The relationship between microvascular endothelial function and carotid-radial pulse wave velocity in patients with mild hypertension

Abstract

Carotid-radial pulse wave velocity (CRPWV) can be measured rapidly using applanation tonometry and significantly higher values have been reported among patients with risk factors for vascular disease. Forearm blood flow responses to intrabrachial infusion of acetylcholine independently predict cardiovascular morbidity among hypertensive patients. We aimed to examine the relationship between CRPWV, a potentially informative, noninvasive measure and this more established parameter of arterial health. One hundred and fifteen mildly hypertensive individuals (67% men, mean (± SD) age 54 ± 8 years, mean (± SD) blood pressure (BP) 143 ± 16/83 ± 12 mmHg) were recruited from a weekly medical outpatient clinic. Each volunteer had CRPWV measured using sequential tonometry before forearm blood flow responses to intra-arterial, endothelium-dependent (acetylcholine) and independent (sodium nitroprusside) vasodilators were assessed. There was a significant negative correlation between CRPWV and maximum forearm blood flow response to acetylcholine (r = -0.225, p = 0.016). This association remained significant in a multiple regression analysis (β = -0.213, p = 0.034). Mean arterial pressure and weight were additional independent predictors of CRPWV in this model. There was no such relationship between CRPWV and response to sodium nitroprusside (r = 0.088, p = 0.349). In patients with mild hypertension, a poor forearm blood flow response to acetylcholine independently predicted faster CRPWV, thus linking an established measure of microvascular endothelial function with a noninvasive index of conduit vessel stiffness.