VALERIA APARECIDA DA COSTA HONG
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conferenceObject User embracement vs. technology based distance learning in therapy adherence in arterial hypertension(2016) GUERRA, G.; WEN, C. L.; VIEIRA, M.; FISTAROL, I. R. B.; TSUNEMI, M. H.; GIORGI, D. M. A.; HONG, V.; MOTTA, R. A.; KOWALSKI, I. S. G.; OLEVEIRA, J. C. De; CONSOLIM-COLOMBO, F. M.; LOPES, H. F.; BORTOLOTTO, L. A.- The impact of metabolic syndrome on metabolic, proinflammatory and prothrombotic markers according to the presence of high blood pressure criterion(2013) GIL, Juliana S.; DRAGER, Luciano F.; GUERRA-RICCIO, Grazia M.; MOSTARDA, Cristiano; IRIGOYEN, Maria C.; COSTA-HONG, Valeria; BORTOLOTTO, Luiz A.; EGAN, Brent M.; LOPES, Heno F.OBJECTIVES: We explored whether high blood pressure is associated with metabolic, inflammatory and prothrombotic dysregulation in patients with metabolic syndrome. METHODS: We evaluated 135 consecutive overweight/obese patients. From this group, we selected 75 patients who were not under the regular use of medications for metabolic syndrome as defined by the current Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults criteria. The patients were divided into metabolic syndrome with and without high blood pressure criteria (>= 130/>= 85 mmHg). RESULTS: Compared to the 45 metabolic syndrome patients without high blood pressure, the 30 patients with metabolic syndrome and high blood pressure had significantly higher glucose, insulin, homeostasis model assessment insulin resistance index, total cholesterol, low-density lipoprotein-cholesterol, triglycerides, uric acid and creatinine values; in contrast, these patients had significantly lower high-density lipoprotein-cholesterol values. Metabolic syndrome patients with high blood pressure also had significantly higher levels of retinol-binding protein 4, plasminogen activator inhibitor 1, interleukin 6 and monocyte chemoattractant protein 1 and lower levels of adiponectin. Moreover, patients with metabolic syndrome and high blood pressure had increased surrogate markers of sympathetic activity and decreased baroreflex sensitivity. Logistic regression analysis showed that high-density lipoprotein, retinol-binding protein 4 and plasminogen activator inhibitor-1 levels were independently associated with metabolic syndrome patients with high blood pressure. There is a strong trend for an independent association between metabolic syndrome patients with high blood pressure and glucose levels. CONCLUSIONS: High blood pressure, which may be related to the autonomic dysfunction, is associated with metabolic, inflammatory and prothrombotic dysregulation in patients with metabolic syndrome.
- Does Obstructive Sleep Apnea Influence Blood Pressure and Arterial Stiffness in Response to Antihypertensive Treatment?(2018) FATURETO-BORGES, Fernanda; JENNER, Raimundo; COSTA-HONG, Valeria; LOPES, Heno F.; TEIXEIRA, Sandra H.; MARUM, Elias; GIORGI, Dante A. M.; CONSOLIM-COLOMBO, Fernanda M.; BORTOLOTTO, Luiz A.; LORENZI-FILHO, Geraldo; KRIEGER, Eduardo M.; DRAGER, Luciano F.Untreated obstructive sleep apnea (OSA) is common in patients with hypertension and may impair blood pressure (BP) and target-organ damage responses to antihypertensive therapy. In this study, we recruited hypertensive patients who underwent treatment with a 30-day regimen of hydrochlorothiazide 25 mg plus enalapril (20 mg BID) or losartan (50 mg BID) and were assessed with a baseline clinical evaluation, polysomnography, 24-hour ambulatory BP monitoring, and carotid-femoral pulse wave velocity. All the examinations except for polysomnography were repeated at 6 and 18 months of follow-up. We studied 94 hypertensive patients (mean age, 55 +/- 9 years). The frequency of OSA was 55%. Compared with baseline, we did not observe significant differences between groups in 24-hour BP, daytime systolic and diastolic BPs, or night-time systolic BP at 6 and 18 months. The BP control rate at 24 hours (<130/80 mmHg) was similar between the groups (baseline, 42.3% versus 45.2%; 6 months, 46.9% versus 57.5%; 18 months, 66.7% versus 61.5%). However, patients with OSA had higher night-time diastolic BP decrease than did the non-OSA group (6 months, -4.9 +/- 11.8 versus -0.3 +/- 10.3 mmHg; 18 months, -6.7 +/- 11.1 versus -1.2 +/- 10.6 mmHg; P=0.027). There were no differences in the number and class of antihypertensive medications prescribed during follow-up. In terms of arterial stiffness, patients with OSA had higher pulse wave velocity than did patients without OSA at baseline (10.3 +/- 1.9 versus 9.2 +/- 1.7 m/s; P=0.024), but both groups had similar decreases in pulse wave velocity during follow-up. In conclusion, with combined antihypertensive treatment aimed at controlling BP, hypertensive patients with OSA had similar 24-hour BP and arterial stiffness to those without OSA.
- Effects of CPAP on Metabolic Syndrome in Patients With OSA A Randomized Trial(2022) GIAMPA, Sara Q. C.; FURLAN, Sofia F.; FREITAS, Lunara S.; MACEDO, Thiago A.; LEBKUCHEN, Adriana; CARDOZO, Karina H. M.; CARVALHO, Valdemir M.; MARTINS, Franco C.; AZAM, Indira F. B.; COSTA-HONG, Valeria; LOPES, Heno F.; BAPTISTA, Mariana L.; ROCHITTE, Carlos E.; BORTOLOTTO, Luiz A.; LORENZI-FILHO, Geraldo; DRAGER, Luciano F.BACKGROUND: OSA is associated with metabolic syndrome (MS), but it is unclear whether OSA treatment with CPAP can revert MS. RESEARCH QUESTION: Does OSA treatment with CPAP per se have effects on the MS reversibility and the associated metabolic, adiposity and vascular parameters? STUDY DESIGN AND METHODS: The TREATOSA-MS trial is a randomized placebo-controlled trial that enrolled adult patients with a recent diagnosis of MS and moderate or severe OSA (apnea-hypopnea index [AHI], >= 15 events/h) to undergo therapeutic CPAP or nasal dilator strips (placebo group) for 6 months. Before and after each intervention, we measured anthropometric variables, BP, glucose, and lipid profile. To control potential-related mechanisms and consequences, we also measured adiposity biomarkers (leptin and adiponectin), body composition, food intake, physical activity, subcutaneous and abdominal fat (visceral and hepatic fat), and endothelial function. RESULTS: One hundred patients (79% men; mean age, 48 +/- 9 years; BMI, 33 +/- 4 kg/m(2); AHI, 58 +/- 29 events/h) completed the study (n = 50 per group). The mean CPAP adherence was 5.5 +/- 1.5 h/night. After 6 months, most patients with OSA randomized to CPAP retained the MS diagnosis, but the rate of MS reversibility was higher than observed in the placebo group (18% vs 4%; OR, 5.27; 95% CI, 1.27-35.86; P = .04). In the secondary analysis, CPAP did not promote significant reductions in the individual components of MS, weight, hepatic steatosis, lipid profile, adiponectin, and leptin, but did promote a very modest reduction in visceral fat and improved endothelial function (all analyses were adjusted for baseline values). INTERPRETATION: Despite the higher rate of MS reversibility after CPAP therapy as compared with placebo, most patients retained this diagnosis. The lack of significant or relevant effects on adiposity biomarkers and depots supports the modest role of OSA in modulating MS.
conferenceObject LARGE ARTERIES IMPAIRMENT ARE CORRELATED TO AGEING AND DIABETES IN PATIENTS WITH STAGE 3 HYPERTENSION(2015) BORTOLOTTO, L.; SOUZA, M. G.; HONG, V. C.; GIORGI, D. M. A.; LOPES, H. F.; DRAGER, L. F.; CONSOLIM-COLOMBO, F. M.; KRIEGER, E. M.- Hypertensive heart disease: Benefit of carvedilol in hemodynamic, left ventricular remodeling, and survival(2019) DOMINGUEZ, Renata F.; COSTA-HONG, Valeria A. da; FERRETTI, Luan; FERNANDES, Fabio; BORTOLOTTO, Luiz A.; CONSOLIM-COLOMBO, Fernanda M.; EGAN, Brent M.; LOPES, Heno F.Objectives: The aim of this study was to determine if carvedilol improved structural and functional changes in the left ventricle and reduced mortality in patients with hypertensive heart disease. Methods: Blood pressure, heart rate, echocardiographic parameters, and laboratory variables, were assessed pre and post treatment with carvedilol in 98 eligible patients. Results: Carvedilol at a median dose of 50 mg/day during the treatment period in hypertensive heart disease lowered blood pressure 10/10 mmHg, heart rate 10 beats/min, improved left ventricular ejection fraction from baseline to follow-up (median: 6 years) (36%-47%)) and reduced left ventricular end-diastolic and end-systolic dimensions (62 vs 56 mm; 53 vs 42 mm, respectively, all p-values <0.01). Left ventricular ejection fraction increased in 69% of patients. Patients who did not have improved left ventricular ejection fraction had nearly six-fold higher mortality than those that improved (relative risk; 5.7, 95% confidence interval: 1.3-25, p = 0.022). Conclusion: Carvedilol reduced cardiac dimensions and improved left ventricular ejection fraction and cardiac remodeling in patients with hypertensive heart disease. These treatment-related changes had a favorable effect on survival.
conferenceObject The Influence Of Religiosity On The Embracement Vs. Technology Based Distance Learning In Therapy Adherence In Patient Hypertensive(2016) GUERRA, Grazia M.; WEN, Chao L.; VIEIRA, Margarida; FISTAROL, Isabela; TSUNEMI, Miriam H.; GIORGI, Dante M.; MOTTA, Raquel A.; OLIVEIRA, Jefferson C.; HONG, Valeria; LOPES, Heno F.conferenceObject ARTERIAL STIFFNESS IN PATIENTS WITH STAGE 3 HYPERTENSION IS CORRELATED TO INFLAMMATION AND NOCTURNAL BLOOD PRESSURE(2015) BORTOLOTTO, L.; COSTA-HONG, V.; GIORGI, D. M. A.; LOPES, H. F.; DRAGER, L. F.; CONSOLIM-COLOMBO, F. M.; LIMA, J. J. G. De; KRIEGER, E. M.conferenceObject Blood pressure and sympathetic activity markers are associated with monocyte chemoattractant protein 1 (MCP1) levels(2015) LOPES, H.; DOMINGUEZ, R. F.; SANTOS, J. G.; COSTA-HONG, V.; BORTOLOTTO, L. A.; CONSOLIM-COLOMBO, F.- Association of obstructive sleep apnea with arterial stiffness and nondipping blood pressure in patients with hypertension(2017) JENNER, Raimundo; FATURETO-BORGES, Fernanda; COSTA-HONG, Valeria; LOPES, Heno F.; TEIXEIRA, Sandra H.; MARUM, Elias; GIORGI, Dante A. M.; CONSOLIM-COLOMBO, Fernanda M.; BORTOLOTTO, Luiz A.; LORENZI-FILHO, Geraldo; KRIEGER, Eduardo M.; DRAGER, Luciano F.Whether sex influences the association of obstructive sleep apnea (OSA) with markers of cardiovascular risk in patients with hypertension is unknown. In this study, 95 hypertensive participants underwent carotid-femoral pulse wave velocity, 24-hour ambulatory blood pressure monitoring, echocardiogram, and polysomnography after a 30-day standardized treatment with hydrochlorothiazide plus enalapril or losartan. OSA was present in 52 patients. Compared with non-OSA patients, pulse wave velocity values were higher in the OSA group (men: 11.1 +/- 2.2 vs 12.7 +/- 2.4m/s, P=.04; women: 11.8 +/- 2.4 vs 13.2 +/- 2.2m/s, P=.03). The proportion of diastolic dysfunction was significant in men and women with OSA. Compared with non-OSA patients, nondipping systolic blood pressure in OSA was higher in men (14.3% vs 46.4%) and in women (41.4% vs 65.2%). OSA was independently associated with pulse wave velocity (=1.050; P=.025) and nondipping systolic blood pressure (odds ratio, 3.03; 95% confidence interval, 1.08-8.55; P=.035) in the regression analysis. In conclusion, OSA is independently associated with arterial stiffness and nondipping blood pressure in patients with hypertension regardless of sex.