Gil F. Salles

Universidade Federal do Rio de Janeiro

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Claudia R.L. Cardoso

Universidade Federal do Rio de Janeiro

Nathalie C. Leite

Universidade Federal do Rio de Janeiro

Elizabeth Silaid Muxfeldt

Hospital Universitário Clementino Fraga Filho

Cristiane Alves Villela‐Nogueira

Hospital Universitário Clementino Fraga Filho

Roberto Fiszman

Hospital Universitário Clementino Fraga Filho

Kátia Vergetti Bloch

Universidade Federal do Rio de Janeiro

Marcel T. Ferreira

Instituto Evandro Chagas

Armando da Rocha Nogueira

Sociedade Brasileira de Cardiologia

Fábio de Souza

Universidade Federal do Estado do Rio de Janeiro

Ramón C. Hermida

Universidade de Vigo

Cooperative Institutions

Universidade Federal do Rio de Janeiro

137

Sociedade Brasileira de Cardiologia

108

Hospital Universitário Clementino Fraga Filho

Universidade de São Paulo

Universidade do Estado do Rio de Janeiro

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Fundação Oswaldo Cruz

Servier (France)

Abbott (Germany)

Omron (Japan)

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PROGNOSTIC IMPACT OF AORTIC STIFFNESS IN PATIENTS WITH RESISTANT HYPERTENSION

Journal of Hypertension (2019)

Larissa K.C. Gorgonio Claudia R.L. Cardoso Gil F. Salles

Objective: The prognostic importance of aortic stiffness in patients with resistant hypertension has never been investigated. We aimed to evaluate it for the occurrence of adverse cardiovascular outcomes and mortality in a prospective cohort of resistant hypertensive patients. Design and method: Aortic stiffness was assessed by carotid-femoral pulse wave velocity (cf-PWV) at baseline in 891 resistant hypertensive patients who were followed-up for a median of 7.8 years. Multivariate Cox analysis examined the associations between cf-PWV and the occurrence of total cardiovascular events (CVE), major adverse CVEs (MACE), and cardiovascular and all-cause mortalities. The improvement in risk stratification was assessed by C-statistic and the integrated discrimination improvement (IDI) index. Results: During follow-up, 138 patients had a CVE (123 MACE), and 142 patients died (91 from cardiovascular causes). The cf-PWV, analyzed either as a continuous or as a categorical variable, predicted all cardiovascular and mortality outcomes. Patients with increased aortic stiffness (cf-PWV >10m/s after correction for the white-coat effect or uncorrected directly-measured >11m/s) had a significant 2.0 to 2.4-fold increased risk of CVEs and mortality, after adjustments for other risk factors, including 24-hour ambulatory blood pressures and dipping patterns. Aortic stiffness significantly improved cardiovascular risk stratification, with IDI indices ranging from 12% (for total CVEs) to 18% (for MACE). Conclusions: Increased aortic stiffness predicts adverse cardiovascular outcomes and mortality, and improves cardiovascular risk stratification in resistant hypertensive patients. Carotid-femoral PWV measurement should be included into the routine clinical management of patients with resistant hypertension.

Mace

10.1097/01.hjh.0000572060.44805.a7

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Factors associated with microalbuminuria in resistant hypertension

International Journal of Cardiology (2006)

Armando da Rocha Nogueira Aline Silva Fernandes Evandro Silva Freire Coutinho Gil F. Salles Elizabeth Silaid Muxfeld

Microalbuminuria

Albuminuria

10.1016/j.ijcard.2006.08.031

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Citations (8)

P1001 : Carotid-femoral pulse wave velocity (CF-PWV) as a surrogate marker of advanced liver fibrosis in type-2 diabetic (T2DM) patients evaluated by transient hepatic elastography

Journal of Hepatology (2015)

Nathalie C. Leite Marcel T. Ferreira Gil F. Salles Claudia R.L. Cardoso C.A. Villela- Nogueira

Transient elastography

Surrogate endpoint

10.1016/s0168-8278(15)31202-2

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Dynamic changes in liver stiffness assessed by transient elastography as a prognostic factor in NAFLD patients with prediabetes and type 2 diabetes

Journal of Hepatology (2023)

Elias Maleh Claudia Regina Cardoso Gil F. Salles Ana Carolina Cardoso Lorrane V. Santos

Transient elastography

Prediabetes

10.1016/s0168-8278(23)02012-3

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Prognostic value of ventricular repolarization prolongation in resistant hypertension: a prospective cohort study

Journal of Hypertension (2009)

Gil F. Salles Claudia RL Cardoso Elizabeth Silaid Muxfeldt

Objective The prognostic value of prolonged ventricular repolarization in patients with resistant hypertension is unknown. The aim of this prospective study was to investigate the usefulness of electrocardiographic QT-interval parameters as predictors of cardiovascular morbidity and mortality. Methods At baseline, 538 resistant hypertensive patients had five QT-interval components measured in standard 12-lead ECGs: maximum QRS, QTpeak, QTend, JT and Tpeak-to-end-interval durations. Primary endpoints were a composite of fatal and nonfatal cardiovascular events, all-cause and cardiovascular mortalities. Multiple Cox regression assessed the associations between QT-interval parameters and subsequent endpoints. Results After a median follow-up of 4.8 years, 69 (12.8%) patients died, 46 from cardiovascular causes, and 107 (19.9%) fatal or nonfatal cardiovascular events occurred. After adjustment for several traditional risk factors, including 24-h ambulatory systolic blood pressure, an increment of 1 SD (35 ms) in QTcend-interval was associated with hazard ratios of 1.38 (1.15–1.67), 1.51 (1.16–1.98) and 1.30 (1.03–1.64), respectively, for the composite endpoint, cardiovascular mortality and all-cause mortality. Further adjustment for left ventricular hypertrophy attenuated the relative risks, but they remained significant for cardiovascular mortality (1.45, 1.07–1.97) and for the composite endpoint (1.35, 1.11–1.66). After full adjustment, a prolonged QTcend-interval (≥460 ms) conferred a 1.7-fold (1.1–2.6) higher risk of having a future fatal or nonfatal cardiovascular event. No other QT-interval component added further prognostic information to QTcend-interval duration. Conclusions Prolonged ventricular repolarization is a risk marker for cardiovascular morbidity and mortality in patients with resistant hypertension, over and beyond traditional cardiovascular risk factors, including ambulatory blood pressure and left ventricular hypertrophy.

Clinical endpoint

10.1097/hjh.0b013e32832720b3

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Citations (28)

Prevalence of subclinical hypercortisolism in type 2 diabetic patients from the Rio de Janeiro Type 2 Diabetes Cohort Study

Journal of Diabetes and its Complications (2016)

Denise Costa Flávia Lúcia Conceição Nathalie C. Leite Marcel T. Ferreira Gil F. Salles

Subclinical infection

Dexamethasone suppression test

10.1016/j.jdiacomp.2016.05.006

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Citations (14)

High fitness is associated with a better cardiovascular risk profile in patients with type 2 diabetes mellitus

Hypertension Research (2011)

Claudia RL Cardoso Maicon Maia Fátima Palha de Oliveira Nathalie C. Leite Gil F. Salles

10.1038/hr.2011.50

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Citations (17)

Prognostic impact from clinic, daytime, and night-time systolic blood pressure in nine cohorts of 13 844 patients with hypertension

Journal of Hypertension (2014)

George C. Roush Robert Fagard Gil F. Salles Sante D. Pierdomenico Gianpaolo Reboldi

Background and method: To determine which SBP measure best predicts cardiovascular events (CVEs) independently, a systematic review was conducted for cohorts with all patients diagnosed with hypertension, 1+ years follow-up, and coronary artery disease and stroke outcomes. Lead investigators provided ad hoc analyses for each cohort. Meta-analyses gave hazard ratios from clinic SBP (CSBP), daytime SBP (DSBP), and night-time SBP (NSBP). Coefficients of variation of SBP measured dispersion. Nine cohorts (n = 13 844) were from Europe, Brazil, and Japan. For sleep–wake SBP classification, seven cohorts used patient-specific information. Results: Overall, NSBP's dispersion exceeded DSBP's dispersion by 22.6% with nonoverlapping confidence limits. Within all nine cohorts, dispersion for NSBP exceeded that for CSBP and DSBP. For each comparison, P = 0.004 that this occurred by chance. Considered individually, increases in NSBP, DSBP, and CSBP each predicted CVEs: hazard ratios (95% confidence intervals) = 1.25 (1.22–1.29), 1.20 (1.15–1.26), and 1.11 (1.06–1.16), respectively. However, after simultaneous adjustment for all three SBPs, hazard ratios were 1.26 (1.20–1.31), 1.01 (0.94–1.08), and 1.00 (0.95–1.05), respectively. Cohorts with baseline antihypertensive treatment and cohorts with patient-specific information for night–day BP classification gave similar results. Within most cohorts, simultaneously adjusted hazard ratios were greater for NSBP than for DSBP and CSBP: P = 0.023 and 0.012, respectively, that this occurred by chance. Conclusion: In hypertensive patients, NSBP had greater dispersion than DSBP and CSBP in all cohorts. On simultaneous adjustment, compared with DSBP and CSBP, increased NSBP independently predicted higher CVEs in most cohorts, and, overall, NSBP independently predicted CVEs, whereas CSBP and DSBP lost their predictive ability entirely.

Stroke

Post-hoc analysis

10.1097/hjh.0000000000000355

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Citations (246)

Prognostic Effect of the Nocturnal Blood Pressure Fall in Hypertensive Patients

Hypertension (2016)

Gil F. Salles Gianpaolo Reboldi Robert Fagard Claudia R.L. Cardoso Sante D. Pierdomenico

The prognostic importance of the nocturnal systolic blood pressure (SBP) fall, adjusted for average 24-hour SBP levels, is unclear. The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) examined this issue in a meta-analysis of 17 312 hypertensives from 3 continents. Risks were computed for the systolic night-to-day ratio and for different dipping patterns (extreme, reduced, and reverse dippers) relative to normal dippers. ABC-H investigators provided multivariate adjusted hazard ratios (HRs), with and without adjustment for 24-hour SBP, for total cardiovascular events (CVEs), coronary events, strokes, cardiovascular mortality, and total mortality. Average 24-hour SBP varied from 131 to 140 mm Hg and systolic night-to-day ratio from 0.88 to 0.93. There were 1769 total CVEs, 916 coronary events, 698 strokes, 450 cardiovascular deaths, and 903 total deaths. After adjustment for 24-hour SBP, the systolic night-to-day ratio predicted all outcomes: from a 1-SD increase, summary HRs were 1.12 to 1.23. Reverse dipping also predicted all end points: HRs were 1.57 to 1.89. Reduced dippers, relative to normal dippers, had a significant 27% higher risk for total CVEs. Risks for extreme dippers were significantly influenced by antihypertensive treatment (P<0.001): untreated patients had increased risk of total CVEs (HR, 1.92), whereas treated patients had borderline lower risk (HR, 0.72) than normal dippers. For CVEs, heterogeneity was low for systolic night-to-day ratio and reverse/reduced dipping and moderate for extreme dippers. Quality of included studies was moderate to high, and publication bias was undetectable. In conclusion, in this largest meta-analysis of hypertensive patients, the nocturnal BP fall provided substantial prognostic information, independent of 24-hour SBP levels.

10.1161/hypertensionaha.115.06981

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Citations (447)

Electronic Health Record in medical education: perceptions of teachers and preceptors

Figshare (2022)

Ana Maria Pereira Rangel Miriam Struchiner Gil F. Salles

Abstract: Introduction: The implementation of the Electronic Health Record (EHR) in hospital teaching units has promoted the integration of Health Information Technology (HIT) into medical education and clinical practice. Objective: The study analyzed teachers and preceptors’ perceptions about the integration of EHR in curricular practices at a public university. Method: A qualitative study, in which data was collected through semi-structured interviews with six medical professors and four preceptors. The study adopted as categories of analysis the domains of competences and learning results from the use of EHR, identified and improved in a British multicenter study (Digital Health, Data Access and Generation, Communication, Multiprofessional Work, Accompaniment and Monitoring). A new category entitled “Pedagogical Issues”, was included to stimulate subjects’ reflections on their pedagogical practices with the EHR. Thematic content analysis was used for data analysis. Results: Teachers and preceptors agree that students need formal guidance on how to use HIT in their educational and professional development, and to preserve the secrecy and confidentiality of information during patient care using the EHR. For them, the use of decision support systems associated with EHR contributes to the teaching-learning process, in addition to allowing greater visibility of information from other health professionals, and facilitates student access to patients’ clinical data. EHR is a support tool that has the potential to promote the use of active methodologies, to contextualize teaching, to provide student autonomy and authorship, and to instigate them in the search for knowledge. Conclusion: HIT curricular integration has been pointed out as a way for students to develop clinical competences and skills, when using EHR in their clinical practice units.

Electronic health record

Electronic medical record

10.6084/m9.figshare.19945732

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