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Published on: October 22, 2014
Endothelial Function Is Impaired in Patients Receiving Antihypertensive Drug Treatment Regardless of Blood Pressure
Tatsuya Maruhashi1, Junko Soga1, Noritaka Fujimura1
1From the Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences (T.M., J.S., N.F., N.I., S.M., Y.I., A.I., M.K., T.M., N.O., S.K., S.M., H.H., T.H., Y.K.) and Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine (Y.A., F.B.M.Y., K.N., Y.H.), Hiroshima University, Japan; Department of Gastroenterology and Metabolism, Biomedical Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan (K.C.); Division of Regeneration and Medicine, Hiroshima University Hospital, Japan (K.N., A.N., Y.H.); Department of Rehabilitation, Faculty of General Rehabilitation, Hiroshima International University, Japan (C.G.); Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y., T.K.); Division of Biomedical Engineering, National Defense Medical College Research Institute, Tokorozawa, Japan (B.T.); Cardiovascular Medicine, University of Leicester, United Kingdom (T.S.); Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan (T.I.); Department of Clinical Pharmacology and Therapeutics, University of the Ryukyu School of Medicine, Okinawa, Japan (S.U.); Clinical Research Support Center, Faculty of Medicine, The University of Tokyo, Japan (T.Y.); Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Japan (T.F.); Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.); Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan (T.I.); Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan (S.K.); Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology, Yamagata University School of Medicine, Japan (K.W.); Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Japan (Y.T.); Department of Medical Education and Population-Based Medicine, Postgraduate School of Medicine, Wakayama Medical University, Japan (T.H.); Department of Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Japan (M.S.); Department of General Medicine, Shimane University Faculty of Medicine, Izumo, Japan (Y.I.); Department of Cardiovascular and Renal Medicine, Saga University, Japan (K.N.); Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan (K.M.); The Third Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan (Y.O.); Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan (T.F.); Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan (H.I.); and Faculty of Fukuoka Medical Technology, Teikyo University, Japan (H.I.).
Insights
Antihypertensive drug treatment may mask the relationship between high blood pressure and endothelial dysfunction. Even with controlled blood pressure, treated patients show impaired endothelial function compared to untreated individuals.
Area of Science:
- Cardiovascular Medicine
- Clinical Physiology
Background:
- Hypertension is a significant risk factor for cardiovascular disease, often linked to endothelial dysfunction.
- Endothelial function, assessed via flow-mediated vasodilation (FMD), is crucial for vascular health.
- The impact of antihypertensive treatment on the blood pressure-endothelial function relationship remains unclear.
Purpose of the Study:
- To investigate whether antihypertensive treatment status influences the association between blood pressure and endothelial function.
- To compare endothelial function in treated hypertensive patients versus antihypertensive drug-naive subjects across different blood pressure levels.
Main Methods:
- Cross-sectional study involving 2297 participants (1822 drug-naive, 475 treated hypertensive patients).
- Measurement of flow-mediated vasodilation (FMD) to assess endothelial function.
- Statistical analysis, including propensity score matching, to compare FMD between groups and its association with systolic blood pressure.
Main Results:
- In drug-naive subjects, higher systolic blood pressure was significantly associated with lower FMD (P<0.001).
- In treated hypertensive patients, no significant relationship was observed between systolic blood pressure and FMD (P=0.77).
- Endothelial dysfunction was more prevalent in treated hypertensive patients than in untreated subjects across all systolic blood pressure categories.
Conclusions:
- Antihypertensive treatment may attenuate the direct correlation between systolic blood pressure and endothelial function.
- Endothelial function appears impaired in treated hypertensive patients, irrespective of their achieved blood pressure levels.
- Further research is needed to understand the long-term vascular effects of antihypertensive therapies on endothelial health.
Abstract:
Hypertension is associated with endothelial dysfunction. Blood pressure significantly correlates with endothelial function in antihypertensive drug-naive subjects. The purpose of this study was to determine whether treatment status affects the relationship between blood pressure and endothelial function. We measured flow-mediated vasodilation (FMD) in 2297 subjects, including 1822 antihypertensive drug-naive subjects and 475 treated hypertensive patients. FMD significantly decreased in relation to increase in systolic blood pressure (8.2±3.1% in subjects with systolic blood pressure of <120 mm Hg, 7.5±2.8% for 120-129 mm Hg, 7.1±2.8% for 130-139 mm Hg, and 6.7±2.6% for ≥140 mm Hg; P<0.001). Systolic blood pressure was independently associated with FMD in untreated subjects. In contrast, there was no significant relationship between systolic blood pressure and FMD in treated hypertensive patients (4.6±3.1% in treated hypertensives with systolic blood pressure of <120 mm Hg, 4.8±2.7% for 120-129 mm Hg, 4.9±2.8% for 130-139 mm Hg, and 4.5±2.3% for ≥140 mm Hg; P=0.77). Propensity score matching analysis revealed that the prevalence of endothelial dysfunction defined as FMD of less than the division point for the lowest tertile, and the middle tertile of FMD was significantly higher in treated hypertensive patients than in untreated subjects in all systolic blood pressure categories. Endothelial function assessed by FMD was impaired regardless of the level of blood pressure achieved by antihypertensive drug treatment in hypertensive patients.
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