Small Artery Remodeling Is the First Manifestation of Target Organ Damage in Mild Essential Hypertension.
Blood vessels participate in the development and maintenance of high blood pressure (BP), and play a role in its complications. We evaluated the prevalence of structural and functional alterations of resistance arteries and cardiac hypertrophy in mild essential hypertensive patients. Thirty-eight patients (47±1 years; 71% male; clinic BP 148±2/99±1mmHg) were compared to 10 age-matched normotensive controls (44±3 years; 40% male; BP 113±4/76±2mmHg). Arteries were studied on a pressurized myograph. Renal function was normal in all subjects. Remodeling and growth indexes of vessels were 72% and 28%, respectively. The prevalence of abnormal structure (media to lumen ratio), endothelial function (maximal acetylcholine response) and cardiac hypertrophy by ECG was 97%, 58%, and 47% (greater than mean+1SD of controls), and 63%, 34%, and 26% (greater than mean+2SD of controls), respectively. Geometry-independent vascular stiffness (the slope of incremental elastic modulus vs. media stress) was similar in both groups. By multivariate analysis, structural alterations correlated with mean BP (p<0.01). Mean BP correlated with endothelial function (p<0.01), structure (p<0.05) and cardiac hypertrophy (p<0.05). Endothelial function was impaired in the highest tertile of vascular stiffness compared to the lowest tertile (p<0.01). In conclusion, structural alterations were demonstrated in most mild hypertensive patients, followed in frequency by endothelial dysfunction and finally cardiac hypertrophy. Small artery vascular remodeling precedes other clinically relevant manifestations of target organ damage in mild essential hypertension.