Impaired microvascular dilatation and capillary rarefaction in young adults with a predisposition to high blood pressure.

Noon, Joseph P.; Walker, Brian R.; Webb, David J.; Shore, Angela C.; Holton, David; Edwards, Hugh V.; Watt, Graham

doi:10.1172/jci119354

Cited by 299 publications

(208 citation statements)

References 37 publications

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“…Some authors consider this rarefaction a form of autoregulation, reflecting the long-term adaptation of microcirculation to the elevated blood pressure or the initial increase of blood flow. 11 Our study also agreed with the results of Noon et al, 12 who found that people with high blood pressure whose parents also had high blood pressure had fewer capillaries on the dorsum of their fingers, suggesting that defective angiogenesis may be an etiological component in the inheritance of high blood pressure. 12 Also, Draaijer et al 13 found that sodium-resistant borderline hypertensives had a possible structural reduction in nailfold skin capillary density when compared with both sodium-sensitive and control subjects.…”

Section: Discussionsupporting

confidence: 91%

Rarefaction of Skin Capillaries in Borderline Essential Hypertension Suggests an Early Structural Abnormality

et al. 1999

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Abstract-We recently showed that rarefaction of skin capillaries in the dorsum of the fingers of patients with essential hypertension is due to the structural (anatomic) absence of capillaries rather than functional nonperfusion. It is not known whether this rarefaction is primary (ie, antedates the onset of hypertension) or secondary (ie, as a consequence of sustained and prolonged elevation of blood pressure [BP]). The aim of the present investigation was to study skin capillary density in a group of patients with mild borderline hypertension to assess whether rarefaction antedates the onset of sustained elevation of BP. The study group included 18 patients with mild borderline hypertension (mean supine BP, 136/83 mm Hg), 32 normotensive controls (mean BP, 126/77 mm Hg), and 45 patients with established essential hypertension (mean BP, 156/98 mm Hg). The skin of the dorsum of the fingers was examined by intravital capillary videomicroscopy before and after venous congestion at 60 mm Hg for 2 minutes. Patients with borderline essential hypertension had the lowest resting capillary density when compared with normotensive controls and patients with established hypertension. Maximal capillary density with venous congestion in the borderline group remained the lowest. The study confirmed that patients with borderline essential hypertension have skin capillary densities that are equally low as or even lower than patients with established hypertension. Both groups had significantly lower capillary densities than normal controls. One explanation for the results is that capillary rarefaction may be due to an early structural abnormality in essential hypertension. (Hypertension. 1999;34:655-658.)

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Section: Discussionsupporting

confidence: 91%

Rarefaction of Skin Capillaries in Borderline Essential Hypertension Suggests an Early Structural Abnormality

et al. 1999

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“…We and others have hypothesized that microvascular abnormalities may not only be a consequence of hypertension, but may in fact precede -and contribute to -the elevation of blood pressure, hence creating a vicious circle (6,23). Indeed, structural and functional microvascular abnormalities have been reported in normotensive subjects at risk for hypertension (14,(24)(25)(26). Our understanding of the role of obesity-associated microvascular abnormalities in the development of hypertension has been enhanced by studies in the spontaneously hypertensive rat.…”

Section: Discussionmentioning

confidence: 99%

Insulin's microvascular vasodilatory effects are inversely related to peripheral vascular resistance in overweight, but insulin‐sensitive subjects

Hornstra

Serné

Eringa

et al. 2013

Obesity

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Objective: The mechanisms underlying obesity-related hypertension are incompletely understood. Microvascular dysfunction might play a role by increasing peripheral vascular resistance (PVR). Metabolic and microvascular effects of insulin are impaired in obesity, but how these impairments contribute to disturbed blood pressure homeostasis is unclear. Specifically, it is unknown whether local microvascular vasoactive effects of insulin play a role in determining systemic vascular resistance. The aim of this study was to investigate the association between PVR and local microvascular effects of insulin. Design and Methods: Thirty-seven healthy, overweight subjects (age 25-55 years, BMI 25-30 kg/m 2 ) were cross-sectionally studied. Local insulin-mediated vasodilation was measured using skin laser Doppler fluxmetry combined with transcutaneous iontophoresis of insulin. For comparison, local vasodilatory effects of acetylcholine and sodium nitroprusside were measured. PVR was calculated from mean arterial pressure and cardiac output, assessed by pulse-dye densitometry. Results: PVR was inversely correlated with insulin-mediated vasodilation (r ¼ À0.50; P < 0.01). This finding was maintained after adjustment for age, sex, blood pressure, and smoking. PVR was not associated with local microvascular effects of acetylcholine. Conclusions: Our study in overweight subjects suggests that insulin's role in the microvasculature may contribute to blood pressure control.

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“…Microvascular dysfunction has already been described in OB, 22 first-degree relatives of diabetic 23 and hypertensive patients, 24 polycystic ovary syndrome 25 and type 2 diabetes mellitus 17 using different methods. Our data confirmed that OW/obese, sedentary, non-smoking and normoglycemic …”

Section: Discussionmentioning

confidence: 99%

Microvascular dysfunction: a direct link among BMI, waist circumference and glucose homeostasis in young overweight/obese normoglycemic women?

2009

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Objective: Capillary recruitment is impaired in obesity (OB), possibly worsening glucose and insulin availability to target organs. In this study, we investigated whether functional microvascular parameters were correlated with clinical-anthropometrical data and whether these parameters would influence OB-related metabolic disorders, especially glucose homeostasis, in young overweight (OW)/obese women. Design: Cross-sectional clinical study of microvascular reactivity in young OW/obese women. Subjects and methods: A total of 10 lean (23.1 ± 3.2 years, body mass index (BMI) 22.3 ± 1.6 kg m À2 ) and 42 OW/obese (24.9±3.5 years; BMI 34.5±5.7 (25.7-46.5) kg m À2 ) sedentary non-smoking women were evaluated. Lipid profile, fasting plasma glucose (PG), post-load PG (75 g-2 h), insulin, C-reactive protein, HOMA-IR (homeostasis model assessment for insulin resistance) index and anthropometric variables (weight, BMI, waist and hip circumferences, waist-to-hip ratio and blood pressure (BP)) were determined. Functional microvascular parameters (functional capillary density, red blood cell velocity at baseline and peak (RBCV max ), and time taken to reach RBCV max (TRBCV max ) during post-occlusive reactive hyperemia after 1 min arterial occlusion) were evaluated by nailfold videocapillaroscopy. Results: The time taken to reach RBCV max was significantly longer in OW/obese patients compared with control subjects (8.6±2.4 versus 5.7±1.1 s, Po0.001), and its delay was directly associated with adiposity levels, systolic BP and insulin resistance, and inversely related to high-density lipoprotein-cholesterol. Post-load PG could be correlated with TRBCV max (R ¼ 0.48, Po0.05) and RBCV max (R ¼ À0.29, Po0.05), and it was influenced by weight, waist circumference and TRBCV max (adjusted R 2 ¼ 24%) as well. Conclusions: In the investigated group of young OW/obese women, the direct correlation between post-load PG and TRBCV max links microvascular parameters with metabolic variables and suggests a key role for microcirculation in OB-related metabolic disorders.

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Impaired microvascular dilatation and capillary rarefaction in young adults with a predisposition to high blood pressure.

Cited by 299 publications

References 37 publications

Rarefaction of Skin Capillaries in Borderline Essential Hypertension Suggests an Early Structural Abnormality

Rarefaction of Skin Capillaries in Borderline Essential Hypertension Suggests an Early Structural Abnormality

Insulin's microvascular vasodilatory effects are inversely related to peripheral vascular resistance in overweight, but insulin‐sensitive subjects

Microvascular dysfunction: a direct link among BMI, waist circumference and glucose homeostasis in young overweight/obese normoglycemic women?

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