In situations of myocardial ischemia that occur in many hypertensive patients, miR-133a is also downregulated, promoting an increase in MT-1 MMP, in addition to elevating other pro-fibrotic genes such as transforming growth factor beta receptor 1 (TGFBR1), latent transforming growth factor binding protein 1 (LTBP1), matrix metalloproteinase 9 (MMP9), phosphorylated Smad2 (pSMAD2) and COLIAI, inducing activation of TGF-β signaling pathway, leading to vascular and cardiac fibrosis [83]. The gene discussed is MMP9; the disease is myocardial ischemia.