Effects Of Metabolic Syndrome On The Vascular Structure, Function And Target Organ Damage In Patients With Essential Hypertension

Part one: Effects of metabolic syndrome on the endothelial function and target organ damage in patients with essential hypertensionObjective: To observe the impacts of metabolic syndrome (MS) on endothelial funct- ion and target organ damage in patients with essential hypertension (EH).Methods: 156 patients with hypertension were assigned in two groups: essential hyp- ertension with metabolic syndrome (EH+MS, n=61) group, essential hypertension wi- thout metabolic syndrome (EH+nonMS, n=95) group. 31 healthy subjects was normal control (NC). The change of brachial artery vascular diameter, blood flow volume and vascular resistance were measured after reactive hyperemia by color Doppler ultrasonography.Results:(1) Triglyceride (TG), fasting blood glucose (FBG), body mass index (BMI) were hi- gher in EH+MS group than that in EH+nonMS group (P<0.05).(2) Function of Endothelium-dependent Dilatation (FMD %) was significantly lower in EH+MS group than that in EH+nonMS and NC group [(7.08±3.21)% vs (8.18± 1.74)% and (10.41±4.52)%, P <0.05 and 0.01 respectively].(3) Rate of flow volume of reactive hyperemia (△Q) was lower in EH+MS group th- an that in EH+nonMS and NC group [(154.19±78.94)% vs (196.44±64.22)% and (221.81±89.64)%, P <0.05 and 0.01 respectively], no significant differences was fou- nd between EH+nonMS group with NC group (P>0.05).(4) The high sequence of forearm dilatation capability was: NC group (3.21±0.90)> EH+nonMS (2.89±0.73)> EH+MS group (2.58±0.76), P <0.05.(5) The incidence of carotid atherosclerotic plaque was among three groups 18/61 (29.0%), 19/95 (20.2%) and 1/31 (3.2%) respectively, P<0.05.(6) The incidence of left ventricular hypertrophy (LVH) among three groups was: EH +MS group (59%)> EH+nonMS group (37.9%)> NC group (9.7%), P <0.05.(7)FMD was negatively related with age, systolic blood pressure (SBP), diastolic blood pressure (DBP), TG, fibrinogen (Fib) respectively (P<0.05). The left ventricular mass index (LVMI) was positively related with age, SBP, DBP, BMI, TG respectively (P<0.05).Conclusion:(1) Metabolic syndrome had aggravating effects on endothelial function and target organ damage in patients with hypertention.(2) FMD was negatively related with age, SBP, DBP, TG, Fib respectively. In clinical prctices, progressive measures must be taken to control blood pressure, lipid, and plasma fibrinogen to improve the endothelial function.(3) LVMI was positively related with age, SBP, DBP, BMI, TG respectively. Thus it was indispensable that intensive measures must be taken to control blood pressure, lipid and body weight to reduce the occurrence of LVH and postpone the develo- pment of atherosclerosis.Part two: Effects of metabolic syndrome on the structure and function of carotid artery in patients with essential hypertensionObjective: To investigate the effects of MS on the structure and function of carotid artery in patients with EH.Methods: The subjects was the same as the former. The inner diameter (D), intima- media thickness (IMT), blood flow rate in the end phase of dilatation (ED), peak val- ue of blood flow rate in the systolic phase (PS), time average velocity (TAV), blood vessel resistance of carotid artery were measured by color Doppler ultrasonography.Results:(1) The inner diameter and IMT were significantly higher in EH+MS group than that in EH+nonMS group and NC group (D: 0.84±0.11 vs 0.80±0.11 and 0.75±0.08 cm, P<0.05; IMT: 0.087±0.021 vs 0.078±0.017 and 0.067±0.013 cm, P<0.05).(2) ED was significantly lower in EH+MS group(18.78±6.23 cm/s) than that in EH+ nonMS group (21.13±6.72 cm/s) and NC group (24.71±6.30 cm/s), P<0.05.(3) The resistance of carotid artery (mm Hg·S-1/L) was higher in EH+MS group than that in EH+nonMS group and NC group (11 887.61±2 894.00 vs 11 023.94±2 773.26 and 8 761.48±2 305.56, P<0.05).(4) IMT was positively related with age, BMI, SBP, DBP, TG, Fib respectively(P< 0.05), negatively related with HDL-C (P<0.01); TAV was negatively related with age, BMI, SBP, DBP, TG respectively(P<0.05), positively related with HDL-C (P<0.05).Conclusion:(1) Metabolic syndrome promoted the development of arteriosclerosis in hypertensive patients.(2) IMT was positively related with age, BMI, SBP, DBP, TG, Fib respectively, TAV was negatively related with age, BMI, SBP, DBP, TG respectively, thus it was impor- tant to strengthen the general control of blood pressure, blood lipid and body weight in preventing or postponing the development of atherosclerosis.