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Endothelial function and common carotid artery wall thickening in patients with essential hypertension
L Ghiadoni1, S Taddei, A Virdis
1I Clinica Medica, University of Pisa, Italy.
Insights
Carotid artery thickening in hypertension is linked to reduced endothelium-dependent vasodilation. This suggests endothelial dysfunction may contribute to early arterial changes in essential hypertension.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Hypertension Research
Background:
- Intimal-medial thickening of the carotid artery is an early indicator of atherosclerosis.
- Cardiovascular risk factors can impair endothelial function, contributing to atherosclerosis.
- Essential hypertension is a significant cardiovascular risk factor.
Purpose of the Study:
- To investigate the relationship between vascular reactivity and carotid intimal-medial thickening in patients with essential hypertension.
- To determine if endothelial dysfunction is associated with early arterial structural alterations.
Main Methods:
- B-mode ultrasound to measure carotid intimal-medial thickening.
- Strain-gauge plethysmography for forearm vascular response to acetylcholine (endothelium-dependent) and sodium nitroprusside (endothelium-independent).
- Echocardiography for left ventricular mass index and calculation of minimal forearm vascular resistances.
Main Results:
- Carotid intimal-medial thickening showed a significant inverse correlation with acetylcholine-induced vasodilation (P<0.001, r=-0.58) and age (r=-0.40).
- No significant correlation was found between carotid thickening and response to sodium nitroprusside, minimal forearm vascular resistances, or left ventricular mass index.
- Vasodilation to acetylcholine did not correlate with minimal forearm vascular resistances or left ventricular mass index.
Conclusions:
- In patients with essential hypertension, carotid wall thickening is associated with impaired endothelium-dependent vasodilation.
- Endothelial dysfunction may play a role in the early structural changes observed in the carotid artery in essential hypertension.
- Further research is needed to fully interpret findings across different vascular beds.
Abstract:
Intimal-medial thickening of the carotid wall is considered an early marker of atherosclerosis. Endothelial function is impaired in the presence of various cardiovascular risk factors that are implicated in the pathogenesis of atherosclerosis. To evaluate the relationship between vascular reactivity and carotid intimal-medial thickening, in 44 (mean+/-SD age, 45.7+/-8.8 years; range, 28 to 60 years; 31 men and 13 women) patients with essential hypertension who had never been treated and whose history of increased blood pressure was no longer than 12 months, we evaluated several parameters: intimal-medial thickening of the common carotid arteries (by B-mode ultrasound); forearm vascular response (by strain-gauge plethysmography) to intrabrachial infusion of acetylcholine (0.15, 0.45, 1.5, 4.5, and 15 microg/100 mL forearm tissue per minute), an endothelium-dependent vasodilator, or sodium nitroprusside (1, 2, and 4 microg/100 mL forearm tissue per minute), an endothelium-independent vasodilator; calculated minimal forearm vascular resistances (the ratio between mean arterial pressure and maximal forearm vasodilation induced by 13 minutes of ischemia and 1 minute of exercise); and left ventricular mass index (on echocardiography profile). Carotid wall intimal-medial thickening showed a significant (P<0.001) inverse correlation with vasodilation to acetylcholine (r=-0.58) and age (r=-0.40), whereas no correlation was observed with the response to sodium nitroprusside or with minimal forearm vascular resistances, left ventricular mass index, systolic and diastolic blood pressures, and plasma cholesterol and glucose levels. Moreover, vasodilation to acetylcholine showed no correlation with minimal forearm vascular resistances or left ventricular mass index. Although comparison of different vascular "districts," such as the forearm microcirculation and carotid artery, does not allow for a conclusive interpretation, the present data indicate that in patients with essential hypertension, carotid wall thickening is associated with reduced endothelium-dependent vasodilation and suggest that endothelial dysfunction might be involved in early arterial structural alterations.