Sympatholytic effects of transcranial direct current stimulation (tDCS) on blood pressure levels in resistant hypertensive subjects - A novel therapeutic approach

• Grant number: 16/18104-5
• Support Opportunities: Regular Research Grants
• Start date: February 01, 2018
• End date: January 31, 2020
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Heitor Moreno Junior
• Grantee: Heitor Moreno Junior
• Host Institution: Faculdade de Ciências Médicas (FCM). Universidade Estadual de Campinas (UNICAMP). Campinas , SP, Brazil
• Associated researchers: Alessandra Mileni Versuti Ritter ; Ana Paula Cabral de Faria Modolo ; Bruno Rodrigues

Abstract

The mechanisms of resistance to antihypertensive treatment are not fully elucidated, but it has been associated to hyperactivity of sympathetic nervous system (SNS). Invasive therapies have been developed for the RHTN treatment, but SNS hyperactivity remains as a challenge in clinical practice. Thus, the use of cerebral stimulation techniques, such as non-invasive transcranial direct current stimulation (tDCS) on cortex in HAR subjects seems promising due to potential modulation of BP levels. Moreover, some previous studies have shown that a cortical sympathetic modulation induced by tDCS can reduce BP; however, the main outcome in these investigations was the improvement in the depression after tDCS on cerebral cortex. The current randomized clinical trial aims to evaluate weather using a 2-week tDCS period (6 sessions) reduces BP levels in RHTN subjects associated to a decreasing of sympathetic tonus in the absence of depression. This double blind crossover study will include 20 patients allocated to two groups (1) PLACEBO Stimulation (sham)/INTERVENTION (tDCS): sham stimulation for 2 weeks followed by tDCS intervention for another 2-week period. (2) INTERVENTION (tDCS)/PLACEBO stimulation (sham): tDCS intervention for 2 weeks followed by placebo stimulation-sham for another 2-week period. All cortical stimulations will be performed between an interval of at least 1 week. The clinical variables office BP, central BP (Sphygmocor) and sympathetic nervous activity (microneurography) and biomarkers tests will be assessed in the pre- and post-period of tDCS and placebo-sham periods, but hemodynamic parameters (Finometer) will be simultaneously analyzed during each tDCS and placebo protocols. We hypothesize (H1) that the tDCS "treatment" after 2 weeks reduces BP levels in RHTN patients probably by modulating the tonus of the cortical SNS. Secondarily, some variations in both immune-inflammatory and hormonal (especially RAAS) in this clinical condition with complex physiopathology will also be investigated. (AU)

Scientific publications

(7)

(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)

RUBIO, TATIANE AZEVEDO; RODRIGUES, BRUNO; CAIEIRO DA COSTA, LARISSA MORETE; FERREIRA-MELO, SILVIA ELAINE; BONALUME TACITO, LUCIA HELENA; MORENO, BEATRIZ; VILELA MARTIN, JOSE FERNANDO; SANTO CESTARIO, ELIZABETH DO ESPIRITO; GODOY, MOACIR FERNANDES; MORENO-JUNIOR, HEITOR; et al. Linear and non-linear analyses of autonomic modulation in uncontrolled and controlled elderly resistant hypertensives. Experimental Gerontology, v. 159, MAR 2022. (16/18104-5)

RODRIGUES, BRUNO; BARBOZA, CATARINA A.; MOURA, ELIEZER G.; MINISTRO, GABRIELA; FERREIRA-MELO, SILVIA E.; CASTANO, JAVIER B.; RUBERTI, OLIVIA M.; DE AMORIM, RIVADAVIO F. B.; MORENO, JR., HEITOR. Transcranial direct current stimulation modulates autonomic nervous system and reduces ambulatory blood pressure in hypertensives. CLINICAL AND EXPERIMENTAL HYPERTENSION, v. 43, n. 4, p. 320-327, MAY 19 2021. (16/18104-5, 17/24726-1)

MORENO, HEITOR. Pseudo and resistant hypertension: A chaotic perspective. JOURNAL OF CLINICAL HYPERTENSION, v. 24, n. 6, p. 6-pg., 2022-04-25. (16/18104-5)

MINISTRO, GABRIELA; CASTANO, JAVIER B.; BARBOZA, CATARINA A.; MOURA, ELIEZER G.; FERREIRA-MELO, SILVIA E.; MOSTARDA, CRISTIANO T.; FATTORI, ANDRE; MORENO-JUNIOR, HEITOR; RODRIGUES, BRUNO. ACUTE TRANSCRANIAL DIRECT CURRENT STIMULATION (tDCS) IMPROVES VENTILATORY VARIABILITY AND AUTONOMIC MODULATION IN RESISTANT HYPERTENSIVE PATIENTS. Respiratory Physiology & Neurobiology, v. 297, p. 8-pg., 2022-03-01. (16/18104-5, 17/24726-1)

PIRES, NAYARA FRACCARI; COELHO-JUNIOR, HELIO JOSE; GAMBASSI, BRUNO BAVARESCO; CABRAL DE FARIA, ANA PAULA; VERSUTI RITTER, ALESSANDRA MILENI; BARBOZA, CATARINA DE ANDRADE; FERREIRA-MELO, SILVIA ELAINE; RODRIGUES, BRUNO; MORENO JUNIOR, HEITOR. Combined Aerobic and Resistance Exercises Evokes Longer Reductions on Ambulatory Blood Pressure in Resistant Hypertension: A Randomized Crossover Trial. Cardiovascular Therapeutics, v. 2020, AUG 1 2020. (17/21320-4, 16/18104-5)

RUBERTI, OLIVIA MORAES; YUGAR-TOLEDO, JUAN CARLOS; MORENO, HEITOR; RODRIGUES, BRUNO. Hypertension telemonitoring and home-based physical training programs. BLOOD PRESSURE, v. 30, n. 6, OCT 2021. (16/18104-5, 19/02975-5)

RODRIGUES, BRUNO; BARBOZA, CATARINA A.; MOURA, ELIEZER G.; MINISTRO, GABRIELA; FERREIRA-MELO, SILVIA E.; CASTANO, JAVIER B.; NUNES, WILTON M. S.; MOSTARDA, CRISTIANO; COCA, ANTONIO; VIANNA, LAURO C.; et al. Acute and Short-Term Autonomic and Hemodynamic Responses to Transcranial Direct Current Stimulation in Patients With Resistant Hypertension. FRONTIERS IN CARDIOVASCULAR MEDICINE, v. 9, p. 16-pg., 2022-03-11. (16/18104-5, 17/24726-1)