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H 026 CARDIOVASCULAR REMODELING (CONCENTRIC LEFT VENTRICLE HYPERTROPHY AND INCREASE IN THE INTIMA-MEDIA THICKNESS) IN REFRACTORY HYPERTENSION
H 026
CARDIOVASCULAR REMODELING (CONCENTRIC LEFT VENTRICLE HYPERTROPHY AND INCREASE IN THE INTIMA-MEDIA THICKNESS) IN REFRACTORY HYPERTENSION
H 028
Juan Carlos Yugar Toledo, Leoni Adriana de Souza, Samira Ubaid Girioli, Marcelo Arruda Nakazone, José Fernando Vilela Martin, Heitor Moreno Jr
Antonio Carlos Tanajura de Macedo, Augusto Gurgel Faria Araújo, Daniel Batista Munhoz, Tiago Nóbrega Morato, Jose Carlos Quinaglia e Silva, Andrei Carvalho Sposito
FCM-UNICAMP – Farmacologia Cardiovascular Campinas SP BRASIL e FAMERP – Clínica Médica Biologia Molecular São José do Rio Preto SP BRASIL
InCor-DF Brasilia e HBDF Brasília, DF BRASIL
Among the forms of cardiovascular system remodeling caused by chronic pressure overload are left ventricle hypertrophy (LVH) and vascular remodeling. The Framingham Heart Study demonstrated the prognostic value of detecting LVH in risk stratification for cardiovascular disease. Evaluation of carotid artery intima-media thickness (IMT) by US is being used to detect vascular remodeling and atherosclerosis at an early stage. To evaluate the left ventricle mass and IMT of carotid arteries in hypertensive and control individuals, 70 refractory hypertensive (RH), 80 controlled hypertensive (CH) patients and 70 normotensive controls (CT) were studied. Evaluations of the left ventricle mass were respectively 342.7 ±116.9 g; 241.3 ± 104.2 g e 182.3± 39.6 g for the RH, CH and CT Groups (P < 0.0001 RH vs. CH and CT). The mass/SC index was greater for the RH Group compared to the CH and CT Groups. The RH and CH Groups showed a significant increase in IMT compared to the CT Group (0.74±0.12 mm (RH) and 0.71±11 mm (CH) versus 0.63±0.06 mm (CT); P<0.0001). There was no significant difference for IMT between the RH and CH Group (P>0.05). The results show that RH and CH patients present with cardiovascular remodeling (LVH and increases in carotid artery IMT) that manifest as morphologic cardiovascular changes associate to arterial hypertension, chiefly in RH. H 027
Although conventional risk factors are helpful in the identification and prevention of cardiovascular events, they are absent in half of patients who present myocardial infarction (MI). In this regard, some new risk factors have been investigated and among then are social factors such as education level, household income and depression. To verify this issue, we evaluated 121 patients who were enrolled into the Brasilia Cohort Study at the first 24 hours of MI symptoms between May of 2006 to January of 2007. A standardized medical questionnaire including Beck Depression Inventory, nutritional and social evaluation was completed during the first 24 hours after MI. Major cardiovascular events (recurrent MI, Death) occurring in the first month were equally recorded. There was no association between education level and the incidence of conventional cardiovascular risk factors such as diabetes, hypertension, smoking habit and dyslipidemia. Systemic inflammatory reaction in the first 24 hours after MI was higher in individuals with lower education level (below the median of 4 years) than the counterparts (2.5±4.3 vs. 1.2 ± 2.3 mg/dL; p=0.03). Likewise, the survival free of events in the first year after MI was lower for those less educated patients (148±18 vs. 183±13 days; Log Rank p=0.048). In Conclusion, lower education level is independently associated with a higher systemic inflammatory reactivity and recurrence of MI or death in the first year after MI.
CORRELATION OF ANKLE-BRACHIAL INDEX MEASURED BY DOPPLER SPHYGMOMANOMETER AND AUTOMATIC OSCILLOMETRIC DEVICE IN ELDERLY PATIENTS
H 029
Roberto Dischinger Miranda, Dionísio Alvarez Mateos Filho, Marco Antonio Mota Gomes, Audes Diógenes de Magalhães Feitosa, Clineu de Mello Almada Filho, João Toniolo Neto, Maysa Seabra Cendoroglo
Faculdade de Medicina de São Jose do Rio Preto-FAMERP São Jose do Rio Preto SP BRASIL
Introduction: Peripheral arterial disease (PAD) is associated with high cardiovascular risk and is more common in elderly patients. The ankle-brachial index (ABI) is a non-invasive recognized method to detect these patients. Its use in clinical practice is limited by the need of specialized equipment and the time required for performance. Purpose: We hypothesized that the ABI obtained by oscillometric automatic device could provide accuracy necessary for office practice. Methods: Each patient signed an informed consent. After 10 minutes of rest, blood pressure of both arms and legs, was taken in duplicate by validated automatic oscillometric devide (Microlife MAM – BP 3AC-1) and by mercury sphygmomanometer with Doppler ultrasound. Mean value was used for ABI calculation. Results: 144 outpatients with 60 years old or more, were included. The correlation coefficient was 0.632 in the left leg and 0.705 in the right leg. ABI obtained with oscillometric automatic presented average value slightly higher (0,06) than with the Doppler method.
Mean ±SD
ABI Left 1,07 0,15
Oscillometric ABI Right 1,12 0,12
ACE GENETIC POLYMORPHISMS IN PATIENTS SUFFERING HYPERTENSIVE CRISES
José Fernando Vilela Martin, Cristina Hiromi Kuniyoshi, André Néder Ramires Abdo, Juan Carlos Yugar Toledo, Letícia G Andrade, Afonso A Carvalho Loureiro, Doroteia Rossi Silva Souza, Marcela Augusta Souza Pinhel
Geriatric Division of Federal University of São Paulo Sao Paulo SP BRASIL
Doppler ABI Right 1,05 0,17
LOW EDUCATION LEVEL IS AN INDEPENDENT PREDICTOR FOR SYSTEMIC INFLAMMATORY REACTIVITY AND RECURRENCE OF CARDIOVASCULAR EVENTS AFTER ST ELEVATION MYOCARDIAL INFARCTION: SUB ANALYSIS OF THE BRASÍLIA COHORT STUDY
High blood pressure (HBP) is a highly prevalent disease and its physiopathology is related to physiological, environmental and genetic factors. Hypertensive crises are a complication of HBP which course to a symptomatic acute elevation of diastolic arterial pressure (DAP ³ 120 mmHg), classified as emergency (EHC) when accompanied by target-organ lesion or urgency (UHC) when not. The angiotensin converting enzyme (ACE) is implicated in arterial pressure control. Thus, studies associate ACE gene polymorphisms (insertion “I” and deletion “D” alleles) to susceptibility for cardiovascular and hypertensive diseases. The objectives of this work were to analyze the ACE polymorphisms (I/I; I/D; D/D) in individuals suffering from UHC (n=22) and EHC (n=32) and characterize the groups in respect to age, gender and ethnical background. Genomic DNA was extracted from leukocytes and submitted to amplification by polymerase chain reaction. The Fisher exact test (allelic and genotypic frequencies) and the t-test (continuous variables) were utilized for statistical analysis with statistical significance being set for a p-value <0.05. The I/D genotype had the highest frequency in both UHC (90%) and EHC (93%) individuals (p=0.63). The D allele was slightly more prevalent in both groups (0.54 and 0.56, respectively; p=1.0). The mean age in EHC was greater than in UHC patients (66±13 and 58.2±13.9, respectively; p=0.04), and there was a predominance of men in both groups (51.1% in EHC and 56.6% in UHC; p=0.07). There was also a predominance of white individuals in both groups (78% in EHC and 52% in UHC; p=0.59). In conclusion, the D allele, considered a risk factor for cardiovascular diseases, did not exhibit differences in individuals suffering from urgent or emergency hypertensive crises. However, a higher mean age was found in the EHC group, suggesting that this may be a risk factor for the severity of hypertensive crises.
ABI Left 1,12 0,13
Conclusions: Oscillometric automatic showed to be a reliable method to obtain ABI. We believe that the use of this technique can make the ABI more frequently measured in clinical practice. This can bring on more precocious diagnosis and treatment of patients with high cardiovascular risk.
12
CARDIOVASCULAR REMODELING (CONCENTRIC LEFT VENTRICLE HYPERTROPHY AND INCREASE IN THE INTIMA-MEDIA THICKNESS) IN REFRACTORY HYPERTENSION
H 028
Juan Carlos Yugar Toledo, Leoni Adriana de Souza, Samira Ubaid Girioli, Marcelo Arruda Nakazone, José Fernando Vilela Martin, Heitor Moreno Jr
Antonio Carlos Tanajura de Macedo, Augusto Gurgel Faria Araújo, Daniel Batista Munhoz, Tiago Nóbrega Morato, Jose Carlos Quinaglia e Silva, Andrei Carvalho Sposito
FCM-UNICAMP – Farmacologia Cardiovascular Campinas SP BRASIL e FAMERP – Clínica Médica Biologia Molecular São José do Rio Preto SP BRASIL
InCor-DF Brasilia e HBDF Brasília, DF BRASIL
Among the forms of cardiovascular system remodeling caused by chronic pressure overload are left ventricle hypertrophy (LVH) and vascular remodeling. The Framingham Heart Study demonstrated the prognostic value of detecting LVH in risk stratification for cardiovascular disease. Evaluation of carotid artery intima-media thickness (IMT) by US is being used to detect vascular remodeling and atherosclerosis at an early stage. To evaluate the left ventricle mass and IMT of carotid arteries in hypertensive and control individuals, 70 refractory hypertensive (RH), 80 controlled hypertensive (CH) patients and 70 normotensive controls (CT) were studied. Evaluations of the left ventricle mass were respectively 342.7 ±116.9 g; 241.3 ± 104.2 g e 182.3± 39.6 g for the RH, CH and CT Groups (P < 0.0001 RH vs. CH and CT). The mass/SC index was greater for the RH Group compared to the CH and CT Groups. The RH and CH Groups showed a significant increase in IMT compared to the CT Group (0.74±0.12 mm (RH) and 0.71±11 mm (CH) versus 0.63±0.06 mm (CT); P<0.0001). There was no significant difference for IMT between the RH and CH Group (P>0.05). The results show that RH and CH patients present with cardiovascular remodeling (LVH and increases in carotid artery IMT) that manifest as morphologic cardiovascular changes associate to arterial hypertension, chiefly in RH. H 027
Although conventional risk factors are helpful in the identification and prevention of cardiovascular events, they are absent in half of patients who present myocardial infarction (MI). In this regard, some new risk factors have been investigated and among then are social factors such as education level, household income and depression. To verify this issue, we evaluated 121 patients who were enrolled into the Brasilia Cohort Study at the first 24 hours of MI symptoms between May of 2006 to January of 2007. A standardized medical questionnaire including Beck Depression Inventory, nutritional and social evaluation was completed during the first 24 hours after MI. Major cardiovascular events (recurrent MI, Death) occurring in the first month were equally recorded. There was no association between education level and the incidence of conventional cardiovascular risk factors such as diabetes, hypertension, smoking habit and dyslipidemia. Systemic inflammatory reaction in the first 24 hours after MI was higher in individuals with lower education level (below the median of 4 years) than the counterparts (2.5±4.3 vs. 1.2 ± 2.3 mg/dL; p=0.03). Likewise, the survival free of events in the first year after MI was lower for those less educated patients (148±18 vs. 183±13 days; Log Rank p=0.048). In Conclusion, lower education level is independently associated with a higher systemic inflammatory reactivity and recurrence of MI or death in the first year after MI.
CORRELATION OF ANKLE-BRACHIAL INDEX MEASURED BY DOPPLER SPHYGMOMANOMETER AND AUTOMATIC OSCILLOMETRIC DEVICE IN ELDERLY PATIENTS
H 029
Roberto Dischinger Miranda, Dionísio Alvarez Mateos Filho, Marco Antonio Mota Gomes, Audes Diógenes de Magalhães Feitosa, Clineu de Mello Almada Filho, João Toniolo Neto, Maysa Seabra Cendoroglo
Faculdade de Medicina de São Jose do Rio Preto-FAMERP São Jose do Rio Preto SP BRASIL
Introduction: Peripheral arterial disease (PAD) is associated with high cardiovascular risk and is more common in elderly patients. The ankle-brachial index (ABI) is a non-invasive recognized method to detect these patients. Its use in clinical practice is limited by the need of specialized equipment and the time required for performance. Purpose: We hypothesized that the ABI obtained by oscillometric automatic device could provide accuracy necessary for office practice. Methods: Each patient signed an informed consent. After 10 minutes of rest, blood pressure of both arms and legs, was taken in duplicate by validated automatic oscillometric devide (Microlife MAM – BP 3AC-1) and by mercury sphygmomanometer with Doppler ultrasound. Mean value was used for ABI calculation. Results: 144 outpatients with 60 years old or more, were included. The correlation coefficient was 0.632 in the left leg and 0.705 in the right leg. ABI obtained with oscillometric automatic presented average value slightly higher (0,06) than with the Doppler method.
Mean ±SD
ABI Left 1,07 0,15
Oscillometric ABI Right 1,12 0,12
ACE GENETIC POLYMORPHISMS IN PATIENTS SUFFERING HYPERTENSIVE CRISES
José Fernando Vilela Martin, Cristina Hiromi Kuniyoshi, André Néder Ramires Abdo, Juan Carlos Yugar Toledo, Letícia G Andrade, Afonso A Carvalho Loureiro, Doroteia Rossi Silva Souza, Marcela Augusta Souza Pinhel
Geriatric Division of Federal University of São Paulo Sao Paulo SP BRASIL
Doppler ABI Right 1,05 0,17
LOW EDUCATION LEVEL IS AN INDEPENDENT PREDICTOR FOR SYSTEMIC INFLAMMATORY REACTIVITY AND RECURRENCE OF CARDIOVASCULAR EVENTS AFTER ST ELEVATION MYOCARDIAL INFARCTION: SUB ANALYSIS OF THE BRASÍLIA COHORT STUDY
High blood pressure (HBP) is a highly prevalent disease and its physiopathology is related to physiological, environmental and genetic factors. Hypertensive crises are a complication of HBP which course to a symptomatic acute elevation of diastolic arterial pressure (DAP ³ 120 mmHg), classified as emergency (EHC) when accompanied by target-organ lesion or urgency (UHC) when not. The angiotensin converting enzyme (ACE) is implicated in arterial pressure control. Thus, studies associate ACE gene polymorphisms (insertion “I” and deletion “D” alleles) to susceptibility for cardiovascular and hypertensive diseases. The objectives of this work were to analyze the ACE polymorphisms (I/I; I/D; D/D) in individuals suffering from UHC (n=22) and EHC (n=32) and characterize the groups in respect to age, gender and ethnical background. Genomic DNA was extracted from leukocytes and submitted to amplification by polymerase chain reaction. The Fisher exact test (allelic and genotypic frequencies) and the t-test (continuous variables) were utilized for statistical analysis with statistical significance being set for a p-value <0.05. The I/D genotype had the highest frequency in both UHC (90%) and EHC (93%) individuals (p=0.63). The D allele was slightly more prevalent in both groups (0.54 and 0.56, respectively; p=1.0). The mean age in EHC was greater than in UHC patients (66±13 and 58.2±13.9, respectively; p=0.04), and there was a predominance of men in both groups (51.1% in EHC and 56.6% in UHC; p=0.07). There was also a predominance of white individuals in both groups (78% in EHC and 52% in UHC; p=0.59). In conclusion, the D allele, considered a risk factor for cardiovascular diseases, did not exhibit differences in individuals suffering from urgent or emergency hypertensive crises. However, a higher mean age was found in the EHC group, suggesting that this may be a risk factor for the severity of hypertensive crises.
ABI Left 1,12 0,13
Conclusions: Oscillometric automatic showed to be a reliable method to obtain ABI. We believe that the use of this technique can make the ABI more frequently measured in clinical practice. This can bring on more precocious diagnosis and treatment of patients with high cardiovascular risk.
12