Acute and Short-Term Autonomic and Hemodynamic Responses to Transcranial Direct Current Stimulation in Patients With Resistant Hypertension.

Previously, we demonstrated that acute transcranial direct current stimulation (tDCS) reduced blood pressure (BP) and improved autonomic modulation in hypertensives. We hypothesized that acute and short-term tDCS intervention can promote similar benefits in resistant hypertensive patients (RHT). We assessed the impact of one (acute intervention) and ten (short-term intervention) tDCS or SHAM (20 min, each) sessions on BP, pulse interval (PI) and systolic blood pressure variabilities, humoral mechanisms associated with BP regulation, and cytokines levels. True RHT subjects (n = 13) were randomly submitted to one and ten SHAM and tDCS crossing sessions (1 week of "washout"). Hemodynamic (Finometer®, Beatscope), office BP, and autonomic variables (accessed through spectral analysis of the pulse-to-pulse BP signal, in the time and frequency domain - Fast Fourrier Transform) were measured at baseline and after the short-term intervention. 24 h-ambulatory BP monitoring was measured after acute and short-term protocols. Acute intervention: tDCS reduced BP, cardiac output, and increase high-frequency band of PI (vagal modulation to the heart). Short-term protocol: tDCS did not change BP and cardiac output parameters. In contrast, central systolic BP (-12%), augmentation index (-31%), and pulse wave velocity (34%) were decreased by the short-term tDCS when compared to SHAM. These positive results were accompanied by a reduction in the low-frequency band (-37%) and an increase of the high-frequency band of PI (+62%) compared to SHAM. These findings collectively indicate that short-term tDCS concomitantly improves resting cardiac autonomic control and pulse wave behavior and reduces central BP in RHT patients, https://ensaiosclinicos.gov.br/rg/RBR-8n7c9p.

ACUTE TRANSCRANIAL DIRECT CURRENT STIMULATION (tDCS) IMPROVES VENTILATORY VARIABILITY AND AUTONOMIC MODULATION IN RESISTANT HYPERTENSIVE PATIENTS.

Here, we assessed the impact of one session of transcranial direct current stimulation (tDCS) or SHAM (20 min, each) on ventilatory responses to cardiopulmonary exercise test, central and peripheral blood pressure (BP), and autonomic modulation in resistant hypertensive (RHT) patients. RHT subjects (n = 13) were randomly submitted to SHAM and tDCS crossing sessions (1 week of "washout"). Patients and a technician who set the tDCS/Sham room up were both blind. After brain stimulation, patients were submitted to a cardiopulmonary exercise test to evaluate ventilatory and cardiovascular response to exercise. Hemodynamic (Finometer®, Beatscope), and autonomic variables were measured at baseline (before tDCS/Sham) and after incremental exercise. RESULTS: Our study shows that tDCS condition improved heart rate recovery, VO2 peak, and vagal modulation (after cardiopulmonary exercise test); attenuated the ventilatory variability response, central and peripheral blood pressure well as sympathetic modulation (after cardiopulmonary exercise test) in comparison with SHAM. These data suggest that acute tDCS sessions prevented oscillatory ventilation behavior during the cardiopulmonary exercise test and mitigated the increase of systolic blood pressure in RHT patients. After the exercise test, tDCS promotes better vagal reentry and improved autonomic modulation, possibly reducing central blood pressure and aortic augmentation index compared to SHAM. Brazilian Registry of Clinical Trials (ReBEC): https://ensaiosclinicos.gov.br/rg/RBR-8n7c9p.

Transcranial direct current stimulation modulates autonomic nervous system and reduces ambulatory blood pressure in hypertensives.

Purpose: Transcranial direct current stimulation (tDCS) seems to positively modulate the autonomic nervous system in different clinical conditions and healthy subjects; however, its effects on hypertensive (HTN) patients are not completely known. This study aimed to evaluate the effects of a tDCS or SHAM session (20 min) on blood pressure (BP) and autonomic variables of HTN patients.Materials and Methods: Subjects (n = 13) were randomly submitted to SHAM and tDCS sessions (1 week of washout). Hemodynamic and autonomic variables were measured at baseline, during, and immediately after tDCS or SHAM stimulation (Finometer®, Beatscope). Ambulatory BP measurement (ABPM) was evaluated after the experimental period.Results: Hemodynamic variables were not changed by tDCS, except for the fall in peripheral vascular resistance (Δ = -1696.51 ± 204.65 dyn.s/cm5). After the tDCS, sympathetic modulation was decreased (-61.47%), and vagal modulation was increased (+38.09%). Such acute autonomic changes may have evoked positive results observed in 24 hs-systolic blood pressure (Δ = -8.4 ± 6.2; P = .0022) and 24hs-diastolic blood pressure (Δ = -5.4 ± 4.2; P = .0010) in tDCS subjects compared with that in SHAM.Conclusion: These findings suggest that the tDCS could promote positive acute adjustments on cardiac autonomic control and reduced values on 24-hs BP of HTN patients. More than a proof-of-concept, these results may point out to the future, where brain stimulation (tDCS) can be used to HTN syndromes, such as refractory HTN.

Central blood pressure and aortic pulse wave reflection in water-exercised postmenopausal hypertensive women: A cross-sectional study.

Exercise training has been associated with the attenuation of cardiovascular impairment after menopause. This study aimed to compare central and peripheral blood pressure and aortic pulse wave reflection in sedentary and trained (aerobic exercise in the water) hypertensive postmenopausal women. Hypertensive postmenopausal women were divided into sedentary (SED, n = 53) and trained groups (TR, n = 31). Self-reporting from the trained group presented a mean of 1.7 ± 0.3 years of exercise practice in the water. Central blood pressure and amplification indexes (AIx) were obtained by the applanation tonometry of radial and aortic arteries. No changes were observed in systolic blood pressure (SBP) in the TR group than the SED group; however, office diastolic blood pressure (DBP) was reduced compared to the SED group. Central blood pressure and augmentation index (AIx@75%) values were similar in the SED and TR groups. These data suggest that self-reported long-term exercise training in the water could not improve central hemodynamic variables in postmenopausal hypertensive women compared to sedentary ones. However, it should be emphasized that DBP levels were reduced in trained subjects, which might reduce cardiovascular outcomes.

Interrupción proximal de la arteria pulmonar derecha aislada e hipoplasia pulmonar ipsilateral: Presentación de caso / Pulmonary Artery Right Interruption Isolated With Ipsilateral Pulmonary Hypoplasia: Case Report

Las cardiopatías congénitas complejas se presentan con una gran variedad de malformaciones que pueden afectar el tronco de la arteria pulmonar y las arterias pulmonares. Es infrecuente encontrar de manera aislada la interrupción de una de las mismas. En este caso se explican las ayudas diagnósticas imaginológicas que llevaron al diagnóstico de interrupción proximal de la arteria pulmonar derecha sin asociación con otra malformación congénita, en una paciente a quien se le diagnosticó, inicialmente, síndrome de drenaje venoso anómalo.

The complex congenital heart disease may present with a variety of malformations in the main pulmonary artery. However, it is not common to find in isolation the absence of one of the pulmonary arteries. In this case report, we explain the diagnostic imaging aid that led to the diagnosis of proximal interruption of the right pulmonary artery without association to other congenital malformation in a patient in whom a syndrome of anomalous venous drainage was initially thought.

Clinical implications of different biomarkers in elderly patients with heart failure.

AIMS: The aim of this article was to determine the importance of neuroendocrine and inflammatory biomarkers in elderly patients (>70 years) with heart failure (HF). METHODS: In this retrospective and observational study, TNF-α, IL-6, IL-18, Fas (Apo1), BNP, C-reactive protein and cystatin C values were calculated, as well as the relationship between them and the clinical evolution of patients. RESULTS: A total of 124 patients (mean age ± standard deviation: 83±5 years) were included. After a mean follow-up of 2.4 years, 40.3% of patients were hospitalized for HF and 15.3% of patients died. Those patients who were hospitalized for HF compared with those that did not were hospitalized for HF showed higher values of IL-6 (9.8±13.1 vs 4.65±5.8 pg/ml; p=0.003) and those who died compared with those who are alive higher values of IL-18 (437.1±137.4 vs 299.7±167.2 pg/ml; p=0.01), C-reactive protein (12.6±19.4 vs 6.1±9.4 mg/l; p=0.03), BNP (704.2±428.6 vs 418.5±410.6 pg/ml; p=0.008) and cystatin C (1.76±0.6 vs 1.45±0.5 mg/l; p=0.04). In the multivariate analysis, only IL-18 (hazard ratio: 1.4; 95% CI: 1.05-1.8; p=0.027) remained as an independent predictor for mortality. CONCLUSION: In elderly patients with HF, the determination of biomarkers may be helpful to establish those patients at higher risk.