[Noninvasive assessment of endothelial function in hemodialyzed hypertensive patients by laser Doppler flowmetry].
BACKGROUND
End stage renal disease and hypertension are associated with higher cardiovascular mortality. Endothelial dysfunction plays an important role in the pathogenesis of cardiovascular diseases. The authors investigated the endothelium-dependent and -independent vasodilation in the forearm skin microcirculation and the plasma markers of endothelial damage in hypertensive hemodialysed patients and in normotensive control subjects.


METHODS
Laser Doppler flowmetry with iontophoresis of acetylcholine and sodium nitroprusside and the postocclusive reactive hyperemia test was performed in 22 normal control subjects and in 21 hemodialysed patients with hypertension. Levels of endothelin-1, big-endothelin, and von Willebrand Factor were measured, as well.


RESULTS
The average hyperemic response to the two doses of acetylcholine iontophoresis was 474 +/- 83%; 836 +/- 97% in the control subjects, and 160 +/- 26%; 360 +/- 67% in the hemodialysed patients group (p < 0.05). The vasodilation after the two doses of sodium nitroprusside was 381 +/- 60%, 782 +/- 81% in the control group and 186 +/- 42%; 379 +/- 63% in the dialysed patients group (p < 0.05 compared to control, respectively). The average peak flow during the postocclusive reactive hyperemia test was significantly lower in hemodialysed hypertensives (234 +/- 48%) compared to healthy control subjects (434 +/- 36%, p < 0.05). Levels of endothelin-1, big endothelin, von Willebrand Factor and von Willebrand Factor activity were significantly higher in the patient group compared to the control subjects.


CONCLUSIONS
In hemodialysed hypertensive patients, both endothelium-dependent and -independent vasodilation are impaired. Markers of endothelial damage are elevated referring the progression of vascular disease.
Fovarosi Onkormányzat Szent Imre Kórház, Belgyógyászati Mátrix Intézet Angiológia Profil, Budapest. katalin.farkas@sztimrehosp.hu
Katalin
K
Farkas
János
J
Nemcsik
Endre
E
Kolossváry
Zoltán
Z
Járai
János
J
Borvendég
Eva
E
Nádory
Csaba
C
Farsang
István
I
Kiss
D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D019332:Endothelin-1 / Q000097:blood; D004730:Endothelium, Vascular / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D005542:Forearm; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000503:physiopathology*; D007478:Iontophoresis; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D006435:Renal Dialysis; D012867:Skin / Q000098:blood supply*; D014463:Ultrasonography; D014664:Vasodilation; D014841:von Willebrand Factor / Q000378:metabolism
D015415:Biomarkers; D019332:Endothelin-1; D014841:von Willebrand Factor