The relationship of endothelial function and arterial stiffness with subclinical target organ damage in essential hypertension

Juvenile primary hypertension is associated with attenuated macro- and microvascular dilator function independently of body weight

OBJECTIVE

Hypertension has become a global medical and public health issue even in childhood. It is well accepted that hypertension is associated with impaired endothelium-dependent vascular reactivity in adult patients. However, there is a lack of data on hypertension-related endothelial dysfunction in hypertensive children. Thus, present study aimed to evaluate the association of primary hypertension in the pediatric population with macro- and microvascular function, and to assess the potential role of oxidative stress in that connection.

METHODS

Fifty-two children were enrolled in this study; 26 normotensive (NT) and 26 with primary hypertension (HT), both sexes, 9-17 years old. In addition to anthropometric, hemodynamic and biochemical measurements, peripheral microvascular responses to occlusion (postocclusive reactive hyperemia, PORH), local heating (local thermal hyperemia, LTH), iontophoretically applied acetylcholine (AChID) and sodium nitroprusside (SNPID) were evaluated by laser Doppler flowmetry (LDF). Furthermore, brachial artery flow-mediated dilation (FMD) was measured and biomarker of oxidative stress was determined.

RESULTS

PORH, AChID and LTH were impaired in hypertensive compared to normotensive children, while SNPID did not differ between groups. FMD was decreased in hypertensive compared to normotensive children. Serum concentration of 8- iso -PGF2α was significantly elevated in hypertensive compared to normotensive children.

CONCLUSION

Even in childhood, primary hypertension is associated with attenuated endothelial function and reduced endothelium-dependent responses to various physiological stimuli. Juvenile hypertension is related to increased level of vascular oxidative stress. All changes are independent of BMI.

Association of T-cell receptor repertoires and arterial stiffness in patients with essential hypertension

BACKGROUND

Abnormal immune responses, particularly T-cell activity, are linked to vascular complications in hypertension, but mechanisms remain unknown. Our study aims to explore the association between arterial stiffness, assessed by brachial-ankle pulse wave velocity (baPWV), and T-cell receptor (TCR) repertoires in essential hypertension patients, focusing on understanding the role of T cells in the development of arterial stiffness in this population.

METHODS

The study included 301 essential hypertension patients and 48 age-matched normotensive controls. Essential hypertension patients were stratified into high (baPWV ≥1400 cm/s, n = 213) and low (baPWV <1400 cm/s, n = 88) baPWV groups. High-throughput sequencing analyzed peripheral TCRβ repertoires.

RESULTS

Significant TCRβ repertoire differences were observed between essential hypertension and normotensive groups, as well as between high and low baPWV essential hypertension subgroups. Specifically, patients in the high baPWV group exhibited notable variations in the utilization of specific TCR beta joining (TRBJ) and variable (TRBV) genes compared to the low baPWV group. These alterations were accompanied by reduced TCRβ diversity (represented by diversity 50 s), increased percentages of the largest TCRβ clones, and a higher number of TCRβ clones exceeding 0.1%. The presence of specific TCRβ clones was detected in both groups. Furthermore, reduced diversity 50s and elevated percentages of the largest TCRβ clones were independently correlated with baPWV, emerging as potential risk factors for increased baPWV in essential hypertension patients.

CONCLUSION

TCR repertoires were independently associated with arterial stiffness in patients with essential hypertension, implicating a potential role for dysregulated T-cell responses in the pathogenesis of arterial stiffness in this patient population.Trial registration: ChiCTR2100054414.

Effect of early endothelial function improvement on subclinical target organ damage in hypertensives

Endothelial dysfunction is acknowledged as a marker for subclinical target organ damage (STOD) in hypertension, though its therapeutic potential has not yet been clarified. This study assessed whether early endothelial function improvement (EEFI) reduced STOD in patients with essential hypertension (EH). We conducted a retrospective cohort analysis of 456 EH patients initially free from STOD. Endothelial function was assessed using brachial artery flow-mediated dilation (FMD), with values ≤ 7.1% indicating dysfunction. Patients were initially categorized by endothelial status (dysfunction: n = 180, normal: n = 276), and further divided into improved or unimproved groups based on changes within three months post-enrollment. During a median follow-up of 25 months, 177 patients developed STOD. The incidence of STOD was significantly higher in patients with initial dysfunction compared to those with normal function. Kaplan-Meier analysis indicated that the improved group had a lower cumulative incidence of STOD compared to the unimproved group (p < 0.05). Multivariable Cox regression confirmed EEFI as an independent protective factor against STOD in EH patients (p < 0.05), regardless of their baseline endothelial status, especially in those under 65 years old, non-smokers, and with low-density lipoprotein cholesterol levels ≤ 3.4 mmol/L. In conclusion, EEFI significantly reduces STOD incidence in EH patients, particularly in specific subgroups, emphasizing the need for early intervention in endothelial function to prevent STOD.

Modifiable risk factors mediate the effect of gastroesophageal reflux disease on stroke and subtypes: A Mendelian randomization study

OBJECTIVES

Previous observational studies have suggested that gastroesophageal reflux disease (GERD) increases the risk of stroke, but the specific underlying mechanisms are unclear. We investigated the causal associations of GERD with stroke and its subtypes using Mendelian randomization (MR), and evaluated the potential mediating effects of modifiable stroke risk factors in the causal pathway.

METHODS

Genetic instrumental variables for GERD were extracted from the latest genome-wide association study (GWAS) summary level data. We initially performed two-sample MR to examine the association of GERD with stroke and its subtypes, including ischemic stroke, intracranial hemorrhage, and the major subtypes of ischemic stroke. Two-step MR was further employed to investigate the mediating effect of 15 risk factors in the causal pathway.

RESULTS

We found significant causal associations of genetically predicted GERD with increased risk of stroke (OR: 1.22 95% CI: 1.126-1.322), ischemic stroke (OR: 1.19 95% CI: 1.098-1.299), and large-artery stroke (OR: 1.49 95% CI: 1.214-1.836). Replication and sensitivity analyses yielded consistent effect directions and similar estimates. Further mediation analyses indicated that hypertension (HTN), systolic blood pressure (SBP), and type 2 diabetes (T2D) mediated 36.0%, 9.0%, and 15.8% of the effect of GERD on stroke; 42.9%, 10.8%, and 21.4% for ischemic stroke, and 23.3%; 7.9%, and 18.7% for large-artery stroke, respectively.

CONCLUSIONS

This study supports that GERD increases susceptibility to stroke, ischemic stroke, and large-artery stroke, and is partially mediated by HTN, SBP, and T2D.

Thrombospondin 2 is a novel biomarker of essential hypertension and associated with nocturnal Na+ excretion and insulin resistance

BACKGROUND

Thrombospondins (TSPs) play important roles in several cardiovascular diseases. However, the association between circulating (plasma) thrombospondin 2 (TSP2) and essential hypertension remains unclear. The present study was aimed to investigate the association of circulating TSP2 with blood pressure and nocturnal urine Na+ excretion and evaluate the predictive value of circulating TSP2 in subjects with hypertension.

METHODS AND RESULTS

603 newly diagnosed essential hypertensive subjects and 508 healthy subjects were preliminarily screened, 47 healthy subjects and 40 newly diagnosed essential hypertensive subjects without any chronic diseases were recruited. The results showed that the levels of circulating TSP2 were elevated in essential hypertensive subjects. The levels of TSP2 positively associated with systolic blood pressure (SBP), diastolic blood pressure (DBP), and other clinical parameters, including homeostasis model assessment of insulin resistance (HOMA-IR), brachial-ankle pulse wave velocity, and serum triglycerides, but negatively associated with nocturnal urine Na+ concentration and excretion and high-density lipoprotein cholesterol. Results of multiple linear regressions showed that HOMA-IR and nocturnal Na+ excretion were independent factors related to circulating TSP2. Mantel-Haenszel chi-square test displayed linear relationships between TSP2 and SBP (χ2 = 35.737) and DBP (χ2 = 26.652). The area under receiver operating characteristic curve (AUROC) of hypertension prediction was 0.901.

CONCLUSION

Our study suggests for the first time that the circulating levels of TSP2 may be a novel potential biomarker for essential hypertension. The association between TSP2 and blood pressure may be, at least in part, related to the regulation of renal Na+ excretion, insulin resistance, and/or endothelial function.

Effects of two-month treatment with a mixture of natural activators of autophagy on oxidative stress and arterial stiffness in patients with essential hypertension: A pilot study

BACKGROUND AND AIMS

Trehalose, spermidine, nicotinamide, and polyphenols are natural substances that exert pro-autophagic and antioxidant properties. Their role in blood pressure (BP) regulation and preservation of vascular function in essential hypertension is unknown. The aim of this study was to evaluate the effect of a mixture of these agents on BP level, markers of oxidative stress, autophagy, endothelial function, and vascular stiffness in outpatients with grade 1 uncomplicated essential hypertension.

METHODS AND RESULTS

A single-centre, open-label, case-control, pilot study was conducted in adult outpatients (aged ≥18 years) receiving or not the mixture for two months along with the standard therapies. Both at baseline and at the end of the treatment the following clinical parameters were evaluated: brachial seated office BP level, central aortic pressure, pulse wave velocity, augmentation index (AI@75). Both at baseline and at the end of the treatment, a blood sample was drawn for the measurement of: H2O2, HBA%, levels of sNOX2-dp, Atg 5, P62, endothelin 1, and NO bioavailability. The mixture of nutraceuticals did not influence BP levels. Patients receiving the mixture showed a significant decrease of oxidative stress, stimulation of autophagy, increased NO bioavailability and no increase of the AI@75, in contrast to what observed in hypertensive patients not receiving the mixture.

CONCLUSIONS

The supplementation of the trehalose, spermidine, nicotinamide, and polyphenols mixture counteracted hypertension-related arterial stiffness through mechanisms likely dependent on oxidative stress downregulation and autophagy stimulation. These natural activators of autophagy may represent favourable adjuvants for prevention of the hypertensive cardiovascular damage.

Arterial stiffness is associated with cancer mortality: Insight from Kailuan study

BACKGROUND

There is limited evidence on the association between arterial stenosis and the risk of all-cause mortality in cancer patients (ACMC). This study investigated whether the status of arterial function and structure measured by brachial-ankle pulse wave velocity (baPWV) is associated with ACMC.

METHODS

A total of 43,943 Chinese adults underwent a baPWV examination. Cox proportional hazards model was used to assess the association between the baPWV values and ACMC.

RESULTS

During a total follow-up duration of 3.81 ± 2.50 years, there were 157 deaths among 553 cancer cases diagnosed during the follow-up. Patients with baPWV ≥18 m/s showed an increased risk of ACMC compared to patients with ideal vascular function. In the multivariate-adjusted model, we observed a significant association between arterial stiffness severity and ACMC with a hazard ratio (HR) 2.72 (95% confidence interval [CI]: 1.55-4.80; p < 0.001) in those with baPWV ≥18 m/s. With a 1-SD increase in baPWV, the HR (95% CI) for ACMC in the entire cohort, men, and patients ≤60 years old were 1.20 (95% CI: 1.03-1.41; p < 0.05), 1.20 (95% CI: 1.01-1.43; p < 0.05), and 1.44 (95% CI: 1.10-1.44; p = 0.008), respectively.

CONCLUSIONS

Increased arterial stiffness measured by baPWV is associated with ACMC. The association between high baPWV (≥18 m/s) and risk of all-cause mortality was prominent in men and those ≤60 years of age.

A Critical Review on Vasoactive Nutrients for the Management of Endothelial Dysfunction and Arterial Stiffness in Individuals under Cardiovascular Risk

Pathophysiological conditions such as endothelial dysfunction and arterial stiffness, characterized by low nitric oxide bioavailability, deficient endothelium-dependent vasodilation and heart effort, predispose individuals to atherosclerotic lesions and cardiac events. Nitrate (NO₃^-), L-arginine, L-citrulline and potassium (K⁺) can mitigate arterial dysfunction and stiffness by intensifying NO bioavailability. Dietary compounds such as L-arginine, L-citrulline, NO₃^- and K⁺ exert vasoactive effects as demonstrated in clinical interventions by noninvasive flow-mediated vasodilation (FMD) and pulse-wave velocity (PWV) prognostic techniques. Daily L-arginine intakes ranging from 4.5 to 21 g lead to increased FMD and reduced PWV responses. Isolated L-citrulline intake of at least 5.6 g has a better effect compared to watermelon extract, which is only effective on endothelial function when supplemented for longer than 6 weeks and contains at least 6 g of L-citrulline. NO₃^- supplementation employing beetroot at doses greater than 370 mg promotes hemodynamic effects through the NO₃^--NO2-/NO pathway, a well-documented effect. A potassium intake of 1.5 g/day can restore endothelial function and arterial mobility, where decreased vascular tone takes place via ATPase pump/hyperpolarization and natriuresis, leading to muscle relaxation and NO release. These dietary interventions, alone or synergically, can ameliorate endothelial dysfunction and should be considered as adjuvant therapies in cardiovascular diseases.

Influence of Shift Work on Arterial Stiffness and Systemic Inflammation: A 3-Year Follow-up Study in Industry

OBJECTIVE

To assess changes in cardiovascular disease risk factors during a 3-year follow-up among 57 rotating shift workers and 29 day workers in industry.

METHODS

We collected demographics by questionnaire, examined blood pressure, heart rate, pulse wave velocity, carotid media thickness, and maximal oxygen uptake. We assessed blood samples for determination of lipids, glycosylated hemoglobin, C-reactive protein, markers of inflammation, and particle concentrations/respirable dust. Baseline comparisons were analyzed using logistic regression (plaque) and linear regression for all other outcomes. We applied mixed models to assess differences in change in health outcomes between the shift workers and the day workers.

RESULTS

At baseline, the adhesion molecules soluble vascular cell adhesion molecule 1 and soluble P-selectin were elevated among the shift workers compared with that of the day workers. There was a significant difference in change in pulse wave velocity between shift workers (1.29-m/s increase) and day workers (0.11-m/s increase) over the 3-year follow-up. Respirable dust levels were below the Norwegian occupational exposure limit.

CONCLUSIONS

Shift work in industry is associated with arterial stiffening reflecting increased risk for future cardiovascular disease. More uncertainly, we found some support for systemic inflammation.