Histórico familiar de hipertensão está associado à anormalidades metabólicas e hemodinâmicas precoces. O exercício físico tem importante papel na prevenção e tratamento da hipertensão, mas as adaptações hemodinâmicas, metabólicas e hormonais em resposta ao treinamento físico não tem sido estudadas em indivíduos com histórico familiar de hipertensão. Nós comparamos os efeitos do treinamento com exercício intervalado (TI) e contínuo (CT) sobre variáveis hemodinâmicas, metabólicas e hormonais em normotensos filhos de hipertensos. Cinqüenta e nove mulheres saudáveis filhas de pais hipertensos, randomizadas para TI (n: 16; 24,4±3,8 anos), TC (n: 16; 26,6±4,9 years) ou grupo controle (CFH+; n: 12), e 15 mulheres jovens com pais normotensos tiveram a monitorização da pressão arterial ambulatorial (MAPA), velocidade de onda de pulso carótido-femoral (VOP), e bioquímica (colesterol total e frações, triglicérides, glicose, insulina e razão insulina/glicose) analisados antes e após 16 semanas de seguimento. Níveis de PA, nor-epinefrina (NE), endothelina-1 (ET-1) e nitrito/nitrato (NOx) também foram analisados durante um teste de esforço cardiopulmonar (TE). Treinamento físico foi realizado três vezes por semana durante 40 minutos à 65% do VO2PICO (TC) ou alternando 2 minutos à 55% com 1 minute à 85% VO2PICO (TI). MAPA, glicemia e níveis de colesterol foram similares entre os 4 grupos, mas os 3 grupos com histórico familiar positivo de hipertensão apresentaram maiores níveis de insulina e razão insulina/glicose, VOP, NE e ET-1, e menores níveis de NOx quando comparado com o grupo CFH-. Os dois tipos de exercício foram igualmente efetivos na melhora da MAPA, insulina e razão insulina/glicose; porém, TI foi mais efetivo para a melhora da VOP e condicionamento cardiorrespiratório, bem como para a melhora da resposta da PA, NE, ET-1 e NOx durante o TE. Após o seguimento, TI apresentou insulina e razão insulina/glicose, VOP, NE e ET-1 inferior e NOx superior ao de CFH+, enquanto apenas ET-1 do TC foi inferior à de CFH+. Concluindo, ambos os programas de treinamento melhoraram o perfil hemodinâmico, metabólico e hormonal de mulheres jovens normotensas filhas de hipertenso. Porém, o TI demonstrou-se mais efetivo para a melhora de algumas das variáveis analisadas. Estes achados podem ter importantes implicações para o desenho de programas exercício físico para a prevenção de hipertensão arterial hereditária. / Family history of hypertension is associated with early metabolic and hemodynamic abnormalities. Exercise training has an important role in the prevention and treatment of hypertension, but the hemodynamic, metabolic and hormonal adaptations to exercise training has not been studied in subjects with family history of hypertension. We compared the effects of aerobic interval (IT) and continuous exercise training (CT) on hemodynamic, metabolic and hormonal variables in offspring of hypertensive subjects. Fiftynine healthy women offspring of hypertensive subjects, randomized to IT (n: 16; 24.4±3.8 years), CT (n: 16; 26.6±4.9 years) or control group (CFH+; n: 12), and 15 young women with normotensive parents (CFH-) had their ambulatorial blood pressure (ABP), carotid-femoral pulse wave velocity (PWV), and biochemistry (total cholesterol and fractions, triglycerides, glucose, insulin and insulin-to-glucose ratio) analyzed before and after a 16- week follow-up. BP, nor-epinephrine (NE), endothelin-1 (ET-1) and nitrite/nitrate (NOx) levels were also analyzed during a graded exercise test (GXT). Exercise training was performed three times-a-week for 40 minutes at 65% of VO2PEAK (CT) or alternating 2 minutes at 55% with 1 minute at 85% VO2PEAK (IT). ABP, glucose and cholesterol levels were similar among all groups, but the 3 groups with positive family history of hypertension displayed increased insulin and insulin-to-glucose ratio, PWV, NE and ET-1, and decreased NOx when compared to CFH-. The 2 exercise groups were equally effective in improving ABP, insulin and insulin-to-glucose ratio; however, IT was superior to CT at improving PWV and cardiorespiratory fitness, as well as the BP, NE, ET-1 and NOx during the GXT. After the follow-up, IT group displayed insulin and insulin-to-glucose ratio, PWV, NE and ET-1 decreased and NOx increased than the CFH+, but only ET-1 was decreased in CT than CFH+. In conclusion, both exercise training programs improved hemodynamic, metabolic and hormonal profile in healthy young women offspring of hypertensive subjects. However, IT was more efficient for improving several of the analyzed variables. These findings may have important implications for exercise training programs for the prevention of an inherited hypertensive disorder.

As doenças cardiovasculares (DCV) de origem aterosclerótica estão entre as principais causas de morbimortalidade cardiovascular. A periodontite, por meio de bacteremia e endotoxemia, tem sido apontada como possível fator de risco para início e progressão da aterosclerose. A proposta desta revisão foi buscar, reunir e analisar evidências científicas atuais de nível I e II sobre a associação entre periodontite e aterosclerose em seres humanos. As bases de dados consultadas foram: Medline (Medical Literature Analysis and Retrieval System), registro Cochrane de ensaios controlados (Cochrane Central Register of Controlled Trials - Central) e registro Cochrane de revisões sistemáticas (Cochrane Databasis of Systematic Reviews - CDSR). Foram identificados 532 estudos, sendo 22 elegíveis, dos quais nove atenderam aos critérios de inclusão. A amostra foi composta por 100% de ensaios clínicos randomizados controlados (ECRC). Oito estudos (89%) avaliaram o efeito do tratamento periodontal quanto aos parâmetros clínicos periodontais e marcadores relacionados à fisiopatologia da aterosclerose, em três destes (37,5%) o efeito do tratamento periodontal foi testado com antibioticoterapia e um (11%) avaliou o efeito somente da antibioticoterapia. Sete (78%) avaliaram níveis séricos de proteína C-reativa (PCR) antes e após o tratamento periodontal, em quatro (57%) houve redução deste marcador nas avaliações posteriores a seis semanas. Cinco (55,5%) avaliaram níveis séricos de interleucina-6 (IL-6), dos quais três (60%) relataram redução após mais de um mês do tratamento periodontal. Fatores lipídicos foram avaliados em três estudos (33%) e todos relataram melhoria significativa após tratamento periodontal. Evidências científicas de nível II apontam que a periodontite parece provocar alterações nos marcadores sistêmicos relacionados à fisiopatologia da aterosclerose podendo o tratamento periodontal ser benéfico para controlar marcadores séricos de risco para aterosclerose, com resultados significativos em casos mais severos de periodontite e para os marcadores lipídicos. / Cardiovascular diseases (CVD) caused by atherosclerosis are among the leading causes of cardiovascular morbity and mortality. Periodontitis through bacteremia and endotoxemia has been identified as a possible risk factor for initiation and progression of atherosclerosis. The purpose of this review was to seek, gather and analyze evidence of level I and II available in the literature on the association between periodontitis and atherosclerosis in the last ten years. The databases were consulted: Medline (Medical Literature Analysis and Retrieval System), Cochrane register of controlled trials (Cochrane Central Register of Controlled Trials - Central) and record Cochrane systematic reviews (Cochrane Database of Systematic Reviews - CDSR). We identified 532 studies, of which 22 eligible, of which 9 met the inclusion criteria. The sample consisted of 100% of randomized controlled trials (ECRC). Eight studies (89%) evaluated the effect of periodontal treatment on the clinical periodontal parameters and markers related to the pathophysiology of atherosclerosis in these three (37.5%) the effect of periodontal treatment has been tested with antibiotics and one (11%) evaluated only the effect of antibiotic therapy. Seven (78%) evaluated serum levels of C-reactive protein (CRP) before and after periodontal treatment in four (57%) decreased this marker in subsequent evaluations to six weeks. Five (55.5%) evaluated serum levels of interleukin-6 (IL-6), of which three (60%) reported a decrease after more than a month of periodontal treatment. Lipid factors were evaluated in three studies (33%) and all reported significant improvement after periodontal treatment. Strong scientific evidence (Level II) indicate that periodontitis seems to cause changes in systemic markers related to the pathophysiology of atherosclerosis, periodontal treatment may be beneficial to control serum markers for atherosclerosis, with significant results in more severe cases of periodontitis and the lipid markers.

Histórico familiar de hipertensão está associado à anormalidades metabólicas e hemodinâmicas precoces. O exercício físico tem importante papel na prevenção e tratamento da hipertensão, mas as adaptações hemodinâmicas, metabólicas e hormonais em resposta ao treinamento físico não tem sido estudadas em indivíduos com histórico familiar de hipertensão. Nós comparamos os efeitos do treinamento com exercício intervalado (TI) e contínuo (CT) sobre variáveis hemodinâmicas, metabólicas e hormonais em normotensos filhos de hipertensos. Cinqüenta e nove mulheres saudáveis filhas de pais hipertensos, randomizadas para TI (n: 16; 24,4±3,8 anos), TC (n: 16; 26,6±4,9 years) ou grupo controle (CFH+; n: 12), e 15 mulheres jovens com pais normotensos tiveram a monitorização da pressão arterial ambulatorial (MAPA), velocidade de onda de pulso carótido-femoral (VOP), e bioquímica (colesterol total e frações, triglicérides, glicose, insulina e razão insulina/glicose) analisados antes e após 16 semanas de seguimento. Níveis de PA, nor-epinefrina (NE), endothelina-1 (ET-1) e nitrito/nitrato (NOx) também foram analisados durante um teste de esforço cardiopulmonar (TE). Treinamento físico foi realizado três vezes por semana durante 40 minutos à 65% do VO2PICO (TC) ou alternando 2 minutos à 55% com 1 minute à 85% VO2PICO (TI). MAPA, glicemia e níveis de colesterol foram similares entre os 4 grupos, mas os 3 grupos com histórico familiar positivo de hipertensão apresentaram maiores níveis de insulina e razão insulina/glicose, VOP, NE e ET-1, e menores níveis de NOx quando comparado com o grupo CFH-. Os dois tipos de exercício foram igualmente efetivos na melhora da MAPA, insulina e razão insulina/glicose; porém, TI foi mais efetivo para a melhora da VOP e condicionamento cardiorrespiratório, bem como para a melhora da resposta da PA, NE, ET-1 e NOx durante o TE. Após o seguimento, TI apresentou insulina e razão insulina/glicose, VOP, NE e ET-1 inferior e NOx superior ao de CFH+, enquanto apenas ET-1 do TC foi inferior à de CFH+. Concluindo, ambos os programas de treinamento melhoraram o perfil hemodinâmico, metabólico e hormonal de mulheres jovens normotensas filhas de hipertenso. Porém, o TI demonstrou-se mais efetivo para a melhora de algumas das variáveis analisadas. Estes achados podem ter importantes implicações para o desenho de programas exercício físico para a prevenção de hipertensão arterial hereditária. / Family history of hypertension is associated with early metabolic and hemodynamic abnormalities. Exercise training has an important role in the prevention and treatment of hypertension, but the hemodynamic, metabolic and hormonal adaptations to exercise training has not been studied in subjects with family history of hypertension. We compared the effects of aerobic interval (IT) and continuous exercise training (CT) on hemodynamic, metabolic and hormonal variables in offspring of hypertensive subjects. Fiftynine healthy women offspring of hypertensive subjects, randomized to IT (n: 16; 24.4±3.8 years), CT (n: 16; 26.6±4.9 years) or control group (CFH+; n: 12), and 15 young women with normotensive parents (CFH-) had their ambulatorial blood pressure (ABP), carotid-femoral pulse wave velocity (PWV), and biochemistry (total cholesterol and fractions, triglycerides, glucose, insulin and insulin-to-glucose ratio) analyzed before and after a 16- week follow-up. BP, nor-epinephrine (NE), endothelin-1 (ET-1) and nitrite/nitrate (NOx) levels were also analyzed during a graded exercise test (GXT). Exercise training was performed three times-a-week for 40 minutes at 65% of VO2PEAK (CT) or alternating 2 minutes at 55% with 1 minute at 85% VO2PEAK (IT). ABP, glucose and cholesterol levels were similar among all groups, but the 3 groups with positive family history of hypertension displayed increased insulin and insulin-to-glucose ratio, PWV, NE and ET-1, and decreased NOx when compared to CFH-. The 2 exercise groups were equally effective in improving ABP, insulin and insulin-to-glucose ratio; however, IT was superior to CT at improving PWV and cardiorespiratory fitness, as well as the BP, NE, ET-1 and NOx during the GXT. After the follow-up, IT group displayed insulin and insulin-to-glucose ratio, PWV, NE and ET-1 decreased and NOx increased than the CFH+, but only ET-1 was decreased in CT than CFH+. In conclusion, both exercise training programs improved hemodynamic, metabolic and hormonal profile in healthy young women offspring of hypertensive subjects. However, IT was more efficient for improving several of the analyzed variables. These findings may have important implications for exercise training programs for the prevention of an inherited hypertensive disorder.

Research on health effects of particulate matter (PM) has been a very active area in the last two decades. One plausible mechanism by which exposure to PM affects human health includes modification of autonomic endothelium function. Decreased endothelium activity causes heightened risks of cardiovascular disease. A human exposure chamber designed to conduct experiments to quantify diminished function of endothelium from short term exposure to PM is described. The chamber consists of two stages for containment and pre-treatment of PM and exposure of human subjects. Concentrations of CO, CO2, NO, NO2, O3, and PM2.5, are monitored and controlled in the exposure room. The PM used in the human exposure experiments was characterized chemically and morphologically. During January and February of 2009, chemical analysis of PM2.5 was done during inversion periods in Salt Lake City, UT. An Ambient Ion Monitor (AIM) was deployed to measure the concentrations of anions in both particulate and gas phases. The chemical data provided by AIM was complemented by measurements by the Department of Air Quality that included PM10, PM2.5, O3, NO, NO2, NH3 and CO. The goal of the study was to determine whether ammonia or nitric acid is the limiting reagent in formation of PM during inversions. Nitric acid is the limiting reagent. Concentrations of ammonia are an order of magnitude higher than nitric acid.

Obesity is a major epidemic and is increasing in prevalence worldwide. The health problems and consequences of obesity include cardiovascular disease (CVD) risk factors, such as hypertension, hyperlipidemia, glucose intolerance and diabetes mellitus. Each of these abnormalities directly promotes atherosclerosis. More recently, visceral obesity has been shown to be independently associated with abnormalities of both the ventricular and vascular structure and function. The mechanisms by which they occur remain incompletely defined. Cardiovascular magnetic resonance imaging (CMR) offers several advantages for evaluation of cardiac structure and function in the obese. The high accuracy and reproducibility of the technique allows for detection of very small changes in ventricular volumes, mass, ejection fraction, and cardiac output with a relatively small sample size, as compared with echocardiography. In this thesis we investigated whether cardiovascular magnetic resonance imaging can better characterize possible cardiac abnormalities associated with obesity, in the absence of other confounding comorbidities. Obesity is associated with myocardial and vascular function, the extent of reversibility of these abnormalities with rapid acute weight loss remains uncertain. Therefore the first aim of the study was to (i) determine the relationship between obesity and left ventricular structure and function using magnetic resonance imaging, and (ii) the acute effects of rapid diet-induced weight loss on cardiac and vascular function in normal obese and obese diabetic men. Erectile dysfunction is related to cardiovascular risk factors such as obesity by an impairment of endothelial function. Therefore, symptoms of erectile dysfunction are probably to precede cardiovascular disease and events. The second aim of this study was to (i) determine the relationship between obesity and erectile function (EF), sexual desire (SD), lower urinary tract symptoms (LUTS) and quality of life (QOL) measures in obese males, and (ii) determine the effects of rapid diet-induced weight loss on EF, SD, LUTS and QOL measures in normal obese and obese diabetic men. In this group of men, obesity was associated with mild/moderate erectile dysfunction, and significant LUTS, which together with sexual desire improved following rapid diet induced weight loss, but was not directly related to the amount of weight loss or changes in measured metabolic state. Pericardial adipose tissue (PAT) covers 80% of the heart and constitutes 20% of its weight. PAT mass is related to the amount of abdominal fat and the risk of coronary atherosclerosis. Epicardial fat mass may be a sensitive indicator of cardiovascular risk. The third aim of this study was to (i) determine the relationship between obesity and PAT volume and (ii) effectively evaluate the impact of caloric restriction and associated weight reduction on epicardical fat volume via cardiac magnetic resonance imaging (CMR). This is the first study to show a reduction in PAT volume is associated with caloric restriction. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1352389 / Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2009

Obesity is a major epidemic and is increasing in prevalence worldwide. The health problems and consequences of obesity include cardiovascular disease (CVD) risk factors, such as hypertension, hyperlipidemia, glucose intolerance and diabetes mellitus. Each of these abnormalities directly promotes atherosclerosis. More recently, visceral obesity has been shown to be independently associated with abnormalities of both the ventricular and vascular structure and function. The mechanisms by which they occur remain incompletely defined. Cardiovascular magnetic resonance imaging (CMR) offers several advantages for evaluation of cardiac structure and function in the obese. The high accuracy and reproducibility of the technique allows for detection of very small changes in ventricular volumes, mass, ejection fraction, and cardiac output with a relatively small sample size, as compared with echocardiography. In this thesis we investigated whether cardiovascular magnetic resonance imaging can better characterize possible cardiac abnormalities associated with obesity, in the absence of other confounding comorbidities. Obesity is associated with myocardial and vascular function, the extent of reversibility of these abnormalities with rapid acute weight loss remains uncertain. Therefore the first aim of the study was to (i) determine the relationship between obesity and left ventricular structure and function using magnetic resonance imaging, and (ii) the acute effects of rapid diet-induced weight loss on cardiac and vascular function in normal obese and obese diabetic men. Erectile dysfunction is related to cardiovascular risk factors such as obesity by an impairment of endothelial function. Therefore, symptoms of erectile dysfunction are probably to precede cardiovascular disease and events. The second aim of this study was to (i) determine the relationship between obesity and erectile function (EF), sexual desire (SD), lower urinary tract symptoms (LUTS) and quality of life (QOL) measures in obese males, and (ii) determine the effects of rapid diet-induced weight loss on EF, SD, LUTS and QOL measures in normal obese and obese diabetic men. In this group of men, obesity was associated with mild/moderate erectile dysfunction, and significant LUTS, which together with sexual desire improved following rapid diet induced weight loss, but was not directly related to the amount of weight loss or changes in measured metabolic state. Pericardial adipose tissue (PAT) covers 80% of the heart and constitutes 20% of its weight. PAT mass is related to the amount of abdominal fat and the risk of coronary atherosclerosis. Epicardial fat mass may be a sensitive indicator of cardiovascular risk. The third aim of this study was to (i) determine the relationship between obesity and PAT volume and (ii) effectively evaluate the impact of caloric restriction and associated weight reduction on epicardical fat volume via cardiac magnetic resonance imaging (CMR). This is the first study to show a reduction in PAT volume is associated with caloric restriction. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1352389 / Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2009

abstract: Heart failure is a major worldwide health concern and is the leading cause of hospitalization among elderly Americans. Approximately 50% of those diagnosed with heart failure have heart failure with preserved ejection fraction (HFPEF). HFPEF presents a therapeutic dilemma because pharmacological strategies that are effective for the treatment of heart failure and reduced ejection fraction have failed to show benefit in HFPEF. Long term moderate intensity exercise programs have been shown to improve diastolic function in patients HFPEF. High intensity interval training (HIIT) has been shown to improve diastolic function in patients with heart failure and reduced ejection fraction. However, the effects of high intensity interval training in patients with HFPEF are unknown. Fourteen patients with HFPEF were randomized to either: (1) a novel program of high-intensity aerobic interval training (n = 8), or (2) a commonly prescribed program of moderate-intensity (MOD) aerobic exercise training (n = 6). Before and after four weeks of exercise training, patients underwent a treadmill graded exercise test for the determination of peak oxygen uptake (VO2peak), a brachial artery reactivity test for assessment of endothelium-dependent flow-mediated dilation (BAFMD), aortic pulse wave velocity assessment as an index of vascular stiffness and two-dimensional echocardiography for assessment of left ventricular diastolic and systolic function. I hypothesized that (1) high-intensity aerobic interval training would result in superior improvements in FMD, aortic pulse wave velocity, VO2peak, diastolic function and, (2) changes in these parameters would be correlated with changes in VO2peak. The principal findings of the study were that a one month long high intensity interval training program resulted in significant improvements in diastolic function as measured by two-dimensional echocardiography [pre diastolic dysfunction (DD) grade - 2.13 + 0.4 vs. post DD grade - 1.25 + 0.7, p = 0.03]. The left atrial volume index was reduced in the HIIT group compared to MOD ( - 4.4 + 6.2 ml/m2 vs. 5.8 + 10.7 ml/m2, p = 0.02). Early mitral flow (E) improved in the HIIT group (pre - 0.93 + 0.2 m/s vs. post - 0.78 + 0.3 m/s, p = 0.03). A significant inverse correlation was observed between change in BAFMD and change in diastolic dysfunction grade (r = - 0.585, p = 0.028) when all the data were pooled. HIIT appears to be a time-efficient and safe strategy for improving diastolic function in patients with heart failure and preserved ejection fraction. These data may have implications for cardiovascular risk reduction in this population. / Dissertation/Thesis / Ph.D. Exercise and Wellness 2012

Fundação Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro / A hipertensão arterial resistente (HAR) é definida pela persistência da pressão arterial (PA)&#8805;140/90mmHg a despeito do uso de 3 anti-hipertensivos em doses plenas, incluindo diurético. Revisão recente da literatura mostra poucos estudos avaliando o perfil e o comportamento da função endotelial em pacientes com HAR. Objetiva avaliar a função endotelial em pacientes hipertensos resistentes. Estudo transversal com 60 pacientes que foram avaliados em uma visita (V3) de um estudo longitudinal, onde numa primeira fase todos pacientes tiveram padronização do tratamento anti-hipertensivo. Foram incluídos pacientes (V0) com PA>160/100mmHg e <220mmHg e todos receberam clortalidona 25mg/dia e enalapril 20mg 2x/dia ou losartana 50mg 2x/dia (intolerantes ao enalapril). Visita 1: se PA>140/90mmHg acrescentou-se anlodipino 5mg/dia, foi realizado avaliação laboratorial de rotina do hipertenso e monitorização ambulatorial da PA-24h (MAPA). Visita 2: se PA>140/90mmHganlodipino foi titulado para 10mg/dia. Visita 3: todos os pacientes receberam avaliação clínica, da pressão arterial por MAPA, laboratorial de rotina e da função endotelial. Formaram-se dois grupos: os que controlaram a PA, grupo hipertensão arterial controlada (HAC); e os que permaneceram com PA de consultório>140/90mmHg e PA na MAPA-24h>130/80mmHg, foram considerados resistentes. O grupo HAR recebeu aleatoriamente espironolactona ou clonidina por mais 12 semanas para tentar controlar a PA e o grupo HAC teve assistência farmacológica mantida no mesmo período. A PA foi avaliada por método oscilométrico com aparelho digital semi-automático Microlife modelo BP3AC1-1PC e MAPA por aparelho SpaceLabs 90207. A função endotelial avaliada através de tonometria arteriolar periférica (PAT) pelo Endo-PAT2000 e por biomarcadores (I-CAM-1, V-CAM-1, VEGF, MCP-1, IL-6, adiponectina) através da técnica LuminexTMxMAP. Dos 60 pacientes avaliados, 36 controlaram a PA, grupo HAC, e 24 permaneceram resistentes ao tratamento, grupo HAR, na visitaV3. Na avaliação da PA pela MAPA-24h observamos que no grupo HAC a PAS-24h foi de 121,1+1,7mmHg e no grupo HAR 147+3,3mmHg, enquanto a PAD-24h no grupo HAC foi de 76,64+1,5mmHg e no grupo HAR 88,58+2,4mmHg (p<0,0001). O descenso noturno, apesar de maior no grupo HAC, não apresentou significância estatística entre os dois grupos (p> 0,05). A função endotelial avaliada através do PAT mostrou índice de hiperemia reativa de 1,850,056 e 1,65+0,074 nos grupos HAC e HAR respectivamente (p= 0,036) e quando avaliada através dos biomarcadores observamos: ICAM-1 (HAC= 186,6+12,65 vs HAR= 240,9+23,76ng/ml, p= 0,038), VCAM-1 (HAC= 627,137,09vs HAR= 706,086,10ng/ml, p= 0,372),VEGF (HAC= 403,394,91 vs HAR= 612,788,27pg/ml, p= 0,123) e MCP-1 (HAC= 694,969,09 vs HAR= 787,052,80pg/ml, p= 0,315). Na avaliação dos biomarcadores inflamatórios, observamos IL-6 no grupo HAC= 1,8970,2165pg/mle no HAR= 9,7934,421pg/ml (p= 0,027) e adiponectina no grupo HAC= 105701516pg/ml e HAR= 84221295pg/ml (p=0,301). A razão de prevalência do comprometimento da função endotelial no grupo HAR foi de 54% (OR= 3,55; 95% IC 1,18- 10.67; p= 0,029). No presente trabalho, as análises das variáveis estudadas na visita V3, mostraram que os pacientes com HAR têm maior comprometimento da função endotelial que os pacientes com HAC. / Resistant hypertension (RH) is defined by the persistence of blood pressure (BP)&#8805;140/90mmHg despite the use of 3 antihypertensive drugs at full doses, including a diuretic. Recent review of the literature shows few studies evaluating the profile and behavior of endothelial function in patients with RH. to evaluate endothelial function in resistant hypertensive patients. Cross-sectional study with 60 patients who were evaluated in a visit (V3) of a longitudinal study, where all patients initially had standardization of antihypertensive treatment. Patients with BP&#8805; 160/100mmHg and <220mmHg were included (V0) and they all received chlorthalidone 25mg/day and enalapril 20mg 2x/day or losartan 50mg 2x/day (intolerant enalapril). Visit 1: whether BP&#8805; 140/90mmHg amlodipine 5mg/day was added, it was conducted routine hypertensive laboratory evaluation and ambulatory monitoring of BP-24h (AMBP). Visit 2: if BP&#8805; 140/90mmHg amlodipine was titrated to 10mg/day. Visit 3: all patients received clinical evaluation, blood pressure by AMBP, routine laboratory and endothelial function. Two groups were formed: those who controlled the BP,group controlled hypertension (CH); and those who remained with BP&#8805; 140/90mmHg and BP on ABPM-24h&#8805; 130/80mmHg, were considered resistant. The RH group randomly received spironolactone or clonidine for 12 more weeks to try to control the BP and the CH group had pharmacological assistance maintained the same period. BP was measured by oscillometric method with semi-automatic digital device Microlife model BP3AC1-1PC and ABPM by SpaceLabs 90207 appliance. The endothelial function was valued through peripheral arteriolar tonometry (PAT) by Endo-PAT2000 and through biomarkers (I-CAM-1, V-CAM-1, VEGF, MCP-1, IL-6, adiponectin) by LuminexTMxMAP technique. Of the 60 patients evaluated, 36 controlled the BP, CH group, and 24 remained resistant to treatment, RH group in visit V3. In the assessment of BP by AMBP-24h was observed that in the CH group SBP-24h was 121.1+1.7 mmHg and RH group 147+3.3 mmHg, whereas DBP-24h in CH group was 76.64+1.5 mmHg and RH group 88.58+2.4 mmHg (p<0.0001). The nocturnal fall in BP, although higher in RH group, showed no statistical significance between the two groups (p> 0.05). Endothelial function assessed by the PAT showed reactive hyperemia index of 1.850.056 and 1.65+0.074 in CH and RH groups respectively (p = 0.036) and when evaluated by the biomarkers was observed: ICAM-1 (CH = 186.6+12.65ng/ml vs. RH= 240.9+23.76ng/ml, p= 0.038) VCAM-1 (CH= 627.137.09ng/ml vs. RH= 706.086.10ng/ml, p= 0.372), VEGF (CH= 403.394.91pg/ml vs.RH= 612.788.27pg/ml, p= 0.123) and MCP-1 (CH= 694.969.09pg/ml vs. RH=787.052.80pg/ml, p= 0.315). In the assessment of inflammatory biomarkers, was observed IL-6 in groups CH= 1.890.22pg/ml and RH= 9,794,41pg/ml (p= 0.027) and adiponectin in CH= 105701516pg/ml and RH= 1295 8422pg/ml (p= 0.301). The prevalence rate of impaired endothelial function in the RH group was 54% (OR = 3.55; 95% CI 1.18 - 10.67; p= 0.029). Conclusions: in this study, the analyzes of variables at visit V3, showed that patients with RH have greater impairment of endothelial function than patients with CH.

Fundação Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro / A hipertensão arterial resistente (HAR) é definida pela persistência da pressão arterial (PA)&#8805;140/90mmHg a despeito do uso de 3 anti-hipertensivos em doses plenas, incluindo diurético. Revisão recente da literatura mostra poucos estudos avaliando o perfil e o comportamento da função endotelial em pacientes com HAR. Objetiva avaliar a função endotelial em pacientes hipertensos resistentes. Estudo transversal com 60 pacientes que foram avaliados em uma visita (V3) de um estudo longitudinal, onde numa primeira fase todos pacientes tiveram padronização do tratamento anti-hipertensivo. Foram incluídos pacientes (V0) com PA>160/100mmHg e <220mmHg e todos receberam clortalidona 25mg/dia e enalapril 20mg 2x/dia ou losartana 50mg 2x/dia (intolerantes ao enalapril). Visita 1: se PA>140/90mmHg acrescentou-se anlodipino 5mg/dia, foi realizado avaliação laboratorial de rotina do hipertenso e monitorização ambulatorial da PA-24h (MAPA). Visita 2: se PA>140/90mmHganlodipino foi titulado para 10mg/dia. Visita 3: todos os pacientes receberam avaliação clínica, da pressão arterial por MAPA, laboratorial de rotina e da função endotelial. Formaram-se dois grupos: os que controlaram a PA, grupo hipertensão arterial controlada (HAC); e os que permaneceram com PA de consultório>140/90mmHg e PA na MAPA-24h>130/80mmHg, foram considerados resistentes. O grupo HAR recebeu aleatoriamente espironolactona ou clonidina por mais 12 semanas para tentar controlar a PA e o grupo HAC teve assistência farmacológica mantida no mesmo período. A PA foi avaliada por método oscilométrico com aparelho digital semi-automático Microlife modelo BP3AC1-1PC e MAPA por aparelho SpaceLabs 90207. A função endotelial avaliada através de tonometria arteriolar periférica (PAT) pelo Endo-PAT2000 e por biomarcadores (I-CAM-1, V-CAM-1, VEGF, MCP-1, IL-6, adiponectina) através da técnica LuminexTMxMAP. Dos 60 pacientes avaliados, 36 controlaram a PA, grupo HAC, e 24 permaneceram resistentes ao tratamento, grupo HAR, na visitaV3. Na avaliação da PA pela MAPA-24h observamos que no grupo HAC a PAS-24h foi de 121,1+1,7mmHg e no grupo HAR 147+3,3mmHg, enquanto a PAD-24h no grupo HAC foi de 76,64+1,5mmHg e no grupo HAR 88,58+2,4mmHg (p<0,0001). O descenso noturno, apesar de maior no grupo HAC, não apresentou significância estatística entre os dois grupos (p> 0,05). A função endotelial avaliada através do PAT mostrou índice de hiperemia reativa de 1,850,056 e 1,65+0,074 nos grupos HAC e HAR respectivamente (p= 0,036) e quando avaliada através dos biomarcadores observamos: ICAM-1 (HAC= 186,6+12,65 vs HAR= 240,9+23,76ng/ml, p= 0,038), VCAM-1 (HAC= 627,137,09vs HAR= 706,086,10ng/ml, p= 0,372),VEGF (HAC= 403,394,91 vs HAR= 612,788,27pg/ml, p= 0,123) e MCP-1 (HAC= 694,969,09 vs HAR= 787,052,80pg/ml, p= 0,315). Na avaliação dos biomarcadores inflamatórios, observamos IL-6 no grupo HAC= 1,8970,2165pg/mle no HAR= 9,7934,421pg/ml (p= 0,027) e adiponectina no grupo HAC= 105701516pg/ml e HAR= 84221295pg/ml (p=0,301). A razão de prevalência do comprometimento da função endotelial no grupo HAR foi de 54% (OR= 3,55; 95% IC 1,18- 10.67; p= 0,029). No presente trabalho, as análises das variáveis estudadas na visita V3, mostraram que os pacientes com HAR têm maior comprometimento da função endotelial que os pacientes com HAC. / Resistant hypertension (RH) is defined by the persistence of blood pressure (BP)&#8805;140/90mmHg despite the use of 3 antihypertensive drugs at full doses, including a diuretic. Recent review of the literature shows few studies evaluating the profile and behavior of endothelial function in patients with RH. to evaluate endothelial function in resistant hypertensive patients. Cross-sectional study with 60 patients who were evaluated in a visit (V3) of a longitudinal study, where all patients initially had standardization of antihypertensive treatment. Patients with BP&#8805; 160/100mmHg and <220mmHg were included (V0) and they all received chlorthalidone 25mg/day and enalapril 20mg 2x/day or losartan 50mg 2x/day (intolerant enalapril). Visit 1: whether BP&#8805; 140/90mmHg amlodipine 5mg/day was added, it was conducted routine hypertensive laboratory evaluation and ambulatory monitoring of BP-24h (AMBP). Visit 2: if BP&#8805; 140/90mmHg amlodipine was titrated to 10mg/day. Visit 3: all patients received clinical evaluation, blood pressure by AMBP, routine laboratory and endothelial function. Two groups were formed: those who controlled the BP,group controlled hypertension (CH); and those who remained with BP&#8805; 140/90mmHg and BP on ABPM-24h&#8805; 130/80mmHg, were considered resistant. The RH group randomly received spironolactone or clonidine for 12 more weeks to try to control the BP and the CH group had pharmacological assistance maintained the same period. BP was measured by oscillometric method with semi-automatic digital device Microlife model BP3AC1-1PC and ABPM by SpaceLabs 90207 appliance. The endothelial function was valued through peripheral arteriolar tonometry (PAT) by Endo-PAT2000 and through biomarkers (I-CAM-1, V-CAM-1, VEGF, MCP-1, IL-6, adiponectin) by LuminexTMxMAP technique. Of the 60 patients evaluated, 36 controlled the BP, CH group, and 24 remained resistant to treatment, RH group in visit V3. In the assessment of BP by AMBP-24h was observed that in the CH group SBP-24h was 121.1+1.7 mmHg and RH group 147+3.3 mmHg, whereas DBP-24h in CH group was 76.64+1.5 mmHg and RH group 88.58+2.4 mmHg (p<0.0001). The nocturnal fall in BP, although higher in RH group, showed no statistical significance between the two groups (p> 0.05). Endothelial function assessed by the PAT showed reactive hyperemia index of 1.850.056 and 1.65+0.074 in CH and RH groups respectively (p = 0.036) and when evaluated by the biomarkers was observed: ICAM-1 (CH = 186.6+12.65ng/ml vs. RH= 240.9+23.76ng/ml, p= 0.038) VCAM-1 (CH= 627.137.09ng/ml vs. RH= 706.086.10ng/ml, p= 0.372), VEGF (CH= 403.394.91pg/ml vs.RH= 612.788.27pg/ml, p= 0.123) and MCP-1 (CH= 694.969.09pg/ml vs. RH=787.052.80pg/ml, p= 0.315). In the assessment of inflammatory biomarkers, was observed IL-6 in groups CH= 1.890.22pg/ml and RH= 9,794,41pg/ml (p= 0.027) and adiponectin in CH= 105701516pg/ml and RH= 1295 8422pg/ml (p= 0.301). The prevalence rate of impaired endothelial function in the RH group was 54% (OR = 3.55; 95% CI 1.18 - 10.67; p= 0.029). Conclusions: in this study, the analyzes of variables at visit V3, showed that patients with RH have greater impairment of endothelial function than patients with CH.

As doenças cardiovasculares (DCV) de origem aterosclerótica estão entre as principais causas de morbimortalidade cardiovascular. A periodontite, por meio de bacteremia e endotoxemia, tem sido apontada como possível fator de risco para início e progressão da aterosclerose. A proposta desta revisão foi buscar, reunir e analisar evidências científicas atuais de nível I e II sobre a associação entre periodontite e aterosclerose em seres humanos. As bases de dados consultadas foram: Medline (Medical Literature Analysis and Retrieval System), registro Cochrane de ensaios controlados (Cochrane Central Register of Controlled Trials - Central) e registro Cochrane de revisões sistemáticas (Cochrane Databasis of Systematic Reviews - CDSR). Foram identificados 532 estudos, sendo 22 elegíveis, dos quais nove atenderam aos critérios de inclusão. A amostra foi composta por 100% de ensaios clínicos randomizados controlados (ECRC). Oito estudos (89%) avaliaram o efeito do tratamento periodontal quanto aos parâmetros clínicos periodontais e marcadores relacionados à fisiopatologia da aterosclerose, em três destes (37,5%) o efeito do tratamento periodontal foi testado com antibioticoterapia e um (11%) avaliou o efeito somente da antibioticoterapia. Sete (78%) avaliaram níveis séricos de proteína C-reativa (PCR) antes e após o tratamento periodontal, em quatro (57%) houve redução deste marcador nas avaliações posteriores a seis semanas. Cinco (55,5%) avaliaram níveis séricos de interleucina-6 (IL-6), dos quais três (60%) relataram redução após mais de um mês do tratamento periodontal. Fatores lipídicos foram avaliados em três estudos (33%) e todos relataram melhoria significativa após tratamento periodontal. Evidências científicas de nível II apontam que a periodontite parece provocar alterações nos marcadores sistêmicos relacionados à fisiopatologia da aterosclerose podendo o tratamento periodontal ser benéfico para controlar marcadores séricos de risco para aterosclerose, com resultados significativos em casos mais severos de periodontite e para os marcadores lipídicos. / Cardiovascular diseases (CVD) caused by atherosclerosis are among the leading causes of cardiovascular morbity and mortality. Periodontitis through bacteremia and endotoxemia has been identified as a possible risk factor for initiation and progression of atherosclerosis. The purpose of this review was to seek, gather and analyze evidence of level I and II available in the literature on the association between periodontitis and atherosclerosis in the last ten years. The databases were consulted: Medline (Medical Literature Analysis and Retrieval System), Cochrane register of controlled trials (Cochrane Central Register of Controlled Trials - Central) and record Cochrane systematic reviews (Cochrane Database of Systematic Reviews - CDSR). We identified 532 studies, of which 22 eligible, of which 9 met the inclusion criteria. The sample consisted of 100% of randomized controlled trials (ECRC). Eight studies (89%) evaluated the effect of periodontal treatment on the clinical periodontal parameters and markers related to the pathophysiology of atherosclerosis in these three (37.5%) the effect of periodontal treatment has been tested with antibiotics and one (11%) evaluated only the effect of antibiotic therapy. Seven (78%) evaluated serum levels of C-reactive protein (CRP) before and after periodontal treatment in four (57%) decreased this marker in subsequent evaluations to six weeks. Five (55.5%) evaluated serum levels of interleukin-6 (IL-6), of which three (60%) reported a decrease after more than a month of periodontal treatment. Lipid factors were evaluated in three studies (33%) and all reported significant improvement after periodontal treatment. Strong scientific evidence (Level II) indicate that periodontitis seems to cause changes in systemic markers related to the pathophysiology of atherosclerosis, periodontal treatment may be beneficial to control serum markers for atherosclerosis, with significant results in more severe cases of periodontitis and the lipid markers.