The structural arteriolar changes in diabetes mellitus and essential hypertension: The relative contribution of ageing and high blood pressure

Longhini, C; Scorzoni, Daniela; Bazzanini, F; D, Manservigi; Fratti, D; Gilli, Giuseppe; Musacci, G. F.

doi:10.1093/oxfordjournals.eurheartj.a015409

Cited by 7 publications

(7 citation statements)

References 25 publications

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“…The findings were similar in type 2D and type 2DϩH, and calculations of growth and remodeling indexes clearly point to the vessels having undergone hypertrophy, a feature noted in previous investigations in diabetes. 1,4 Myogenic tone was assessed across a range of pressures up to 200 mm Hg, and we demonstrated myogenic responses with a rise in intraluminal pressures in vessels from control subjects: Small arteries from patients with EH showed a similar profile, but responses were shifted to higher pressures, reflecting a shift in the autoregulatory response. However, in type 2D and type 2DϩH, myogenic responsiveness was severely impaired across the whole pressure range.…”

Section: Discussionmentioning

confidence: 81%

“…After viability assessment with KPSS, each vessel was stimulated as follows: (1) Ϫ5 mol/L L-N G -monomethylarginine (L-NMMA), an inhibitor of nitric oxide synthase, the response to Ach was repeated as in (2). (4) Cumulative response to endothelial independent nitro donor sodium nitroprusside was performed on a preconstricted vessel (mol/L): 10 Ϫ9 , 3ϫ10 Ϫ9 , 10 Ϫ8 , 3ϫ10 Ϫ8 , 10 Ϫ7 , 3ϫ10 Ϫ7 , 10 Ϫ6 , 3ϫ10 Ϫ6 , and 10 Ϫ5 .…”

Section: Pharmacological Assessment and Passive Structurementioning

confidence: 99%

“…In one study, minimum forearm vascular resistance was found to be increased, suggesting that small-vessel structure was altered. 1 However, studies in type 2D are fraught with difficulty, given the recognized associations with hypertension and dyslipidemia, both of which are known to influence small-artery structure and function. 2,3 Recently, Rizzoni et al 4 reported that small arteries of patients with type 2D have an increased media thickness to lumen diameter ratio compared with vessels from control subjects: This appeared to be due to a combination of remodeling and hypertrophy.…”

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confidence: 99%

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Vascular Structural and Functional Changes in Type 2 Diabetes Mellitus

et al. 2002

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Background-To further investigate vascular morphology and function in type 2 (non-insulin-dependent) diabetes mellitus (type 2D), small arteries were examined in vitro from carefully defined cohorts of patients with or without concomitant hypertension and the results compared with those from selected normotensive nondiabetic control subjects and a group of untreated patients with essential hypertension (EH). Methods and Results-Blood vessels were studied through the use of pressure myography to determine vascular morphology, mechanics, and myogenic responsiveness, together with testing of constrictor and dilator function. Small arteries from patients with EH demonstrated eutrophic inward remodeling and an increased distensibility. Vessels from type 2D patients demonstrated hypertrophy, a further increase in distensibility, and a highly significant loss of myogenic responsiveness compared with patients with EH and control patients. Vasoconstrictor function to norepinephrine was normal in patients with type 2D and type 2DϩH and EH. Endothelium-dependent dilation was normal in patients with EH but abnormal in patients with type 2D and type 2DϩH. There was a significant correlation between dilator impairment and the degree of dyslipidemia recorded in all groups. Conclusions-These results demonstrate vascular hypertrophy in small arteries from patients with type 2D. This could be a consequence of impaired myogenic responsiveness, which will increase wall stress for a given intraluminal pressure, which may be a stimulus for vascular hypertrophy. A substantial proportion of endothelial dysfunction can be attributed to an effect of the abnormal lipid profile seen in such patients. (Circulation. 2002;106:3037-3043.)

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Section: Discussionmentioning

confidence: 81%

Section: Pharmacological Assessment and Passive Structurementioning

confidence: 99%

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confidence: 99%

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Vascular Structural and Functional Changes in Type 2 Diabetes Mellitus

et al. 2002

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“…In contrast, forearm minimal vascular resistance (an indirect index of resistance artery structure) was greater in NIDDM patients than in normotensive (NT) controls. 11 However, no data obtained with direct, reliable techniques are presently available on small artery structure in human NIDDM.…”

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confidence: 99%

Structural Alterations in Subcutaneous Small Arteries of Normotensive and Hypertensive Patients With Non–Insulin-Dependent Diabetes Mellitus

et al. 2001

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Background-It is not presently known whether non-insulin-dependent diabetes mellitus (NIDDM) is associated with the presence of structural alterations in small arteries or whether the combination of hypertension and NIDDM may have an additive effect on endothelial dysfunction. Therefore, we investigated subcutaneous small arteries in 12 normotensive subjects (NT group), 18 patients with essential hypertension (EH group), 13 patients with NIDDM, and 11 patients with NIDDM and EH (NIDDMϩEH group). Methods and Results-Subcutaneous small arteries were evaluated by a micromyographic technique. The internal diameter, the media-to-lumen ratio, remodeling and growth indices, and the collagen-to-elastin ratio were calculated. Concentration-response curves to acetylcholine, bradykinin, the endothelium-independent vasodilator sodium nitroprusside, and endothelin-1 were performed. The media-to-lumen ratio was higher in the EH, NIDDM, and NIDDMϩEH groups compared with the NT group. EH patients showed the presence of eutrophic remodeling, whereas NIDDM and NIDDMϩEH patients showed 40% to 46% cell growth. The collagen-to-elastin ratio was significantly increased in the EH and NIDDMϩEH groups compared with the NT group. The vasodilatation to acetylcholine and bradykinin was similarly reduced in EH, NIDDM, and NIDDMϩEH groups compared with the NT group. The contractile responses to endothelin-1 were similarly reduced in EH, NIDDM, and NIDDMϩEH patients. Conclusions-Our data suggest that the effects of NIDDM and EH on small artery morphology are quantitatively similar but qualitatively different and that the presence of hypertension in diabetic patients has little additive effect on small artery morphology and none on endothelial dysfunction.

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“…These results agree with another study that did not find a correlation between age and vascular resistance in hypertensive and diabetic patients, indicating the involvement of other neurohumoral factors. 30 Although differences in the known duration of hypertension could influence results, these differences are almost unavoidable when diabetic hypertensive subjects treated with antihypertensive agents and untreated hypertensive patients are recruited. Furthermore, small-artery structure was not correlated significantly with duration of hypertension.…”

Section: Discussionmentioning

confidence: 99%

Persistent Remodeling of Resistance Arteries in Type 2 Diabetic Patients on Antihypertensive Treatment

et al. 2004

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Abstract-We hypothesized that resistance arteries from diabetic patients with controlled hypertension have less remodeling than vessels from untreated hypertensive subjects. Eight normotensive subjects (aged 44Ϯ3 years, 3 men; values are meanϮSEM), 19 untreated hypertensive subjects (46Ϯ2 years, 9 men), and 23 hypertensive subjects with type 2 diabetes mellitus under antihypertensive treatment (58Ϯ1 years, 15 men) were studied. Resistance arteries dissected from gluteal subcutaneous tissue were assessed on a pressurized myograph. Most diabetic patients (70%) were being treated with angiotensin-converting enzyme inhibitors. Although systolic blood pressure was still above the normotensive range in these patients (144Ϯ2 versus 150Ϯ3 mm Hg in hypertensive and 114Ϯ4 mm Hg in normotensive subjects), diastolic blood pressure was well controlled (83Ϯ2 mm Hg) and significantly lower compared with that in untreated hypertensives (100Ϯ1 mm Hg; PϽ0.001) but higher than in normotensives (76Ϯ3 mm Hg; PϽ0.05). Thus, pulse pressure was higher in diabetic patients (PϽ0.05). The media-to-lumen ratio of resistance arteries was greater in hypertensives (0.083Ϯ0.002) compared with normotensive controls (0.059Ϯ0.003; PϽ0.05) and was even higher in diabetic hypertensive subjects (0.105Ϯ0.004; PϽ0.001 versus normotensive controls). The medial cross-sectional area was greater in diabetic and hypertensive patients compared with normotensive controls (PϽ0.001). Acetylcholineinduced relaxation was impaired in vessels from hypertensive patients and from patients with both diabetes mellitus and hypertension (PϽ0.05 versus normotensive controls), whereas endothelium-independent vasorelaxation was similar in all groups. Despite effective antihypertensive treatment, resistance arteries from hypertensive diabetic patients showed marked remodeling, greater than that of vessels from untreated, nondiabetic, hypertensive subjects, in agreement with the high cardiovascular risk of subjects suffering from both diabetes and hypertension. Key Words: diabetes mellitus Ⅲ hypertension, detection and control Ⅲ angiotensin-converting enzyme inhibitors Ⅲ remodeling Ⅲ endothelium T ype 2 diabetes mellitus (DM-2) is a major cardiovascular risk factor. In the UKPDS study, the incidence of complications of diabetes was strongly associated with elevated blood pressure (BP). 1 Moreover, tight BP control substantially reduced the risk of macrovascular disease, stroke, and deaths related to diabetes. 2 Macrovessels and microvessels of diabetic patients show marked structural remodeling and impaired endothelial function. In a large, population-based cohort study, DM-2 was associated with increased stiffness of large arteries, as assessed by ultrasound. 3 Other ultrasound studies of large arteries have confirmed the presence of stiffer vessels in patients with DM-2. 4,5 In hypertensive patients, we previously reported that endothelial function of small arteries is correlated with that of large vessels, but ultrasound assessment of large arteries appeared to be less se...

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The structural arteriolar changes in diabetes mellitus and essential hypertension: The relative contribution of ageing and high blood pressure

Cited by 7 publications

References 25 publications

Vascular Structural and Functional Changes in Type 2 Diabetes Mellitus

Vascular Structural and Functional Changes in Type 2 Diabetes Mellitus

Structural Alterations in Subcutaneous Small Arteries of Normotensive and Hypertensive Patients With Non–Insulin-Dependent Diabetes Mellitus

Persistent Remodeling of Resistance Arteries in Type 2 Diabetic Patients on Antihypertensive Treatment

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