title: Interaction between vascular dysfunction and cardiac mass increases the risk of cardiovascular outcomes in essential hypertension.
abstract: OBJECTIVE
  To investigate the additive prognostic impact of both forearm endothelial dysfunction and left ventricular mass (LVM) for future cardiovascular events.
  
  
  RESULTS
  We enrolled 324 Caucasian, never treated, hypertensive outpatients. Endothelial function, by intra-arterial infusion of acetylcholine (ACh), and echocardiographic LVM were investigated. Patients were divided into tertiles on the basis of their increase in ACh-stimulated forearm blood flow (FBF) and LVM indexed by body surface area (LVMI). Cardiovascular events assessed were: fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, transient cerebral ischaemic attack, unstable angina, coronary revascularization procedures, and symptomatic aorto-iliac occlusive disease. During a mean follow-up of 45.2+/-23.6 months, there were 47 new cardiovascular events (3.8 events/100 patient-years). The event rate was 6.8, 2.8, and 1.6% in the tertiles of ACh-stimulated FBF (log-rank test, P=0.0009), and 1.4, 3.4, and 6.6% in the tertiles of LVMI (log-rank test, P=0.0002), respectively. Besides, a significant interaction was documented between FBF and LVMI. In fact, the cardiovascular risk increases up to 11.4% in patients with low FBF and high LVMI.
  
  
  CONCLUSIONS
  For the first time, we demonstrate that the co-existence of LVH and endothelial dysfunction in hypertensive patients increases significantly the risk of subsequent cardiovascular events.
authors.affiliation: Internal Medicine and Cardiovascular Diseases Unit, Department of Experimental and Clinical Medicine G. Salvatore, University Magna Graecia of Catanzaro, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Sciacqua
authors.forename: Angela
authors.initials: A
authors.lastname: Scozzafava
authors.forename: Arturo
authors.initials: A
authors.lastname: Pujia
authors.forename: Raffaele
authors.initials: R
authors.lastname: Maio
authors.forename: Francesco
authors.initials: F
authors.lastname: Borrello
authors.forename: Francesco
authors.initials: F
authors.lastname: Andreozzi
authors.forename: Marco
authors.initials: M
authors.lastname: Vatrano
authors.forename: Susanna
authors.initials: S
authors.lastname: Cassano
authors.forename: Maria
authors.initials: M
authors.lastname: Perticone
authors.forename: Giorgio
authors.initials: G
authors.lastname: Sesti
authors.forename: Francesco
authors.initials: F
authors.lastname: Perticone
mesh_terms: D000109:Acetylcholine / Q000494:pharmacology; D001783:Blood Flow Velocity / Q000502:physiology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology; D018572:Disease-Free Survival; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D006973:Hypertension / Q000401:mortality / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000494:pharmacology
chemical_list: D014665:Vasodilator Agents; D000109:Acetylcholine