Prognostic role of reversible endothelial dysfunction in hypertensive postmenopausal women

Modena, Maria Grazia; Bonetti, Lorenzo; Coppi, Francesca; Bursi, Francesca; Rossi, Rosario

doi:10.1016/s0735-1097(02)01976-9

Cited by 514 publications

(391 citation statements)

References 51 publications

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“…Endothelial dysfunction has been shown to be a good predictor of cardiovascular events [19][20][21][22][23][24] and has been described as a 'barometer for cardiovascular risk' [25]. We were therefore somewhat surprised by our previous study, which showed that in a normotensive population of patients with type 2 diabetes, spironolactone actually worsened the key prognostic marker of endothelial function [10].…”

Section: Discussionmentioning

confidence: 90%

Spironolactone for poorly controlled hypertension in type 2 diabetes: conflicting effects on blood pressure, endothelial function, glycaemic control and hormonal profiles

et al. 2008

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Aims/hypothesis Aldosterone antagonism improves endothelial function (and reduces deaths) in chronic heart failure. It is not known whether similar effects occur in other high-risk groups such as patients with diabetes and hypertension. We therefore assessed the full effects of aldosterone blockade in poorly controlled hypertensive patients with type 2 diabetes, focussing on blood pressure, endothelial function, glycaemic control and key hormones. Methods We performed a randomised, placebo-controlled, double-blind, crossover study on 50 patients with type 2 diabetes and treated but poorly controlled hypertension, comparing spironolactone versus placebo. Patients had their endothelial function assessed by standard forearm venous occlusion plethysmography. Results There was no significant improvement in endotheliumdependent vasodilatation in response to acetylcholine, despite highly significant reductions in systolic and diastolic blood pressure. However, spironolactone significantly worsened glycaemic control, plasma angiotensin II and cortisol. Conclusions/interpretation Spironolactone is highly effective in lowering blood pressure in patients with type 2 diabetes and poorly controlled hypertension on standard treatment, but does not improve vascular endothelial function in this group. We speculate that any tendency for the spironolactoneinduced lowering of blood pressure to improve endothelial function is offset by its tendency to worsen glycaemic control and increase the levels of angiotensin II and even possibly cortisol.Trials Registry no.: ISRCTN 76558770

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Section: Discussionmentioning

confidence: 90%

Spironolactone for poorly controlled hypertension in type 2 diabetes: conflicting effects on blood pressure, endothelial function, glycaemic control and hormonal profiles

et al. 2008

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“…Modena and colleagues [72] measured how FMD changed in 400 postmenopausal women before and 6 months after establishment of optimal blood pressure control. Women responding to therapy with >10% FMD improvement had significantly fewer events during 67 month follow-up.…”

Section: Endothelial Dysfunction-a Hallmark Of Cardiovascular Diseasementioning

confidence: 99%

Endothelial dysfunction in cardiovascular disease and Flammer syndrome—similarities and differences

et al. 2017

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The endothelium has increasingly been recognized as a smart barrier and a key regulator of blood flow in microand macrovascular beds. Endothelial dysfunction marks a stage of atherosclerosis and is an important prognostic marker for cardiovascular disease. Yet, some people who tend to be slim and physically active and with rather low blood pressure show a propensity to respond to certain stimuli such as emotional stress with endothelial-mediated vascular dysregulation (Flammer syndrome). This leads to characteristic vascular symptoms such as cold hands but also a risk for vascularmediated diseases such as normal-tension glaucoma. It is the aim of this review to delineate the differences between Flammer syndrome and its Bcounterpart^endothelial dysfunction in the context of cardiovascular diseases.

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“…These include brachial artery flow-mediated dilatation and venous occlusion plethysmography 1,23 . Severity of hypertension correlates with impairment of endothelial function and anti-hypertensive therapies that improve endothelial function in addition to lowering blood pressure may be associated with greater improvements in overall cardiovascular risk 1,24,25 .…”

Section: Measuring Endothelial Functionmentioning

confidence: 99%

“…The endothelium is an important early target of hypertension and endothelial dysfunction is a risk marker for future cardiovascular events 22 . Targeting Anti-hypertensive strategies that improve endothelial function as well as lowering blood pressure may be more effective in reducing overall cardiovascular risk than approaches which lower blood pressure but have no effect on endothelial function 1,24,104 . Indeed, the Overall, the evidence would suggest that clinicians should consider the vascular effects of anti-hypertensive drugs and non-pharmacological approaches to lowering blood pressure.…”

Section: Why Should We Target the Vascular System In The Treatment Ofmentioning

confidence: 99%

Drug Treatment of Hypertension: Focus on Vascular Health

Cameron

Lang

Touyz

2016

Drugs

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Hypertension, the most common preventable risk factor for cardiovascular disease and death, is a growing health burden. Serious cardiovascular complications result from target organ damage including cerebrovascular disease, heart failure, ischaemic heart disease and renal failure. While many systems contribute to blood pressure elevation, the vascular system is particularly important, because vascular dysfunction is a cause and consequence of hypertension. Hypertension is characterised by a vascular phenotype of endothelial dysfunction, arterial remodelling, vascular inflammation and increased stiffness. Antihypertensive drugs that influence vascular changes associated with high blood pressure have greater efficacy for reducing cardiovascular risk than drugs that reduce blood pressure but have little or no effect on the adverse vascular phenotype. Angiotensin converting enzyme Key Points• Hypertension is characterized by a vascular phenotype of endothelial dysfunction and structural remodeling.• Anti-hypertensive drugs that target the vascular changes associated with hypertension appear to be most efficacious• New anti-hypertensive drugs should promote vascular health as well as reducing blood pressure 3

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Prognostic role of reversible endothelial dysfunction in hypertensive postmenopausal women

Abstract: This study demonstrates that a significant improvement in endothelial function may be obtained after six months of antihypertensive therapy and clearly identifies patients who possibly have a more favorable prognosis.

Cited by 514 publications

References 51 publications

Spironolactone for poorly controlled hypertension in type 2 diabetes: conflicting effects on blood pressure, endothelial function, glycaemic control and hormonal profiles

Spironolactone for poorly controlled hypertension in type 2 diabetes: conflicting effects on blood pressure, endothelial function, glycaemic control and hormonal profiles

Endothelial dysfunction in cardiovascular disease and Flammer syndrome—similarities and differences

Drug Treatment of Hypertension: Focus on Vascular Health

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