Impaired endothelial function in hypertensive elderly patients evaluated by high resolution ultrasonography

BACKGROUND: Multiple investigations both in experimental models and in midd le aged patients with essential hypertension have demonstrated impaired end othelium-dependent vasodilation. OBJECTIVE: To determine whether hypertension exerts an additional negative effect on endothelial function of large arteries in hypertensive elderly pa tients who may already be affected by en dothelial dysfunction due to aging . PATIENTS AND METHODS: Thirteen elderly patients with hypertension (69+/-9 y ears of age [mean +/- SD]) were compared with 13 matched healthy elderly su bjects (72+/-6 years of age). High resolution vascular ultrasound was used to measure brachial artery responses to reactive hyperemia (with increased flow causing endothelium-dependent dilation) and to sublingual nitroglyceri ne (causing endothelium-independent dilation). RESULTS: Flow-mediated diameter (FMD) was significantly impaired in the hyp ertensive elderly group (6.7+/-3.3% versus 13.3+/-3.8% in the control group , P<0.05). No significant difference could be found in nitroglycerine-induc ed dilation between the elderly control group (12.1+/-4.9%) and the hyperte nsive elderly (10.2+/-6.8%). On simple linear analysis, FMD was inversely c orrelated with age (r=-0.60, P=0.03) in the healthy elderly group. FMD in t he hypertensive elderly was inversely related to age (r=-0.41, P=0.04) and mean blood pressure (r=-0.61, P=0.01). CONCLUSIONS: This study showed decreased FMD with aging even in the healthy elderly, with a further decline in hypertensive elderly compared with heal thy elderly subjects. This impairment of FMD in the hypertensive elderly gr oup was related to age and mean blood pressure, indicating that aging and h ypertension may impair endothelial function in the brachial artery of elder ly patients with hypertension.