GUILHERME VEIGA GUIMARAES
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/11 - Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Hospital das Clínicas, Faculdade de Medicina
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
- Effects of short-term heated water-based exercise training on systemic blood pressure in patients with resistant hypertension: a pilot study(2013) GUIMARAES, Guilherme V.; CRUZ, Lais G. B.; TAVARES, Aline C.; DOREA, Egidio L.; FERNANDES-SILVA, Miguel M.; BOCCHI, Edimar A.High blood pressure (BP) increases the risk of cardiovascular diseases, and its control is a clinical challenge. Regular exercise lowers BP in patients with mild-to-moderate hypertension. No data are available on the effects of heated water-based exercise in hypertensive patients. Our objective was to evaluate the effects of heated water-based exercise on BP in patients with resistant hypertension. We tested the effects of 60-min heated water-based exercise training three times per week in 16 patients with resistant hypertension (age 55 +/- 6 years). The protocol included walking and callisthenic exercises. All patients underwent 24-h ambulatory blood pressure monitoring (ABPM) before and after a 2-week exercise program in a heated pool. Systolic office BP was reduced from 162 to 144 mmHg (P<0.004) after heated-water training. After the heated-water exercise training during 24-h ABPM, systolic BP decreased from 135 to 123 mmHg (P=0.02), diastolic BP decreased from 83 to 74 mmHg (P=0.001), daytime systolic BP decreased from 141 to 125 mmHg (P=0.02), diastolic BP decreased from 87 to 77 mmHg (P=0.009), night-time systolic BP decreased from 128 to 118 mmHg (P=0.06), and diastolic BP decreased from 77 to 69 mmHg (P=0.01). In addition, BP cardiovascular load was reduced significantly during the 24-h daytime and night-time period after the heated water-based exercise. Heated water-based exercise reduced office BP and 24-h daytime and night-time ABPM levels. These effects suggest that heated water-based exercise may have a potential as a new therapeutic approach to resistant hypertensive patients.
- Heated water-based exercise training reduces 24-hour ambulatory blood pressure levels in resistant hypertensive patients: A randomized controlled trial (HEx trial)(2014) GUIMARAES, Guilherme Veiga; CRUZ, Lais Galvani de Barros; FERNANDES-SILVA, Miguel Morita; DOREA, Egidio Lima; BOCCHI, Edimar AlcidesBackground: Regular exercise is an effective intervention to decrease blood pressure (BP) in hypertension, but no data are available concerning the effects of heatedwater-based exercise (HEx). This study examines the effects of HEx on BP in resistant hypertensive patients. Methods: This is a parallel, randomized controlled trial. 125 nonconsecutive sedentary patients with resistant hypertension from a hypertension outpatient clinic in a university hospital were screened; 32 patients fulfilled the study requirements. The training was performed for 60-minute sessions in a heated pool (32 C), three times a week for 12 weeks. The HEx protocol consisted of callisthenic exercises and walking inside the pool. The control group was asked to maintain habitual activities. The main outcome measure was change in mean 24-hour ambulatory BP (ABPM). Results: 32 patients (HEx n = 16; control n = 16) were randomized; none were lost to follow-up. Office BPs decreased significantly after heated water exercise (36/12 mm Hg). HEx decreased 24-hour systolic (from 137 +/- 23 to 120 +/- 12 mm Hg, p = 0.001) and diastolic BPs (from 81 +/- 13 to 72 +/- 10 mm Hg, p = 0.009); daytime systolic (from 141 +/- 24 to 120 +/- 13 mm Hg, p < 0.0001) and diastolic BPs (from 84 +/- 14 to 73 +/- 11 mm Hg, p = 0.003); and nighttime systolic (from 129 +/- 22 to 114 +/- 12 mm Hg, p = 0.006) and diastolic BPs (from 74 +/- 11 to 66 +/- 10 mm Hg, p < 0.0001). The control group after 12 weeks significantly increased in 24-hour systolic and diastolic BPs, and daytime and nighttime diastolic BPs. Conclusion: HEx reduced office BPs and 24-hour ABPM levels in resistant hypertensive patients. These effects suggest that HEx may be a potential new therapeutic approach in these patients.
- Inflammatory biomarkers and effect of exercise on functional capacity in patients with heart failure: Insights from a randomized clinical trial(2017) FERNANDES-SILVA, Miguel M.; GUIMARAES, Guilherme V.; RIGAUD, Vagner O. C.; LOFRANO-ALVES, Marco S.; CASTRO, Rafael E.; CRUZ, Lais G. de Barros; BOCCHI, Edimar A.; BACAL, FernandoBackground: In patients with heart failure, inflammation has been associated with worse functional capacity, but it is uncertain whether it could affect their response to exercise training. We evaluated whether inflammatory biomarkers are related to differential effect of exercise on the peak oxygen uptake (VO2) among patients with heart failure. Design: Open, parallel group, randomized controlled trial. Methods: Patients with heart failure and ejection fraction 0.4 were randomized into exercise training or control for 12 weeks. Patients were classified according to: 1) inflammatory biomarkers blood levels, defined as low' if both interleukin-6 and tumor necrosis factor-alpha blood levels were below median, and high' otherwise; and 2) galectin-3 blood levels, which also reflect pro-fibrotic processes. Results: Forty-four participants (507 years old, 55% men, 25% ischemic) were allocated to exercise training (n=28) or control (n=16). Exercise significantly improved peak VO2 among participants with low' inflammatory biomarkers (3.5 +/- 0.9 vs. -0.7 +/- 1.1ml/kg per min, p=0.006), as compared with control, but not among those with high' inflammatory biomarkers (0.4 +/- 0.6 vs. -0.2 +/- 0.7ml/kg per min, p=0.54, p for interaction=0.009). Similarly, exercise improved peak VO2 among participants with below median (2.4 +/- 0.8 vs. -0.3 +/- 0.9ml/kg per min, p=0.032), but not among those with above median galectin-3 blood levels (0.3 +/- 0.7 vs. -0.7 +/- 1.0ml/kg per min, p=0.41, p for interaction=0.053). Conclusion: In patients with heart failure, levels of biomarkers that reflect pro-inflammatory and pro-fibrotic processes were associated with differential effect of exercise on functional capacity. Further studies should evaluate whether exercise training can improve clinical outcomes in patients with heart failure and low levels of these biomarkers.
- Effects of age on aerobic capacity in heart failure patients under beta-blocker therapy: Possible impact in clinical decision-making?(2013) CIOLAC, Emmanuel Gomes; BOCCHI, Edimar Alcides; SILVA, Miguel Morita Fernandes da; TAVARES, Aline Cristina; TEIXEIRA-NETO, Iram Soares; GUIMARAES, Guilherme VeigaBackground: Heart failure (HF) is associated with impaired maximal aerobic capacity as indicated by decreases in peak oxygen uptake (peak VO2). Considering that aging by itself has a negative effect on this variable, the evaluation of maximum capacity is often questioned because current predicted peak VO2 is based on subjects without heart disease or beta-blocker therapy. In contrast, if decline in predicted and attained peak VO2 were age-related, proportionally, loss of aerobic function (predicted peak VO2, %) would remain stable over time in these patients. The purpose of this investigation is to assess the effects of age on peak VO2 in HF patients taking beta-blockers. Methods: We retrospectively evaluated 483 (132 female) patients (aged 20-88 years, LVEF 31 +/- 11%) with non-ischemic (n = 362), ischemic (n = 74) and Chagas-related HF (n = 47) who had been submitted to an incremental cardiopulmonary exercise testing on a motorized treadmill. Linear regression was used to develop the equation to predict peak VO2, based on age. Results: Peak VO2 decreased 0.9 mL/min/kg per age-decade, maximum HR also decreased with aging and VE/VCO2 slope was similar among all decades. The predicted new beta-blocker equation to peak VO2bb was 20.934 - 0.092 x age. Conclusions: Clinical interpretation of aerobic capacity impairment is influenced by aging in HF patients. This evidence must be considered when using peak VO2 for prognostic stratification and clinical decision-making in patients with HF under beta-blocker therapy.
- Age-Related Maximum Heart Rate Among Ischemic and Nonischemic Heart Failure Patients Receiving beta-Blockade Therapy(2012) SILVA, Miguel Morita Fernandes; BACAL, Fernando; ROQUE, Jean Marcelo; TEIXEIRA-NETO, Iram Soares; CARVAS JUNIOR, Nelson; BOCCHI, Edimar Alcides; GUIMARAES, Guilherme VeigaBackground: Equations to predict maximum heart rate (HRmax) in heart failure (HF) patients receiving beta-adrenergic blocking (BB) agents do not consider the cause of HF. We determined equations to predict HRmax in patients with ischemic and nonischemic HF receiving BB therapy. Methods and Results: Using treadmill cardiopulmonary exercise testing, we studied HF patients receiving BB therapy being considered for transplantation from 1999 to 2010. Exclusions were pacemaker and/or implantable defibrillator, left ventricle ejection fraction (LVEF) >50%, peak respiratory exchange ratio (RER) <1.00, and Chagas disease. We used linear regression equations to predict HRmax based on age in ischemic and nonischemic patients. We analyzed 278 patients, aged 47 +/- 10 years, with ischemic (n = 75) and nonischemic (n = 203) HF. LVEF was 30.8 +/- 9.4% and 28.6 +/- 8.2% (P = .04), peak VO2 16.9 +/- 4.7 and 16.9 +/- 5.2 mL kg(-1) min(-1) (P = NS), and the HRmax 130.8 +/- 23.3 and 125.3 +/- 25.3 beats/min (P = .051) in ischemic and nonischemic patients, respectively. We devised the equation HRmax = 168 - 0.76 x age (R-2 = 0.095; P = .007) for ischemic HF patients, but there was no significant relationship between age and HRmax in nonischemic HF patients (R-2 = 0.006; P = NS). Conclusions: Our study suggests that equations to estimate HRmax should consider the cause of HF. (J Cardiac Fail 2012;18:831-836)
- MicroRNAs: new players in heart failure(2013) OLIVEIRA-CARVALHO, Vagner; SILVA, Miguel Morita Fernandes da; GUIMARAES, Guilherme Veiga; BACAL, Fernando; BOCCHI, Edimar AlcidesMicroRNAs (miRNAs) are a class of non-coding small RNAs representing one of the most exciting areas of modern medical science. miRNAs modulate a large and complex regulatory network of gene expression of the majority of the protein-coding genes. Currently, evidences suggest that miRNAs play a crucial role in the pathogenesis of heart failure. Some miRNAs as miR-1, miR-133 and miR-208a are highly expressed in the heart and strongly associated with the development of cardiac hypertrophy. Recent data indicate that these miRNAs as well as miR-206 change their expression quickly in response to physical activity. The differential regulation of miRNAs in response to exercise suggests a potential value of circulating miRNAs (c-miRNAs) as biomarkers of physiological mediators of the cardiovascular adaptation induced by exercise. Likewise, serum levels of c-miRNAs such as miR-423-5p have been evaluated as potential biomarkers in the diagnosis and prognosis of heart failure. On the other hand, the manipulation of miRNAs levels using techniques such as 'miR mimics' and 'antagomiRs' is becoming evident the enormous potential of miRNAs as promising therapeutic strategies in heart failure.
- Hypotensive Effect of Heated Water-Based Exercise Persists After 12-Week Cessation of Training in Patients With Resistant Hypertension(2018) GUIMARAES, Guilherme Veiga; FERNANDES-SILVA, Miguel Morita; DRAGER, Luciano Ferreira; CRUZ, Lais Galvani de Barros; CASTRO, Rafael Ertner; CIOLAC, Emmanuel Gomes; BOCCHI, Edimar AlcidesBackground: Heated water-based exercise (HEx) promotes a marked reduction of blood pressure (BP), but it is not entirely clear whether its effects on BP persist after cessation of HEx. Methods: We analyzed the effects of cessation of HEx on 24-hour ambulatory BP monitoring (ABPM) in patients with resistant hypertension (RH). Thirty-two patients (aged 53 +/- 6 years) with RH (4 to 6 antihypertensive drugs) were randomly assigned to HEx (n = 16) or control (n = 16) groups. Antihypertensive therapy remained unchanged during the protocol. The HEx group participated in 36 sessions (60 minutes) in a heated pool (32 degrees C [89.6 degrees F]) for 12 weeks (training), followed by 12 weeks of cessation of training. The control group was evaluated during the same period and instructed to maintain their habitual activities. Results: HEx and control groups had similar BP levels at baseline. HEx training reduced the 24-hour systolic (-19.5 +/- 4.6 vs 3.0 +/- 0.7 mm Hg, P = 0.001) and diastolic BP (-11.1 +/- 2.4 vs 2.06 +/- 0.9 mm Hg, P = 0.001) at week 12, compared with the control group. After 12 weeks of training cessation (week 24), 24-hour BP remained significantly lower in the HEx group than in the control group (-9.6 +/- 3.8 vs 6.3 +/- 3.5 mm Hg, P = 0.01 and -7.5 +/- 2.2 vs 2.2 +/- 1.0 mm Hg, P = 0.009, for systolic and diastolic BP, respectively), although these differences were attenuated. Conclusions: BP remained lower after cessation of 12-week training among patients with RH who underwent HEx compared with the controls. The carryover effects of HEx on BP may help to overcome the challenging problem of exercise compliance in long-term follow-up.