Internal Medicine Department, Hypertension Clinic, State Medical School at Sao Jose do Rio Preto (FAMERP), Ave Brig Faria Lima, 5416, Sao Jose do Rio Preto, SP, 15090-000, Brazil.
Medical School FACERES, Sao Jose do Rio Preto, SP, Brazil.
BMC Cardiovasc Disord. 2020 Mar 12;20(1):132. doi: 10.1186/s12872-020-01412-5.
Matrix metalloproteinase-9 (MMP-9) participates in the degradation of components of the extracellular matrix and it is involved in vascular remodeling and vasomotor changes. The aim of this study was to investigate the plasma levels of MMP-9 in acute vascular alterations due to hypertensive crisis.
This cross-sectional study was performed in 40 normotensive (NT) and 58 controlled hypertensive subjects (CHyp) followed up in outpatient clinic. Moreover, 57 patients with hypertensive emergency (HypEmerg) and 43 in hypertensive urgency (HypUrg), seen in emergency department, were also included. Hypertensive crisis was divided into HypEmerg, which was characterized by levels of systolic blood pressure (BP) ≥ 180 mmHg and/or diastolic BP ≥ 120 mmHg complicated with target-organ damage (TOD), and HypUrg, defined by BP elevation without TOD. Univariate and multivariate regression analysis was performed to identify the influence of independent variables on MMP-9 levels. A p-value < 0.05 was considered statistically significant.
The mean age was 43.5 years in the NT group (11 men); 57.7 years in the CHyp group (29 men); 59.4 years in the HypUrg group (21 men) and 62.4 years in the HypEmerg group (31 men). The age was statistically different in the NT group compared to other 3 groups. The mean BP was 116.5 ± 13.9/72.4 ± 10.6 mmHg for NT, 123.2 ± 12.6/79 ± 9.2 for CHyp, 194.1 ± 24.3/121.4 ± 17.3 for HypUrg and 191.6 ± 34.3/121.7 ± 18.8 mmHg for HypEmerg, respectively (p-value< 0.0001 between groups). MMP-9 levels were statistically different between the HypEmerg (2.31 ± 0.2 ng/mL) and HypUrg groups (2.17 ± 0.3 ng/mL) compared to the NT (1.94 ± 0.3 ng/mL) (p-value < 0.01 and p-value < 0.05, respectively) and CHyp groups (1.92 ± 0.2 ng/mL) (p-value < 0.01). Uric acid was the only independent variable for predicting MMP-9 levels (p-value = 0.001).
MMP-9 concentrations are significantly higher in the hypertensive crisis groups (urgency and emergency) compared to the control groups. Therefore, MMP-9 may be a biomarker or mediator of pathophysiologic pathways in cases of acute elevations of blood pressure.
基质金属蛋白酶-9（MMP-9）参与细胞外基质成分的降解，参与血管重塑和血管舒缩变化。本研究旨在探讨高血压危象导致的急性血管改变时血浆 MMP-9 水平。
本横断面研究纳入了 40 名血压正常（NT）和 58 名血压控制良好的高血压患者（CHyp），他们在门诊接受随访。此外，还纳入了 57 名高血压急症（HypEmerg）和 43 名高血压亚急症（HypUrg）患者，这些患者均在急诊就诊。高血压危象分为 HypEmerg，其特征为收缩压（BP）≥180mmHg 和/或舒张压（BP）≥120mmHg 并伴有靶器官损伤（TOD），以及 HypUrg，定义为 BP 升高而无 TOD。采用单因素和多因素回归分析确定独立变量对 MMP-9 水平的影响。p 值<0.05 被认为具有统计学意义。
NT 组的平均年龄为 43.5 岁（11 名男性）；CHyp 组为 57.7 岁（29 名男性）；HypUrg 组为 59.4 岁（21 名男性），HypEmerg 组为 62.4 岁（31 名男性）。NT 组与其他 3 组的年龄存在统计学差异。NT 组的平均 BP 为 116.5±13.9/72.4±10.6mmHg，CHyp 组为 123.2±12.6/79.0±9.2mmHg，HypUrg 组为 194.1±24.3/121.4±17.3mmHg，HypEmerg 组为 191.6±34.3/121.7±18.8mmHg（组间比较 p 值均<0.0001）。MMP-9 水平在 HypEmerg（2.31±0.2ng/mL）和 HypUrg 组（2.17±0.3ng/mL）与 NT（1.94±0.3ng/mL）（p 值均<0.01）和 CHyp 组（1.92±0.2ng/mL）（p 值均<0.01）之间存在统计学差异。尿酸是预测 MMP-9 水平的唯一独立变量（p 值=0.001）。
与对照组相比，高血压危象组（紧急和亚紧急）的 MMP-9 浓度明显升高。因此，MMP-9 可能是急性血压升高时病理生理途径的生物标志物或介质。
