Efeitos da administração de probióticos sobre biomarcadores inflamatórios e suas associações com a função autonômica cardíaca de mulheres com hipertensão arterial sistêmica: análise secundária de um ensaio randomizado, triplo-cego e controlado por placebo

Abstract

The role of inflammation in the pathogenesis of systemic arterial hypertension (SAH) has been described. Compromised intestinal barrier integrity leads to systemic exposure to pathogens, antigens, and luminal endotoxins, which may trigger a low-grade chronic inflammatory process that may contribute to cardiac autonomic dysfunction and the development and maintenance of SAH. The aim of this study was to investigate whether adjuvant probiotic therapy is able to reduce inflammation in women with SAH and to analyze the correlation of inflammatory biomarkers with parameters of cardiac autonomic function in this population. This is a secondary analysis of a triple-blind study in which a total of 36 women were randomized into two groups: probiotic (n=19) or placebo (n=17). The probiotic group received 109 CFU/day of each strain of Lactobacillus paracasei LPC37, Lactobacillus rhamnosus HN001, Lactobacillus acidophilus NCFM, and Bifidobacterium lactis HN019. The placebo group received an identical bag of polydextrose (1 g/day). Clinical, biochemical (serum concentrations of IL-2, IL-4, IL-6, IL-10, IL-17A, IFN-γ and TNF-α) and heart rate variability (HRV) data were collected at baseline and after 8 weeks of intervention. Women who received probiotics showed an increase in serum concentrations of IL-17A (p=0.02) and a decrease in IFN-γ (p=0.01) and an increase in IL-10 (p=0.03) compared to the placebo group. The administration of probiotics or placebo did not change serum concentrations of TNF-α and IL-6 (p>0.05). Serum concentrations of IL-2 and IL-4 were reduced in women receiving placebo or probiotics (p<0.001). Correlations between HRV and inflammatory variables showed that IFN-γ was positively correlated with HR (heart rate), LF (low frequency), LF/HF and SD2/SD1 ratio and negatively correlated with HF (high frequency). IL-10 was negatively correlated with HR, LF, LF/HF and SD2/SD1 and positively correlated with HF. IL-6 correlated negatively with RMSSD (root mean square of the sum of the squares of the successive differences between adjacent normal beats) and SD1 and positively with SD2/SD1 ratio. Finally, IL-4 showed a negative correlation with SDRR (standard deviation between the duration of RR intervals), RMSSD, pRR50 (number of pairs of consecutive normal-to-normal intervals that differed by 50 ms), SD1 and SD2. In general, probiotic supplementation appeared to have an anti-inflammatory effect, as observed by the elevation of IL-10 in women with SAH. Pro-inflammatory biomarkers were positively correlated with greater sympathetic tone activity in HRV analysis