Global Journal of Medical Research, F: Diseases, Volume 23 Issue 2

However, the Brazilian Guidelines on Hypertension states there is a relationship between a sedentary lifestyle and hypertension since the lack of physical activity is 27.5%, with a higher prevalence among women (31.7%) than men (23.4%), confirming the profile found in the sample studied (2,16) . Ethnicity is also considered an essential factor for hypertension because non-white individuals are more likely to develop higher cardiovascular risk. Non-white individuals (90.2%) were the majority in the study population, consistent with the ethnicity prevalent in the region (2) . Regarding the education/instruction of the individual, it is associated that the lower level of education can generate limited conditions of absorption of information to people about their health, linking to more illness and negative correlation with the prevention, control of hypertension, and treatment adherence. In the sample, we obtained 32.8% of individuals with incomplete primary education and 13.1% with no education, with a total of 43.9% of people with little or no education, which seems to be a more relevant factor for the differences in the prevalence of hypertension than ethnic implication itself. In addition to risk factors being predictors of outcomes, hypertensive patients should periodically undergo laboratory tests, and these, when associated with traditional cardiovascular risks, can assist in this stratification. In hypertensive patients, it is also essential to investigate associated comorbidities, especially DM. According to the Guidelines of the Brazilian Society of Diabetes, fasting glucose levels for non- pregnant adults are considered normal when they vary between 70-99 mg/dL (17) . In the study, 71.1% of the patients in the sample presented glycemic changes, which corroborates directly with the increase in CV risk (60.6%). Smoking is associated with the development of albuminuria, which may contribute to progressive kidney disease and increased risk of CVD (14,18) . According to the Dialysis Morbidity and Mortality Study (DMMS) Wave 2, 40% of patients on dialysis are current smokers (16.6%) or former smokers (24.2%) (19) . Smoking has vasoconstrictive, thromboembolic, and direct effects on the vascular endothelium and is a strong predictor of increased serum creatinine levels in non-diabetic patients 65 years of age and older (20, 21) . Among the inflammatory markers is IL-6, a pro- inflammatory cytokine that acts in different tissues, mainly concerning immune and humoral effects, and is released primarily by adipocytes (22-24) . Visceral adipose tissue releases about 15 to 30% of all IL-6 production (23) . This fact strengthens the inclusion of obesity as one of the risk factors for CVD (23) . IL-6 also has effects on carbohydrate and lipid metabolism. As adipose tissue is an essential source of this cytokine, in obese individuals, IL-6, as a potent stimulator of CRP, can inhibit the activity of lipoprotein lipase, causing a low glucose uptake mediated by insulin, increasing insulin resistance, exemplified in table 3, which shows the direct relationship of glycemia and IL-6, as well as CRP (25,26) . The neutrophil/lymphocyte ratio (NLR) can be used as an easy marker of integration into the laboratory routine at virtually no additional cost. There is an increase in NLR when there are inflammatory events (27) . High serum levels of CRP indicate a higher risk of the individual developing coronary and cardiovascular diseases, through the elevation of BP, by hemodynamic, hormonal, and biomechanical mechanisms (28-32) . In the sample, hypertensive patients with higher abdominal circumference and BMI had the highest values of CRP, showing that obesity is directly related to hypertension. A direct relationship was also established between CRP and glycemia and IL-6, reaffirming cardiovascular risk. On the other hand, Ferritin is associated with the presence of anemia and, in high concentrations, implies iron overload, resulting in oxidative stress, therefore participating in the inflammatory effect. No impact of anemia was detected in the population studied. However, it is considered a non-traditional risk factor in the development of cardiovascular diseases, as it contributes to myocardial hypertrophy and indirectly to higher mortality of patients with CKD (17, 33) . The results of the present study should be analyzed considering some limitations. Despite being a population-based sample, the individuals allocated were limited to those treated in a reference health unit linked to the Family Health Strategy, which may affect the generalization of the results. Another limiting fact is based on the food issue. Although eating habits have an important impact on BP reduction, this study should have evaluated them, considering the logistical difficulty in applying dietary recalls. However, all participants were asked if the unit’s professionals about adopting consistent eating habits to control hypertension instructed them. Another question infers the sample size; although it is sufficient for the analysis, there is a limitation of the cross-sectional design, making it impossible to establish causal relationships between exposure and disease development. In conclusion, although hypertension has a multifactorial etiology, obesity, smoking, and glycemia were the risk factors positively correlated with it. Given this, it is essential to intensify the control of hypertension and cardiovascular risk factors, aiming to reduce or control morbidity and mortality through prevention and better quality of life for the population. 34 Year 2023 Global Journal of Medical Research Volume XXIII Issue II Version I ( D ) F © 2023 Global Journals Inflammatory Markers and Risk Factors in Hypertensive Patients: A Cross-Sectional Study