Citocinas inflamatórias e fatores de coagulação se associam à crise hipertensiva

Abstract

Recent evidence suggests that there is an inflammatory process underlying the vascular disease associated with chronic hypertension and that inflammation plays an important role in the pathogenesis of the elevation of blood pressure (BP). However, there are few studies that have evaluated the role of the inflammatory process in understanding the pathogenesis of acute elevation of BP. Objectives - To assess the involvement of inflammatory cytokines, endothelial dysfunction and coagulation markers, in individuals with hypertensive crisis (HC) and identify clinical profile and metabolic presentation of HC. Methods - We studied 274 individuals: 74 normotensive (NT), 74 controlled hypertensive (CH), 50 with hypertensive urgency (HU) and 78 with hypertensive emergencies (HE). The serum levels of cytokines were performed by MULTIPLEX technique and ELISA. We applied analysis of variance for a comparative study between the groups, considering significance level for P-value <0.05. Results - Individuals of HE group were older than individuals from the other groups (65.5 years) in comparison with individuals NT (53,5 years; p<0.0001) and HU (58 years; p=0.0264). The levels of blood pressure and heart rate were higher in the HC group (198.5 mmHg; 120 mmHg and 85 bpm, respectively) in relation to NT group (117 mmHg, 75 mmHg and 68 bpm, respectively) and CH (113.5 mmHg, 71 mmHg and 71 bpm, respectively; p<0.001 for all). Blood glucose level was significantly lower in the NT group (91 mg/dL) in relation to the groups CH, HU and HE (98 mg/dL, 109 mg/dL and 113 mg/dL, respectivamente; p=0.0016, p<0.0001 and p< 0.0001, respectively). Total cholesterol was higher in the group HU (207 mg/dL) in comparison to CH and HE (171 mg/dL and 185 mg/dL, respectively; p=0.0027 and p=0.0269, respectively) and HDL-c was significantly lower in the group HE (44 mg/dL) in relation to the NT group (50 mg/dL; p= 0.0088). Potassium levels were lower in group HE (4.2 mEq/L) compared to the other 3 groups NT, CH and HU (4.5 mEq/L, 4.4 mEq/L nd 4.4 mEq/L, respectively; p=0.0118, p=0.036 and p= 0.036; respectively). IL-1β, IL-6, IL-8, IL-10 e TNF-α levels were significantly higher in patients with HC (0.22pg/mL; 5.7pg/mL; 21.7pg/mL; 4.8pg/mL and 20.6pg/mL respectively) in comparison to NT group (0.07pg/mL; 0.63pg/mL; 11.4pg/mL; 2.28pg/mL e 14.27pg/mL respectively; p<0.0001 for all) and CH (0.05pg/mL; 0.67pg/mL; 9.7pg/mL; 1.15pg/mL and 12.42 pg/mL respectively; p<0.0001 for all). IL-18 levels were also higher in HC group (20.7pg/mL) in relation with NT (16.95pg/mL; p=0.0012) and CH (10.3pg/mL; p<0.0001). C-reactive protein (CRP) and fibrinogen levels were higher in HC group (0.66ug/mL and 0.05ug/mL respectively, p<0.0001 for all) in comparison to NT group (0.19 ug/mL and 0.01 ug/mL respectively, p.0001 for all) and in relation to CH (0.14ug/mL and 0.01ug/mL respectively, p<0.0001 for alls). The logistic regression analysis showed that the chance to belong to HC group was higher in the presence of variables IL-1β, IL-6, IL-8, IL-10, IL-18, TNF-α, CRP and fibrinogen. Conclusion - The levels of inflammatory cytokines, anti-inflammatory and coagulation factors are higher in groups HU and HE in relation to groups NT and CH. This highlights the role of inflammatory markers, endothelial dysfunction and coagulation factors in the physiopathogenesis of the acute event hypertensive.