Triantafyllou Areti, Anyfanti Panagiota, Triantafyllou Georgios, Zabulis Xenophon, Aslanidis Spyros, Douma Stella
3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
J Am Soc Hypertens. 2016 Aug;10(8):640-6. doi: 10.1016/j.jash.2016.04.007. Epub 2016 May 13.
Capillary rarefaction is typically encountered in essential hypertension, yet identification of factors interfering with this phenomenon remains substantially underinvestigated. We examined whether components of metabolic profile (dyslipidemia, insulin resistance), inflammatory (high-sensitivity C-reactive protein, high-sensitivity C-reactive protein), and angiogenic (vascular endothelial growth factor) factors are implicated in this phenomenon in a population of newly diagnosed, never-treated hypertensive patients and normotensive controls. Nailfold capillary density was estimated with nailfold capillaroscopy using specifically designed software. A total of 159 individuals, 93 hypertensives, and 66 normotensives were included. Nailfold capillary density was lower among hypertensives compared to normotensives (146.4 ± 31.0 vs. 155.4 ± 26.9, respectively; P = .047). In the total population, capillary density significantly correlated with high-density lipoprotein (HDL) (r = 0.232; P = .003), HDL/low-density lipoprotein ratio (r = 0.175; P = .025), age (r = 0.236; P = .003), but neither with vascular endothelial growth factor or high-sensitivity C-reactive protein. An inverse association was found with body mass index (r = -0.174; P = .029), insulin levels (r = -0.200; P = .018), and homeostasis model assessment-insulin resistance (r = -0.223; P = .009). In the separate analysis for the hypertensive population, sex (P = .014) and homeostasis model assessment-insulin resistance (P = .011) were identified as significant predictors of capillary rarefaction after adjustment for other factors. On the contrary, only HDL levels (P = .036) predicted capillary density in the multiple regression model for the normotensive population. Different aspects of impaired metabolic profile, that is, insulin resistance and low HDL levels, but not angiogenic or inflammatory markers, appear to be independently associated with capillary rarefaction in hypertensive and normotensive individuals.
毛细血管稀疏现象在原发性高血压中较为常见,但对于干扰这一现象的因素的识别仍未得到充分研究。我们研究了代谢谱成分(血脂异常、胰岛素抵抗)、炎症(高敏C反应蛋白)和血管生成(血管内皮生长因子)因素在一组新诊断的、未经治疗的高血压患者和血压正常对照人群中是否与这一现象有关。使用专门设计的软件通过甲襞毛细血管镜检查来估计甲襞毛细血管密度。总共纳入了159名个体,其中93名高血压患者和66名血压正常者。与血压正常者相比,高血压患者的甲襞毛细血管密度较低(分别为146.4 ± 31.0和155.4 ± 26.9;P = 0.047)。在总体人群中,毛细血管密度与高密度脂蛋白(HDL)显著相关(r = 0.232;P = 0.003)、HDL/低密度脂蛋白比值(r = 0.175;P = 0.025)、年龄(r = 0.236;P = 0.003),但与血管内皮生长因子或高敏C反应蛋白均无相关性。发现与体重指数(r = -0.174;P = 0.029)、胰岛素水平(r = -0.200;P = 0.018)以及稳态模型评估-胰岛素抵抗(r = -0.223;P = 0.009)呈负相关。在对高血压人群的单独分析中,在对其他因素进行调整后,性别(P = 0.014)和稳态模型评估-胰岛素抵抗(P = 0.011)被确定为毛细血管稀疏的显著预测因素。相反,在血压正常人群的多元回归模型中,只有HDL水平(P = 0.036)可预测毛细血管密度。代谢谱受损的不同方面,即胰岛素抵抗和低HDL水平,而非血管生成或炎症标志物,似乎在高血压和血压正常个体中与毛细血管稀疏独立相关。