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INTRODUCTION: Coenzyme Q10 (CoQ10) has shown promising results as an adjuvant therapy to statins. However, the efficacy of this agent is still unclear. Hypothesis: The use of CoQ10 mitigates statin-related myopathic pain. METHODS: PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing CoQ10 supplementation with placebo in patients taking statins. A random-effects model was employed to compute the mean difference (MD) with 95% confidence interval (CI). Statistical analysis was performed using R software 4.3.1. RESULTS: A total of 5 studies and 227 patients were included, of whom 48% were randomized to CoQ10 supplementation. Compared with placebo, CoQ10 had no effects on pain severity score (MD -0.94; 95% CI -3.80 to 1.91; p=0.5), and pain intensity score (MD -1.51; 95% CI -4.09 to 1.06; p = 0.2). Moreover, no association was found with low density lipoprotein cholesterol levels (MD -0.07; 95% CI -0.47 to 0.34; p = 0.7). CONCLUSIONS: In this meta-analysis of 5 RCTs, supplementation with CoQ10 did not yield statistically significant results. These findings suggest that CoQ10 has no impact on statin-related myopathic pain.
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BACKGROUND: Obesity represents a major obstacle for controlling hypertension, the leading risk factor for cardiovascular mortality. OBJECTIVES: The purpose of this study was to determine the long-term effects of bariatric surgery on hypertension control and remission. METHODS: We conducted a randomized clinical trial with subjects with obesity grade 1 or 2 plus hypertension using at least 2 medications. We excluded subjects with previous cardiovascular events and poorly controlled type 2 diabetes. Subjects were assigned to Roux-en-Y gastric bypass (RYGB) combined with medical therapy (MT) or MT alone. We reassessed the original primary outcome (reduction of at least 30% of the total antihypertensive medications while maintaining blood pressure levels <140/90 mm Hg) at 5 years. The main analysis followed the intention-to-treat principle. RESULTS: A total of 100 subjects were included (76% women, age 43.8 ± 9.2 years, body mass index: 36.9 ± 2.7 kg/m2). At 5 years, body mass index was 36.40 kg/m2 (95% CI: 35.28-37.52 kg/m2) for MT and 28.01 kg/m2 (95% CI: 26.95-29.08 kg/m2) for RYGB (P < 0.001). Compared with MT, RYGB promoted a significantly higher rate of number of medications reduction (80.7% vs 13.7%; relative risk: 5.91; 95% CI: 2.58-13.52; P < 0.001) and the mean number of antihypertensive medications was 2.97 (95% CI: 2.33-3.60) for MT and 0.80 (95% CI: 0.51-1.09) for RYGB (P < 0.001). The rates of hypertension remission were 2.4% vs 46.9% (relative risk: 19.66; 95% CI: 2.74-141.09; P < 0.001). Sensitivity analysis considering only completed cases revealed consistent results. Interestingly, the rate of apparent resistant hypertension was lower after RYGB (0% vs 15.2%). CONCLUSIONS: Bariatric surgery represents an effective and durable strategy to control hypertension and related polypharmacy in subjects with obesity. (GAstric bypass to Treat obEse Patients With steAdy hYpertension [GATEWAY]; NCT01784848).
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Objective: Left ventricular hypertrophy (LVH) is a prevalentcondition in chronic kidney disease (CKD) very oftenunderdiagnosed and misdiagnosed. Electrocardiography(ECG) is an easily accessible LVH diagnostic tool. Weevaluated the usefulness of commonly applied ECG criteriafor LVH diagnosis in CKD patients.Methods: Cross-sectional evaluation of 253 nondialysisdependentCKD stages 35 patients (61 [5367] years;65% men). Left ventricular mass (LVM) was assessed byechocardiography (ECHO). ECG was performed to assessCornell voltage and SokolowLyon voltage and theirproducts (Cornell product and SokolowLyon product,respectively).Results: The prevalence of LVH ranged from 72 to 89%depending on ECHO criteria used. Cornell product showedthe best correlation with ECHO-estimated LVM (r»0.41;P<0.001). Across sex-specific tertiles of ECHO-LVM, ECGcriteria increased and patients were more oftenhypertensive, obese, fluid overloaded, inflamed, and withhigher albuminuria. Cornell product showed the strongestassociation with ECHO-LVM in crude and adjustedregression models, and the higher predictive performancefor all the ECHO-based LVH definitions. However, whenapplying literature-based ECG cut-offs for LVH diagnosis,SokolowLyon product showed a higher specificity. Theagreement between ECG criteria cut-offs and ECHO-baseddefinitions of LVH was in general poor, and the number ofpatients reclassified correctly by ECHO ranged from 77 to94%.Conclusion: Our data suggest that ECG alone is a weakindicator of LVH, and do not support its routine use as aunique tool in the screening of LVH in CKD patients.Further studies are needed to confirm these results and totry establishing adequate cut-offs for LVH diagnosis in thispopulation.
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Albuminúria , Doenças Cardiovasculares , UremiaRESUMO
Recognition and treatment of secondary causes of hypertension among patients with resistant hypertension may help to control blood pressure and reduce cardiovascular risk. However, there are no studies systematically evaluating secondary causes of hypertension according to the Seventh Joint National Committee. Consecutive patients with resistant hypertension were investigated for known causes of hypertension irrespective of symptoms and signs, including aortic coarctation, Cushing syndrome, obstructive sleep apnea, drugs, pheochromocytoma, primary aldosteronism, renal parenchymal disease, renovascular hypertension, and thyroid disorders. Among 125 patients (age: 52±1 years, 43% males, systolic and diastolic blood pressure: 176±31 and 107±19 mm Hg, respectively), obstructive sleep apnea (apnea-hypopnea index: >15 events per hour) was the most common condition associated with resistant hypertension (64.0%), followed by primary aldosteronism (5.6%), renal artery stenosis (2.4%), renal parenchymal disease (1.6%), oral contraceptives (1.6%), and thyroid disorders (0.8%). In 34.4%, no secondary cause of hypertension was identified (primary hypertension). Two concomitant secondary causes of hypertension were found in 6.4% of patients. Age >50 years (odds ratio: 5.2 [95% CI: 1.9-14.2]; P<0.01), neck circumference ≥41 cm for women and ≥43 cm for men (odds ratio: 4.7 [95% CI: 1.3-16.9]; P=0.02), and presence of snoring (odds ratio: 3.7 [95% CI: 1.3-11]; P=0.02) were predictors of obstructive sleep apnea. In conclusion, obstructive sleep apnea appears to be the most common condition associated with resistant hypertension. Age >50 years, large neck circumference measurement, and snoring are good predictors of obstructive sleep apnea in this population.
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Resistência a Medicamentos , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Apneia Obstrutiva do Sono/complicações , Idoso , Análise de Variância , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial , Brasil , Estudos de Coortes , Feminino , Seguimentos , Humanos , Hiperaldosteronismo/complicações , Hiperaldosteronismo/diagnóstico , Hipertensão/epidemiologia , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Polissonografia/métodos , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologiaRESUMO
Recognition and treatment of secondary causes of hypertension among patients with resistant hypertension mayhelp to control blood pressure and reduce cardiovascular risk. However, there are no studies systematically evaluatingsecondary causes of hypertension according to the Seventh Joint National Committee. Consecutive patients withresistant hypertension were investigated for known causes of hypertension irrespective of symptoms and signs, includingaortic coarctation, Cushing syndrome, obstructive sleep apnea, drugs, pheochromocytoma, primary aldosteronism, renalparenchymal disease, renovascular hypertension, and thyroid disorders. Among 125 patients (age: 52 1 years, 43%males, systolic and diastolic blood pressure: 176 31 and 107 19 mm Hg, respectively), obstructive sleep apnea(apnea-hypopnea index: 15 events per hour) was the most common condition associated with resistant hypertension(64.0%), followed by primary aldosteronism (5.6%), renal artery stenosis (2.4%), renal parenchymal disease (1.6%),oral contraceptives (1.6%), and thyroid disorders (0.8%). In 34.4%, no secondary cause of hypertension was identified(primary hypertension). Two concomitant secondary causes of hypertension were found in 6.4% of patients. Age 50years (odds ratio: 5.2 [95% CI: 1.9 14.2]; P 0.01), neck circumference 41 cm for women and 43 cm for men (oddsratio: 4.7 [95% CI: 1.316.9]; P 0.02), and presence of snoring (odds ratio: 3.7 [95% CI: 1.311]; P 0.02) werepredictors of obstructive sleep apnea. In conclusion, obstructive sleep apnea appears to be the most common conditionassociated with resistant hypertension. Age 50 years, large neck circumference measurement, and snoring are goodpredictors of obstructive sleep apnea in this population.
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Causalidade , Hipertensão , Pressão Arterial , Síndromes da Apneia do SonoRESUMO
A hipertensão sistólica isolada (HSI) é definida como pressão arterial sistólica > 140 mmHg e pressão arterial diastólica < 90 mmHg, sendo a forma mais prevalente de elevação da pressão arterial em pacientes acima de 50 anos de idade. Vários fatores têm sido considerados possíveis moduladores do desenvolvimento progressivo da HSI. Estão associados ao seu desenvolvimento os hábitos nutricionais com maior ingestão de sal ao longo da vida, o remodelamento vascular,a rigidez arterial, a ativação do sistema renina-angiotensina aldosterona(SRAA), entre outros diversos fatores que ainda necessitam ser mais bem estudados.
Isolated systolic hypertension (ISH) is defined as systolic blood pressure > 140 mmHg and diastolic blood pressure < 90 mmHg. ISH is the most prevalent form of hypertension in individuals aged above 50 years. Several factors determine the development of ISH, as increased salt intake during life time, vascular remodeling, arterial stiffness, renin-angiotensin-aldosterone system activation, and other factors that should be better evaluated.
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Humanos , Pessoa de Meia-Idade , Hipertensão/fisiopatologia , Pressão Arterial/fisiologiaAssuntos
Humanos , Masculino , Idoso , Hiperaldosteronismo/complicações , Hiperaldosteronismo/diagnósticoRESUMO
OBJECTIVES: To compare the morbidity and mortality of patients with and without metabolic syndrome (MS) (according to the First Brazilian Guidelines for Diagnosis and Treatment of MS) undergoing coronary artery bypass graft (CABG) during hospitalization and after 30 days. METHODS: A total of 107 patients who underwent CABG with no associated procedures were assessed between August and October 2005; 74 (69.2%) of them had MS. Criteria of in-hospital outcome were: acute atrial fibrillation (AF), prolonged mechanical ventilation (MV), need for transfusion of blood products, number of hours spent in the ICU, length of hospital stay (days), respiratory and surgical wound infection, and death. For 30 days, the combination of events such as the need for readmission to hospital, surgical wound infection and death was assessed. RESULTS: The mean age was 60.6 +/- 9.7 years, and the group with MS presented a higher body mass index and body surface, and a higher prevalence of diabetes. No statistically significant difference was observed in the occurrence of in-hospital events such as AF (15.2% vs. 16.2%), MV (3.0% vs. 2.7%), number of units of blood products used (3.2 +/- 2.7 vs. 2.6 +/- 2.9), length of ICU stay (53.7 +/- 27.3 vs. 58.9 +/- 56.5), length of hospital stay (9.2 +/- 8.7 x 8.5 +/- 8.5), respiratory infection (6.1% vs. 2.7%), surgical wound infection (3.0% vs. 5.4%), and mortality rate (3.0% vs. 0.0%). The occurrence of combined events in 30 days was similar in both groups (12.2% vs. 20.3%, p = NS). CONCLUSION: Patients with MS did not have increased morbidity and mortality when undergoing CABG, however they had a higher trend of occurrence of surgical wound infection.