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Recent studies suggest that supplemental Ca (SC) increases the risk of cardiovascular events, whereas dietary Ca (DC) decreases the risk of cardiovascular events. Although frequently consumed with meals, it remains unclear whether Ca can mitigate or aggravate the deleterious effects of a high-fat meal on cardiovascular risk factors. This study aimed to evaluate the effects of SC or DC on blood pressure (BP) and microvascular function (MVF) in the postprandial period in obese women challenged with a high-fat meal. In this cross-over controlled trial, sixteen obese women aged 20–50 years were randomly assigned to receive three test meals (2908 kJ (695 kcal); 48 % fat): high DC (HDCM; 547 mg DC), high SC (HSCM; 500 mg SC–calcium carbonate) and low Ca (LCM; 42 mg DC). BP was continuously evaluated from 15 min before to 120 min after meals by digital photoplethysmography. Before and 120 min after meals, participants underwent evaluation of serum Ca and microvascular flow after postocclusive reactive hyperaemia (PORH) by laser speckle contrast imaging. Ionised serum Ca rose significantly only after HSCM. Systolic BP increased after the three meals, whereas diastolic BP increased after LCM and HDCM. Hyperaemia peak, hyperaemia amplitude and AUC evaluated after PORH decreased with LCM. After HDCM, there was a reduction in hyperaemia peak and hyperaemia amplitude, whereas HSCM decreased only hyperaemia peak. However, comparative analyses of the effects of three test meals on serum Ca, BP and MVF revealed no significant meal×time interaction. This study suggests that in obese women SC and DC do not interfere with the effects of a high-fat meal on BP and MVF.

Nutritional intervention for weight loss is one of the treatment options for obstructive sleep apnoea (OSA) in patients with overweight or obesity. However, the effects of moderate energy restriction on OSA severity are not yet known. The present study aimed to evaluate the effects of moderate energy restriction on OSA severity and CVD risk factors in obese patients with OSA. In this 16-week randomised clinical trial, twenty-one obese subjects aged 20–55 years and presenting an apnoea/hypopnoea index (AHI)≥5 events/h were randomised into two groups: the energy restriction group (ERG) and the control group (CG). The ERG was instructed to follow an energy-restricted diet −3347·2 kJ/d (−800 kcal/d) and the CG was advised not to change their food intake. At the beginning and at the end of the study, participants underwent evaluation of the following: OSA (Watch-PAT200®), nutritional parameters, blood pressure, sympathetic activity, inflammatory biomarkers, metabolic profile and endothelial function. The ERG (n11), compared with the CG (n10), had a significantly greater reduction in body weight (Cohen’sd=−1·19;Pd=−0·95;P=0·04) and in plasma concentrations of adrenaline (Cohen’sd=−1·02;P=0·04) as well as a significantly greater increase in minimum O2saturation (Cohen’sd=1·08;P=0·03). Although energy restriction was not associated with significant improvements in CVD risk factors, medium-to-large effect sizes were observed, suggesting that the statistically non-significant difference between groups may be due to the small sample size. This study suggests that in obese patients with OSA, moderate energy restriction is able to reduce the parameters of OSA severity and sympathetic activity.

The aim of this study is to compare spironolactone versus clonidine as the fourth drug in patients with resistant hypertension in a multicenter, randomized trial. Medical therapy adherence was checked by pill counting. Patients with resistant hypertension (no office and ambulatory blood pressure [BP] monitoring control, despite treatment with 3 drugs, including a diuretic, for 12 weeks) were randomized to an additional 12-week treatment with spironolactone (12.5–50 mg QD) or clonidine (0.1–0.3 mg BID). The primary end point was BP control during office (P =1.00). Secondary end point analysis showed similar office BP (33.3% versus 29.3%) and ambulatory BP monitoring (44% versus 46.2%) control for spironolactone and clonidine, respectively. However, spironolactone promoted greater decrease in 24-h systolic and diastolic BP and diastolic daytime ambulatory BP than clonidine. Per-protocol analysis (limited to patients with ≥80% adherence to spironolactone/clonidine treatment) showed similar results regarding the primary end point. In conclusion, clonidine was not superior to spironolactone in true resistant hypertensive patients, but the overall BP control was low (≈21%). Considering easier posology and greater decrease in secondary end points, spironolactone is preferable for the fourth-drug therapy. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01643434.

Non-fasting hypertriacylglycerolaemia is a risk factor for CVD and the amount of fat in a meal seems to be the main factor influencing postprandial lipaemia. Although several studies suggest that Ca can increase faecal fat excretion, it is not known whether Ca can decrease postprandial TAG. This study aimed to evaluate the influence of dietary Ca (DC) and supplemental Ca (SC) on lipaemia, glucose metabolism, C-reactive protein (CRP) and adiponectin during postprandial period in obese women challenged with a high-fat meal. In this cross-over controlled trial, sixteen obese women aged 20–50 years were randomly assigned to receive three test meals (approximately 2900 kJ; 48 % fat): high DC (547 mg DC), high SC (HSCM; 500 mg SC-calcium carbonate) and low Ca (42 mg DC). Blood samples were collected in the fasting period and at minutes 120 and 240 after meals to evaluate total cholesterol and fractions, TAG, glucose, insulin, high-sensitivity CRP and adiponectin. Serum levels of TAG and insulin increased significantly after all test meals. Only after HSCM total cholesterol did not present a significant increase and LDL-cholesterol had a significant decrease. Postprandial glucose, HDL-cholesterol, CRP and adiponectin did not present significant changes after the three test meals. The comparative analysis of the effects of the three test meals on serum lipids, glucose, insulin, CRP and adiponectin revealed no significant meal-by-time interaction. These results suggest that in obese women challenged with a high-fat meal DC and SC do not interfere with postprandial lipaemia, glucose metabolism, CRP and adiponectin.

Objective: Obesity is characterized by chronic subclinical inflammation, which is critical to endothelial dysfunction. Weight loss, induced by lifestyle interventions, is associated with a decline in biomarkers of inflammation and endothelial dysfunction. There is little evidence that high dietary calcium intake may reduce inflammation and improve endothelial function. The purpose of this study was to evaluate the effects of weight loss from a high-calcium energy-reduced diet on biomarkers of inflammation, fibrinolysis, and endothelial function in obese individuals. Methods: In this randomized clinical trial, we analyzed the data from 35 obese adults who lost at least 3% of initial body weight, during a period of 16 wk of energy restriction (� 800 Kcal/d). Individuals were randomized into the following dietary regimens: (1) a high calcium diet (HCD; 1200–1300 mg/d) or (2) a low-calcium diet (LCD

Background: There is evidence that vitamin D deficiency is associated with increased risk of cardiovascular disease. However, it is not known if this association is independent of dietary calcium, intracellular calcium and serum levels of parathormone, calcitriol and calcium. Objectives: To investigate the independent relationship of vitamin D deficiency with insulin resistance, lipid profile, inflammatory status, blood pressure and endothelial function. Method: Cross-sectional study conducted with 73 healthy Brazilian premenopausal women aged 18 . 50 years. All participants were evaluated for: 25 hydroxyvitamin D serum levels, anthropometric parameters, body composition, calcium metabolism, insulin resistance, lipoprotein profile, inflammatory status, blood pressure and endothelial function. Endothelial function was assessed by reactive hyperemia index using Endo-PAT 2000R. Women were stratified in two groups: with vitamin D deficiency (25 hydroxyvitamin D < 20 ng/ml; n=12) and without vitamin D deficiency (25 hydroxyvitamin D ≥ 20 ng/ml; n=61). Results and discussion: Participants with vitamin D deficiency compared with those without deficiency of this vitamin had significantly higher levels of glucose (88.25 �± 3.24 vs. 80.15 �± 1.13 mg/dl), greater HOMA-IR (6.43 ± 0.73 vs. 4.42 �± 0.25) and lower reactive hyperemia index (1.68 �± 0.1 vs. 2.17 �± 0.1). After adjustments for confounding factors including age, body mass index, waist circumference, dietary calcium, intracellular calcium and serum levels of parathormone, calcitriol and calcium differences between groups remained significant, regarding glucose and HOMA-IR. Conclusions: The findings of the present study suggest that vitamin D deficiency is associated with insulin resistance independent of dietary calcium, intracellular calcium and serum levels of parathormone, calcitriol and calcium in healthy premenopausal women.

Obesity is the major risk factor for the development of hypertension. This association accentuates the risk of cardiovascular disease, as it is frequently accompanied by the components of the metabolic syndrome. This randomised open parallel study evaluated the chronic effects of moxonidine--a selective imidazoline receptor agonist--on blood pressure, plasma catecholamines, leptin, insulin and components of the metabolic syndrome in obese hypertensives. Amlodipine was used as the control drug. Our results showed that moxonidine and amlodipine significantly reduced blood pressure when measured using the oscillometric method and 24-hour blood pressure monitoring. Moxonidine therapy decreased systolic blood pressure from 160.4 +/- 2.4 to 142.1 +/- 3.3 mmHg (p < 0.005) and diastolic blood pressure from 102.4 +/- 1.3 to 89.7 +/- 1.6 mmHg (p < 0.005) after 24 weeks of treatment. Moxonidine administration reduced the supine arterial plasma levels of adrenaline from 63.2 +/- 6.6 to 49.0 +/- 6.7 pg/ml (p < 0.005), the supine arterial plasma levels of noradrenaline from 187.9 +/- 10.7 to 149.7 +/- 13.2 pg/ml (p < 0.01) and the orthostatic venous plasma levels of noradrenaline from 258.6 +/- 25.0 to 190.3 +/- 16.4 pg/ml (p = 0.03). Those variables were not changed by amlodipine. The plasma levels of leptin and insulin 120 min after a glucose load decreased after moxonidine administration from 27.2 +/- 3.5 to 22.6 +/- 2.9 pg/ml (p < 0.05) and from 139.7 +/- 31.2 to 76.0 +/- 15.2 U/ml (p < 0.05), respectively. Amlodipine, however, did not modify those variables. This study showed a comparable reduction in blood pressure with both antihypertensive drugs. Moxonidine decreased sympathetic nervous activity, improved insulin resistance and reduced the plasma levels of leptin.

Background: There is evidence that vitamin D deficiency is associated with increased risk of cardiovascular disease. However, it is not known if this association is independent of dietary calcium, intracellular calcium and serum levels of parathormone, calcitriol and calcium. Objectives: To investigate the independent relationship of vitamin D deficiency with insulin resistance, lipid profile, inflammatory status, blood pressure and endothelial function. Method: Cross-sectional study conducted with 73 healthy Brazilian premenopausal women aged 18 . 50 years. All participants were evaluated for: 25 hydroxyvitamin D serum levels, anthropometric parameters, body composition, calcium metabolism, insulin resistance, lipoprotein profile, inflammatory status, blood pressure and endothelial function. Endothelial function was assessed by reactive hyperemia index using Endo-PAT 2000R. Women were stratified in two groups: with vitamin D deficiency (25 hydroxyvitamin D < 20 ng/ml; n=12) and without vitamin D deficiency (25 hydroxyvitamin D ≥ 20 ng/ml; n=61). Results and discussion: Participants with vitamin D deficiency compared with those without deficiency of this vitamin had significantly higher levels of glucose (88.25 ± 3.24 vs. 80.15 ± 1.13 mg/dl), greater HOMA-IR (6.43 ± 0.73 vs. 4.42 ± 0.25) and lower reactive hyperemia index (1.68 ± 0.1 vs. 2.17 ± 0.1). After adjustments for confounding factors including age, body mass index, waist circumference, dietary calcium, intracellular calcium and serum levels of parathormone, calcitriol and calcium differences between groups remained significant, regarding glucose and HOMA-IR. Conclusions: The findings of the present study suggest that vitamin D deficiency is associated with insulin resistance independent of dietary calcium, intracellular calcium and serum levels of parathormone, calcitriol and calcium in healthy premenopausal women.

Introduction: Weight loss is one of the treatment options for obstructive sleep apnea (OSA) in patients with excess body adiposity. However, the effects of moderate energy restriction on OSA are not known. Objective: To evaluate the effects of moderate energy restriction on severity of OSA, blood pressure (BP), sympathetic activity, oxidative stress, inflammation, body adiposity, metabolic profile and endothelial function in obese patients with OSA. Methods: A 16-week randomized clinical trial, involving 21 obese subjects aged 20-55y with apnea/hipopnea index (AHI) ≥ 5 events/h. Subjects were randomized in 2 groups: 11 in energy restriction group (ERG) and 10 in control group (CG). ERG was instructed to follow an energy-restricted diet (-800 kcal/day) and CG was advised not to change food intake. At the beginning and at the end of the study, participants underwent evaluation of: OSA with Watch- PAT200® including the determination of OSA severity parameters, body adiposity, BP, plasma catecholamines, c-reactive protein (CRP), adiponectin, malondialdehyde, metabolism of glucose, lipid profile and endothelial function (Endo PAT 2000®). Results: ERG, compared to CG, presented significantly greater reduction in body weight (-5.6±1.8 vs. 0.4±1.2kg, p4% (-33.7±15.6 vs. 1.8±7.9, p=0.04); plasma adrenaline (-12.7±3.0 vs. -1.3±3.9pg/mL, p=0.04); and significantly greater increase in minimum O2 saturation (4.6±1.6 vs. -0.6±1.4%, p=0.03). ERG showed greater decrease, however without statistical significance, in systolic BP (-4.2±1.9 vs. 2.3±1.4mmHg, p=0.05), insulin (-5.1±1.9 vs. -0.7±1.3μU/mL, p=0.07) and HOMA-IR (-1.2±0.5 vs. -0.08±0.3, p=0.09). During the study period, changes in body adiposity presented significant correlation with changes in parameters of OSA severity, BP, insulin, HOMA-IR, norepinephrine and adiponectin. Changes in parameters of OSA severity presented significant association with changes in CRP. Conclusions: This study suggests that in obese patients with OSA moderate energy restriction is able to reduce body adiposity, parameters of OSA severity and sympathetic nervous system activity.

Background: Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular disease (CVD). Several of the proposed mechanisms for the development of CVD in OSA are similar to those proposed for the increased risk of CVD in obesity, being difficult to determine the influence of OSA on these pathogenic mechanisms in obese individuals. Objectives: The purpose of this study was to evaluate the relationship of OSA with endothelial function, oxidative stress, inflammatory biomarkers, metabolic profile, sympathetic nervous system activity and blood pressure (BP) in obese individuals. Methods: In this cross-sectional study, were included 53 obese adults (28 women). Sleep study was performed with Watch-PAT200® and the diagnosis of OSA was made when apnea-hipopnea index (AHI) ≥5 events/h (n=33). All participants underwent evaluation of: body adiposity, BP, plasma catecholamines, high sensitivity C-reactive protein (hs-CRP), adiponectin, malondialdehyde, glucose, insulin, lipid profile and endothelial function (Endo-PAT 2000®). Results: Mean age (39.6 ± 1.5 vs. 32.5 ± 2.1y) and percentage of male participants (61% vs. 25%) were significantly higher in participants with OSA than in those without OSA (p=0.01). In univariate analysis participants with OSA compared with those without OSA exhibited higher values of neck circumference (40.98 ± 0.63 vs. 38.65 ± 0.75 cm, p=0.02), glucose (92.54 ± 1.97 vs. 80.2 ± 1.92 mg/dL, p=0.0001), noradrenaline (0.16±0.02 vs. 0.12±0.03 ng/mL, p=0.02) and systolic BP (126.05 ± 1.61 vs. 118.16 ± 1.86 mmHg, p=0.003). After adjustment for confounders, only glucose and hs-CRP were significantly higher in OSA patients. In correlation analysis, after controlling for confounders, AHI was associated with neck circumference (r=0.31,p=0.03) and hs-CRP (r=0.30,p=0.04), while minimum O2 saturation was associated with neck circumference (r=-0.31,p=0.03), insulin (r=-0.29,p=0.04) and HOMA-IR (r=-0.30,p=0.04). Conclusion: The present study suggests that in obese individuals OSA is associated with inflammation and worse glycemia; higher AHI correlates with increased central adiposity and inflammation; and lower oxygen saturation is related with insulin resistance.

Background: Cardiovascular diseases are the leading cause of mortality in Western countries. Some studies have suggested that green tea has beneficial effects on different cardiovascular risk factors. However, others have failed to show such an association. Objective: To evaluate the effects of green tea on blood pressure, endothelial function, metabolic profile, inflammatory biomarkers and body adiposity in obese pre-hypertensive women. Methods: Crossover randomized controlled double-blinded trial. Twenty women with obesity and pre-hypertension, aged 28-59 years, with stable body weight were randomized to receive a daily supplement of 3 capsules that contained either 500mg of green tea extract (GTE) or a matching placebo for 4 weeks, with a washout period of 2 weeks between the treatments. Blood pressure was evaluated by ambulatory blood pressure monitoring (ABMP). Endothelial function was evaluated by peripheral arterial tonometry method, using Endo-PAT 2000®. The inflammatory status was assessed by interleukin 6, tumor necrosis factor alpha, vascular cell adhesion molecule, intercellular adhesion molecule, plasminogen activator inhibitor-1, vascular endothelial growth factor, E-selectin, adiponectin and C-reactive protein. Results: After administration of GTE compared with placebo there was a significant reduction in systolic blood pressure during 24h (pre 130.3±1.7 vs. post 127.0±2.0 mmHg; p= 0.02), daytime (pre 134.0±1.7 vs. post 130.7±2.0 mmHg; p= 0.04) and nighttime (pre 122.2±1.8 vs. post 118.4±2.2 mmHg; p= 0.02). After consumption of green tea, there was an increase, although not statistically significant, in reactive hyperemia index (pre 1.98±0.10 vs. post 2.22±0.14), besides reduction in the concentration of intercellular adhesion molecule (pre 91.8±8.0 vs. post 85.8±5.6 ng/ml) and vascular endothelial growth factor (pre 195.8±46.2 vs. post 158.6±38.7 pg/ml), however without statistical significance. The other variables did not change significantly after consumption of green tea. Conclusions: The findings of the present study suggest that green tea has a beneficial effect on blood pressure and possibly on endothelial function.

Background: Recent evidence suggests that vitamin D deficiency is associated with an increased risk of cardiovascular morbidity and mortality. However, the relationship between vitamin D deficiency and cardiovascular disease risk factors has not been established. Objectives: To investigate the prevalence of vitamin D deficiency and its association with body adiposity, metabolic profile, inflammatory biomarkers, blood pressure (BP) and endothelial function in healthy premenopausal women. Methods: In this cross-sectional study were included 73 adult women who were submitted to the evaluation of: serum levels of 25 hidroxyvitamin D [25(OH)D]; body adiposity; metabolic profile (glucose, insulin, HOMA-IR, leptin, triglycerides and cholesterol); inflammatory biomarkers (adiponectin and C-reactive protein); BP; and endothelial function by serum concentrations of adhesion molecules and by reactive hyperemia index (RHI), determined by peripheral arterial tonometry, using Endo-PAT 2000®. Participants were stratified into 2 groups according to their vitamin D status: with vitamin D deficiency (Group 1; 25 (OH) D < 20ng/ml; n=12), and without vitamin D deficiency (Group 2; 25 (OH) D ≥ 20ng/ml; n=61). Results: The prevalence of vitamin D deficiency was 16% (12 of 73). Women in Group 1 compared with those in Group 2 were older (36.5±3.2 vs. 30.4±1.1 years; p=0.03) and showed higher values of BMI (28.7±1.4 vs. 25.1±0.7kg/m2; p=0.03); % body fat (35.3±1.7 vs. 31.1±0.7%; p=0.02); glucose (88.3±3.2 vs. 80.2±1.1 mg/dl; p=0.01); HOMA-IR (6.3±0.7 vs. 4.4±0.2; p=0.002); and leptin (29.6±3.5 vs. 20.9±1.7 ng/ml; p=0.04). RHI was lower in participants in Group 1 than in Group 2 (1.7±0.1 vs. 2.1±0.1; p=0.02). After adjustments for age and BMI, women with vitamin D deficiency remained with higher levels of glucose and HOMA-IR, and lower levels of RHI. Systolic and diastolic BP were higher in Group 1 than in Group 2 (110.2 ± 5.1 vs. 102.9 ± 1.4mmHg and 72.8 ± 4,0 vs. 68.6 ± 1.3mmHg, respectively), however without statistical significance. The other variables did not differ between groups. Conclusions: In the present study, vitamin D deficiency was associated with higher body adiposity, greater insulin resistance and worse endothelial function in women.

Background: Obstructive sleep apnea (OSA) is considered an independent risk factor for cardiovascular disease and reported as the most common secondary cause of high blood pressure (BP) maintenance. Objective: To determine the prevalence of OSA and verify its association with endothelial function behavior and anthropometric parameters in patients with resistant hypertension (RHGroup) and BP controlled by medication (CHGroup). Methods: Cross-sectional study involving 40 hypertensive patients (20 in RHG and 20 in CHG), aged between 18 and 75 years. Endothelial function and OSA were assessed by peripheral arterial tonometry. BP was measured by oscillometric method on automatic device. Endothelial function was assessed by peripheral arterial tonometry (PAT) by EndoPAT2000 and the OSA diagnosis also through PAT, using the portable device WatchPAT200. Anthropometric evaluation was performed through measurements of waist (WaC), hip and neck circumference (NC), BMI, waist to height ratio (WHtR), and body composition assessed by BIA. Results: The prevalence of OSA in RHG was 85% (17 of 20)[apnea-hypopnea index = 12.39±1.89], and 80% (16 of 20) in CHG (AHI=20.74±4.69) and it was more frequent in men (93.7% [15 of 16] vs 75% [16 of 24]; p=0.0455, OR =3.86; 95% IC 0.99 to 5.09). Both groups presented similar anthropometric parameters values. Endothelial function evaluated by reactive hyperemia index was similar in both groups (RHG: 1.88±0.44 vs CHG: 2.03±0.43; p=0.47). Although we found differences in oxygen desaturation> 4% (RHG: 28.75 ± 5.08 vs CHG: 64.15 ± 16.97, p = 0.05), total sleep time (RHG: 307.2 ± 71.3 vs CHG: 323.3 ± 83.8 min) and minimum saturation (RHG: 87.8±3.8 vs CHG: 83.3±10.6%) was not different. In general, OSA was correlated with weight (r = 0.5135, p = 0.0007), BMI (r = 0.4146, p = 0.0078), WaC (r = 0, 4458, p = 0.005), NC (r = 0.3863, p = 0.01) and WHtR (r = 0.3907, p = 0.01) and independently associated with impairment of endothelial function (p = 0.0297, OR = 0.17, 95% CI 0.04 to 0.72). Conclusions: The findings of the present study show that the prevalence of OSA was similar in both groups and suggest that, in hypertensive subjects, OSA occurs more frequently in men, being associated with endothelial dysfunction and correlated positively with weight, BMI and WaC.

Recent studies have suggested that dietary Ca may have beneficial effects on adiposity, insulin resistance, dyslipidaemia and blood pressure (BP). One potential mechanism underlying these benefits involves modifications in intracellular Ca concentration ([Ca2+]i). The present study aimed to evaluate the associations of dietary Ca with adiposity, erythrocyte [Ca2+]i, metabolic profile, BP, inflammatory state and endothelial function in healthy pre-menopausal women. In the present cross-sectional study, seventy-six women aged 18–50 years were submitted to the evaluation of dietary intake, anthropometric parameters, body composition, erythrocyte [Ca2+]i, biochemical variables, endothelial function and BP. A FFQ was used to assess usual dietary intake. Endothelial function was evaluated by serum concentrations of adhesion molecules and by the peripheral arterial tonometry (PAT) method, using Endo-PAT 2000®. Participants were allocated into two groups according to Ca intake: low-Ca group (LCG;n32; n44; ≥ 600 mg/d). Women in the LCG compared with those in the HCG exhibited, after adjustments for potential confounders, higher values of BMI, waist circumference, waist:height ratio, percentage of body fat, insulin, homeostasis model assessment of insulin resistance, leptin, diastolic and mean BP; and lower levels of HDL-cholesterol, adiponectin and vascular cell adhesion molecule 1. Endothelial function assessed by PAT and [Ca2+]iwas similar in both groups. Subjects in the HCG had lower OR for prevalent overweight, obesity, abdominal obesity, insulin resistance, HDL-cholesterol 120 mmHg. The findings of the present study suggest that high Ca intake is inversely associated with some cardiovascular risk factors.

Background. Hypertension and excess body weight are important risk factors for endothelial dysfunction. Recent evidence suggests that high-polyphenol dark chocolate improves endothelial function and lowers blood pressure. This study aimed to evaluate the association of chocolate 70% cocoa intake with metabolic profile, oxidative stress, inflammation, blood pressure, and endothelial function in stage 1 hypertensives with excess body weight.Methods. Intervention clinical trial includes 22 stage 1 hypertensives without previous antihypertensive treatment, aged 18 to 60 years and presents a body mass index between 25.0 and 34.9 kg/m2. All participants were instructed to consume 50 g of chocolate 70% cocoa/day (2135 mg polyphenols) for 4 weeks. Endothelial function was evaluated by peripheral artery tonometry using Endo-PAT 2000 (Itamar Medical).Results. Twenty participants (10 men) completed the study. Comparison of pre-post intervention revealed that (1) there were no significant changes in anthropometric parameters, percentage body fat, glucose metabolism, lipid profile, biomarkers of inflammation, adhesion molecules, oxidized LDL, and blood pressure; (2) the assessment of endothelial function through the reactive hyperemia index showed a significant increase: 1.94 ± 0.18 to 2.22 ± 0.08,P=0.01.Conclusion.In individuals with stage 1 hypertension and excess body weight, high-polyphenol dark chocolate improves endothelial function.

Objective: To evaluate the behavior of BP and endothelial function after spironolactone or clonidine, associated with optimized antihypertensive treatment in patients with resistant hypertension (PRH). Methods: Prospective and randomized study, visits every 4 weeks. VISIT (V) 0: Inclusion of patients with BP>160/100mmHg and 140/90 amlodipine was added 5mg/day. Laboratory evaluation (LE), plasma renin and aldosterone and 20 min ECG, ABPM. V2: If BP>140/90 amlodipine titrated to 10mg/day. V3 (Randomization): ABPM, LE and assessment of endothelial function. If BP>140/90 and/or 24h ABPM>130/80 patients received spironolactone 12.5mg/day or clonidine 0.200mg/day. V4 and V5 (PRH): titration of clonidine (0.200mg to 0.600mg) or spironolactone (12.5mg to 50mg). V6: The same evaluation of V3. Patients with controlled BP in V3 have maintained their medication in V4, V5 and V6 and undergo the same tests that PRH. BP and ABPM was assessed by an automatic device; endothelial function by tonometry arteriolar peripheral (PAT) with Endo-PAT2000 ® and biomarkers (I-CAM, V-CAM, E-sel, PCR); plasma renin and aldosterone by RIA. Results: So far the study evaluated 46 patients where 28 patients had controlled BP and 13 remained resistant. In the spironolactone group the 24h-BP behavior, assessed by ABPM was SBP (V1) 162,8±7,9 and (V6) 124,3±3,7 (p Conclusion: Despite the statistically significant reduction of BP with spironolactone and clonidine, it seems that the improvement in endothelial function has been most pronounced in the clonidine group, although without statistical relevance.

Background: Recent studies suggest that dietary calcium may have beneficial effects on adiposity, insulin resistance, dyslipidemia and blood pressure (BP). One potential mechanism underlying these benefits involves modifications in intracellular calcium concentration ([Ca 2+ ]i). Objectives: To evaluate the associations of dietary calcium with adiposity, erythrocyte [Ca 2+ ]i, metabolic profile, BP, inflammatory state and endothelial function in healthy premenopausal women. Methods: In this cross-sectional study 76 women aged 18-50 years were submitted to the evaluation of dietary intake, anthropometric parameters, body composition, erythrocyte [Ca 2+ ]i, biochemical variables, endothelial function and BP. A food frequency questionnaire was used to assess the usual dietary intake. Endothelial function was evaluated by serum concentrations of adhesion molecules and by peripheral arterial tonometry (PAT) method, using Endo-PAT 2000 ® . Participants were allocated in two groups according to calcium intake: low calcium group (LCG; n=32; < 600mg/day) and high calcium group (HCG; n=44; ≥ 600mg/day). Results: Women in LCG compared with those in HCG exhibited, after adjustments for potential confounders (age and intake of energy, alcohol, protein, carbohydrates and lipids) higher values of body mass index (27.0 ± 1.1 vs. 25.6 ± 0.8 kg/m 2 , p = 0.02), waist circumference (87.8 ± 2.7 vs. 84.4 ± 2.1cm, p = 0.04), waist-to-height ratio (0.54 ± 0.02 vs. 0.52 ± 0.01, p = 0.02), percentage of body fat (27.0 ± 1.1 vs. 25.6 ± 0.8, p = 0.02), insulin (27.2 ± 2.9 vs. 22.6 ± 1.4 μU/ml, p = 0.02), HOMA-IR (5.7 ± 0.6 vs. 4.7 ± 0.4, p = 0.02), leptin (24.9 ± 2.5 vs. 21.5 ± 2.2ng/ml, p = 0.01) and diastolic BP (72.4 ± 2.0 vs. 68.2 ± 1.6mmHg, p = 0.04); and lower levels of HDL-cholesterol (52.9 ± 2.2 vs. 58.6 ± 1.8mg/dl, p = 0.004) and adiponectin (31.9 ± 3.5 vs. 34.6 ± 3.0μg/ml, p = 0.004). Endothelial function assessed by PAT and [Ca 2+ ]i were similar in both groups. Subjects in HCG had lower odds ratio for prevalent overweight, obesity, abdominal obesity, insulin resistance, HDL-cholesterol < 60mg/dl and systolic BP > 120mmHg. Conclusions: The findings of the present study suggest that high calcium intake is inversely associated with some cardiovascular risk factors.

Background: Obstructive sleep apnea (OSA) is considered an independent risk factor for cardiovascular disease. There is evidence that individuals with OSA may have increased levels of inflammatory mediators, altered metabolic profile and endothelial dysfunction. Objective: To evaluate the relation of OSA with endothelial function, anthropometric parameters, body composition, metabolic profile and blood pressure in obese individuals. Methods: Cross-sectional study involving 22 obese patients with body mass index >30 and < 40 kg/m 2 , aged between 24 and 54 years. The diagnosis of OSA was performed using the equipment Watch-PAT200 ® . Endothelial function by peripheral arterial tonometry method, using Endo-PAT 2000 ® . Results: After the evaluation of apnea hypopnea index (AHI), participants were allocated in two groups according to AHI: OSA group (OSAG; n=11; AHI = 18.4 ± 3.9) and control group (CG; n=11; AHI= 2.6 ± 0.3). The percentage of men in AOSG (82%, n = 9) was greater than in CG (36%, n = 4); p = 0.03. Both groups presented similar (p > 0.05) age (OSAG: 38.7 ± 1.9 vs. CG: 35.3 ± 3.3y), as well as body mass index (OSAG: 33.2 ± 0.8 vs. CG: 33.3 ± 0.7kg/m 2 ); % body fat (OSAG: 31.5 ± 1.15 vs. CG: 35.7 ± 0.7kg/m 2 ); and waist circumference (OSAG: 106.2 ± 2 vs. CG: 106.8 ± 2.9cm). Participants in OSAG presented higher values of neck circumference (42.3 ± 0.9 vs. 38.9 ± 1.2cm; P=0.03) and glucose (95.8 ± 3.5 vs. 82.5 ±3.1mg/dL; p=0.01). Subjects with and without OSA had similar levels (p>0,05) of total cholesterol (OSAG: 204.7 ± 10.5 vs. CG: 217.2 ± 13.3mg/dL), HDL-cholesterol (OSAG: 48.1 ± 5.3 vs. CG: 49.5 ± 2.9mg/dL), LDL-cholesterol (OSAG: 129.56± 9.5 vs. CG: 138,3 ± 12.1mg/dL), trigycerides (OSAG: 156.1 ± 24.5 vs. GC: 146.8 ± 19.5mg/dL) and diastolic BP (OSAG: 77.8 ± 2.5 vs. CG: 78.6 ± 2.1mmHg). Mean values of systolic BP presented a tendency to be higher in OSAG (127.4 ± 2.8 vs. 120.7±2mmHg; p=0.07). Endothelial function evaluated by reactive hyperemia index was similar in both groups (OSAG: 1.98 ± 0.14 vs. CG: 1.94 ± 0.14; p=0.86). Conclusions: The findings of the present study suggest that in obese subjects OSA occurs more frequently in men and is associated with higher values of neck circumference and of serum glucose.

Dietary intervention is an important approach in the prevention of cardiovascular disease. Over the last decade, some studies have suggested that a calcium-rich diet could help to control body weight, with anti-obesity effects. The potential mechanism underlying the impact of calcium on body fat has been investigated, but it is not fully understood. Recent evidence has also suggested that a calcium-rich diet could have beneficial effects on other cardiovascular risk factors, such as insulin resistance, dyslipidemia, hypertension and inflammatory states. In a series of studies, it was observed that a high intake of milk and/or dairy products (the main sources of dietary calcium) is associated with a reduction in the relative risk of cardiovascular disease. However, a few studies suggest that supplemental calcium (mainly calcium carbonate or citrate) may be associated with an increased risk of cardiovascular events. This review will discuss the available evidence regarding the relationship between calcium intake (dietary and supplemental) and different cardiovascular risk factors and/or events.

OBJECTIVE: This study aimed to evaluate long-term weight loss in overweight hypertensive patients receiving dietary counseling. METHODS: Longitudinal study included overweight hypertensive patients who had an initial individual consultation with a nutritionist between January 2002 and December 2005 and were followed for four years in a hypertension clinic. Patients who had at least four consultations during the follow-up period were included in the dietary counseling group. Those who scheduled their first consultation but missed that appointment or had fewer than four consultations during the follow-up period were allocated to the control group. Target Energy intake was calculated at 20-25 kcal/kg actual body weight/day. RESULTS: The study included 102 patients aged 55 + 1 years old (58 in the dietary counseling group). As compared with the control group, patients in the dietary counseling group showed a significantly greater reduction in body weight (-3.6 + 0.8 vs. 0.8 + 0.7 kg), which remained significant after controlling for age, gender, baseline body mass index, and the use of different antihypertensive and antidiabetic drugs. Weight loss between 5.0% and 9.9% was observed in a significantly higher percentage of patients in the dietary counseling group (28% vs. 11%). A weight loss of at least 10% was only observed in dietary counseling group patients, who had a significantly lower odds ratio for increasing the number and/or dosage of antihypertensive agents, even after controlling for age, gender, and baseline body mass index. CONCLUSIONS: Dietary counseling may be associated with long-term weight loss in overweight hypertensive patients.

A decisao terapeutica deve ser baseada no risco cardiovascular considerando-se a presenca de fatores de risco, lesao em orgao-alvo e/ou doenca cardiovascular estabelecida, e nao apenas no nivel da PA. ABORDAGEM PARA NIVEIS DE PA ENTRE 130-139/85-89 mmHg A justificativa para intervencoes em pessoas com esses niveis de PA baseia-se no fato de que metade do onus atribuivel ocorre para pressoes sistolicas entre 130 e 150 mmHg, isto e, incluindo o comportamento limitrofe de PA1 (Grau B). Uma importante consideracao a [...]

Clinical trials designed to examine the effects of calcium supplementation on abdominal obesity have had ambiguous results.This study aimed to evaluate, during energy restriction, the effects of a high-calcium diet (HCD) on measures of abdominal obesity and cardiometabolic risk factors in Brazilian obese subjects of multiethnic origin.We conducted a randomised clinical trial. Fifty obese subjects of both sexes, aged 22-55 years, with stable body weight and a low calcium intake were randomised into the following outpatient dietary regimens: (i) a low-calcium diet (LCD;500 mg/day) or (ii) a HCD [1200-1300 mg/day, supplemented with non-fat powdered milk (60 g/day)]. Both groups followed an energy-restricted diet (-800 kcal/day) throughout the study (16 weeks).Thirty-nine participants completed the study. After 16 weeks of energy restriction, a significant reduction was observed in all anthropometric parameters, metabolic variables (except for high-density lipoprotein cholesterol) and blood pressure levels in both the groups. Insulin was significantly reduced only in the HCD group. Subjects on the HCD compared with those on the LCD exhibited a greater reduction in waist circumference (p = 0.002), waist-to-hip ratio (p = 0.0001), diastolic blood pressure (p = 0.04) and mean blood pressure (p = 0.03).Our study suggests that increased calcium intake may enhance the beneficial effects of energy restriction on abdominal obesity and blood pressure.

Among the main etiologies of secondary arterial hypertension figure out the tumorous affections of adrenal gland, located on cortex - primary aldosteronism (Conn’s syndrome) and Cushing’s syndrome - or at glandular medulla - pheocromocytoma. Although these tumors are at most benign the surgical resection is needed in order to eliminate the disturbances provided by them and to limit the mass growth, being curative in about 80-90% of the cases. In this paper some particularities above surgical treatment of these diseases will be focused emphasizing the pre-operative prepare of the patients and the currently preconized approach.

Obesity is the major risk factor for the development of hypertension. This association accentuates the risk of cardiovascular disease, as it is frequently accompanied by the components of the metabolic syndrome. This randomised open parallel study evaluated the chronic effects of moxonidine--a selective imidazoline receptor agonist--on blood pressure, plasma catecholamines, leptin, insulin and components of the metabolic syndrome in obese hypertensives. Amlodipine was used as the control drug. Our results showed that moxonidine and amlodipine significantly reduced blood pressure when measured using the oscillometric method and 24-hour blood pressure monitoring. Moxonidine therapy decreased systolic blood pressure from 160.4 +/- 2.4 to 142.1 +/- 3.3 mmHg (p0.005) and diastolic blood pressure from 102.4 +/- 1.3 to 89.7 +/- 1.6 mmHg (p0.005) after 24 weeks of treatment. Moxonidine administration reduced the supine arterial plasma levels of adrenaline from 63.2 +/- 6.6 to 49.0 +/- 6.7 pg/ml (p0.005), the supine arterial plasma levels of noradrenaline from 187.9 +/- 10.7 to 149.7 +/- 13.2 pg/ml (p0.01) and the orthostatic venous plasma levels of noradrenaline from 258.6 +/- 25.0 to 190.3 +/- 16.4 pg/ml (p = 0.03). Those variables were not changed by amlodipine. The plasma levels of leptin and insulin 120 min after a glucose load decreased after moxonidine administration from 27.2 +/- 3.5 to 22.6 +/- 2.9 pg/ml (p0.05) and from 139.7 +/- 31.2 to 76.0 +/- 15.2 U/ml (p0.05), respectively. Amlodipine, however, did not modify those variables. This study showed a comparable reduction in blood pressure with both antihypertensive drugs. Moxonidine decreased sympathetic nervous activity, improved insulin resistance and reduced the plasma levels of leptin.