Microcirculation and Inflammatory Markers in Patients With Resistant, Stages 1/2 Hypertension and Normal Blood Pressure

Study Overview
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Brief Summary
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Nailfold videocapillaroscopy (NVC), Venous occlusion Plethysmography (VOP) and inflammatory biomarkers have been used to study endothelial function in patients with resistant hypertension, stages 1 and 2 hypertension and normotensive. This was a cross-sectional study.

Detailed Description
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Microcirculation determines peripheral resistance contributing to increased blood pressure. The nailfold videocapillaroscopy (NVC), Venous occlusion Plethysmography (VOP) and biomarkers can be used to evaluate the microcirculation in arterial hypertension (AH). The objective of this study is to analyze the behavior of serum inflammatory markers and study the microcirculation by nailfold videocapillaroscopy (NVC) and Venous Occlusion Plethysmography in patients with resistant hypertension (RH), with stages 1 and 2 hypertension (MMH ) and normotensive (CG). A cross-sectional study with 75 patients has been performed: 25 with resistant hypertension (RH), 25 with stages 1 and 2 hypertension (MMH) and 25 normotensive (CG). All underwent anamnesis, dosage serum markers and conducting NVC, VOP. Hypertensive patients without statin use and with controlled or uncontrolled blood pressure were also analyzed. For the statistical analysis were used: Kruskal -Wallis ANOVA, Dunn test and ANCOVA for correction of confusion factors such as age and BMI.

Official Title
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Inflammatory Biomarkers and Endothelial Function Assessed by Venous Occlusion Plethysmography and Nailfold Videocapillaroscopy in Patients With Resistant Hypertension, Stages 1 and 2 and Normotensive

Conditions
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High Blood Pressure

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinical diagnosis of controlled High Blood Pressure stages 1 and 2 (blood pressure levels from 140/90 mmHg to 179/109 mmHg) . Resistant Hypertension (uncontrolled hypertension, with values ≥140/90 mmHg, using three or more antihypertensive drugs of different classes, including a diuretic, or controlled hypertension with four or more drugs). Normal Blood Pressure. Exclusion Criteria: Diabetes Mellitus, Types 1 or 2. Heart Failure. Myocardial infarction or stroke with less than three months of the event. Chronic kidney disease. Use of hormonal or non-hormonal anti-inflammatory drugs. Recent trauma (less than three months). Autoimmune diseases. Infectious processes in activity. Neoplasia. Aspirin use (anti-inflammatory dose). Obesity grade III (Body Mass Index>40 kg/m2).

Ages Eligible for Study
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Minimum Age: 27 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Resistant Hypertension (RH)<br>uncontrolled hypertension, with values ≥140/90 mmHg, using three or more antihypertensive drugs of different classes, including a diuretic, or controlled hypertension with four or more drugs. | |
| Stages 1 and 2 Hypertension (MMH)<br>According to the VI Brazilian Guidelines of hypertension, with blood pressure levels ranging from 140/90 mmHg to 179/109 mmHg, with up to two antihypertensive drugs of different classes and blood pressure levels controlled in the last two months. | |
| Normotensive (CG)<br>Blood Pressure <140/90 mmHg and without comorbidities. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Blood Pressure (mmHg) | Hemodynamic Variable | 1 day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functional Capillary Density (FCD, number capillaries/mm2 ) | Microcirculatory variable from Nailfold Videocapillaroscopy | 1 day | 
| Afferent Capillary Diameter (micrometer) | Microcirculatory variable from Nailfold Videocapillaroscopy | 1 day | 
| Apical Capillary Diameter (micrometer) | Microcirculatory variable from Nailfold Videocapillaroscopy | 1 day | 
| Efferent Capillary Diameter (micrometer) | Microcirculatory variable from Nailfold Videocapillaroscopy | 1 day | 
| Red Blood Cell Velocity (mm/s) | Microcirculatory variable from Nailfold Videocapillaroscopy | 1 day | 
| Maximum Red Blood Cell Velocity (mm/s) | Microcirculatory variable from Nailfold Videocapillaroscopy | 1 day | 
| Time to reach Maximum Red Blood Cell Velocity (s) | Microcirculatory variable from Nailfold Videocapillaroscopy | 1 day | 
| Waist circumference (cm) | Anthropometrical Variable | 1 day | 
| Hip circumference (cm) | Anthropometrical Variable | 1 day | 
| Waist to Hip Ratio | Anthropometrical Variable | 1 day | 
| Body Mass Index (Kg/m2) | Anthropometrical Variable | 1 day | 
| Maximal Forearm Blood Flow during reactive Hyperemia | Vascular Reactivity Variables from Venous Occlusion Plethysmography | 1 day | 
| Maximal Forearm Blood Flow after sublingual nitroglycerine | Vascular Reactivity Variables from Venous Occlusion Plethysmography | 1 day | 
| Vascular Cell Adhesion Molecule (VCAM, ng/dl) | Inflammatory Biomarker | up to 2 weeks | 
| Intercellular Adhesion Molecule (ICAM, ng/dl) | Inflammatory Biomarker | up to 2 weeks | 
| Adiponectin (ng/dl) | Inflammatory Biomarker | up to 2 weeks | 
| Endothelin (pg/dl) | Inflammatory Biomarker | up to 2 weeks | 
| C Reactive Protein (CRP, mg/dl) | Inflammatory Biomarker | up to 2 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Nailfold Videocapillaroscopy, Venous Occlusion Plethysmography, Endothelial Function, Microcirculation, Inflammatory Biomarkers