ANDREA PIO DE ABREU

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina

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  • article 42 Citação(ões) na Scopus
    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.
  • conferenceObject
    Influence of Time of Day on Post-Exercise Hypotension Might Be Different in Hypertensives Receiving Different Anti-hypertensive Drugs: An Exploratory Study
    (2016) BRITO, Leandro; PECANHA, Tiago; FECCHIO, Rafael; SOUSA, Patricia; REZENDE, Rafael; NAVARRO, Manilla; SILVA, Giovanio; ABREU, Andrea; MION-JUNIOR, Decio; FORJAZ, Claudia
  • article 1 Citação(ões) na Scopus
    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 Ferreira
  • bookPart
    Hipertensão arterial e os rins
    (2013) SILVA, Giovanio Vieira da; ABREU, Andrea Pio de
  • article 2 Citação(ões) na Scopus
    Activation of Mechanoreflex, but not Central Command, Delays Heart Rate Recovery after Exercise in Healthy Men
    (2021) PECANHA, Tiago; BRITO, Leandro Campos de; FECCHIO, Rafael Yokoyama; SOUSA, Patricia Nascimento de; SILVA, Natan Daniel; COUTO, Patricia Guimaraes; ABREU, Andrea Pio de; SILVA, Giovanio Vieira da; MION, Decio; LOW, David A.; FORJAZ, Claudia Lucia de Moraes
    This study tested the hypotheses that activation of central command and muscle mechanoreflex during post-exercise recovery delays fast-phase heart rate recovery with little influence on the slow phase. Twenty-five healthy men underwent three submaximal cycling bouts, each followed by a different 5-min recovery protocol: active (cycling generated by the own subject), passive (cycling generated by external force) and inactive (no-cycling). Heart rate recovery was assessed by the heart rate decay from peak exercise to 30s and 60s of recovery (HRR (30s) , HRR (60s) fast phase) and from 60s-to-300s of recovery (HRR (60-300s) slow phase). The effect of central command was examined by comparing active and passive recoveries (with and without central command activation) and the effect of mechanoreflex was assessed by comparing passive and inactive recoveries (with and without mechanoreflex activation). Heart rate recovery was similar between active and passive recoveries, regardless of the phase. Heart rate recovery was slower in the passive than inactive recovery in the fast phase (HRR (60s) =20 +/- 8vs.27 +/- 10bpm, p<0.01), but not in the slow phase (HRR (60-300s) =13 +/- 8vs.10 +/- 8bpm, p=0.11). In conclusion, activation of mechanoreflex, but not central command, during recovery delays fast-phase heart rate recovery. These results elucidate important neural mechanisms behind heart rate recovery regulation.
  • conferenceObject
  • article 16 Citação(ões) na Scopus
    Obstructive sleep apnea and ambulatory blood pressure monitoring: current evidence and research gaps
    (2021) PIO-ABREU, Andrea; MORENO JR., Heitor; DRAGER, Luciano F.
    Obstructive Sleep Apnea (OSA) is a common condition characterized by intermittent collapse of the upper airway during sleep, resulting in partial (hypopnoeas) and total obstructions (apneas). These respiratory events observed in OSA may trigger multiple pathways involved in the blood pressure (BP) instability during the night and potentially influencing daytime BP as well (carry-over effects). This review provides an update about the impact of OSA and its treatments on 24-h BP control. Overall, there is growing evidence suggest that OSA is associated with higher frequency of nondipping BP pattern and nocturnal hypertension in a dose-dependent manner. The presence of nondiping BP (especially the reverse pattern) is independently associated with OSA regardless of sleep-related symptoms suggesting a potential tool for screening OSA in patients with clinical indication for performing ABPM. Beyond dipping BP, preliminary evidence associated OSA with white-coat effect and higher frequency of masked hypertension and BP variability than the control group (no OSA). Unfortunately, most of the evidence on the evidence addressing the impact of OSA treatment on BP was limited to office measurements. In the last years, data from observational and randomized studies pointed that CPAP is able to promote 24-h BP decrease especially in patients with resistant and refractory hypertension. A randomized trial suggests that CPAP is able to decrease the rate of masked hypertension as compared to no treatment in patients with severe OSA. Interestingly, nondipping BP is a good predictor of BP response to CPAP making ABPM an interesting tool for better OSA management.
  • article 11 Citação(ões) na Scopus
    Resistant Hypertension: Time to Consider the Best Fifth Anti-Hypertensive Treatment
    (2018) PIO-ABREU, Andrea; DRAGER, Luciano F.
    Resistant hypertension (RH) is a growing clinical condition worldwide associated with target-organ damage and poor prognosis compared to non-resistant counterparts. The purpose of this review is to perform a critical evaluation of preferable drug choices for managing RH highlighting the evidence that significant proportion of patients remained uncontrolled despite using four anti-hypertensive drugs. Until recently, the fourth drug therapy was main derived from personal opinion or small interventional studies. The recent data derived from two multicentric randomized trials, namely PATHWAY-2 and ReHOT, pointed spironolactone as the preferable fourth drug therapy in patients with confirmed RH as compared to bisoprolol and doxazosin (PATHWAY-2) as well as clonidine (ReHOT). However, significant proportion of patients (especially observed in ReHOT trial that used 24-h ambulatory blood pressure monitoring) did not achieve optimal blood pressure with the fourth drug. This finding underscores the need of new approaches and treatment options in this important research area. The current evidence pointed that significant proportion of RH patients are requiring more than four drugs for controlling BP. This statement is particularly true considering the new criteria proposed by the 2017 Guidelines for diagnosing RH (> 130 x 80 mmHg). New combinations, drugs, or treatments should be tested aiming to reduce the RH burden. Based on the aforementioned multicentric trials, we proposed the first five preferable anti-hypertensive classes in the overall context of RH.
  • article 300 Citação(ões) na Scopus
    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