Hypertension is a serious medical condition. Although men and women of all racial groups in the US suffer from high blood pressure, black women have the highest rates of hypertension. For instance, the age-adjusted prevalence of hypertension among black women ages 20 and over is 44.3, compared to 28.1 among white women, 40.5 among black men, and 31.1 among white men. Past research has focused on SES and behavioral factors as potential explanations for blood pressure disparities between black and white women. But, even after controlling for such factors, considerable disparities remain. The goal of this research is to examine cultural and social factors that have been shown to increase blood pressure. Specifically, I examine social support, psychosocial characteristics, and contextual factors associated with race/ethnicity and hypertension, in hopes of explaining some of the disparities in high blood pressure between black and white women. iii Using data from Waves I, III, and IV of the National Longitudinal Study of Adolescent Health (Add Health), I estimated a sequence of multinomial logistic regression models predicting prehypertension and hypertension in young adulthood. Cross-sectional models show that racial disparities in hypertension remain after controlling for social support, psychosocial characteristics, and contextual factors. In fact, the only covariate that substantially reduced the racial disparity in hypertension was body mass index (BMI), a fairly reliable measure of body fatness for most people. I also estimated a set of multinomial logistic regression models predicting odds of prehypertension and hypertension by adolescent and cumulative social support, as well as psychosocial, contextual, and behavioral factors. These models were included to determine if early life and/or cumulative factors and conditions would help explain racial blood pressure disparities not explained by adulthood factors. Findings show that none of the early life or cumulative social support, psychosocial, contextual, or behavioral factors helped to explain racial differences in prehypertension or hypertension. Even after controlling for these factors, black women are still 1.18 times more likely than white women to have prehypertension and over two times more likely to suffer hypertension. Indeed, my findings indicate that, of the factors included in all these models, only race, age, and BMI were significant predictors of blood pressure. Also, BMI was the only factor to explain some of the disparities between black and white women. These results are similar to other studies that have examined racial health disparities, suggesting that simply being a black woman in US society may be unhealthy. The health effects of racism, discrimination, and other sources of stress faced disproportionately by black women are not easily measured by social science research, which is possibly why racial disparities in blood pressure have yet to be explained. Future research should also explore possible epigenetic effects introduced by the health conditions experienced by previous generations, as well as the influence of prenatal and early life environments.

Master of Science / Department of Kinesiology / Craig A. Harms / Subjects with prehypertension are at risk for developing hypertension (HTN). Hypertension is associated with low-grade systemic inflammation (LGSI). Aerobic exercise training (ET) is a proven means to reduce both blood pressure and LGSI in healthy and diseased subjects. Recently, high intensity interval training (HIIT) has been show to elicit similar cardiovascular and metabolic adaptations as ET in healthy and at-risk populations in a more time efficient manner. Therefore, we hypothesized that HIIT would elicit greater reductions in blood pressure and LGSI than ET. Twelve pre-hypertensive subjects (systolic blood pressure 127.0 ± 8.5 mmHg; diastolic blood pressure 86.2 ± 4.1 mmHg) were randomly assigned to an ET group (n=5) and a HIIT group (n=7). All subjects performed an incremental test to exhaustion (VO2max) on a cycle ergometer prior to, after 4 weeks, and after 8 weeks of training. Resting heart rate and blood pressure were measured prior to and three times a week during training. LGSI was measured via high-sensitivity C-reactive protein (hs-CRP) prior to, after 4 weeks and after 8 weeks of training. ET subjects performed an eight week exercise training program at 40% VO2 reserve determined from the VO2max test, while HIIT subjects performed exercise at 60% peak power determined from the VO2max test. ET group trained four days/week while HIIT trained three days/week. ET exercised for 30 minutes continuously at a constant workload and cadence of 60 rpm while HIIT performed a protocol on a 1:1 work-to-rest ratio at a constant workload and cadence of 100 rpm. Both groups showed similar (p<0.05) decreases in mean arterial (ET = -7.3%, HIIT = -4.5%), systolic (ET = -6.6%, HIIT = -8.8%), and diastolic (ET= -9.7, HIIT= -8.2%) blood pressure. HIIT decreased in LGSI (-33.7%) while ET did not change LGSI (p>0.05). VO2max increased ~25% with both HIIT and ET with no differences (p>0.05) between groups. These data suggest both HIIT and ET similarly decreased resting blood pressure and increased VO2max while HIIT was effective in decreasing LGSI in subjects who were pre-hypertensive.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-06-14T16:59:15Z No. of bitstreams: 1 LudmilaPortela.pdf: 1058297 bytes, checksum: c77012b14cdfda08968d5cfef5bcca51 (MD5) / Made available in DSpace on 2017-06-14T16:59:15Z (GMT). No. of bitstreams: 1 LudmilaPortela.pdf: 1058297 bytes, checksum: c77012b14cdfda08968d5cfef5bcca51 (MD5) Previous issue date: 2015-07-01 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Prehypertension is a pressure range above that considered ideal corresponding systolic blood pressure between 120-139 mmHg and / or diastolic between 80-89mmHg, it is associated with increased cardiovascular events and is intermediate path to hypertension. It is still controversial whether hypertensive patients have decreased quality of life (QOL) compared with normotensive. In the literature, there are few studies evaluating QOL among prehypertensive and comparing the three groups. The study of QOL is of great interest because it is an indicator for evaluation of effectiveness, efficiency and impact of diseases.. OBJECTIVES: To assess QOL pre-hypertensive patients, comparing it with that of normotensive and hypertensive individuals.METHODS: cross-sectional study, patients were raised through the active search for social action events and task forces on health between June 2013 and June 2014. We included those aged 18 to 70 years and considered pre-hypertensive those with PA between 120-139 mmHg systolic and / or diastolic 80-89 mmHg between normotensive BP <120 / 80mmHg and hypertensive PA≥ 140/90 and / or previously diagnosed. Quality of life was assessed using the SF-36. RESULTS: A total of 141 individuals, 38% (n = 53) normotensive, 33% (n = 47) pre-hypertensive and 29% (n = 41) hypertensive. Regarding QOL, the average functional capacity of normotensive (84.43) and pre-hypertensive (84.36) was superior to the hypertensive (73.41%) (p = 0.05). The physical aspect of the normotensive (82.45) was higher than that of hypertensive (63.41) (p = 0.034), there was no difference in physical appearance of the pre-hypertensive to comparer with the other groups. By comparing the other domains of QOL with blood pressure levels showed no statistical difference. Overall, the three groups obtained domain scores above the average of 50. Lower quality of life of pre-hypertensive not shown to be compromised in this study. SAH committed QOL as the physical aspect and the functional capacity of individuals. / INTRODUÇÃO: A pré-hipertensão representa uma faixa de pressão arterial (PA) acima daquela considerada ideal, correspondendo a PA sistólica entre 120-139 mmHg e/ou diastólica entre 80-89 mmHg. Está associada ao aumento de eventos cardiovasculares e é caminho intermediário para a hipertensão arterial sistêmica. Ainda é controverso se pacientes hipertensos apresentam diminuição da qualidade de vida (QV) quando comparados com normotensos. Na literatura, existem poucos estudos avaliando a QV entre pré-hipertensos e comparando com normotensos e hipertensos. O estudo da QV é de grande interesse, pois funciona como indicador para avaliação da eficácia do tratamento e impacto das doenças. OBJETIVOS: Avaliar a QV de pacientes pré-hipertensos, comparando-a com a de indivíduos normotensos e hipertensos. METODOLOGIA: estudo transversal. Os pacientes foram captados por meio da busca ativa em eventos de ação social e mutirões sobre saúde, entre junho de 2013 e junho de 2014. Foram incluídos indivíduos de ambos os sexos, com idade entre 18 e 70 anos e considerados pré-hipertensos aqueles com PA sistólica entre 120-139 mmHg e/ou diastólica entre 80-89 mmHg, normotensos com PA <120/80mmHg e hipertensos PA≥ 140/90 e/ ou com diagnóstico prévio. A QV foi avaliada utilizando a escala de avaliação de QV SF-36. RESULTADOS: Foram avaliados 141 indivíduos, sendo 38%(n= 53) normotensos, 33% (n=47) pré-hipertensos e 29% (n=41) hipertensos. Quanto a QV, a média do escore da Capacidade Funcional dos normotensos (84,43) e pré-hipertensos (84,36) mostrou-se superior a dos hipertensos (73,41) (p=0,05). O aspecto físico dos normotensos (82,45) foi superior a dos hipertensos (63,41) (p=0,034) e não houve diferença no aspecto físico dos pré-hipertensos em comparação com os demais grupos. Ao comparar os demais domínios da QV com níveis pressóricos, não houve diferença estatística. No geral, os três grupos obtiveram escores dos domínios acima da média de 50. CONCLUSÃO: A qualidade de vida dos pré-hipertensos não demonstrou estar comprometida nesse estudo. A hipertensão comprometeu a QV quanto ao aspecto físico e à capacidade funcional dos indivíduos.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-12-06T17:06:52Z No. of bitstreams: 1 JacquelineCantanhede.pdf: 6344249 bytes, checksum: c518cd1af256d3ecceca532df03539a7 (MD5) / Made available in DSpace on 2017-12-06T17:06:52Z (GMT). No. of bitstreams: 1 JacquelineCantanhede.pdf: 6344249 bytes, checksum: c518cd1af256d3ecceca532df03539a7 (MD5) Previous issue date: 2017-09-13 / The Prehypertension is characterized with systolic blood pressure levels between 120 - 139 mmHg and diastolic blood pressure 80-89mmHg, considered an intermediate state for the development of arterial hypertension. Detecting risk factors for prehypertension becomes important to prevent thousands of premature deaths. Vitamin D deficiency has been linked to high blood pressure and consequently to cardiovascular diseases that are responsible for high global morbidity and mortality. Thus, the analysis of the relationship between prehypertension and vitamin D is fundamental because it allows preventive intervention and avoids the progression to hypertension, thus reducing morbidity and mortality due to cardiovascular diseases. The present study aims to evaluate the association between serum 25 (OH) D levels and prehypertension. This is a cross-sectional study with a quantitative approach carried out at the Hospital Universitário da Universidade Federal do Maranhão in São Luís, Maranhão, Brazil. The 161 adults with prehypertensive and normotensive conditions participated in this study. Socio-demographic, anthropometric, behavioral and clinical data of the participants of both genders between 30 and 50 years old were used. Statistical analysis was performed using SPSS® software version 23. Data were treated using descriptive procedures. The Kolmogorov-Smirnov test was used to verify the normality of the variables. The results were considered statistically significant if p <0.05. In relation to the cardiometabolic risk factors, there was a statistically significant difference (p <0.05) between the control group and the study in the parameters evaluated (BMI, WC and WHtR). The prehypertensive group had a higher mean. Participants with excess weight have statistically higher odds of presenting prehypertension (OR = 3.62, 95% CI = 1.79-7.31 p <0.001). Regarding the Cardiometabolic Risk Factors stratified by gender, a statistically higher percentile was observed in females. Regarding systolic and diastolic blood pressure and vitamin D, there was a statistically significant difference (p <0.05) in all variables analyzed. For males, there was no statistically significant difference in the vitamin D variable. Mean SBP and DBP, and vitamin D (36.15 ± 12.31), were higher in the study group. Especially women (33.65 ± 10.41). In this study, the association of vitamin D and the presence of prehypertension was not observed. The serum vitamin D level of most participants was considered adequate. The female population had a higher prevalence of increased cardiometabolic levels and a higher prevalence of inadequate levels of vitamin D. There was no correlation between serum vitamin D levels with anthropometric data and blood pressure levels. / Pré - hipertensão é caracterizada com níveis de pressão arterial sistólica entre 120 -139 mmHg e pressão arterial diastólica 80-89mmHg, considerada um estado intermediário para o desenvolvimento da hipertensão arterial, representa grande fator de risco para as doenças cardiovasculares. Detectar fatores de risco para pré-hipertensão torna-se importante para evitar milhares de mortes prematuras. A deficiência de vitamina D têm sido relacionada com pressão arterial elevada e consequentemente com doenças cardiovasculares que são responsáveis por elevada morbimortalidade mundial. Desta forma, a análise da relação entre pré- hipertensão e vitamina D é fundamental, pois, pode permitir a intervenção preventiva e evita a progressão para hipertensão reduzindo assim a morbimortalidade por doenças cardiovasculares. O presente estudo tem por objetivo avaliar a associação entre os níveis séricos de 25 (OH)D e pré-hipertensão. Trata-se de um estudo transversal, realizado no Hospital Universitário da Universidade Federal do Maranhão no município de São Luís/ Maranhão. Participaram deste estudo 161 adultos em condições de pré-hipertensos e normotensos. Foram utilizados dados sóciodemográficos, antropométricos, comportamentais e clínicos dos participantes de ambos os sexos com idades entre 30 a 50 anos. A análise estatística foi realizada através do software SPSS versão 23. Os dados foram tratados por meio de procedimentos descritivos. O teste de Kolmogorov-Smirnov foi utilizado para verificar a normalidade das variáveis. Os resultados foram considerados estatisticamente significativos se p <0,05. Em relação, aos fatores de risco cardiometabólicos houve diferença estatisticamente significativa (p<0,05) entre o grupo controle e estudo nos parâmetros avaliados índice de massa corpórea, circunferência da cintura e relação cintura estatura. O grupo de pré-hipertensos apresentou maior média. Participantes com excesso de peso tem estatisticamente maior chance de apresentar pré - hipertensão (OR= 3,62; IC 95%=1,79-7,31 p<0,001). Em relação aos Fatores de Risco Cardiometabólicos estratificados por sexo. Observou-se um percentual estatisticamente maior no sexo feminino. Em relação, a pressão arterial sistólica e diastólica e vitamina D, houve diferença estatisticamente significativa (p<0,05) em todas as variáveis analisadas. Para sexo masculino não houve diferença estatisticamente significativa na análise da variável Vitamina D. A média PAS e PAD, e da vitamina D (36,15 ±12,31) foi maior no grupo estudo. Em especial as mulheres (33,65±10,41). Neste estudo não foi observado associação da vitamina D e a presença de pré- hipertensão. O nível sérico de vitamina D da maioria dos participantes foi considerado adequado. A população do sexo feminino apresentou maior prevalência dos níveis cardiometabólicos aumentados e maior prevalência dos níveis inadequado de vitamina D. Não houve correlação entre os níveis séricos de vitamina D com os dados antropométricos e níveis pressóricos.

abstract: PURPOSE: Lean hypertension (HTN) is characterized by a mechanistically different HTN when compared to obese HTN. The purpose of this study is to assess whether body phenotype influences blood pressure (BP) responses following both acute and chronic exercise. METHODS: Obese (body mass index (BMI) > 30 kg/m2) and lean (BMI < 25 kg/m2) men with pre-hypertension (PHTN) (systolic BP (SBP) 120 - 139 or diastolic BP (DBP) 80 - 89 mm Hg) were asked to participate in a two-phase trial. Phase 1 assessed differences in post-exercise hypotension between groups in response to an acute exercise bout. Phase 2 consisted of a two-week aerobic exercise intervention at 65-70% of heart rate (HR) max on a cycle ergometer. Primary outcome measures were: brachial BP, central (aortic) BP, cardiac output (CO), and systemic vascular resistance (SVR) measured acutely after one exercise session and following two weeks of training. RESULTS: There were no differences between groups for baseline resting brachial BP, central BP, age, or VO2 peak (all P > 0.05). At rest, obese PHTN had greater CO compared to lean PHTN (6.3 ± 1 vs 4.7 ± 1 L/min-1, P = 0.005) and decreased SVR compared to lean PHTN (1218 ± 263 vs 1606 ± 444 Dyn.s/cm5, P = 0.003). Average 60-minute post-exercise brachial and central SBP reduced by 3 mm Hg in Lean PHTN in response to acute exercise (P < 0.005), while significantly increasing 4 mm Hg for brachial and 3 mm Hg for central SBP (P < 0.05). SVR had a significantly greater reduction following acute exercise in lean PHTN (-223 Dyn·s/cm5) compared to obese PHTN (-75 Dyn·s/cm5, P < 0.001). In lean subjects chronic training reduced brachial BP by 4 mm Hg and central BP by 3 mm Hg but training had no effect on the BP’s in obese subjects. Resting BP reduction in response to training was accompanied by reductions in SVR within lean (-169 Dyn·s/cm5, P < 0.001), while obese experienced increased SVR following training (47 Dyn·s/cm5, P < 0.001). CONCLUSION: Hemodynamic response to both acute and chronic exercise training differ between obese and lean individuals. / Dissertation/Thesis / Doctoral Dissertation Exercise Science 2016

The primary goal of this project was to develop, implement, and evaluate a lifestyle modification intervention that did not require extensive, ongoing personal contact to improve lifestyle behaviors shown to lower blood pressure (BP) in adults with prehypertension (N=23, mean age=54, mean BP=126.7/75.1). Incorporating clinical practices and psychological approaches to behavior change, this intervention used primarily the DASH Eating Plan, coupled with a low-sodium diet and a walking program; it applied social cognitive theory to health behavior change, specifically self-regulation for self-monitoring and management of BP, diet, exericse, and weight. The study compared two conditions, the DASH 2 Wellness Only standard of care condition to the DASH 2 Wellness Plus treatment condition on the primary outcome measures of fruit and vegetable (servings/day), sodium consumption (milligrams/day), physical activity (steps/day), weight (kgs), and blood pressure (primarily systolic BP). Consistent with hypotheses, MANOVAs detected significant differences between the conditions with D2W Plus evidencing a larger increase in change of total daily steps (M= 2900.14, SD= 1903.83) than D2W Only, (M= 636.39, SD= 1653.26), a larger decrease in systolic BP change (MMHG) (M= 15.14, SD= 4.33) than D2W Only, (M= 4.61, SD= 8.28), and a larger decrease in weight change (kg) (M= 4.78, SD= 3.81) than D2W Only, (M= 1.47, SD= 2.57). While conditions did not significantly differ on daily sodium reduction or fruit and vegetable increase, D2W Plus evidenced a larger decrease in sodium (mg) (M= 932.22, SD= 1019.22) than D2W Only, (M= 423.64, SD= 749.15) and larger increase in fruit and vegetable increase, (M= 2.10, SD= 1.73) than D2W Only, (M= 1.02, SD= 2.24). It was also hypothesized that the D2W Plus condition would show greater improvements in nutrition-specific and PA-specific health beliefs of self-regulation, social support, self-efficacy, social support, and outcome-expectancy compared to those in the D2W Only condition. A MANOVA revealed significant group differences in PA-specific health beliefs primarily attributable to increased PA self-regulation in D2W Plus compared to D2W Only, (M= 1.78, SD= 0.75) and (M= 0.55, SD= 0.57), respectively. While no overall significant group differences were found for nutrition-specific health beliefs, analyses showed meaningful differences in nutrition-specific health beliefs attributable to increased nutrition self-regulation strategies in D2W Plus compared to D2W Only. Results provide preliminary support for the efficacy of an electronic delivery of an intervention aimed at improving lifestyle behaviors and lowering BP in middle-aged individuals with prehypertension. / Ph. D.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2018-08-14T14:50:32Z No. of bitstreams: 1 josariaferrazamaral.pdf: 6841892 bytes, checksum: 28ae67360c5280e7ba4e68f796d29a90 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-09-03T16:32:25Z (GMT) No. of bitstreams: 1 josariaferrazamaral.pdf: 6841892 bytes, checksum: 28ae67360c5280e7ba4e68f796d29a90 (MD5) / Made available in DSpace on 2018-09-03T16:32:25Z (GMT). No. of bitstreams: 1 josariaferrazamaral.pdf: 6841892 bytes, checksum: 28ae67360c5280e7ba4e68f796d29a90 (MD5) Previous issue date: 2018-06-29 / Introdução: Indivíduos com histórico familiar de hipertensão arterial sistêmica (HAS) ou pré-hipertensão apresentam anormalidades autonômicas e vasculares, tanto em repouso quanto em resposta a situações estressoras. Tendo em vista que essas alterações estão relacionadas ao desenvolvimento da HAS e que nos indivíduos com histórico familiar de HAS há alta incidência de pré-hipertensão, o entendimento dessas disfunções em indivíduos pré-hipertensos com histórico de HAS é de fundamental importância. Objetivo: Comparar as funções autonômica e vascular em repouso e as respostas hemodinâmicas durante estresse mental e exercício isométrico de preensão manual de pré-hipertensos e normotensos com histórico familiar de HAS. Métodos: Vinte e cinco voluntários jovens com histórico familiar de HAS (30±5 anos, 24±4 kg/m²), sendo 14 normotensos (PAS: 116 [105-119], PAD: 67[60-71] mmHg) e 11 préhipertensos (PAS: 128[124-132], PAD: 75[71-75] mmHg) foram submetidos à avaliação da função vascular (hiperemia reativa, Hokanson®) e da modulação autonômica cardíaca e periférica, quantificada, respectivamente, por meio da análise espectral da frequência cardíaca (ECG) e da pressão arterial sistólica (FinometerPRO®). A análise da função de transferência foi utilizada para mensurar o ganho e o tempo de resposta do barorreflexo. Além disso, foram registrados pressão arterial, frequência cardíaca (Dixtal®), fluxo sanguíneo muscular do antebraço e calculada a condutância vascular do antebraço (Hokanson®) por 3 minutos durante o repouso e 1º, 2º e 3º minutos dos protocolos de estresse mental (Stroop Color Word Conflict Test) e de exercício isométrico de preensão manual a 30% da contração voluntária máxima (Saehan®). Os dados foram reportados como média ± desvio padrão ou como mediana [1º quartil - 3º quatil]. A significância estatística adotada foi de 5%. Resultados: Pré-hipertensos, em relação aos normotensos, possuem maior condutância vascular tanto em repouso (3,48±1,26 vs. 2,67±0,72 unidades; p=0,05, tamanho do efeito (TE): 1,13) quanto no pico hiperemia reativa (25,02±8,18 vs. 18,66±6,07 unidades; p=0,04, TE: 1,05). Os índices da modulação autonômica cardíaca foram semelhantes entre os grupos. Entretanto, na modulação autonômica periférica, foi observado, nos pré-hipertensos em relação aos normotensos, maior variabilidade (9,4 [4,9-12,7] vs. 18,3 [14,8-26,7] mmHg²; p<0,01) e maiores componentes espectrais de muito baixa (6,9 [2,0-11,1] vs. 13,5 [10,7-22,4] mmHg²; p=0,01) e baixa frequências (1,7 [1,0-3,0] vs. 3,0 [2,0-4,0] mmHg²; p=0,04) da pressão arterial sistólica. Adicionalmente, observamos menor ganho do controle barorreflexo nos pré-hipertensos em relação aos normotensos (12,16±4,18 vs. 18,23±7,11 ms/mmHg; p=0,03, TE:1,1), porém com tempo de retardo semelhante (-1,55±0,66 vs. -1,58±0.72 s; p=0,90). Durante todo o protocolo de estresse mental os grupos normotenso e pré-hipertenso aumentaram (deltas) significativa e similarmente a pressão arterial sistólica (efeito tempo: p<0,01, efeito interação: p=0,70, efeito grupo: p=0,58), diastólica (efeito tempo: p<0,01, efeito interação: p=0,35, efeito grupo: p=0,78) e média (efeito tempo: p<0,01, efeito interação: p=0,82, efeito grupo: p=0,60), a frequência cardíaca (efeito tempo: p<0,01, efeito interação: p=0,68, efeito grupo:p=0,66), o fluxo sanguíneo muscular (efeito tempo: p<0,01, efeito interação: p=0,42, efeito grupo: p=0,91) e a condutância vascular do antebraço (efeito tempo: p=0,01, efeito interação: p=0,47, efeito grupo: p=84) em relação ao basal. Não sendo observadas diferenças entre as respostas dos grupos em nenhuma das variáveis. De modo semelhante, durante todo o protocolo de exercício isométrico, ambos os grupos aumentaram (deltas) significativa e similarmente a pressão arterial sistólica (efeito tempo: p<0,01, efeito interação: p=0,35, efeito grupo: p=0,99), diastólica (efeito tempo: p<0,01, efeito interação: p=0,93, efeito grupo: p=0,79) e média (efeito tempo: p<0,01, efeito interação: p=0,89, efeito grupo: p=0,89) e a frequência cardíaca (efeito tempo: p<0,01, efeito interação: p=0,65, efeito grupo:p=0,79 em relação ao basal. Porém, o fluxo sanguíneo muscular do antebraço aumentou em relação ao basal apenas no terceiro minuto (efeito tempo: p<0,01, efeito interação: p=0,62, efeito grupo: p=0,98) e a condutância vascular do antebraço (efeito tempo: p=0,06, efeito interação: 0,66, efeito grupo: p=0,92) se manteve semelhante ao basal em ambos os grupos estudados em todos os momentos. Não foram observadas diferenças entre os grupos em nenhuma das variáveis. Conclusão: Jovens pré-hipertensos com histórico familiar de HAS possuem disfunção autonômica e condutância vascular do antebraço aumentada quando comparados a normotensos com o mesmo fator de risco. Durante estresse mental e exercício físico, os grupos estudados apresentam resposta hemodinâmica semelhante. Adicionalmente, ambos os grupos apresentam disfunção vascular durante o exercício, caracterizada por ausência de vasodilatação durante essa manobra. / Introduction: Individuals with a family history of systemic arterial hypertension (SAH) or prehypertension have autonomic and vascular abnormalities, both at rest and in response to stressful situations. Considering that these changes are related to the development of SAH and that in individuals with a family history of SAH there is a high incidence of prehypertension, the understanding of these disorders in prehypertensive individuals with a history of SAH is of fundamental importance. Objective: To compare the autonomic and vascular functions in rest and the hemodynamic response during mental stress and isometric handgrip exercise the prehypertensive and normotensive patients with family history of SAH. Methods: Twenty-five young volunteers with family history of SAH (30±5 years, 24±4 kg/m²), 14 normotensive (SBP: 116 [105-119], DBP: 67[60-71] mmHg) and 11 prehypertensive subjects (SBP: 128[124-132], DBP: 75[7175] mmHg) were submitted to vascular function evaluation (reactive hyperemia, Hokanson®), and cardiac and peripheral autonomic modulation, quantified, respectively, by spectral analysis of heart rate (ECG) and systolic blood pressure (SBP, FinometerPRO®). The transfer function analysis was used to measure the gain and response time of baroreflex. Additionally, were recorded blood pressure, heart rate (Dixtal®) and forearm blood flow and calculated forearm vascular conductance (Hokanson®) for 3 minutes during rest and 1º, 2º and 3º minutes of the protocols of mental stress (Stroop Color Word Conflict Test) and isometric exercise at 30% of maximal voluntary contraction (Saehan®). Data were presented as mean ± standard deviation of the mean or as median [1º quartile – 3º quartile]. The statistical significance adopted was 5%. Results: Pre-hypertensive individuals, in relation to normotensive individuals, have higher forearm vascular conductance both at rest (3.48 ± 1.26 vs. 2.67 ± 0.72 units, p = 0.05, effect size (ES): 1.13) and peak reactive hyperemia (25, 02 ± 8.18 vs. 18.66 ± 6.07 units, p = 0.04, ES: 1.05). The indices of cardiac autonomic modulation were similar between the groups. However, in the peripheral autonomic modulation, greater variability was observed in prehypertensive patients compared to normotensive individuals (9.4 [4.9-12.7] vs. 18.3 [14.8-26.7] mmHg²; p < 0.01) and higher spectral components of very low (6.9 [2.0-11.1] vs. 13.5 [10.7-22.4] mmHg², p = 0.01) and low frequencies (1.7 [1.0-3.0] vs. 3.0 [2.0-4.0] mmHg², p = 0.04) of SBP. Additionally, we observed a lower gain of baroreflex control in prehypertensive patients compared to normotensive patients (12.16 ± 4.18 vs. 18.23 ± 7.11 ms/mmHg, p = 0.03, ES: 1.1), but similar delay time (-1.55 ± 0.66 vs. -1.58 ± 0.72 s, p = 0.90). During the protocols of mental stress normotensive and prehypertensive groups increased (deltas) significantly and similarly systolic blood pressure (time effect: p<0.01, interaction effect: p=0.70, group effect: p=0.58), diastolic (time effect:p<0.01, interaction effect: p=0.35, group effect: p=0.78) and mean (time effect: p<0.01, interaction effect: p=0.82, group effect: p=0.60), heart rate (time effect: p<0.01, interaction effect: p=0.68, group effect: p=0.66), forearm muscle blood flow (time effect: p<0.01, interaction effect: p=0.42, group effect: p=0.91) and forearm vascular conductance (time effect: p=0.01, interaction effect: p=0.47, group effect: p=0.84) in relation to the baseline. No differences were observed between group responses in any of the variables. Similarly, throughout the isometric exercise protocol, both groups increased (deltas) significantly and similarly systolic blood pressure (time effect: p<0.01, interaction effect: p=0.35, group effect: p=0.99), diastolic (time effect:p<0.01, interaction effect: p=0.93, group effect: p=0.79) and mean (time effect: p<0.01, interaction effect: p=0.89, group effect: p=0.89) and heart rate (time effect: p<0.01, interaction effect: p=0.65, group effect: p=0.79) in relation to the baseline. However, the forearm muscle blood flow increased from baseline only in the third minute time effect: p<0.01, interaction effect: p=0.62, group effect: p=0.98) and forearm vascular conductance (time effect: p=0.06, interaction effect: p=0.66, group effect: p=0.92) remained similar to baseline in both groups in all moments. No differences were observed between groups in any of the variables. Conclusion: Young prehypertensive patients with family history of SAH have autonomic dysfunction and increased forearm vascular conductance when compared to normotensive patients with the same risk factor. During mental stress and physical exercise, the groups studied had a similar hemodynamic response. Additionally, both groups present vascular dysfunction during exercise, characterized by the absence of vasodilation during this maneuver.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-10-25T12:38:03Z No. of bitstreams: 2 Dissertação - Ana Carolina Arantes - 2017.pdf: 2233037 bytes, checksum: afdbf744fedfa1ebf396b3683ca1bf8d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-10-25T12:38:31Z (GMT) No. of bitstreams: 2 Dissertação - Ana Carolina Arantes - 2017.pdf: 2233037 bytes, checksum: afdbf744fedfa1ebf396b3683ca1bf8d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-10-25T12:38:31Z (GMT). No. of bitstreams: 2 Dissertação - Ana Carolina Arantes - 2017.pdf: 2233037 bytes, checksum: afdbf744fedfa1ebf396b3683ca1bf8d (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-09-14 / Introduction: The effects of salt intake reduction on casual blood pressure (BP) among hypertensive patients have been widely studied. However, there are few data about this issue in the context of arterial stiffness, as well as in normotensive and pre-hypertensive subjects. Objective:To evaluate the effects of progressive reduction in intake of the addition salt (from 6 grams / day to 4 grams/day) on peripheral and central pressure values as well as arterial stiffness in normotensive, prehypertensive and hypertensive. Methodology: This is an interventional, single-blind clinical trial, with 13 weeks of follow-up and 4 weeks interval between evaluations, performed with technical-administrative workers and teachers from a public university. Inclusion criteria were age between 20 and 60 years, both genders and which meal at home at least 4 times per week. Exclusion criteria were BP ≥160/100 mmHg, using two or more antihypertensive drugs, secondary hypertension; diabetes, history of myocardial infarction or stroke in the last 6 months, and special need diet. This study was approved by the institution’s Ethics Committee and all the participants signed the informed consent form. Recruitment was performed at the workplace, with a questionnaire about dietary habits, anthropometric and casual BP measurement (OMRON 705CP automatic device). According to the BP levels, participants were classified as normotensive (≤130/85 mmHg), pre-hypertensive (130-139/85-89 mmHg) and hypertensive stage I (≥140- 159/90-99 mmHg). The other evaluated variables were home blood pressure monitoring (HBPM), central blood pressure (CBP) measurement by tonometry (SphygmoCor® system), 24-hour urinarysodium, and dietary salt intake. The participants were instructed to reduce the consumption of foods with high sodium content. The addition of salt used during the follow-up was controlled by delivering individual packages for daily family consumption. The protocol adherence was evaluated by controlling the returned packages at each visit. The data were structured and analyzed using Stata software (version 12). Descriptive analysis was performed using relative and absolute frequencies, as well as median and interquartile range or mean and standard deviation for distribution of categorical and quantitative variables, respectively. For comparison between groups at visit 1, Kruskal-Wallis and Fisher's Exact tests were used. The comparison between the groups was done before and after the intervention using Wilcoxon test and paired Student T test. The correlation between BP values and urinary sodium levels was performed using the Spearman test. For all tests, the significance level was set at 5% and the confidence interval was 95%. Results: Fifty-five participants were evaluated, 32 males (median age 48 years). According to BP values, 18 were normotensive, 15 pre-hypertensive and 22 hypertensive. The salt of addition was reduced at each visit from 6 to 4 g/day. The groups are similar in relation to age and sex. There was no difference between blood pressure measurements and sodium excretion before and after the intervention. The parameters of arterial stiffness also did not suffer. Conclusion: Gradual reduction of addition salt intake in a 13-week follow-up is not able to reduce the loss of danger and mean values of blood pressure. / Introdução: Os efeitos da redução na ingestão de sal sobre a pressão arterial casual de hipertensos já foram amplamente estudados, entretanto essa análise ainda é escassa no contexto da rigidez arterial e em indivíduos normotensos e pré-hipertensos. Objetivo: Avaliar os efeitos da redução progressiva na ingestão do sal de adição (de 6 gramas/dia para 4 gramas/dia) sobre os valores dapressão periférica e central assim como a rigidez arterial em normotensos, pré-hipertensos e hipertensos. Metodologia: Ensaio clínico, simples cego, com 13 semanas de seguimento e intervalo de 4 semanas entre as consultas, realizado com trabalhadores técnico-administrativos e docentes universitários. Critérios de inclusão: idade entre 20 a 60 anos, para ambos os sexos e refeição principal (almoço e/ou jantar) em casa no mínimo 4x/semana. Critérios de exclusão: pressão arterial (PA) ≥160/100 mmHg, uso de dois ou mais medicamentos anti-hipertensivos, hipertensão secundária; diabéticos, história de infarto do miocárdio ou acidente vascular cerebral nos últimos 6 meses e necessidade de alguma dieta especial. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da instituição e os participantes assinaram o Termo de Consentimento Livre e Esclarecido. O recrutamento foi realizado no local de trabalho, aplicando-se questionários sobre hábitos alimentares, medidas antropométricas e medida casual da PA com o aparelho automático OMRON 705CP. Os participantes foram classificados, de acordo com a medida casual da pressão arterial, em normotensos (≤130/85 mmHg), pré-hipertensos (130-139/85-89 mmHg) e hipertensos estágio I (≥140-159/90-99 mmHg). As variáveis avaliadas foram a medida casual, monitorização residencial da pressão arterial (MRPA), medida central da pressão arterial (PAC) por tonometria com o aparelho sphygmocor, sódio urinário de 24h e mensuração do sal de adição. Os participantes foram orientados a reduzir o consumo de alimentos com alto teor de sódio e o sal de adição utilizado no período do seguimento foi controlado com a entrega em embalagens individuais, para o consumo diário familiar. A adesão ao protocolo foi avaliada pelo controle das embalagens e pesagem do sal de adição retornado em cada visita. Os dados foram estruturados e analisados no programa Stata versão 12. Foram utilizadas frequências absolutas e relativas para análise estatística descritiva e mediana e intervalo inter-quartil ou média e desvio padrão, para as variáveis categóricas e quantitivas. A distribuição dos dados foi analisada pelo teste Shapiro-Wilk; para a comparação entre grupos na V1B foram realizados os testes de Kruskal-Wallis e Exato de Fisher; comparação intra grupo foi feita antes e após a intervenção pelos testes de Wilcoxon e t-Student pareado; correlação entre valores de PA e níveis de sódio urinário via teste de Spearman. Para todos os testes considerou-se o nível de significância em 5% e intervalo de confiança de 95%. Resultados: Foram avaliados 55 participantes com intervalos de 04 semanas, 32 do sexo masculino (mediana de 48 anos) sendo 18 normotensos, 15 pré-hipertensos e 22 hipertensos, redução progressiva no sal de adição a cada visita de 6 até 4 gramas ao dia. Os grupos foram semelhantes em relação a idade e sexo. Não houve diferença entre medidas de pressão arterial e excreção de sódio antes e depois da intervenção. Os parâmetros de rigidez arterial também não sofreram alterações significativas. Conclusão: A redução gradativa da ingestão de sal de adição num seguimento de 13 semanas não foi capaz de reduzir de maneira significativa os valores periféricos e centrais da pressão arterial.

Introduction : L’hypertension artérielle est un problème majeur de santé publique. Dans la population adulte, environ 1,56 milliard sera atteint de cette pathologie en 2025 si rien n’est fait. Une brève période d’hypertension au cours du jeune âge augmente les risques d’hypertension à l’âge adulte. Agir positivement sur les facteurs de risque modifiables permet une meilleure prévention. La pratique de l’activité physique est depuis longtemps reconnue comme un moyen efficace de prévention chez les adultes. Objectif : L’objectif de la présente recherche est d’étudier entre l’association longitudinale de l’activité physique et la préhypertension/hypertension artérielle chez les adolescents. Méthode: La pression artérielle a été mesurée trois fois par des techniciens qualifiés durant les cinq premières années de suivi (1999-2005) chez 638 filles et 586 garçons de l’étude NICO. Une tension artérielle comprise entre le 90e et le 95e percentile en fonction de l’âge et du sexe est définie comme une préhypertension et celle située au-dessus du 95e percentile comme une hypertension. Chaque 3 mois, ces adolescents ont fourni des informations concernant leur pratique d’activité physique. L’association de l’activité physique et la préhypertension/hypertension artérielle chez les garçons et chez les filles a été estimé à l’aide de modèles marginaux. Résultats : Les analyses révèlent que chez les filles, la majorité des indicateurs d’activité physique étudiés apparait protectrice contre le développement de la préhypertension/hypertension artérielle et les résultats sont statistiquement significatifs sauf pour l’activité physique légère (ratio de cotes (RC) (95% intervalle de confiance) = 0,98 (0,86-1,12). Le RC de l’activité physique modérée est de 0,89 (0,80-0,98), celui de l’activité physique vigoureuse de 0,80 (0,65-0,98), celui de l’activité physique modérée à vigoureuse de 0,89 (0,81-0,98) et celui de la fréquence de l’activité physique = 0,78 (0,68-0,91). Aucun indicateur d’activité physique n’est statistiquement significatif chez les garçons. Conclusion: La pratique d’activité physique modérée ou modérée à vigoureuse est associée la préhypertension/hypertension artérielle uniquement chez les filles. / Introduction: Hypertension is a major public health problem. If no action is taken, 1.56 billion adults will be diagnosed with this pathology by 2025. Even a brief period of hypertension at a young age increases the risk of hypertension in adulthood. Preventive intervention targeting modifiable risk factors is a viable route to better prevention, and the practice of physical activity has long been recognized as an effective means of preventing hypertension in adults. Objective: The objective of this research is to assess the longitudinal association between physical activity and prehypertension/hypertension in adolescents. Method: Blood pressure was measured three times by trained technicians during the first five years of follow-up (1999-2005) in 638 girls and 586 boys participating in the Nicotine Dependence in Teens (NDIT) Study. BP between the age- and sex-specific 90th and 95th percentile was defined as prehypertension; BP above the 95th percentile was defined as hypertension. Every three months, adolescents provided data on their practice of physical activity. The association between physical activity and prehypertension/hypertension among boys and girls was estimated using marginal models. Results: In girls, all physical activity indicators except light physical activity (odds ratio (OR) (95% confidence interval) = 0.98 (0.86-1.12)) were statistically significantly protective against prehypertension/hypertension; OR for moderate physical activity = 0.89 (0.80-0.98); OR for vigorous physical activity = 0.80 (0.65-0.98); OR for moderate-to-vigorous physical activity = 0.89 (0.81-0.98); OR for frequency of physical activity = 0.78 (0.68-0.91). None of the physical activity indicators were significant among boys. Conclusion: The practice of moderate or moderate-to-vigorous physical activity is associated with protection against prehypertension/hypertension, in girls but not boys.

Hypertension is a global disease that many effected people in developing countries is not aware of. Hypertension is linked with cardiovascular disease. Prehypertension is not a disease but if not correctly treated, it could develop into hypertension. The aim of the study was to investigate if there are any differences in circadian blood pressure between two study groups, one group with normal blood pressure and one group with prehypertension. This study was a explorative study and its design is based on measurements of blood pressure values and a questionnaire was used to help get the data collection. 51 students volunteered to have their blood pressure taken from them and out of these 51, 24 where selected into two groups of 12 each for the Ambulatory blood pressure monitoring. hese 24 students would be a part of our study and an ambulatory (Schiller-102 plus) blood pressure monitor was used to collect the data. The prevalence of prehypertension findings in the clinical testing phase was 37% of the population. There was a variation between the groups during the day (systolic) but there was not a significant difference during the night.