The major arteries and skin microcirculatory vessels status and antihypertensive therapy effect on them in hypertensive patients with high and very high cardiovascular risk

Aim: to assess the state of the large blood vessels and skin microcirculatory vessels and the effects of angiotensin II receptor blockers (ARB) on them in hypertensive patients with high and very high cardiovascular risk (CVR). Subjects and methods. We examined 59 hypertensive patients aged 35-60 years, of which 29 high CVR subjects and 30 very high CVR (without antihypertensive therapy within 2 weeks prior to the study). In all subjects the evaluation of target organ damage, laser Doppler flowmetry (LDF) with initial perfusion parameters registration and amplitude-frequency spectrum of LDF-grams analysis, registration of central blood pressure, local stiffness parameters and photoplethysmography (PTMG) were performed. The second study was carried out after 2 weeks of antihypertensive treatment with ARB. Results. A significant increase in endothelial rhythm amplitude and coefficient of variation in very high risk hypertensive patients in comparison with a group of high-risk patients was found. In the group of very high-risk hypertensive patients central arterial pressure, augmentation index and local stiffness values were higher (n/a), the rate of carotid arteries extensibility was significantly reduced. There was a significant large vessels impairment in very high risk group according PTMG data. Target blood pressure level achieved in up to 80% of patients after 2 weeks treatment. During the re-examination a statistically significant improvement in the large arteries was found, LDF parameters also improved, but significant values was not reached. Conclusion. The findings suggest that with increasing degree of CVR in patients with hypertension there is a progressive deterioration of both large vessels and microcirculation state. After short-term antihypertensive therapy the function of large vessels improve in very high risk hypertensive patients, but the state of the microvasculature not changes significantly.

arterial hypertension, microcirculation, laser Doppler flowmetry, vascular stiffness, cardiovascular risk

1. Laurent S, Boutouyrie P, Asmar R et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001; 37 (5): 1236-41.

2. Федорович А.А. Функциональное состояние регуляторных механизмов микроциркуляторного кровотока в норме и при артериальной гипертензии по данным лазерной допплеровской флоуметрии. Регионарное кровообращение и микроциркуляция. 2010; 9 (1): 33-45.

3. Маколкин В.И., Подзолков В.И., Бранько В.В. Микроциркуляция в кардиологии. М.: Визарт, 2004.

4. Федорович А.А., Гориева Ш.Б., Рогоза А.Н. и др. Функциональное состояние регуляторных механизмов микроциркуляторного кровотока в норме и при артериальной гипертензии по данным лазерной допплеровской флоуметрии. Мед. алфавит. 2014; 2 (14): 58-68.

5. Беленков Ю.Н., Привалова Е.В., Данилогорская Ю.А. и др. Ремоделирование сосудистого русла у больных артериальной гипертонией: возможности диагностики и коррекции. Кардиология. 2012; 6: 67-72.

6. Ершова А.И. Биохимические показатели и структурно - функциональные особенности каротидных артерий и аорты у больных семейной гиперхолестеринемией. Дис. … канд. мед. наук. М., 2012.

7. Laurent S, Cockcroft J, Van Bortel L et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27 (21): 2588-605.

8. Nürnberger J, Keflioglu-Scheiber A, Opazo Saez A.M et al. Augmentation index is associated with cardiovascular risk. J. Hypertens 2002; 20 (12): 2407-14.

9. Vlachopoulos C, Aznaouridis K, O’Rourke M.F et al. Prediction of cardiovascular events and all - cause mortality with central haemodynamics: a systematic review and meta-analysis. Eur Heart J 2010; 31 (15): 1865-71.

10. Rosenwasser R.F, Shah N.K, Smith S.M et al. Baseline predictors of central aortic blood pressure: a PEAR substudy. J Am Soc Hypertens 2014; 8 (3): 152-8.

11. Izzo J.L. Brachial vs. central systolic pressure and pulse wave transmission indicators: a critical analysis. Am J Hypertens 2014; 27 (12): 1433-42.

12. Крупаткин А.И. Клиническая нейроангиофизиология конечностей. М.: Научный мир, 2003.

13. Крупаткин А.И., Сидоров В.В. Лазерная допплеровская флоуметрия микроциркуляции крови. М.: Медицина, 2005.

14. Rossi M, Bradbury A, Magagna A et al. Investigation of skin vasoreactivity and blood flow oscillations in hypertensive patients: effect of short-term antihypertensive treatment. J Hypertens 2011; 29 (8): 1569-76.

15. Dart A, Silagy C, Dewar E et al. Aortic distensibility and left ventricular structure and function in isolated systolic hypertension. Eur Heart J 1993; 14 (11): 1465-70.

16. Puato M, Palatini P, Zanardo M et al. Increase in carotid intima - media thickness in grade I hypertensive subjects: white-coat versus sustained hypertension. Hypertension 2008; 51 (5): 1300-5.

17. Urbina E.M, Khoury P.R, Mc Coy C.E et al. Triglyceride to HDL-C ratio and increased arterial stiffness in children, adolescents, and young adults. Pediatrics 2013; 131 (4): 1082-90.

18. Bellido C.A, Iavicoli O.R, Rusak E.J et al. Continuous improvement of arterial compliance beyond blood pressure decrease after 5 years of antihypertensive treatment. J Clin Hypertens (Greenwich) 2006; 8: 555-60.

19. Kosch M, Levers A, Lang D et al. A randomized, double-blind study of valsartan versus metoprolol on arterial distensibility and endothelial function in essential hypertension. Nephrol Dial Transplant 2008; 23: 2280-5.

20. Song H, Bao W, Wang H et al. Effects of extended-release felodipine on endothelial vasoactive substances in patients with essential hypertension. Clin Chem Lab Med 2008; 46: 393-5.

21. Schiffrin E.L, Deng L.Y. Comparison of effects of angiotensin Iconverting enzyme inhibition and beta - blockade for 2 years on function of small arteries from hypertensive patients. Hypertension 1995; 25: 699-703.

22. Schiffrin E.L, Deng L.Y, Larochelle P. Effects of a beta - blocker or a converting enzyme inhibitor on resistance arteries in essential hypertension. Hypertension 1994; 23: 83-91.

23. Schiffrin E.L, Deng L.Y, Larochelle P. Progressive improvement in the structure of resistance arteries of hypertensive patients after 2 years of treatment with an angiotensin I-converting enzyme inhibitor. Comparison with effects of a beta-blocker. Am J Hypertens 1995; 8: 229-36.

24. Ghiadoni L, Virdis A, Magagna A et al. Effect of the angiotensin II type 1 receptor blocker candesartan on endothelial function in patients with essential hypertension. Hypertension 2000; 35: 501-6.

25. Schiffrin E.L, Park J.B, Pu Q. Effect of crossing over hypertensive patients from a beta - blocker to an angiotensin receptor antagonist on resistance artery structure and on endothelial function. J Hypertens 2002; 20: 71-8.

26. Rizzoni D, Porteri E, De Ciuceis C et al. Effect of treatment with candesartan or enalapril on subcutaneous small artery structure in hypertensive patients with noninsulin - dependent diabetes mellitus. Hypertension 2005; 45: 659-65.

27. Savoia C, Touyz R.M, Endemann D.H et al. Angiotensin receptor blocker added to previous antihypertensive agents on arteries of diabetic hypertensive patients. Hypertension 2006; 48: 271-7.