Paulo Henrique Waib | Faculdade de Medicina de Marília (original) (raw)

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Papers by Paulo Henrique Waib

Hipertension is a highly prevalent disease that often goes indetected and is associated with othe... more Hipertension is a highly prevalent disease that often goes indetected and is associated with other comorbities and risk factors that create high costs and overhead. Lowering of blood pressure and prevention of hypertension is in first instance preferable by lifestyle changes with aerobic exercise being an integral component. However it has been neglected frequently by heatlh care programs that has costly medication actions instead. To investigate the aerobictraining/detraining effects on blood pressure (BP) efficiency and costs the study involved 80 adults, overweight men who were not taking antihypertensive medications or dieting, and were accomplished to all intervention tasks. Based on

Arq. bras. cardiol, Jan 1, 1995

Circulation, Jan 1, 2003

Background-The information that insulin sensitivity and glycogen synthesis are reduced in hyperte... more Background-The information that insulin sensitivity and glycogen synthesis are reduced in hypertension arises primarily from studies using insulin infusions. Whether glycogen metabolism is actually altered in a physiological condition, such as during and after prolonged exercise, is currently unknown. Methods and Results-To examine this issue, 9 hypertensive and 11 normotensive subjects were evaluated on a rest day and after intense and prolonged exercise on a separate day. Insulin sensitivity and hemodynamic variables were measured on both days. On the exercise day, whole-body substrate utilization was assessed and muscle biopsies were taken in the leg at baseline, immediately after exercise, and 2.5 and 4 hours after exercise. Insulin sensitivity at rest was lower in hypertensive than normotensive subjects (PϽ0.05) and increased after exercise in normotensive (PϽ0.01) but not in hypertensive (PϭNS) subjects. Leg blood flow increased after exercise in both groups but to a lesser extent in hypertensive than normotensive subjects. Baseline glycogen content and maximal glycogen synthase activity were higher in hypertensive than normotensive subjects (PϽ0.001). Glycogen concentration decreased relatively less (Ϫ35 versus Ϫ66%) and returned to baseline levels faster in hypertensive subjects after exercise. Hypertensive subjects used Ϸ40% less carbohydrates during exercise (PϽ0.001) at the expense of greater free fatty acid oxidation. Conclusions-It is concluded that increased intramuscular glycogen storage and resynthesis in hypertension are independent of blood flow and may represent compensatory mechanisms for the reduced insulin sensitivity and carbohydrate metabolism in this condition.

Arq. bras. cardiol, Jan 1, 1991

Revista de Saúde …, Jan 1, 2002

... Instituição: São Paulo (Estado). Secretaria de Desenvolvimento. Faculdade de Medicina de Mari... more ... Instituição: São Paulo (Estado). Secretaria de Desenvolvimento. Faculdade de Medicina de Marilia (FAMEMA). Processo: 98/15931-8. Início: 01 de agosto de 2000. Término: 31 de julho de 2007. Área do conhecimento: Ciências da saúde - Medicina. ...

Abstract Orientador: Roberto Jorge da Silva Franco. Co-orientador: Paulo Henrique Waib. Resumo: O... more Abstract Orientador: Roberto Jorge da Silva Franco. Co-orientador: Paulo Henrique Waib. Resumo: O exercício físico aeróbio tem sido proposto como medida não medicamentosa para o tratamento da hipertensão. Apesar de existirem trabalhos científicos realizados ...

Abstract Este trabalho foi realizado no periodo de marco de 1991 a dezembro de 1993, tendo como o... more Abstract Este trabalho foi realizado no periodo de marco de 1991 a dezembro de 1993, tendo como objetivo avaliar o efeito de diferentes protocolos de atividade fisica sobre a pressao arterial e capacidade aerobia de individuos adultos do sexo masculino, com ...

…, Jan 1, 2002

Physical exercise increases insulin sensitivity in conditions associated with insulin resistance,... more Physical exercise increases insulin sensitivity in conditions associated with insulin resistance, such as obesity and diabetes, but little is known in this regard in hypertension. Whether postexercise changes in hemodynamics and/or changes in insulin-induced vasodilatation could contribute to a postexercise increase in insulin sensitivity in hypertensive subjects is unknown. We investigated the effects of acute physical exercise on insulin sensitivity in 10 hypertensive and 10 normotensive subjects during a control evaluation (CTRL), during lower body negative pressure (LBNP), after 30 minutes of mild bicycle exercise (POSTEX), and during LBNP after exercise (POSTEXϩLBNP). Insulin-induced vasodilatation was assessed from peak forearm blood flow during the intravenous glucose tolerance test. Cardiac output (4.9Ϯ0.3 versus 5.3Ϯ0.4 L/min, meanϮSEM) and insulin sensitivity (the glucose disappearance rate over insulin area under the curve: 0.91Ϯ0.07 versus 1.38Ϯ0.25 min Ϫ1 /[pmol · L Ϫ1 ] · minute) were lower (both PϽ0.05) in hypertensive than in normotensive subjects, respectively. Cardiac output decreased during LBNP, increased during POSTEX, and was similar to control during POSTEXϩLBNP in both groups. Insulin sensitivity was unchanged during LBNP, increased during POSTEX, and remained elevated during POSTEXϩLBNP in hypertensive subjects, whereas it remained unchanged in normotensives. Peak forearm blood flow was significantly lower in hypertensive than in normotensive subjects, despite higher insulin levels in hypertensives, and was not modified by LBNP or exercise. In conclusion, insulin sensitivity increases after exercise in hypertensive subjects, and the increase in cardiac output does not contribute to this effect. Endogenous insulin-induced vasodilatation is reduced in hypertensive subjects, and this insulin action is not affected by physical exercise. (Hypertension. 2002;39:989-995.)

The American journal of …, Jan 1, 2007

Doppler echocardiography has been used for the diagnosis of anthracycline-induced cardiotoxicity.... more Doppler echocardiography has been used for the diagnosis of anthracycline-induced cardiotoxicity. However, few data are available that include asymptomatic children previously treated with a low cumulative dose of this drug and therefore have a low risk of cardiac dysfunction. The aim of this study was to evaluate after-exercise cardiac function in asymptomatic children previously treated with a low cumulative dose of anthracycline and no clinical or laboratory evidence of cardiotoxicity. Doppler echocardiography was performed before and immediately after physical exercise in 29 children aged 5 to 17 years (anthracycline [ADRIA] group). All had finished cancer treatment with anthracycline derivatives for >1 year (cumulative dose 100 mg/m 2 ). Results were compared with those from age-and gender-matched healthy children (control group; n ‫؍‬ 26) using the Mann-Whitney rank test. Exercise-induced cardiac function changes within groups were analyzed using Wilcoxon's signed-rank test. Exercise induced significant increases in left ventricular systolic function indexes in both groups. However, the ADRIA group had significantly lower changes in left ventricular ejection fraction (ADRIA group 0.71 ؎ 0.02 vs 0.80 ؎ 0.04 and control group 0.71 ؎ 0.02 vs 0.89 ؎ 0.05, p ‫؍‬ 0.0017) and end-systolic stress-volume index (ADRIA group 4.59 ؎ 0.69 vs 6.4 ؎ 2.0 g.cm ؊2 /ml.m ؊2 and control group 5.49 ؎ 0.98 vs 11.54 ؎ 2.86 g.cm ؊2 /ml.m ؊2 ; p <0.0001), indicating decreased functional systolic reserve. In conclusion, asymptomatic children previously treated with low cumulative doses of anthracycline had decreased functional systolic reserve evidenced by exercise, suggesting a nonclinically manifested cardiotoxicity.

Journal of …, Jan 1, 1998

Evaluate the effects of 2 weeks of treatment with tasosartan (1) on cardiac function at rest and ... more Evaluate the effects of 2 weeks of treatment with tasosartan (1) on cardiac function at rest and during submaximal exercise, (2) on exercise peak oxygen uptake, and (3) on regional haemodynamics at rest in a control condition and during the recovery period of submaximal exercise in patients with essential hypertension. Twenty-four patients with moderate hypertension participated in this randomized, double-blind, crossover, placebo-controlled study. Each patient received tasosartan (100 mg/day) or placebo during two periods of 2 weeks separated by 2 weeks of washout. Ambulatory blood pressure was assessed at the end of each period. Blood pressure, heart rate, cardiac output, stroke volume, total peripheral resistance were measured at rest and during submaximal exercise at the same end points. Regional blood flow and vascular resistance were additionally assessed in the forearm and calf at rest. At rest in the control condition, tasosartan significantly reduced blood pressure although total peripheral resistance, cardiac output and stroke volume as well as forearm and calf vascular resistances were not significantly affected compared to placebo. During submaximal exercise and during the recovery period after submaximal exercise, the reduced blood pressure found with tasosartan was associated with a reduced total peripheral resistance compared to placebo whereas cardiac output, heart rate, or stroke volume were not affected. Peak workload and oxygen uptake were unaffected by tasosartan. The results of this study indicate that antagonism of the AT1 receptor with tasosartan reduces blood pressure at rest and during submaximal exercise but not during maximal exercise. The reduced blood pressure was associated with a reduced total peripheral resistance during submaximal exercise but not at rest in the control condition while cardiac output was unaltered in either condition. Lastly, tasosartan did not impair working capacity as measured from peak workload and oxygen uptake.

American Journal of …, Jan 1, 1998