AMP hydrolysis reduction in blood plasma of breast cancer elderly patients after different treatments.

Adenine nucleotides are important signaling molecules that mediate biological functions in many conditions, including cancer. The enzymes CD39 and CD73 produce adenosine in the extracellular milieu that has a very important role in tumor development. This study aimed to evaluate nucleotide hydrolysis in the plasma blood of breast cancer elderly patients. In this prospective cohort study, we investigated the ectonucleotidases activity in breast cancer elderly patients, at the moment of diagnosis and after treatment. Control group consisted of elderly women without cancer diagnostic. The nucleotide hydrolysis assay was performed by the malachite green method and used ATP, ADP, or AMP as substrates. Paired t test or Wilcoxon rank-sum test was used. Our data showed that breast cancer patients presented high levels of ATP and AMP hydrolyses when compared to control group at the moment of diagnosis. When analyzing the differences between the samples at the time of diagnostic and 6 months after treatment, we observed a significant reduction on CD73 activity after all treatments used: surgery, chemotherapy, radiotherapy, or hormone therapy. The results with APCP, a specific CD73 inhibitor, showed that the AMP hydrolysis was inhibited in all conditions evaluated. We observed a diminished ADPase activity in the patients without metastasis when compared to metastatic breast cancer patients. The results showed that AMP hydrolysis was reduced in the blood plasma of breast cancer elderly patients after different treatments. This study strengthens the potential role of CD73 enzyme as a biomarker for breast cancer treatment response.

Angiotensin-converting enzyme insertion/deletion polymorphism, 24-h blood pressure profile and left ventricular hypertrophy in hypertensive individuals: a cross-sectional study.

BACKGROUND: The absence of nocturnal blood pressure dipping (ND) identified by 24-h ambulatory blood pressure monitoring (ABPM) correlates with a worse cardiovascular prognosis. The renin-angiotensin system influences blood pressure levels and the occurrence of target organ damage (TOD). Thus, the aim of this study was to correlate the angiotensin-converting enzyme gene (ACE) insertion/deletion (I/D) polymorphism with the 24-h blood pressure profile and TOD in hypertensive individuals. METHODS: 155 non-diabetic hypertensive individuals on antihypertensive treatment underwent ABPM. Peripheral blood samples were drawn for biochemistry and genetic analysis of the ACE I/D polymorphism by polymerase chain reaction. ND was defined as ≥10 % differences in the mean systolic blood pressure (BP) during wakefulness and sleep. RESULTS: There were no differences in clinical or biochemical variables or TOD in respect to ND status, except for higher BP levels during sleep (p < 0.001) in non-dippers. There was significant difference in the prevalence of left ventricular hypertrophy (LVH) between ACE genotypes (II: 13.0 %; ID: 34.1 %; DD: 46.5 %; p value = 0.024) with an increased risk in carriers of the DD genotype (OR = 5.80; IC 95 % 1.50-22.44; p value = 0.011). Carriers of the D allele had higher systolic BP during wakefulness and by ABPM (p < 0.05), higher left ventricular mass (117.3 ± 50.0 vs. 100.3 ± 25.7; p value = 0.017) and higher prevalence of LVH (37.4 vs. 12.5 %; OR = 4.14; 95 % IC: 1.17-14.65; p value = 0.028), compared to the II genotype. CONCLUSIONS: The DD genotype is associated with a higher prevalence of LVH. The presence of the D allele appears to be associated with higher mean 24-h and wake systolic BP measured by ABPM in hypertensive patients under antihypertensive treatment.

Nebivolol reduces central blood pressure in stage I hypertensive patients: experimental single cohort study / Nebivolol reduz pressão arterial central em pacientes hipertensos estágio I: estudo experimental de coorte única

CONTEXT AND OBJECTIVES: Assessment of central blood pressure (BP) has grown substantially over recent years because evidence has shown that central BP is more relevant to cardiovascular outcomes than peripheral BP. Thus, different classes of antihypertensive drugs have different effects on central BP despite similar reductions in brachial BP. The aim of this study was to investigate the effect of nebivolol, a β-blocker with vasodilator properties, on the biochemical and hemodynamic parameters of hypertensive patients. DESIGN AND SETTING: Experimental single cohort study conducted in the outpatient clinic of a university hospital. METHODS: Twenty-six patients were recruited. All of them underwent biochemical and hemodynamic evaluation (BP, heart rate (HR), central BP and augmentation index) before and after 3 months of using nebivolol. RESULTS: 88.5% of the patients were male; their mean age was 49.7 ± 9.3 years and most of them were overweight (29.6 ± 3.1 kg/m2) with large abdominal waist (102.1 ± 7.2 cm). There were significant decreases in peripheral systolic BP (P = 0.0020), diastolic BP (P = 0.0049), HR (P < 0.0001) and central BP (129.9 ± 12.3 versus 122.3 ± 10.3 mmHg; P = 0.0083) after treatment, in comparison with the baseline values. There was no statistical difference in the augmentation index or in the biochemical parameters, from before to after the treatment. CONCLUSIONS: Nebivolol use seems to be associated with significant reduction of central BP in stage I hypertensive patients, in addition to reductions in brachial systolic and diastolic BP. .

CONTEXTO E OBJETIVOS: A avaliação da pressão arterial central (PAc) tem crescido substancialmente nos últimos anos porque as evidências mostraram que PAc central é mais relevante para os desfechos cardiovasculares do que pressão arterial (PA) periférica. Assim, diferentes classes de anti-hipertensivos têm efeitos diferentes sobre PAc apesar de reduções semelhantes na PA braquial. O objetivo foi investigar o efeito do nebivolol, β-bloqueador com propriedades vasodilatadoras, nos parâmetros bioquímicos e hemodinâmicos de pacientes hipertensos. TIPO DE ESTUDO E LOCAL: Estudo de coorte única experimental realizado em ambulatório de hospital universitário. MÉTODOS: Todos os 26 pacientes recrutados foram submetidos à avaliação bioquímica e hemodinâmica (PA, frequência cardíaca, FC, PAc, augmentation index) antes e após três meses usando nebivolol. RESULTADOS: 88,5% dos indivíduos eram do sexo masculino, com média de idade de 49,7 ± 9,3 anos, predominância de sobrepeso (29,6 ± 3,1 kg/m2) e aumento da cintura abdominal (102,1 ± 7,2 cm). Houve diminuição significativa da PA sistólica periférica (P = 0,0020) e diastólica (P = 0,0049), da FC (P < 0,0001) e da PAc (129,9 ± 12,3 x 122,3 ± 10,3 mmHg, P = 0,0083) após o tratamento em comparação aos valores basais. Não houve diferença no augmentation index, nem nos parâmetros bioquímicos antes e após o período de tratamento. CONCLUSÕES: O uso de nebivolol parece estar associado à redução significativa da PAc em hipertensos estágio 1, além da redução da pressão sistólica e diastólica braquial. .

Nebivolol reduces central blood pressure in stage I hypertensive patients: experimental single cohort study.

CONTEXT AND OBJECTIVES: Assessment of central blood pressure (BP) has grown substantially over recent years because evidence has shown that central BP is more relevant to cardiovascular outcomes than peripheral BP. Thus, different classes of antihypertensive drugs have different effects on central BP despite similar reductions in brachial BP. The aim of this study was to investigate the effect of nebivolol, a ß-blocker with vasodilator properties, on the biochemical and hemodynamic parameters of hypertensive patients. DESIGN AND SETTING: Experimental single cohort study conducted in the outpatient clinic of a university hospital. METHODS: Twenty-six patients were recruited. All of them underwent biochemical and hemodynamic evaluation (BP, heart rate (HR), central BP and augmentation index) before and after 3 months of using nebivolol. RESULTS: 88.5% of the patients were male; their mean age was 49.7 ± 9.3 years and most of them were overweight (29.6 ± 3.1 kg/m2) with large abdominal waist (102.1 ± 7.2 cm). There were significant decreases in peripheral systolic BP (P = 0.0020), diastolic BP (P = 0.0049), HR (P < 0.0001) and central BP (129.9 ± 12.3 versus 122.3 ± 10.3 mmHg; P = 0.0083) after treatment, in comparison with the baseline values. There was no statistical difference in the augmentation index or in the biochemical parameters, from before to after the treatment. CONCLUSIONS: Nebivolol use seems to be associated with significant reduction of central BP in stage I hypertensive patients, in addition to reductions in brachial systolic and diastolic BP.

Associação entre cintura abdominal e periodontite em indivíduos hipertensos / Association between waist circumference and periodontitis in hypertensive individuals

A síndrome metabólica (SM) é um conjunto de fatores de risco cardiovascular, incluindo elevação da pressão arterial (PA), dislipidemia, hiperglicemia e alteração da cintura abdominal (CA). Alterações metabólicas comumente encontradas em indivíduos hipertensos podem coexistir na doença periodontal (DP). Assim, esse estudo teve como objetivos avaliar a presença de DP em indivíduos hipertensos e associá-la aos critérios diagnósticos de SM. Os hipertensos foram investigados por meio de questionários, exames clínicos periodontais e testes bioquímicos. Noventa e sete indivíduos foram selecionados e divididos de acordo com a presença ou ausência de DP. Medidas da PA sistólica e diastólica, da CA e do índice de massa corporal (IMC), além de exames bioquímicos foram comparados entre os dois grupos. O modelo de regressão logística foi ajustado para variáveis que apresentaram significância estatística ao teste t. Os resultados foram considerados significantes quando valor p < 0,05. Foram estudados 62 hipertensos sem DP e 35 com DP. Hipertensos com DP apresentaram maior número de critérios diagnósticos da SM do que hipertensos sem DP (2,7 x 2,2; respectivamente, p = 0,025). A prevalência de SM foi maior no grupo de hipertensos com DP (52,9 versus 33,9%), embora não significante. Hipertensos com DP apresentaram maior nível de glicemia e de CA do que aqueles sem DP. À regressão logística, indivíduos hipertensos com CA > 108 cm apresentaram risco 4 vezes maior de terem DP. Não houve diferença entre os quartis em relação à glicemia. Doença periodontal em indivíduos hipertensos se associa à hiperglicemia e, especialmente, à cintura abdominal aumentada, os quais são parâmetros diagnósticos de síndrome metabólica.

Metabolic syndrome (MS) is a set of cardiovascular risk factors, including elevated blood pressure (BP), dyslipidemia, hyperglycemia and changes in waist circumference (WC). Metabolic abnormalities commonly found in hypertensive individuals can coexist in periodontal disease (PD). Thus, this study aimed to evaluate the presence of PD in hypertensive individuals and associate it with the diagnostic criteria for MS. The hypertensive patients were investigated by questionnaires, clinical periodontal and biochemical tests. Ninety-seven subjects were selected and divided based on the presence or absence of PD. Measures of systolic and diastolic BP, WC and body mass index (BMI), and biochemical tests were compared between the two groups. The logistic regression model was adjusted for variables that showed statistical significance t test. Results were considered significant when p < 0.05. We studied 62 hypertensive patients without PD and 35 with PD. Hypertensive patients with PD showed greater number of diagnostic criteria of MS than hypertensive individuals without PD (2.7 versus 2.2, respectively, p = 0.025). The prevalence of MS was higher in hypertensive patients with PD (52.9 versus 33.9%), although not statistically significant. Hypertensive patients with PD had higher serum glucose and WC than those without PD. In logistic regression, hypertensive subjects with WC > 108 cm showed four times greater risk of having PD. There was no difference between quartiles relative to glycemia. Periodontal disease in hypertensive patients is associated with hyperglycemia and, especially, increased waist circumference, which are diagnostic parameters of metabolic syndrome.

Relevância do polimorfismo inserção/deleção para enzima conversora da angiotensina em casuística brasileira com hipertensão arterial sistêmica e hipertrofia ventricular esquerda / Relevance of insertion/deletion polymorphism for angiotensin converting enzyme in Brazilian patients with hypertension and left ventricular hypertrophy

As doenças cardiovasculares são a principal causa de mortalidade no mundo atual, sendo a hipertensão arterial a mais prevalente delas e o principal fator de risco para complicações. Entre elas, destaca-se a hipertrofia ventricular esquerda, que também é considerada uma adaptação à sobrecarga de pressão representada pela hipertensão. Polimorfismo genético inserção/deleção (I/D) para enzima conversora da angiotensina I (ECA) tem sido relacionado a complicações, constituindose fator de risco independente para o desenvolvimento de lesões de órgãos-alvo em indivíduos hipertensos, incluindo a hipertrofia ventricular esquerda (HVE). Este estudo teve como objetivos analisar a influência do polimorfismo I/D da ECA no perfil lipídico e na presença ou ausência de HVE em pacientes hipertensos. Foram estudados 42 indivíduos hipertensos com HVE (G1) e 61 indivíduos hipertensos sem a hipertrofia (G2), com média de idade semelhante entre os dois grupos, sem diferença estatisticamente significante. O índice de massa ventricular esquerda foi 1,82 ± 0,20 g/m2 e 1,74 ± 0,20 g/m2 (p = 0,03) para os grupos G1 e G2, respectivamente. Indivíduos com e sem HVE apresentaram maior prevalência do alelo D e do genótipo ID. Não houve associação entre perfil lipídico, polimorfismo da ECA e HVE. Pacientes com HVE portadores do genótipo DD representam um subgrupo com índices de risco de Castelli elevados, mostrando desvantagem em relação aos demais genótipos.

Cardiovascular diseases are the leading cause of mortality in the world today. Hypertension is the most prevalent cardiovascular disease and the main risk factor for complications. Among them stands out left ventricular hypertrophy (LVH), which is also regarded as an adaptation to pressure overload represented by hypertension. Genetic polymorphism insertion/deletion (I/D) to angiotensin I converting enzyme (ACE) has been linked to complications, thus becoming an independent risk factor for the development of target organ damage in hypertensive subjects, including LVH. This study aimed to analyze the influence of I/D polymorphism of the ACE in the lipid profile and the presence or absence of LVH in hypertensive patients. We studied 42 hypertensive patients with LVH (G1) and 61 hypertensive patients without LVH (G2). The left ventricular mass index was 1.82 ± 0.2 and 1.74 ± 0.2 g/m² g/m² (p = 0.03) for G1 and G2, respectively. Individuals with and withoutLVH had a higher prevalence of the D allele and genotype ID. There was no association between lipid profile, ACE polymorphism and LVH. Patients with LVH carrying the DD genotype represent a subgroup with high Castelli risk, showing a disadvantage compared with other genotypes.

Fatores associados ao aumento no índice de incremento de pressão radial em indivíduos hipertensos / Factors associated with increased radial augmentation index in hypertensive individuals

FUNDAMENTO: A rigidez arterial é uma variável preditora de morbimortalidade e um possível marcador de lesão vascular. Sua avaliação não invasiva por tonometria radial e análise do índice de incremento (r-AI) permite identificar os pacientes expostos a um maior risco cardiovascular. OBJETIVO: Analisar a influência do r-AI em variáveis clínico-bioquímicas e sua influência na prevalência de dano em órgão-alvo em pacientes hipertensos. MÉTODOS: Cento e quarenta pacientes hipertensos consecutivos, em seguimento clínico ambulatorial, foram submetidos à análise transversal. Os níveis de pressão arterial (PA) e o r-AI foram obtidos por tonometria de aplanação da artéria radial (HEM-9000AI, Onrom). Os pacientes foram alocados em tercis r-AI (r-AI < 85 por cento; 85 < r-AI < 97 por cento; r-AI > 97 por cento). RESULTADOS: A amostra era predominantemente composta por mulheres (56,4 por cento), com idade média de 61,7 ± 11,7 anos e índice de massa corporal de 29,6 ± 6,1 Kg/m². O maior tercil apresentou uma proporção maior de mulheres (p = 0,001), maior PA sistólica (p = 0,001) e pressão de pulso (p = 0,014), e menor peso (p = 0,044), altura (p < 0,001) e frequência cardíaca (p < 0,001). A análise multivariada demonstrou que o peso (β = -0,001, p = 0,017), frequência cardíaca (β = -0,001, p = 0,007) e pressão central (β = 0,015, p < 0,001) se correlacionam com o r-AI de maneira independente. Em análises de regressão logística, o 3º tercil r-AI foi associado a uma diminuição do diabete (DM) (OR = 0,41; 95 por cento CI 0,17-0,97; p = 0,042). CONCLUSÃO: Este estudo demonstrou que peso, frequência cardíaca e PA central se relacionam com o r-AI de maneira independente.

BACKGROUND: Arterial stiffness is a variable predictor of morbidity and mortality and a possible marker of vascular injury. Its non-invasive assessment by radial tonometry and analysis of the augmentation index (r-AI) allows identifying patients exposed to higher cardiovascular risk. OBJECTIVE: To analyze the influence of r-AI on clinical-biochemical variables and its influence on the prevalence of target-organ damage in hypertensive patients. METHODS: 140 consecutive hypertensive patients, followed-up in an outpatient clinic, were analyzed in a cross-sectional study. Blood pressure (BP) levels and r-AI were obtained by applanation tonometry of the radial artery (HEM-9000AI, Onrom). The patients were allocated into r-AI tertiles (r-AI < 85 percent; 85< r-AI < 97 percent; r-AI > 97 percent). RESULTS: The sample was predominantly composed of women (56.4 percent), mean age of 61.7 ± 11.7 years and body mass index 29.6 ± 6.1 Kg/m². The highest tertile showed higher proportion of women (p = 0.001), higher systolic BP (p = 0.001) and pulse pressure (p = 0.014), and lower weight (p = 0.044), height (p < 0.001) and heart rate (p < 0.001). Multivariate analysis demonstrated that weight (β = -0.001, p = 0.017), heart rate (β = -0.001, p = 0.007) and central pressure (β = 0.015, p < 0.001) correlated independently with r-AI. In logistic regression analyses, the 3rd r-AI tertile was associated to lower levels of diabetes (DM) (OR = 0.41; 95 percent CI 0.17-0.97; p = 0.042). CONCLUSION: This study demonstrated that weight, heart rate and central BP were independently related to r-AI.

Factors associated with increased radial augmentation index in hypertensive individuals.

BACKGROUND: Arterial stiffness is a variable predictor of morbidity and mortality and a possible marker of vascular injury. Its non-invasive assessment by radial tonometry and analysis of the augmentation index (r-AI) allows identifying patients exposed to higher cardiovascular risk. OBJECTIVE: To analyze the influence of r-AI on clinical-biochemical variables and its influence on the prevalence of target-organ damage in hypertensive patients. METHODS: 140 consecutive hypertensive patients, followed-up in an outpatient clinic, were analyzed in a cross-sectional study. Blood pressure (BP) levels and r-AI were obtained by applanation tonometry of the radial artery (HEM-9000AI, Onrom). The patients were allocated into r-AI tertiles (r-AI < 85%; 85< r-AI < 97%; r-AI > 97%). RESULTS: The sample was predominantly composed of women (56.4%), mean age of 61.7 ± 11.7 years and body mass index 29.6 ± 6.1 Kg/m². The highest tertile showed higher proportion of women (p = 0.001), higher systolic BP (p = 0.001) and pulse pressure (p = 0.014), and lower weight (p = 0.044), height (p < 0.001) and heart rate (p < 0.001). Multivariate analysis demonstrated that weight (ß = -0.001, p = 0.017), heart rate (ß = -0.001, p = 0.007) and central pressure (ß = 0.015, p < 0.001) correlated independently with r-AI. In logistic regression analyses, the 3rd r-AI tertile was associated to lower levels of diabetes (DM) (OR = 0.41; 95% CI 0.17-0.97; p = 0.042). CONCLUSION: This study demonstrated that weight, heart rate and central BP were independently related to r-AI.

Hypertensive crisis: clinical-epidemiological profile.

Hypertensive crisis (HC) stands out as one type of acute elevation in blood pressure (BP) and can manifest as hypertensive emergency (HE-with target-organ damage (TOD)) or hypertensive urgency (HU-without TOD), usually accompanied by levels of diastolic BP ≥120 mmHg. The aim of this study was to characterize the clinical-epidemiological profile of HC over the course of 1 year in a university reference hospital and perform a review of the literature. The study was a cross-sectional study, conducted over a period of 1 year (2006) in 362 patients who presented for treatment at the emergency hospital with HC, as described above. Among all patients examined, 231 individuals met the criteria for HE and 131 met the criteria for HU. Patients with HE were older (P<0.001) and more sedentary (P=0.026) than those with HU. Furthermore, fewer HE patients than HU patients had previously undergone antihypertensive treatment (P=0.006). The groups did not differ regarding BP levels, gender, smoking or body mass index. Dyspnea (41.1%), thoracic pain (37.2%) and neurological deficit (27.2%) were common signs/symptoms in those with HE. Meanwhile, in the group with HU, we most frequently found headache (42.0%), thoracic pain (41.2%) and dyspnea (34.3%). Among the forms of HE, we most frequently observed acute lung edema (30.7%), myocardial infarction/unstable angina (25.1%), and ischemic (22.9%) and hemorrhagic (14.8%) stroke. HC is a clinical entity associated with high morbidity in the emergency room. Individuals with HE are older and sedentary and have lower rates of antihypertensive treatment. Adequate control of BP should be pursued as a way to avoid this severe complication of hypertension.

[Absence of nocturnal dipping is associated with stroke and myocardium infarction]. / Ausência de descenso noturno se associa a acidente vascular cerebral e infarto do miocárdio.

BACKGROUND: The arterial hypertension varies in according to the circadian cycle, presenting physiologic fall of blood pressure (BP) during sleep (dipping). The absence of this fall or its increase associates to higher incidence of target-organ damages. OBJECTIVE: To analyze the prevalence of dipping in hypertensive individuals, to correlate dipping to the blood pressure levels, clinic, and socio-demographic factors, and biochemical characteristics and to associate it cardiovascular events (stroke and myocardial infarction). METHODS: Hypertensive individuals were submitted to the ambulatory blood pressure monitoring. Presence of dipper was defined as fall >10% of the systolic BP of the day for sleep. RESULTS: 163 evaluated patients were divided in dippers (D, n=53) and nondippers (ND, n=110). Between the groups there was not significant difference to the age, sex, race, time of hypertension, glycemia, LDL-cholesterol, total cholesterol, triglycerides, schooling, smoking, and history of diabetes. D presented BP higher than the ND during the day and lower during sleep. ND had higher body mass index (BMI) (p=0.0377), lower level of HDL-cholesterol (p=0.0189), and higher pulse pressure during sleep (p=0.0025). History of stroke alone (p=0,046) and combined with myocardial infarction (p=0.032) were more frequent in nondippers individuals. In the logistic regression, only ND was associated independently with stroke or myocardial infarction. CONCLUSION: ND was associated in an independent way with the target-organ damages analyzed, what demonstrates its importance and strengthens the necessity of more aggressive treatment with objective to reach BP goals e, consequently, to prevent the development of new cardiologic and cerebrovascular events.

Ausência de descenso noturno se associa a acidente vascular cerebral e infarto do miocárdio / Absence of nocturnal dipping is associated with stroke and myocardium infarction / La ausencia de descenso nocturno de la presión arterial se asocia a accidente cerebrovascular e infarto de miocardio

Fundamento: A pressão arterial (PA) varia de acordo com o ciclo circadiano, apresentando quedas fisiológicas durante o sono (descenso noturno - DN). A ausência dessa queda se associa a maior incidência de lesões em órgãos-alvo. Objetivo: Analisar a prevalência de DN em indivíduos hipertensos, correlacionar DN aos níveis pressóricos, variáveis clínicas, fatores sociodemográficos e bioquímicos e associá-lo a eventos cardiovasculares (acidente vascular cerebral - AVC e infarto agudo do miocárdio - IAM). Métodos: Foram avaliados 163 hipertensos, submetidos a monitorização ambulatorial da pressão arterial. DN foi definido como queda >10 por cento da PA sistólica do período da vigília para o de sono. Resultados: Os pacientes foram divididos em grupos dipper (D) e não dipper (ND). Não houve diferença significante entre os grupos quanto a idade, sexo, raça, tempo de hipertensão, glicemia, LDL-colesterol, colesterol total, triglicérides, escolaridade, tabagismo, história de diabetes. Grupo dipper apresentou PA superior a ND durante a vigília e inferior durante o sono. Grupo ND cursou com maior índice de massa corpórea (IMC) (p=0,0377), menor HDL-colesterol (p=0,0189) e maior pressão de pulso durante o sono (p=0,0025). História de AVC ou IAM foram mais frequentes em ND. À regressão logística, apenas a ausência de descenso noturno associou-se independentemente a AVC ou IAM. Conclusão: A ausência de DN associou-se de maneira independente às lesões em órgãos-alvo analisadas, o que demonstra a sua importância e reforça a necessidade de tratamento mais agressivo com objetivo de se atingir as metas pressóricas e, consequentemente, evitar o desenvolvimento de novos eventos cardiocerebrovasculares.

Background: The arterial hypertension varies in according to the circadian cycle, presenting physiologic fall of blood pressure (BP) during sleep (dipping). The absence of this fall or its increase associates to higher incidence of target-organ damages. Objective: To analyze the prevalence of dipping in hypertensive individuals, to correlate dipping to the blood pressure levels, clinic, and socio-demographic factors, and biochemical characteristics and to associate it cardiovascular events (stroke and myocardial infarction). Methods: Hypertensive individuals were submitted to the ambulatory blood pressure monitoring. Presence of dipper was defined as fall >10 percent of the systolic BP of the day for sleep. Results: 163 evaluated patients were divided in dippers (D, n=53) and nondippers (ND, n=110). Between the groups there was not significant difference to the age, sex, race, time of hypertension, glycemia, LDL-cholesterol, total cholesterol, triglycerides, schooling, smoking, and history of diabetes. D presented BP higher than the ND during the day and lower during sleep. ND had higher body mass index (BMI) (p=0.0377), lower level of HDL-cholesterol (p=0.0189), and higher pulse pressure during sleep (p=0.0025). History of stroke alone (p=0,046) and combined with myocardial infarction (p=0.032) were more frequent in nondippers individuals. In the logistic regression, only ND was associated independently with stroke or myocardial infarction. Conclusion: ND was associated in an independent way with the target-organ damages analyzed, what demonstrates its importance and strengthens the necessity of more aggressive treatment with objective to reach BP goals e, consequently, to prevent the development of new cardiologic and cerebrovascular events.

Fundamento: La presión arterial (PA) varía de acuerdo al ciclo circadiano, presentando descensos fisiológicos durante el sueño (descenso nocturno - DN). La ausencia de ese descenso se asocia a mayor incidencia de lesiones en órganos blanco. Objetivo: Analizar la prevalencia de DN en individuos hipertensos, correlacionar DN a los niveles de presión, variables clínicas, factores sociodemográficos y bioquímicos y asociarlos a eventos cardiovasculares (accidente cerebrovascular - ACV e infarto agudo de miocardio - IAM). Métodos: Fueron evaluados 163 hipertensos, sometidos a monitoreo ambulatorio de la presión arterial. El DN fue definido como descenso > 10 por ciento de la PA sistólica del período de vigilia al de sueño. Resultados: Los pacientes fueron divididos en grupos dipper (D) y no dipper (ND). No existió diferencia significativa entre los grupos en cuanto a edad, sexo, raza, tiempo de hipertensión, glucemia, LDL-colesterol, colesterol total, triglicéridos, escolaridad, tabaquismo, historia de diabetes. El Grupo dipper presentó PA superior al ND durante la vigilia e inferior durante el sueño. El Grupo ND cursó con mayor índice de masa corporal (IMC) (p=0,0377), menor HDL-colesterol (p=0,0189) y mayor presión de pulso durante el sueño (p=0,0025). Historia de ACV o IAM fueron más frecuentes en ND. En la regresión logística, sólo la falta de descenso nocturno se asoció independientemente del ACV o del IAM. Conclusión: La ausencia de DN se asoció de manera independiente a las lesiones en órganos blanco analizadas, lo que demuestra su importancia y refuerza la necesidad de tratamiento más agresivo con el objetivo de alcanzar las metas tensionales y, en consecuencia, evitar el desarrollo de nuevos eventos cardio y cerebrovasculares.

Factors associated with impaired urinary albumin excretion in hypertensive individuals: albuminuria and hypertension.

Albuminuria is well established as a cardiovascular and renal risk factor. This study aimed to analyze factors associated with this condition in 267 hypertensive individuals, stratified according to urinary albumin excretion (UAE) as: G1--130 individuals with normoalbuminuria (24-h UAE<20 µg/min); G2--113 with microalbuminuria (UAE between 20 and 200 µg/min); and G3--24 with macroalbuminuria (UAE≥200 µg/min). There were significant differences among the groups for blood pressure levels, left ventricular mass and index, estimated glomerular filtration rate, serum creatinine, renal dysfunction and diabetes mellitus (p<0.05). Macroalbuminuria was associated with renal dysfunction (OR=5.91; 95% CI: 2.44-14.31; p<0.001) and microalbuminuria with LVH (OR=2.21; 95% CI: 1.27-3.85; p=0.005). The association between UAE with blood pressure levels, diabetes and target-organ damage in hypertensive individuals suggests that adequate control of cardiovascular risk factors should be pursued to decrease morbidity associated with these conditions.