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Pulse pressure and endothelial dysfunction in never-treated hypertensive patients
Roberto Ceravolo1, Raffaele Maio, Arturo Pujia
1Internal Medicine and Cardiovascular Diseases Unit, Department of Experimental and Clinical Medicine G. Salvatore, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy.
Journal of the American College of Cardiology
|May 28, 2003
Summary
High pulse pressure (PP) is linked to reduced forearm vasodilation in hypertensive patients. This finding highlights PP as a key indicator of endothelial dysfunction and cardiovascular risk.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Vascular Biology
Background:
- Pulse pressure (PP) is a significant predictor of cardiovascular events.
- Endothelial dysfunction, characterized by impaired vasodilation to acetylcholine (ACh), is linked to cardiovascular risk factors.
- The prognostic importance of endothelial dysfunction in coronary and forearm vasculature is increasingly recognized.
Purpose of the Study:
- To investigate the association between pulse pressure (PP) and endothelium-dependent vasodilation.
- To assess PP as a predictor of endothelial dysfunction in never-treated hypertensive individuals.
Main Methods:
- 262 never-treated hypertensive patients (age 30-55) underwent clinical and ambulatory blood pressure (BP) monitoring.
- Forearm vasodilation was assessed using strain-gauge plethysmography during intra-arterial infusion of acetylcholine (ACh) and sodium nitroprusside.
- Endothelium-dependent and -independent vasodilation responses were measured.
Main Results:
- Systolic BP, not diastolic BP, significantly influenced PP.
- A significant inverse correlation was found between ACh-stimulated forearm blood flow (FBF) and age, BMI, clinic/monitored systolic BP, and clinic/monitored PP.
- Monitored PP emerged as the strongest independent predictor of ACh-stimulated FBF, explaining 33.6% of the variation; each 1 mm Hg increase in monitored PP correlated with an 8.7% decrease in ACh-stimulated FBF.
Conclusions:
- Monitored pulse pressure (PP) is inversely correlated with acetylcholine-stimulated vasodilation.
- Elevated PP may impair vasodilation by increasing oxidative stress and reducing nitric oxide production due to decreased shear stress.
- Ambulatory BP monitoring accurately predicts hypertension-associated endothelial dysfunction.