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From short-term blood pressure variability to atherosclerosis: Relative roles of vascular stiffness and endothelial

Alfonso Tatasciore1, Marta Di Nicola2, Roberto Tommasi1

  • 1Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.

Journal of Clinical Hypertension (Greenwich, Conn.)
|July 9, 2020
PubMed

Insights

Both average blood pressure and short-term blood pressure variability are linked to hypertension-mediated organ damage, including increased carotid artery intima-media thickness. Endothelial dysfunction plays a role in intima-media thickness but has a minor role in arterial stiffening related to blood pressure variability.

Area of Science:

  • Cardiovascular Medicine
  • Hypertension Research
  • Vascular Biology

Background:

  • Arterial blood pressure (BP) average levels and short-term BP variability (BPV) are associated with hypertension-mediated organ damage.
  • Increased carotid artery intima-media thickness (IMT) and carotid-femoral pulse wave velocity (PWV) are key indicators of this damage.
  • Endothelial dysfunction is a potential mediator of these BP-related vascular changes.

Purpose of the Study:

  • To investigate the role of endothelial dysfunction in mediating the relationship between BP average levels, BPV, and hypertension-mediated organ damage.
  • To examine the associations of BP average levels and short-term systolic BPV with IMT and PWV.
  • To determine how endothelial function parameters, specifically brachial artery flow-mediated dilation (FMD) and digital reactive hyperemia index (RHI), explain these relationships.

Main Methods:

  • Cross-sectional study involving 189 newly diagnosed, untreated hypertensive patients.
  • Evaluation of relationships between average BP, short-term systolic BPV (using standard deviation of awake SBP or 24-hour-weighted SBP), IMT, and PWV.
  • Assessment of endothelial function using FMD and RHI, and analysis using multivariable models.

Main Results:

  • Both average systolic blood pressure (SBP) and measures of SBPV were significantly related to IMT and PWV.
  • BP parameters showed only weak associations with FMD and RHI.
  • FMD and RHI were related to IMT but not PWV, and contributed independently to IMT prediction in multivariable models.

Conclusions:

  • Endothelial dysfunction is independently associated with IMT in hypertensive patients.
  • Endothelial dysfunction plays a minor role in the link between BP variability and arterial stiffening (PWV).
  • Average BP levels and short-term BP variability are significant predictors of IMT and PWV, independent of endothelial function in this cohort.

Keywords:
arterial stiffnessblood pressureblood pressure variabilityflow-mediated dilationhypertensionintima-media thicknesspulse wave velocityreactive hyperemia index

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