Prognostic Significance of Endothelial Dysfunction in Hypertensive Patients

Perticone, Francesco; Ceravolo, Roberto; Pujia, Arturo; Ventura, Giorgio; Iacopino, Saverio; Scozzafava, Angela; Ferraro, Alessandro; Chello, Massimo; Mastroroberto, Pasquale; Verdecchia, Paolo; Schillaci, Giuseppe

doi:10.1161/01.cir.104.2.191

Cited by 969 publications

(681 citation statements)

References 45 publications

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“…8 Indeed, the cumulative cardiovascular event rates in hypertensive patients with high-grade endothelial dysfunction were higher than in hypertensive patients with lowgrade endothelial dysfunction. 27 These findings suggest that forearm endothelial dysfunction is a prediction of future cardiovascular events in patients with hypertension. Lerman and Zeiher 28 reported the results of multivariant analysis of hazard ratios of studies showing an association between coronary or peripheral endothelial function and cardiovascular events.…”

Section: Endothelial Functionmentioning

confidence: 91%

“…Recently, several investigators, including us, have evaluated the effects of intra-arterial infusion of NO agonists, such as acetylcholine, methacholine and bradykinin, and intra-arterial infusion of NO antagonists on forearm blood flow using a mercury-filled Silastic strain-gauge plethysmography and the effects on coronary blood flow using a Doppler flow guide wire. [9][10][11]17,26,27,35 The responses to intraarterial infusion of vasoactive agents should be most suitable for assessing endothelial function, because the use of agonists to stimulate NO release and the use of antagonists of NO allow us to draw more specific conclusions concerning the role of basal and stimulated NO release. However, the invasive methods are time consuming and are a burden for patients.…”

Section: Endothelial Functionmentioning

confidence: 99%

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Endothelial dysfunction and hypertension in aging

2012

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Hypertension is one of the common diseases in the elderly. The prevalence of hypertension markedly increases with advancing age. Both aging and hypertension have a critical role in cardiovascular and cerebrovascular complications. Although aging and hypertension, either independently or collectively, impair endothelial function, aging and hypertension may have similar cascades for the pathogenesis and development of endothelial dysfunction. Nitric oxide (NO) has an important role in regulation of vascular tone. Decrease in NO bioavailability by endothelial dysfunction would lead to elevation of blood pressure. An imbalance of reduced production of NO or increased production of reactive oxygen species, mainly superoxide, may promote endothelial dysfunction. One possible mechanism by which the prevalence of hypertension is increased in relation to aging may be advancing endothelial dysfunction associated with aging through an increase in oxidative stress. In addition, endothelial cell senescence is also involved in aging-related endothelial dysfunction. In this review, we focus on recent findings and interactions between endothelial function, oxidative stress and hypertension in aging.

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Section: Endothelial Functionmentioning

confidence: 91%

Section: Endothelial Functionmentioning

confidence: 99%

Endothelial dysfunction and hypertension in aging

2012

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“…In many epidemiologic studies, exaggerated blood pressure response to exercise has been implicated to predict future cardiovascular events such as systemic hypertension, congestive heart failure, and ischemic heart diseases. [1][2][3] During exercise tests, diastolic blood pressure (DBP) may not increase or may often decrease, but SBP has been increasing at a steady rate as a function of an increase in cardiac output against peripheral adaptation during exercise. 4 Nitric oxide released by the vascular endothelium has been known to relax vascular smooth muscle, thereby decreasing vascular resistance and blood pressure.…”

Section: Introductionmentioning

confidence: 99%

Endothelial dysfunction in patients with exaggerated blood pressure response during treadmill test

Chang

Chung

Choi

et al. 2004

Clinical Cardiology

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SummaryBackground: The diagnostic and prognostic importance of exaggerated blood pressure response to exercise is controversial. Endothelial dysfunction has been demonstrated in patients with atherosclerosis and risk factors for coronary artery disease, but there is a paucity of information on patients with exercise-induced hypertension.Hypothesis: We designed the study to evaluate endothelial function in patients with exaggerated blood pressure response during exercise.Methods: Exercise-induced hypertension was defined as systolic blood pressure ≥ 210 mmHg in men and ≥ 190 mmHg in women during the treadmill test. Using a high-resolution ultrasound technique, endothelial function of the brachial artery in patients with exercise-induced hypertension (n = 25) and control subjects (n = 25) was investigated.Results: Endothelium-dependent vasodilation was impaired in patients with exercise-induced hypertension compared with controls (7.77 ± 5.14 vs. 2.81 ± 2.29%, p < 0.05). On univariate analysis, the extent of vasodilation correlated negatively with age (r = Ϫ0.43, p < 0.05) and ∆ systolic blood pressure (r = Ϫ0.39, p < 0.05). Even after adjustment for factors known to affect endothelial function, endothelium-dependent vasodila-

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“…b-Blockers are known to have unfavourable effects on EDVD, 52 while improvement in EF in the rilmenidine group can be explained by a direct decrease in sympathetic stimulation and positive metabolic changes contributing to the functioning of the vascular endothelium. Endothelial dysfunction is considered nowadays an independent negative risk factor, 16 and documenting positive effects in EDVD can serve as additional evidence for rilmenidine benefits in hypertension management. Additionally, although the long-term cardiovascular consequences of such deleterious effects remain unclear, a recent metaanalysis evidenced an increasing cardiovascular mortality with atenolol compared with other antihypertensive classes.…”

Section: Discussionmentioning

confidence: 99%

“…The positive prognostic value of LVH regression and carotid IMT decrease is well documented, [10][11][12][13][14][15] whereas the independent prognostic significance of endothelial dysfunction is now actively studied. 16 The data of major clinical trials and meta-analyses indicate that angiotensin II receptor antagonists and ACE inhibitors are more effective in correction of LVH and EF compared with other drug classes, [17][18][19][20][21][22] while calcium antagonists can reverse carotid atherosclerosis. [23][24][25] All the same, the relatively newer drug class of I 1 -imidazoline receptor agonists was not included in the majority of meta-analyses and is less studied in the field of both hard and intermediate end point prevention.…”

Section: Introductionmentioning

confidence: 99%

How can we block sympathetic overactivity? Effects of rilmenidine and atenolol in overweight hypertensive patients

et al. 2006

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The aim of the present study was to evaluate effects of long-term treatment with rilmenidine compared with atenolol on lipid and glucose metabolism and cardiovascular remodelling in hypertension. In total, 37 patients with hypertension were randomised to rilmenidine 1-2 mg/day or atenolol 50-100 mg/day for 26 weeks. Standard oral glucose tolerance test with a parallel measurement of insulin and glucose levels was performed. The 'areas under the curve' (AUC) for insulin and glucose were calculated. Plasma lipids, left ventricular mass index (LVMI), and intima-media thickness (IMT) were measured. Brachial artery diameter during reactive hyperaemia was used to test endotheliumdependent vasodilatation (EDVD). Blood pressure reduction was equally achieved in both treatment arms. The fasting glucose level increased in the atenolol group from 4.870.6 to 5.270.7 mmol/l (Po0.01). The AUC of glucose in rilmenidine group decreased from 860793 to 737766 mmol/min/l (Po0.05), and in the atenolol group it increased from 937786 to 989788 mmol/min/l (Po0.05). Rilmenidine showed a positive effect on lipid levels, whereas in the atenolol group a significant decrease of high-density lipoprotein cholesterol was observed. Left ventricular mass index decreased with rilmenidine by 9.6% and by 6.9% with atenolol (Po0.05). Intima-media thickness significantly decreased in the rilmenidine group. Endothelium-dependent vasodilatation slightly increased on in the rilmenidine group, while on in the atenolol group it remained unchanged. Our data suggest that in hypertensive patients central inhibition of sympathetic drive can produce favourable effects on glucose and lipid metabolism compared with standard b-blockade with a similar antihypertensive efficacy. Rilmenidine also provides beneficial effects on cardiovascular remodelling and altered endothelial function in hypertension.

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Prognostic Significance of Endothelial Dysfunction in Hypertensive Patients

Abstract: Our data suggest that forearm endothelial dysfunction is a marker of future cardiovascular events in patients with essential hypertension.

Cited by 969 publications

References 45 publications

Endothelial dysfunction and hypertension in aging

Endothelial dysfunction and hypertension in aging

Endothelial dysfunction in patients with exaggerated blood pressure response during treadmill test

How can we block sympathetic overactivity? Effects of rilmenidine and atenolol in overweight hypertensive patients

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