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Updated: Apr 20, 2026
Ultrasound Assessment of Endothelial Function: A Technical Guideline of the Flow-mediated Dilation Test
Published on: April 27, 2016
Effect of non-antihypertensive drugs on endothelial function in hypertensive subjects evaluated by flow-mediated
Michiaki Miyamoto, Kazuhiko Kotani, Nobuyuki Taniguchi1
1Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke- City, Tochigi 329-0498, Japan. Kazukotani@jichi.ac.jp.
Insights
Several non-antihypertensive drugs, including statins and pioglitazone, can improve endothelial function in patients with hypertension (HTN). These findings offer new insights into managing HTN beyond traditional blood pressure-lowering medications.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Medical Imaging
Background:
- Hypertension (HTN) is a significant risk factor for atherosclerosis and associated cardiovascular complications.
- Endothelial dysfunction, assessed by flow-mediated vasodilation (FMD), is closely linked to HTN.
- Current management of HTN primarily focuses on antihypertensive drugs, but non-antihypertensive agents may also impact endothelial function.
Purpose of the Study:
- To review clinical trials examining the effects of non-antihypertensive medications on endothelial function in hypertensive patients.
- To evaluate changes in FMD as a measure of endothelial function.
- To explore potential alternative therapeutic strategies for managing HTN-related endothelial dysfunction.
Main Methods:
- Systematic review of clinical trials involving patients with hypertension.
- Assessment of endothelial function using ultrasound-based flow-mediated vasodilation (FMD).
- Analysis of data from studies using various non-antihypertensive drugs, including statins, pioglitazone, orlistat, celecoxib, aspirin, alagebrium, and estrogen-replacement therapy.
Main Results:
- Statins improved FMD in hypercholesterolemic hypertensive patients, reducing cholesterol without significant BP changes.
- Pioglitazone enhanced FMD in non-diabetic hypertensive patients by improving insulin sensitivity.
- Orlistat improved FMD in obese hypertensive patients, correlating with weight reduction and some BP decrease.
- Celecoxib, aspirin (with statins), alagebrium, and estrogen-replacement therapy also demonstrated improvements in FMD in specific hypertensive populations, with varying effects on BP.
Conclusions:
- Non-antihypertensive drugs can positively influence endothelial function, as measured by FMD, in patients with hypertension.
- These findings suggest that certain non-antihypertensive medications may offer additional benefits in HTN management by improving endothelial health.
- Further research into these agents could provide novel therapeutic avenues for comprehensive HTN care.
Abstract:
Hypertension (HTN) is a major risk factor for atherosclerosis. Flow-mediated vasodilation (FMD) is an ultrasonic method used to evaluate endothelial function, which is associated with HTN and related complications. We summarized clinical trials focusing on the effects of non-antihypertensive drugs on endothelial function, as evaluated by FMD, in patients with HTN. Hypercholesterolemic patients with HTN who used the cholesterol- lowering drugs HMG-CoA reductase inhibitors (statins) had improved FMD with a reduction in cholesterol levels and no significant change in blood pressure (BP). Non-diabetic patients with HTN who used the insulinsensitizing drug pioglitazone had improved FMD with a reduction in insulin resistance. Obese patients with HTN who used the anti-obesity drug orlistat had improved FMD with a reduction in BP and weight, and the improvement in FMD was correlated with weight reduction. Patients with HTN who used the selective cyclocxygenase-2 inhibitor celecoxib had improved FMD with no significant change in BP. Hypercholesterolemic patients with HTN who used aspirin added to a statin had improved FMD with a reduction in BP. Patients with HTN who used the advanced glycation endproduct crosslink breaker alagebrium had improved FMD with no significant change in BP. Postmenopausal women with HTN who used estrogen-replacement therapy had improved FMD. The possibility of improvement in FMD levels has, therefore, been suggested with several non-antihypertensive drugs. In addition to the direct effects of antihypertensive drugs on endothelial function, use of these non-antihypertensive drugs may give important insights into HTN management.
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