Journal
AMERICAN JOURNAL OF HYPERTENSION
Volume 25, Issue 1, Pages 46-53Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/ajh.2011.176
Keywords
blood pressure; endothelium; hypertension; intima-media thickness; left ventricular mass; pulse wave velocity; young adults
Categories
Funding
- British Heart Foundation [FS/06/024]
- Oxford BHF Centre for Research Excellence
- NIHR Oxford Biomedical Research Centre
- Oxford Health Services Research Committee
- Medical Research Council
- British Heart Foundation [FS/11/65/28865] Funding Source: researchfish
- Medical Research Council [G0700349] Funding Source: researchfish
- Great Ormond Street Hospital Childrens Charity [V1244] Funding Source: researchfish
- MRC [G0700349] Funding Source: UKRI
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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 fora 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. CONCLUSION 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.
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