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Abstract

Hypertensive patients are at high risk of thrombosis and atherosclerosis, which can be reduced by lowering blood pressure. The complications of hypertension and the beneficial effects of blood pressure reduction may be related to endothelial damage and/or abnormal angiogenesis.

136 ‘high-risk’ hypertensives patients (untreated BP>160/100 mmHg or treated BP>140/90 mmHg) were studied. We defined patients as ‘High-risk’ with 3 or more of the following risk factors: age>55, male, smoking, cholesterol >6.5 mmol/l, diabetes mellitus, family history of coronary artery disease, previous ischaemic stroke, peripheral vascular disease, left ventricular hypertrophy on ECG, and Q waves or T inversion on ECG. These hypertensives were randomly assigned to treatment with atenolol ± bendroflumethiazide or amlodipine ± perindopril. At baseline and after 6 months treatment we assessed endothelial damage and angiogenesis by measuring von Willebrand factor (vWF) and vascular endothelial growth factor (VEGF) by ELISA. Baseline levels were compared with 21 healthy normotensive controls. (See Table)

controlsHigh-risk Hypertensives at baselineHigh-risk Hypertensives after 6 months treatment
N21136136
Age [years]57.6 (5.4)59.5 (6.6)
systolic BP [mmHg]131 (17.2)161 (17.1)1)150 (16.9)2)
diastolic BP [mmHg]86 (9.7)91 (10.0)1)85 (9.7)2)
VEGF [ng/ml]50 (18-117)200 (140-410)1)145 (95-400)2)
vWF [IU/ml]95 (19)134 (38)1)128 (33)2)
controlsHigh-risk Hypertensives at baselineHigh-risk Hypertensives after 6 months treatment
N21136136
Age [years]57.6 (5.4)59.5 (6.6)
systolic BP [mmHg]131 (17.2)161 (17.1)1)150 (16.9)2)
diastolic BP [mmHg]86 (9.7)91 (10.0)1)85 (9.7)2)
VEGF [ng/ml]50 (18-117)200 (140-410)1)145 (95-400)2)
vWF [IU/ml]95 (19)134 (38)1)128 (33)2)
controlsHigh-risk Hypertensives at baselineHigh-risk Hypertensives after 6 months treatment
N21136136
Age [years]57.6 (5.4)59.5 (6.6)
systolic BP [mmHg]131 (17.2)161 (17.1)1)150 (16.9)2)
diastolic BP [mmHg]86 (9.7)91 (10.0)1)85 (9.7)2)
VEGF [ng/ml]50 (18-117)200 (140-410)1)145 (95-400)2)
vWF [IU/ml]95 (19)134 (38)1)128 (33)2)
controlsHigh-risk Hypertensives at baselineHigh-risk Hypertensives after 6 months treatment
N21136136
Age [years]57.6 (5.4)59.5 (6.6)
systolic BP [mmHg]131 (17.2)161 (17.1)1)150 (16.9)2)
diastolic BP [mmHg]86 (9.7)91 (10.0)1)85 (9.7)2)
VEGF [ng/ml]50 (18-117)200 (140-410)1)145 (95-400)2)
vWF [IU/ml]95 (19)134 (38)1)128 (33)2)

Values are expressed as mean and (SD), except VEGF as median and IQR. Statistical analysis: paired and unpaired T-Test as appropriate, except for VEGF, Mann-Whitney Test or paired Wilcoxon Test. 1) p<0.05 controls vs. baseline, 2) p<0.05 baseline vs. 6 months treatment.

High-risk hypertensive patients demonstrate abnormal angiogenesis and endothelial damage when compared to controls. Both these abnormalities are beneficially reduced following 6 months of antihypertensive treatment. These findings may be pathophysiologically related to hypertension, its complications and the beneficial effects of blood pressure lowering.

angiogenesis, VEGF, endothelial damage
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© American Journal of Hypertension, Ltd. 2001
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