(Hypertension. 1999;33:575-580.)
© 1999 American Heart Association, Inc.
Scientific Contributions |
Effect of Treatment on Flow-Dependent Vasodilation of the Brachial Artery in Essential Hypertension
From the Cattedra di Medicina Interna, University of Brescia, Brescia, Italy.
Correspondence to Maria Lorenza Muiesan, MD, Cattedra di Medicina Interna, UOP Scienze Mediche, Universitá di Brescia, c/o Spedali Civili, 1a Medicina, Brescia 25100, Italy. E-mail muiesan{at}master.cci.unibs.it
Abstract—The aim of our study was to evaluate the effect of antihypertensive treatment on flow-mediated dilation (FMD)of a large artery, a noninvasive estimate of endothelial function, in hypertensive patients. In 78 consecutive hypertensive patients (40%men; age range, 42 to 67 years) we measured by a high-resolution ultrasound system the changes of brachial artery diameter during reactive hyperemia and after sublingual glyceryl trinitrate (400 µg); brachial artery flow velocity was measured by pulsed Doppler. The results of 2 studies are reported. In the first study, this procedure was repeated in 58 patients after 6 and 12 months of treatment with a combination of antihypertensive drugs; in a second study, the FMD was assessed in 20 patients after 2 months of monotherapy with either nifedipine or hydrochlorothiazide. In the first study, FMD was significantly increased after treatment compared with baseline (from 3.1±3% at baseline to 6.5±4.5% at 6 months and to 8.12±4.6% at 12 months; P<0.001 by ANOVA), concomitant with blood pressure reduction (from 162±24/102±13 mm Hg to 141±12/89±6 mm Hg and to 141±9/89±6 mm Hg; P<0.001 by ANOVA); significant changes of endothelium-independent dilation were also observed, but only after 12 months of treatment (from 14.2±4.8 at baseline to 15.5±4.7 at 6 months and 16.8±5.9% at 12 months; P=0.03 by ANOVA). In the second study, FMD was significantly increased during nifedipine treatment as compared with baseline (from 5±6.18% at baseline to 9.45±3.94%, P<0.001), while it did not change in patients receiving hydrochlorothiazide (from 5.15±5.28% at baseline to 4.69±4.34%, NS). No significant changes of endothelium–independent dilation were observed with both drugs (from 17.10±2.4% to 18.14±3.76% and from 18.73±4.07% to 17.46±4.27% during nifedipine and hydrochlorothiazide, respectively, NS). Thus, in essential hypertensive patients an improvement of the impaired FMD of the brachial artery, evaluated by noninvasive ultrasound, may be observed after long-term, effective blood pressure reduction, suggesting a beneficial effect of antihypertensive treatment on endothelial function. It seems that beyond blood pressure control, a calcium antagonist may be more effective than a diuretic in this respect.
Key Words: vasodilation • arteries, brachial • hypertension, essential • antihypertensive therapy • blood pressure
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