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Cited by 1,059Cardiovascular Health and Disease PreventionNitric Oxide and Endothelin EffectsBlood Pressure and Hypertension Studies

Prognostic Significance of Endothelial Dysfunction in Hypertensive Patients

Perticone, Francesco, Ceravolo, Roberto, Pujia, Arturo, Ventura, Giorgio, Iacopino, Saverio, Scozzafava, Angela, Ferraro, Alessandro, Chello, Massimo +3 more·2001·Circulation
DOI 10.1161/01.cir.104.2.191
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Abstract

Background — Forearm endothelial dysfunction, characterized by an impaired vasodilating response to acetylcholine (ACh), may be associated with several cardiovascular risk factors, including essential hypertension. Although the prognostic value of coronary endothelial dysfunction has been demonstrated, that of forearm endothelial dysfunction is still unknown. Methods and Results — Endothelium-dependent and -independent vasodilation was investigated in 225 never-treated hypertensive patients (age, 35 to 54 years) by intra-arterial infusion of increasing doses of ACh and sodium nitroprusside. Patients were divided into tertiles on the basis of their increase in ACh-stimulated forearm blood flow (FBF) from basal: group 1, from 30% to 184%; group 2, from 185% to 333%; and group 3, from 339% to 760% increase from basal. During a mean follow-up of 31.5 of months (range, 4 to 84 months), there were 29 major adverse events at the cardiac (n=19), cerebrovascular (n=9), or peripheral vascular (n=1) level. Events included myocardial infarction, angina, coronary revascularization procedures, stroke, transient cerebral ischemic attack, and aortoiliac occlusive disease. Event rate per 100 patient-years was 8.17, 4.34, and 2.02 in the first, second, and third tertiles of peak percent increase in FBF during ACh infusion. The excess risk associated with an FBF increase in the first tertile was significant (relative risk, 2.084; 95% CI, 1.25 to 3.48; P =0.0049) after controlling for individual risk markers, including 24-hour ambulatory blood pressure. Conclusions — Our data suggest that forearm endothelial dysfunction is a marker of future cardiovascular events in patients with essential hypertension.

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  • Endothelial dysfunction occurs early in the pathogenesis of atherosclerosis, and predicts future cardiovascular events.

    “Endothelial dysfunction occurs early in the pathogenesis of atherosclerosis, and predicts future cardiovascular events.”

    From The Vasculature in Prediabetes (2018) · cites this paper as [30]

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  1. Fuster V, Badimon L, Badimon JJ, et al. The pathogenesis of coronary artery disease. N Engl J Med. 1992;326:242-250.
  2. de Graaf JC, Banga JD, Moncada S, et al. Nitric oxide inhibitor of platelet adhesion under flow conditions. Circulation. 1992;85:2284 -2290.
  3. Collins R, Peto R, McMahon S, et al. Blood pressure, stroke, and coro- nary heart disease, part 2: short-term reductions in blood pressure: overview of randomized drug trials in their epidemiological context. Lancet. 1990;335:827-838.
  4. is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Circulation doi: 10.1161/01.CIR.104.2.191 2001;104:191-196 Circulation. http://circ.ahajournals.org/content/104/2/191 Wide Web at: The online version of this article, along with updated information and services, is located on the World http://circ.ahajournals.org//subscriptions/ is online at: Circulation Information about subscribing to Subscriptions: http://www.lww.com/reprints Information about reprints can be found online at: Reprints: document. and Rights Question and Answer Permissions the middle column of the Web page under Services. Further information about this process is available in the the online version of the published article for which permission is being requested is located, click Request Permissions in can be via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once Circulation Requests for permissions to reproduce figures, tables, or portions of articles originally published in Permissions: · DOI

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Authors
Perticone, F., Ceravolo, R., Pujia, A., Ventura, G., Iacopino, S., Scozzafava, A., Ferraro, A., Chello, M., Mastroroberto, P., Verdecchia, P., & Schillaci, G.
Affiliations
University of Perugia (IT)
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2001-07-10
Volume
104
Issue
2
Pages
191-196
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/01.cir.104.2.191
OpenAlex
W2155766891
Cited by
1,059
References
42
Citations by year
2026: 7 · 2025: 6 · 2024: 5 · 2023: 16 · 2022: 27 · 2021: 28 · 2020: 23 · 2019: 22 · 2018: 28 · 2017: 31 · 2016: 34 · 2015: 27 · 2014: 43 · 2013: 25 · 2012: 67
FWCI
41.67
Type
journal article
Language
en
Open access
closed
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
  • Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords
endothelial dysfunction, essential hypertension, forearm blood flow, acetylcholine-induced vasodilation, cardiovascular risk prediction, major adverse cardiovascular events, sodium nitroprusside
MeSH terms
Acetylcholine, Adult, Antihypertensive Agents, Blood Flow Velocity, Blood Pressure, Dose-Response Relationship, Drug, Endothelium, Vascular, Female, Follow-Up Studies, Forearm, Humans, Hypertension, Infusions, Intra-Arterial, Male, Middle Aged, Nitroprusside, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Factors, Vasodilation, Vasodilator Agents, Proportional Hazards Models, Disease Progression, Risk Assessment, Disease-Free Survival

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