Peripheral vascular damage in hypertension

The authors relate the pathophysiologic, hemodynamic and pharmacologic aspects of peripheral vascular damage in arterial hypertension. Particular attention is paid to the role of structural and functional changes both large elastic and muscular arteries (macroangiopathy) and small resistance vessels (microangiopathy) in the determinism and maintenance of arterial hypertension. These changes include impaired arterial wall compliance, vascular hyperactivity to agonists due to both hypertrophy and hyperplasia of smooth muscle cells, and endothelial dysfunction seen as an increase in endothelial permeability as well as an impaired release of relaxing and contracting factors. In the second part, personal observations are related. The aim of the research was to individuate hemodynamic non invasive patterns of peripheral vascular damage in essential, mild or moderate, hypertensives and to evaluate the hemodynamic peripheral effect of hypotensive drugs. The hemodynamic evaluation has been carried out by means of epiaortic vessels and lower limbs echo-Doppler, strain gauge plethysmography of lower limbs, and echocardiography. The following parameters have been considered: Trevis index, rest flow, peak flow, total time, resistance index of Pourcelot, left ventricular mass and ejection fraction. The first study involved 100 subjects (60 males and 40 females) with mild or moderate hypertension and a control group of 60 healthy subjects (35 males and 25 females). The hypertensives, compared to normotensives, showed an increase of Trevis index, reduction of peak flow, increase of total time and increase of resistance index. The second study was performed on 60 hypertensive subjects, 28 (17 diabetics) treated with nicardipine slow-release (40 mg twice a day) and 32 treated with terazosine (2-4 mg once a day). The treatment with nicardipine slow-release showed an increase of Trevis index, increase of rest flow and reduction of resistance index; the left ventricular mass resulted reduced. The treatment with terazosine showed a significant increase of rest flow and peak flow, reduction of total time, increase of Trevis index, reduction of resistance index, reduction of left ventricular mass. These data, concordantly with what known in literature, showed in hypertension an hemodynamic situation characterized by high resistance circulations, expression of arteriolar involvement. Nicardipine and terazosine can be placed as first choice hypotensive drugs adding at the hypotensive efficacy and tolerability a positive effect on peripheral vascular damage.