Abstract
Hypertension, one of the most important risk factors for cardiovascular diseases, is associated with both left ventricular hypertrophy and endothelial dysfunction. Both have been recently recognized as independent predictors of clinical events in different groups of patients. In fact, a dysfunctioning endothelium loses its antiatherosclerotic and antithrombotic action, and, therefore, promotes the atherosclerotic process. Similarly, cardiac hypertrophy is recognized as a powerful and independent risk factor for cardiovascular morbidity and mortality because it predisposes to arrhythmias and maximizes the consequences of acute myocardial ischemia. Recently, an evident interaction has been demonstrated between endothelial dysfunction and left ventricular mass. In particular, the coexistence of both left ventricular hypertrophy and endothelial dysfunction almost doubles the risk for future vascular events in hypertensives. Thus, in hypertensive patients, it is clinically useful to choose an aggressive therapeutic strategy—to reduce left ventricular mass and to improve endothelial function.
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References and Recommended Reading
McMahon S, Peto R, Cutler J, et al.: Blood pressure, stroke, and coronary heart disease. Part 1. Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990, 335:765–774.
Casale PN, Devereux RB, Millner N, et al.: Value of echocardiographic measurement of left ventricular mass in predicting cardiovascular morbid events in hypertensive men. Ann Intern Med 1986, 105:173–178.
Koren MJ, Devereux RB, Casale PN, et al.: Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med 1991, 114:345–352.
Panza JA, Quyyumi AA, Brush JE, Epstein SE: Abnormal endothelium-dependent vascular relaxation in patients with essential hypertension. N Engl J Med 1990, 323:22–27.
Vane JR, Auggard EE, Botting RM: Regulatory functions of the vascular endothelium. N Engl J Med 1990, 323:27–36.
Ross R: Atherosclerosis: an inflammatory disease. N Engl J Med 1999, 340:115–126.
Palmer RMJ, Ferrige AG, Moncada S: Nitric oxide release accounts for the biological activity of endotheliumderived relaxing factor. Nature 1987, 327:524–526.
Furchgott RF, Zawadzki JV: The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature 1980, 288:373–376.
Lüscher TF, Vanhoutte PM: The Endothelium: Modulator of Cardiovascular Function. Boca Raton, FL: CRC Press; 1990.
MacAllister RJ, Fickling SA, Whitley GS, Vallance P: Metabolism of methylarginines by human vasculature: implications for the regulation of nitric oxide synthesis. Br J Pharmacol 1994, 112:43–48.
Vallance P, Leone A, Calver A, et al.: Accumulation of an endogenous inhibitor of nitric oxide synthesis in chronic renal failure. Lancet 1992, 339:572–575.
Cooke JP, Dzan VJ: Derangements of the nitric oxide synthase pathway, L-arginine, and cardiovascular diseases. Circulation 1997, 96:379–382.
Perticone F, Sciacqua A, Maio R, et al.: Asymmetric dimethylarginine, L-Arginine, and endothelial dysfunction in essential hypertension. J Am Coll Cardiol 2005, 46:518–523.
Treasure CB, Klein JL, Weintraub WS, et al.: Beneficial effects of cholesterol-lowering therapy on the coronary endothelium in patients wit coronary artery disease. N Engl J Med 1995, 332:481–487.
Schächinger V, Britten MB, Zeiher AM: Prognostic impact of coronary vasodilator dysfunction on adverse longterm outcome of coronary heart disease. Circulation 2000, 101:1899–1906.
Perticone F, Ceravolo R, Pujia A, et al.: Prognostic significance of endothelial dysfunction in hypertensive patients. Circulation 2001, 104:191–196. Forearm endothelial dysfunction predicts long-term atherosclerotic disease progression and cardiovascular event rates in hypertensive patients.
Lerman A, Zeiher AM: Endothelial function and cardiac events. Circulation 2005, 111:363–368.
Levy D, Garrison RJ, Savage DD, Simon AC: Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990, 322:1561–1566.
Verdecchia P, Porcellati C, Schillaci G, et al.: Ambulatory blood pressure: an independent predictor of prognosis in essential hypertension. Hypertension 1994, 24:793–801.
Hammond IW, Devereux RB, Alderman MH, et al.: The prevalence and correlates of echocardiographic left ventricular hypertrophy among employed patients with uncomplicated hypertension. J Am Coll Cardiol 1986, 7:639–650.
Abergel E, Tase M, Bohlender J, et al.: Which definition for echocardiographic left ventricular hypertrophy? Am J Cardiol 1995, 75:498–502.
Girerd X, Laurent S, Pannier B, et al.: Arterial distensibility and left ventricular hypertrophy in patients with sustained essential hypertension. Am Heart J 1991, 22:1210–1214.
Verdecchia P, Schillaci G, Borgioni C, et al.: Prognostic value of left ventricular mass and geometry in systemic hypertension with left ventricular hypertrophy. Am J Cardiol 1996, 78:197–202.
de Simone G, Greco R, Mureddu GF, et al.: Relation of left ventricular diastolic properties to systolic function in arterial hypertension. Circulation 2000, 101:152–157.
Ganau A, Devereux RB, Pickering TG, et al.: Relation of left ventricular hemodynamic load and contractile performance to left ventricular mass in hypertension. Circulation 1990, 81:25–36.
Schmieder RE, Messerli FH, Garavaglia GE, et al.: Dietary salt intake: a determinant of cardiac involvement in essential hypertension. Circulation 1988, 78:951–956.
Perticone F, Ceravolo R, Cosco C, et al.: Deletion polymorphism of angiotensin-converting enzyme gene and left ventricular hypertrophy in southern Italian patients. J Am Coll Cardiol 1997, 29:365–369.
Reaven GM, Lithell H, Landsberg L: Hypertension and associated metabolic abnormalities. The role of insulin resistance and the sympathoadrenal system. N Engl J Med 1996, 334:374–381.
Colao A, Marzullo P, Di Somma C, Lombardi G.: Growth hormone and the heart. Clin Endocrinol 2001, 54:137–154.
Ceravolo R, Maio R, Cuda G, et al.: Relation of fasting insulin related to insertion/deletion polymorphism of angiotensin-converting enzyme-gene and cardiac mass in never-treated patients with systemic hypertension. Am J Cardiol 2003, 92:1234–1237.
Schelling P, Fischer H, Ganten D: Angiotensin and cell growth: a link to cardiovascular hypertrophy? J Hypertens 1991, 9:3–15.
Devereux RB, Roman MJ: Hypertensive cardiac hypertrophy: pathophysiologic and clinical characteristics. In Hypertension: Pathophysiology, Diagnosis and Management, edn 2. Edited by Laragh JH, Brenner BM. New York, NY: Raven Press; 1995:409–432.
Dandona P, Aljada A, Chaudhuri A, et al.: Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes, and inflammation. Circulation 2005, 11:1448–1454.
Lorell BH, Carabello BA: Left ventricular hypertrophy: pathogenesis, detection, and prognosis. Circulation 2000, 102:470–479.
Vasan RS, Larson MG, Levy D, et al.: Distribution and categorization of echocardiographic measurements in relation to reference limits: the Framingham Heart Study: formulation of a height- and sex-specific classification and its prospective validation. Circulation 1997, 96:1863–1873.
Messerli FH, Ventura HO, Elizardi DJ, et al.: Hypertension and sudden death: increased ventricular ectopic activity in left ventricular hypertrophy. Am J Med 1984, 77:18–22.
Haider AW, Larson MG, Benjamin EJ, Levy D: Increased left ventricular mass and hypertrophy are associated with increased risk for sudden death. J Am Coll Cardiol 1998, 32:1454–1459.
Schillaci G, Verdecchia P, Porcellati C, et al.: Continuous relation between left ventricular mass and cardiovascular risk in essential hypertension. Hypertension 2000, 35:580–586.
Kannel WB, Gordon T, Castelli WP, Margolis JR: Electrocardiographic left ventricular hypertrophy and risk of coronary artery disease: the Framingham Study. Ann Intern Med 1970, 72:813–822.
Perticone F, Maio R, Ceravolo R, et al.: Relationship between left ventricular mass and endothelium-dependent vasodilation in never-treated hypertensive patient. Circulation 1999, 99:1991–1996.
Silacci P, Desgeorges A, Mazzolai L, et al.: Flow pulsatility is a critical determinant of oxidative stress in endothelial cells. Hypertension 2001, 38:1162–1166.
Miller JA, Lever AF: Implications of pulse pressure as a predictor of cardiac risk in patients with hypertension. Hypertension 2000, 36:907–911.
Ceravolo R, Maio R, Pujia A, et al.: Pulse pressure and endothelial dysfunction in never treated hypertensive patients. J Am Coll Cardiol 2003, 41:1753–1758.
Widlansky ME, Gokce N, Keaney JF Jr, Vita JA: The clinical implications of endothelial dysfunction. J Am Coll Cardiol 2003, 42:1149–1160. The detection of endothelial dysfunction provides important diagnostic and prognostic information in patients who are at risk for vascular disease.
Modena MG, Bonetti L, Coppi F, et al.: Prognostic role of reversible endothelial dysfunction in hypertensive postmenopausal women. J Am Coll Cardiol 2002, 40:505–510.
Schindler TH, Hornig B, Buser PT, et al.: Prognostic value of abnormal vasoreactivity of epicardial coronary arteries to sympathetic stimulation in patients with normal coronary angiograms. Arterioscler Thromb Vasc Biol 2003, 23:495–501.
Sciacqua A, Scozzafava A, Pujia A, et al.: Interaction between vascular dysfunction and cardiac mass increases the risk of cardiovascular outcomes in essential hypertension. Eur Heart J 2005, 26:921–927. Endothelial dysfunction and LVH are independent predictors of cardiovascular events, but their coexistence doubles this risk in hypertensive patients.
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Sciacqua, A., Borrello, F., Vatrano, M. et al. Effect of interaction between left ventricular dysfunction and endothelial function in hypertension. Current Science Inc 8, 212–218 (2006). https://doi.org/10.1007/s11906-006-0053-4
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DOI: https://doi.org/10.1007/s11906-006-0053-4