To describe immune basal profile and its predictive value on the incidence of cardiovascular events and blood pressure evolution in hypertensive stage I subjects.Design and method:
Patients with mild hypertension were recruited with at least 5 years from diagnosis. Exclusion criteria were: GFR> 60 ml/min/1.73 m2 (MDRD) microalbuminuria> 30 mg/24 hs, previous CV events, autoimmune disease, use of imunomodulatory agents or corticosteroids. At entry and follow up office and 24 hs ambulatory BP was measured; cell subpopulations were measured by flow cytometry in peripheral blood and direct cell count respectively, using T and dendritic cells monoclonal antibodies. End points were defined as the incidence of stroke, ischemic heart disease, new onset diabetes, cardiovascular and all-cause mortality, and number/doses of antihypertensive drugs and BP.Results:
72 subjects were classified in two groups: a) hipertensives, n:50 (24 women, 55.0 ± 9.0 years, 132 ± 6.4/80.3 ± 8.7 mmHg, number of antihypertensive drugs 2.0 ± 1.5.) and b) normotensive, n:22 (12 women, 53 ± 11 years). Median follow up: 5.4. ± 3.3 years. The distribution of immune markers in hypertensive was expressed as median x 106 cells / L (range): 650.40 CD4 + (272–980), CD8 + 110.37 (80–143), CD4 + / CD8 + 5.30 (2.50–9.90), CD25 + 86.90 (80.0–99.6), CD86 + (69.8–448.70), CD83 + (69.40–145). Compared to controls, HTs had a profile with higher CD3 + CD4 + CD83 + CD86 + (<0.001). At follow up, we found a direct association between the RR of events in the entire population (HT and NT) with higher baseline CD4 +, CD83 +, CD86 +, increased CD4 + / CD8 +, CD25 + lower ratio / CD4 + (<0.001). HTs had more events than NTs: 9.4 vs 0% stroke, ischemic heart disease 12.5 vs 7.1%, all-cause mortality 2 vs 0%. Among hypertensive greater CD4 + / CD8 + and / or lower ratio CD25 + / CD4 + were highly predictive of new cases of DBT.Conclusions:
In hypertensive stage I we identified a specific immune cell activation pattern.