BackgroundResistant hypertension (RH) treatment requires an adequate and intense therapeutic approach. However, the results are not always satisfactory despite intensive treatment. Of the different pathophysiological mechanisms involved in the pathogenesis of RH, sympathetic overstimulation and therapies that block the sympathetic system have been widely studied. These approaches, however, are invasive and expensive. Another possible approach is by transcutaneous electrical nerve stimulation (TENS), a noninvasive method that modulates activity by using low-frequency transcutaneous electrical stimulation to inhibit primary afferent pathways. Thus, the current study will evaluate the effect of applying TENS in the cervicothoracic region of subjects with RH and will seek to develop a new low-cost and readily available therapy to treat this group of hypertensive individuals.Methods/designThis is a randomized, single blind (subject), parallel-assignment study controlled with a sham group and including participants aged 40 to 70 years with resistant hypertension. The trial has two arms: the treatment and control (sham group). The treatment group will be submitted to the stimulation procedure (TENS). The sham group will not be submitted to stimulation. The primary outcomes will be a reduction in the peripheral blood pressure and adverse events. The secondary outcomes will be a reduction the central blood pressure. The study will last 30 days. The sample size was calculated assuming an alpha error of 5 % to reject the null hypothesis with a statistical power of 80 %, thereby resulting in 28 participants per group (intervention versus sham).DiscussionIn recent decades, RH has become very common and costly. Adequate control requires several drugs, and in many cases, treatment is not successful. Sympathetic nervous system inhibition by renal denervation and central inhibition have significant effects in reducing BP; however, these treatments are costly and invasive. Another type of sympathetic nervous system inhibition can also be noninvasively achieved by electric current. Therefore, the application of TENS may be a new therapeutic option for treating resistant hypertensive individuals.Trial RegistrationClinical Trials NCT02365974Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1302-8) contains supplementary material, which is available to authorized users.
Objective: To compare the pulse wave velocity (PWV) results obtained by Sphygmocor AtCor Medical, by radial tonometry, and Mobil-Ambulatory Blood Pressure Monitor-Pulse Wave Velocity (Mobil-ABPM-PWV) 24 hours, an oscillometric method. Design and method: Sixty-three controlled hypertensive (41 female and 22 male) and sixty-three resistant hypertensive (36 female and 27 male) patients were recruited and submitted to evaluation of arterial stiffness by the SphygmoCor (radial tonometry) and by Mobil-ABPM-PWV (oscillometric method). Linear regression and Bland-Altmann test were used to statistics analysis. Results: The correlations of the PWV as assessed with Mobil-ABPM-PWV 24 hours with the values obtained using the SphygmoCor radial tonometry were significant (controlled hypertensive patients: r = 0.54, P < 0001; resistant hypertensive patients: r = 0.48, P < 0.001). Comparison Bland-Altman plot showed concordance correlation coefficient (controlled hypertensive patients = 5.0, P < 0.0001 and resistant hypertensive patients = 4.8, P < 0.0001). Figures 1–4. Conclusions: The oscillometric method Mobil-ABPM-PWV is an easy-to-use and time-effective method for assessing arterial stiffness compared with the SphygmoCor AtCor radial tonometry.
Objective: To compare the influence of dietary sodium intake through 24-hours urinary sodium excretion (Na + Ur24 h) on arterial stiffness markers in controlled and resistant hypertensive individuals. Design and method: 126 patients were randomized in an observational and cross-sectional study, divided into two groups: 63 in the controlled hypertension group (CHTN) and 63 in the resistant hypertension group (RHTN). All were submitted to clinical evaluation, laboratory tests, Na + Ur24 h and non-invasive central hemodynamic evaluation by the SphygmoCor® and Mobil-O-Graph® system to determine arterial stiffness parameters. Results: Clinical characteristics and laboratory tests were similar in both groups. There was no statistical significance between CHTN and RHTN for Na + Ur24 h values (186.60 ± 92.15 vs.179.76 ± 66.91 mEq/L, respectively). The carotid-femoral pulse wave velocity (cfPWVc) showed no statistically significant difference between CHTN and RHTN (10.52 ± 2.47 m/s vs. 10.21 ± 2.27 m/s, respectively). Central hemodynamic parameters were statistically different between the groups assessed by 24-hour ambulatory blood pressure monitoring (ABPM - Mobil-O-Graph®). RHTN group had higher cardiac output during sleep and greater vascular resistance during wakefulness and 24 hours than CHTN group (p < 0.05) in ABPM. Conclusions: Na + Ur24 h excretion is similar between groups, but there is better adherence to dietary sodium intake restriction in the resistant hypertension group. Physiological hemodynamic parameters are altered in the RHTN group, such as cardiac output and peripheral vascular resistance, a fact that evidences their participation in the pathophysiological process of resistant hypertension.
Background Systemic arterial hypertension (SAH) is one of the major risk factors related to the development of cardiovascular diseases (CVD). Sodium intake is linked to elevated blood pressure and can be estimated by 24-h urinary sodium excretion. The objective of this study was to correlate 24 h urinary sodium excretion, blood pressure and arterial stiffness (AS) parameters in hypertensive individuals. Methods We evaluated 53 patients who underwent in-office 24-h blood pressure tests and AS parameters using the Mobil-O-Graph® equipment. Te patients were divided into controlled hypertensive and resistant hypertensive. Unpaired t-test was performed with significance at p < 0.05. Results Mean age was 64.32 years; weight 77.56 kg; height 1.61 m; and BMI of 29.68 kg/m2. Resistant hypertensive patients (25 subjects) have systolic blood pressure (SBP) (p < 0.0001), diastolic blood pressure (DBP) (p = 0.004), 24 h SBP (p < 0.0001), 24 h DBP (p = 0.002), pulse pressure (PP) (p < 0.0001), central systolic blood pressure (cSBP) (p = 0.0003) and central diastolic blood pressure (cDBP) (p = 0.021) higher than controlled hypertensive patients (28 subjects). Conclusion Peripheral and central arterial pressures are higher in resistant hypertensive than in controlled hypertensive. Sodium excretion is unrelated to hemodynamic variables. Age is related to the elevation of central pressure and pulse wave velocity.
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