title: Small artery structure during antihypertensive therapy is an independent predictor of cardiovascular events in essential hypertension.
abstract: OBJECTIVE
  Structural changes of small resistance arteries occur early in the disease process of essential hypertension and predict cardiovascular events in previously untreated patients. We investigated whether on-treatment small artery structure also identifies patients at elevated risk despite normalization of blood pressure (BP).
  
  
  METHODS
  We conducted a long-term follow-up survey of cardiovascular events in 134 moderate-risk patients with 9-12 months of well treated essential hypertension. All participants underwent subcutaneous biopsies with determination of small artery structure in terms of media to lumen ratio (M : L) before and during treatment.
  
  
  RESULTS
  After 9-12 months of treatment SBP was lowered from 164 ± 15 to 134 ± 14 mmHg (P < 0.01) and M : L reduced from 0.084 ± 0.028 to 0.075 ± 0.024 (P < 0.01). Mean follow-up hereafter was 15 years representing a total of 2035 years for the entire cohort. During this period 47 patients suffered a predefined cardiovascular event. For patients with on-treatment M : L above the mean value of the cohort (≥0.075), the hazard ratio was 2.14 [95% confidence interval (CI) 1.19-3.84, P = 0.01] and also those with M : L above mean +2SD of a normotensive population (≥0.098) had an elevated risk (hazard ratio 2.99, 95% CI 1.60-5.58, P < 0.01). Both results were adjusted for heart score (a 10-year mortality risk estimate integrating age, sex, smoking status, cholesterol level and SBP). Analysis of changes in M : L during treatment showed significantly higher event rates among patients with increased M : L and vice versa (hazard ratio 1.36 per 25% change, 95% CI 1.07-1.73, P = 0.013).
  
  
  CONCLUSIONS
  On-treatment small artery structure identifies individuals still at increased cardiovascular risk despite long-term BP normalization and may be an additional target for therapy to prevent cardiovascular events.
authors: Department of Renal Medicine, Aarhus University Hospital, Denmark. nhbuus@dadlnet.dk
authors: Niels H
authors: NH
authors: Buus
authors: Ole N
authors: ON
authors: Mathiassen
authors: Morten
authors: M
authors: Fenger-Grøn
authors: Michael N
authors: MN
authors: Præstholm
authors: Inger
authors: I
authors: Sihm
authors: Niels K
authors: NK
authors: Thybo
authors: Anne P
authors: AP
authors: Schroeder
authors: Kristian
authors: K
authors: Thygesen
authors: Christian
authors: C
authors: Aalkjær
authors: Ole L
authors: OL
authors: Pedersen
authors: Michael J
authors: MJ
authors: Mulvany
authors: Kent L
authors: KL
authors: Christensen
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001158:Arteries / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000473:pathology*
chemical_list: D000959:Antihypertensive Agents