HYPERTENSION
Flow-mediated vasodilation and the risk of developing hypertension in healthy postmenopausal women
Rosario Rossi, MD*,*,
Emilio Chiurlia, MD*,
Annachiara Nuzzo, MD*,
Elena Cioni, MD*,
Giorgia Origliani, PhD and
Maria Grazia Modena, MD, FESC, FACC*
* Institute of Cardiology, University of Modena and Reggio Emilia, Modena, Italy
Bene Essere Donna Center, Azienda Universitaria-Ospedaliera Policlinico, Modena, Italy
Manuscript received May 5, 2004;
revised manuscript received June 26, 2004,
accepted July 6, 2004.
* Reprint requests and correspondence: Dr. Rosario Rossi, Institute of Cardiology, University of Modena and Reggio Emilia, Policlinico, Via del Pozzo, 71, 41100 Modena, Italy (Email: rossi.r{at}policlinico.mo.it).
OBJECTIVES: This study provided the opportunity to assess the relationship between endothelial vasomotor function and incidence of hypertension in a cohort of postmenopausal women.
BACKGROUND: Both menopause and hypertension are associated with endothelial dysfunction and are well-known risk factors for atherosclerotic-related disease.
METHODS: We conducted a prospective cohort study that began in 1996 on 952 apparently healthy postmenopausal women, age 53 ± 5 years (range 44 to 60 years), with initially normal levels of blood pressure and no history of hypertension. All participants were followed up for a mean period of 3.6 ± 0.7 years (range 0.5 to 6.9 years). Endothelial function was measured as flow-mediated dilation of the brachial artery using high-resolution ultrasound.
RESULTS: During follow-up 112 women developed hypertension. The adjusted relative risk for women with flow-mediated dilation of 3.5 or less (lowest quartile) was 5.77 (95% confidence interval 4.34 to 8.10) versus women with flow-mediated dilation of 5.5 or greater (highest quartile, referent). Each one-unit decrease of flow-mediated dilation was associated with a significant 16% (95% confidence interval 12% to 33%) increase in the multiple-adjusted relative risk of incident hypertension.
CONCLUSIONS: These prospective data indicate a significant increase in the relative risk of hypertension with each unit decrease of flow-mediated dilation that is independent of age and baseline systolic and diastolic pressure values. This could suggest that an impaired endothelial vasomotor function precedes and predicts the future development of hypertension in postmenopausal women.
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Abbreviations and Acronyms
| | AII = angiotensin II | | AT2 = angiotensin type 2 receptors | | BAD = brachial artery diameter | | BP = blood pressure | | FMD = flow-mediated dilation | | NO = nitric oxide | | PAI-1 = plasminogen activator inhibitor 1 |
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