The pathophysiological mechanism of resistant hypertension (RH) is related to increased vascular smooth muscle tone and blood volume, exacerbation of the activity of the sympathetic system and hyperactivity of the renin-angiotensin-aldosterone system (RAAS), all of which are important regulatory mechanisms of blood pressure. Hypertension is associated with reduced endothelial homeostasis, and thus the best treatment would not only reduce blood pressure but also reverse endothelial injury. RH is associated with more serious vascular dysfunction, assessed by endothelium-dependent vasodilation and the presence of serum biomarkers. Arterial stiffness also constitutes an important independent factor that can determine risk of cardiovascular events in patients with RH; it is an important indicator of vascular changes, and is associated with cardiovascular mortality. Arterial stiffness can be assessed by 3 measures: central blood pressure, augmentation index (AIx) and pulse wave velocity (PWV). PWV is a recognized as main marker of the severity of vascular injury. The increase in central blood pressure caused by backward (reflected) waves can be evaluated as an index derived from an analysis of the central aortic blood pressure curve known as the AIx, and depends on the magnitude and time of the reflected waves and indirectly on heart frequency and arterial stiffness. The evaluation of patients with RH is focused on the identification of causes of hypertension guided by the clinical features of hypertension and metabolic, vascular, endocrine and family history.
Considering that chronic disease treatment is seen as a challenge to health professionals, the adherence to therapy has been studied in several variables, such as socio-economic aspects, medicines, habits of daily life and food. The aim of the proposed study is to evaluate the influence of an educational program directed at patients with prehypertension and hypertension on pressure levels, biochemical variables, arterial stiffness and matrix metalloproteinase 9 (MMP-9). It is a case-control study. The participants will be allocated to three groups: 50 individuals with normal blood pressure; 80 with prehypertension; and 80 patients with hypertension in outpatient follow up with controlled blood pressure levels. Socio-demographic and behavioral data will be collected through interviews. Blood will be collected for biochemical analysis and the determination of MMP levels. Arterial stiffness will be evaluated through ambulatory blood pressure monitoring. The level of significance will be set to 5% (p<0.05).
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