Clinical study
Prognostic role of reversible endothelial dysfunction in hypertensive postmenopausal women

https://doi.org/10.1016/S0735-1097(02)01976-9Get rights and content
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Abstract

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.

Abbreviations

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

Cited by (0)

This study was partially supported by a grant from the Italian Ministero dell’Università e della Ricerca Scientifica e Tecnologica (MURST) and was sponsored by the WOmen’s Cardiovascular Disease Association (WOCDA) and Bene Essere Donna Center (Azienda Policlinico of Modena Authority Project).