RELATION OF ENDOTHELIUM, THROMBOGENESIS, AND HEMORHEOLOGY IN SYSTEMICHYPERTENSION TO ETHNICITY AND LEFT-VENTRICULAR HYPERTROPHY

Although the arterial tree is exposed to increased pressure in hyperte nsive patients, paradoxically, the complications of hypertension (hear t attacks, stroke) are mainly thrombotic rather than hemorrhagic. Pati ents with left ventricular (LV) hypertrophy are at high risk of the co mplications of hypertension. We performed a cross-sectional study of 1 78 patients attending a hypertension clinic in a city center teaching hospital, and measured plasma levels of the soluble adhesion molecule P-selectin (associated with platelet activity/function and atheroscler osis), the von Willebrand factor (vWf; a marker of endothelial dysfunc tion), fibrin D-dimer (an index of thrombogenesis), plasminogen activa tor inhibitor (PAI, an index of fibrinolysis), lipoprotein(a) (Lp(a), associated with thrombogenesis and atherogenesis) and hemorheological indexes (fibrinogen, hematocrit, plasma viscosity, hemoglobin) in pati ents with essential hypertension, in whom the LV mass and LV mass inde x were determined using echocardiography. The 178 patients (86 men, me an age 54 +/- 15 years) were compared with 47 normotensive healthy con trols (aged 56 +/- 20 years). Hypertensive patients had higher P-selec tin, PAI, vWf, fibrin D-dimer, Lp(a), plasma fibrinogen, and plasma vi scosity when compared with controls. Black hypertensive patients had h igher Lp(a) levels and LV septal and posterior wall thickness on echoc ardiography, but lower plasma PAI levels. Patients with LV hypertrophy (defined as a LV mass index >134 g/m(2) in men or >110 g/m(2) in wome n) had higher plasma fibrinogen compared with those without LV hypertr ophy. Systolic blood pressures were significantly correlated to age, p lasma viscosity, plasma fibrinogen, and vWf. Diastolic blood pressures were significantly correlated with age and plasma fibrinogen. Fibrino gen levels were correlated with LV mass, LV mass index, left atrial si ze, plasma viscosity, and vWf. Fibrin D-dimer levels were significantl y correlated with vWf and fibrinogen levels. Thus, hypertensive patien ts have high plasma fibrinogen levels, thrombogenesis, and impaired fi brinolysis (as indicated by high D-dimer and PAI levels, respectively) , platelet activation (raised soluble P-selectin), and endothelial dys function (high vWF). The high plasma fibrinogen levels were related to blood pressures, LV mass index (and LV hypertrophy), and left atrial size. These abnormalities in hemorheologic factors and markers of thro mbogenesis and endothelial function may act synergistically to increas e the risk of thrombogenesis and atherosclerosis in hypertensive patie nts. (C) 1997 by Excerpta Medica, Inc.