Small artery remodeling is the most prevalent (earliest?) form of target organ damage in mild essential hypertension

Background The heart and blood vessels are exposed to elevated blood pressu re (BP) in hypertensive patients, but their changes in response to BP or no n-hemodynamic stimuli may be different, and occur with different time-cours es. To evaluate this, we studied the prevalence of structural and functiona l alterations of resistance arteries and cardiac hypertrophy in patients wi th mild essential hypertension. Methods Resistance arteries were dissected from gluteal subcutaneous tissue from 38 hypertensive patients (47 +/- 1 years; 71% male; BP 148 +/- 2/99 /- mmHg), studied on a pressurized myograph, and compared to those from 10 normotensives (44 +/- 3 years; 40% male; BP 113 +/- 4/76 +/- 2 mmHg). Results The prevalence of abnormal structure (media-to-lumen ratio, M/L) an d impaired endothelial function (maximal acetylcholine response) was 97 and 58% (abnormal was defined as greater than mean + 1 SD of normotensives), o r 63 and 34% (abnormal defined as greater than mean + 2SD). Thirty four per cent of hypertensive patients exhibited left ventricular hypertrophy by ech ocardiography. When grouped into tertiles according to increasing ambulator y systolic BP (SBP), the highest BP tertile showed increased M/L (P < 0.01) and left ventricular mass index (LVMI, P < 0.05) and marginally decreased endothelial function (P = 0.07). LVMI was greatest in the tertile of patien ts with highest M/L (P < 0.05). Endothelial function was decreased in the t ertile with greatest vascular stiffness (P < 0.01). By multivariate analysi s, M/L correlated with ambulatory SEP (beta = 0.40, P = 0.02), and LVMI cor related with ambulatory SEP (beta = 0.41, P = 0.001) and body mass index (b eta = 0.30, P < 0.05). Female sex influenced endothelial function negativel y (<beta> = -0.63, P < 0.01). Conclusion Structural alterations of resistance arteries were demonstrated in most hypertensive patients, followed by endothelial dysfunction and card iac hypertrophy in a smaller number of hypertensives. Small artery structur al remodeling may precede most clinically relevant manifestations of target organ damage in mild essential hypertension. J Hypertens 19:921-930 (C) 20 01 Lippincott Williams & Wilkins.