Endothelial dysfunction indicates target organ damage in hypertensive patients. The integrity of endothelial glycocalyx (EG) plays a vital role in vascular permeability, inflammation and elasticity, and finally to cardiovascular disease. The authors aimed to investigate the role of increased HDL cholesterol (HDL‐C) levels, which usually are considered protective against cardiovascular disease, in EG integrity in older hypertensive patients. The authors studied 120 treated hypertensive patients older than 50 years were divided regarding HDL‐C tertiles in group HDLH (HDL‐C ≥ 71 mg/dL, upper HDL‐C tertile) and group HDLL (HDL‐C < 71 mg/dL, two lower HDL‐C tertiles). Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranging from 5 to 9 µm) using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non‐invasive accurate index of reduced EG thickness. PBR 5‐9 was significantly decreased in group HDLH (P = 0.04). In the whole population, HDL‐C was inversely but moderately related to PBR 5‐9 (r = −0.22, P = 0.01). In a multiple linear regression analysis model, using age, BMI, smoking habit, HDL‐C, LDL‐C, and office SBP, as independent variables, the authors found that BMI (β = 0.25, P = 0.006) independently predicted PBR 5‐9 in the whole population. In older hypertensive patients, HDL‐C ranging between 71 and 101 mg/dL might moderately protect EG and subsequently endothelial function. Future studies in several groups of low‐ or high‐risk hypertensives are needed in order to evaluate the beneficial role of extremely elevated HDL‐C regarding cardiovascular risk evaluation as well as endothelial glycocalyx as a novel index of target organ damage in essential hypertension.
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An association between androgenic alopecia (AGA), coronary artery disease, and hypertension has been reported in previous epidemiological studies. The authors evaluated the relationship of target organ damage caused by hypertension with AGA in 101 newly diagnosed and untreated hypertension men with mild to moderate AGA (AGAm), severe AGA (AGAs), and non‐AGA. Pulse wave velocity (PWV), office and 24‐hour pulse pressure (PP), carotid intima‐media thickness (IMT), left ventricular hypertrophy (LVH), coronary flow reserve (CFRd), and AGA severity by Hamilton‐Norwood scale were estimated. CFRd was significantly impaired in AGAs patients compared with AGAm (P=.007) and non‐AGA patients (P=.02). No differences were found within groups regarding PWV, PP, IMT, and LVH. AGA severity was related to CFRd (independently) and PP while AGA duration and age of onset were related to CFRd and PP, respectively. The authors conclude that impaired coronary microcirculation and aortic stiffness might precede the appearance of significant stenotic coronary lesions in hypertensive patients with severe AGA. In addition, hypertensive patients with severe and early AGA onset seem to be exposed to an augmented cardiovascular risk.
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