AHA/ACC-defined stage 1 hypertensive adults do not display cutaneous microvascular endothelial dysfunction
AHA/ACC-defined stage 1 hypertensive adults do not display cutaneous microvascular endothelial dysfunction
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DOI：
10.1152/ajpheart.00179.2020
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发表时间：
2020-09-01
影响因子：
4.8
通讯作者：
Alexander, Lacy M.
中科院分区：
文献类型：
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作者：
Dillon, Gabrielle A.;Greaney, Jody L.;Alexander, Lacy M.
2017年，美国心脏协会（AHA）和美国心脏病学会（ACC）将1期高血压重新定义为收缩压（BP）130-139 mmHg或舒张压80-89 mmHg;然而，1期高血压成人微血管内皮功能障碍的程度仍然不明确。我们检验了以下假设：与非高血压成年人（NTN：BP = 40 mmHg）相比，1期高血压（HTN 1）成年人存在皮肤微血管内皮功能障碍，并且这种分级损害将由一氧化氮（NO）依赖性扩张的减少介导。该回顾性分析包括20例NTN（5例男性; 45-64岁; BP 94-114/60-70 mmHg），22例HTN 1（11例男性; 40-74岁; BP 110-134/70-88 mmHg）。HTN 2型44例（男性27例，年龄40-74岁，血压128-180/80-110 mmHg）。还使用24小时动态血压监测评估血压和夜间下降状态。在皮内微透析灌注乙酰胆碱（ACh; 10（10）至10（-1）M）单独和同时与非特异性一氧化氮（NO）合酶抑制剂N-G-硝基-t-精氨酸甲酯（t-NAME; 15 mM）期间，测量红细胞流量（激光多普勒血流仪）。与NTN相比，HTN 2的ACh诱导的舒张功能受损（P < 0.01），而HTN 1的ACh诱导的舒张功能未受损（P = 0.85）。此外，NO依赖性扩张在HTN 2中明显减少（P < 0.01），但在HTN 1中不明显（P = 0.76）。无论血压如何，非杓型血压患者的内皮依赖性舒张功能受损（夜间收缩压下降= 10%，P < 0.05）。总之，NO介导的内皮依赖性舒张功能障碍在HTN 1中并不明显。无论BP分类。这是第一项评估高血压成人内皮功能调节机制的研究，根据美国心脏协会（AHA）和美国心脏病学会（ACC）2017年制定的临床指南进行分类。与血压正常的成年人相比，一氧化氮介导的内皮依赖性舒张功能在2期成人中受损。但不是第一阶段高血压缺乏夜间血压下降的成年人表现出内皮依赖性舒张功能的降低。
In 2017, the American Heart Association (AHA) and American College of Cardiology (ACC) redefined stage 1 hypertension to systolic blood pressure (BP) 130-139 mmHg or diastolic BP 80-89 mmHg; however, the degree to which microvascular endothelial dysfunction is evident in adults with stage 1 hypertension remains equivocal. We tested the hypotheses that cutaneous microvascular endothelial dysfunction would be present in adults with stage 1 hypertension (HTN1) compared with nonnotensive adults (NTN: BP = 40 mmHg) and that this graded impairment would be mediated by reductions in nitric oxide (NO)-dependent dilation. This retrospective analysis included 20 NTN (5 men; 45-64 yr; BP 94-114/60-70 mmHg), 22 HTN1 (11 men; 40-74 yr; BP 110-134/70-88 mmHg). and 44 HTN2 (27 men; 40-74 yr; BP 128-180/80-110 mmHg). BP and nocturnal dipping status were also assessed using 24-h ambulatory BP monitoring. Red cell flux (laser Doppler flowmetry) was measured during intradermal microdialysis perfusion of acetylcholine (ACh; 10(10) to 10(-1) M) alone and concurrently with the nonspecific nitric oxide (NO) synthase inhibitor N-G-nitro-t-arginine methyl ester (t-NAME; 15 mM). ACh-induced dilation was impaired in HTN2 (P < 0.01), but not in HTN1 (P = 0.85), compared with NTN. Furthermore, reductions in NO-dependent dilation were evident in HTN2 (P < 0.01) but not in HTN1 (P = 0.76). Regardless of BP, endothelium-dependent dilation was impaired in nondippers (nighttime drop in systolic BP = 10%, P < 0.05). In conclusion, functional impairments in NO-mediated endothelium-dependent dilation were not evident in HTN1. However, regardless of BP classification. the lack of a nocturnal dip in BP was associated with blunted endothelium-dependent dilation.NEW & NOTEWORTHY This is the first study to pharmacologically assess the mechanistic regulation of endothelial function in adults with hypertension, classified according to the 2017 clinical guidelines set for by the American Heart Association (AHA) and American College of Cardiology (ACC). Compared with that in normotensive adults, nitric oxide-mediated endothelium-dependent dilation is impaired in adults with stage 2. but not stage 1, hypertension. Adults lacking a night-time dip in blood pressure demonstrated reductions in endothelium-dependent dilation.