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Huang X, Huang X, Pan M, Lin J, Xie L. Effect of early endothelial function improvement on subclinical target organ damage in hypertensives. Sci Rep 2024; 14:16078. [PMID: 38992162 PMCID: PMC11239846 DOI: 10.1038/s41598-024-67143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/08/2024] [Indexed: 07/13/2024] Open
Abstract
Endothelial dysfunction is acknowledged as a marker for subclinical target organ damage (STOD) in hypertension, though its therapeutic potential has not yet been clarified. This study assessed whether early endothelial function improvement (EEFI) reduced STOD in patients with essential hypertension (EH). We conducted a retrospective cohort analysis of 456 EH patients initially free from STOD. Endothelial function was assessed using brachial artery flow-mediated dilation (FMD), with values ≤ 7.1% indicating dysfunction. Patients were initially categorized by endothelial status (dysfunction: n = 180, normal: n = 276), and further divided into improved or unimproved groups based on changes within three months post-enrollment. During a median follow-up of 25 months, 177 patients developed STOD. The incidence of STOD was significantly higher in patients with initial dysfunction compared to those with normal function. Kaplan-Meier analysis indicated that the improved group had a lower cumulative incidence of STOD compared to the unimproved group (p < 0.05). Multivariable Cox regression confirmed EEFI as an independent protective factor against STOD in EH patients (p < 0.05), regardless of their baseline endothelial status, especially in those under 65 years old, non-smokers, and with low-density lipoprotein cholesterol levels ≤ 3.4 mmol/L. In conclusion, EEFI significantly reduces STOD incidence in EH patients, particularly in specific subgroups, emphasizing the need for early intervention in endothelial function to prevent STOD.
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Affiliation(s)
- Xiaodong Huang
- Department of Emergency, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, China
- Xiamen Key Laboratory for Clinical Efficacy and Evidence-Based Research of Traditional Chinese Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Xianwei Huang
- Department of Emergency, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, China
- Xiamen Key Laboratory for Clinical Efficacy and Evidence-Based Research of Traditional Chinese Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Mandong Pan
- Department of Emergency, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, China
- Xiamen Key Laboratory for Clinical Efficacy and Evidence-Based Research of Traditional Chinese Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Jiyan Lin
- Department of Emergency, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, China
- Xiamen Key Laboratory for Clinical Efficacy and Evidence-Based Research of Traditional Chinese Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Liangdi Xie
- Department of Geriatrics, Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
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Murray EC, Delles C, Orzechowski P, Renc P, Sitek A, Wagenaar J, Guzik TJ. Vascular phenotypes in early hypertension. J Hum Hypertens 2023; 37:898-906. [PMID: 36528682 PMCID: PMC9758678 DOI: 10.1038/s41371-022-00794-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 12/03/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
The study characterises vascular phenotypes of hypertensive patients utilising machine learning approaches. Newly diagnosed and treatment-naïve primary hypertensive patients without co-morbidities (aged 18-55, n = 73), and matched normotensive controls (n = 79) were recruited (NCT04015635). Blood pressure (BP) and BP variability were determined using 24 h ambulatory monitoring. Vascular phenotyping included SphygmoCor® measurement of pulse wave velocity (PWV), pulse wave analysis-derived augmentation index (PWA-AIx), and central BP; EndoPAT™-2000® provided reactive hyperaemia index (LnRHI) and augmentation index adjusted to heart rate of 75bpm. Ultrasound was used to analyse flow mediated dilatation and carotid intima-media thickness (CIMT). In addition to standard statistical methods to compare normotensive and hypertensive groups, machine learning techniques including biclustering explored hypertensive phenotypic subgroups. We report that arterial stiffness (PWV, PWA-AIx, EndoPAT-2000-derived AI@75) and central pressures were greater in incident hypertension than normotension. Endothelial function, percent nocturnal dip, and CIMT did not differ between groups. The vascular phenotype of white-coat hypertension imitated sustained hypertension with elevated arterial stiffness and central pressure; masked hypertension demonstrating values similar to normotension. Machine learning revealed three distinct hypertension clusters, representing 'arterially stiffened', 'vaso-protected', and 'non-dipper' patients. Key clustering features were nocturnal- and central-BP, percent dipping, and arterial stiffness measures. We conclude that untreated patients with primary hypertension demonstrate early arterial stiffening rather than endothelial dysfunction or CIMT alterations. Phenotypic heterogeneity in nocturnal and central BP, percent dipping, and arterial stiffness observed early in the course of disease may have implications for risk stratification.
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Affiliation(s)
- Eleanor C Murray
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
| | - Christian Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Patryk Orzechowski
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Automatics and Robotics, AGH University of Science and Technology, Kraków, Poland
| | - Pawel Renc
- Sano Centre for Computational Science, Krakow, Poland
- Department of Computer Science, AGH University of Science and Technology, Krakow, Poland
| | - Arkadiusz Sitek
- Massachusetts General Hospital, Harvard Medical School, Harvard University Boston, Boston, MA, USA
| | - Joost Wagenaar
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Tomasz J Guzik
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
- Department of Medicine and Omicron Functional Genomics Laboratory, Jagiellonian University Collegium Medicum, Krakow, Poland.
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Twerenbold S, Hauser C, Gander J, Carrard J, Gugleta K, Hinrichs T, Schmidt-Trucksäss A, Hanssen H, Streese L. Short-term high-intensity interval training improves micro- but not macrovascular function in hypertensive patients. Scand J Med Sci Sports 2023. [PMID: 36840395 DOI: 10.1111/sms.14343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Arterial hypertension is a global health burden that affects vascular structure and function. Assessment of endothelial function can improve cardiovascular (CV) risk stratification. Exercise treatment reduces over all CV risk and improves vascular health. However, it is still not clear which part of the vascular bed is most sensitive to exercise treatment in patients with CV risk. This study aimed to investigate the effects of an 8-week walking based and supervised high-intensity interval training (HIIT) on macro- and microvascular endothelial function as add-on therapy in patients with arterial hypertension. METHODS Forty patients (mean age 58 ± 7 years) treated for arterial hypertension were randomized in the HIIT (3×/week) or control group (CG) receiving standard physical activity recommendations. Arteriolar (aFID) and venular (vFID) flicker light-induced dilatation for retinal microvascular and flow-mediated dilatation (FMD) for macrovascular endothelial function were assessed. In addition, standardized assessments of patients' characteristics were performed before and after 8 weeks. RESULTS Both groups reduced weight and body mass index but only the HIIT group reduced body fat, visceral fat, and increased peak oxygen uptake after 8 weeks. The control group reduced diastolic blood pressure. No blood pressure changes were found in the HIIT group. Arteriolar FID increased in the HIIT group independently of confounders (pre: 2.40 ± 0.98%, post: 3.19 ± 1.31%, p < 0.001) but not in the control group (pre: 3.06 ± 1.50%, post: 2.90 ± 1.46%, p = 0.280). No changes were found for FMD in either group. CONCLUSION Arteriolar FID was found to be a sensitive vascular biomarker to assess exercise-induced microvascular improvements even in a short time setting of an 8-week exercise therapy with HIIT. Short-term exercise training affects microvascular endothelial function but not large artery endothelial function. Thus, retinal aFID appears to be a sensitive biomarker to detect short-term exercise efficacy on a vascular level. Dynamic retinal vessel analysis as a diagnostic approach may prove to be an ideal candidate vascular biomarker to monitor treatment effects of exercise in patients with hypertension on top of standard clinical care and may support clinical decision-making in the future.
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Affiliation(s)
- Simon Twerenbold
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Christoph Hauser
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Josephine Gander
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Justin Carrard
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | | | - Timo Hinrichs
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Lukas Streese
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
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Mućka S, Miodońska M, Jakubiak GK, Starzak M, Cieślar G, Stanek A. Endothelial Function Assessment by Flow-Mediated Dilation Method: A Valuable Tool in the Evaluation of the Cardiovascular System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811242. [PMID: 36141513 PMCID: PMC9517126 DOI: 10.3390/ijerph191811242] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 05/10/2023]
Abstract
Cardiovascular diseases (CVDs) in the course of atherosclerosis are one of the most critical public health problems in the world. Endothelial cells synthesize numerous biologically active substances involved in regulating the functions of the cardiovascular system. Endothelial dysfunction is an essential element in the pathogenesis of atherosclerosis. Thus, the assessment of endothelial function in people without overt CVD allows for a more accurate estimate of the risk of developing CVD and cardiovascular events. The assessment of endothelial function is primarily used in scientific research, and to a lesser extent in clinical practice. Among the tools for assessing endothelial function, we can distinguish biochemical and physical methods, while physical methods can be divided into invasive and non-invasive methods. Flow-mediated dilation (FMD) is based on the ultrasound assessment of changes in the diameter of the brachial artery as a result of increased blood flow. FMD is a non-invasive, safe, and repeatable test, but it must be performed by qualified and experienced medical staff. The purpose of this paper is to present the literature review results on the assessment of endothelial function using the FMD method, including its methodology, applications in clinical practice and research, limitations, and future perspectives.
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Affiliation(s)
- Szymon Mućka
- Student Research Group, Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland
| | - Martyna Miodońska
- Student Research Group, Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland
| | - Grzegorz K. Jakubiak
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland
- Correspondence: (G.K.J.); (A.S.)
| | - Monika Starzak
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Specialistic Hospital No. 2 in Bytom, Batorego 15 St., 41-902 Bytom, Poland
| | - Grzegorz Cieślar
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland
| | - Agata Stanek
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland
- Correspondence: (G.K.J.); (A.S.)
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Yang X, Zhou B, Zhou L, Cui L, Zeng J, Wang S, Shi W, Zhang Y, Luo X, Xu C, Xue Y, Chen H, Chen S, Wang G, Guo L, Jose PA, Wilcox CS, Wu S, Wu G, Zeng C. Development and Validation of Prediction Models for Hypertensive Nephropathy, the PANDORA Study. Front Cardiovasc Med 2022; 9:794768. [PMID: 35360013 PMCID: PMC8960139 DOI: 10.3389/fcvm.2022.794768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
ImportanceHypertension is a leading cause of end-stage renal disease (ESRD), but currently, those at risk are poorly identified.ObjectiveTo develop and validate a prediction model for the development of hypertensive nephropathy (HN).Design, Setting, and ParticipantsIndividual data of cohorts of hypertensive patients from Kailuan, China served to derive and validate a multivariable prediction model of HN from 12, 656 individuals enrolled from January 2006 to August 2007, with a median follow-up of 6.5 years. The developed model was subsequently tested in both derivation and external validation cohorts.VariablesDemographics, physical examination, laboratory, and comorbidity variables.Main Outcomes and MeasuresHypertensive nephropathy was defined as hypertension with an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 and/or proteinuria.ResultsAbout 8.5% of patients in the derivation cohort developed HN after a median follow-up of 6.5 years that was similar in the validation cohort. Eight variables in the derivation cohort were found to contribute to the risk of HN: salt intake, diabetes mellitus, stroke, serum low-density lipoprotein, pulse pressure, age, hypertension duration, and serum uric acid. The discrimination by concordance statistics (C-statistics) was 0.785 (IQR, 0.770-0.800); the calibration slope was 1.129, the intercept was –0.117; and the overall accuracy by adjusted R2 was 0.998 with similar results in the validation cohort. A simple points scale developed from these data (0, low to 40, high) detected a low morbidity of 7% in the low-risk group (0–10 points) compared with >40% in the high-risk group (>20 points).Conclusions and RelevanceA prediction model of HN over 8 years had high discrimination and calibration, but this model requires prospective evaluation in other cohorts, to confirm its potential to improve patient care.
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Affiliation(s)
- Xiaoli Yang
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Bingqing Zhou
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Li Zhou
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Liufu Cui
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Jing Zeng
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Shuo Wang
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Weibin Shi
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Ye Zhang
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Xiaoli Luo
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Chunmei Xu
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Yuanzheng Xue
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
| | - Hao Chen
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Guodong Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Li Guo
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Pedro A. Jose
- Division of Renal Disease & Hypertension, The George Washington University School of Medicine & Health Sciences, Washington, DC, United States
| | - Christopher S. Wilcox
- Division of Nephrology and Hypertension, Department of Medicine and Center for Hypertension, Kidney and Vascular Health, Georgetown University, Washington, DC, United States
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
- *Correspondence: Shouling Wu,
| | - Gengze Wu
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
- Gengze Wu,
| | - Chunyu Zeng
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory for Hypertension Research, Chongqing Cardiovascular Clinical Research Center, Chongqing Institute of Cardiology, Chongqing, China
- State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, The Third Military Medical University, Chongqing, China
- Cardiovascular Research Center of Chongqing College, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Chongqing, China
- Chunyu Zeng,
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Walia R, Arunachalam V, Chauhan U, Khapre M, Arora P. Endothelial dysfunction assessed by brachial artery flow-mediated dilatation predicts severe COVID-19-related disease. J Family Med Prim Care 2022; 11:319-324. [PMID: 35309652 PMCID: PMC8930105 DOI: 10.4103/jfmpc.jfmpc_281_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/03/2021] [Accepted: 07/10/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Endothelial dysfunction, inflammation, and hypercoagulability are hallmarks of severe COVID-19 related disease. Endothelial function can be measured non-invasively by flow-mediated dilatation in the brachial artery. We planned a study to measure it as a marker of the severity of COVID-19 disease. Objective: To evaluate the association of clinically recognizable endothelial dysfunction in COVID-19 disease and its usefulness as a marker of severe COVID-19-related disease. Methods: 20 COVID-19 patients being admitted to our unit were analyzed for endothelial dysfunction and correlated with disease severity as per computed tomography (CT) chest score. Patients with diabetes, atherosclerotic coronary artery disease, dyslipidemia, chronic renal disease, and infections other than COVID-19 were excluded. Endothelial dysfunction was measured by flow-mediated dilatation in the brachial artery. Results: The mean age was 46.4 ± 16.5 years; 70% were males. The mean CT severity score was 22 ± 8; 60% required supplemental oxygen and steroids. The incidence of endothelial dysfunction was more in patients with a computed tomography severity score of >19.5 or oxygen saturation of <93% at room air as compared to mild cases (P = 0.003). Endothelial dysfunction was more evident >7 days after onset of disease as compared to early (<7 days) disease (P = 0.016). There was negative correlation between % flow-mediated dilatation in brachial artery and severity of lung involvement and prolonged symptomatic phase. Conclusions: Endothelial dysfunction as measured by impaired brachial artery flow mediated dilatation correlates with disease severity.
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Endothelial function of healthy adults from 20 to 91 years of age: prediction of cardiovascular risk by vasoactive range. J Hypertens 2021; 39:1361-1369. [PMID: 33470736 DOI: 10.1097/hjh.0000000000002798] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Brachial arterial low flow-mediated constriction (L-FMC) and flow-mediated dilation (FMD) are ultrasound-based biomarkers that emerge into scientific and clinical practice indicating cardiovascular effects of medical and lifestyle-based treatment beyond classical risk factors. This study is the first to provide reference values and to assess the predictive value of L-FMC, FMD and their composite endpoint vasoactive range (VAR) in healthy adults. METHODS L-FMC, FMD and VAR were measured in 457 nonsmoking adults of 20-91 years without chronic diseases, medication, with normal heart function and very low cardiovascular risk. Sex-specific percentiles were calculated and predictive ability for elevated cardiovascular risk was assessed using receiver-operating characteristic (ROC) curves. RESULTS From 20 to 91 years of age, L-FMC increased 86.1 and 105.3%, FMD decreased 63.6 and 47.1% and VAR decreased 58.3 and 55.2% in women and men, respectively. Area under the ROC curves was 0.54 (95% CI = 0.49-0.54) for L-FMC, 0.67 (95% CI = 0.62-0.67) for FMD and 0.72 (95% CI = 0.67-0.72) for VAR (P < 0.001). Discriminatory cut-offs for elevated risk were 0.24% for L-FMC (sensitivity = 0.42, specificity = 0.67), 6.4% for FMD (sensitivity = 0.71, specificity = 0.60) and 6.3% for VAR (sensitivity = 0.62, specificity = 0.73). CONCLUSION This study demonstrates reduced endothelial function with aging in healthy men and women with very low cardiovascular risk. Percentiles crossed cut-offs for elevated cardiovascular risk between 50 and 55 years in men and 70 and 75 years in women, indicating higher risk for cardiovascular disease in men. VAR showed the highest ability to identify individuals with elevated cardiovascular risk, and should be included in the monitoring and treatment of accelerated vascular aging even in healthy individuals.
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Keating SE, Coombes JS, Stowasser M, Bailey TG. The Role of Exercise in Patients with Obesity and Hypertension. Curr Hypertens Rep 2020; 22:77. [PMID: 32880740 DOI: 10.1007/s11906-020-01087-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This review sought to evaluate the role of exercise in patients with obesity and comorbid hypertension, with a focus on contemporary literature (since January 2015). RECENT FINDINGS No reviews have included patients classified with both obesity and hypertension and there is a paucity of randomised controlled trials examining the benefits of exercise in this population. Moreover, just one of 19 reviews examining the role of exercise on blood pressure included studies that met pre-defined inclusion criterion for hypertension, although seven conducted subgroup analyses stratified by mean baseline blood pressure. These demonstrated significantly larger reductions in blood pressure in hypertensive than pre-hypertensive and normotensive samples. There is a significant research-practice gap for understanding and influencing the role of exercise for patients with obesity and hypertension. This review provides recommendations for future research and consensus-based recommendations that promote exercise as a principle therapy for patients with obesity and hypertension.
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Affiliation(s)
- Shelley E Keating
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia. .,Physiology and Ultrasound Lab in Science and Exercise (PULSE), School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia.
| | - Jeff S Coombes
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Michael Stowasser
- Endocrine Hypertension Research Center, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Tom G Bailey
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia.,Physiology and Ultrasound Lab in Science and Exercise (PULSE), School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
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9
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Vascular, cardiac and renal target organ damage associated to arterial hypertension: which noninvasive tools for detection? J Hum Hypertens 2020; 34:420-431. [DOI: 10.1038/s41371-020-0307-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/04/2020] [Accepted: 01/27/2020] [Indexed: 01/16/2023]
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10
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Ji QH, Zhao MM, Gong HP, Lv XZ, Ma WH. Association of YKL-40 with endothelial dysfunction in patients with essential hypertension. EUR J INFLAMM 2020. [DOI: 10.1177/2058739220959939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Human cartilage glycoprotein 39 (YKL-40) is related with presence and extent of atherosclerosis, which can be a new biomarker of inflammation and endothelial dysfunction. The relationship between YKL-40 and endothelial dysfunction in patients with essential hypertension (EH) has not been intensively investigated. The relationship between serum level of YKL-40 and endothelial dysfunction was evaluated in 60 EH subjects and 50 normal control (NEH) subjects. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum levels of YKL-40. Brachial artery flow-mediated vasodilation (FMD) was used to measure endothelial-dependent nitric oxide-mediated vasodilatory capacity as the function of endothelial index. This study demonstrated that YKL-40 expression was significantly increased ( p < 0.05) in EH subjects compared with NEH subjects. The FMD was significantly impaired in EH subjects compared with NEH subjects. YKL-40 was not only negatively correlated with FMD, but also with carotid artery intima-media thickness (IMT). Multiple liner regression analysis identified that YKL-40 was independent of FMD development. The level of YKL-40 was elevated in EH patients and inversely related with FMD and may be independent of endothelial dysfunction in EH.
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Affiliation(s)
- Qing-hong Ji
- Department of Obstetrics, The Second Hospital of Shandong University, Jinan, China
| | - Meng-meng Zhao
- Department of Cardiology, The Second Hospital of Shandong University, Jinan, China
| | - Hui-ping Gong
- Department of Cardiology, The Second Hospital of Shandong University, Jinan, China
| | - Xian-zhong Lv
- Department of Obstetrics, The Second Hospital of Shandong University, Jinan, China
| | - Wei-hong Ma
- Department of Obstetrics, The Second Hospital of Shandong University, Jinan, China
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11
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Thijssen DHJ, Bruno RM, van Mil ACCM, Holder SM, Faita F, Greyling A, Zock PL, Taddei S, Deanfield JE, Luscher T, Green DJ, Ghiadoni L. Expert consensus and evidence-based recommendations for the assessment of flow-mediated dilation in humans. Eur Heart J 2019; 40:2534-2547. [DOI: 10.1093/eurheartj/ehz350] [Citation(s) in RCA: 338] [Impact Index Per Article: 67.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/13/2018] [Accepted: 05/24/2019] [Indexed: 12/18/2022] Open
Abstract
Abstract
Endothelial dysfunction is involved in the development of atherosclerosis, which precedes asymptomatic structural vascular alterations as well as clinical manifestations of cardiovascular disease (CVD). Endothelial function can be assessed non-invasively using the flow-mediated dilation (FMD) technique. Flow-mediated dilation represents an endothelium-dependent, largely nitric oxide (NO)-mediated dilatation of conduit arteries in response to an imposed increase in blood flow and shear stress. Flow-mediated dilation is affected by cardiovascular (CV) risk factors, relates to coronary artery endothelial function, and independently predicts CVD outcome. Accordingly, FMD is a tool for examining the pathophysiology of CVD and possibly identifying subjects at increased risk for future CV events. Moreover, it has merit in examining the acute and long-term impact of physiological and pharmacological interventions in humans. Despite concerns about its reproducibility, the available evidence shows that highly reliable FMD measurements can be achieved when specialized laboratories follow standardized protocols. For this purpose, updated expert consensus guidelines for the performance of FMD are presented, which are based on critical appraisal of novel technical approaches, development of analysis software, and studies exploring the physiological principles underlying the technique. Uniformity in FMD performance will (i) improve comparability between studies, (ii) contribute to construction of reference values, and (iii) offer an easy accessible and early marker of atherosclerosis that could complement clinical symptoms of structural arterial disease and facilitate early diagnosis and prediction of CVD outcomes.
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Affiliation(s)
- Dick H J Thijssen
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosa Maria Bruno
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
- Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, Pisa, Italy
| | - Anke C C M van Mil
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sophie M Holder
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Francesco Faita
- Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, Pisa, Italy
| | - Arno Greyling
- Department Nutrition & Health, Unilever Vlaardingen, Vlaardingen, The Netherlands
| | - Peter L Zock
- Department Nutrition & Health, Unilever Vlaardingen, Vlaardingen, The Netherlands
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - John E Deanfield
- Institute of Cardiovascular Sciences, University College of London, 1 St Martin le Grand, London, UK
| | - Thomas Luscher
- Royal Brompton and Harefield Hospitals, London University Heart Center, Sydney Street, London, UK
| | - Daniel J Green
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, Western Australia, Perth, Australia
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
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12
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Association between common carotid artery diameter and target organ damage in essential hypertension. J Hypertens 2018; 36:537-543. [DOI: 10.1097/hjh.0000000000001590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Early Detection System of Vascular Disease and Its Application Prospect. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1723485. [PMID: 28042567 PMCID: PMC5155081 DOI: 10.1155/2016/1723485] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/30/2016] [Accepted: 10/25/2016] [Indexed: 01/12/2023]
Abstract
Markers of imaging, structure, and function reflecting vascular damage, integrating a long time accumulation effect of traditional and unrecognized cardiovascular risk factors, can be regarded as surrogate endpoints of target organ damage before the occurrence of clinical events. Prevention of cardiovascular disease requires risk stratification and treatment of traditional risk factors, such as smoking, hypertension, hyperlipidemia, and diabetes. However, traditional risk stratification is not sufficient to provide accurate assessment of future cardiovascular events. Therefore, vascular injury related parameters obtained by ultrasound or other noninvasive devices, as a surrogate parameter of subclinical cardiovascular disease, can improve cardiovascular risk assessment and optimize the preventive treatment strategy. Thus, we will summarize the research progress and clinical application of early assessment technology of vascular diseases in the present review.
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14
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Gkaliagkousi E, Gavriilaki E, Triantafyllou A, Douma S. Clinical Significance of Endothelial Dysfunction in Essential Hypertension. Curr Hypertens Rep 2016; 17:85. [PMID: 26371063 DOI: 10.1007/s11906-015-0596-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The endothelium is recognized as a major determinant of vascular physiology and pathophysiology. Over the last few decades, a plethora of studies have implicated endothelial dysfunction in the progression of atherosclerosis and the subclinical target organ damage observed in essential hypertension. However, the clinical significance of diagnosing endothelial dysfunction in patients with essential hypertension remains under investigation. Although a number of vascular and non-vascular markers of endothelial dysfunction have been proposed, there is an ongoing quest for a marker in the clinical setting that is optimal, inexpensive, and reproducible. In addition, endothelial dysfunction emerges as a promising therapeutic target of agents that are readily available in clinical practice. In this context, a better understanding of its role in essential hypertension becomes of great importance. Here, we aim to investigate the clinical significance of endothelial dysfunction in essential hypertension by accumulating novel data on (a) early diagnosis using robust markers with prognostic value in cardiovascular risk prediction, (b) the association of endothelial dysfunction with subclinical vascular organ damage, and (c) potential therapeutic targets.
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Affiliation(s)
- Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Eukarpia, 564 03, Thessaloniki, Greece.
| | - Eleni Gavriilaki
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Eukarpia, 564 03, Thessaloniki, Greece
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Eukarpia, 564 03, Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Eukarpia, 564 03, Thessaloniki, Greece
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15
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Increased plasma neopterin levels are associated with reduced endothelial function and arterial elasticity in hypertension. J Hum Hypertens 2015. [DOI: 10.1038/jhh.2015.72] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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16
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Predictive value of endothelial dysfunction: a call to action. J Hypertens 2014; 32:2355-6. [PMID: 25376249 DOI: 10.1097/hjh.0000000000000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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