Prognostic significance of endothelial dysfunction in hypertensive patients

The forearm endothelial dysfunction, characterized by an impaired vasodilating response to acetylcholine (ACh), has been observed in patients with major cardiovascular risk factors, as well as essential hypertension. Recently, it has been reported the prognostic value of coronary endothelial dysfunction for subsequent cardiovascular events, but there are no informations about prognostic significance of forearm endothelial dysfunction. Thus, we evaluated the cardiovascular events in previously never-treated hypertensive patients on the basis of their endothelial function. The endothelium-dependent and -independent vasodilation was evaluated, at the time of diagnostic study, in 225 patients (aged 35 to 54 years) by intra-arterial increasing doses of ACh and sodium nitroprusside. Patients were divided in tertiles on the basis of their ACh-stimulated forearm blood flow (FBF): group 1 from 30 to 184, group 2 from 185 to 333, and group 3 from 339 to 760 percent increase from basal. During a mean follow-up of 31.5 of months (range 4 to 84 months), there were 29 cardiovascular morbid events at the cardiac (n=19), cerebrovascular (n=9), or peripheral vascular (n=1) level. Cardiovascular events included myocardial infarction, angina, coronary revascularization procedures, stroke, transient cerebral ischemic attack, and aorto-iliac occlusive disease. The rate of total cardiovascular events (per 100 patients-year) was 8.17, 4.34, and 2.02 in the first, second and third tertile of peak percent increase in FBF during ACh infusions. In conclusion Forearm endothelial dysfunction observed in previously never treated and uncomplicated hypertensive patients may be considered a marker for the future cardiovascular morbid events.