Monocyte chemoattractant protein-1 and hypertension: An overview

Background: The association between hypertension and cardiovascular disease (CVD) has been increasingly studied through early inflammatory biomarkers. The monocyte chemoattractant protein-1 (MCP-1) is the main chemokine implicated in the inflammatory endothelial process, attracting monocytes and macrophages to the atherosclerotic plaque. Methods: We reviewed the main observational studies that have analyzed serum MCP-1 in patients with hypertension regardless of CVD, relating them to target organ damage (TOD). Results: As endothelial dysfunction continues and TOD accumulates, MCP-1 has been perpetuated at higher levels. The relationship between this chemokine and the increase in comorbidities, such as chronic kidney disease, dyslipidaemia, diabetes, and coronary artery disease, became clearer from the observational studies. However, patients with such morbidities use medications with potential anti-inflammatory effects. Conclusion: There is no normal threshold of MCP-1 for the healthy population, nor a uniform curve pattern, due to a balance between genetic factors, age, gender, comorbidities, TOD, and anti-inflammatory effects of drugs. In fact, MCP-1 seems to have a promising role as a tool for further improvement in cardiovascular risk stratification, as prognostic studies have demonstrated an association with fatal and non-fatal cardiovascular outcomes, regardless of other clinical and laboratory predictors.(AU)

Antecedentes: Se ha venido estudiando con mayor frecuencia la asociación entre hipertensión y enfermedad cardiovascular a través de los biomarcadores inflamatorios tempranos. La proteína 1 quimioatrayente de monocitos (MCP-1) es la principal quimioquina implicada en el proceso inflamatorio endotelial, que atrae monocitos y macrófagos a la placa aterosclerótica. Métodos: Revisamos los principales estudios observacionales que han analizado la MCP-1 sérica en pacientes hipotensos independientemente de enfermedad cardiovascular, relacionándolos con el daño del órgano diana. Resultados: A medida que prosigue la disfunción endotelial, y se acumula daño en el órgano diana, MCP-1 se perpetúa a niveles mayores. La relación entre esta quimioquina y el incremento de las comorbilidades, tales como la enfermedad renal crónica, la dislipidemia, la diabetes y la enfermedad arterial coronaria se hizo más evidente a partir de los estudios observacionales. Sin embargo, los pacientes con dichas morbilidades utilizan medicaciones con efectos antiinflamatorios potenciales. Conclusión: No existe un umbral normal de MCP-1 para la población sana, ni un patrón de curva uniforme, debido al equilibrio entre factores genéticos, edad, sexo, comorbilidades, TOD y efectos antiinflamatorios de los fármacos. De hecho, MCP-1 parece tener un rol prometedor como herramienta de mejora futura de la estratificación del riesgo cardiovascular, ya que los estudios pronósticos han demostrado una asociación con los resultados cardiovasculares fatales y no fatales, independientemente de otros factores predictivos clínicos y de laboratorio.(AU)

Monocyte chemoattractant protein-1 and hypertension: An overview.

BACKGROUND: The association between hypertension and cardiovascular disease (CVD) has been increasingly studied through early inflammatory biomarkers. The monocyte chemoattractant protein-1 (MCP-1) is the main chemokine implicated in the inflammatory endothelial process, attracting monocytes and macrophages to the atherosclerotic plaque. METHODS: We reviewed the main observational studies that have analyzed serum MCP-1 in patients with hypertension regardless of CVD, relating them to target organ damage (TOD). RESULTS: As endothelial dysfunction continues and TOD accumulates, MCP-1 has been perpetuated at higher levels. The relationship between this chemokine and the increase in comorbidities, such as chronic kidney disease, dyslipidaemia, diabetes, and coronary artery disease, became clearer from the observational studies. However, patients with such morbidities use medications with potential anti-inflammatory effects. CONCLUSION: There is no normal threshold of MCP-1 for the healthy population, nor a uniform curve pattern, due to a balance between genetic factors, age, gender, comorbidities, TOD, and anti-inflammatory effects of drugs. In fact, MCP-1 seems to have a promising role as a tool for further improvement in cardiovascular risk stratification, as prognostic studies have demonstrated an association with fatal and non-fatal cardiovascular outcomes, regardless of other clinical and laboratory predictors.

Resistant hypertension: a practical clinical approach.

Resistant hypertension (RH) is defined as an uncontrolled office blood pressure (BP) despite the use of at least three antihypertensive drugs. With an increasing prevalence, RH implies in a very high cardiovascular risk and needs a careful clinical approach, aiming to control BP and to reduce its morbidity and mortality. The initial diagnostic approach involves drug adherence checking and the evaluation of antihypertensive scheme, emphasizing the use of diuretics and adequate combination and dosages of the two other drugs, which preferentially reduces cardiovascular risk and promotes prevention/regression of target organ damages. Because of an exaggerated white-coat effect, ambulatory BP monitoring (ABPM) at baseline is mandatory to classify patients into true RH (uncontrolled ambulatory BPs) and white-coat RH (controlled ambulatory BPs), and define initial therapeutic approach. Ideally, the objective is ambulatory BP control, so the treatment follow-up shall be based on ABPM measurements. The treatment involves lifestyle changes and use of adequate combinations of antihypertensive agents from different classes. In this way, patients with true RH need to intensify antihypertensive treatment by adding aldosterone antagonists as the fourth drug and also changing antihypertensive treatment to bedtime. Otherwise, in patients with controlled ambulatory BP, the therapeutic scheme should be maintained and ABPM or home BP monitoring repeated serially. Despite pharmacological interventions, ambulatory BP control in RH patients remains challenging and new interventional procedures have been recently proposed, as renal denervation and baroreflex activation therapy. Currently, these procedures shall be reserved to true RH patients in whom other alternatives have failed.