title: Impaired endothelial responses in apparently healthy young people associated with subclinical variation in blood pressure and cardiovascular phenotype.
abstract: BACKGROUND
  A phenomenon of endothelial impairment, independent of classical cardiovascular risk factors, has been observed in young people. We identified subjects with persistently reduced, or declining, endothelial function during adolescence and early adulthood, without apparent cardiovascular risk, and investigated the clinical relevance of this finding.
  
  
  METHODS
  Endothelial vasomotor responses were assessed by brachial artery flow-mediated dilatation (FMD) at age 15 years in 47 subjects (22 males) who returned for a repeated measurement at age 25. Subjects underwent quantification of left ventricular mass (LVM) and function by cardiovascular magnetic resonance, central arterial stiffness by applanation tonometry, and common carotid artery intima-media thickness using ultrasound on their visit at age 25.
  
  
  RESULTS
  Individuals with low average FMD over 10-year period, although normotensive, had 5 mm Hg higher systolic blood pressure and, significantly greater LVM (73.48 ± 7.73 vs. 56.25 ± 9.54 g/m(2), P = 0.0001), carotid intima-media thickness (cIMT) (0.53 ± 0.06 vs. 0.47 ± 0.04 mm, P = 0.03), and pulse wave velocity (5.97 ± 0.63 vs. 5.29 ± 0.59 m/s, P = 0.02) than those with higher endothelial responses. Subjects with the greatest decline in FMD over 10 years had a significant increase in mean arterial pressure but similar cardiovascular phenotype.
  
  
  CONCLUSIONS
  Persistently reduced, or declining, endothelial function during adolescence, in the absence of overt cardiovascular disease, is a sensitive early marker associated with subclinical changes in blood pressure (BP) and an adverse cardiovascular phenotype. The findings highlight the potential importance of endothelial responses during adolescence in primary prevention strategies for hypertension.
authors: Department of Cardiovascular Medicine, University of Oxford, Oxford, UK.
authors: Merzaka
authors: M
authors: Lazdam
authors: Adam J
authors: AJ
authors: Lewandowski
authors: Ilias
authors: I
authors: Kylintireas
authors: Colin
authors: C
authors: Cunnington
authors: Jonathan
authors: J
authors: Diesch
authors: Jane
authors: J
authors: Francis
authors: Corinne
authors: C
authors: Trevitt
authors: Stefan
authors: S
authors: Neubauer
authors: Atul
authors: A
authors: Singhal
authors: Paul
authors: P
authors: Leeson
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D001916:Brachial Artery / Q000502:physiology; D002318:Cardiovascular Diseases / Q000209:etiology; D059168:Carotid Intima-Media Thickness; D004730:Endothelium, Vascular / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology; D008297:Male; D010641:Phenotype; D012307:Risk Factors; D059289:Vascular Stiffness; D014664:Vasodilation / Q000502:physiology