Microcirculação e biomarcadores em indivíduos com hipertensão arterial resistente, hipertensão leve a moderada e em normotensos

• Autor(a) principal: Junqueira, Camillo de Léllis Carneiro
• Data de Publicação: 2016
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/8598
• topic: Microcirculation; Biomarkers; Arterial hypertension; Microcirculação; Biomarcadores; Hipertensão arterial; Hipertensão arterial; Microcirculação; Inflamação; Biomarcadores; CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::CARDIOLOGIA

The increased peripheral vascular resistance is related to the Primary Hypertension. Microcirculation influences peripheral vascular resistance and therefore contributes to arterial blood pressure increase. Nailfold Videocapillaroscopy (NVC), venous occlusion plethysmography by (VOP), inflammatory markers and adhesion molecules are used to evaluate microcirculation and the analysis of vascular damage in Hypertension. The objective of this study was to compare the behavior of serum inflammatory markers and study the microcirculation by NVC and VOP in patients with resistant hypertension (RH), patients with hypertension Mild to moderate (MMH) and normotensive patients (Control Group - CG). 75 subjects were included in this study, 25 diagnosed with resistant hypertension (RH), 25 with mild to moderate hypertension (MMH) and 25 normotensive (CG). All patients underwent anamnesis, dosage serum markers such as C-reactive protein (CRP), Endothelin, Adiponectin, I-CAM, V-CAM and conducting to NVC and VOP. It was also carried out sub analysis of hypertensive patients without statin use and with or without blood pressure control. The NVC variables analyzed were functional capillary density, capillary diameters, maximum red blood cell velocity (RBCVmax) during the reactive hyperemia response/RBCVbaseline after 1 min arterial occlusion at the finger base and time to reach RBCVmax . The VOP variables analyzed were: flow rate and resistance in the basal period, post-ischemic 5 minutes on the forearm (endothelium-dependent phase) and post-use of sublingual nitroglycerin (endothelium-independent phase). The statistical tests used: ANOVA Kruskal-Wallis, Dunn test and ANCOVA. The mean age of subjects was 49.9±14.2 years, the mean BMI was 27,5±4,98 kg/m2, 41.3% were male and 58.7% female. In the analyzes of NVC and VOP, statistically significant changes were observed (p <0.05) with minor RBCV values, RBCVmax, most time to reach RBCVmax, lower percentage of maximum flow rate and greater post-ischemic minimum resistance in the RH group in relation to MMH and CG, as well as in patients of RH and MMH that had no blood pressure levels controlled. The densities and diameters of capillaries, post-nitroglycerin phase VOP did not show any significant difference between groups. The CRP showed higher values in RH and MMH groups. It was also observed increased endothelin in patients without statin use in both hypertensive groups. In conclusion, patients with more severe forms of hypertension and/or lack of blood pressure control, demonstrated greater functional damage in the microcirculation and impaired vascular reactivity, as assessed by NVC and VOP, as well as higher serum levels of inflammatory markers.