Serum phosphorus levels are associated with endothelial dysfunction in hypertensive patients.
Recent data demonstrated that serum phosphorus, within the normal range, is an independent predictor of atherosclerotic cardiovascular disease, independently of renal function. Traditional cardiovascular risk factors are important mediators of endothelial dysfunction, the early step of atherosclerosis. We designed this study to evaluate a possible correlation between serum phosphorus and endothelium-dependent vasodilation, evaluated by the strain-gauge plethysmography, in naïve hypertensives.



We investigated by strain-gauge plethysmography, the relationship between forearm blood flow (FBF) response to acetylcholine (ACh) and serum phosphorus in 500 patients with uncomplicated, never-treated, essential hypertension, divided by phosphorus tertiles. There were no significant differences among tertiles with the exclusion of forearm blood flow (FBF). Phosphorus (β = -0.454; P = 0.0001), estimated-glomerular filtration rate (e-GFR, by CKD-EPI formula) (β = 0.261; P = 0.0001), gender (β = 0.215; P = 0.0001), BMI (β = -0.086; P = 0.018), HDL-cholesterol (β = 0.077; P = 0.036) were significantly related to endothelium-dependent vasodilation. In an additional analysis including serum high sensitivity C-reactive protein (hs-CRP) (measured in 400 patients) in the same model, the link between serum phosphorus and ACh-stimulated FBF did not change (β = -0.422; P = 0.0001). Clinically relevant, 0.1 mg of phosphorus increase is associated with a reduction of 22% of ACh-stimulated FBF. On multiple logistic regression analysis, the risk of endothelial dysfunction was about twice higher in patients in the second (OR = 1.754, 95% CI = 1.055-2.915; P = 0.030) and three-fold higher in the third tertile (OR = 2.939, 95% CI = 1.598-5.408; P = 0.0001) in comparison with those in the first tertile of phosphorus.



An impaired ACh-stimulated FBF is associated with serum phosphorus levels, within the normal range, in hypertensives.
Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Italy.
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Perticone
Azienda Ospedaliera Mater Domini, Catanzaro, Italy.
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Maio
Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
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Sciacqua
Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
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Cimellaro
Department of Health Sciences, University Magna Græcia of Catanzaro, Italy.
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Andreucci
CNR-IBIM, National Research Council-Institute of Biomedicine, Reggio Calabria, Italy.
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Tripepi
CNR-IBIM, National Research Council-Institute of Biomedicine, Reggio Calabria, Italy.
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Zoccali
Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
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Sesti
Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy. Electronic address: perticone@unicz.it.
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Perticone
D000109:Acetylcholine / Q000008:administration & dosage; D000328:Adult; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology*; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010758:Phosphorus / Q000097:blood*; D010991:Plethysmography; D011237:Predictive Value of Tests; D012307:Risk Factors; D014664:Vasodilation / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage
D015415:Biomarkers; D014665:Vasodilator Agents; D010758:Phosphorus; D000109:Acetylcholine
Atherosclerosis; Cardiovascular risk factors; Endothelium; Essential hypertension; Phosphorus