Estudo da associação da vitamina D e do inibidor da 3- hidroximetilglutaril coa redutase na função endotelial em portadores de hipertensão arterial: um estudo duplo-cego, placebo-controlado

• Ano de defesa: 2020
• Autor(a) principal: Kohatsu, Anderson Simabuco [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Vitamin D; Statin; Hypertension; Endothelial Disfunction; Inflammation; Vitamina D; Estatina; Hipertensão Arterial Sistêmica; Disfunção Endotelial; Inflamação
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=9299853; https://hdl.handle.net/11600/64386

Hypertension is considered a substantial trouble in public health. Because it is an easily diagnosed disease, but difficult to control and follow up, it needs special attention especially due to its association with cardiovascular outcomes and the great impact on morbidity and mortality of the population. The biological vulnerability of an inflammatory vascular environment can lead to impaired vascular regulation linked to a process of endothelial dysfunction and, consequently, a higher risk of developing hypertension. In this scenario, there is growing evidence of the benefits of Vitamin D and the 3- Hydroxymethylglutaryl CoA Reductase Inhibitor (Statin) in reducing inflammation and improving endothelial function through pleiotropic effects. However, the number of intervention studies is limited and raises questions about causal relationship, long-term interaction and benefits of these drugs in blood pressure control. The present double-blind, placebo-controlled study using a 2x2 factorial design proposals to evaluate the effect of the association between Vitamin D and Statin, compared with their respective placebos, on blood pressure, mensuration of dimethyl arginine-asymmetric endothelial function (ADMA) and inflammatory profile in patients with hypertension. Sixty eligible subjects were randomized to 4 groups of 15 patients at a 1: 1: 1: 1 ratio to receive simvastatin 40mg/day or vitamin D 200,000Ui starting dose followed by 100,000Ui/month (4 doses) alone or simvastatin with vitamin D or placebos treatment over 22 weeks. Throughout the period, monthly consultations were performed with monitoring of clinical parameters including blood pressure and antihypertensive adjustments in a stepwise manner according to protocol. Additionally before the intervention and at the end of the study, blood pressure was also measured by ambulatory blood pressure monitoring (ABPM) and laboratory tests including serum ADMA and C-reactive protein measurements from all participants. The results obtained with the intervention did not determine changes in systemic blood pressure levels at the end of follow-up, either by ABPM or office blood pressure, nor did it change the values of asymmetric dimethylarginine and C-reactive protein. Thus, we demonstrated that vitamin D supplementation and simvastatin treatment, alone or in combination, over 22 weeks in hypertensive patients with low cardiovascular risk did not lead to a reduction in blood pressure or changes in variables related to endothelial function and inflammation.