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(Hypertension. 2005;46:210.)
© 2005 American Heart Association, Inc.
Fifth International Workshop on Structure and Function of Large Arteries |
From the Departments of Pharmacology (J.B., R.J., M.I., C.T.) and Pharmacy (P.A.), Rouen University Hospital, France.
Correspondence to R. Joannides, Département de Pharmacologie, INSERM U644, IFRMP 23, CHU de Rouen, 76031 Rouen Cedex, France. E-mail robinson.joannides{at}chu-rouen.fr
| Abstract |
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Key Words: arteries elasticity compliance nitric oxide potassium channels endothelium-derived factors
| Introduction |
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| Methods |
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Instrumentation
Systemic blood pressure and heart rate were measured on the dominant arm by mean of a brachial cuff oscillometric device (Dinamap). Radial internal diameter, wall thickness, blood flow, and arterial pressure were continuously measured in the nondominant arm using a high-precision echo-tracking device (NIUS 02) coupled to a Doppler system (Doptek) and a finger photoplethysmograph (Finapres) as described previously.2,3,7,20 From arterial blood samples, total blood viscosity was measured using a cone-plate viscometer (Ex100 constant temperature bath).20,21 From the individual values of radial artery internal diameter (d), blood flow (Q), and total blood viscosity (µ), the mean arterial wall shear stress (
) was calculated as
=[(4 µQ)/(
r3)] and r=d/2).20
Mechanics of the Radial Artery
From the measured variables arterial pressure (p), internal diameter (d), and wall thickness (h), the cross-section (S)pressure curve was fitted as S=
[
/2+tang1([pß]/
)], S=
d2/4, where
, ß, and
are the 3 optimal fit parameters of the model.22 The cross-sectional compliance (C) was expressed as C=(
/
)/[1+([pß]/
)2] and the incremental elastic modulus (Ei) as Ei=3/8[d(d+2h)2/h(d+h)]|g!p/|g!d.23 The midwall stress (
) was calculated as
=2p(ri · re)2/(re2ri2), where re and ri are the external and internal radii, respectively, and r the radius at midwall (r=(re+ri)/2).7,20 Finally, from the individual values, the diametermidwall stress, the modulusmidwall stress, and the compliancemidwall stress curves were constructed to assess the effect of the inhibitors at identical levels of wall-loading conditions.
Study Protocol
Subjects were supine in a quiet, air-conditioned room (22°C to 24°C). A 27-gauge needle was inserted under local anesthesia (1% lidocaine) into the brachial artery of the nondominant arm, and saline was infused (1 mL/min). After instrumentation, oral aspirin (UPSA 500 mg; laboratoire UPSA) was given to block vascular cyclooxygenase activity.15,24 After 30 minutes of resting, arterial parameters were recorded at baseline for 5 minutes. Then, sodium nitroprusside (SNP; 20 nmol/L per minute) was infused for 3 minutes to assess the NO-mediated endothelium-independent dilatation. Thirty minutes after completion of SNP infusion and return to basal values of radial artery blood flow and diameter, for 8 minutes, subjects received, in random order, either the NO synthase inhibitor L-NMMA (8 µmol/L per minute; Clinalfa) or the vascular KCa channel inhibitor tetraethylammonium chloride (TEA; 9 µmol/L per minute; Clinalfa), or their combination. At the end of the inhibitor infusion, the same protocol of SNP administration was repeated. From this continuous recording, mean values were calculated from 15 consecutive cardiac cycles during the last minute of each infusion period. At each time, all parameters were calculated at operational pressure (mean arterial pressure). In absence of change in systemic blood pressure during the different experimental procedures, only digital arterial pressure used for calculations is shown.
Statistical Analysis
Results are expressed as mean±SEM. The effects of the inhibitors on the mean values were compared using ANOVA with subjects, periods, and inhibitors as factors, followed by a modified Student t test when applicable. This analysis was repeated with the mean wall shear stress or the variation of the radial artery flow as covariate. The relationships obtained after the inhibitors were compared with those obtained at baseline using an ANCOVA with midwall stress as covariate and subjects and periods as factors. A value of P<0.05 was considered statistically significant.
| Results |
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None of the inhibitors affected arterial pressure or heart rate (Table 2). In addition, cross-sectional area was not modified by L-NMMA or TEA, or their combination (Table 1).
After L-NMMA, internal diameter, wall thickness, radius-to-wall thickness ratio, and midwall stress were not modified (all NS). Radial artery flow decreased from 11.7±2.6 to 9.2±1.8 103 L/min (P<0.05), and the mean wall shear stress decreased from 4.3±0.6 to 3.5±0.5 101 Pa (P<0.05). After inhibition of NO synthesis, the pulse diameter to pulse pressure ratio increased nonsignificantly by 9±5%, from 8.0±1.1 102 m/Pa. The incremental elastic modulus of the arterial wall decreased (P<0.05), and the radial artery compliance increased, however, not significantly.
After TEA, internal diameter decreased (P<0.05), and wall thickness increased, however, not significantly. The radius-to-wall thickness ratio decreased (P<0.05), explaining, in absence of change in arterial pressure, the decrease in radial artery midwall stress (P<0.05). Radial artery flow decreased from 10.9±2.3 to 8.5±1.8 103 L/min (P<0.05), but as a result of the concomitant decrease in radial artery diameter and flow, the mean wall shear stress was not significantly modified by TEA (from 4.6±0.8 to 4.4±0.8 101 Pa). After the blockade of KCa channels, the pulse diameter-to-pulse pressure ratio decreased by 18±5%, from 8.9±1.7 102 m/Pa (P<0.05). The incremental elastic modulus of the arterial wall was not modified (NS), but the radial artery compliance decreased (P<0.05).
After the combination of L-NMMA and TEA, internal diameter decreased, and wall thickness increased (both P<0.05). The radius-to-wall thickness ratio decreased (P<0.05), explaining, in absence of change in arterial pressure, the decrease in radial artery midwall stress (P<0.05). Radial artery flow decreased from 10.5±2.4 to 7.7±0.8 103 L/min (P<0.05), but as a result of the concomitant decrease in radial artery diameter and flow, the mean wall shear stress was not significantly modified by the combination (from 4.0±0.6 to 4.0±0.7 101 Pa). After NO synthesis inhibition combined to KCa blockade, the pulse diameter-to-pulse pressure ratio decreased by 34±5%, from 8.5±1.1 102 m/Pa (P<0.05). The incremental elastic modulus of the arterial wall increased, and the radial artery compliance decreased (both P<0.05). The effect of the combination of L-NMMA and TEA on all these parameters was more pronounced than those of TEA alone (all P<0.05).
The effects of L-NMMA and TEA and their combination on the geometric and mechanical parameters of the radial artery remained significant even after mean wall shear stress or changes in radial artery flow were included as covariates into analysis (all P<0.05).
Internal Diameter, Elastic Modulus, and Arterial ComplianceMidwall Stress Curves
Figure 1 shows the effect of L-NMMA on the internal diameter, elastic modulus, and arterial compliancemidwall stress curves. Before and after L-NMMA, the radial artery diameter and the elastic modulus of the arterial wall increased, and the radial artery compliance decreased with the midwall stress (both P<0.001). After L-NMMA, there was no significant change in the diametermidwall stress curve. The modulusmidwall stress curve was shifted downward (P<0.001), reflecting a decrease in arterial wall stiffness. The compliancemidwall stress curve was shifted upward (P<0.001). These effects were more marked at high levels of midwall stress. The decrease in arterial wall stiffness and the increase in compliance, which occurred in the absence of any change in arterial pressure or geometry, suggest that inhibition of NO synthesis was associated with an isometric smooth muscle relaxation.
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Figure 2 shows the effects of TEA and of the combination of L-NMMA and TEA on the internal diameter, elastic modulus, and arterial compliancemidwall stress curves. The radial artery diameter and the elastic modulus of the arterial wall increased, and the radial artery compliance decreased with the midwall stress in all cases (all P<0.001). After TEA, there was a downward shift in the diametermidwall stress curve and an upward shit in the modulusmidwall stress curve (both P<0.001). Thus, KCa channel blockade was associated with a smooth muscle contraction that explains the decrease in arterial diameter and the increase in arterial wall stiffness at each level of stress. As a result, the compliancemidwall stress curve was shifted downward at each level of stress (P<0.001).
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After the combination of L-NMMA and TEA, the internal diameter, elastic modulus, and arterial compliancemidwall stress curves were shifted in the same way as after TEA alone (all P<0.001). However, the shift of these curves was more pronounced after the combination of L-NMMA and TEA than after TEA alone (all P<0.01). Thus, when combined with KCa channel blockade, the NO synthesis inhibition was associated to a larger smooth muscle contraction than after TEA alone.
Radial Artery Endothelium-Independent Dilatation
Figure 3 shows the effects of SNP on the internal diameter, elastic modulus, and arterial compliancemidwall stress curves in control conditions. After SNP, there was an upward shift of the diametermidwall stress curve and a downward shift in the modulusmidwall stress curve (both P<0.001). As a result, the compliancemidwall stress curve was shifted upward at each level of stress (P<0.001).
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SNP induced an increase in radial artery diameter before (2.724±0.072 to 3.293±0.109 103 m; P<0.05) and after L-NMMA (from 2.691±0.095 to 3.360±0.128 103 m; P<0.05), before (2.694±0.084 to 3.274±0.117 103 m; P<0.05) and after TEA (2.502±0.078 to 3.143±0.116 103 m; P<0.05), and before (from 2.694±0.084 to 3.274±0.117 103 m; P<0.05) and after their combination (2.415±0.093 to 3.207±0.134 103 m; P<0.05). The increase in radial artery diameter was enhanced by L-NMMA alone and in combination with TEA (both P<0.05), whereas TEA alone did not significantly modify this response.
| Discussion |
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The present study was performed in healthy subjects at the level of the radial artery to assess in vivo the role of NO and vascular KCa channels and their potential interaction in the regulation of basal conduit artery diameter and mechanics. All experiments were performed after administration of aspirin to inhibit vascular cyclooxygenase and to exclude a role for PGI2 in our results.15,24 The inhibition of endothelial NO synthesis was obtained with L-NMMA, infused at a dose of 8 µmol/min, known to abolish the radial artery dilatation to high gradual doses of acetylcholine without affecting hemodynamics.3 In addition, we used the nonspecific inhibitor of vascular KCa channels, TEA, as a pharmacological tool for the exploration of EDHF activity.14,15 Indeed, although the biological nature of EDHF remains to be discussed, its endothelium-dependent hyperpolarizing mechanism appears mainly related to the opening of vascular KCa channels leading to smooth muscle cell relaxation.12,13 Thus, TEA was infused at a dose of 9 µmol/min to obtain, for a basal radial artery flow of 10 mL/min, a local concentration of 1 mmol/L higher than those shown to selectively block a single KCa channel without affecting the function of other potassium channels.15,25 As expected, L-NMMA reduced radial artery flow, confirming the role of NO in the regulation of the basal arteriolar tone in humans.13,57,14,15 In addition, as more recently reported by use of plethysmography in healthy subjects,15 TEA reduced radial artery flow in our study, also demonstrating a role of KCa channels in the control of basal arteriolar tone.
Concerning the conduit arteries, the local administration of L-NMMA did not significantly modify blood pressure nor the radial diameter but decreased the arterial wall stiffness, thus demonstrating, in accordance with our previous report,7 although less marked, paradoxical isometric smooth muscle cell relaxation after NO synthase inhibition. An absence of decrease in the diameter or alteration in the mechanical properties of conduit arteries was reported in vivo despite local administration of doses of L-NMMA up to 60 µmol/min in absence of significant change in blood pressure.28,26 Conversely, other studies demonstrated a significant effect of local NO synthesis inhibition on arterial diameter and mechanics.9,10,2730 These results could be explained by the heterogeneity of the vascular tree5,27,28 and by the in-crease in blood pressure after systemic administration of L-NMMA.2931 In addition, the invasive methodological approaches used in some studies could have provided more sensitivity, but they also could have potentiated the vascular effect of NO synthesis inhibition by majoring the local decrease in flow9 or by interfering with KCa channel activity.10,32 In this context, L-NMMA induced in our subjects an enhanced dilatation to SNP compared with baseline conditions. This hypersensitivity of the smooth muscle cells to a nitrovasodilator after NO synthase inhibition has been observed previously in vitro and in vivo and reflects the suppression of an endogenous NO release in the arterial wall.3,11 Thus, this hypersensitivity and the absence of decrease in resting diameter despite the concomitant decrease in flow after L-NMMA once again suggest more the presence of compensatory mechanisms occurring after inhibition of NO synthesis to maintain this diameter than the absence of NO basal release.3 Thus, according to the magnitude or the ability to develop such mechanisms, the effect of L-NMMA on diameter and mechanics could vary, explaining also the apparent divergences observed. Indeed, although the impact of arterial pressure on this mechanism needs to be evaluated, the higher blood pressure level observed in the present study, although within the normal range, could have decreased the magnitude of the effect noted after L-NMMA compared with our previous experiment.7
In this context, TEA induced a significant decrease in radial artery diameter and compliance obtained at operational pressure and at each level of stress, demonstrating for the first time in vivo that vascular KCa channels are involved in the regulation of basal peripheral conduit artery mechanics in humans. At operational pressure, the elastic modulus was not modified. This was the consequence of the simultaneous decrease in midwall stress attributable to the lower radius-to-wall thickness ratio after vasoconstriction. When evaluated at stable wall-loading conditions by use of the elastic modulusmidwall stress curve, TEA was associated to an increase in modulus at each level of stress, thus confirming the wall stiffness increase and the withdrawing of a relaxant influence after KCa channel blockade. The effect of TEA on radial artery geometry and stiffness cannot be related to a flow-dependent mechanism because radial artery mean wall shear stress (ie, the physiological flow stimulus) was not significantly affected by TEA. In addition, as described previously in human resistance arteries,14,15 TEA did not modify radial artery dilatation to SNP, arguing against a decrease in smooth muscle cell ability to relax after KCa channel blockade. Previous animal and ex vivo experiments have shown that vascular KCa channels are involved in the endothelium-dependent dilatation of conduit arteries.1619,33,34 However, their role in the regulation of basal conduit artery diameter and tone has been less investigated. Nevertheless, it was demonstrated that KCa channels contribute to the control of the resting membrane potential of human gastroepiploic arteries.18 In addition, Popp et al16 showed that the activation of muscular KCa channels was mainly dependent of the basal release of an EDHF in porcine coronary arteries and participates in the regulation of arterial compliance. Thus, our results obtained at the level of the radial artery suggest that the activation of vascular KCa channels involved in the regulation of resting diameter and mechanics results from the basal release of an EDHF in vivo.
Finally, we observed that the combined administration of L-NMMA and TEA induced a greater decrease in radial artery diameter and compliance than TEA alone. In addition, this combination induced a significant increase in the operational elastic modulus despite the larger decrease in midwall stress than after TEA alone, thus supporting the dramatic increase in wall stiffness at each level of stress reflected by the upward shift of the modulusmidwall stress curve. As already discussed for TEA alone, this effect could not be related to a flow-dependent mechanism or to a decrease in vascular smooth muscle cell reactivity. In this context, KCa channel blockade unmasks the vasoconstrictor effect of L-NMMA on the radial artery, thus giving evidence of the role of NO in the regulation of resting diameter and mechanics at the level of a peripheral conduit artery in humans.9 Moreover, this synergistic effect of the combined administration of L-NMMA and TEA demonstrates that vascular KCa channels compensate for the loss of endothelial NO synthesis to maintain the basal radial diameter and mechanics, explaining why L-NMMA, when administrated alone, was ineffective to induce radial artery constriction and, in contrast, decreased the isometric wall artery muscular tone. These results are consistent with previous studies showing that an increase in NO availability decreases EDHF-mediated conduit artery dilatation in animals35 and that at the opposite, chronically impaired NO-dependent dilatation present in pathology is associated to an upregulation of EDHF, acting as a back-up mechanism to preserve endothelium-dependent dilatation of resistance and conduit arteries.19,3641
Perspectives
Our in vivo study gives evidence for the first time that an alternative pathway acting through the stimulation of KCa channels is activated at baseline and upregulated during NO deficiency at the level of human peripheral conduit arteries to maintain resting diameter and mechanical properties in physiological state. These results strongly support the hypothesis of a basal release of an EDHF at this level. Whether this mechanism is still effective in aging humans and in pathophysiological conditions needs further investigation. This could be of importance in the regulation of cardiovascular coupling and arterial conductance at rest and during exercise, and therefore its alteration could contribute to the pathophysiology of many cardiovascular diseases.4244 Furthermore, the presence of such mechanisms at the level of epicardial coronary arteries or proximal conduit arteries more frequently concerned by atherosclerosis45 could participate in the prevention of atherosclerosis in addition to NO.46
| Acknowledgments |
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Received February 8, 2005; first decision February 24, 2005; accepted April 1, 2005.
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