Abstract
BackgroundMost hypertensive patients, despite a proper control of their cardiovascular risk factors, have cardiovascular complications, evidencing the importance of controlling and/or reversing target-organ damage. In this sense, endothelial dysfunction has been associated with the presence of cardiovascular risk factors and related cardiovascular outcomes. Since hypertension often clusters with other risk factors such as dyslipemia, diabetes and obesity, in this study we have investigated the effect of intensive multifactorial treatment on circulating vascular progenitor cell levels on high-risk hypertensive patients.DesignWe included108 hypertensive patients receiving intensive multifactorial pharmacologic treatment and dietary recommendations targeting blood pressure, dyslipemia, hyperglycemia and weight for 12 months. After the treatment period, blood samples were collected and circulating levels of endothelial (CD34+/KDR+, CD34+/VE-cadherin+) and smooth muscle (CD14+/endoglin+) progenitor cells were identified by flow cytometry. Additionally, plasma concentration of vascular endothelial growth factor (VEGF) was determined by ELISA.ResultsMost hypertensive patients (61±12 years, 47% men) showed cardiovascular parameters within normal ranges at baseline. Moreover, body mass index and the majority of the biochemical parameters (systolic and diastolic blood pressure, fasting glucose, total cholesterol, HDL-c, LDL-c, creatinine and hs-CRP) significantly decreased overtime. After 12 months of intensive treatment, CD34+/KDR+ and CD14+/endoglin+ levels did not change, but CD34+/VE-cadherin+ cells increased significantly at month 12 [0.9(0.05–0.14)% vs 0.05(0.02–0.09)% P<0.05]. However, VEGF plasma concentration decreased significantly overtime [89.1(53.9–218.7) vs [66.2(47.5–104.6) pg/mL, P<0.05].ConclusionsLong-term intensive treatment in hypertensive patients further improves cardiovascular risk and increases circulating EPCs, suggesting that these cells could be a therapeutic target.
Highlights
In the past, the goal of treating hypertension was merely blood pressure (BP) reduction, and antihypertensive therapy demonstrated to diminish cardiovascular events around 25% [1]
Since hypertension often clusters with other risk factors such as dyslipemia, diabetes and obesity, in this study we have investigated the effect of intensive multifactorial treatment on circulating vascular progenitor cell levels on high-risk hypertensive patients
The injured vessels release circulating endothelial cells (CECs) and endothelial microparticles (EMPs), and their determination have demonstrated to closely reflect the status of activated/damaged endothelium [4].endothelial cells have limited capacity for regeneration, contrasting to the traditional concept that the repair of vascular endothelium was achieved by neighboring endothelial proliferation [5]
Summary
The goal of treating hypertension was merely blood pressure (BP) reduction, and antihypertensive therapy demonstrated to diminish cardiovascular events around 25% [1]. The balance between endothelial fragmentation into EMPs and endothelial repair by EPCs has been defined as “vascular competence” of each individual [4] In this sense, in untreated hypercholesterolemic patients, Pirro et al have reported an increased ratio of EMPs/EPCs, as well as a positive correlation with aortic stiffness, a reliable marker of atherosclerosis [8]. Despite a proper control of their cardiovascular risk factors, have cardiovascular complications, evidencing the importance of controlling and/or reversing target-organ damage. In this sense, endothelial dysfunction has been associated with the presence of cardiovascular risk factors and related cardiovascular outcomes. Since hypertension often clusters with other risk factors such as dyslipemia, diabetes and obesity, in this study we have investigated the effect of intensive multifactorial treatment on circulating vascular progenitor cell levels on high-risk hypertensive patients.
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