Association between diabetes mellitus and central arterial stiffness in elderly patients with systemic arterial hypertension.

BACKGROUND: Aging increases the risk of chronic diseases, especially cardiovascular diseases, leading to changes in cardiovascular anatomy and physiology even in the absence of other comorbidities. Numerous cardiovascular risk factors (CVRFs), such as diabetes mellitus (DM) and systemic arterial hypertension (SAH), can modify the functional and structural properties of large vessels, increasing arterial stiffness. OBJECTIVE: To determine whether elderly patients with hypertension with DM have greater central arterial stiffness than elderly patients with SAH without DM. METHODS: The Study of Pulse Wave Velocity in the Elderly in an Urban Area in Brazil (EVOPIU) included 1,192 patients aged ≥ 60 years who underwent applanation tonometry (AT) to evaluate carotid-femoral pulse wave velocity (cfPWV). From this database, 1,133 patients were selected from 6 groups: NDN (nondiabetic normotensives; n: 127); DN (diabetic normotensives; n: 64); NDCH (nondiabetic controlled hypertensives; n: 168); DCH (diabetic controlled hypertensives; n: 275); NDH (nondiabetic hypertensives; n: 217) and DH (diabetic hypertensives; n: 282). All groups underwent AT to obtain cfPWV and central and peripheral arterial pressures. RESULTS: The pulse wave velocities found were as follows: NDN vs DN (8.9 ± 0.2 m/s vs 9.4 ± 0.2; P = .103); NDCH vs DCH (9.0 ± 0.2 m/s vs. 9.6 ± 0.1 m/s; P= .04) and NDH vs DH (9.2 ± 0.1 m/s vs. 9.6 ± 0.1 m/s; P= .045). When the diabetic groups were compared, there were no differences in cfPWV values, and the same occurred when the nondiabetic groups were compared. CONCLUSIONS: Elderly patients with diabetes and hypertension have greater central arterial stiffness than patients without diabetes and hypertension, regardless of systemic blood pressure control. The central arterial stiffness caused by vascular aging seems to be a common factor among all the studied groups.

Probability of At Least One High Arterial Blood Pressure Measurement in Elderly Patients with Healthy Vascular Aging in Two Years of Follow-Up.

BACKGROUND/AIMS: Elderly patients with normal systemic arterial blood pressure associated with femoral carotid pulse velocity (cf-PWV) less than 7.6 m/s and without associated comorbidities are considered to have good vascular health. The aim of the current study was to verify the probability that elderly patients with good vascular health have at least one blood pressure measurement above the different thresholds for systolic blood pressure (120, 130 and 140 mmHg) during two years of follow-up. METHODS: We selected 72 normotensive patients (< 140/90 mmHg) without comorbidities and divided them into group A, with cf-PWV < 7.6 m/s (n = 27; 65 ± 4 years), and group B, with cf-PWV ≥ 7.6 m/s (n = 45; 66± 8 years). These patients were followed for two years and were observed in 3 outpatient visits (0, 12 and 24 months). At each visit, the brachial pressures were indirectly measured in triplicate, and applanation tonometry was performed. RESULTS: When group A and group B were compared, the odds ratio (OR) of having a systolic pressure measurement ≥ 140 mmHg in two years of follow-up was 0.22 (P < 0.0001); ≥ 130 mmHg, the OR was 0.49 (P < 0.0007), and ≥ 120 mmHg, the OR was 0.54 (P < 0.001). Group A and group B showed increased values of cf-PWV during the two years of follow-up (P < 0.05). Changes in the average systolic brachial pressure were not significant during the two years in groups A or B. CONCLUSION: Vascular health in elderly individuals seems to protect against occasional elevations in systemic arterial pressure.

A Specific Angiographic View of Left Coronary Artery Bifurcation in the Left Main Percutaneous Coronary Intervention Era.

OBJECTIVES: We propose a right lateral (90-120° RAO) with 30° cranial angiographic view to expose the bifurcation of the left main coronary artery (LMCA) when previously used routine projections were inefficient at clearly showing this region. BACKGROUND: Little has been published in the medical literature regarding angiographic projections dedicated to special anatomies. METHODS: A total of 84 patients were subjected to the proposed projections. A reproducibility study, conducted with the participation of 2 independent observers, judged the effectiveness of the proposed projection. The Prevalence and Bias Adjusted Kappa (PABAK) index, with a 95% confidence interval (CI), was used to demonstrate the intensity of intra/inter-observer agreement. RESULTS: The proposed projection was efficient in 79% of the angiograms, with agreement of 0.76 (0.6-0.9; P ≤ 0.001). The origins and the proximal segments of: the anterior descending coronary artery were exposed in 89% of the angiograms, agreement of 0.86 (0.7-1.0; P ≤ 0.001); the circumflex artery were exposed in 83% of the angiograms, with agreement of 0.72 (0.5-1.0; P ≤ 0.001); and the intermediate branch, when present, were exposed in 89% of the angiograms, agreement of 0.79 (0.6-1.0; P ≤ 0.001). CONCLUSION: The right lateral (90-120° RAO) with 30° cranial projection is effective, safe, and reproducible. In special situations where routine projections fail, this proposed projection can reveal important details of the anatomy of the bifurcation of the LMCA during conventional coronary angiography or be the working projection during coronary angioplasty. (J Interven Cardiol 2016;29:293-299).

Body fat predicts urinary tract infection in kidney transplant recipients: a prospective cohort study.

BACKGROUND: The association between obesity and infectious diseases is increasingly reported in the literature. There are scarce studies on the association between obesity and urinary tract infection after kidney transplantation (KTx). These studies defined obesity based on body mass index, and their results were conflicting. The present study aimed to evaluate this association using bioelectrical impedance analysis for body composition evaluation, and obesity definition. METHODS: A single-center cohort study was conducted. Demographic, clinical, anthropometric, and laboratory data were collected at KTx admission, and bioelectrical impedance analysis was performed to measure the visceral fat area, waist circumference, and total fat mass. The occurrence of urinary tract infection (symptomatic bacteriuria and/or histological evidence of pyelonephritis) was evaluated within three months after KTx. RESULTS: Seventy-seven patients were included in the cohort, and 67 were included in the final analysis. Urinary tract infection was diagnosed in 23.9% of the transplanted patients. Waist circumference (HR: 1.053; 95% CI 1.005-1.104; p = 0.032), visceral fat area (HR: 1.015; 95% CI 1.003-1.027; p = 0.014), and total fat mass (HR: 1.075; 95% CI 1.008-1.146; p = 0.028) were associated with urinary tract infection occurrence after KTx, using Cox regression models. Patients with high waist circumference (above 102 cm for men and above 88 cm for women) had a 4.7 times higher risk of a urinary tract infection than those with normal waist circumference (HR: 4.726; 95% CI 1.267-17.630; p = 0.021). Kaplan-Meier curves showed that patients with high waist circumference, high visceral fat area, and high total fat mass had more urinary tract infections (Log-rank test p = 0.014, p = 0.020, and p = 0.018, respectively). Body mass index was not able to predict urinary tract infection in the study sample. CONCLUSIONS: Waist circumference, visceral fat area, and total fat mass, assessed by bioelectrical impedance analysis, were predictors of urinary tract infection risk within the first three months after KTx.

Vascular stiffness and healthy arterial aging in older patients with optimal blood pressure.

INTRODUCTION: Pulse wave velocity is used to diagnose central arterial stiffness (CAS) and quantify healthy vascular aging (HVA). OBJECTIVE: To evaluate the CAS and HVA in elderly patients with systemic blood pressure levels classified as optimal/normal. METHODS: A total of 102 patients without comorbidities and with systolic pressure (SP) < 120 mmHg and diastolic pressure (DP) < 80 mmHg were selected from the EVOPIU database (Pulse Wave Velocity of Elderly Individuals in an Urban area of Brazil). The carotid-femoral pulse wave velocity (c-fPWV) and the central and peripheral pressures were evaluated in all patients. The patients were divided into four groups: G1: (n = 19, with c-fPWV < 7.6 m/s, without medication), G2 (n = 26, c-fPWV ≥ 7.6 m/s; without medication), G3 (n = 25, c-fPWV < 7.6 m/s with antihypertensive medication), and G4 (n = 32, c-fPWV ≥ 7.6 m/s with antihypertensive medication). RESULTS: In our sample, 56.7% of patients had c-fPWV ≥ 7.6 m/s. The central systolic pressure in G1 [99 (10) mmHg] was lower than that found in the other three groups [vs. 112 (14) mmHg, 111 (15), 112 (20) mmHg; P < 0.05)]. CONCLUSION: Older people with optimal arterial blood pressure do not necessarily have HVA and could have c-fPWV values close to the limits established for CAS diagnosis.

Use of small doses of furosemide in chronic kidney disease patients with residual renal function undergoing hemodialysis.

BACKGROUND: The objective of the present study was to verify whether chronic renal patients on hemodialysis (HD) with residual diuresis who were using small doses of furosemide present different levels of urinary volume and sodium excretion compared to patients with residual diuresis who do not use this drug. METHODS: We studied 19 chronic renal patients on HD who presented any level of residual diuresis. Urine was collected during the 24-h interdialytic period, and physical examinations and blood sampling took place immediately before the start of HD. Patients were divided into two groups: the diuretic group (DG, n = 10), in which patients had been using 40 mg of furosemide for at least 3 months, and the non-diuretic group (NDG, n = 9), in which patients used no diuretics. RESULTS: Although both groups presented the same average glomerular filtration rate (p > 0.05) and time in dialysis (p > 0.05) the DG presented an average of twice the urinary volume in 24 h (1142 ± 184 vs. 453 ± 135 ml/24 h, respectively; p = 0.008) and double the total excreted sodium mass compared to patients in the NDG (112 ± 22.4 vs. 45.2 ± 16.0 mEq/24 h, respectively; p = 0.02). CONCLUSION: The results of this study have shown that chronic use of small doses of furosemide in chronic renal patients with residual diuresis could increase urinary volume and sodium excretion compared to patients who did not use this drug.

Influence of climate on the number of hospitalizations for nephrolithiasis in urban regions in Brazil.

INTRODUCTION: Nephrolithiasis has a worldwide prevalence of approximately 5 to 15%, and its occurrence is associated with age, sex, race, dietary habits, geographic location, climatic conditions, and other factors. The objective of the present study was to determine the association between climate and the number of hospitalizations for nephrolithiasis (NH) in Brazilian cities located in different climatic regions. METHODS: We analyzed data from cities with tropical and subtropical climates. The effects of the lowest (LT), mean (MT), and highest (HT) monthly temperatures and relative humidity of the air (RH) were assessed. RESULTS: A positive association was found between the number of hospitalizations for nephrolithiasis and temperature ((LT x NH; R2=0.218; P<0.0001) (MT x NH; R2=0.284; P<0.0001) (HT x NH; R2=0.317; P<0.0001)), and a negative association was found between the number of hospitalizations for nephrolithiasis and the relative humidity (RH x NH; R2=0.234; P<0.0001). Interactions were also observed between MT and RH with respect to their effects on the NH, as described by a linear model (NH = 4.688 + 0.296 x MT - 0.088 x RH). The NH was higher in cities with tropical climates than in cities with subtropical climates (82.4 ± 10.0 vs 28.2 ± 1.6; P<0.00001). CONCLUSION: There is an association between the NH and variations in temperature and relative humidity.

Serum Uric Acid Is Positively Associated with Muscle Mass and Strength, but Not with Functional Capacity, in Kidney Transplant Patients.

BACKGROUND: Our aim was to associate serum uric acid (UA) with muscle mass, strength and functional capacity in kidney transplant patients (KTPs). METHODS: A cross-sectional study was performed on 113 KTPs. The fat-free mass and total and appendicular muscle mass were estimated by performing a bioelectrical impedance analysis. The strength was evaluated using the handgrip strength test (HGS) and the five times sit to stand test (5STS). The functional capacity was evaluated using the 4 m walk test and the short physical performance battery (SPPB). RESULTS: Linear regression showed that the UA levels were positively associated with the muscle mass, fat-free mass, appendicular muscle mass, muscle mass index and appendicular muscle mass index. The 5STS results (seconds) were inversely associated with the UA levels, showing that individuals with higher UA were more likely to have more strength. However, UA was not associated with the HGS, 4 m walk test and SPPB results. CONCLUSION: UA levels were positively associated with muscle mass and strength, but not with functional capacity, in KTPs.

Frailty predicts surgical complications after kidney transplantation. A propensity score matched study.

BACKGROUND AND OBJECTIVE: Surgical complications after kidney transplantation can lead to catastrophic outcomes. Frailty has been associated with important kidney transplantation outcomes; however, there are no studies assessing this measure of physiological reserve as a specific predictor of surgical complications in this population. Such an assessment was, therefore, the objective of the present study. METHODS: A total of 87 individuals aged ≥ 18 years who underwent kidney transplantation between March 2017 and March 2018 were included. At the time of admission for kidney transplantation, demographic, clinical, and kidney transplantation data were collected, and the frailty score was calculated according to Fried et al., which comprises five components: shrinking, weakness, exhaustion, low activity, and slowed walking speed. Urological, vascular, and general surgical complications were assessed three months later, or until graft loss or death. The propensity score was used to achieve a better homogeneity of the sample, and new analyses were performed in this new, balanced sample. RESULTS: Of the 87 individuals included, 30 (34.5%) had surgical complications. After propensity score matching, the risk of surgical complications was significantly higher among the frail individuals (RR 2.14; 95% CI 1.01-4.54; p = 0.035); specifically, the risk of noninfectious surgical complications was significantly higher among these individuals (RR 2.50; 95% CI 1.11-5.62; p = 0.017). CONCLUSION: The results showed that individuals with some degree of frailty before kidney transplantation were more subject to surgical complications. The calculation of the frailty score for transplant candidates and the implementations of measures to increase the physiological reserve of these patients at the time of kidney transplantation may possibly reduce the occurrence of surgical complications.

Arterial stiffness in elderly patients with normotension and hypertension in Brazil.

Data on arterial stiffness in older populations, according to blood pressure (BP) levels, are scarce in Brazil. The objective of this study was to establish reference values for core measures of arterial stiffness, including carotid-femoral pulse wave velocity (cf-PWV) and aortic augmentation index (AIx), in a cohort of older individuals with normotension (NT) and hypertension. Cross-sectional analysis was performed with applanation tonometry data from 1192 patients aged 60 years or older. The authors classified patients according to their BP levels as having NT, controlled hypertension (CH), and uncontrolled hypertension (UH). The cf-PWV values were 9.11 ± 0.16 m/s (NT), 9.12 ± 0.18 m/s (CH), and 9.42 ± 2.2 m/s (UH) (P < 0.005; UH vs NT and CH). The AIx was 33.3% for the entire cohort and similar across all groups. The cf-PWV increased with age but reached a ceiling at 75 years. Compared with men, women had a higher AIx but similar cf-PWV levels. In conclusion, the markers of arterial stiffness were similar among individuals with NT/CH and higher among individuals with UH.

Vascular stiffness and healthy arterial aging in older patients with optimal blood pressure / Rigidez vascular e envelhecimento arterial saudável em pacientes idosos com pressão arterial ideal

ABSTRACT Introduction: Pulse wave velocity is used to diagnose central arterial stiffness (CAS) and quantify healthy vascular aging (HVA). Objective: To evaluate the CAS and HVA in elderly patients with systemic blood pressure levels classified as optimal/normal. Methods: A total of 102 patients without comorbidities and with systolic pressure (SP) < 120 mmHg and diastolic pressure (DP) < 80 mmHg were selected from the EVOPIU database (Pulse Wave Velocity of Elderly Individuals in an Urban area of Brazil). The carotid-femoral pulse wave velocity (c-fPWV) and the central and peripheral pressures were evaluated in all patients. The patients were divided into four groups: G1: (n = 19, with c-fPWV < 7.6 m/s, without medication), G2 (n = 26, c-fPWV ≥ 7.6 m/s; without medication), G3 (n = 25, c-fPWV < 7.6 m/s with antihypertensive medication), and G4 (n = 32, c-fPWV ≥ 7.6 m/s with antihypertensive medication). Results: In our sample, 56.7% of patients had c-fPWV ≥ 7.6 m/s. The central systolic pressure in G1 [99 (10) mmHg] was lower than that found in the other three groups [vs. 112 (14) mmHg, 111 (15), 112 (20) mmHg; P < 0.05)]. Conclusion: Older people with optimal arterial blood pressure do not necessarily have HVA and could have c-fPWV values close to the limits established for CAS diagnosis.

RESUMO Introdução: A velocidade da onda de pulso é usada para diagnosticar a rigidez arterial central (RAC) e quantificar o envelhecimento vascular saudável (EVS). Objetivo: Avaliar a RAC e o EVS em pacientes idosos com níveis pressóricos sistêmicos classificados como ideais/normais. Métodos: Um total de 102 pacientes sem comorbidades e com pressão sistólica (PS) < 120 mmHg e pressão diastólica (PD) < 80 mmHg foram selecionados do banco de dados EVOPIU (Estudo da Velocidade de Onda de Pulso em Idosos em área Urbana no Brasil). Foram avaliadas a velocidade da onda de pulso carotídeo-femoral (VOPcf) e as pressões central e periférica em todos os pacientes. Os pacientes foram divididos em quatro grupos: G1: (n = 19; com VOPcf < 7,6 m/s; sem medicação), G2 (n = 26; VOPcf ≥ 7,6 m/s; sem medicação), G3 (n = 25; VOPcf < 7,6 m/s com medicação anti-hipertensiva), e G4 (n = 32; VOPcf ≥ 7,6 m/s com medicação anti-hipertensiva). Resultados: Em nossa amostra, 56,7% dos pacientes apresentaram VOPcf ≥ 7,6 m/s. A pressão sistólica central no G1 [99 (10) mmHg] foi inferior à encontrada nos outros três grupos [vs. 112 (14) mmHg, 111 (15), 112 (20) mmHg; P < 0,05)]. Conclusão: Pessoas idosas com pressão arterial ideal não necessariamente têm EVS e podem apresentar valores de VOPcf próximos aos limites estabelecidos para o diagnóstico de RAC.

Blood pressure variability in the elderly. Association between postprandial and sleeping periods.

INTRODUCTION: The variability of arterial blood pressure (BP) is considered an important cardiovascular risk factor. OBJECTIVE: To verify the possible associations between the postprandial and the sleeping blood pressure variability. METHODS: This study evaluated systolic, diastolic, mean, pulse pressures and heart variability in 69 elderly patients in preprandial, postprandial and sleeping periods. One 24 hours ambulatory blood pressure monitoring was used for measurements and the results were showed in the time-rate index. RESULTS: We observed a decrease in the systolic blood pressure values from preprandial to postprandial and to the sleeping periods (124.7 ± 14.6, 113.2 ± 15.3 and 108.5 ± 13.9mmHg, respectively; p = 0.003). Associations between BP variability of the postprandial and sleeping periods were obtained for systolic, diastolic and mean arterial pressure. CONCLUSION: The correlation between postprandial and sleeping BP variability has rarely been demonstrated in the literature. These correlations between BP changes after eating and during sleep might suggest that both events could coexist in other clinical situations.

Correlation between pre- and post-dialysis blood pressure levels in hemodialysis patients with intradialytic hypertension.

PURPOSE: To determine the association between arterial systolic blood pressure values at the beginning and at the end of a hemodialysis (HD) session in intradialytic hypertension patients. METHODS: This study evaluated the arterial systolic blood pressure patterns in 154 chronic kidney failure patients; among these patients, 18 were identified as having intradialytic hypertension. In the patients with intradialytic hypertension, four consecutive HD sessions were analyzed in which the systolic, diastolic, mean, and pulse blood pressures were automatically determined every 30 min. RESULTS: A linear relationship was revealed between the systolic blood pressure levels measured after 30 min and those obtained after 240 min of HD (r = 0.3894, p = 0.001). This association became stronger after 90 min (r = 0.5471; p < 0.001), indicating that for intradialytic hypertension patients, systolic blood pressure values at the beginning of HD were correlated with systolic blood pressure values at the end of the session. CONCLUSIONS: For intradialytic hypertension patients, values obtained at the end of HD are correlated with the initial values. This information could facilitate planning and earlier treatment.

Influence of climate on the number of hospitalizations for nephrolithiasis in urban regions in Brazil / Influência do clima sobre o número de internações por nefrolitíase em regiões urbanas no Brasil

Abstract Introduction: Nephrolithiasis has a worldwide prevalence of approximately 5 to 15%, and its occurrence is associated with age, sex, race, dietary habits, geographic location, climatic conditions, and other factors. The objective of the present study was to determine the association between climate and the number of hospitalizations for nephrolithiasis (NH) in Brazilian cities located in different climatic regions. Methods: We analyzed data from cities with tropical and subtropical climates. The effects of the lowest (LT), mean (MT), and highest (HT) monthly temperatures and relative humidity of the air (RH) were assessed. Results: A positive association was found between the number of hospitalizations for nephrolithiasis and temperature ((LT x NH; R2=0.218; P<0.0001) (MT x NH; R2=0.284; P<0.0001) (HT x NH; R2=0.317; P<0.0001)), and a negative association was found between the number of hospitalizations for nephrolithiasis and the relative humidity (RH x NH; R2=0.234; P<0.0001). Interactions were also observed between MT and RH with respect to their effects on the NH, as described by a linear model (NH = 4.688 + 0.296 x MT - 0.088 x RH). The NH was higher in cities with tropical climates than in cities with subtropical climates (82.4 ± 10.0 vs 28.2 ± 1.6; P<0.00001). Conclusion: There is an association between the NH and variations in temperature and relative humidity.

Resumo Introdução: A prevalência mundial da nefrolitíase situa-se entre 5% e 15%. Sua ocorrência está associada a idade, sexo, raça, hábitos alimentares, localização geográfica, condições climáticas e outros fatores. O objetivo do presente estudo foi determinar a associação entre clima e número de internações por nefrolitíase (IN) em cidades brasileiras localizadas em diferentes regiões climáticas. Métodos: Analisamos dados de cidades com climas tropicais e subtropicais. Nossa avaliação considerou os efeitos das temperaturas mensais mais baixas (TMB), sua média (TM) e mais altas (TMA) e da umidade relativa do ar (UR). Resultados: Foi identificada associação positiva entre o número de internações por nefrolitíase e temperatura ((TMB vs. IN; R2 = 0,218; P<0,0001) (TM vs. IN; R2 = 0,284; P<0,0001) (TMA vs. IN; R2 = 0,317; P<0,0001)) e associação negativa entre o número de internações por nefrolitíase e umidade relativa do ar (UR vs. IN; R2 = 0,234; P <0,0001). Também foram observadas interações entre TM e UR com relação aos seus efeitos sobre a IN, conforme descrito por um modelo linear (IN = 4,668 + 0,296 x TM - 0,088 x UR). IN foi mais acentuada nas cidades com climas tropicais do que nas cidades com climas subtropicais (82,4 ± 10,0 vs. 28,2 ± 1,6; P<0,00001). Conclusão: Existe associação entre IN e variações de temperatura e umidade relativa.

Relative and absolute changes in urinary neutrophil gelatinase-associated lipocalin and correlation with small increases in serum creatinine levels after coronary angiography: an observational study.

INTRODUCTION/AIMS: The Acute Kidney Injury Network classification is based on small increases in serum creatinine (sCr) for stage 1. This study investigated whether changes in the urinary concentration of neutrophil gelatinase-associated lipocalin (uNGAL) could predict small increases in sCr in patients undergoing coronary angiography. METHODS: The uNGAL was measured before contrast infusion and 2 and 4 h afterwards. Patients were divided into 2 subgroups: G1 (n = 103), where sCr increased by <0.3 mg/dl, and G2 (n = 22), where sCr increased by ≥0.3 mg/dl 48 h after the angiography. To determine the sensitivity and specificity for the absolute and relative variations of uNGAL, a receiver operating characteristic curve analysis was performed. RESULTS: In G2, the uNGAL concentration increased over baseline values (15.9 vs. 9.2 ng/dl; p < 0.05), and it was also 2-fold higher in G2 versus G1 (15.9 vs. 8.0 ng/dl; p < 0.001). The uNGAL remains an independent predictor of the small increases in sCr, and, for an increase of 50% over baseline levels, it showed 60% sensitivity and 81% specificity. CONCLUSION: Changes in uNGAL concentration 2 h after the infusion of contrast media showed marginal sensitivity to predict small increases in sCr.

Blood pressure variability in the elderly. Association between postprandial and sleeping periods / Variabilidade da Pressão Arterial no Idoso. Associação entre os períodos pós prandial e sono

Abstract Introduction: The variability of arterial blood pressure (BP) is considered an important cardiovascular risk factor. Objective: To verify the possible associations between the postprandial and the sleeping blood pressure variability. Methods: This study evaluated systolic, diastolic, mean, pulse pressures and heart variability in 69 elderly patients in preprandial, postprandial and sleeping periods. One 24 hours ambulatory blood pressure monitoring was used for measurements and the results were showed in the time-rate index. Results: We observed a decrease in the systolic blood pressure values from preprandial to postprandial and to the sleeping periods (124.7 ± 14.6, 113.2 ± 15.3 and 108.5 ± 13.9mmHg, respectively; p = 0.003). Associations between BP variability of the postprandial and sleeping periods were obtained for systolic, diastolic and mean arterial pressure. Conclusion: The correlation between postprandial and sleeping BP variability has rarely been demonstrated in the literature. These correlations between BP changes after eating and during sleep might suggest that both events could coexist in other clinical situations.

Resumo Introdução: A variabilidade da Pressão Arterial Sistêmica (PAS) é considerada um importante fator de risco cardio vascular. Objetivo: Verificar as possíveis associações entre as variabilidades pressóricas nos períodos pós prandial e durante o sono. Métodos: A variabilidade das pressões sistólica, diastólica, média, de pulso e frequência cardíaca foram avaliadas em 69 pacientes idosos nos períodos pós prandial e durante o sono. A Monitorização Ambulatorial da Pressão Arterial de 24 horas foi usada para o cálculo da variabilidade pressórica e os resultados apresentados no índice frequência tempo. Resultados: Observamosuma redução nos níveis sistólicos pos prandiais em relação ao período pre prandial e durante o sono (124.7 ± 14.6, 113.2 ± 15.3 e 108.5 ± 13.9mmHg, respectivamente; p = 0.003). A associação das variabilidade das pressões sistólicas, diastólicas e média foram confirmadas (p < 0.005) entre osperíodos avaliados. Conclusão: A correlação entre as variabilidades da pressão arterial apos as refeições e o sono tem sido pouco demonstrada na literatura. Estas relações podem sugerir que ambos os eventos podem coexistir em outras situações clínicas.

[Comparison between the central and brachial blood pressure values in patients with hypertension undergoing cineangiocoronarography].

INTRODUCTION: Systolic blood pressure (SP) and pulse pressure (PP) rise gradually during the aging process as a consequence of a reduction in arterial elasticity. The measure of systemic arterial pressure (SAP) taken at the root of the aorta has been considered an independent determinant of cardiovascular mortality superior to the values of brachial SAP. AIM: To compare the values of SAP central to those of braquial SAP in patients of different age brackets who have systemic hypertension. METHOD: We evaluated the central SAP at the root of the aorta and the brachial SAP in the left arm using the ocillometric method 244 hypertensive patients who had been submitted to cineangiocoronarography. Five groups of patients were constituted: Group I, 39-49 years-old (y.o.), n = 36; Group II, 50-59 y.o., n = 67; Group III, 60-69 y.o., n = 69; Group IV, 70-79 y.o., n = 46; Group V, > 80 y.o., n = 26. RESULTS: When central SP was compared to brachial SP, it was possible to find significance in patients who were 50 y.o and upwards. It was not possible to find a statistical difference between central diastolic pressure and brachial except in patients between the ages of 60-69 y.o. When comparing central to brachial PP, we observed that central PP was significantly greater (between 11 and 15 mmHg) in all patient above the age of 50 y.o. CONCLUSION: In older people, the values of SP and PP, taken directly at the root of the aorta, are superior to those obtained by indirect means from the brachial artery. These differences are significant from the age of 50 y.o. onwards.