ENDOTHELIUM – A TARGET ORGAN OF THERAPEUTIC EFFECT IN WOMEN WITH ARTERIAL HYPERTENSION AND ESTROGEN DEFICIENCY
https://doi.org/10.17802/2306-1278-2015-3-61-67
Abstract
Purpose. To study the endothelial function in the onset of arterial hypertension (AH) in perimenopausal women and to evaluate the possibility of the influence of antihypertensive therapy on endothelial dysfunction.
Materials and methods. The study included 81 patients with essential hypertension (EH) I–II stage of 1–2 degrees and 23 healthy perimenopausal women. The level of estradiol and follicle stimulating hormone (FSH) were analyzed. Endothelial function was assessed by endothelium-dependent (EDVD), endothelium-independent (ENVD) vasodilation of the brachial artery and laboratory markers.
Results. Regardless of the AH stage and degree 50 % of patients had endothelial dysfunction by EDVD / ENVD and vasoconstriction endothelial markers (endothelin-1 (ET-1), asymmetric dimethylarginine (ADMA)) were increased. 12 weeks of treatment showed a statically significant reduction (p<0,05) in the concentration of ET-1 and ADMA, and increasing NO production (p<0,05) in all patients with hypertension.
Conclusion. Perimenopausal women with EH regardless of the stage and degree blood pressure had a violation of EDVD/ ENVD and a change of endothelial markers. Monotherapy blockers of the renin-angiotensin-aldosterone system (RAAS) showed blood pressure normalisation and endothelial function improvement in most women with AH stage I-II and 1 degree, with 2 degree required a combination therapy with the addition of bisoprolol and low doses of hydrochlorothiazide to RAAS.
About the Authors
R. I. Stryuk
Moscow State University of Medicine and Dentistry named after A. I. Evdokimov
Russian Federation
Moscow
Russian Federation
Moscow
I. S. Gomova
Moscow State University of Medicine and Dentistry named after A. I. Evdokimov
Russian Federation
Moscow
Russian Federation
Moscow
Ya. V. Brytkova
Moscow State University of Medicine and Dentistry named after A. I. Evdokimov
Russian Federation
Moscow
Russian Federation
Moscow
O. V. Tatarinova
Moscow State University of Medicine and Dentistry named after A. I. Evdokimov
Russian Federation
Moscow
Russian Federation
Moscow
References
1. Kearney P. M., Whelton M., Reynolds K., Muntner P., Whelton P. K. Global burden of hypertension: analysis of worldwide data. Lancet. 2005; 365: 217–223.
2. Mosca L., Appel L. J., Benjamin E. J., Berra K., ChandraStrobos N., Fabunmi R. P. et al. American Heart Association. AHA Scientific Statement. Evidence-based guidelines for cardiovascular disease prevention in women. Circulation. 2004; 109: 672–693. doi: 10.1161/01.CIR.0000114834.85476.81.
3. Мычка В. Б. // Женское сердце. Москва: Новости; 2012; 190 с. Mychka V. B. // Zhenskoe serdce. Moscow: Novosti; 2012. [In Russ].
4. Чазова И. Е., Сметник В. П., Балан В. Е., Зайдиева Я. З., Майчук Е. Ю., Мычка В. Б. и др. Ведение женщин с сердечно-сосудистым риском в пери- и постменопаузе: консенсус российских кардиологов и гинекологов. Consillium Medicum. 2008; 6 (10): 5–16. Chazova I. E., Smetnik V. P., Balan V. E., Zajdieva Ja. Z., Majchuk E. Ju., Mychka V. B. i dr. Vedenie zhenshhin s serdechno-sosudistym riskom v peri- i postmenopauze: konsensus rossijskih kardiologov i ginekologov. Consillium Medicum. 2008; 6 (10): 5–16. [In Russ].
5. Бувальцев В. И. Дисфункция эндотелия как новая концепция профилактики и лечения сердечно-сосудистых заболеваний. Международный медицинский журнал. 2002; 10: 202–208. Buval′cev V. I. Disfunkcija jendotelija kak novaja koncepcija profilaktiki i lechenija serdechno-sosudistyh zabolevanij. Mezhdunarodnyj medicinskij zhurnal. 2002; 10: 202–208. [In Russ].
6. Qin Y. Q., Chen A. H., Tang X. M. Echo-tracking technology for evaluating the impact of blood pressure on vascular endothelial function. Nan Fang Yi Ke Da Xue Xue Bao. 2012; 32 (3): 396–399.
7. Wildman R. P., Colvin A. B., Powell L. H., Matthews K. A., Everson-Rose S. A., Hollenberg S. et al. Associations of endogenous sex hormones with the vasculature in menopausal women: the Study of Women′s Health Across the Nation (SWAN). Menopause. 2008 May-Jun; 15 (3): 414–421.
8. Deanfield J. E., Halcox J. P., Rabelink T. J. Endothelial function and dysfunction: testing and clinical relevance. Circulation. 2007; 10 (115): 1285–1295.
9. Landmesser U., Drexler H. Endothelial function and hypertension. Current Opinion in Cardiology. 2007; 4 (22): 316–320.
10. Xu J., Zou M. H. Molecular insights and therapeutic targets for diabetic endothelial dysfunction. Circulation. 2009; 13 (120): 1266–1286.
11. Moreau Р., d’Uscio L. V., Shaw S., Takase H., Barton M., Lüscher T. F. Angiotensin II increases tissue endothelin and induces vascular hypertrophy. Circulation. 1997; 96: 1593–1597. doi:10.1161/01.CIR.96.5.1593.
12. Best P. J., Berger P. B., Miller V. M., Lerman A. The effect of estrogen replacement therapy on plasma nitric oxide and endothelin-1 levels in postmenopausal women. Ann. Intern. Med. 1998; 128: 285–288.
13. Anwaar I., Rendell M., Gottsater A., Lindgarde F., Hulthen U. L., Mattiasson I. Hormone replacement therapy in healthy postmenopausal women. Effects on intraplatelet cyclic guanosine monophosphate, plasma endothelin-1 and neopterin. J. Intern. Med. 2000; 247: 463–470.
14. Ylikorkala O., Orpana A., Puolakka J., Pyorala T., Viinikka L. Postmenopausal hormonal replacement decreases plasma levels of endothelin-1. J. Clin. Endocrinol. Metab. 1995; 80: 3384–3387.
15. Wynne F. L., Khalil R. A. Testosterone and coronary vascular tone: implications in coronary artery disease. J. Endocrinol. Invest. 2003; 26: 181–186.
16. Wilbert-Lampen U., Seliger C., Trapp A., Straube F., Plasse A. Female sex hormones decrease constitutive endothelin-1 release via endothelial sigma-1/cocaine receptors: an action independent of the steroid hormone receptors. Endothelium. 2005; 12: 185–191.
17. Perticone F., Ceravolo R., Pujia A., Ventura G., Iacopino S., Scozzafava A. et al. Prognostic significance of endothelial dysfunction in hypertensive patients. Circulation. 2001; 104: 191–196. doi:10.1161/01.CIR.104.2.181.
18. Quyyumi A. A. Endothelial function in health and disease: new insights into the genesis of cardiovascular disease. Am. J. Med. 1998; 105: 32–39.
19. Perticone F., Sciacqua A., Maio R., Perticone M., Maas R., Boger R. H. et al. Asymmetric dimethylarginine, L-arginine, and endothelial dysfunction in essential hypertension. J. Am. Coll. Cardiol. 2005; 46 (3): 518–523.
20. Boger R. H., Lenzen Н., Hanefeld С., Bartling A., Osterziel K. J., Kusus M. et al. Asymmetric dimethylarginine and the risk of coronary heart disease: relationship with traditional risk factors as assessed in the multicenter CARDIAC study. J. Am. Coll. Cardiol. 2004; 43 (5s2): A515–A515. doi: 10.1016/S0735-1097(04)92181-X.
21. Boger R. H. Asymmetric dimethylarginine (ADMA) modulates endothelial function – therapeutic implications. Vasc. Med. 2003; 8: 149–151.
22. Родионов Р. Н., Блохин И. О., Галагудза М. М., Шляхто Е. В., Лентц С. Р. Асимметричный диметиларгинин и его роль в этиологии и патогенезе сердечно-сосудистых заболеваний. Артериальная гипертензия. 2008; 14 (8): 306–314.
23. Rodionov R. N., Blohin I. O., Galagudza M. M., Shljahto E. V., Lentc S. R. Asimmetrichnyj dimetilarginin i ego rol′ v jetiologii i patogeneze serdechno-sosudistyh zabolevanij. Arterial′naja gipertenzija. 2008; 14 (8): 306–314. [In Russ].
24. Inaba Y., Chen J. A., Bergmann S. R. Prediction of future cardiovascular outcomes by flow-mediated vasodilatation of brachial artery: a meta-analysis. Int. J. Cardiovasc. 2010; 26 (6): 631–640. doi: 10.1007/s10554-010-9616-1.
25. Flow-mediated dilation and cardiovascular risk prediction: A systematic review with meta-analysis Rouyanne T. Ras Martinette T. Streppel, Richard Draijer, Peter L. Zock international Journal of Cardiology. 2013; 168 (1): 344–351.
26. Крамарева В. Н., Луговской Э. В. Показатели свертывающей системы крови и противотромботические механизмы у больных эссенциальной артериальной гипертензией. Украiнський медичний часопис. 2010; 3: 104–106. Kramareva V. N., Lugovskoj Je. V. Pokazateli svertyvajushhej sistemy krovi i protivotromboticheskie mehanizmy u bol′nyh jessencial′noj arterial′noj gipertenziej. Ukrаins′kij Medichnij Chasopis. 2010; 3: 104–106. [In Russ].
27. Резяпова Н. Х. Фактор Виллебранда и его значение в развитии дисфункции эндотелия у больных артериальной гипертонией. Аспирантский вестник Поволжья. 2010; № 3–4: 71–74. Rezjapova N. H. Faktor Villebranda i ego znachenie v razvitii disfunkcii jendotelija u bol′nyh arterial′noj gipertoniej. Aspirantskij vestnik Povolzh′ja. 2010; № 3–4: 71–74. [In Russ].
28. Hlubocká Z., Umnerová V., Heller S., Peleska J., Jindra A., Jáchymová M. et al. Circulating intercellular cell adhesion molecule-1, endothelin-1 and von Willebrand factormarkers of endothelial dysfunction in uncomplicated essential hypertension: the effect of treatment with ACE inhibitors. Journal of human hypertension. 2002; 8 (16): 557–562.
29. Yavuz D., Koç M., Toprak A., Akpιnar I., Velioğlu A., Deyneli O. et al. Effects of ACE inhibition and AT1-receptor antagonism on endothelial function and insulin sensitivity in essential hypertensive patients. Journal of the Renin-Angiotensin-Aldosterone System. 2003; 3 (4): 197–203. doi:10.3317/jraas.2003.032.
30. Ghiadoni L., Versari D., Magagna A., Kardasz I., Plantinga Y., Giannarelli C. et al. Ramipril dose-dependently increases nitric oxide availability in the radial artery of essential hypertension patients. Journal of Hypertension. 2007; 2 (25): 361–366. doi: 10.1097/HJH.0b013e3280115901.
31. Koh K. K., Han S. H., Chung W. J., Ahn J. Y., Jin D. K., Kim H. S. et al. Comparison of effects of Losartan, Irbesartan, and Candesartan on flow-mediated brachial artery dilation and on inflammatory and thrombolytic markers in patients with systemic hypertension. American Journal of Cardiology. 2004; 11 (93): 1432–1435. doi: http://dx.doi.org/10.1016/j.amjcard.2004.02.050.
32. Ghiadoni L., Magagna A., Versari D., Kardasz I., Huang Y., Taddei S. et al. Different effect of antihypertensive drugs on conduit artery endothelial function. Hypertension. 2003; 6 (41): 1281–1286. doi:10.1161/01.HYP. 0000070956. 57418.22.
Review
For citations:
Stryuk R.I., Gomova I.S., Brytkova Ya.V., Tatarinova O.V. ENDOTHELIUM – A TARGET ORGAN OF THERAPEUTIC EFFECT IN WOMEN WITH ARTERIAL HYPERTENSION AND ESTROGEN DEFICIENCY. Complex Issues of Cardiovascular Diseases. 2015;(3):61-67. (In Russ.) https://doi.org/10.17802/2306-1278-2015-3-61-67
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