Made available in DSpace on 2014-06-11T19:23:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-02-18Bitstream added on 2014-06-13T19:09:02Z : No. of bitstreams: 1 oliveirajr_sa_me_botfm.pdf: 1126092 bytes, checksum: 9767b89b53ffc12296fa5f7b701bc920 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Tem sido demonstrado que a obesidade promove remodelação cardíaca em ratos. Este estudo investigou a influência da obesidade induzida por dieta hipercalórica (HP) sobre as variáveis nutricionais e o remodelamento cardíaco, considerando a hipertrofia, fibrose intersticial e composição de cadeias pesadas de miosina (MHC), em ratos normotensos Wistar Kyoto (WKY) e ratos espontaneamente hipertensos (SHR). Parcelas de SHR (20) e WKY (20) com 60 dias de idade foram distribuídas em quatro grupos: SHR-C, SHR-OB, WKY-C e WKY-OB. Os grupos C receberam uma dieta normocalórica (C, 3,15 Kcal/g) e os grupos OB foram tratados com uma dieta hipercalórica (4,5 Kcal/g) durante 20 semanas. Dois critérios foram adotados para refinar a composição dos grupos em referência à obesidade, baseados na ingestão alimentar e no peso corporal (PC). As determinações nutricionais incluíram ingestão calórica, eficiência alimentar, PC, adiposidade, glicemia e perfil lipidêmico. A pressão arterial sistólica (PAS) foi mensurada antes e após a intervenção dietética. As análises morfológicas abrangeram a pesagem dos átrios, ventrículos direito e esquerdo e o estudo da umidade procedeu-se em fragmentos cardíacos, hepáticos e pulmonares. Secções histológicas miocárdicas foram utilizadas para cálculo da área seccional do miócito (AM) e fração intersticial de colágeno (FIC). A composição relativa de MHCs foi determinada por eletroforese de gel de poliacrilamida duodecil sulfato de sódio. A composição dos grupos foi submetida à análise estatística pelo teste de proporções binomiais entre e dentro das populações. Algumas variáveis nutricionais e a PAS foram analisadas por MANOVA no modelo de medidas repetidas. Os demais dados foram avaliados por ANOVA e teste de Tukey. Uma interação vigente entre linhagem e tratamento foi notada na composição dos grupos. / Obesity has been shown to induce cardiac remodeling in rats. In this study, we investigated the influence of obesity induced by high-fat diet (HFD) on nutritional variables and cardiac remodeling, concerning hypertrophy, interstitial fibrosis and myosin heavy chain composition, in normotensive Wistar Kyoto (WKY) and spontaneously hypertensive (SHR) rats. Sixty-day-old SHR (n=20) and WKY (n=20) were distributed into four groups: SHR-C, SHR-OB, WKY-C e WKY-OB. The C groups received a control diet (C, 3,15 Kcal/g) and the OB groups were treated with a HFD (4,5 Kcal/g) during 20 weeks. Two criteria were adopted to refine the groups composition in reference to obesity based on food consumption and body weight (BW). Nutritional determinations included energy intake, feed efficiency, BW, adiposity, glycemia and lipid profile. Systolic blood pressure (SBP) was measured before and after diet intervention. Morphological analysis involved atria, right and left ventricles weights and humidity study was realized with cardiac, liver and lung pieces. Using myocardial histological sections, myocyte cross sectional areas (MA) and collagen interstitial fraction (CIF) were measured. Relative myosin heavy chain (MHC) composition was determined using sodium dodecyl sulfatepolyacrylamide gel electrophoresis. The groups compositions were submitted to statistical analysis by the binomial proportional test between and within populations. Some nutritional variables and SBP were analyzed by two-way MANOVA in repeated measures model. Other data were evaluated by two-way ANOVA and Tukey test. An interaction between strain and treatment was noted to groups composition. Alimentar efficiency was increased only in the WKYOB and glycemic tolerance was impaired in both OB groups. HFD induced an increase of BW (WKY-C 481.6±39.4 g; WKY-OB 611.4±48.2 g; p<0.05; SHRC 370.3±16.0 g; SHR-OB 410.8±9.3 g; p<0.05) and adiposity in both strains.

Hipertensão do avental branco significa uma elevação persistente da pressão arterial no consultório médico ou clínica, com pressão normal em quaisquer outras circunstâncias. Existem diversos questionamentos a respeito da origem, significado clínico, prognóstico e tratamento desta manifestação. Em relação à etiologia, nossa hipótese é que uma alteração endotelial, resultando em deficiência na produção ou utilização de óxido nítrico endógeno, constitua um fator primário para a ocorrência da hipertensão do avental branco. Este estudo, desenvolvido entre moradores do município de Dumont - São Paulo, Brasil, teve como objetivos caracterizar os participantes em relação a fatores demográficos, alterações fisiológicas e metabólicas para posteriormente identificar e comparar os níveis plasmáticos de nitrato - produto da degradação do óxido nítrico ? entre os sujeitos da pesquisa. De uma amostra de 441 voluntários, selecionamos 109 indivíduos, que foram divididos em três grupos: normotensão (no=58), hipertensão essencial (no=33) e hipertensão do avental branco (no=18), após medidas de pressão arterial com aparelho oscilométrico e exame de Monitorização Ambulatorial da Pressão Arterial. Realizamos entrevista, mensuração de dados e coleta de exames laboratoriais para comparação das variáveis encontradas entre os grupos. Para o tratamento estatístico, foram utilizados os testes ANOVA e Tukey. Os resultados foram expressos como médias ± erros padrões das médias. As diferenças foram consideradas estatisticamente significativas para p<0,05. A prevalência de hipertensão do avental branco foi de 34,1%, com predominância do sexo feminino (83,3%), média de idade de 45,28 anos, sendo a maioria natural do Estado de São Paulo (66,7%), de cor branca (88,9%), alfabetizada (33,3%), casada (72,2%), com histórico familiar para doenças cardiovasculares (72,2%). A análise da quantificação de nitrato plasmático apontou diferença significativa entre os grupos hipertensão do avental branco e normotensão em comparação aos hipertensos, com elevação dos níveis de nitrato sérico em portadores de hipertensão essencial. Também encontramos diferença estatisticamente significativa para índice de massa corporal, relação cintura/quadril, glicemia e creatinina plasmáticas, na comparação entre hipertensos do avental branco e normotensos. As distinções observadas entre os grupos e a presença de variações clínicas, demográficas e bioquímicas possibilitam inferir que a hipertensão do avental branco é uma condição que deve ser analisada de maneira distinta em relação a indivíduos normotensos e portadores de hipertensão essencial. / The white coat hypertension is understood as a persistent increase in arterial pressure in the medical office or clinic, while normal blood pressure is observed in any other circumstances. There are several issues regarding the origin, clinical meaning, prognosis and treatment of this condition. Concerning the etiology, our hypothesis is that an endothelial alteration, leading to deficiency either in the production or utilization of endogenous nitric oxide, may constitute a primary factor for the occurrence of white coat hypertension. This study, developed with the population of the city of Dumont São Paulo, Brazil, aims to characterize the participants in relation to demographical factors and metabolic and physiological changes to afterwards identify and compare plasma levels of nitrate product of nitric oxide degradation among the researchs subjects. We selected 109 individuals, from a sample of 441, who were divided in three groups: normotensive (n=58), essential hypertension (n=33) and white coat hypertension (n=18), following arterial pressure measures with oscilometric device and Arterial Pressure Monitoring Exam. Interviews, data measures and laboratory exams were accomplished as to enable the comparison of the variables found between groups. For the statistical treatment, ANOVA and Tukeys test were used. Results were expressed in terms of means ± means standard deviations. The significance level adopted was p<0,05. White coat hypertension prevalence was of 34,1% with predominance of the feminine gender (83,3%), mean age 45,28, most of the participants original from the state of São Paulo (66,7%), white (88,9%), alphabetized (33,3%), married (72,2%) and with family history of cardiovascular diseases (72,2%). Quantification of plasma nitrate showed significant difference between the white coat hypertension group and the normotensive group in comparison to hypertensive patients, with increased levels of serum nitrate in essential hypertension patients. We also found statistically significant difference for corporal mass index, hip/waist ratio, plasma glucose and creatinine, in the comparison between white coat hypertensive and normotensive patients. The distinctions observed between groups and the presence of clinical, demographical and biochemical variations allow us to suggest that the white coat hypertension is a condition which must be analyzed in a distinct way in relation to normotensive and essential hypertension patients.

Orientador: André Fattori / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T03:54:34Z (GMT). No. of bitstreams: 1 Santimaria_MarianaReis_M.pdf: 28450698 bytes, checksum: 2e1055cfe2400d22b7a31841a19cfc4b (MD5) Previous issue date: 2013 / Resumo: O resumo poderá ser visualizado no texto completo da tese digital / Abstract: The abstract is available with the full electronic document / Mestrado / Gerontologia / Mestra em Gerontologia

Made available in DSpace on 2014-06-12T18:29:07Z (GMT). No. of bitstreams: 2 arquivo3560_1.pdf: 2032950 bytes, checksum: 88f842dfc56d6d3c0cf70f9617ca74c3 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2009 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A Hipertensão Arterial (HAS) é um fator de risco modificável na gênese da doença aterosclerótica, cujo controle pode reduzir o risco cardiovascular dos pacientes com HIV/aids. Objetivos: Estimar a prevalência de HAS e descrever as características dos pacientes com HAS em pacientes com HIV/aids. Métodos: Estudo seccional e estudo de caso-controle aninhado a uma coorte, em 1000 pacientes com HIV/aids, realizado no período de junho/2007 a dezembro/2008, em dois serviços de referência ao atendimento do HIV/aids em Pernambuco, Brasil. Considerou-se hipertensão níveis &#8805;140/90 mmHg, confirmados numa segunda visita, ou uso de medicação antihipertensiva. Resultados: Dos 1000 pacientes, foram estudados 958 e 42 foram perdas. 388 (40,50%) eram normotensos, 325 (33,92%) préhipertensos e 245 (25,57%) hipertensos, destes apenas 36 (14,8%) estavam com a PA controlada e 62 (54,39%) tiveram o diagnóstico de HAS após o diagnóstico do HIV. Lipodistrofia estava presente em 95 (38,9%), sobrepeso em 95 (38,8%), obesidade em 34 (13,9%). CT &#8805; 200mg% ocorreu em 43 (30,9%), LDL &#8805;130 mg% em 24 (22%), HDL <40 mg% em 75 (52,1%), TG &#8805;150 mg% em 84 (60%) e diabete melito em 4 (2,9%), tabagismo em 56 (23,1%). A carga viral estava indetectável ou <10.000 cópias em 54 (80,6%) e níveis de linfócitos CD4 estavam > 350 cel/mm3 em 80 (63,5%). O uso de anti-retroviral (ARV) ocorreu em 179 (82,5%), 89 (41,6%) em uso de inibidores de protease (IP) e 95 (44,4%) sem IP. 148 (87,1%) utilizavam ARV por mais de 12 meses. O estudo caso-controle entre pacientes com HIV/aids hipertensos e normotensos, mostrou que os fatores de risco tradicionais tais como a idade >40 anos (OR=3,06; IC=1,91-4,97), o sexo masculino (OR=1,85; IC=1,15- 3,01), o índice de massa corpórea > 25 (OR=5,51; IC=3,36-9,17) e triglicerídeos > 150 mg/dL (OR=1,69; IC=1,05-2,71), mostraram-se independente e significativamente associados à hipertensão. A lipodistrofia não esteve associada à hipertensão. O tempo de tratamento ARV e os níveis de linfócitos CD4 < 200 células/mm3 estiveram associados à hipertensão na análise univariada, entretanto não permanecram no modelo multivariado final. O tipo de esquema ARV não apresentou associação com hipertensão. Conclusão: A hipertensão nos pacientes com HIV/aids está em parte associada a fatores não modificáveis como a idade, o sexo e a história familiar de hipertensão. Elevada freqüência de hipertensos não controlados e riscos cardiovasculares nos infectados pelo HIV, impõem necessidade de medidas preventivas e terapêuticas contra a HAS neste grupo, devendo objetivar o controle dos fatores reversíveis associados à doença, particularmente os erros dietéticos e o ganho excessivo de peso

Made available in DSpace on 2014-06-12T18:29:38Z (GMT). No. of bitstreams: 2 arquivo8007_1.pdf: 2539897 bytes, checksum: 09eb24d17155fea95438e7a2df0a3321 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2005 / A Hipertensão arterial sistêmica (HAS) está associada a elevada morbimortalidade cardiovascular. Seu componente pulsátil, a pressão de pulso (PP), tem sido recentemente estudada como forte determinante desta relação. O objetivo deste estudo foi determinar a relação entre a PP medida pela Monitoriação Residencial da Pressão Arterial (MRPA) e o Índice de Massa Ventricular Esquerdo (IMVE). Por análise de banco de dados, foram selecionados 83 pacientes, hipertensos ou não, que realizaram MRPA e ecocardiograma em um período menor que 6 meses, no ano de 2004. Os critérios de exclusão foram: idade inferior a 18 anos, valvulopatias mitral ou aórtica, presença de disfunção segmentar e fração de ejeção inferior a 55% ao ecocardiograma. Permaneceram 72 pacientes para a análise, sendo 41 mulheres e 31 homens, com idade média de 52 ± 17 anos, com variação de 25 a 85 anos. O índice de massa corporal (IMC) foi de 29 ± 6 Kg/m2, e 63,9% dos pacientes eram hipertensos. O sexo feminino apresentou maior idade e usou anti-hipertensivos em maior frequência. Houve elevação progressiva da pressão arterial sistólica (PAS) e da PP com a idade, mas nem estas nem a pressão arterial distólica (PAD) variaram com o sexo ou com o IMC. A média do IMVE foi 109 ± 25 g/m2 e não houve diferença entre os sexos. Foram considerados hipertensos os pacientes com PAS>135 mmHg ou PAD>85 mmHg ou que usavam antihipertensivos. Hipertrofia ventricular esquerda (HVE) foi definida como IMVE>134 g/m2 em homens e >110 g/m2 em mulheres. Foi encontrada relação significativa entre HAS e HVE (p=0,02) e entre PP>53 mmHg e aumento do IMVE (p=0,003). Na análise de regressão linear foi observado correlação entre o IMVE e a PAS (r=0,356; p=0,002) e o IMVE e a PP (r=0,429; p<0,001), e não houve correlação com a PAD (r=0,0459; p=0,702). A análise de regressão múltipla passo a passo para correlacionar a IMVE com as demais variáveis, determinou que a PP isoladamente construiria a melhor equação para determinar o IMVE. As mulheres com PP< 53 mmHg apresentaram IMVE de 100,3 g/m2 e as com PP>53 mmHg, de 120,8 g/m2 (p=0,016), o que implica no diagnóstico de HVE. Entre os homens, esta diferença não foi significativa (107,2 g/m2 e 122,6 g/m2 ; p=0,078). Concluindo, estes dados demonstram que o IMVE correlacionou-se com a PP, e que esta correlação foi ainda maior que com a PAS ou a PAD

The carotid artery wall moves longitudinally along the length of the vessel, although little is known about what causes this motion, or what health information it represents. The overarching purpose of this dissertation was to investigate the regulation of carotid artery longitudinal wall motion (CALM) in humans, as well as how CALM can be used to infer information about arterial health. Through observational and experimental designs, we tested evidence for a structural ventricular-vascular coupling effect, which postulates that systolic anterograde CALM is influenced by the forward blood shear rate while systolic retrograde CALM is influenced by left ventricular rotation, although the data suggests a moderate influence of left ventricular rotation, and minimal influence of shear rate. In cross-sectional analyses, we demonstrated that diastolic CALM variables are better related to age and health status compared to systolic CALM displacement and that this relationship was independent of traditional measures of arterial stiffness. These experimental and observational results directed the use of diastolic CALM as a potential indicator of arterial health in subsequent studies, due to the relative independence from systolic events. While there was no effect of 12-weeks of exercise training in healthy men on diastolic CALM variables, we observed increased systolic retrograde CALM and diastolic CALM acceleration in men with a history of resistance exercise training compared to sedentary men, suggesting an effect of habitual exercise training. Our novel findings suggest that CALM is regulated by a complex system, in part related to both arterial wall structure and ventricular-vascular coupling, and may have clinical value in complimenting measures of traditional arterial stiffness in humans. Future studies should examine whether local changes to arterial wall structure or indirect changes in regulatory control dictate differences in CALM with aging and with chronic exercise training, before integrating CALM into routine measurement of arterial health. / Thesis / Doctor of Philosophy (PhD) / We have known for a long time that arteries expand in order to absorb pressure; however, only recently have we identified that arteries also move longitudinally along the length of the arterial wall. The overarching purpose of this dissertation was to study what causes carotid artery longitudinal wall motion (CALM), and how we can use this information to understand arterial health. We demonstrated that CALM is partly controlled through the forward blood velocity wave and left ventricular rotation of the heart, and that diastolic CALM is uniquely related to aging and health status, but is not impacted by exercise training in healthy men. There are many aspects of CALM that need to be examined before wide-spread use, though our results indicate that CALM represents a new way of studying arterial health, which has the potential to complement traditional measures of cardiovascular disease risk in humans.

<p> This study examined the effects of isometric handgrip training (IHG) on resting blood pressure and resting arterial compliance in the carotid and brachial arteries of medicated hypertensive individuals. Previous studies found that isometric training reduced resting arterial blood pressure (RBP) in high-normal and medicated hypertensive individuals. Investigators have also found an improvement in central arterial compliance with aerobic training and a reduction in central arterial compliance with age, cardiovascular disease and resistance training. The effects of isometric training on arterial compliance have not been examined previously.</p> <p> Ten participants participated in a one-hand IHG intervention, nine participants in a two-hand IHG intervention and 5 participants served as the non-exercising controls. Each experimental group performed four, 30% maximal voluntary IHG contractions for 2 minutes, 3 days a week, for 8 weeks. The one-hand group trained only their non-dominant hand, while the two-hand group trained both hands. Measurements of resting arterial blood pressure, and cross sectional compliance of the brachial and carotid arteries were made pre-training, after four weeks of training and after the completion of the eight-week training protocol.</p> <p> There were no changes in resting arterial blood pressure after training. Mean carotid and brachial artery diameters did not change with resistance training. There were no significant changes in brachial or carotid cross sectional compliance with isometric training. In conclusion, moderated level isometric training did not elicit changes in resting arterial blood pressure and resting muscular and elastic arterial compliance in medicated hypertensive individuals compared to a non-exercising control group.</p> / Thesis / Master of Science (MSc)

Increased platelet activation and inflammation play a key role in atherothrombosis. Patients with peripheral arterial disease are at increased risk of adverse cardiovascular events, particularly at the time of surgery. We postulated that the increase in peri-operative cardiovascular events is mediated by increased platelet activation and inflammation. We hypothesized that peri-operative dual anti-platelet therapy would improve biomarkers of atherothrombosis without causing unacceptable bleeding in patients undergoing surgery for critical limb ischaemia (CLI). Prior to interventional study, I validated a sensitive flow cytometric technique for the reproducible assessment of in vivo platelet activation in patients with peripheral arterial disease. Thirty patients with stable claudication, attended on two occasions to permit within-day and between-day comparisons. A variety of platelet activation markers were compared to the gold standard of platelet–monocyte aggregation. Platelet-monocyte aggregation demonstrated comparable within-day (mean difference ± co-efficient of reproducibility; 0.9±15.4%) and between-day reproducibility (2.0±12.4%). Plateletmonocyte aggregates correlated well with other platelet activation markers (P selectin r=0.30; Platelet CD40L r=0.41; Platelet microparticles r=0.27; P≤0.026) and monocyte activation markers (monocyte CD40 r=0.27;monocyte CD11b r=0.47; P≤0.026). In a cross sectional study, I demonstrated that resting in vivo platelet activation and inflammation was increased in patients with CLI in comparison to healthy controls, patients with stable claudication and those undergoing treatment for acute coronary syndromes. In addition, platelet activation and inflammation throughout the peri-operative period was markedly increased in CLI patients compared with non-vascular patients undergoing arthroplasty, and exceeded the rise attributable to the stress of surgery itself. In a prospective double-blind randomised controlled trial, 108 patients undergoing infra-inguinal revascularisation or amputation for CLI were maintained on aspirin (75 mg daily) and randomised to clopidogrel (600 mg prior to surgery, and 75 mg daily for 3 days; n=50) or matched placebo (n=58). Peri-operative in vivo platelet activation and inflammation, cardiac-Troponin I (c-TnI) release and bleeding outcomes were recorded. Clopidogrel reduced markers of platelet activation and inflammation before surgery and throughout the post-operative period. Overall, there were 18 troponin-positive events (16.7%), with half of the troponin rises (9) occurring prior to surgery. Patients with postoperative elevations in c-Tn I had significantly greater levels of pre-operative platelet-monocyte aggregation, monocyte CD40, IL-6 and hsCRP. However, despite reducing platelet and inflammatory markers, clopidogrel did not have a direct effect on peri-operative c-Tn I. There was no increase in major life-threatening or minor bleeding, although blood transfusions and wound haematomas were significantly increased. Using sensitive and validated methodologies, I have provided a detailed examination of in vivo platelet activation and inflammation in high-risk vascular surgical patients. This approach has provided the first objective assessment of the risks and benefits of intensive peri-operative anti-platelet therapy in this patient group. Dual anti-platelet therapy reduced biomarkers of atherothrombosis without causing unacceptable bleeding. However, large-scale clinical trials would be required to confirm whether these reductions translate into improvements in clinical outcome.

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