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Background Physical activity is associated with reduced arterial stiffness, although such a relationship has not been reported in those with resistant hypertension. Therefore, this study aimed to determine the association between daily physical activity and arterial stiffness in patients with resistant hypertension. Methods Fifty-seven (57) patients with resistant hypertension (50.9% men), aged 58.8±9.4 years, were consecutively recruited. Arterial stiffness was evaluated using carotid-femoral pulse wave velocity (cf-PWV). Daily physical activity was objectively assessed with accelerometers during 7 consecutive days. Results Patients had a body mass index of 29.0±4.0 kg/m2 (84.3% overweight/obese) and were taking an average 4.5 antihypertensive medications. Overall, the cf-PWV was 9.2±2.4 m/s and the majority of participants (n=41, 71.9%) presented a cf-PWV Conclusions Higher daily levels of light-intensity and total physical activity were associated with lower arterial stiffness. Nonetheless, this association is weak and attenuated or abolished when adjusted for blood pressure and age. These results suggest that physical activity may play an important role as a lifestyle intervention for patients with resistant hypertension. Future studies with larger samples sizes are necessary to confirm this preliminary data.

Reports suggest that the blood pressure (BP) response to an acute bout of exercise is associated with the BP response to aerobic training in participants with elevated BP. These associations have not been tested among patients with resistant hypertension. This study aimed to determine whether the BP response to acute exercise predicts the 24-h ambulatory BP response to a 12-week exercise training program in patients with resistant hypertension (n = 26, aged 59.3 ± 8.2 years, 24-h ambulatory BP 127.4 ± 12.2/75.6 ± 7.8 mm Hg) who completed the exercise arm of the EnRicH trial. Ambulatory BP measurements were obtained before and after the exercise program to assess the chronic BP response. To assess acute BP changes, resting BP was measured before and 10 min after three exercise sessions in the third week of training and averaged. The resting systolic (9.4 ± 6.7, p 0.001) and diastolic BP (1.9 ± 3.2, p = 0.005) were reduced after acute exercise. The 24-h systolic (6.2 ± 12.2, p = 0.015) and diastolic BP (4.4 ± 6.1, p = 0.001) were decreased after exercise training. The reductions in systolic BP after acute exercise were associated with the reductions in 24-h systolic BP after exercise training (ß = 0.538, adjusted r

Introduction Resistant hypertension is a major challenge of modern cardiovascular medicine, as it is a puzzling problem without a clear solution. Exercise training clearly reduces blood pressure (BP) and oxidative stress in patients with hypertension, however evidence is limited regarding resistant hypertension. Purpose To determine the effect of an aerobic exercise training program in BP, angiotensin II and oxidative stress in patients with resistant hypertension. Methods EnRicH is a prospective, two-center, single-blinded, randomized controlled trial with a parallel two-arm group. Sixty patients with resistant hypertension were randomly assigned in a 1:1 ratio to undergo a 12-week aerobic exercise training program (exercise) or usual care (control). The powered primary efficacy measure was 24-hour ambulatory systolic BP change from baseline. Secondary outcome measures included daytime and nighttime ambulatory BP, office BP, cardiorespiratory fitness, and oxidative stress and inflammatory biomarkers: Interferon-gamma (IFN-y), Angiotensin II, vascular endothelial growth factor (VEGF), and superoxide dismutase (SOD). Results Fifty-three patients (exercise n=26, control n=27) completed the study. Patients were mainly women (54.7%), with an office BP of 140.7±15.9/84.2±9.4 mm Hg and taking an average of 4.6 antihypertensive medications (median, 5; range, 3 to 7). At baseline, no differences were found between groups for the study outcomes and patient characteristics. Ambulatory systolic BP was reduced −7.1 mm Hg (95% CI, −12.8 to −1.4; P=0.015) in the exercise group (127.4±12.2 to 121.2±12.2, p=0.007) compared to control group (126.1±17.2 to 126.9±15.2, p=514) over 24-hour. In addition, 24-hour ambulatory diastolic BP (−5.1 mm Hg, −7.9 to −2.3, P=0.001), daytime ambulatory systolic (−8.4 mm Hg, −14.3 to −2.5, P=0.006), and diastolic BP (−5.7 mm Hg, −9.0 to −2.4, P=0.001) were also reduced in the exercise group compared to the control group. There were no differences in the change of nighttime ambulatory BP between groups. Cardiorespiratory fitness improved in the exercise group by 14% (4.7 ml.kg-1.min-1, P Conclusions A 12-week moderate intensity aerobic exercise program reduced ambulatory BP, angiotensin II and oxidative stress in patients with resistant hypertension. The antihypertensive effects of exercise in patients with resistant hypertension may be mediated by positive changes in oxidative stress and inflammatory biomarkers. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): European Union through European Regional Development Fund – Operational Competitiveness Factors Program (COMPETE)Portuguese Government through FCT - Foundation for Science and Technology

Background The prognostic impact of white-coat hypertension (WCHT) is still a matter of debate and controversy. Night-time blood pressure (NBP) is related strongly to cardiovascular (CV) prognosis, but this has not been considered currently in the definition of WCHT. Patients and methods We investigated the long-term CV prognosis of 2659 patients submitted at admission to 24 h-ambulatory blood pressure (BP) monitoring divided into three groups: normotension (NT) (n=812; 59% female; ageing 49±13 years), sustained hypertension (SHT) (n=1230; 56% female; ageing 51±13 years) and WCHT (n=617; 55% female; ageing 50±3 years) defined as office BP of at least 140/90 mmHg, daytime BP less than 135/85 mmHg and NBP less than 120/70 mmHg. Results The median follow-up was 7.6 years (range: 0.4-24.4), during which a total of 257 CV events (36 fatal) occurred (46% strokes, 32% coronary and 22% others), 38 in NT, 31 in WCHT and 188 in SHT. The event rate per 100 patient-years was 0.60 in the WCHT group, 0.66 in the NT group and 2.09 in the SHT group. Cox's regression analysis adjusted for covariables showed a higher risk of CV events in patients with SHT than WCHT [hazard ratio (HR)=2.230, 95% confidence interval: 1.339-3.716, P=0.002], whereas there was no difference between WCHT and NT groups. Event-free survival was significantly different from SH versus WCHT and NT groups. Within the group of WCHT, 29% of patients received sustained antihypertensive medication during the follow-up, but the HR of CV events between WCHT either treated or not treated did not differ: HR=0.76 (95% confidence interval: 0.37-1.51, P=0.42). Conclusion In patients with WCHT defined by normal daytime and NBP values, the risk of CV events was significantly lower than that of SHT and similar to that of NT patients, suggesting that NBP should be included in the WCHT definition and in its prognostic stratification.

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Portuguese Foundation for Science and Technology (FCT) European Regional Development Fund – Operational Competitiveness Factors Program (COMPETE) Background Physical activity has been associated with reduced arterial stiffness in patients with hypertension. However, in resistant hypertension, a specific population with an increased risk for target organ damage, cardiovascular morbidity, and mortality, the evidence is sparse. Purpose The present study aimed to determine the association between daily physical activity and arterial stiffness in patients with resistant hypertension. Methods Fifty-seven patients with resistant hypertension were recruited. Physical activity was objectively assessed during 7 consecutive days with accelerometers. Arterial stiffness was evaluated using carotid-femoral pulse wave velocity (cf-PWV) . Results Participants (50.9% men), aged 58.8 ± 9.4 years, were mainly overweight and were taking in average 4.5 antihypertensive medications. The cf-PWV showed an inverse correlation with light-intensity physical activity (r = -0.290, p = 0.029) and total daily physical activity (r = -0.287, p = 0.030). Additionally, cf-PWV tended to be inversely associated with the number of steps per day (r = -0.242, p = 0.069). Patients with higher risk of cardiovascular events (cf-PWV ≥ 10 m/s) tended to spend less time in light-intensity physical activity (324.0 ± 129.4 vs. 380.5 ± 103.1 min/day, p = 0.090) and to perform less total daily physical activity (351.5 ± 141.7 vs. 411.7 ± 109.1 min/day, p = 0.091) than participants with cf-PWV below the risk threshold value. Conclusions Higher levels of total physical activity and daily levels of light-intensity were associated to lower arterial stiffness. These results emphasize the importance of physical activity as a nonpharmacological tool for patients with resistant hypertension.

Background Some of the patients admitted for acute myocardial infarction have non-obstructive coronary artery disease (MINOCA). Their prognosis is not always benign, making it necessary the development of tools for risk stratification of these patients. Objectives To describe the characteristics of a sample of patients admitted for suspected MINOCA and to evaluate the prognostic value of GRACE score in this population. Methods This was a retrospective, observational, single-center, cohort study involving 56 consecutive patients with MINOCA. During one-year follow-up, patients were assessed for mortality and major adverse cardiovascular events (MACE) – a composite of all-cause mortality and hospitalization due to acute myocardial infarction, heart failure, ischemic stroke, and acute limb ischemia. Statistical analysis was performed using a non-parametric approach, with the Mann-Whitney U test for quantitative variables and ROC curves for assessing the discriminatory power of the Grace score in predicting cardiovascular events. The level of significance was set at 5%. Results Of the 56 MINOCA patients included in the study (median age 67 years), 55.4% were female. During the one-year follow-up, mortality rate was 5.5% and 9.1% of patients had MACE. A higher GRACE score was associated with mortality (p = 0.019; AUC 0.907; 95%CI 0.812–1.000; cut off 138) and MACE (p =0.034; AUC 0.790; 95%CI 0.632–0.948; cutoff 114). Conclusion The definition of MINOCA includes various diagnoses and prognoses, and the GRACE score is useful for risk stratification of patients with this condition.

Although there has been an observed progress in the treatment of hypertension, its prevalence remains elevated and constitutes a leading cause of cardiovascular disease development. Resistant hypertension is a challenge for clinicians, as the available treatment options have reduced success. Physical activity and exercise training play an important role in the management of blood pressure. The importance of physical activity and exercise training as part of a comprehensive lifestyle intervention is acknowledged by several professional organizations in their recommendations/guidelines for the management of arterial hypertension. Aerobic exercise, dynamic resistance exercise, and concurrent training - the combination of dynamic resistance and aerobic exercise training in the same exercise session or on separate days - has been demonstrated to reduce blood pressure and help in the management of hypertension. The present review draws attention to the importance of exercise training in the management of blood pressure in both hypertension and resistant hypertension individuals. This work is financed by FEDER funds through the Operational Competitiveness Factors Program – COMPETE and by National Funds through FCT – Foundation for Science and Technology within the project “P2020-PTDC/DTPDES/1725/2014.” iBiMED is a research unit supported by the Portuguese Foundation for Science and Technology (FCT) (Ref: UID/BIM/04501/2013) and POCI-01–0145-FEDER-007628 funds. CIDESD is a research unit supported by FCT (UID/DTP/04045/2013) and by the European Regional Development Fund, through COMPETE 2020 (POCI-01–0145-FEDER-006969). Susana Lopes received a PhD grant from the Foundation for Science and Technology (SFRH/BD/129454/2017). published

IMPORTANCE: Limited evidence suggests exercise reduces blood pressure (BP) in individuals with resistant hypertension, a clinical population with low responsiveness to drug therapy. OBJECTIVE: To determine whether an aerobic exercise training intervention reduces ambulatory BP among patients with resistant hypertension. DESIGN, SETTINGS, AND PARTICIPANTS: The Exercise Training in the Treatment of Resistant Hypertension (EnRicH) trial is a prospective, 2-center, single-blinded randomized clinical trial performed at 2 hospital centers in Portugal from March 2017 to December 2019. A total of 60 patients with a diagnosis of resistant hypertension aged 40 to 75 years were prospectively enrolled and observed at the hospitals’ hypertension outpatient clinic. INTERVENTIONS: Patients were randomly assigned in a 1:1 ratio to a 12-week moderate-intensity aerobic exercise training program (exercise group) or a usual care control group. The exercise group performed three 40-minute supervised sessions per week in addition to usual care. MAIN OUTCOMES AND MEASURES: The powered primary efficacy measure was 24-hour ambulatory systolic BP change from baseline. Secondary outcomes included daytime and nighttime ambulatory BP, office BP, and cardiorespiratory fitness. RESULTS: A total of 53 patients completed the study, including 26 in the exercise group and 27 in the control group. Of these, 24 (45%) were women, and the mean (SD) age was 60.1 (8.7) years. Compared with the control group, among those in the exercise group, 24-hour ambulatory systolic BP was reduced by 7.1 mm Hg (95% CI, −12.8 to −1.4; P = .02). Additionally, 24-hour ambulatory diastolic BP (−5.1 mm Hg; 95% CI, −7.9 to −2.3; P = .001), daytime systolic BP (−8.4 mm Hg; 95% CI, −14.3 to −2.5; P = .006), and daytime diastolic BP (−5.7 mm Hg; 95% CI, −9.0 to −2.4; P = .001) were reduced in the exercise group compared with the control group. Office systolic BP (−10.0 mm Hg; 95% CI, −17.6 to −2.5; P = .01) and cardiorespiratory fitness (5.05 mL/kg per minute of oxygen consumption; 95% CI, 3.5 to 6.6; P

Background. The long-term prognosis and transition towards sustained ambulatory hypertension (SHT) of white-coat hypertension (WCHT) remain uncertain particularly in those with both normal nighttime and daytime blood pressure (BP) values. Different classification criteria and the use of antihypertensive drugs may contribute to conflicting results. Patients and Methods. We prospectively evaluated for a 7.1 year transition to SHT in 899 nondiabetic subjects free from cardiovascular (CV) events: normotensive (NT) (n = 344; 52, 9% female; ageing 48 ± 14 years); untreated WCHT (UnWCHT n = 399; 50, 1% female; ageing 51 ± 14 years); and treated WCHT with antihypertensive drugs after baseline (TxWCHT n = 156; 54, 4% female; ageing 51 ± 15 years). All underwent 24 h ambulatory BP monitoring (24 h-ABPM) at baseline, at 30 to 60 months, and at 70 to 120 months thereafter. WCHT was at baseline (with no treatment) as office BP ≥ 140/or 90 mm·Hg, daytime BP p < 0.009 ). The mean annual increase of average 24 h-systolic BP was 0.48 + 0.93 in NT and 0.73 + 1.06 in UnWCHT, whereas annual SBP in office increased in NT by 1.2 + 0.95 but decreased in UnWCHT by 1.36 + 1.35 mm Hg ( p < 0.01 ). Conclusion. Untreated WCHT patients exhibit a faster and a higher risk of developing SHT compared to NT with TxWCHT assuming an intermediate position between them.

Submitted by Fernando Ribeiro (fernando.ribeiro@ua.pt) on 2020-06-12T13:40:21Z No. of bitstreams: 1 Hypertension Research post print.pdf: 330565 bytes, checksum: a5030be19ca5e955d0534307f4db5348 (MD5) Approved for entry into archive by Alexandra Bastos (alexandrabastos@ua.pt) on 2020-06-12T15:19:15Z (GMT) No. of bitstreams: 1 Hypertension Research post print.pdf: 330565 bytes, checksum: a5030be19ca5e955d0534307f4db5348 (MD5) Made available in DSpace on 2020-06-12T15:19:15Z (GMT). No. of bitstreams: 1 Hypertension Research post print.pdf: 330565 bytes, checksum: a5030be19ca5e955d0534307f4db5348 (MD5) Previous issue date: 2019-08-26 published

Paragangliomas (PGLs) are extra-adrenal neuroendocrine tumors, classified as sympathetic or parasympathetic according to their origin in the paraganglia of the autonomic nervous system. Sympathetic PGLs are mostly functional, presenting in a variable and non-specific way. We report a case of PGL, which was diagnosed further to an investigation of acute myocardial infarction in a postpartum woman, highlighting that the absence of typical symptoms may delay the diagnosis.

In this work it is evaluated the possibility of central blood pressure assessment using distension waves, obtained with a low cost optical fiber sensor, instead of regular arterial tonometry. Carotid distension and pressure waveforms were acquired in 15 young subjects. Form factors, root-mean-square error (RMSE), harmonic decomposition and central systolic pressures for both techniques were analysed. The pressure waves assessed by the piezoelectric probe had lower form factors than the ones assessed by the optical fiber sensor, due to the different nature of the waves (51.05 ± 5.15% versus 40.53 ± 5.70%), translating in a RMSE of 14 ± 2%. Regarding the harmonic analysis, paired t -tests shown that the first four harmonics are not significant different (p ⩽ 0.05), and Pearson correlation studies retrieve that the 2nd–7th harmonics are correlated (p ⩽ 0.03). Central systolic pressures were also obtained with both techniques displaying a very strong Pearson correlation (0.99) and a small difference of 0.63 ± 2.40 mmHg. These pre-clinical results support a future clinical validation study in larger and broader cohorts.

Submitted by Fernando Ribeiro (fernando.ribeiro@ua.pt) on 2020-06-12T13:43:02Z No. of bitstreams: 1 Hypertension Research_post-print 2018.pdf: 126864 bytes, checksum: 6e421ade4ae43ad2b5da59e786bd1601 (MD5) Approved for entry into archive by Alexandra Bastos (alexandrabastos@ua.pt) on 2020-06-12T15:28:06Z (GMT) No. of bitstreams: 1 Hypertension Research_post-print 2018.pdf: 126864 bytes, checksum: 6e421ade4ae43ad2b5da59e786bd1601 (MD5) Made available in DSpace on 2020-06-12T15:28:06Z (GMT). No. of bitstreams: 1 Hypertension Research_post-print 2018.pdf: 126864 bytes, checksum: 6e421ade4ae43ad2b5da59e786bd1601 (MD5) Previous issue date: 2019-01 published

Background: The relationship between arterial stiffness, blood pressure (BP) and cardiorespiratory fitness (CRF) has been studied in healthy populations and cardiovascular patients, since all of which proved to be independent predictors of all-cause mortality. We aimed to investigate the association of CRF with arterial stiffness and peripheral and central hemodynamics, in patients with resistant hypertension (RT). Methods: In this cross-sectional study, 30 patients (13 men, 17 women; age, 57.7 ± 8.1 years; weight, 79.2 ± 11.6 kg; body mass index, 29.7 ± 4.0 kg/m2) with resistant hypertension were recruited in the Hospital Infante D. Pedro (Aveiro) and Hospital Pedro Hispano (Matosinhos). Outcome measures included CRF (VO2peak), peripheral and central BP, and carotid-femoral pulse wave velocity (cf-PWV). Correlation analysis was conducted to assess the association between variables. Results: A significant negative correlation was found between VO2peak (33.7 ± 6.2 mLO2/kg/min) and central (141.0±21.3 mmHg; r = −0.395, p = 0.031) and peripheral systolic BP (148.4 ± 21.3 mmHg; r = −0.363, p = 0.049). VO2peak was also correlated with pulse pressure (PP) amplification ratio (1.2 ± 0.1 mmHg; r = 0.361, p = 0.050). The association with central systolic BP (r = −0.403, p = 0.035) and PP amplification ratio (r = 0.408, p = 0.033) remained significant after adjusted for age. VO2peak showed no correlation with PWV (9.4 ± 2.9 m/s; r = −0.075, p = 0.694) and peripheral (88.1 ± 12.2 mmHg; r = −0.138 p = 0.467) and central diastolic BP (88.5 ± 12.7 mmHg; r = −0.133, p = 0.483). Conclusion: This study confirms the inverse relationship between CRF and central systolic BP and PP amplification ratio in RH patients, regardless of age.

Objective: Carotid-femoral Pulse Wave velocity (cfPWV), the gold standard for measuring stiffness, is a marker of organ damage (OLD). Even though cfPWV correlates with casual (BPc), central (CBP) and ambulatory (ABPM) blood pressure (BP), evidence is limited for resistant hypertension (RH). Method: Thirty-three patients (age, 56.1 ± 8.2 years; weight, 78.0 ± 12.4 kg; height, 1.62 ± 0.08 m) with RH participated in a cross-sectional study. Outcomes included clinical data, BPc, ABPM, and carotid-femoral, cfPWV. Correlation analysis was conducted to assess the association between variables; independent t-tests were conducted to compare variables between those participants with cfPWV < and ≥ 10 m/s. Results: Patients (20 women and 13 men) presented a peripheral systolic and diastolic BPc of 144.0 ± 3.8 mmHg and 82.0 ± 1.9 mmHg, respectively. The cfPWV correlated with age (r = 0.356, p = 0.045), 24 h systolic BP (24 h SBP) nightime pulse pressure (night PP), 24 h pulse pressure (24hPP), casual systolic (SBPc) and diastolic BP (DBPc), central systolic (CSBP), diastolic (CDBP) and central pulse pressure (CPP); controlled for age the correlation remained significant for 24h SBP (r=0.446, p=0.009) 24hPP (r=0.464, p=0.007), nightPP (r=0.365, p=0.036), SBPc (r=0.620, p

Objective: Pulse Wave Velocity (PWV) is considered a marker of cardiovascular (CV) risk prognosis. The objective was to evaluate the association of PWV, other features and CV events in a sample of hypertensive patients. Design and method: We studied 314 hypertensive patients without previous CV events evaluated by PWV in a Portuguese average-size hospital, through its descriptive and survival analysis. Results: Of the 314 patients (51% male) ageing 54.0 ± 14.2 years, 31.5% had resistant hypertension, 26.8% were diabetic, 66.6% had hyperlipidaemia, the average body mass index was 28.3 kg m−2, and 16.6% were active smoker. Through a follow-up of 2.1 ± 2.2 years, 28 patients (8.9%) had a CV event. Comparison of the patients with PWV ≤ 10 ms−1 and the patients with PWV >10 ms−1, showed statistical significance for age (64.3 ± 10.5 vs 50.2 ± 13.4 years, p < 0.0001), casual systolic blood pressure (137.4 ± 16.3 mmHg vs 154.4 ± 21.4 mmHg, p < 0.0001), PWV (7.9 ± 1,2 ms−1 vs 12.2 ± 1.9 ms−1, p < 0.0001) left ventricular hypertrophy (193,3 ± 58.6 vs 235,8 ± 65.1, p < 0.01) and left auricular volume (19,9 ± 3.9 vs 23.3 ± 5.8, p < 0.002). Patients with PWV>10ms−1, 77,3% had left ventricular hypertrophy (p < 0.004) and 70% had left auricular enlargement (p < 0.08). In the survival analysis, the Kaplan Meier curve showed a worse prognosis for CV events with PWV > 10 ms−1 (log rank 6.0, p < 0,014). Conclusions: Higher PWV indicating worse artery damage is associated with end organ damage like left ventricular hypertrophy and left auricular enlargement. In patients with no previous CV events, PWV>10 ms−1 is an indicator for worse prognosis for CV events.

Objective:To assess whether aerobic exercise training reduces 24-hour ambulatory blood pressure (ABP) in patients with resistant hypertension (RH).Design and method:Twenty-five patients with resistant hypertension (age: 59.4 ± 7.4 years old, weight: 79.3 ± 12.7 kg, body mass index: 29.4 ± 4.1 kg/m2)

Objective:White coat hypertensive subjects (WCH) are usually classified on the basis of normal daytime ambulatory or home blood pressures (BP). Since nighttime BP is the most powerful predictor of risk, we evaluate the long term transition towards hypertension of WCH with normal daytime and normal n

Objective: To assess ambulatory blood pressure monitoring (ABPM) circadian patterns and their determinants in a large sample of normotensive and hypertensive patients. Methods: A total of 26 170 individual ABPM recordings from 1995 to 2015 were analyzed. Mean office blood pressure (OBP), 24-hour blood pressure (BP), daytime BP and nocturnal BP were measured. Circadian patterns were classified by nocturnal systolic BP fall as extreme dipper (ED, ≥20%), dipper (D, 10%-19.9%), non-dipper (ND, 0%-9.9%), and reverse dipper (RD, 30 kg/m2 vs. others (46.5 vs. 42.9%, p43%, including in NT. Age and BMI predicted non-dipping. Resumo: Objetivo: Avaliar os perfis circadiários da pressurometria ambulatória 24 h (ABPM) numa vasta população de normotensos e hipertensos. Métodos: Analisaram-se 26 170 registos de ABPM (1995-2015). Avaliou-se a pressão arterial (BP) de consultório (cBP), diurna (dayBP), noturna (nightBP) e de 24-horas (24hBP). Perfis circadiários definidos pela queda percentual noturna (Nqueda %) da pressão sistólica (SBP): extreme dipper (ED>=20%), dipper (D, 10%-19,9%), non-dipper (ND 0%-9,9%) e reverted dipper (RD =65 versus < 65 anos (54,9 versus 33,1%, p

Departamento de Hipertensao Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil

Objectives:To assess whether exercise training improves 24-hour ambulatory blood pressure (ABP) in patients with resistant hypertension (RH).Methods:In this randomized-control trial (ClinicalTrials.gov: NCT03090529), 19 patients with resistant hypertension (age: 59.4 ± 7.9 years, weight: 81.3 ± 11.7

Background and purpose A single bout of aerobic exercise acutely decreases blood pressure, even in older adults with hypertension. Nonetheless, blood pressure responses to aerobic exercise in very old adults with hypertension have not yet been documented. Therefore, this study aimed to assess the effect of a single session of aerobic exercise on postexercise blood pressure in very old adults with hypertension. Methods Eighteen older adults with essential hypertension were randomized into exercise (N = 9, age: 83.4 ± 3.2 years old) or control (N = 9, age: 82.7 ± 2.5 years old) groups. The exercise group performed a session of aerobic exercise constituting 2 periods of 10 minutes of walking at an intensity of 40% to 60% of the heart rate reserve. The control group rested for the same period of time. Anthropometric variables and medication status were evaluated at baseline. Heart rate and systolic and diastolic blood pressures were measured at baseline, after exercise, and at 20 and 40 minutes postexercise. Results Systolic blood pressure showed a significant interaction for group × time (F3,24 = 6.698; P = .002; ηp(2) = 0.153). In the exercise group, the systolic blood pressure at 20 (127.3 ± 20.9 mm Hg) and 40 minutes (123.7 ± 21.0 mm Hg) postexercise was significantly lower in comparison with baseline (135.6 ± 20.6 mm Hg). Diastolic blood pressure did not change. Heart rate was significantly higher after the exercise session. In the control group, no significant differences were observed. Conclusions A single session of aerobic exercise acutely reduces blood pressure in very old adults with hypertension and may be considered an important nonpharmacological strategy to control hypertension in this age group.

Objectives: to report a case of hypereosinophilic syndrome which presented clinically acute coronary syndrome. Materials and methods: we describe a case of a 69-year-old woman with acute coronary syndrome and peripheral hypereosinophilia. Results: the condition rapidly evolved to severe heart failure. Coronary disease was excluded by cardiac catheterization. Systemic corticosteroid therapy was initiated and further secondary causes of hypereosinophilia were excluded.

Objective: To evaluate in untreated subjects the reproducibility of mean values and four circadian patterns between two ambulatory blood pressure monitoring (ABPM) recordings separated by 1–11 months. Methods: We performed a retrospective analysis of 481 individuals (59% women) evaluated by ABPM on two occasions, visit 1 (V1) and 2 (V2), separated by 5.5+0.2 months. Four circadian patterns were defined by night/day systolic blood pressure (SBP) ratios: reverse dippers (RD), ratio >1.0; non-dippers (ND), ratio 0.9–1.0; dippers (D), ratio 0.8– 1,0, non-dippers, ND se ratio 0,9- < 1,0, dippers, D se ratio 0,8- < 0,9 e extreme dippers, ED se ratio < 0,8. Cálculo dos coeficientes de correlação (CCc) e de concordância (Φ) entre os valores da MAPA nas V1-V2 e a reprodutibilidade dos perfis RD, ND, D e ED em V1 pela proporção de indivíduos que permaneceram no mesmo perfil em V2. Resultados: As médias de 24 horas foram 126,8/75,9 ± 0,5/0,5 (V1) versus 126,5/75,7 ± 0,5/0,4 mm Hg (V2) (n.s.). A descida noturna da PAS foi 9,8 ± 0,4 (V1) e 9,6 ± 0,3% (V2) (n.s.). Entre os vários parâmetros da MAPA, os CC oscilaram 0,41-0,69 (p < 0,001) e os ΦC entre 0,34-0,57 (p < 0,01). Em V1, ED foram n = 38 (7,9%), D n = 216 (44,9%), ND n = 187 (38,9%) e RD n = 40 (8,3%). Em V2 somente mantiveram o perfil de V1, 26,3% dos ED, 44,9% dos D, 54,5% dos ND e 40% dos RD. Conclusão: Em indivíduos não tratados, a reprodutibilidade a menos de um ano da MAPA é elevada para os valores médios mas modesta relativamente aos perfis circadiários, sugerindo baixa preditibilidade de risco cardiovascular dos perfis de descida noturna da pressão arterial. Keywords: 24-hour ambulatory blood pressure monitoring, Reproducibility, Circadian patterns, Dipping, Palavras-chave: Pressurometria ambulatória de 24 horas, MAPA, Reprodutibilidade, Perfis circadiários (dipping)

Introduction Coronary artery disease is associated with decreased levels of physical activity, contributing to increases in abdominal fat and consequently increasing metabolic risk. The innovative use of microcurrents may be an effective method to increase the lipolytic rate of abdominal adipocytes. This study aimed to investigate the effects of utilizing microcurrents in a home-based exercise program in subjects with coronary artery disease to assess changes in total, subcutaneous and visceral abdominal adipose tissue. Methods This controlled trial included 44 subjects with myocardial infarction, randomly divided into Intervention Group 1 (IG1; n = 16), Intervention Group 2 (IG2; n = 12) and Control Group (CG; n = 16). IG1 performed a specific exercise program at home during 8 weeks, and IG2 additionally used microcurrents on the abdominal region before the exercise program. All groups were given health education sessions. Computed tomography was used to evaluate abdominal, subcutaneous and visceral fat, accelerometers to measure habitual physical activity and the semi-quantitative food frequency questionnaire for dietary intake. Results After 8 weeks, IG2 showed a significantly decrease in subcutaneous fat (p ≤ 0.05) when compared to CG. Concerning visceral fat, both intervention groups showed a significant decrease in comparison to the CG (p ≤ 0.05). No significant changes were found between groups on dietary intake and habitual physical activity, except for sedentary activity that decreased significantly for IG2 in comparison with CG (p ≤ 0.05). Conclusion This specific home-based exercise program using microcurrent therapy for individuals with coronary artery disease showed improvements in visceral and subcutaneous abdominal fat.

Pulse waveform features related to cardiovascular pathologies and arterial stiffness have been extensively studied, and optical fiber sensors have been studied with an aim to simplify the pulse waveform acquisition in the carotid artery. In this paper, a novel optical fiber sensor to record pulse waveform in the carotid artery has been proposed.The pulse waveform optical fiber sensor design, based on fiber Bragg gratings, is presented. The probe was characterized, and its response to controlled waveforms was studied. Finally, tests were performed on human subjects.The developed sensor has a displacement sensitivity of 21.2 pm/μm, with ability to detect the carotid pulse wave in the neck surface, with a resolution of 1.3 mmHg.This study revealed a new technological approach for acquisition of the central pulse waveform.

INTRODUCTION The aim of this study was to compare the 24-h ambulatory blood pressure (ABP) profile in never-treated black hypertensive patients living in Africa, Mozambique (20-80 years), versus never-treated white hypertensive patients living in Europe. PATIENTS AND METHODS ABP recordings of untreated black hypertensive patients and white hypertensive patients with 24-h ABP of 130/80 mmHg or more were retrospectively selected from two computerized database records of ABP and matched for age by decades, sex, and BMI. RESULTS Black hypertensive patients were n=548, 47 ± 12 years, 52% women, BMI=28.0 ± 8.2 kg/m(2), 7% smokers, 7% diabetics; white hypertensive patients were n=604, 47 ± 15 years, 52% women, BMI=27.4 ± 5.1 kg/m(2), 8.4% diabetics, and 18% smokers (P

The association of the Mediterranean diet and exercise appears to have a protective role, reducing cardiovascular risk. This study investigated the effects of education sessions on the Mediterranean diet and an exercise program in modifying eating behaviors, body composition and abdominal fat. An experimental study was performed on 20 subjects with known coronary heart disease randomly assigned to experimental (n=10) and control (n=10) groups. Both groups received education sessions on the Mediterranean diet, but the experimental group also followed an eight-week program of specific exercises. A semiquantitative food frequency questionnaire was administered to analyze food intake, bioimpedance was used to measure weight, fat mass and lean mass, and waist circumference was measured to calculate waist-to-height ratio. After eight weeks, protein (p, A associação da dieta mediterrânica e de exercício físico parecem apresentar um papel protetor na diminuição do risco cardiovascular. Este estudo pretende verificar os efeitos de sessões de educação fundamentadas na dieta mediterrânica e de um programa de exercícios na modificação de comportamentos alimentares, composição corporal e gordura abdominal. Estudo experimental composto por 20 indivíduos, com doença arterial coronária conhecida, distribuídos aleatoriamente em dois grupos: experimental (n = 10) e controlo (n = 10). Ambos os grupos foram sujeitos às sessões de educação para a saúde, mas o grupo experimental executou um programa suplementar de exercícios específicos durante oito semanas. Foi utilizado o questionário semiquantitativo de frequência alimentar para análise da ingestão de alimentos, a bioimpedância para medição do peso, massa gorda e massa magra, e o perímetro da cintura para cálculo da razão cintura‐estatura. Após as oito semanas, o grupo experimental ingeriu significativamente menos proteínas (p < 0,05) e colesterol (p < 0,05) em comparação com o grupo controlo. Do momento inicial para o final, verificou‐se apenas no grupo controlo uma diminuição significativa na ingestão de hidratos de carbono (p < 0,05) e de gorduras saturadas (p < 0,05). Ambos os grupos diminuíram significativamente a percentagem de gordura total (p < 0,05) e massa gorda (p < 0,05). O grupo experimental diminuiu significativamente a razão cintura‐estatura (p < 0,05). A dieta mediterrânica reduziu a ingestão alimentar de hidratos de carbono e gorduras saturadas, refletindo‐se na redução da massa gorda. A associação do programa de exercícios demonstrou benefícios acrescidos na diminuição da ingestão de proteínas e de colesterol, assim como na redução da gordura abdominal.