Prognostic significance of flow-mediated dilatation of the brachial artery in hypertensive patients; possible role of central blood pressure.

Background The prognostic role of endothelial
dysfunction, as evaluated by flow-mediated vasodilatation
of the brachial artery, has been demonstrated in patients at
very high risk. We aimed to investigate whether flowmediated
vasodilatation predicts cardiovascular events in
uncomplicated hypertensive patients.
Methods and results A total of 172 prospectively identified
uncomplicated hypertensive patients (age 56W8 years,
41% women, 48 with diabetes mellitus type 2) were studied.
At baseline all patients were untreated and underwent
baseline standard laboratory examination. A standard
echocardiogram was performed for the evaluation of left
ventricular anatomy and function and patients with systolic
dysfunction or left ventricular wall motion abnormalities
were excluded. Endothelial function was measured as flowmediated
vasodilatation of the brachial artery using highresolution
ultrasound. Patients were followed for 95W37
months (range 2–136 months). A first nonfatal or fatal
cardiovascular event occurred in 32 patients. The incidence
of cardiovascular events was 1.4 and 3.1 per 100 patientyears
in patients with a flow-mediated vasodilatation below
and above the median value (4.7%), respectively (P<0.005
by the log-rank test). In Cox analysis, controlling for age, sex,
glycemia, cholesterol, smoking, BMI, systolic and diastolic
blood pressure at baseline and left ventricular mass index, a
low flow-mediated vasodilatation conferred an increased
risk of cardiovascular events (odds ratio 2.67, 95%
confidence interval 1.17 to 6.1, PU0.02).
Conclusion The presence of endothelial dysfunction, as
evaluated by flow-mediated vasodilatation of the brachial
artery, identifies hypertensive patients at increased risk of
nonfatal and fatal cardiovascular events.