VALERIA APARECIDA DA COSTA HONG
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- 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.
conferenceObject Increased Blood Pressure Variability and Baroreflex Impairment in Patients With End-stage Renal Disease Undergoing Hemodialysis(2013) SCAPINI, Katia B.; HONG, Valeria C.; FERREIRA, Janaina B.; SOUZA, Silvia B.; FERREIRA, Naomi V.; MORAES, Oscar A.; CONSOLIM-COLOMBO, Fernanda M.; LIMA, Jose J. de; MOSTARDA, Cristiano; IRIGOYEN, Maria C.- Renal Denervation by Ablation with Innovative Technique in Resistant Hypertension(2013) BORTOLOTTO, Luiz Aparecido; MIDLEJ-BRITO, Thiago; PISANI, Cristiano; COSTA-HONG, Valeria; SCANAVACCA, MauricioThe authors review the concept of resistant hypertension and the involvement of the sympathetic nervous system in hypertension as a rational basis for the technique of renal sympathetic denervation (RSD) performed percutaneously. This revision is the result of an active search for scientific articles with the term “renal denervation” in the Medline and PubMed databases. The techniques and devices used in the procedure are presented, as well as clinical outcomes at six,12 and 24 months after the intervention with the Symplicity catheter. Significant decreases and progressively higher reductions of systolic and diastolic blood pressure were observed after RSD. The complication rate was minimal. New devices for RSD and its ongoing clinical studies are cited. In conclusion, the RSD presents itself as an effective and safe approach to resistant hypertension. Results from ongoing studies and longer follow-up of these patients are expected to confirm the initial results and put into perspective the expansion of the procedure use in hypertension approach.
- Reference intervals for common carotid intima-media thickness measured with echotracking: relation with risk factors(2013) ENGELEN, Lian; FERREIRA, Isabel; STEHOUWER, Coen D.; BOUTOUYRIE, Pierre; LAURENT, Stephane; BOUTOUYRIE, Pierre; LAURENT, Stephane; JOUVEN, Xavier; EMPANA, Jean-Philippe; BOZEC, Erwan; SIMON, Tabassome; PANNIER, Bruno; MATTACE-RASO, Francesco U. S.; HOFMAN, Albert; FRANCO, Oscar H.; KAVOUSI, Maryam; ROOIJ, Frank J. van; WITTEMAN, Jacqueline; RIETZSCHEL, Ernst; VERMEERSCH, Sebastian; SEGERS, Patrick; BORTEL, Luc Van; BACQUER, Dirk De; DAELE, Caroline Van; BUYZERE, Marc De; BOTS, Michiel L.; SCHOUW, Yvonne T. van der; GROBBEE, Diederick E.; UITERWAAL, Cuno S.; EVELEIN, Annemieke; GRAAF, Yolanda van der; VISSEREN, Frank L. J.; STEHOUWER, Coen; FERREIRA, Isabel; DEKKER, Jacqueline; NIJPELS, Giel; TWISK, Jos; SMULDERS, Yvo; SCHALKWIJK, Casper; GREEVENBROEK, Marleen van; KALLEN, Carla van der; LAAR, Roel van de; FESKENS, Edith; STAESSEN, Jan; THIJS, Lutgarde; KOUZNETSOVA, Tatyana; JIN, Yu; LIU, Yanping; BENETOS, Athanase; LABAT, Carlos; LACOLLEY, Patrick; WANG, Jiguang; LI, Yan; FISCHER, Joachim; TERRIS, Darcey; JARCZOK, Marc; THOLE, Maren; HEUTEN, Hilde; GOOVAERTS, Inge; ENNEKENS, Guy; VRINTS, Christiaan; RYLISKYTE, Ligita; LAUCEVICIUS, Aleksandras; RYLISKIENE, Kristina; KUZMICKIENE, Jurgita; BIANCHINI, Elisabetta; GHIADONI, Lorenzo; BRUNO, Rosa Maria; CARTONI, Giulia; TADDEI, Stefano; TOLEZANI, Elaine C.; HONG, Valeria; BORTOLOTTO, Luiz; VERMEER, Cees; BRAAM, Lavienja; KNAPEN, Marjo; DRUMMEN, Nadja; RIMOLDI, Stefano F.; STUCKI, Fabian; HUTTER, Damian; REXHAJ, Emrush; FAITA, Francesco; SARTORI, Claudio; SCHERRER, Urs; ALLEMANN, Yves; DELAHOUSSE, Michel; KARRAS, Alexandre; GIANNATTASIO, Cristina; CESANA, Francesca; NAVA, Stefano; MALOBERTI, Alessandro; KOLLAI, Mark; PINTER, Alexandra; HORVATH, Tamas; NARKIEWICZ, Krzysztof; SZYNDLER, Anna; HOFFMANN, Michal; NOWAK, Robert; POLONIS, Katarzyna; THUILLEZ, Christian; JOANNIDES, Robinson; BELLIEN, Jeremy; ANGEL, Kristin; ATAR, Dan; FILIPOVSKY, Jan; AGHARAZII, Mohsen; BRIET, MarieAims Common carotid artery intima-media thickness (CCIMT) is widely used as a surrogate marker of atherosclerosis, given its predictive association with cardiovascular disease (CVD). The interpretation of CCIMT values has been hampered by the absence of reference values, however. We therefore aimed to establish reference intervals of CCIMT, obtained using the probably most accurate method at present (i.e. echotracking), to help interpretation of these measures. Methods and results We combined CCIMT data obtained by echotracking on 24 871 individuals (53 men; age range 15-101 years) from 24 research centres worldwide. Individuals without CVD, cardiovascular risk factors (CV-RFs), and BP-, lipid-, and/or glucose-lowering medication constituted a healthy sub-population (n = 4234) used to establish sex-specific equations for percentiles of CCIMT across age. With these equations, we generated CCIMT Z-scores in different reference sub-populations, thereby allowing for a standardized comparison between observed and predicted (normal) values from individuals of the same age and sex. In the sub-population without CVD and treatment (n = 14 609), and in men and women, respectively, CCIMT Z-scores were independently associated with systolic blood pressure [standardized s 0.19 (95 CI: 0.16-0.22) and 0.18 (0.15-0.21)], smoking [0.25 (0.19-0.31) and 0.11 (0.04-0.18)], diabetes [0.19 (0.05-0.33) and 0.19 (0.02-0.36)], total-to-HDL cholesterol ratio [0.07 (0.04-0.10) and 0.05 (0.02-0.09)], and body mass index [0.14 (0.12-0.17) and 0.07 (0.04-0.10)]. Conclusion We estimated age- and sex-specific percentiles of CCIMT in a healthy population and assessed the association of CV-RFs with CCIMT Z-scores, which enables comparison of IMT values for (patient) groups with different cardiovascular risk profiles, helping interpretation of such measures obtained both in research and clinical settings.
- Renal Artery Stenosis Predicts Coronary Artery Disease in Patients with Hypertension(2013) MACEDO, Thiago A.; PEDROSA, Rodrigo P.; COSTA-HONG, Valeria; KAJITA, Luiz J.; MORAIS, Gustavo R.; LIMA, Jose J. G. De; DRAGER, Luciano F.; BORTOLOTTO, Luiz A.In hypertensive patients with indication of renal arteriography to investigate renal artery stenosis (RAS) there are no recommendations regarding when to investigate coronary artery disease (CAD). Moreover, the predictors of CAD in patients with RAS are not clear. We aimed to evaluate the frequency and the determinants of CAD in hypertensive patients referred to renal angiography. Eighty-two consecutive patients with high clinical risk suggesting the presence of RAS systematically underwent renal angiography and coronary angiography during the same procedure. Significant arterial stenosis was defined by an obstruction >= 70% to both renal and coronary territories. Significant CAD was present in 32/82 (39%) and significant RAS in 32/82 (39%) patients. Both CAD and RAS were present in 25.6% from the 82 patients. Patients with severe CAD were older (63 +/- 12 vs. 56 +/- 13 years; p = 0.03) and had more angina (41 vs. 16%; p = 0.013) compared to patients without severe CAD. Significant RAS was associated with an increased frequency of severe CAD compared to patients without significant RAS (66% vs. 22%, respectively; p<0.001). Myocardial scintigraphy showed ischemia in 21.8% of the patients with CAD. Binary logistic regression analysis showed that RAS >= 70% was independently associated with CAD >= 70% (OR: 11.48; 95% CI 3.2-40.2; p<0.001), even in patients without angina (OR: 13.48; 95% CI 2.6-12.1; p<0.001). Even considering a small number of patients with significant RAS, we conclude that in hypertensive patients referred to renal angiography, RAS >= 70% may be a strong predictor of severe CAD, independently of angina, and dual investigation should be considered.