CANNABIDIOL AND RESISTANT HYPERTENSION: EVIDENCE ON BLOOD PRESSURE MODULATION
DOI:
https://doi.org/10.36557/2009-3578.2025v11n2p1954-1968Palavras-chave:
Cannabidiol; Resistant Hypertension; Blood Pressure; Phytocannabinoids; Complementary TherapiesResumo
Introduction: Resistant hypertension, defined as uncontrolled blood pressure despite the use of three or more antihypertensive agents, represents an important cardiovascular risk factor and a therapeutic challenge. Cannabidiol (CBD), a phytocannabinoid from Cannabis sativa without significant psychoactive effects, has gained attention for its vasodilatory, anti-inflammatory, antioxidant, and autonomic-modulating properties. Method: An Integrative Literature Review was conducted in PubMed, ScienceDirect, SciELO, and Web of Science databases, using the descriptors Cannabidiol, Blood Pressure, Resistant Hypertension, and Hypertension. Original articles published between 2019 and 2025, in Portuguese and English, directly addressing the use of CBD in blood pressure modulation were included. After a systematized screening, 14 studies composed the final sample. Results: The studies show that CBD may promote discrete yet consistent reductions in baseline blood pressure and attenuate pressure spikes in stress-induced situations. Preclinical models reinforce its role in vasodilation and improvement of endothelial function, in addition to effects on inflammatory modulation and autonomic nervous system activity. Clinical trials in humans corroborate these findings, but present limitations related to sample size, methodological heterogeneity, and short follow-up duration. Discussion: Controversies remain regarding dose standardization, formulation, and route of administration, as well as long-term safety. Potential drug interactions with antihypertensives warrant caution in clinical practice. Final considerations: CBD emerges as an innovative and promising alternative for patients with resistant hypertension, though still at an experimental stage. Multicenter, randomized, long-term trials are essential to consolidate evidence on efficacy and safety, enabling future clinical recommendations.
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ACELAJADO, M. C. et al. Treatment of Resistant and Refractory Hypertension. Circulation Research, v. 124, n. 7, p. 1061–1070, 29 mar. 2019. DOI: 10.1161/CIRCRESAHA.118.312156. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469348/. Acesso em: 15 ago. 2025.
ARAÚJO, M.; ALMEIDA, M. B.; ARAÚJO, L. L. N. Mecanismo de ação dos canabinoides: visão geral. Brazilian Journal of Pain (BrJP), v. 6, suppl. 2, p. S109–S113, 2023. DOI: 10.5935/2595-0118.20230028-pt. Disponível em: https://www.scielo.br/j/brjp/a/DkrHzwvf9ngstvdd89KMHjk/?lang=pt. Acesso em: 18 ago. 2025.
BALACHANDRAN, P.; ELSOHLY, M. A.; HILL, K. P. Cannabidiol interactions with medications, illicit substances, and alcohol: a comprehensive review. Journal of General Internal Medicine, v. 36, n. 7, p. 2074–2084, 2021. DOI: 10.1007/s11606-020-06504-8. PMID: 33515191; PMCID: PMC8298645. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8298645/. Acesso em: 19 ago. 2025.
BARANOWSKA-KUCZKO, M. et al. Vasodilatory effects of cannabidiol in human pulmonary and rat small mesenteric arteries: modification by hypertension and the potential pharmacological opportunities. Journal of Hypertension, v. 38, n. 5, p. 896–911, maio 2020. DOI: 10.1097/HJH.0000000000002333. Disponível em: https://journals.lww.com/jhypertension/fulltext/2020/05000/vasodilatory_effects_of_cannabidiol_in_human.16.aspx. Acesso em: 18 ago. 2025.
DUJIĆ, G. et al. Chronic effects of oral cannabidiol delivery on 24-h ambulatory blood pressure in patients with hypertension (HYPER-H21-4): a randomized, placebo-controlled, and crossover study. Cannabis and Cannabinoid Research, v. 9, n. 4, p. 979–989, 2024. DOI: 10.1089/can.2022.0320. PMID: 37093160. Disponível em: https://pubmed.ncbi.nlm.nih.gov/37093160/. Acesso em: 19 ago. 2025.
GANONG, L. H. Integrative reviews of nursing research. Research Nursing Health, v.10, n.1, p.01-10, 1987. Disponível em: https://pubmed.ncbi.nlm.nih.gov/3644366/. Acesso em: 17 ago. 2025.
HENSON, J. D. Enhancing endocannabinoid control of stress with cannabidiol. Journal of Clinical Medicine, Basel, v. 10, n. 24, art. 5852, 2021. DOI: 10.3390/jcm10245852. Disponível em: https://www.mdpi.com/2077-0383/10/24/5852? Acesso em: 19 ago. 2025.
KICMAN, A.; TOCZEK, M. The Effects of Cannabidiol, a Non-Intoxicating Compound of Cannabis, on the Cardiovascular System in Health and Disease. International Journal of Molecular Sciences, Basel, v. 21, n. 18, artigo 6740, 2020. DOI: 10.3390/ijms21186740. PMID: 32937917. Disponível em: https://www.mdpi.com/1422-0067/21/18/6740?. Acesso em: 18 ago. 2025.
KUMRIĆ, M. et al. CBD supplementation reduces arterial blood pressure via modulation of the sympatho-chromaffin system: a substudy from the HYPER-H21-4 trial. Biomedicine & Pharmacotherapy, v. 160, p. 114387, fev. 2023. DOI: 10.1016/j.biopha.2023.114387. Disponível em: https://www.sciencedirect.com/science/article/pii/S075333222300175. Acesso em: 15 ago. 2025.
LEMES, M. A. et al. Evaluation strategies in active learning in higher education in health: integrative review. Revista Brasileira de Enfermagem, v.47, n.2, 2021. Disponível em: https://www.scielo.br/j/reben/a/KG8VgQhpKf9ySfCwjkyNY6w/?format=pdf&lang=en. Acesso em: 17 ago. 2025.
LOCKWOOD, C.; MUNN, Z.; PORRITT, K. Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. International Journal of Evidence-based Healthcare, v.13, n.3, p.179-187, 2015. Disponível em: https://pubmed.ncbi.nlm.nih.gov/26262565/. Acesso em: 18 ago. 2025.
LOCKWOOD, C. et al. Systematic reviews of qualitative evidence. In: Aromataris, E; Munn, Z. (Editors). JBI Manual for Evidence Synthesis. JBI, 2020. Disponível em: https://jbi-global-wiki.refined.site/space/MANUAL/355860482. Acesso em: 17 ago. 2025.
MILLAR, S. A. et al. A systematic review of cannabidiol dosing in clinical populations. British Journal of Clinical Pharmacology, v. 85, n. 9, p. 1888–1900, jul. 2019. DOI: 10.1111/bcp.14038. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710502/. Acesso em: 15 ago. 2025.
MOHER, D. et al. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoSMed, v. 6, n.7, p.1000097, 2009. Disponível em: https://pubmed.ncbi.nlm.nih.gov/19621072/. Acesso em: 18 ago. 2025.
MUJAHID, K. et al. Cannabidiol as an immune modulator: A comprehensive review. Saudi Pharmaceutical Journal, v. 33, n. 3, p. 11, 23 maio 2025. DOI: 10.1007/s44446-025-00005-7. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102056/. Acesso em: 15 ago. 2025.
NAYA, N. M. et al. Molecular and Cellular Mechanisms of Action of Cannabidiol. Molecules, v. 28, n. 16, art. 5980, 9 ago. 2023. DOI: 10.3390/molecules28165980. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10458707/. Acesso em: 18 ago. 2025.
NOUBIA-J, J. J. et al. Global prevalence of resistant hypertension: a meta-analysis of data from 3.2 million patients. Heart, v. 105, n. 2, p. 98–105, jan. 2019. DOI: 10.1136/heartjnl-2018-313599. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30087099/. Acesso em: 15 ago. 2025.
Organização Mundial da Saúde (WHO). Hypertension. 2023. Disponível em: https://www.who.int/news-room/fact-sheets/detail/hypertension. Acesso em: 15 ago. 2025.
ONG, M. J. Y. et al. The use of cannabidiol as adjunctive therapy in adult patients with drug-resistant epilepsy: a systematic review and meta-analysis. Therapeutic Advances in Neurological Disorders, v. 18, art. 17562864251313914, 2025. DOI: 10.1177/17562864251313914. Disponível em: https://journals.sagepub.com/doi/10.1177/17562864251313914?. Acesso em: 19 ago. 2025.
O’SULLIVAN, S. E. et al. The therapeutic potential of purified cannabidiol. Journal of Cannabis Research, v. 5, n. 1, art. 21, 13 jun. 2023. DOI: 10.1186/s42238-023-00186-9. Disponível em: https://jcannabisresearch.biomedcentral.com/articles/10.1186/s42238-023-00186-9. Acesso em: 18 ago. 2025.
REMISZEWSKI, P. et al. Chronic cannabidiol administration fails to diminish blood pressure in rats with primary and secondary hypertension despite its effects on cardiac and plasma endocannabinoid system, oxidative stress and lipid metabolism. International Journal of Molecular Sciences, v. 21, n. 4, art. 1295, 14 fev. 2020. DOI: 10.3390/ijms21041295. Disponível em: https://www.mdpi.com/1422-0067/21/4/1295
. Acesso em: 15 ago. 2025.
SOUZA, M. T.; SILVA, M. D.; CARVALHO, R. Integrative review: what is it? How to do it? Einstein, v.8, n.1, p.102-106, 2010. Disponível em: https://www.scielo.br/j/eins/a/ZQTBkVJZqcWrTT34cXLjtBx/?format=pdf&lang=pt. Acesso em: 17 ago. 2025.
STERN, C.; JORDAN, Z.; MCARTHUR, A. Developing the review question and inclusion criteria. The American Journal of Nursing, v.14, n.4, p.53-56, 2014. Disponível em: https://pubmed.ncbi.nlm.nih.gov/24681476/. Acesso em: 17 ago. 2025.
URLIĆ, H. et al. Antihypertensive effects of CBD are mediated by altered inflammatory response: a sub-study of the HYPER‑H21‑4 trial. Journal of Functional Foods, v. 110, art. 105873, 2023. DOI: 10.1016/j.jff.2023.105873. Disponível em: https://lexariabioscience.com/wp-content/uploads/2023/11/Journal-of-Functional-Foods-Antihypertensive-effects-of-CBD-are-mediated-by-altered-inflammatory-response. Acesso em: 18 ago. 2025.
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Copyright (c) 2025 Arthur Junqueira Ferreira Santos, Rodolfo de Oliveira Medeiros, Loren Ferrarezi, Guilherme de Lúcio Consalter, Camila Menon Oliveros, Vitor Turra Rondinelli Pereira, Sophia Evaristo Coércio, Gabriel de Abreu Paschoal, Gabriel Baraldi Labegalini, João Victor Cardoso Casarin
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