title: Plasma asymmetric dimethylarginine and coronary and peripheral endothelial dysfunction in hypertensive patients.
abstract: BACKGROUND
  The attenuation of coronary flow reserve (CFR) and endothelium-mediated vasodilation of the brachial artery (EMV-BA) have been frequently reported in hypertensive patients. The present study investigated the link between CFR and EMV-BA in hypertensive patients. We hypothesized that changes in serum asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, and concomitant insulin resistance may be underlying factors connecting the two pathologic alterations.
  
  
  METHODS
  A total of 75 patients (30 men and 45 women, 61.5 +/- 10.1 years of age) with essential hypertension and without coronary artery disease and diabetes mellitus were included in the study. Measurements of CFR were made using adenosine-triphosphate stress transthoracic Doppler echocardiography, and forearm EMV-BA was measured by venous occlusion strain gauge plethysmography. A plasma ADMA assay and a 75-g oral glucose tolerance test were also performed.
  
  
  RESULTS
  Average CFR and EMV-BA values were 2.54 +/- 0.63 and 86.0 +/- 54.7%, respectively. A significant correlation was found between CFR and EMV-BA (r = 0.493, P <.001). Both CFR and EMV-BA were also significantly correlated with age and plasma ADMA concentration, but were not correlated with insulin resistance, plasma insulin, or left ventricular mass. Multiple regression analysis revealed that ADMA was the only statistically independent parameter associated with CFR and EMV-BA.
  
  
  CONCLUSIONS
  The similar deterioration in endothelial function in coronary and peripheral vascular territories may be mainly due to increased plasma ADMA concentration. Plasma ADMA appears to play a major role in endothelial dysfunction in hypertensive patients, independent of insulin resistance or left ventricular hypertrophy.
authors.affiliation: Division of Hypertension and Nephrology, National Cardiovascular Center, Suita, Osaka, Japan. takiuchi@hsp.ncvc.go.jp
authors.forename: Shin
authors.initials: S
authors.lastname: Takiuchi
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujii
authors.forename: Kei
authors.initials: K
authors.lastname: Kamide
authors.forename: Takeshi
authors.initials: T
authors.lastname: Horio
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakatani
authors.forename: Aki
authors.initials: A
authors.lastname: Hiuge
authors.forename: Hiromi
authors.initials: H
authors.lastname: Rakugi
authors.forename: Toshio
authors.initials: T
authors.lastname: Ogihara
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Kawano
mesh_terms: D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood*; D003326:Coronary Circulation; D015150:Echocardiography, Doppler; D004730:Endothelium, Vascular / Q000378:metabolism* / Q000503:physiopathology; D005260:Female; D005542:Forearm / Q000098:blood supply; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged
chemical_list: C018524:N,N-dimethylarginine; D001120:Arginine