Endothelial dysfunction in patients with hypertension and peripheral artery disease

Cover Page

Abstract


Aim. To assess endothelial function in patients with hypertension and peripheral artery disease.

Methods. The study included 100 patients with an established diagnosis of essential hypertension. Ultrasonic duplex scanning of brachiocephalic arteries and lower limb arteries was performed. The functional state of the endothelium was evaluated using postocclusive reactive hyperemia test by D.S. Celermajer.

Results. Atherosclerotic plaques in the carotid arteries were found in 71% of patients, in the lower limb arteries - in 60%. The combined affection of both vascular beds was diagnosed in 51% of patients. Endothelial dysfunction was found in 64% of patients. In patients with carotid arterial system atherosclerosis, brachial artery dilation response was 6.1%, while in those with intact carotid arteries - 4.7% (p=0.041). The value of the brachial artery dilation response in patients with atherosclerotic lesions of lower extremities arteries was 5.9%. In the subgroup of patients with intact lower limbs arteries, the increase in brachial artery diameter was 9.60% an average (p=0.04). Among 51 people with affection of both vascular systems the brachial artery diameter increase was 5.4%, while in comparison, in the subgroup consisting of 49 patients without combined carotid and lower limb arteries lesions, - 9.9% (p=0.003). According to the results of the correlation analysis, the relation between endothelial dysfunction and the maximum percentage of stenosis of the carotid arteries and lower limb arteries at the level of tibial segment was revealed.

Conclusion. In patients with hypertension and peripheral artery disease, decrease in dilation response in endothelium-dependent vasodilation test was registered regardless of the localization of atherosclerotic lesions; endothelial dysfunction in essential hypertension was associated with the highest percentage of stenosis of the carotid arteries and lower limb arteries at the level of tibial segment.


M N Denisenko

South Ural State Medical University

Author for correspondence.
Email: henkel-07@mail.ru

V V Genkel

South Ural State Medical University

Email: henkel-07@mail.ru

I I Shaposhnik

South Ural State Medical University

Email: henkel-07@mail.ru

  1. Белоцерковская М.А., Родин Ю.В., Юсупов Р.Ю. Эндотелий-зависимая вазодилатация и гомоцистеин как маркёры эндотелиальной дисфункции у больных со стенотическими поражениями сонных артерий. Международ. неврол. ж. 2014; 8 (70): 24-28.
  2. Куликов В.П. Основы ультразвукового исследования сосудов. М.: Видар-М. 2015; 392 с.
  3. Brevetti G., Silvestro A., Schiano V. et al. Endothelial dysfunction and cardiovascular risk prediction in peripheral arterial disease: additive value of flow-mediated dilation to ankle-brachial pressure index. Circulation. 2003; 28 (108): 2093-2098. http://dx.doi.org/10.1161/01.CIR.0000095273.92468.D9
  4. Bonetti P.O., Lerman L.O., Lerman A. Endothelial dysfunction - a marker of atherosclerotic risk. Arterioscler. Thromb. Vasc. Biol. 2003; 23: 168-175. http://dx.doi.org/10.1161/01.ATV.0000051384.43104.FC
  5. Deanfield J.E., Halcox J.P., Rabelink T.J. Endothelial function and dysfunction: testing and clinical relevance. Circulation. 2007; 13 (10): 1285-1295. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.652859
  6. European Carotid Surgery Trialists’ Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998; 9 (351): 1379-1387. http://dx.doi.org/10.1016/S0140-6736(97)09292-1
  7. Giannotti G., Doerries C., Mocharla P.S. et al. Impaired endothelial repair capacity of early endothelial progenitor cells in prehypertension: relation to endothelial dysfunction. Hypertension. 2010; 55: 1389-1397. http://dx.doi.org/10.1161/HYPERTENSIONAHA.109.141614
  8. Gokce N., Keaney J.F., Hunter L.M. et al. Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events in patients with peripheral vascular disease. J. Am. Coll. Cardiol. 2003; 21 (41): 1769-1775. http://dx.doi.org/10.1016/S0735-1097(03)00333-4
  9. Hage F.G., Oparil S., Xing D. et al. C-reactive protein-mediated vascular injury requires complement. Arterioscler. Thromb. Vasc. Biol. 2010; 30: 1189-1195. http://dx.doi.org/10.1161/ATVBAHA.110.205377
  10. Kizhakekuttu T.J., Widlansky M.E. Natural antioxidants and hypertension: promise and challenges. Cardiovasc. Ther. 2010; 28: 20-32. http://dx.doi.org/10.1111/j.1755-5922.2010.00137.x
  11. Lind L. Flow-mediated vasodilation was found to be an independent predictor of changes in the carotid plaque status during a 5-year follow-up. J. Atheroscler. Thromb. 2014; 21 (2): 161-168. http://dx.doi.org/10.5551/jat.18572
  12. Maldonado F.J., Miralles J.H., Aguilar E.M. et al. Relationship between noninvasively measured endothelial function and peripheral arterial disease. Angiology. 2009; 60 (6): 725-731. http://dx.doi.org/10.1177/0003319708327787
  13. Oz F., Elitoka A., Bilgea A.K. et al. Relationship between brachial artery flow-mediated dilation, carotid artery intima-media thickness and coronary flow reserve in patients with coronary artery disease. Cardiol. Res. 2012; 3 (5): 214-221. http://dx.doi.org/10.4021/cr219w
  14. Ross R., Glomset J.A. Atherosclerosis and the arterial smooth muscle cell: proliferation of smooth muscle is a key event in the genesis of the lesions of atherosclerosis. Science. 1973; 80: 1332-1339. http://dx.doi.org/10.1126/science.180.4093.1332
  15. Rundek T., Hundle R., Ratchford E. et al. Endothelial dysfunction is associated with carotid plaque: a cross-sectional study from the population based Northern Manhattan Study. BMC Cardiovasc. Disord. 2006; 17: 6-35. http://dx.doi.org/10.1186/1471-2261-6-35
  16. Sitia S., Tomasoni L., Atzeni F. et al. From endothelial dysfunction to atherosclerosis. Autoimmun. Rev. 2010; 9 (12): 830-834. http://dx.doi.org/10.1016/j.autrev.2010.07.016
  17. Touboul P.J., Hennerici M.G., Meairs S. et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc. Dis. 2012; 34 (4): 290-296. http://dx.doi.org/10.1159/000343145
  18. Yang Z., Ming X.Z. Recent advances in understanding endothelial dysfunction in atherosclerosis. Clin. Med. Res. 2006; 4: 53-65. http://dx.doi.org/10.3121/cmr.4.1.53

Views

Abstract - 266

PDF (Russian) - 188

Cited-By


PlumX


© 2016 Denisenko M.N., Genkel V.V., Shaposhnik I.I.

Creative Commons License

This work is licensed
under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.


Свидетельство о регистрации СМИ ЭЛ № ФС 77-75008 от 1 февраля 2019 года выдано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор)