Small artery structure is an independent predictor of cardiovascular events in essential hypertension.
OBJECTIVE
Structural abnormality of resistance arteries is a characteristic pathophysiological phenomenon in essential hypertension and can be assessed in vitro as an increase in the media: lumen ratio (M: L) of isolated small arteries. We have investigated whether M: L is a risk predictor in uncomplicated essential hypertensive patients. Recently, high M: L was demonstrated as a prognostic marker in patients at high cardiovascular risk, including normotensive type 2 diabetic patients. Since diabetes is associated with pressure-independent changes in M: L, the relevance of this finding to essential hypertension has been uncertain.


METHODS
We conducted a follow-up survey of 159 essential hypertensive patients, who had previously been submitted to a M: L evaluation while participating in a clinical trial. They composed a homogeneous moderate-risk group, with no concomitant diseases, and represented 1661 years of follow-up.


RESULTS
Thirty patients suffered a documented predefined cardiovascular event during follow-up. Increased relative risk (RR) was associated with M: L >or= 0.083 (mean level of the hypertensive cohort), RR = 2.34 [95% confidence interval (CI) 1.11-4.95], and with M: L >or= 0.098 (mean level of a normotensive control group + 2SD), RR = 2.49 (95% CI 1.21-5.11). Both results remained significant (RR = 2.19, 95% CI 1.04-4.64, and RR = 2.20, 95% CI 1.06-4.56, respectively) when adjusted for Heart Score level (10-year mortality risk-estimate, integrating age, gender, systolic blood pressure, cholesterol and smoking).


CONCLUSIONS
Abnormal resistance artery structure independently predicts cardiovascular events in essential hypertensive patients at moderate risk.
Mathiassen
Ole N
ON
Department of Pharmacology, University of Aarhus, Denmark. onm@farm.au.dk
Buus
Niels H
NH
Sihm
Inger
I
Thybo
Niels K
NK
Mørn
Birgitte
B
Schroeder
Anne P
AP
Thygesen
Kristian
K
Aalkjaer
Christian
C
Lederballe
Ole
O
Mulvany
Michael J
MJ
Christensen
Kent L
KL
D000328:Adult; D001158:Arteries / Q000473:pathology*; D002081:Buttocks / Q000473:pathology; D002318:Cardiovascular Diseases / Q000175:diagnosis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017540:Tunica Media / Q000473:pathology*