Related Experiment Video
Updated: Aug 9, 2026
Ultrasound Assessment of Endothelial Function: A Technical Guideline of the Flow-mediated Dilation Test
Published on: April 27, 2016
Endothelial dysfunction: how can one intervene at the beginning of the cardiovascular continuum?
1University of Erlangen/Nuremberg, Germany. roland.schmieder@rzmail.uni-erlangen.de
Insights
Renin-angiotensin system blockade improves endothelial function in patients with hypertension and type 2 diabetes. This early intervention may prevent future renal and cardiac complications, highlighting a new therapeutic target.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Endocrinology
Background:
- Endothelial dysfunction, marked by reduced nitric oxide activity, is an early indicator of atherosclerosis and predicts cardiovascular events.
- Microalbuminuria and estimated glomerular filtration rate, influenced by renal nitric oxide, predict outcomes but indicate later-stage renal impairment.
- Endothelial dysfunction signifies early renal involvement in atherosclerotic processes.
Purpose of the Study:
- To investigate the impact of renin-angiotensin system (RAS) blockade on renal endothelial function in hypertensive patients with type 2 diabetes but without albuminuria.
- To assess whether RAS blockade at earlier disease stages offers cardio- and renoprotective benefits.
- To explore endothelial function as a therapeutic target in the early continuum of renal and cardiovascular disease.
Main Methods:
- The Telmisartan versus Ramipril in renal ENdothelium DYsfunction (TRENDY) trial evaluated endothelial function in the renal vasculature.
- Patients included were diagnosed with hypertension and type 2 diabetes, specifically excluding those with albuminuria.
- Assessment focused on basal nitric oxide activity and endothelium-dependent vasorelaxation.
Main Results:
- RAS blockade, as demonstrated in the TRENDY trial, significantly improved endothelial function, assessed by basal nitric oxide activity.
- These findings align with peripheral circulation improvements observed with angiotensin II receptor blockers.
- The study suggests that early intervention with RAS blockade can enhance endothelial function.
Conclusions:
- Targeting endothelial function early in the renal and cardiovascular continuum through RAS blockade offers a promising strategy.
- This approach may prevent the progression to renal and cardiac failure.
- The results complement findings from trials like DETAIL, supporting the renoprotective effects of RAS inhibitors.
Abstract:
Endothelial dysfunction, characterized by impaired nitric oxide activity, constitutes an early step in the pathogenesis of atherosclerotic disease. Prospective studies have shown that impaired endothelium-dependent vasorelaxation and the vasodilatory response of coronary arteries to acetylcholine predict cardiovascular events. Microalbuminuria and estimated glomerular filtration rate, which are both deeply influenced by renal nitric oxide activity, are predictors of cardiovascular outcome and total mortality but develop at a later stage of renal impairment. Endothelial dysfunction reflects early stage renal involvement in the atherosclerotic processes. The Telmisartan versus Ramipril in renal ENdothelium DYsfunction (TRENDY) trial examined endothelial function of the renal vasculature as a therapeutic target in patients with hypertension and type 2 diabetes, but without albuminuria. The rationale was that blockade of the renin-angiotensin system (RAS) is cardio- and renoprotective at later stages of the disease, but the impact of blockade of the RAS at earlier stages of disease is unknown. The results of TRENDY indicate that the endothelial function, as assessed by basal nitric oxide activity, can be improved after RAS blockade. These data complement the results of the Diabetics Exposed to Telmisartan And enalaprIL (DETAIL) trial, which demonstrated that telmisartan and enalapril similarly decelerate the progression of overt diabetic nephropathy. The results of TRENDY are in accordance with the observed changes in peripheral circulation. Endothelium-dependent vasorelaxation could be improved with angiotensin II receptor blockers, but not with diuretics or beta-blockers, in hypertensive patients. Intervention at the beginning of the renal and cardiovascular continuum offers the opportunity to prevent the fatal development towards renal and cardiac failure.
More Related Videos
08:42Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
08:35Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:29Hypertension II: Pathophysiology
01:23Atherosclerosis IV: Nursing Management
01:26Coronary Artery Disease II: Pathophysiology
01:27Regulation of the Cardiovascular System
The regulation of the cardiovascular system involves the autonomic nervous system (ANS), baroreceptors, and chemoreceptors, ensuring that heart rate and blood pressure are appropriately modulated in response to varying physiological demands.
The ANS comprises two main divisions: the sympathetic and parasympathetic nervous systems. The sympathetic nervous system enhances...
01:27Peripheral Artery Disease III: Interprofessional Care