CLINICAL STUDY
Prognostic role of reversible endothelial dysfunction in hypertensive postmenopausal women
Maria G. Modena, MD, FESC, FACC*,*,
Lorenzo Bonetti, MD*,
Francesca Coppi, MD*,
Francesca Bursi, MD* and
Rosario Rossi, MD*
* Institute of Cardiology, Department of Internal Medicine, University of Modena, Modena, Italy
Manuscript received May 23, 2001;
revised manuscript received April 10, 2002,
accepted April 30, 2002.
* Reprint requests and correspondence: Dr. Maria Grazia Modena, Institute of Cardiology, Department of Internal Medicine, Azienda Ospedaliera-Universitaria, Policlinico, University of Modena, Via del Pozzo, 71. 41100 Modena, Italy.
modena.mariagrazia{at}unimo.it
OBJECTIVES: The aim of the present study was to assess whether optimized antihypertensive treatment is effective in modifying endothelial function and whether an improvement in flow-mediated vasodilation (FMD) in response to treatment, as an expression of reversible endothelial dysfunction, could predict a more favorable prognosis in a population of postmenopausal women.
BACKGROUND: Hypertensive postmenopausal women have been shown to have abnormal endothelium-dependent vascular function. However, FMD may change over time, according to antihypertensive treatment; the prognostic value of these changes has not been investigated.
METHODS: A total of 400 consecutive postmenopausal women with mild-to-moderate hypertension and impaired FMD underwent ultrasonography of the brachial artery at baseline and after six months, while optimal control of blood pressure was achieved using antihypertensive therapy. They were then followed up for a mean period of 67 months (range 57 to 78). Endothelial function was measured as FMD of the brachial artery, using high-resolution ultrasound.
RESULTS: After six months of treatment, FMD had not changed ( 10% relative to baseline) in 150 (37.5%) of 400 women (group 1), whereas it had significantly improved (>10% relative to baseline) in the remaining 250 women (62.5%) (group 2). During follow-up, we noticed 32 events (3.50 per 100 person-years) in group 1 and 15 events (0.51 per 100 person-years) in group 2 (p < 0.0001).
CONCLUSIONS: This study demonstrates that a significant improvement in endothelial function may be obtained after six months of antihypertensive therapy and clearly identifies patients who possibly have a more favorable prognosis.
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Abbreviations and Acronyms
| | BAD | | brachial artery diameter | | BP | | blood pressure | | FMD | | flow-mediated dilation, flow-mediated vasodilation | | JNC-V | | Fifth Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure | | NO | | nitric oxide | | t-PA | | tissue-type plasminogen activator | | u-PA | | urokinase-type plasminogen activator |
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43(4):
616 - 623.
[Abstract]
[Full Text]
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G. B. J. Mancini
Vascular structure versus function: is endothelial dysfunction of independent prognostic importance or not?
J. Am. Coll. Cardiol.,
February 18, 2004;
43(4):
624 - 628.
[Full Text]
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E. J. Benjamin, M. G. Larson, M. J. Keyes, G. F. Mitchell, R. S. Vasan, J. F. Keaney Jr, B. T. Lehman, S. Fan, E. Osypiuk, and J. A. Vita
Clinical Correlates and Heritability of Flow-Mediated Dilation in the Community: The Framingham Heart Study
Circulation,
February 10, 2004;
109(5):
613 - 619.
[Abstract]
[Full Text]
[PDF]
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M. S. M. Ip, H.-F. Tse, B. Lam, K. W. T. Tsang, and W.-K. Lam
Endothelial Function in Obstructive Sleep Apnea and Response to Treatment
Am. J. Respir. Crit. Care Med.,
February 1, 2004;
169(3):
348 - 353.
[Abstract]
[Full Text]
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P. Ganz and J. A. Vita
Testing Endothelial Vasomotor Function: Nitric Oxide, a Multipotent Molecule
Circulation,
October 28, 2003;
108(17):
2049 - 2053.
[Full Text]
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M. E. Widlansky, N. Gokce, J. F. Keaney Jr, and J. A. Vita
The clinical implications of endothelial dysfunction
J. Am. Coll. Cardiol.,
October 1, 2003;
42(7):
1149 - 1160.
[Abstract]
[Full Text]
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J. A. Vita
Tea Consumption and Cardiovascular Disease: Effects on Endothelial Function
J. Nutr.,
October 1, 2003;
133(10):
3293S - 3297.
[Abstract]
[Full Text]
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S. Y. Chan, G. B. J. Mancini, L. Kuramoto, M. Schulzer, J. Frohlich, and A. Ignaszewski
The prognostic importance of endothelial dysfunction and carotid atheromaburden in patients with coronary artery disease
J. Am. Coll. Cardiol.,
September 17, 2003;
42(6):
1037 - 1043.
[Abstract]
[Full Text]
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M. E. Widlansky, D. T. Price, N. Gokce, R. T. Eberhardt, S. J. Duffy, M. Holbrook, C. Maxwell, J. Palmisano, J. F. Keaney Jr, J. D. Morrow, et al.
Short- and Long-Term COX-2 Inhibition Reverses Endothelial Dysfunction in Patients With Hypertension
Hypertension,
September 1, 2003;
42(3):
310 - 315.
[Abstract]
[Full Text]
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J. T. Kuvin and R. H. Karas
Clinical Utility of Endothelial Function Testing: Ready for Prime Time?
Circulation,
July 1, 2003;
107(25):
3243 - 3247.
[Full Text]
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R. A. Vogel
Heads and Hearts: The Endothelial Connection
Circulation,
June 10, 2003;
107(22):
2766 - 2768.
[Full Text]
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A. Sciacqua, M. Candigliota, R. Ceravolo, A. Scozzafava, F. Sinopoli, A. Corsonello, G. Sesti, and F. Perticone
Weight Loss in Combination With Physical Activity Improves Endothelial Dysfunction in Human Obesity
Diabetes Care,
June 1, 2003;
26(6):
1673 - 1678.
[Abstract]
[Full Text]
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