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Navegando FM - Artigos publicados em periódicos por Autor "Afiune Neto, Abrahão"
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Item A comparison between diuretics and angiotensin- receptor blocker agents in patients with stage I hypertension (PREVER-treatment trial): study protocol for a randomized double-blind controlled trial(2011) Fuchs, Flávio Danni; Fuchs, Sandra Cristina Pereira Costa; Moreira, Leila Beltrami; Gus, Miguel; Nóbrega, Antonio Claudio Lucas da; Figueiredo, Carlos Eduardo Poli de; Mion Junior, Decio; Bortolotto, Luiz Aparecido; Consolim-Colombo, Fernanda Marciano; Nobre, Fernando; Coelho, Eduardo Barbosa; Martin, Jose Fernando Vilela; Moreno Junior, Heitor; Cesarino, Evandro José; Franco, Roberto Jorge da Silva; Brandão, Andréa Araujo; Sousa, Marcos Roberto de; Ribeiro, Antônio Luiz Pinho; Jardim, Paulo Cesar Brandao Veiga; Afiune Neto, Abrahão; Scala, Luíz Cesar Nazário; Gomes, Marco Antônio Mota; Chaves Júnior, Hilton de Castro; Alves, João Guilherme Bezerra; Sobral Filho, Dário Celestino; Silva, Ricardo Pereira e; Figueiredo Neto, José Albuquerque de; Irigoyen, Maria Claudia Costa; Castro, Iran; Steffens, André Avelino; Schlatter, Rosane Paixão; Mello, Renato Gorga Bandeira de; Mosele, Francisca; Ghizzoni, Flávia; Berwanger, OtávioBackground: Cardiovascular disease is the leading cause of death in Brazil, and hypertension is its major risk factor. The benefit of its drug treatment to prevent major cardiovascular events was consistently demonstrated. Angiotensin-receptor blockers (ARB) have been the preferential drugs in the management of hypertension worldwide, despite the absence of any consistent evidence of advantage over older agents, and the concern that they may be associated with lower renal protection and risk for cancer. Diuretics are as efficacious as other agents, are well tolerated, have longer duration of action and low cost, but have been scarcely compared with ARBs. A study comparing diuretic and ARB is therefore warranted. Methods/design: This is a randomized, double-blind, clinical trial, comparing the association of chlorthalidone and amiloride with losartan as first drug option in patients aged 30 to 70 years, with stage I hypertension. The primary outcomes will be variation of blood pressure by time, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new subclinical atherosclerosis and sudden death. The study will last 18 months. The sample size will be of 1200 participants for group in order to confer enough power to test for all primary outcomes. The project was approved by the Ethics committee of each participating institution. Discussion: The putative pleiotropic effects of ARB agents, particularly renal protection, have been disputed, and they have been scarcely compared with diuretics in large clinical trials, despite that they have been at least as efficacious as newer agents in managing hypertension. Even if the null hypothesis is not rejected, the information will be useful for health care policy to treat hypertension in Brazil.Item Prevention of hypertension in patients with pre-hypertension: protocol for the PREVER-prevention trial(2011) Fuchs, Flavio Danni; Fuchs, Sandra Cristina Pereira Costa; Moreira, Leila Beltrami; Gus, Miguel; Nóbrega, Antonio Claudio Lucas da; Figueiredo, Carlos Eduardo Poli de; Mion Junior, Decio; Bortolotto, Luiz Aparecido; Consolim-Colombo, Fernanda Marciano; Nobre, Fernando; Coelho, Eduardo Barbosa; Martin, Jose Fernando Vilela; Moreno Junior, Heitor; Cesarino, Evandro José; Franco, Roberto Jorge da Silva; Brandão, Andréa Araujo; Sousa, Marcos Roberto de; Ribeiro, Antônio Luiz Pinho; Jardim, Paulo Cesar Brandao Veiga; Afiune Neto, Abrahão; Scala, Luíz Cesar Nazário; Gomes, Marco Antônio Mota; Chaves Júnior, Hilton de Castro; Alves, João Guilherme Bezerra; Sobral Filho, Dário Celestino; Silva, Ricardo Pereira e; Figueiredo Neto, José Albuquerque de; Irigoyen, Maria Claudia Costa; Castro, Iran; Steffens, André Avelino; Schlatter, Rosane Paixão; Mello, Renato Gorga Bandeira de; Mosele, Francisca; Ghizzoni, Flávia; Berwanger, OtávioBackground: Blood pressure (BP) within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a population- based intervention to prevent the incidence of hypertension and the development of target-organ damage. Methods: This is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution. Discussion: The early use of blood pressure-lowering drugs, particularly diuretics, which act on the main mechanism of blood pressure rising with age, may prevent cardiovascular events and the incidence of hypertension in individuals with hypertension. If this intervention shows to be effective and safe in a population- based perspective, it could be the basis for an innovative public health program to prevent hypertension in Brazil.Item Vascular calcifications seen on mammography: an independent factor indicating coronary artery disease(2009) Oliveira, Evelling Lorena Cerqueira de; Freitas Júnior, Ruffo de; Afiune Neto, Abrahão; Murta, Eddie Fernando Candido; Ferro, Júlio Eduardo; Rocha, Aline Ferreira Bandeira de MeloPURPOSE: Establish a relationship between vascular calcifications seen via mammography and coronary artery disease, estimate the risk ratios, and investigate the interrelationships between vascular calcification and other risk factors for coronary artery disease. MATERIALS AND METHODS: This was a case-control study consisting of 40 women with coronary artery disease in the case group and 40 women without any history of coronary artery disease in the control group who were matched according to age. The study was approved by the Institution’s Research Ethics Committee (consent statement was obtained). Odds ratios and confidence intervals were calculated using univariate analysis. Interrelationships among other risk factors, such as arterial hypertension, dys- lipidemia, smoking and diabetes mellitus, were calculated using multivariate analysis. A p <0.05 was considered to be significant for statistical analysis. RESULTS: The mean ages for the case and control groups were 64.65 years and 63.88 years, respectively. In multivariate analy- sis, the only variables related to coronary artery disease were Vascular calcification [OR 4.71 (CI 1.36-16.33) p=0.014], family history [OR 5.76 (CI 1.58-21.03) p=0.008] and arterial hypertension [OR 15.92 (CI 3.12-81.14) p=0.001]. Although smoking and diabetes are important variables in the pathogenesis of coronary artery disease, these factors did not show statistically significant associations in this sample. CONCLUSION: The presence of vascular calcifications seen via mammography was an independent risk factor for coronary artery disease, as were hypertension and a family history of coronary artery disease.