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Giollo-Junior LT, Cosenso-Martin LN, da Silva Lopes V, Paz Landim M, Barufi Fernandes LA, Aparecido de Oliveira K, Spaziani AO, Santos AP, Silva MA, Yugar-Toledo JC, Vilela-Martin JF. The Effect of Transcutaneous Electrical Nerve Stimulation in Peripheral and Central Hemodynamic Parameters on Resistant Hypertension: A Case Report. Vasc Health Risk Manag 2023; 19:317-323. [PMID: 37215282 PMCID: PMC10199678 DOI: 10.2147/vhrm.s408082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
Resistant hypertension (RH) is characterized by being difficult to control, even with the use of various antihypertensive drugs and is associated with target organ lesions and other comorbidities. Thus, new treatment alternatives such as transcutaneous electrical nerve stimulation (TENS) can offer benefits to resistant hypertensive patients by reducing blood pressure (BP) in a non-invasive way and without the need for the association of more antihypertensive drugs. In this case, a patient with RH was submitted to three weekly applications of TENS on the stellate ganglion lasting 40 min each for 1 month. Peripheral and central hemodynamic assessments were performed by 24-h ambulatory BP monitoring (ABPM) before and after TENS applications. After completion of the TENS applications, significant reductions in office systolic (SBP) and diastolic BP (DBP) were observed. There was also a decrease in peripheral SBP and DBP in the 24-h ABPM and sleep and SBP during wakefulness. Additionally, central parameters including central SBP and pulse wave velocity presented a significant reduction in the 24-h ABPM, during the wakefulness and sleep. TENS is able to attenuate the sympathetic hyperactivity present in RH cases and decrease the peripheral and central hemodynamic parameters of a resistant hypertensive patient.
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Affiliation(s)
- Luiz Tadeu Giollo-Junior
- General Hospital at Brazilian Army, Curitiba, Parana, Brazil
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Luciana Neves Cosenso-Martin
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Valquiria da Silva Lopes
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Manoel Paz Landim
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Leticia Aparecida Barufi Fernandes
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Kleber Aparecido de Oliveira
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Amanda Oliva Spaziani
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Aleandra Polegati Santos
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Marco Antonio Silva
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Juan Carlos Yugar-Toledo
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Jose Fernando Vilela-Martin
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
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Cestario EDES, Vilela-Martin JF, Cosenso-Martin LN, Rubio TA, Uyemura JRR, da Silva Lopes V, Fernandes LAB, Bonalume Tacito LH, Moreno Junior H, Yugar-Toledo JC. Effect of Sequential Nephron Blockade versus Dual Renin-Angiotensin System Blockade Plus Bisoprolol in the Treatment of Resistant Hypertension, a Randomized Controlled Trial (Resistant Hypertension on Treatment - ResHypOT). Vasc Health Risk Manag 2022; 18:867-878. [PMID: 36545494 PMCID: PMC9762262 DOI: 10.2147/vhrm.s383007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/20/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Hypertension is the most important modifiable risk factor for cardiovascular disease and a leading public health concern. Objectives The primary aim was to compare sequential nephron blockade (SNB) versus dual renin-angiotensin system blockade (DRASB) plus bisoprolol in patients with resistant hypertension to observe reductions in systolic and diastolic blood pressure (SBP and DBP) levels after 20 weeks of treatment. Material and Methods This trial was an open-label, prospective, randomized, parallel-group, clinical study with optional drug up-titration. Participants were evaluated during five visits at 28-day intervals. Results The mean age was 55.5 years in the SNB and 58.4 years in the DRASB + bisoprolol group (p=NS). Significant office BP reductions were observed in both groups. SNB group, SBP decreased from 174.5±21.0 to 127.0±14.74 mmHg (p<0.0001), and DBP decreased from 105.3±15.5 to 78.11±9.28 mmHg (p<0.0001). DRASB group, SBP decreased from 178.4±21.08 to 134.4 ± 23.25 mmHg (p<0.0001) and DBP decreased from 102.7±11.07 to 77.33±13.75 mmHg (p<0.0001). Ambulatory blood pressure monitoring (ABPM) showed also significant SBP and DBP reductions in both groups (p<0.0001). Conclusion In patients with RHTN adherent to treatment, SNB and DRASB plus bisoprolol showed excellent therapeutic efficacy, although SNB was associated with earlier SBP reduction.
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Affiliation(s)
| | - Jose Fernando Vilela-Martin
- Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil,Correspondence: Jose Fernando Vilela-Martin, Ave Brig Faria Lima 5416, Sao Jose do Rio Preto, São Paulo, SP, 15090-000, Brazil, Tel +55 17 32015727, Email
| | - Luciana Neves Cosenso-Martin
- Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil
| | - Tatiane Azevedo Rubio
- Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil
| | | | - Valquiria da Silva Lopes
- Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil
| | | | - Lucia Helena Bonalume Tacito
- Endocrinology Division, Internal Medicine Department, Medical School in São José Rio Preto (FAMERP), São Paulo, Brazil
| | - Heitor Moreno Junior
- Cardiovascular Pharmacology Laboratory, Faculty of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Juan Carlos Yugar-Toledo
- Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil
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Andrade DO, Aguiar FL, Mansor ALP, Valente FM, Souza DRS, Lopes VDS, Fernandes LB, Godoy MF, Yugar-Toledo JC, Cosenso-Martin LN, Vilela-Martin JF. Inflammatory cytokines are associated to lower glomerular filtration rate in patients with hypertensive crisis. Front Cardiovasc Med 2022; 9:969339. [PMID: 36247461 PMCID: PMC9559728 DOI: 10.3389/fcvm.2022.969339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionHypertension and kidney function are closely related. However, there are few studies on renal function during acute elevation of blood pressure (BP), denominated hypertensive crisis (HC).ObjectivesTo evaluate the relationship between renal function and inflammatory cytokines in HC, subdivided into hypertensive urgency (HUrg) and emergency (HEmerg).Materials and methodsThis cross-sectional study was carried out in 74 normotensive (NT) and 74 controlled hypertensive individuals (ContrHT) followed up in outpatient care. Additionally, 78 subjects with hypertensive emergency (HEmerg) and 50 in hypertensive urgency (HUrg), attended in emergency room, were also evaluated. Hypertensive crisis was classified into HEmerg, defined by systolic blood pressure (BP) ≥ 180 mmHg and/or diastolic BP ≥ 120 mmHg in presence of target-organ damage (TOD), and HypUrg, clinical situation with BP elevation without TOD. The glomerular filtration rate (eGFR) was estimated, and cytokine levels were measured. Statistical analysis was performed using the Kruskal-Wallis or Mann-Whitney test and Spearman’s correlation, with significant differences p-value < 0.05.ResultsThe median age was 53.5 years in the NT group (52 female), 61 years in the ContrHT group (52 female), and 62.5 years in the HC group (63 female) (p-value < 0.0001). The median BP was 118.5/75 mmHg for NT, 113.5/71 for ContrHT, and 198.5/120 mmHg for HC, respectively (p-value < 0.0001 among groups). BP and heart rate levels were significantly higher in the HC group compared to the NT and ContrHT groups (P < 0.001 for all). The eGFR was significantly lower in HC group compared to the NT and ContrHT groups. The cytokine levels were higher in the HEmerg and HUrg groups compared to ContrHT group (P < 0.0001, except for IL-1β in HUrg vs. ContrHT), without difference between the acute elevation of BP groups. Thus, all cytokines were significantly elevated in patients with HC compared to the control groups (NT and ContrHT). There was a negative correlation between eGFR and the cytokines (IL-1β, IL-6, IL-8, IL-10, and TNF-α) in the HC group.ConclusionElevated inflammatory cytokines are associated with reduced eGFR in individuals with HC compared to control groups, suggesting that the inflammatory process participates in the pathogenesis of acute elevations of BP.
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Affiliation(s)
- Days O. Andrade
- Hypertension Clinical and Medicine Department, State Medical School at São José do Rio Preto, São Paulo, Brazil
| | - Franciana L. Aguiar
- Hypertension Clinical and Medicine Department, State Medical School at São José do Rio Preto, São Paulo, Brazil
| | - Ana Luiza P. Mansor
- Hypertension Clinical and Medicine Department, State Medical School at São José do Rio Preto, São Paulo, Brazil
| | - Flavia M. Valente
- Hypertension Clinical and Medicine Department, State Medical School at São José do Rio Preto, São Paulo, Brazil
| | - Doroteia R. S. Souza
- Biochemistry and Molecular Biology Research Nucleus and Molecular Biology Department, State Medical School at São José do Rio Preto, São Paulo, Brazil
| | - Valquiria da Silva Lopes
- Hypertension Clinical and Medicine Department, State Medical School at São José do Rio Preto, São Paulo, Brazil
| | - Leticia B. Fernandes
- Hypertension Clinical and Medicine Department, State Medical School at São José do Rio Preto, São Paulo, Brazil
| | - Moacir F. Godoy
- Transdisciplinary Nucleus for the Study of Chaos and Complexity, de Cardiology and Cardiovascular Surgery Department, State Medical School at São José do Rio Preto, São Paulo, Brazil
| | - Juan C. Yugar-Toledo
- Hypertension Clinical and Medicine Department, State Medical School at São José do Rio Preto, São Paulo, Brazil
| | - Luciana N. Cosenso-Martin
- Hypertension Clinical and Medicine Department, State Medical School at São José do Rio Preto, São Paulo, Brazil
| | - Jose F. Vilela-Martin
- Hypertension Clinical and Medicine Department, State Medical School at São José do Rio Preto, São Paulo, Brazil
- *Correspondence: Jose F. Vilela-Martin,
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Paz Landim M, Cosenso-Martin LN, Polegati Santos A, Roma Uyemura JR, Barufi Fernandes L, da Silva Lopes V, Yugar-Toledo JC, Vilela-Martin JF. Predictive Factors for Target Organ Injuries in Hypertensive Individuals. Integr Blood Press Control 2021; 14:113-121. [PMID: 34429649 PMCID: PMC8374840 DOI: 10.2147/ibpc.s324151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/27/2021] [Indexed: 01/13/2023] Open
Abstract
Background The causal relationship between systemic arterial hypertension and target organ damage (TOD) is well known, as well as the association with cardiovascular risk factors (CV). Ambulatory blood pressure monitoring (ABPM) is important in monitoring hypertension and assessing the risk of TOD. Objective To evaluate the relationship between blood pressure (BP) and clinical and biochemical parameters in the development of TOD in hypertensive patients. Methods This was a retrospective cohort study with 162 hypertensive patients followed for an average period of 13 years. The TOD investigated were left ventricular hypertrophy (LVH), microalbuminuria, coronary artery disease (CAD) and stroke. Blood pressure was assessed by ABPM and LVH using echocardiogram and electrocardiogram, respectively. Biochemical-metabolic tests and 24-hour microalbuminuria were performed at baseline and follow-up. The P-value <0.05 was considered significant. Results The average age was 69±11.8 years, with a predominance of women (64.8%), white ethnicity (79.6%) and diabetics (78.4%). ABPM showed a significant reduction in BP values during follow-up, although without association with TOD (microalbuminuria, stroke, and CAD), except for LVH that showed a correlation with sleep BP ≥120/70 mmHg (P=0.044). The most frequent TODs were LVH (29.6%), microalbuminuria (26.5%), CAD (19.8%) and stroke (17.3%). In the follow-up, there was an association between LVH and diabetes; microalbuminuria was associated with diabetes and triglycerides; stroke was associated with HDL-cholesterol (HDL-c), microalbuminuria and carotid disease. CAD showed a relationship with age and HDL-c. Conclusion Predictive factors for TOD are age, microalbuminuria, diabetes, HDL-c, triglycerides and carotid disease. Nocturnal BP is correlated with LVH. The absence of a relationship between ABPM and other TODs can be explained by the use of effective drugs, improvement of metabolic and blood pressure parameters.
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Affiliation(s)
- Manoel Paz Landim
- Internal Medicine Department, State Medical School at Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Sao Paulo, Brazil
| | - Luciana Neves Cosenso-Martin
- Internal Medicine Department, State Medical School at Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Sao Paulo, Brazil
| | - Aleandra Polegati Santos
- Internal Medicine Department, State Medical School at Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Sao Paulo, Brazil
| | - Jessica Rodrigues Roma Uyemura
- Internal Medicine Department, State Medical School at Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Sao Paulo, Brazil
| | - Leticia Barufi Fernandes
- Internal Medicine Department, State Medical School at Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Sao Paulo, Brazil
| | - Valquiria da Silva Lopes
- Internal Medicine Department, State Medical School at Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Sao Paulo, Brazil
| | - Juan Carlos Yugar-Toledo
- Internal Medicine Department, State Medical School at Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Sao Paulo, Brazil
| | - Jose Fernando Vilela-Martin
- Internal Medicine Department, State Medical School at Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, Sao Paulo, Brazil
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