Vascular abnormalities in hypertension: Cause, effect, or therapeutic target?

McVeigh, Gary E.; Plumb, Rick; Hughes, Sinead M.

doi:10.1007/s11906-004-0065-x

Cited by 26 publications

(17 citation statements)

References 33 publications

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“…Small artery stiffness influences reflected waves 12 that have been identified in late systole as a pressure augmentation but can also be detected in diastole as an oscillation in the pressure decay that exhibits a frequency and rate of decay. 13 Small artery compliance or stiffness is a marker for endothelial dysfunction that induces a functional change in the microcirculation 14,15 and is a predictor of adverse cardiovascular events. 16 Resting blood pressure may be elevated when small artery tone is increased, but exercise blood pressure becomes a more sensitive guide to the stiffness of the arterial system.…”

Section: Screening Methodologymentioning

confidence: 99%

Arterial Elasticity as Part of a Comprehensive Assessment of Cardiovascular Risk and Drug Treatment

2005

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Abstract-Early cardiovascular disease can be identified in asymptomatic individuals by noninvasive evaluation of functional and structural abnormalities of the vasculature and heart. These abnomalities are usually a consequence of endothelial dysfunction. A panel of 10 tests, including small and large artery elasticity, has been used as the basis for a screening system that provides a score of 0 to 20 as a guide to the severity of disease. Using that Rasmussen score allows for stratification of patients into low, intermediate, or high risk for progression to cardiovascular morbid events. This comprehensive screening can be performed efficiently in a single room with a single technician. The sensitivity and specificity of this screening system in predicting future cardiovascular events, its superiority to traditional risk factor assessment, and its potential to track the response to therapeutic interventions must be validated in long-term follow-up studies. (Hypertension. 2005;46:217-220.)

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Section: Screening Methodologymentioning

confidence: 99%

Arterial Elasticity as Part of a Comprehensive Assessment of Cardiovascular Risk and Drug Treatment

2005

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“…The vast surface area of endothelium in the microcirculation compared with large conduit vessels means the vascular effects of ED will be most apparent in this section of the circulation [25]. A reasonable and plausible assumption is that alteration in vascular structure and endothelial function acts as the substrate for accelerated disease development and the occurrence of morbid events.…”

Section: Discussionmentioning

confidence: 99%

“…These are major risk factors that exhibit strong, positive, and continuous relationships with the risk of cardiovascular disease, even within defined normal ranges. Yet the development and progression of arterial vascular disease is a multifactorial process and isolated abnormalities are poor predictors of risk [23][24][25]. In current clinical practice, available techniques employed for diagnosis of cardiovascular disease tend to be used in response to the development of symptoms, and thus detect disease at a relatively late stage.…”

Section: Cardiovascular Risk Assessment and Measurement Of Endotheliamentioning

confidence: 99%

Measuring endothelial function

Lockhart¹,

McVeigh²,

Cohn

2006

Curr Diab Rep

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Dysfunction of the endothelium and of the arterial wall is well described in patients with atherosclerosis, diabetes, and other risk factors for vascular disease. In recent years, clinical research has focused on elucidating the role of this dysfunction in influencing vascular disease progression. Alteration in the structure of arteries and disruption of the homeostatic functions of the endothelium act as a substrate for end-organ damage and the occurrence of vascular events. Dysfunction of the vascular endothelial cells is probably the earliest event promoting atherosclerotic lesion formation. Therefore, methods capable of assessing endothelial function at a preclinical stage hold potential to refine cardiovascular risk stratification and serve as a guide to monitor the effects of therapeutic interventions. A number of methodologies are currently employed to assess endothelial function, but the optimal approach is not firmly established. In this article, we critically appraise the use of different methodologies employed to study endothelial function as a surrogate marker of future cardiovascular risk.

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“…Effective control of hypertension reduced the risk of microvascular complications in the UKPDS [105]. Intervention with anti-hypertensive drugs at an early stage might theoretically avoid irreversible vascular remodelling and permanent tissue damage [106]. Moreover, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are associated with a reduction in the incidence of new-onset diabetes among patients with essential hypertension [107].…”

Section: Therapeutic Implicationsmentioning

confidence: 99%

Vascular Disease in the Metabolic Syndrome: Do We Need to Target the Microcirculation to Treat Large Vessel Disease?

Krentz

Clough

Byrne³

2009

J Vasc Res

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The metabolic syndrome of vascular risk is threatening large numbers of ever-younger people. To date, the syndrome has been chiefly viewed as a potential risk marker that confers a heightened probability of developing type 2 diabetes and occlusive atherothrombotic disease of large- and medium-sized arteries. Accumulating evidence suggests that the components of the metabolic syndrome may also adversely affect the microvasculature through several inter-related mechanisms. These include the following observations: classic risk factors for macrovascular disease such as high blood pressure and dyslipidaemia also accelerate microvascular complications of diabetes, lesser disturbances of glucose metabolism (i.e. impaired glucose tolerance) may be associated with some forms of microvascular dysfunction, non-glucose intermediary metabolites may promote renovascular hypertension thereby damaging the microvasculature, and insulin resistance appears to be directly associated with microvascular dysfunction. In turn, microvascular complications such as nephropathy and autonomic neuropathy may promote the development and progression of atherosclerosis. We argue that the vascular implications of the metabolic syndrome should be broadened to include the microvasculature. The hypothesis that vascular events can be prevented, or at least deferred, through earlier therapeutic intervention in pre-diabetic subjects with glucose intolerance is amenable to testing in clinical trials.

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Vascular abnormalities in hypertension: Cause, effect, or therapeutic target?

Cited by 26 publications

References 33 publications

Arterial Elasticity as Part of a Comprehensive Assessment of Cardiovascular Risk and Drug Treatment

Arterial Elasticity as Part of a Comprehensive Assessment of Cardiovascular Risk and Drug Treatment

Measuring endothelial function

Vascular Disease in the Metabolic Syndrome: Do We Need to Target the Microcirculation to Treat Large Vessel Disease?

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