Internal and Emergency Medicine

, Volume 8, Issue 3, pp 211–219

Heart rate affects endothelial function in essential hypertension

  • Raffaele Maio
  • Sofia Miceli
  • Angela Sciacqua
  • Giulia Galiano Leone
  • Rosamaria Bruni
  • Paola Naccarato
  • Francesco Martino
  • Giorgio Sesti
  • Francesco Perticone
IM - ORIGINAL

DOI: 10.1007/s11739-011-0618-3

Cite this article as:
Maio, R., Miceli, S., Sciacqua, A. et al. Intern Emerg Med (2013) 8: 211. doi:10.1007/s11739-011-0618-3

Abstract

Increased heart rate (HR) is a risk factor for cardiovascular morbidity and mortality in the general population and in some clinical conditions. Endothelial dysfunction is an adverse prognostic factor for cardiovascular events. The aim of the study was to evaluate the effect of HR on central hemodynamic parameters and endothelial function in hypertension. We evaluated forearm blood flow (FBF) response to intra-arterial infusion of acetylcholine (ACh) and sodium nitroprusside (SNP) in 30 patients with HR ≤60 min−1 and 30 with HR ≥80 min−1. The FBF was measured by strain-gauge plethysmography. Transesophageal atrial pacing was used to increase the HR. Radial artery applanation tonometry and pulse wave analysis were used to derive central aortic pressures and correlate hemodynamic indices. The FBF response to ACh is lower in hypertensives with HR ≤60 min−1 than in those with HR ≥80 min−1 (10.6 ± 4.2 vs. 13.6 ± 5.1 ml × 100 ml−1 of tissue × min−1, P < 0.001). Vascular resistance decreases to 9.3 ± 2.8 U in patients with lower HR versus 7.2 ± 2.1 U in those with higher HR (P = 0.002). The FBF response to SNP is similar in both groups. Central systolic and pulse pressure are higher in bradycardic patients than in those with HR ≥80 min−1 (140 ± 8 vs. 131 ± 8 mmHg, P = 0.0001 and 49 ± 10 vs. 39 ± 11 mmHg, P = 0.0001). All central hemodynamic parameters decrease during incremental atrial pacing. Augmentation index is the strongest predictor of endothelial dysfunction at multivariate analysis. These findings demonstrate that low HR affects endothelium-dependent vasodilation in hypertension. Increased central aortic pressure and hemodynamic correlates seem to be the underlying mechanisms by which bradycardia interferes with endothelium-dependent reactivity.

Keywords

Endothelium Hypertension Heart rate Atrial pacing Cardiovascular events 

Copyright information

© SIMI 2011

Authors and Affiliations

  • Raffaele Maio
    • 1
  • Sofia Miceli
    • 1
  • Angela Sciacqua
    • 1
  • Giulia Galiano Leone
    • 1
  • Rosamaria Bruni
    • 1
  • Paola Naccarato
    • 1
  • Francesco Martino
    • 2
  • Giorgio Sesti
    • 1
  • Francesco Perticone
    • 1
    • 3
  1. 1.Department of Experimental and Clinical Medicine “G. Salvatore”University Magna Græcia of CatanzaroCatanzaroItaly
  2. 2.Department of Pediatrics, Center of Clinic Lipid ResearchUniversity La Sapienza of RomeRomeItaly
  3. 3.Department of Medicina Sperimentale e ClinicaCampus Universitario di GermanetoCatanzaroItaly

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