Small Artery Structure: Time to Take Note?

Abnormal vascular structure is a hallmark of hypertension, but whether this has clinical significance has not been clear. In a landmark study from 2003, Rizzoni and colleagues1 in Brescia demonstrated in a population of 151 hypertensive and normotensive patients that abnormal small artery structure is a predictor of later cardiovascular events, as it is for left ventricular hypertrophy2 and large artery structure.3 Structure was measured as the ratio of media thickness to lumen diameter ex vivo by myography, the patients being followed up an average of 5.4 years. The events recorded included not only hard end points but also a range of possibly questionable soft end points. The Brescia group has now extended that study4 by including an additional 152 subjects, with an average follow-up time of 6.9 years for the entire population of 303 subjects. With this larger population, the Brescia group has not only confirmed the previous result, but has also been able to show that abnormal small artery structure was a predictor of the predefined hard end points (death, stroke, or infarction)—a significant advance. It is remarkable that the predictive value of the abnormal structure was observable despite the treatments that were given during the follow-up period.