Endothelial func-tion in high-risk hypertensive patients

Objective. To evaluate changes in pulse-wave shape and endothelial function (EF) in patients with essential arterial hypertension (AH) treated with calcium-channel blockers (CCB) or inhibitors of angitensin-converting enzyme iACE. Design and methods. Sixty one high-risk hypertesive patients with preserved left ventricular ejection fraction were consequently enrolled in the study and than randomized to CCB or iACE therapy. Also, indapamide or hydrochlorothiazide was administered to most of the patients to achieve blood pressure (BP) goals. Using novel finger photoplethysmographic device AngioScan-01 and traditional ultrasonographic method, endothelial function (EF, in reactive hyperemia test) and pulse-wave characteristics were measured both before and after 5 weeks of treatment. Stiffness index (SI), reflection index (RI), augmentation index (AIx), systolic BP in aorta (SPa), digital pulse amplitude augmentation (by photoplethysmography), and flow-mediated dilation (FMD, by ultrasound) were accessed. Results. The majority of patients at`baseline showed normal SI, and elevated RI, AIx, SPa, and significantly impaired EF . BP goals (< 130/90 mmHg) were achieved in all patients validating further analysis. Decrease in SI (p < 0,05), RI and SPa was found in both treatment arms, whereas trends towards AIx decrease and EF improvement were demonstrated only in iACE group. Also, substantial correlation (r = 0,4, p < 0,05) between finger photoplethysmographic and traditional ultrasonographic EF assessment was found. Conclusions. High-risk hypertensive patients demonstrated increased vascular stiffness and peripheral vasoconstriction, accompanying by impaired EF. Both iACE and CCB treatment resulted in central BP and SI decrease, whereas only iACE therapy was associated with trends in EF and AIx improvement in short-term follow-up. Fair accuracy of photoplethysmographycally in assessment of digital pulse amplitude augmentation (compared with ultrasonographicaly measured flow-mediated dilation) allows to use this simplier and more convenient method in clinical practice.

pulse-wave analysis, endothelial function, arterial hypertension, flow-mediated dilation

1. Милягин В.А., Филичкин Д.Е., Шпынев К.В., Шпынева З.М. и соавт. Контурный анализ центральной и периферической пульсовых волн у здоровых людей и больных артериальной гипертонией // Артериальная гипертензия. - 2009. - Т. 15, № 1. - С. 78-85.

2.

3. Halcox J.P.J., Donald A.E., Ellins E. et al. Endothelial function predicts progression of carotid intima-media thickness // Circulation. - 2009. - Vol. 119, № 7. - P. 1005-1012.

4.

5. Ивашкин В.Т., Драпкина О.М. Клиническое значение оксида азота и белков теплового шока .- Москва, 2001.

6.

7. Драпкина О.М. Особенности синтеза оксида азота и белков теплового шока у больных острым инфарктом миокарда и постинфарктным кардиосклерозом: Дисc. ... д-ра мед. н. - 2004.

8.

9. Hamburg N.M., Keyes M.J, Larson M.G. et al. Cross-sectional relations of digital vascular function to cardiovascular risk factors in the Framingham Heart Study // Circ. - 2008. - Vol. 117, № 19. - P. 2467-2474.

10.

11. Bonetti P.O., Pumper G.M, Higano S.T., Holmes D.R. Jr., Kuvin J.T., Lerman A. Noninvasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia // J. Am. Coll. Cardiol. - 2004. - Vol. 44, № 11. - P. 2137-2141.

12.

13. Lind L., Fors N., Hall J., Marttala K., Stenborg A. A comparison of three different methods to evaluate endothelium-dependent vasodilation in the elderly: The prospective investigation of the vasculature in Uppsala Seniors (PIVUS) Study // Arterioscler. Thromb. Vasc. Biol. - 2005. - Vol. 25, № 11. - P. 2368-2375.

14.

15. Lind L., Hall J., Johansson K. Evaluation of four different methods to measure endotelium-dependent vasodilation in the human peripheral circulation // Clin. Sci. - 2002. - Vol. 102, № 5. - P. 561-567.

16.

17. Kuvin J.T., Patel A.R., Sliney K.A., Pandian N.G. et al. Assessment of peripheral vascular endothelial function with finger arterial wave amplitude // Am. Heart. J. - 2003. - Vol. 146, № 1. - P. 168-174.

18.

19. Williams B., Lacy P.S., Thom S.M. et al. The CAFE Investigators, for the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Investigators, CAFE Steering Committee and Writing Committee. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the conduit artery function evaluation (CAFE) study // Circulation. - 2006. - Vol. 113, № 9. - P. 1213-1225.

20.

21. Mancini G.B.J., Henry G.C., Macaya C. et al. Angiotensin-сonverting enzyme inhibition with quinapril improves endothelial vasomotor dysfunction in patients with coronary artery disease. The TREND (Trial on Reversing ENdothelial Dysfunction) Study // Circulation. - 1996. - Vol. 94, № 3. - P. 258-265.

22.

23. Laurent S., Cockcroft J., Van Bortel L. et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications // Eur. Heart J. - 2006. - Vol. 27, № 21. - P. 2588-2605.