Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

Abstract

Resistant hypertension (RHTN) includes both patients whose blood pressure (BP) is uncontrolled on three or more medications (uncontrolled RHTN (UCRH)) and patients whose BP is controlled with use of four or more drugs (controlled RHTN (CRH)). It is unknown whether endothelial function and nocturnal drop demonstrate a similar pattern in patients with CRH and UCRH. We examined circadian BP patterns and vascular function in these patients. In all, 40 CRH and 26 UCRH patients, and 25 normotensives underwent biochemical testing, ambulatory BP monitoring, determination of brachial artery responses to endothelial-dependent (flow-mediated; dilation (FMD)) and independent (nitroglycerin mediated) stimuli. The nighttime drop in systolic BP (SBP) and diastolic BP (DBP) was less pronounced in UCRH than in CRH (SBP, 1.9±1.6 versus 4.9 ± 1.7%; DBP, 7.5 ± 1.8 versus 10.9 ± 1.8%, UCRH and CRH, respectively; Po0.05). FMD was greater in control group compared with RHTN patients. Patients with UCRH had significantly impaired FMD compared with CRH (5.9 ± 2.3% versus 7.1 ± 5.1%; Po0.0001). Therefore, UCRH patients have less nocturnal dipping and a more impaired endothelial response compared with CRH patients. These findings suggest that important differences among patients with RHTN may allow identify subgroups with increased cardiovascular risk.

Consumption of a boiled Greek type of coffee is associated with improved endothelial function: The Ikaria Study

“…21 Endothelial function represents the health of the vessel wall and is associated with nitric oxide (NO) production in response to shear stress. Moreover, endothelial dysfunction is an important early step in the atherosclerotic process 38 and is associated with resistant hypertension 39 and with adverse cardiovascular events. 11,40 There is convincing evidence that coffee consumption acutely impairs endothelial function.…”

Endothelial dysfunction and diurnal variation of blood pressure: night secrets of arterial hypertension?

“…Indeed, uncontrolled resistant hypertension was featured by significantly more depressed endothelial function than the group responsive to the therapy, and these abnormalities were significantly linked to a lack of nocturnal dipping in BP. 14 One may speculate that better values of the flowmediated dilation the last group could just reflect remittance of the endothelial functionality in response to the BP reduction. Admittedly, changes and fluctuations in arterial shear stress, which parallel BP changes are important regulators of endothelial activity and potential contributors of endothelial dysfunction.…”

Hypertension in Chronic Kidney Disease Part 2

“…22 The prevalence of the rising BP pattern, which has been associated with a high cardiovascular risk in hypertensive patients without CKD, may be up to 2.5-fold more prevalent in CKD, and up to 5-fold more prevalent in ESRD. 76 Potential mechanisms for these alterations in CKD patients include an increase in sympathetic drive during nighttime, 77 enhanced salt sensitivity because of a reduced sodium excretory ability, 78,79 sleep breathing disorders (ie, obstructive sleep apnea), leptin and insulin resistance, 80 endothelial dysfunction, 81 and glucocorticoid, 82,83 or cyclosporine use. 84 Longitudinal studies in CKD populations have provided evidence that elevated nighttime BP levels are better predictors of fatal and nonfatal cardiovascular events, progression to ESRD, and mortality than daytime or 24-hour BP levels.…”