AYRTON ROBERTO MASSARO
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- Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of ROCKET AF(2012) HANKEY, Graeme J.; PATEL, Manesh R.; STEVENS, Susanna R.; BECKER, Richard C.; BREITHARDT, Gunter; CAROLEI, Antonio; DIENER, Hans-Christoph; DONNAN, Geoffrey A.; HALPERIN, Jonathan L.; MAHAFFEY, Kenneth W.; MAS, Jean-Louis; MASSARO, Ayrton; NORRVING, Bo; NESSEL, Christopher C.; PAOLINI, John F.; ROINE, Risto O.; SINGER, Daniel E.; WONG, Lawrence; CALIFF, Robert M.; FOX, Keith A. A.; HACKE, WernerBackground In ROCKET AF, rivaroxaban was non-inferior to adjusted-dose warfarin in preventing stroke or systemic embolism among patients with atrial fibrillation (AF). We aimed to investigate whether the efficacy and safety of rivaroxaban compared with warfarin is consistent among the subgroups of patients with and without previous stroke or transient ischaemic attack (TIA). Methods In ROCKET AF, patients with AF who were at increased risk of stroke were randomly assigned (1:1) in a double-blind manner to rivaroxaban 20 mg daily or adjusted dose warfarin (international normalised ratio 2-0-3.0). Patients and investigators were masked to treatment allocation. Between Dec 18,2006, and June 17,2009,14 264 patients from 1178 centres in 45 countries were randomly assigned. The primary endpoint was the composite of stroke or non-CNS systemic embolism. In this substudy we assessed the interaction of the treatment effects of rivaroxaban and warfarin among patients with and without previous stroke or TIA. Efficacy analyses were by intention to treat and safety analyses were done in the on-treatment population. ROCKET AF is registered with ClinicalTrials.gov, number NCT00403767. Findings 7468 (52%) patients had a previous stroke (n=4907) or TIA (n=2561) and 6796 (48%) had no previous stroke or TIA. The number of events per 100 person-years for the primary endpoint in patients treated with rivaroxaban compared with warfarin was consistent among patients with previous stroke or TIA (2.79% rivaroxaban vs 2.96% warfarin; hazard ratio [HR] 0-94,95% CI 0.77-1.16) and those without (1.44% vs 1.88%; 0.77, 0.58-1-01; interaction p=0.23). The number of major and non-major clinically relevant bleeding events per 100 person-years in patients treated with rivaroxaban compared with warfarin was consistent among patients with previous stroke or TIA (13.31% rivaroxaban vs 13.87% warfarin; HR 0.96,95% CI 0.87-1-07) and those without (16.69% vs 15.19%; 1.10, 0.99-1.21; interaction p=0.08). Interpretation There was no evidence that the relative efficacy and safety of rivaroxaban compared with warfarin was different between patients who had a previous stroke or TIA and those who had no previous stroke or TIA. These results support the use of rivaroxaban as an alternative to warfarin for prevention of recurrent as well as initial stroke in patients with AF.
- 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.
- Evaluation of cerebral autoregulation performance in patients with arterial hypertension on drug treatment(2020) MACHADO, Michel Ferreira; MUELA, Henrique Cotchi Simbo; COSTA-HONG, Valeria Aparecida; YASSUDA, Monica Sanches; MORAES, Natalia Cristina; MEMORIA, Claudia Maia; BOR-SENG-SHU, Edson; MASSARO, Ayrton Roberto; NITRINI, Ricardo; BORTOLOTTO, Luiz Aparecido; NOGUEIRA, Ricardo de CarvalhoCerebral autoregulation (AR) keeps cerebral blood flow constant despite fluctuations in systemic arterial pressure. The final common AR pathway is made up of vasomotor adjustments of cerebrovascular resistance mediated by arterioles. Structural and functional changes in the arteriolar wall arise with age and systemic arterial hypertension. This study evaluated whether AR is impaired in hypertensive patients and whether this impairment differs with disease control. Three groups of patients were prospectively compared: hypertensive patients under treatment with systolic blood pressure (SBP) <140 and diastolic blood pressure (DBP) <90 mm Hg (n = 54), hypertensive patients under treatment with SBP > 140 or DBP > 90 mm Hg (n = 31), and normotensive volunteers (n = 30). Simultaneous measurements of cerebral blood flow velocity (CBFV) and BP were obtained by digital plethysmography and transcranial Doppler, and the AR index (ARI) was defined according to the step response to spontaneous fluctuations in BP. Compared to the uncontrolled hypertension, the normotensive individuals were younger (age 43.42 +/- 11.14,P < .05) and had a lower resistance-area product (1.17 +/- 0.24,P < .05), although age and greater arteriolar stiffness did not affect the CBFV mean of hypertensive patients, whether controlled or uncontrolled (62.85 x 58.49 x 58.30 cm/s,P = .29), most likely because their ARIs were not compromised (5.54 x 5.91 x 5.88,P = .6). Hypertensive patients under treatment, regardless of their BP control, have intact AR capacity.
- 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.
conferenceObject Arterial Stiffness is Associated With Lower Performance on the Cognitive Tests at Different Domains in Hypertensive Patients.(2017) MUELA, Henrique; COSTA-HONG, Valeria; MACHADO, Michel F.; MORAES, Natalia C.; MEMORIA, Claudia M.; YASSUDA, Monica S.; SHU, Edson B.; MASSARO, Ayrton R.; NITRINI, Ricardo; MANSUR, Alfredo; BORTOLOTTO, Luiz- ARTERIAL STIFFNESS IS ASSOCIATED WITH LOWER PERFORMANCE ON THE COGNITIVE TESTS AT DIFFERENT DOMAINS IN HYPERTENSIVE PATIENTS(2016) MUELA, H. C. S.; COSTA-HONG, V.; MACHADO, M. F.; YASSUDA, M. S.; SHU, E. B. S.; MASSARO, A. R.; NITRINI, R.; BORTOLOTTO, L.
bookPart Trombose Venosa Cerebral(2013) DUTRA, Aurélio Pimenta; MASSARO, Ayrton Roberto; CAMARGO, Érica Cristina Sá de