Resumo Fundamento: Diversos índices antropométricos têm sido propostos para determinar a associação entre excesso de peso e fatores de risco cardiovascular. Objetivo: Avaliar a relação entre adiposidade corporal e reatividade microvascular em pacientes hipertensos sob terapia anti-hipertensiva. Métodos: Pacientes hipertensos tratados de 40 a 70 anos foram submetidos à avaliação de índices antropométricos: conicidade (IC), adiposidade corporal (IAC), adiposidade visceral (IAV) e relação cintura-estatura (RCE). Os participantes foram divididos pelos tercis de percentual de gordura (%G) obtido pela bioimpedância elétrica (BIA) e submetidos a teste de reatividade microvascular (laser speckle contrast image), medida da velocidade da onda de pulso (VOP). O valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: A variação da área sob a curva (ASC) da perfusão cutânea foi inferior no tercil superior (97 ± 57% vs. 67 ± 36%; p = 0,027). O %G apresentou correlação significativa com RCE (r = 0,77; p < 0,001), IAV (r = 0,41; p = 0,018), IC (r = 0,60; p < 0,001) e IAC (r = 0,65; p < 0,001) nos homens e somente com RCE (r = 0,55; p < 0,001) e IAC (r = 0,60; p < 0,001) nas mulheres. Na regressão linear, a ASC mostrou associação independente com o %G (β =–3,15; p = 0,04) nas mulheres e com a glicemia (β = –1,15; p = 0,02) nos homens. Não houve diferença nas medidas de VOP. Conclusão: Os índices antropométricos de obesidade foram mais associados ao %G nos homens. A maior adiposidade corporal foi relacionada com menor reatividade microvascular, o que foi mais evidente nas mulheres. Não houve diferença na rigidez arterial, o que pode ter sido influenciado pelo tratamento anti-hipertensivo.

Abstract Background: Several anthropometric indexes have been proposed to determine the association between overweight and cardiovascular risk factors. Objective: To evaluate the relationship between body adiposity and microvascular reactivity in hypertensive patients under antihypertensive therapy. Methods: Treated hypertensive patients aged 40 to 70 were submitted to evaluation of anthropometric indexes: conicity (CI), body adiposity (BAI), visceral adiposity (VAI) and waist-to-height ratio (WHtR). Participants were divided by the terciles of fat percentage (%F) obtained by bioelectrical impedance. The patients underwent microvascular reactivity test (Laser Speckle Contrast Image) and pulse wave velocity (PWV) measurement. The p value <0.05 was considered statistically significant. Results: The variation of the area under the curve (AUC) of the skin perfusion was lower in the upper tercile (97±57% vs. 67±36%; p=0.027). %F showed significant correlation with WHtR (r=0.77; p<0.001), VAI (r=0.41; p=0.018), CI (r=0.60; p<0.001), BAI (r=0.65; p<0.001) in men and only with WHtR (r=0.55; p<0.001) and BAI (r=0.60; p<0.001) in women. In linear regression, AUC was independently associated with %F (β=−3.15; p=0.04) in women and with blood glucose (β=−1.15; p=0.02) in men. There was no difference in PWV measurements. Conclusion: Anthropometric indices were more associated with %F in men. Higher body adiposity was associated with lower microvascular reactivity, which was more evident in women. There was no difference in arterial stiffness, which may have been influenced by antihypertensive treatment.

Abstract Background: Patients with polycystic ovarian syndrome (PCOS) have an increased prevalence of metabolic syndrome and traditional atherosclerotic risk factors, such as dyslipidemia, diabetes and hypertension. Endothelial function and vascular stiffness are surrogate markers of early atherosclerosis, able to predict cardiovascular events. Objective: To compare endothelial function and pulse wave reflection between women with PCOS and healthy controls. Methods: Observational and cross-sectional study that included women with PCOS, age between 18 and 40 years-old and body mass index between 25.0 and 35.0 kg/m2, and healthy controls. Rotterdan criteria was used to diagnose PCOS. Subjects underwent clinical and anthropometric evaluation, laboratory and hormonal assays and imaging tests to measure pulse wave velocity (PWV), augmentation index (AIx) and brachial artery flow-mediated vasodilation (FMD). Kolmogorov-Smirnov test showed normal distribution of most parameters. Unpaired Student t-test was used with significance level established at p < 0.05. Results: A total of 52 patients were included, 29 (56%) in PCOS group and 23 (44%) in control group. Clinical and laboratory parameters were similar between the groups. Women with PCOS had lower FMD (8.8 ± 1.0 vs 12.8 ± 1.2%, p = 0.021); PWV and AIx were similar between the groups (7.5 ± 0.2 vs 7.5 ± 0.3 m/s, p = 0.671 and 21.0 ± 1 vs. 20 ± 2%, p = 0.716, respectively). In the PCOS group, women with higher testosterone levels had higher AIx (25 ± 2 vs. 17 ± 3%, p = 0.045). Conclusions: PCOS women had endothelial dysfunction and those with higher testosterone levels had higher pulse wave reflection as compared with controls.

Resumo Fundamentos: Obesidade, hipertensão arterial sistêmica (HAS) e apneia obstrutiva do sono (AOS) estão intimamente relacionados. Até 70% dos pacientes com AOS podem ser assintomáticos e há evidências que eles apresentam alterações cardiovasculares, em especial HAS noturna. Objetivos: O objetivo deste estudo foi avaliar o comportamento da pressão arterial nas 24 horas em indivíduos obesos assintomáticos com AOS moderada/grave comparando àqueles com AOS leve/ausente. Métodos: Foram selecionados 86 pacientes entre 30 e 55 anos, obesos (IMC 30-39,9 kg/m2), com pressão arterial casual < 140/90 mmHg e sem comorbidades, dos quais 81 foram submetidos à avaliação clínica, medidas antropométricas, monitorização ambulatorial da pressão arterial (MAPA) e Watch-PAT. Os participantes do estudo foram divididos em dois grupos com base no índice de apneia-hipopneia (IAH): grupo 1 com IAH < 15 eventos/h e grupo 2 com IAH ≥ 15 eventos/h. Resultados: Em comparação ao grupo 1, o grupo 2 apresentou maior circunferência de pescoço e maior relação cintura-quadril (40,5 ± 3,2 vs 38,0 ± 3,7 cm, p = 0,002, e 0,94 ± 0,05 vs 0,89±0,05cm, p = 0,001, respectivamente), maiores pressões arteriais sistólica e diastólica na MAPA-24h (122 ± 6 vs 117 ± 8 mmHg, p = 0,014, e 78 ± 6 vs 73 ± 7 mmHg, p = 0,008, respectivamente), bem como maior carga pressórica diastólica noturna (44,6 ± 25,9% vs 31,3 ± 27,3%, p = 0,041). Além disso, houve correlação positiva entre pressão arterial diastólica noturna e IAH (r = 0,43, p < 0,05). Conclusões: Indivíduos obesos assintomáticos com AOS de moderada a grave apresentam maiores valores de PA sistólica e diastólica nas 24 horas em comparação àqueles com AOS ausente/leve, apesar da PA casual normal. Esses resultados indicam que a MAPA pode ser útil na avaliação de pacientes obesos assintomáticos com AOS de moderada à grave.

Abstract Background: Obesity, systemic arterial hypertension (SAH) and obstructive sleep apnea (OSA) are closely related. Up to 70% of patients with OSA may be asymptomatic, and there is evidence that these patients have cardiovascular disease, especially nocturnal SAH. Objectives: The aim of this study was to evaluate 24-hour blood pressure circadian variation in asymptomatic, obese individuals with moderate-to-severe OSA and compare it with that in individuals with mild OSA or without OSA. Methods: Eighty-six obese subjects aged between 30 and 55 years (BMI 30-39 kg/m2), with casual blood pressure < 140/90 mmHg and without comorbidities were recruited. Eighty-one patients underwent clinical and anthropometric assessment, ambulatory blood pressure monitoring (ABPM), and Watch-PAT. Participants were divided into two groups, based on the apnea-hypopnea index (AHI): group 1, with AHI < 15 events/hour, and group 2 with AHI ≥ 15 events/hour. Results: Compared with group 1, group 2 had higher neck circumference and waist-hip circumference (40.5 ± 3.2 cm vs. 38.0 ± 3.7 cm, p = 0.002, and 0.94 ± 0.05 vs. 0.89 ± 0.05, p = 0.001, respectively), higher systolic and diastolic blood pressure measured by the 24-h ABPM (122 ± 6 vs 118 ± 8 mmHg, p = 0.014, and 78 ± 6 vs 73 ± 7 mmHg, p = 0.008, respectively), and higher nocturnal diastolic pressure load (44,6 ± 25,9% vs 31,3 ± 27,3%, p = 0,041). Moreover, there was a positive correlation between nocturnal diastolic blood pressure and AHI (r = 0.43, p < 0.05). Conclusions: Asymptomatic obese subjects with moderate-to-severe OSA have higher systolic and diastolic blood pressure at 24 hours compared with those with absent / mild OSA, despite normal casual blood pressure between the groups. These results indicate that ABPM may be useful in the evaluation of asymptomatic obese patients with moderate-to-severe OSA.