Abstract P193: The Use of Antihypertensive Drugs, But Not Optimal Blood Pressure Level Was a Predictor of Endothelial Dysfunction in Hypertensives: From Multicenter Prospective Observational Study: FMD-J Study
Authors: Chisa Matsumoto, Hirofumi Tomiyama Tomiyama, Akira Yamashina, Taishiro Chikamori
Journal: Circulation (2019)

Background: The predictors of endothelial dysfunction, the initial marker of the development of atherosclerosis, have not been fully clarified. One previous observational study suggested that antihypertensive treatment in hypertensives may be associated with better endothelial function. However, it is not known whether antihypertensive treatment is associated with endothelial function independent from blood pressure level. The objective of this study is to evaluate the association of the use of antihypertensive drugs and blood pressure with endothelial function in the multicenter prospective observational study, FMD-J study. Methods: 685 hypertensive subjects (mean age 62 ± 9 years) in the FMD-J study were followed for 3 years. Endothelial function was evaluated by flow mediated dilation (FMD). The FMD and the conventional risk factors for cardiovascular disease (CVD) were measured at the baseline and the end of the 3-year study period. We defined endothelial dysfunction as continuation of FMD &amp;gt 4% for 3 years. Also, normal endothelial function was defined as continuation of FMD &amp;gt 7 % for 3 years. Multivariate logistic regression analysis adjusted for established CVD risk factors were performed to assess the associations of antihypertensive treatment and endothelial dysfunction / normal endothelial function. We also evaluated whether the class of antihypertensive drugs was associated with endothelial function. Results: 155 subjects had endothelial dysfunction and 71 subjects had normal endothelial function. The multivariate logistic regression analysis revealed that the use of antihypertensive drugs was associated with lower risk of endothelial dysfunction with odds ratio (OR) (95% CI) of 0.20 (0.50-0.86, P=0.03), independent of blood pressure. The use of antihypertensive drugs was also significantly associated with increase of normal endothelial function with OR of .6.28 (2.86-13.80, P &amp;gt 0.001). In contrast, controlling of systolic blood pressure to optimal blood pressure level (&amp;g t130 mm Hg) was associated with neither endothelial dysfunction nor endothelial function. This association was not altered, even when subjects’ systolic blood pressure was controlled to &amp;gt 120 mm Hg. Among the class of antihypertensive drugs, only calcium-channel-blockers, ACE-inhibitors, and ARBs were associated with endothelial function, but diuretics and beta-blockers were not associated with endothelial function. Conclusion: The use of antihypertensive medication, but not optimal blood pressure control was associated with lower risk of endothelial dysfunction in hypertensives. This association seemed to be only limited in calcium-channel-blockers, ACE-inhibitors, and ARBs. Further investigation why the use of antihypertensive drugs was associated with endothelial function independent of blood pressure level, may provide valuable insights into prevention of CVD.