The effect of chronic hypertension on skin blood flow

Rendell, Marc; Milliken, Brian K.; Banset, E. J.; Finnegan, Mary F.; Stanosheck, Christopher; Terando, John V.

doi:10.1097/00004872-199605000-00010

Cited by 10 publications

(4 citation statements)

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“…4,35 Moreover, in subjects with hypertension, changes in skeletal muscle microvascular function are paralleled by changes in skin microvascular function. 36,37 Therefore, skin microcirculation resembles muscle microcirculation in many ways, and the variation in skin microvascular function found in this study may merely be a manifestation of a generalized variation in microvascular function not confined to a single organ. Although direct comparisons between skin and muscle microvascular function have yet to be reported, it seems justified to use the skin microvascular model to assess the role of microvascular function in the relation between insulin sensitivity and blood pressure.…”

Section: Serné Et Al February 23 1999mentioning

confidence: 62%

Microvascular Function Relates to Insulin Sensitivity and Blood Pressure in Normal Subjects

et al. 1999

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Section: Serné Et Al February 23 1999mentioning

confidence: 62%

Microvascular Function Relates to Insulin Sensitivity and Blood Pressure in Normal Subjects

et al. 1999

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“…There has been some speculation that vasomotion may be a compensatory attempt to overcome rarefaction and that the loss of vasomotion in diabetes compounds the effects of hypertension in people with diabetes (77). Rendell et al (78) explored the possibility that chronically elevated vascular pressure in spontaneously hypertensive rats might affect the microvascular constitution of the skin. These researchers measured skin blood flow on the back and the paw in hypertensive and nonhypertensive rats.…”

Section: Effects Of Hypertension On Vascular Reactivity -Type 2 Diabementioning

confidence: 99%

Dermal Neurovascular Dysfunction in Type 2 Diabetes

et al. 2001

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OBJECTIVE -To review evidence for a relationship between dermal neurovascular dysfunction and other components of the metabolic syndrome of type 2 diabetes.RESEARCH DESIGN AND METHODS -We review and present data supporting concepts relating dermal neurovascular function to prediabetes and the metabolic syndrome. Skin blood flow can be easily measured by laser Doppler techniques.RESULTS -Heat and gravity have been shown to have specific neural, nitrergic, and independent mediators to regulate skin blood flow. We describe data showing that this new tool identifies dermal neurovascular dysfunction in the majority of type 2 diabetic patients. The defect in skin vasodilation is detectable before the development of diabetes and is partially correctable with insulin sensitizers. This defect is associated with C-fiber dysfunction (i.e., the dermal neurovascular unit) and coexists with variables of the insulin resistance syndrome. The defect most likely results from an imbalance among the endogenous vasodilator compound nitric oxide, the vasodilator neuropeptides substance P and calcitonin gene-related peptide, and the vasoconstrictors angiotensin II and endothelin. Hypertension per se increases skin vasodilation and does not impair the responses to gravity, which is opposite to that of diabetes, suggesting that the effects of diabetes override and counteract those of hypertension.CONCLUSIONS -These observations suggest that dermal neurovascular function is largely regulated by peripheral C-fiber neurons and that dysregulation may be a component of the metabolic syndrome associated with type 2 diabetes. Diabetes Care 24:1468 -1475, 2001A number of functional disturbances are found in the dermal microvasculature of diabetic subjects. These include decreased microvascular blood flow (1), increased vascular resistance (2), decreased tissue PO 2 (3), and altered vascular permeability characteristics, such as loss of the anionic charge barrier and decreased charge selectivity. Decreased microvascular blood flow and increased vascular resistance in diabetes could result from alterations in dermal neurovascular function, such as impaired dilator responses to substance P, calcitonin gene-related peptide (CGRP), and reactivity to nociceptive stimulation. Diabetes also disrupts vasomotion-the rhythmic contraction exhibited by arterioles and small arteries (4,5). Unmyelinated C-fibers, which constitute the central reflex pathway, are assumed to be damaged in diabetic neuropathy, contributing to abnormalities in cutaneous blood flow (6). Warm thermal sensation is a functional measure of C-fibers in the periphery, and the impairment of this function was paralleled by a reduction of vasomotion. These findings support an interaction between small unmyelinated C-fiber function and vasomotion, although it is not clear whether the neurological deficit precedes or follows the loss of baseline vascular response. A clear relationship between skin microvascular insufficiency and neuropathy has not yet been established. It is possible that ski...

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“…A substantial decrease in skin blood flow reserve in chronic hypertension has been shown. This reduction at sites with significant arteriovenous perfusion is greater than at nutritive sites (Rendell et al, 1996). This is another reason for cold-induced reduction of skin blood flow.…”

Section: Hypothermia and Blood Pressure Regulationmentioning

confidence: 97%