Alterações cardiometabólicas em mulheres hipertensas com obesidade abdominal

• Autor(a) principal: Isbele, Tárik de Almeida
• Data de Publicação: 2009
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/8661
• topic: Hypertension; Abdominal obesity; Metabolic syndrome; Cardiovascular risk; Insulin resistance; Hipertensão; Obesidade abdominal; Síndrome metabólica; Risco cardiovascular; Resistência à insulina; Doenças cardiovasculares; CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::CARDIOLOGIA

Observational studies have demonstrated that weight gain and increase of abdominal circumference are important prognostic indexes in hypertension, and abdominal obesity is a relevant marker of increased cardiovascular risk. The purpose of this study was to identify metabolic and cardiac alterations in a sample of non-diabetic hypertensive women with abdominal obesity. In a cross-sectional study, 120 hypertensive women aged 40-65 years were included and separated in groups without abdominal obesity (AO-, n=42) and with abdominal obesity (AO+, n=78) according waist circumference < or ≥ 88cm, respectively. The participants of this study were submitted to clinical and anthropometric evaluation, and blood and urine were collected for biochemical tests. Afterwards, electrocardiography, echocardiography, and carotid ultrasound were performed. The mean age was 53 years in both groups. The diastolic blood pressure was significantly higher in the group AO+ (90±1 vs 85±1 mmHg, p<0.05). On the other hand, the systolic blood pressure, although higher among obese women, did not reach statistical significance (145±2 vs 140±2 mmHg, p=0.0979). The group AO+ presented greater number of criteria (3.1±0.1 vs 1.4±0.1, p<0.001) and greater prevalence (62.8 vs 11.9%, p<0.001) of metabolic syndrome, with similar Framingham risk score between the two groups. Despite normal and similar serum glucose levels in both groups, patients AO+ presented significantly higher indexes of HOMA-IR (2.62±0.22 vs 1.61±0.17 p<0.01) and HOMA-beta (358±57 vs 200±22 p<0.05). This group also demonstrated significantly greater values of C-reactive protein (0.49±0.05 vs 0.26±0.05mg/dl, p<0.01), uric acid (5.2±0.1 vs 4.2±0.1 mg/dl, p<0.001) and triglycerides (139±8 vs 107±9 mg/dl, p<0.05), and lower HDL-cholesterol levels (49±1 vs 55±2 mg/dl, p<0.05). In echocardiography, the systolic function was comparable between the two groups, but the patients AO+ presented evidences of diastolic dysfunction by tissue Doppler. The patients AO- presented predominantly normal geometry (75%) of left ventricle, while the group AO+ had a higher prevalence of left ventricle hypertrophy (29.2 vs 2.4%). There was no difference between the two groups concerning carotid intima-media thickness. In conclusion, in this sample of middle-age non-diabetic hypertensive women, abdominal obesity was associated with insulin resistance and structural and functional cardiac alterations, with no evidences of atherosclerotic process.