Document Detail

Persistent macrovascular and microvascular dysfunction in patients with malignant hypertension.
MedLine Citation:
PMID:  21263115     Owner:  NLM     Status:  MEDLINE    
Endothelial dysfunction is characteristic of patients with essential hypertension, but only limited data are available on different aspects of endothelial function in patients with malignant-phase hypertension. We investigated myocardial perfusion using real-time quantitative myocardial contrast echocardiography with concurrent assessment of macrovascular and microvascular endothelial damage/dysfunction in patients with previous malignant hypertension (but now in stable phase), who were compared with patients with treated "high-risk" hypertension (hypertension) and healthy controls. We measured flow (hyperemia)-mediated dilation and response to glyceryl trinitrate of brachial artery (ultrasound), microvascular (forearm) response to acetylcholine and sodium nitroprusside (laser Doppler), pulse wave velocity, circulating endothelial and endothelial progenitor cells in 15 patients with malignant hypertension, 40 matched patients with hypertension, and 40 healthy controls. Patients with malignant hypertension had impaired endothelial-dependant response to acetylcholine (P<0.001, but not to sodium nitroprusside) compared with hypertension and impaired reaction to both stimuli compared with healthy subjects (P<0.001). Patients with malignant hypertension had increased circulating endothelial cells (P=0.001), endothelial progenitors (P=0.008), and stiffness (P=0.003). Both hypertensive groups had impaired response to hyperemia and glyceryl trinitrate when compared with healthy controls (P<0.05). Both hypertensive groups had similar myocardial perfusion, which was significantly lower than in healthy controls. There were no significant differences in hyperemia and endothelium-independent stimuli between the 2 hypertensive groups. In conclusion, despite fairly well-controlled blood pressure, malignant hypertension patients had more pronounced abnormalities of macrovascular and microvascular function (which seem to be both endothelium dependent and endothelium independent) compared with patients with hypertension and healthy controls.
Alena Shantsila; Girish Dwivedi; Eduard Shantsila; Mehmood Butt; D Gareth Beevers; Gregory Y H Lip
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-01-24
Journal Detail:
Title:  Hypertension     Volume:  57     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-17     Completed Date:  2011-04-14     Revised Date:  2011-09-06    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  490-6     Citation Subset:  IM    
University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK.
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MeSH Terms
Acetylcholine / pharmacology
Analysis of Variance
Blood Flow Velocity / drug effects,  physiology
Blood Pressure / drug effects,  physiology
Brachial Artery / physiopathology*,  ultrasonography
Endothelium, Vascular / drug effects,  physiopathology*,  ultrasonography
Flow Cytometry
Hypertension, Malignant / physiopathology*,  ultrasonography
Middle Aged
Regional Blood Flow / drug effects,  physiology
Vasodilation / drug effects,  physiology
Vasodilator Agents / pharmacology
Reg. No./Substance:
0/Vasodilator Agents; 51-84-3/Acetylcholine
Comment In:
Hypertension. 2011 Aug;58(2):e7; author reply e8   [PMID:  21670414 ]

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