ABC | Volume 112, Nº4, April 2019

Original Article de Faria et al Inflammatory score and resistant hypertension Arq Bras Cardiol. 2019; 112(4):383-389 Table 1 – Clinical and biochemical characteristics of patients with mild-to-moderate hypertension (HTN) and patients with resistant hypertension (RHTN) HTN (n = 112) RHTN (n = 112) p-value Age (years) 66 ± 10 58 ± 10 < 0.001 Female, n (%) 63 (56) 78 (70) 0.27 Black, n (%) 13 (12) 55 (49) < 0.001 BMI (Kg/m 2 ) 27(25-31) 31(27-35) < 0.001 WC (cm) 94 ± 12 101 ± 14 0.003 FFM (Kg) 53 (46-62) 55 (49-64) 0.11 FM (Kg) 20 (15-27) 26 (20-35) < 0.001 Office SBP (mmHg) 139 (131-149) 149 (134-163) < 0.001 Office DBP (mmHg) 82 (77-85) 85 (78-92) 0.03 ABPM SBP (mmHg) 126 (118-134) 130 (118-144) 0.03 ABPM DBP (mmHg) 75 (70-81) 75 (70-86) 0.22 HR (bpm) 67 (61-75) 67 (58-75) 0.35 Glucose (mg/dL) 97 (90-107) 101 (90-126) 0.09 HbA1C (%) 6.0 (5.7-6.4) 6.3 (5.9-7.3) 0.03 Cholesterol (mg/dL) 165 (136-187) 181 (150-209) 0.001 LDL-c (mg/dL) 88 (64-109) 97 (77-125) 0.004 HDL-c (mg/dL) 48 (41-56) 46 (38-54) 0.31 Triglycerides (mg/dL) 108 (80-150) 126 (93-185) 0.02 Urea (mg/dL) 34 (27-43) 35 (27-44) 0.52 Creatinine (mg/dL) 0.95 (0.79-1.10) 0.94 (0.80-1.18) 0.19 Renin (pg/mL) 29 (14-73) 25 (12-72) 0.39 Aldosterone (pg/mL) 68 (41-111) 92 (56-176) 0.006 Creat. Clear (mL/min/1.73m 2 ) 75 (58-93) 81 (61-97) 0.89 Values are expressed as mean ± standard deviation or median (1st, 3rd quartiles), according to data distribution. BMI: body mass index; WC: waist circumference; FFM: fat-free mass; FM: fat mass; SBP: systolic blood pressure; DBP: diastolic blood pressure; ABPM: ambulatory blood pressure monitoring; HR: heart rate; HbA1C: glycated hemoglobin; LDL: low-density lipoprotein; HDL: high-density lipoprotein; Creat Clear: creatinine clearance. a greater number of antiplatelet drugs and almost all classes of antihypertensive agents, except for angiotensin II receptor blockers (ARBs). On the other hand, a greater number of HTN subjects were taking statins (Table 2). IS was higher in the RHTN compared to HTN group [4 (2-6) vs. 3 (2-5); p = 0.02, respectively – Figure 1]. Curiously, IS positively correlated with BMI (r = 0.40; p < 0.001), WC (r = 0.30; p < 0.001) and FM (r = 0.31; p < 0.001) in all hypertensive subjects. Finally, the independent logistic regression models revealed that IS was associated with the presence of RHTN (Odds ratio (OR) = 1.20; p = 0.02), independently of age, gender and race, although it was no longer significant after the adjustments for the body fat parameters studied (Table 3). Discussion Our study revealed that the integrated measure of pro‑inflammatory and anti-inflammatory cytokines/adipokines scores was associated with the occurrence of RHTN. The IS arises as a strong factor related to body fat parameters, suggesting the relevance of subclinical inflammation in obesity condition regardless of the hypertension degree. Recent findings from our group have suggested that inflammatory process underlies the pathophysiology of RHTN and its related comorbidities like diabetes, obesity and metabolic syndrome. Altered levels of cytokines and adipokines, such as IL-10, IL-1 beta, adiponectin and leptin, were found in RHTN subjects compared to their controls. 5,7,19 Hyperleptinemia and hypoadiponectinemia were associated with the lack of BP control, 5,19 as well as target organ damage – arterial stiffness and microalbuminuria – in this high-risk population. 6 Obese diabetic RHTN subjects showed lower levels of adiponectin combined with a greater autonomic dysfunction (characterized by a hyperactive sympathetic system and a hypoactive parasympathetic system) than non‑diabetic patients. 20 Recently, we have found a huge prevalence of metabolic syndrome in these RHTN subjects (73%), which may explain the high IS. Interestingly, the HTN group also showed a considerable prevalence of the syndrome (60%), 21 which might justify the worsening of their score in our present study. 385