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Non-invasive Assessment of Microvascular and Endothelial Function
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Non-invasive Assessment of Microvascular and Endothelial Function

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Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

T Quinaglia1, L C Martins, V N Figueiredo

  • 1Department of Internal Medicine, Cardiovascular Pharmacology Laboratory, Faculty of Medical Sciences and Clinic Hospital, State University of Campinas, São Paulo, Brazil.

Journal of Human Hypertension
|May 6, 2011
PubMed

Insights

Patients with uncontrolled resistant hypertension (RHTN) show reduced nocturnal blood pressure dipping and impaired endothelial function compared to controlled RHTN patients, suggesting distinct cardiovascular risk profiles.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Hypertension Research

Background:

  • Resistant hypertension (RHTN) encompasses patients with uncontrolled blood pressure (BP) on multiple medications (uncontrolled RHTN - UCRH) and those controlled on four or more drugs (controlled RHTN - CRH).
  • The differences in endothelial function and circadian BP patterns between UCRH and CRH patient groups remain largely unknown.
  • Understanding these distinctions is crucial for stratifying cardiovascular risk within RHTN populations.

Purpose of the Study:

  • To investigate and compare circadian BP patterns and vascular endothelial function in patients with UCRH and CRH.
  • To identify potential differences in endothelial-dependent and independent vasodilation between these RHTN subgroups.
  • To explore whether these physiological differences correlate with varying cardiovascular risk.

Main Methods:

  • Ambulatory BP monitoring was used to assess circadian BP patterns, including nocturnal dipping of systolic BP (SBP) and diastolic BP (DBP).
  • Vascular function was evaluated by measuring brachial artery responses to endothelial-dependent (flow-mediated dilation - FMD) and endothelial-independent (nitroglycerin-mediated) stimuli.
  • Biochemical testing was performed on 40 CRH patients, 26 UCRH patients, and 25 normotensive controls.

Main Results:

  • The nighttime BP drop was significantly less pronounced in UCRH patients compared to CRH patients (SBP: 1.9% vs. 4.9%; DBP: 7.5% vs. 10.9%).
  • Endothelial-dependent flow-mediated dilation (FMD) was significantly impaired in UCRH patients (5.9%) compared to CRH patients (7.1%).
  • Normotensive controls exhibited better FMD than both RHTN groups, and RHTN patients generally showed impaired vascular function compared to controls.

Conclusions:

  • Uncontrolled RHTN patients exhibit diminished nocturnal blood pressure dipping and more severe endothelial dysfunction compared to controlled RHTN patients.
  • These findings highlight significant physiological differences between UCRH and CRH subgroups.
  • Identifying these distinct RHTN subgroups may aid in better risk stratification and personalized management strategies for patients with resistant hypertension.

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