The relationship of endothelial function and arterial stiffness with subclinical target organ damage in essential hypertension

Abstract

This study aimed to explore whether brachial-ankle pulse wave velocity (baPWV) and brachial artery flow-mediated dilation (FMD) or the interaction of both parameters are associated with subclinical target organ damage (STOD) indices in patients with essential hypertension. A total of 4618 patients registered from January 2015 to October 2020 were included. baPWV and FMD were measured to evaluate arterial stiffness and endothelial dysfunction. Whereas left ventricular hypertrophy (LVH), urine albumin-creatinine ratio (UACR), and carotid intima-media thickness (CIMT) were obtained as STOD indicators. On multivariable logistic regression analysis with potential confounders, higher quartiles of baPWV and FMD were significantly associated with an increased risk of STOD. In patients <65 years of age, the odds ratio (OR) of LVH, UACR, and CIMT ≥.9 mm for the fourth versus the first quartile of baPWV were 1.765 (1.390-2.240), 2.832 (2.014-3.813), and 3.075 (2.315-4.084), respectively. In interaction analysis, an increase in baPWV shows a progressively higher risk of STOD across the quartiles of FMD. Also, the estimated absolute risks of LVH, UACR, and CIMT ≥.9 mm for the first to fourth quartile of baPWV increased from 1.88 to 2.75, 2.35 to 4.44, and 3.10 to 6.10, respectively, in patients grouped by FMD quartiles. The addition of baPWV to FMD slightly improved risk prediction for STOD. BaPWV and FMD were independently associated with an increased risk of STOD in patients with essential hypertension especially among patients <65 years of age. Patients with elevated baPWV and decreased FMD parameters are at increased risk of STOD.

Influence of Shift Work on Arterial Stiffness and Systemic Inflammation

“…A cross-sectional survey also reports an increase in PWV without a simultaneous increase in IMT values among shift workers 31 . However, the increase in PWV in the present study might suggest endothelial dysfunction because a relationship between endothelial dysfunction and arterial stiffness has been described in a clinical setting 32 . Endothelial dysfunction also relates to cellular adhesion molecules, 33 which were of higher levels among shift workers as compared with control subjects.…”

“… 31 However, the increase in PWV in the present study might suggest endothelial dysfunction because a relationship between endothelial dysfunction and arterial stiffness has been described in a clinical setting. 32 Endothelial dysfunction also relates to cellular adhesion molecules, 33 which were of higher levels among shift workers as compared with control subjects. Furthermore, we found a correlation between PWV and carotid intima-media thickness, which are also shown in other studies.…”

Arterial stiffness is associated with cancer mortality: Insight from Kailuan study

“…Thus, further studies are required to understand the effect of age and gender‐related physiological changes that affect baPWV. In the past, baPWV was significantly associated with subclinical target organ damage in participants younger than 65 years 25 . The baPWV is known to increase with aging synchronously 14,26 .…”

A Critical Review on Vasoactive Nutrients for the Management of Endothelial Dysfunction and Arterial Stiffness in Individuals under Cardiovascular Risk

“…The endothelium is a semipermeable layer located between the bloodstream and blood vessel wall, comprising a barrier that selectively limits macromolecule movements and guarantees host defense [1]. Endothelial cells, the main endothelium components, play an important role in cardiovascular homeostasis by regulating vascular tone, blood flow, angiogenesis, monocyte/leukocyte adhesion and platelet aggregation [2]. In response to different stimuli, the endothelium maintains the balance between vasoconstriction and vasodilation through the release of both autocrine and paracrine substances, including angiotensin II, endothelin-1, thromboxane A2 and prostacyclin H2, all of which participate in vasoconstriction, while nitric oxide (NO), bradykinin, and hyperpolarizing factors act on vasodilation [3].…”

“…Therefore, early hemodynamic abnormality detection is paramount and depends on the application of reliable and non-invasive techniques, valuable as routine diagnostic procedures. Non-invasive methods, such as flow-mediated vasodilation (FMD) and pulse wave velocity (PWV) measurements, particularly the carotid-femoral (cfPWV) and brachial-ankle (baPWV) pulse wave velocities, which are recognized as indexes of arterial stiffness and the speed at which the arterial pulse propagates along the arterial wall, with cfPWV being considered the gold standard for measuring large artery stiffness, have been employed to assess endothelial function and arterial stiffness, respectively, as cardiovascular event predictors [2,[22][23][24].…”