PP.09.09] IMPROVEMENT OF ENDOTHELIAL GLYCOCALYX AND AORTIC STIFFNESS AFTER ONE YEAR OF SUCCESSFUL TREATMENT IN UNTREATED PATIENTS WITH ESSENTIAL HYPERTENSION

Abstract

Objective: Aortic stiffness is considered a valuable index of subclinical damage in hypertensives offering to cardiovascular risk estimation. The integrity of endothelial glycocalyx plays a vital role in vascular permeability, inflammation and elasticity. We aimed to explore any changes in both aortic stiffness and endothelial glycocalyx in hypertensive patients under medical treatment (MT) or just life style changes (LSC). Design and method: We studied 114 patients with newly diagnosed essential hypertension (mean age 48+10 years, 80 males). At baseline, we performed carotid-femoral artery PWV to evaluate aortic stiffness. Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranged from 5–25 micrometers) was measured as a non-invasive accurate index of reduced endothelial glycocalyx thickness. Twenty six patients (23%) decided to follow only LSC (Group A) while 88 patients (77%) started MT (Group B). All patients re-evaluated at 12+7 months but no earlier than 6 months. Blood pressure (BP) <140/90 mmHg was considered as controlled (office and/or home measurements). Results: There were no significant differences within Groups A and B regarding baseline evaluation of systolic blood pressure (SBP), PWV and PBR 5–25. In Group A, systolic blood pressure (SBP), PWV and PBR were not different from baseline evaluation. However, in the subgroup of LSC with controlled hypertension (Group AC, 9/26), we found that SBP and PWV were reduced (p < 0.05). In Group B, SBP (p < 0.001) and PWV (p = 0.002) were reduced. In the subgroup of MT with uncontrolled hypertension by the physician but controlled by the patient and treated for at least 12 months (Group BUC, 10/88 patients) we found that SBP, PWV and PBR5–25 were decreased (p < 0.05). Conclusions: Cardiovascular risk reduction in hypertensives is based not only in SBP control but also in target organ damage improvement. Our results underline that the expected improvement of aortic stiffness induced by BP control is present independently of the choice of the treatment. Secondly, improvement of endothelial glycocalyx needs long term treatment. Finally, our study shows the importance of the information received by the patients regarding their BP control at home regarding the white coat effect phenomenon in office measurements.