Structural alterations of subcutaneous small-resistance arteries may predict major cardiovascular events in patients with hypertension.
BACKGROUND
Structural alterations in the microcirculation may be considered an important mechanism of organ damage. An increased tunica media to internal lumen ratio of subcutaneous small-resistance arteries (M:L) may predict the development of cardiovascular events in a high-risk population. However, it is not known whether structural alterations of small arteries may also predict major cardiovascular events.


METHODS
Three hundred three subjects were included in the present study. There were 65 normotensive subjects, 111 patients with essential hypertension (33% of them with diabetes mellitus), 109 patients with secondary forms of hypertension, and 18 normotensive diabetic patients. Small-resistance arteries were dissected from subcutaneous fat biopsies and mounted on an isometric myograph, and the M:L was measured. Subjects were reevaluated after an average follow-up time of 6.9 years to assess the occurrence of cardio-cerebrovascular events.


RESULTS
Eleven subjects died of a fatal cardio-cerebrovascular event (FCE), 14 had a major, nonfatal cardiovascular event (stroke or myocardial infarction) (SMI), 23 had a minor cardiovascular event (MCE), and 255 had no cardiovascular event (NCE). A significant difference was observed in M:L and in event-free survival between patients with FCEs+SMIs+MCEs and those with NCE and between patients with FCEs+SMIs and those with NCE. Similar results were obtained by restricting the analysis to patients with essential hypertension.


CONCLUSIONS
Structural alterations of small-resistance arteries may predict FCE and SMI. The prognostic role of small-resistance artery structure also applies to medium-risk patients with essential hypertension, at least when MCEs are included in the analysis.
Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy.
Carolina
C
De Ciuceis
Enzo
E
Porteri
Damiano
D
Rizzoni
Nicola
N
Rizzardi
Silvia
S
Paiardi
Gianluca E M
GE
Boari
Marco
M
Miclini
Francesca
F
Zani
Maria Lorenza
ML
Muiesan
Francesco
F
Donato
Massimo
M
Salvetti
Maurizio
M
Castellano
Guido A M
GA
Tiberio
Stefano M
SM
Giulini
Enrico
E
Agabiti Rosei
D003645:Death, Sudden / Q000209:etiology*; D004576:Electromyography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012867:Skin / Q000098:blood supply*; D020521:Stroke / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors; D017540:Tunica Media / Q000503:physiopathology; D014655:Vascular Resistance / Q000502:physiology*