ENDOTHELIAL DYSFUNCTION AS A RISK FACTOR OF ARTERIAL HYPERTENSION PROGRESSION

Abstract

Endothelial condition is one of the main factors determining the function of the healthy vessels and its change in arterial hypertension (AH). The aim of this study is to evaluate the role of endothelial dysfunction in prognosis of AH. Material and Methods. 918 young adults aged 20–29 years old and normal level of blood pressure (BP) were enrolled in a prospective observational study. The endothelial function was assessed using a brachial reactive hyperemia test with calculation of peak systolic (Vps), maximal terminal diastolic (Ved), time average maximal (TAMX), time average (TAV) blood flow velocity, spectral broadening index (SBI), resistance index (RI), pulsation index (PI), systole-diastolic ratio (SD), intima–media thickness and brachial flow mediated dilation (FMD). Further, the observation period lasted for 5 years. Two groups were chosen according to the level of BP: the 1st group included the patients with AH (BP level 140/90 mm Hg and higher), the 2nd group consisted of the patients with the normal level of BP (lower 140/90 mm Hg). Results. 78 persons were withdrawn from the study for different reasons during observation period. AH was found in 144 participants (18.8%, 95% CI 16.2-21.7%) — group 1, 620 people of group 2 showed normal BP in 620 (81.2%; 95% confidence Interval (CI) 78.3–83.8%). In group 1 FMD was 7.5 (5.3; 9.9)%, in group 2 — 12.3 (10.2; 13.4)% (p<0,05). Based on the data of univariate analysis of male sex (odds ratio (OR) 10.8; 95% CI 7.63–15.28), body mass index (BMI) > 25 kg/m2 (OR 7.17; 95% CI 5.65–9.10), smoking (OR 5.61; 95% CI 4.5–6.98), high normal BP (OR 10.68; 95% CI 6.92– 14.51) and FMD <10% (OR 3.49; 95% CI 2.19–5.57) were significant risk factors of AH. The results of multivariate analysis BMI > 25 kg/m2 , high normal BP and FMD < 10% were independent risk factors. Conclusion. Endothelial dysfunction is an independent risk factor of AH in young patients with initially normal level of AD during 5 years.