HENRIQUE COTCHI SIMBO MUELA
Projetos de Pesquisa
Unidades Organizacionais
16 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 16
conferenceObject Gender Differences of Aortic Wave Reflection and Influence of Menopause on Central Blood Pressure in Patients With Arterial Hypertension.(2017) COSTA-HONG, Valeria; MUELA, Henrique C.; MACEDO, Thiago A.; SALES, Allan R.; BORTOLOTTO, Luiz A.- Coronary events in obese hemodialysis patients before and after renal transplantation(2015) LIMA, Jose Jayme G. De; GOWDAK, Luis Henrique W.; PAULA, Flavio J. de; MUELA, Henrique Cotchi S.; DAVID-NETO, Elias; BORTOLOTTO, Luiz A.We examined the impact of obesity (BMI 30 kg/m(2), n = 357) on prognosis in 1696 hemodialysis (HD) patients before and after renal transplantation (TX). End-points were coronary events, composite cardiovascular (CV) events, and death. Obese HD patients were older (55.9 +/- 9.2 vs. 54.2 +/- 11), had more diabetes (54% vs. 40%), dyslipidemia (49% vs. 30%), altered myocardial scan (38% vs. 31%), myocardial infarction (MI) (16% vs. 10%), coronary intervention (11% vs. 7%), higher total cholesterol (186 +/- 52 vs. 169 +/- 47), and triglycerides (219 +/- 167 vs. 144 +/- 91). Obese undergoing TX had more dyslipidemia (46% vs. 31%), angina (23% vs. 14%), MI (18% vs. 5%), increased total cholesterol (185 +/- 56 vs. 172 +/- 48), and triglycerides (237 +/- 190 vs. 149 +/- 100). Obesity was independently associated with coronary events (log-rank = 0.008, HR 2.55% CI 1.27-5.11) and death (log-rank 0.046, HR 1.52, % CI 1.007-2.30) in TX but not in HD. Obese HD patients had more risk factors and ischemic heart disease, but these characteristics did not interfere with prognosis. In TX patients, obesity predicts coronary events and death.
- Intermittent claudication and severe renal artery stenosis are independently associated in hypertensive patients referred for renal arteriography(2017) MACEDO, Thiago Andrade; DRAGER, Luciano Ferreira; PEDROSA, Rodrigo Pinto; MUELA, Henrique Cotchi Simbo; COSTA-HONG, Valeria; KAJITA, Luiz Junia; BORTOLOTTO, Luiz AparecidoOBJECTIVE: The purpose of this study was to evaluate the association between the presence of clinical symptoms of peripheral artery disease and severe renal artery stenosis in patients referred for renal angiography. METHOD: We included 82 patients with clinical suspicion of renovascular hypertension and performed an imaging investigation (renal Doppler ultrasound and/or renal scintigraphy) for possible renal artery stenosis. All patients underwent renal arteriography and were examined for peripheral artery disease based on the presence of intermittent claudication and ankle-brachial index test results. Severe renal artery stenosis was defined as a lesion causing 70% obstruction. RESULTS: Severe renal artery stenosis was present in 32 of 82 (39%) patients. Patients with severe renal artery stenosis were older (63 +/- 12 vs 56 +/- 12 years, p=0.006), had more intermittent claudication (55 vs 45%, p=0.027), and had a greater prevalence of an ankle-brachial index <0.9 (44% vs 20%, p=0.021) than patients without severe renal artery stenosis. Multivariate logistic regression analysis showed that the presence of intermittent claudication was independently associated with renal artery stenosis >= 70% (OR: 3.33; 95% CI 1.03-10.82, p=0.04), unlike the ankle-brachial index, which showed no association (OR: 1.44; 95% CI 0.37-5.66, p=0.60). CONCLUSION: Intermittent claudication is independently associated with severe renal artery stenosis (>= 70%) in patients clinically suspected of having renovascular hypertension.
conferenceObject Prognostic Value of Serum Uric Acid in Patients on the Waiting List for Renal Transplantation(2012) MUELA, H. C. S.; LIMA, J. J. G. DeBackground: High serum uric acid is associated with increased cardiovascular risk in the general population. Although hyperuricemia is common in patients with chronic kidney disease (CKD), the impact of uric acid on mortality and CV events remains unclear. Objective: We assessed the relationship between base-line serum uric acid and the risk of cardiovascular events and all-cause mortality in a group of patients on the waiting list for renal transplantation before and after renal transplantation. Methods: This was a longitudinal observational study conducted in 1020 hemodialysis patients (54±11 years old, 70% Caucasians, 59% males, 40% diabetics, 38% with CVD, median follow-up 26 months) on the waiting list assessed for cardiovascular risk from July 1999 to June 2011. Data collection was terminated either at the end of the study period or in the moment that the patient had a cardiovascular event or expired. Survival curves were compared by Kaplan-Meier method. 199 patients underwent renal transplantation (50±11 years old, 72% Caucasians, 55% males, 34% diabetics, 26% with associated CVD, median follow-up 19 months). Results: High base-line serum uric acid (≥7.2 mg/dL) was not associated with either CV events (myocardial infarction, stroke, heart failure, sudden death, unstable angina, acute arterial syndrome) or with all-cause mortality. Similar results were observed in subgroups of patients with diabetes, elevated C-reactive protein or associated CV disease. For patients who underwent renal transplantation post-transplant base-line uric acid ≥7.2 mg/dL was associated with increased probability of CV events (p=0.03, HR 1.6, 95% CI 1.03-2,54). Conclusion: Elevated serum uric acid was not predictor of cardiovascular events or death in patients on the waiting list for transplant. However, an increased post-transplant base-line uric acid was related to higher probability of CV events.- Gender differences of aortic wave reflection and influence of menopause on central blood pressure in patients with arterial hypertension(2018) COSTA-HONG, Valeria Aparecida; MUELA, Henrique Cotchi Simbo; MACEDO, Thiago Andrade; SALES, Allan Robson Kluser; BORTOLOTTO, Luiz AparecidoBackground: Evidences suggest that central hemodynamics indexes are independent predictors of future cardiovascular events and all-cause mortality. Multiple factors have been pointed to have potential influence on central aortic function: height, heart rate, left ventricular ejection duration and blood pressure level. Data related to the influence of gender and postmenopausal status on aortic waveform reflection is scarce. We aim to evaluate the impact of gender and menopause on central blood pressure of hypertensive patients. Methods: In a cross sectional study 122 hypertensive patients (52 men and 70 women) were studied. Hypertension was defined as blood pressure (BP) levels >= 140/90 mmHg or use of antihypertensive drugs. Central arterial pressure, augmentation index (AIx) and augmentation index normalized to 75 bpm (AIx75) were obtained using applanation tonometry. Menopause and postmenopause history were accessed by a direct series of questions. Postmenopause was defined as at least one year since last menstruation. Patients were paired by age, gender and menopausal status, and the data were compared considering gender and menopausal status. Results: Height and weight were significantly lower in women than in men at the same age. Conversely, AIx (32.7 +/- 9.8% vs. 20.1 +/- 11.7%, p < 0.01), AIx75 (29.6 +/- 6.7% vs. 18.3 +/- 9.4%, p < 0.01) and central systolic blood pressure (136 +/- 30 vs. 125 +/- 23 mmHg, p = 0.03) were higher in women than men. The menopausal women (mean age of menopause = 48 years) had the worst indexes of aortic wave reflection, compared to men at the same age and younger women. Conclusion: Hypertensive women had both higher reflected aortic pressure waveform and central blood pressure indexes than hypertensive men, and these findings were worsened by the menopausal status.
- GENDER DIFFERENCES OF ARTERIAL STIFFNESS AND CENTRAL BLOOD PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION AND THE INFLUENCE OF MENOPAUSE(2016) BORTOLOTTO, L.; COSTA-HONG, V.; MUELA, H.; SALES, A.
- Applicability of the Test of Variables of Attention – T.O.V.A in Brazilian adults(2018) MEMÓRIA, Cláudia M.; MUELA, Henrique C.S.; MORAES, Natália C.; COSTA-HONG, Valéria A.; MACHADO, Michel F.; NITRINI, Ricardo; BORTOLOTTO, Luiz A.; YASSUDA, Monica S.ABSTRACT The functioning of attention is complex, a primordial function in several cognitive processes and of great interest to neuropsychology. The Test of Variables of Attention (T.O.V.A) is a continuous computerized performance test that evaluates some attention components such as response time to a stimulus and errors due to inattention and impulsivity. Objective: 1) To evaluate the applicability of T.O.V.A in Brazilian adults; 2) To analyze the differences in performance between genders, age ranges, and levels of education; 3) To examine the association between T.O.V.A variables and other attention and cognitive screening tests. Methods: The T.O.V.A was applied to 63 healthy adults (24 to 78 years of age) who also underwent the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Digit Span and Digit Symbol (Wechsler Intelligence Scale for Adults – WAIS-III) and the Trail Making Test. Results: the T.O.V.A was little influenced by age or education, but was influenced by gender. The correlations between some T.O.V.A variables and the Digit Symbol and Trail Making test were weak (r-values between 0.2 and 0.4), but significant (p<0.05). There was no correlation with the Digit Span test. Conclusion: The T.O.V.A showed good applicability and proved adequate for evaluating attentional processes in adults.
- Hypertension Severity Is Associated With Impaired Cognitive Performance(2017) MUELA, Henrique C. S.; COSTA-HONG, Valeria A.; YASSUDA, Monica S.; MORAES, Natalia C.; MEMORIA, Claudia M.; MACHADO, Michel F.; MACEDO, Thiago A.; SHU, Edson B. S.; MASSARO, Ayrton R.; NITRINI, Ricardo; MANSUR, Alfredo J.; BORTOLOTTO, Luiz A.Background-Most evidence of target-organ damage in hypertension (HTN) is related to the kidneys and heart. Cerebrovascular and cognitive impairment are less well studied. Therefore, this study analyzed changes in cognitive function in patients with different stages of hypertension compared to nonhypertensive controls. Methods and Results-In a cross-sectional study, 221 (71 normotensive and 150 hypertensive) patients were compared. Patients with hypertension were divided into 2 stages according to blood pressure (BP) levels or medication use (HTN-1: BP, 140-159/90-99 or use of 1 or 2 antihypertensive drugs; HTN-2: BP, >= 160/100 or use of >= 3 drugs). Three groups were comparatively analyzed: normotension, HTN stage 1, and HTN stage 2. The Mini-Mental State Examination, Montreal Cognitive Assessment, and a validated comprehensive battery of neuropsychological tests that assessed 6 main cognitive domains were used to determine cognitive function. Compared to the normotension and HTN stage-1, the severe HTN group had worse cognitive performance based on MiniMental State Examination (26.8 +/- 2.1 vs 27.4 +/- 2.1 vs 28.0 +/- 2.0; P= 0.004) or Montreal Cognitive Assessment (23.4 +/- 3.7 vs 24.9 +/- 2.8 vs 25.5 +/- 3.2; P< 0.001). On the neuropsychological tests, patients with hypertension had worse performance in language, processing speed, visuospatial abilities, and memory. Age, hypertension stage, and educational level were the best predictors of cognitive impairment in patients with hypertension in different cognitive domains. Conclusions-Cognitive impairment was more frequent in patients with hypertension, and this was related to hypertension severity.
- Higher arterial stiffness is associated with lower cognitive performance in patients with hypertension(2018) MUELA, Henrique C. S.; COSTA-HONG, Valeria A.; YASSUDA, Monica S.; MORAES, Natalia C.; MEMORIA, Claudia M.; MACHADO, Michel F.; BOR-SENG-SHU, Edson; NOGUEIRA, Ricardo C.; MANSUR, Alfredo J.; MASSARO, Ayrton R.; NITRINI, Ricardo; MACEDO, Thiago A.; BORTOLOTTO, Luiz A.Cognitive impairment and elevated arterial stiffness have been described in patients with arterial hypertension, but their association has not been well studied. We evaluated the correlation of arterial stiffness and different cognitive domains in patients with hypertension compared with those with normotension. We evaluated 211 patients (69 with normotension and 142 with hypertension). Patients were age matched and distributed according to their blood pressure: normotension, hypertension stage 1, and hypertension stage 2. Cognitive function was assessed using the Mini-Mental State Examination, Montreal Cognitive Assessment, and a battery of neuropsychological evaluations that assessed six main cognitive domains. Pulse wave velocity was measured using a Complior device, and carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. The hypertension stage 2 group had higher arterial stiffness and worse performance either by Mini-Mental State Examination (26.8 +/- 2.1 vs 27.3 +/- 2.1 vs 28.0 +/- 2.0, P=.003) or the Montreal Cognitive Assessment test (23.4 +/- 3.5 vs 24.9 +/- 2.9 vs 25.6 +/- 3.0, P<.001). On multivariable regression analysis, augmentation index, intima-media thickness, and pulse wave velocity were the variables mainly associated with lower cognitive performance at different cognitive domains. Cognitive impairment in different domains was associated with higher arterial stiffness.
- Impact of hypertension severity on arterial stiffness, cerebral vasoreactivity, and cognitive performance(2017) MUELA, Henrique Cotchi Simbo; COSTA-HONG, Valeria A.; YASSUDA, Monica Sanches; MACHADO, Michel Ferreira; NOGUEIRA, Ricardo de Carvalho; MORAES, Natalia C.; MEMÓRIA, Claudia Maia; MACEDO, Thiago A.; BOR-SENG-SHU, Edson; MASSARO, Ayrton Roberto; NITRINI, Ricardo; BORTOLOTTO, Luiz A.ABSTRACT. Aging, hypertension (HTN), and other cardiovascular risk factors contribute to structural and functional changes of the arterial wall. Objective: To evaluate whether arterial stiffness (AS) is related to cerebral blood flow changes and its association with cognitive function in patients with hypertension. Methods: 211 patients (69 normotensive and 142 hypertensive) were included. Patients with hypertension were divided into 2 stages: HTN stage-1 and HTN stage-2. The mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA) and a battery of neuropsychological (NPE) tests were used to determine cognitive function. Pulse wave velocity was measured using the Complior®. Carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. Middle cerebral artery flow velocity was measured by transcranial Doppler ultrasonography. Results: Both arterial stiffness parameters and cerebral vasoreactivity worsened in line with HTN severity. There was a negative correlation between breath holding index (BHI) and arterial stiffness parameters. Cognitive performance worsened in line with HTN severity, with statistical difference occurring mainly between the HTN-2 and normotension groups on both the MMSE and MoCA. The same tendency was observed on the NPE tests. Conclusion: Hypertension severity was associated with higher AS, worse BHI, and lower cognitive performance.