residual apnoea-hypopnoea index. Objectives To evaluate the benefits and harms of pharmacological treatment compared with active or inactive controls for central sleep apnoea in adults. Search methods We used standard, extensive Cochrane search methods. The latest search date was 30 August 2022. Selection criteria We included parallel and cross-over randomised controlled trials (RCTs) that evaluated any type of pharmacological agent compared with active controls (e.g. other medications) or passive controls (e.g. placebo, no treatment or usual care) in adults with CSA as defined by the International Classification of Sleep Disorders 3rd Edition. We did not exclude studies based on the duration of intervention or follow-up. We excluded studies focusing on CSA due to periodic breathing at high altitudes. Data collection and analysis We used standard Cochrane methods. Our primary outcomes were central apnoea-hypopnoea index (cAHI), cardiovascular mortality and serious adverse events. Our secondary outcomes were quality of sleep, quality of life, daytime sleepiness, AHI, all-cause mortality, time to life-saving cardiovascular intervention, and non-serious adverse events. We used GRADE to assess certainty of evidence for each outcome.Main results We included four cross-over RCTs and one parallel RCT, involving a total of 68 participants. Mean age ranged from 66 to 71.3 years and most participants were men. Four trials recruited people with CSA associated with heart failure, and one study included people with primary CSA. Types of pharmacological agents were acetazolamide (carbonic anhydrase inhibitor), buspirone (anxiolytic), theophylline (methylxanthine derivative) and triazolam (hypnotic), which were given for between three days and one week. Only the study on buspirone reported a formal evaluation of adverse events. These events were rare and mild. No studies reported serious adverse events, quality of sleep, quality of life, all-cause mortality, or time to life-saving cardiovascular intervention.
conferenceObject ADHERENCE TO ANTIHYPERTENSIVE DRUG TREATMENT IN BRAZIL: SYSTEMATIC REVIEW AND META-ANALYSIS(2022) COELHO, Juliana; GUIMARAES, Mayra; SANTOS, Juliano Dos; VAZ, Ana; HIGA, Camila; ALVISI, Joyce; LEE, Renata; DRAGER, Luciano; PIERIN, AngelaconferenceObject GENDER-RELATED DIFFERENCES IN CORONARY ARTERY DISEASE IN PATIENTS WITH RESISTANT HYPERTENSION(2022) SOLIMENE, Maria Cecilia; DRAGER, Luciano; BORTOLOTTO, Luiz- What is the effect of catecholamines on diastolic function in patients with pheochromocytoma and paraganglioma?(2023) MACEDO, Thiago Andrade; DRAGER, Luciano F. F.; VIEIRA, Marcelo Luiz Campos