LUIZ APARECIDO BORTOLOTTO

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Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • conferenceObject
    Accuracy Of Non-Dipping Blood Pressure In Predicting Obstructive Sleep Apnea In Patients SuBMItted To Ambulatory Blood Pressure Monitoring
    (2017) FURLAN, S. F.; GENTA-PEREIRA, D. C.; OMOTE, D. D. Q.; GIORGI, D.; BORTOLOTTO, L. A.; LORENZI-FILHO, G.; DRAGER, L. F.
  • article 12 Citação(ões) na Scopus
    Heritability of arterial stiffness in a Brazilian population: Baependi Heart Study
    (2017) ALVIM, Rafael O.; HORIMOTO, Andrea R. V. R.; OLIVEIRA, Camila M.; BORTOLOTTO, Luiz A.; KRIEGER, Jose E.; PEREIRA, Alexandre C.
    Background: Increased arterial stiffness is an important determinant of cardiovascular disease risk. In addition, it has been recognized that arterial stiffness has familial aggregation; however, there are no studies involving Brazilian families. Thus, the aim of this study was to evaluate the heritability of arterial stiffness in a Brazilian population. Methods: In this study, 1675 eligible individuals (both sexes and aged 18-102 years) were distributed in 125 families resident in the municipality of Baependi, a city located in the southeast of Brazil. Carotid-femoral pulse wave velocity (PWV) was measured with a noninvasive automatic device (Complior; Artech Medical, Pantin, France). Variance component approaches, implemented in the SOLAR computer package (San Antonio, Texas, USA), were applied to estimate the heritability of the studied phenotype under different statistical models. Results: Heritability estimates for carotid-femoral PWV stratified by age ranging from 11 to 35% (higher in individuals aged <= 45 years and lower in individuals aged 18-102 years). Age and hypertension showed significant effects on the PWV trait and significantly affect heritability estimates in all models. Conclusion: We conclude that the heritability of carotid-femoral PWV in a Brazilian population is intermediate, and therefore genetic studies evolving arterial stiffness phenotypes should be encouraged.
  • 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.
  • conferenceObject
    DEVELOPMENT AND IMPLEMENTATION OF THE E-CARE PORTAL HEALTH EDUCATION FOR HYPERTENSION
    (2017) GUERRA, Grazia Maria; WEN, Chao Lung; MOTTA, Raquel Acciarito; VIEIRA, Margarida M. S.; FISTAROL, Isabela Ribeiro Braga; OLIVEIRA, Jefferson Carlos de; BORTOLOTTO, Luiz Aparecido
    The great challenge for the coming decades will be the improvement of therapy adherence for patients with hypertension, diabetes, and chronic diseases. Given the high treatment costs of these diseases for the Brazilian public health system, prevention and adherence become a priority. There are technology tools that can be used to improve communication between the health professional and the patient and thus enhance the effectiveness of the treatment. One of the many types of technology now available is education technology, which is an online repository of data providing a solid basis for health care professional-patient interface. Objective: The aim of this study was to report the building of the Health Education for Hypertension E-Care Portal. Method: This is a descriptive study of the effort that went into investigating adequate technology for an E-Care portal and building it. Three teams collaborated to make the website:the pedagogical team, relying on a research project entitled ""Therapy adherence through education technology applied to hypertensive patients"" carried out at the Heart Institute (InCor), University of Sao Paulo Medical School (FMUSP); the technological team, consulting with the Department of Telemedicine, FMUSP; and the graphic design team from the Distance Learning Nucleus, Sao Camilo University Center. Results: Creation of learning objects and interactions, such as videos with multi-professional interviews (nurse, nutritionist, psychologist, and physical trainer); debates among medical specialists (cardiologist, nephrologist, and neurologist); scripts for automated interactive behavioral situations resulting in an interactive questionnaire with computer-generated imagery; and scripts for three short films to induce behavior changes and therapy adherence by raising awareness: ""Loving others but not taking care of oneself is useless,"" ""Almost means not enough,"" and ""Overcoming obstacles to achieve quality of life."" The underlying technology was that of the virtual man. Also, 3D human body parts (heart, kidneys, and brain) were created to be used in the short films along with explanatory narratives. Conclusion: The use of the technological interactive resources created for the database should provide measurable information on the patients' acquired knowledge and enable the website users to develop enough self-confidence to care for their own health and deal with their problems.
  • article
    Arterial Stiffness: Pathophysiological and Genetic Aspects
    (2017) ALVIM, Rafael de Oliveira; SANTOS, Paulo Caleb Junior Lima; BORTOLOTTO, Luiz Aparecido; MILL, José Geraldo; PEREIRA, Alexandre da Costa
    Abstract Cardiovascular diseases (CVD) are the main cause of mortality and it represents a significant percentage of hospitalizations. In the scenario of minimization of costs of the health system, methods that identify subclinical CVD would be important. Some guidelines include the measures of aortic stiffness and intima-media thickness of the carotid artery as methods to identify subclinical CVD in hypertensive patients. The pulse wave velocity (PWV) is the gold standard for the evaluation of arterial stiffness. In this review, we report the pathophysiology, the determinants of arterial stiffness, and justify its inclusion in the assessment of hypertensive patient due its direct association with cardiovascular risk, as show in the I Diretriz Brasileira de Prevenção Cardiovascular. In addition, we raised the main genetic studies of this phenotype, due to its complexity, can be modulated by dozens of genes. However, a better understanding of the relationship genetic-arterial stiffness and, even an intervention based on genotypes, should be achieved in future studies.
  • article 0 Citação(ões) na Scopus
    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 Aparecido
    OBJECTIVE: 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.
  • article 30 Citação(ões) na Scopus
    Reduced subclinical carotid vascular disease and arterial stiffness in vegetarian men: The CARVOS Study
    (2017) ACOSTA-NAVARRO, Julio; ANTONIAZZI, Luiza; OKI, Adriana Midori; BONFIM, Maria Carlos; HONG, Valeria; ACOSTA-CARDENAS, Pedro; STRUNZ, Celia; BRUNORO, Eleonora; MINAME, Marcio Hiroshi; SALGADO FILHO, Wilson; BORTOLOTTO, Luiz Aparecido; SANTOS, Raul D.
    Background: Dietary habits play an important role in the development of atherosclerosis, the most important cause of morbidity and mortality in the world. The objective of this study was to verify if vegetarian (VEG) diet could be related a better profile of subclinical vascular disease evaluated by arterial stiffness and functional and structural properties of carotid arteries, compared to omnivorous (OMN) diet. Methods: In this cross-sectional study, 44 VEG and 44 OMN apparently healthymen >= 35 years of age, in order to not have confounding risk factors of subclinical atherosclerosis, were assessed for anthropometric data, blood pressure, blood lipids, glucose, C reactive protein (CRP), and arterial stiffness determined by carotid-femoral pulse wave velocity (PWV). Also, carotid intima-media thickness (c-IMT) and distensibility were evaluated. Results: VEG men had lower body mass index, systolic and diastolic blood pressures, fasting serum total cholesterol, LDL and non-HDL-cholesterol, apolipoprotein B, glucose and glycated hemoglobin values in comparison with OMN individuals (all p values <0.05). Markers of vascular structure and function were different between VEG and OMN: PWV 7.1 +/- 0.8 m/s vs. 7.7 +/- 0.9 m/s (p < 0.001); c-IMT 593 +/- 94 vs. 661 +/- 128 mu m (p = 0.003); and relative carotid distensibility 6.39 +/- 1.7 vs. 5.72 +/- 1.8% (p = 0.042), respectively. After a multivariate linear regression analysis, a VEG diet was independently and negatively associated with PWV (p value 0.005). Conclusions: A VEG diet is associated with a more favorable cardiovascular diseases biomarker profile and better vascular structural and functional parameters.
  • article 63 Citação(ões) na Scopus
    Galantamine alleviates inflammation and insulin resistance in patients with metabolic syndrome in a randomized trial
    (2017) CONSOLIM-COLOMBO, Fernanda M.; SANGALETI, Carine T.; COSTA, Fernando O.; MORAIS, Tercio L.; LOPES, Heno F.; MOTTA, Josiane M.; IRIGOYEN, Maria C.; BORTOLOTO, Luiz A.; ROCHITTE, Carlos Eduardo; HARRIS, Yael Tobi; SATAPATHY, Sanjaya K.; OLOFSSON, Peder S.; AKERMAN, Meredith; CHAVAN, Sangeeta S.; MACKAY, Meggan; BARNABY, Douglas P.; LESSER, Martin L.; ROTH, Jesse; TRACEY, Kevin J.; PAVLOV, Valentin A.
    BACKGROUND. Metabolic syndrome (MetS) is an obesity-driven condition of pandemic proportions that increases the risk of type 2 diabetes and cardiovascular disease. Pathophysiological mechanisms are poorly understood, though inflammation has been implicated in MetS pathogenesis. The aim of this study was to assess the effects of galantamine, a centrally acting acetylcholinesterase inhibitor with antiinflammatory properties, on markers of inflammation implicated in insulin resistance and cardiovascular risk, and other metabolic and cardiovascular indices in subjects with MetS. METHODS. In this randomized, double-blind, placebo-controlled trial, subjects with MetS (30 per group) received oral galantamine 8 mg daily for 4 weeks, followed by 16 mg daily for 8 weeks or placebo. The primary outcome was inflammation assessed through plasma levels of cytokines and adipokines associated with MetS. Secondary endpoints included body weight, fat tissue depots, plasma glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), cholesterol (total, HDL, LDL), triglycerides, BP, heart rate, and heart rate variability (HRV). RESULTS. Galantamine resulted in lower plasma levels of proinflammatory molecules TNF (-2.57 pg/ml [95% CI -4.96 to -0.19]; P = 0.035) and leptin (-12.02 ng/ml [95% CI -17.71 to -6.33]; P < 0.0001), and higher levels of the antiinflammatory molecules adiponectin (2.71 mu g/ml [95% CI 1.93 to 3.49]; P < 0.0001) and IL-10 (1.32 pg/ml, [95% CI 0.29 to 2.38]; P = 0.002) as compared with placebo. Galantamine also significantly lowered plasma insulin and HOMA-IR values, and altered HRV. CONCLUSION. Low-dose galantamine alleviates inflammation and insulin resistance in MetS subjects. These findings support further study of galantamine in MetS therapy.
  • article 55 Citação(ões) na Scopus
    Guidelines on the management of arterial hypertension and related comorbidities in Latin America
    (2017) BARBOS, Eduardo; COCA, Antonio; LOPEZ-JARAMILLO, Patricio; RAMIREZ, Agustin J.; SANCHEZ, Ramiro A.; ZANCHETTI, Alberto; BURLANDO, Guillermo; GONZALEZ, Claudio; PISKORZ, Daniel; RAMIREZ, Agustin J.; SANCHEZ, Ramiro A.; SIMSOLO, Rosa; VOTO, Liliana; WAISSMAN, Gabriel Dario; ALESSI, Alexandre; AMODEO, Celso; BRANDAO, Andrea Araujo; BAIOCCHI, Sergio; BARBOSA, Eduardo; BARRETO FILHO, Jose Augusto; BORTOLOTTO, Luiz Aparecido; JARDIM, Paulo Cesar Brandao Veiga; BRASIL, David; MIRANDA, Roberto Dischinger; FRITSCH, Mario; KALIL, Marcio; MACHADO, Carlos Alberto; FEITOSA, Audes Magalhaes; MALACHIAS, Marcus Vinicius Bolivar; MALTA, Deborah; MION JR., Decio; MOREIRA FILHO, Osni; MORENO, Heitor; GOMES, Marco Mota; NOBRE, Fernando; NOGUEIRA, Armando; OIGMAN, Wille; PASSARELLI JR., Oswaldo; RIBEIRO, Jose Marcio; POVOA, Rui Manoel Santos; SCHMID, Helena; BARROSO, Weimar Kunz Sebba; JARDIM, Thiago Veiga; VILELA-MARTIN, Jose Fernando; COBOS, Leonardo; LANAS, Fernando; MOYA, Raul Villar; MENDOZA, Jose Luis Accini; GARCIA-ORTIZ, Luis Hernando; LOPEZ-JARAMILLO, Patricio; MOLINA, Dora Ines; SANCHEZ, Gregorio; URINA-TRIANA, Miguel; MORALES-SALINAS, Alberto; LARA, Joffre; WYSS, Fernando Stuardo; ALCOCER, Luis; CAAMANO, Angel Gonzalez; PARRA-CARRILLO, Jose Z.; ORTELLADO, Jose; MONCLOA, Alfonso Bryce; SANTISTEBAN, Segundo Senclen; DIAZ, Margarita E.; HERNANDEZ, Rafael Hernandez; LOPEZ, Jesus; MACHADO, Livia T.; PONTE-NEGRETTI, Carlos
  • article 35 Citação(ões) na Scopus
    Arterial stiffness and its association with clustering of metabolic syndrome risk factors
    (2017) LOPES-VICENTE, Wanda R. P.; RODRIGUES, Sara; CEPEDA, Felipe X.; JORDAO, Camila Paixao; COSTA-HONG, Valeria; DUTRA-MARQUES, Akothirene C. B.; CARVALHO, Jefferson C.; ALVES, Maria Janieire N. N.; BORTOLOTTO, Luiz A.; TROMBETTA, Ivani C.
    Background: Metabolic syndrome (MetS) is associated with structural and functional vascular abnormalities, which may lead to increased arterial stiffness, more frequent cardiovascular events and higher mortality. However, the role played by clustering of risk factors and the combining pattern of MetS risk factors and their association with the arterial stiffness have yet to be fully understood. Age, hypertension and diabetes mellitus seem to be strongly associated with increased pulse wave velocity (PWV). This study aimed at determining the clustering and combining pattern of MetS risk factors and their association with the arterial stiffness in non-diabetic and non-hypertensive patients. Methods: Recently diagnosed and untreated patients with MetS (n = 64, 49 +/- 8 year, 32 +/- 4 kg/m(2)) were selected, according to ATP III criteria and compared to a control group (Control, n = 17, 49 +/- 6 year, 27 +/- 2 kg/m(2)). Arterial stiffness was evaluated by PWV in the carotid-femoral segment. Patients were categorized and analyzed according MetS risk factors clustering (3, 4 and 5 factors) and its combinations. Results: Patients with MetS had increased PWV when compared to Control (7.8 +/- 1.1 vs. 7.0 +/- 0.5 m/s, p < 0.001). In multivariate analysis, the variables that remained as predictors of PWV were age (beta = 0.450, p < 0.001), systolic blood pressure (beta = 0.211, p = 0.023) and triglycerides (beta = 0.212, p = 0.037). The increased number of risk factors reflected in a progressive increase in PWV. When adjusted to systolic blood pressure, PWV was greater in the group with 5 risk factors when compared to the group with 3 risk factors and Control (8.5 +/- 0.4 vs. 7.5 +/- 0.2, p = 0.011 and 7.2 +/- 0.3 m/s, p = 0.012). Similarly, the 4 risk factors group had higher PWV than the Control (7.9 +/- 0.2 vs. 7.2 +/- 0.3, p = 0.047). Conclusions: The number of risk factors seems to increase arterial stiffness. Notably, besides age and increased systolic blood pressure, alterations in the triglycerides worsened the stiffness of large vessels, emphasizing the importance in addressing this risk factor in MetS patients.