Niels Henrik Buus

Objective Structural abnormality of resistance arteries

is a characteristic pathophysiological phenomenon in

essential hypertension and can be assessed in vitro as an

increase in the media : lumen ratio (M : L) of isolated small

arteries. We have investigated whether M: L is a risk

predictor in uncomplicated essential hypertensive patients.

Recently, high M: L was demonstrated as a prognostic

marker in patients at high cardiovascular risk, including

normotensive type 2 diabetic patients. Since diabetes is

associated with pressure-independent changes in M: L,

the relevance of this finding to essential hypertension has

been uncertain.

Methods We conducted a follow-up survey of 159 essential

hypertensive patients, who had previously been submitted

to a M: L evaluation while participating in a clinical trial. They

composed a homogeneous moderate-risk group, with no

concomitant diseases, and represented 1661 years of

follow-up.

Results Thirty patients suffered a documented predefined

cardiovascular event during follow-up. Increased relative

risk (RR) was associated withM: L>-0.083 (mean level of the

hypertensive cohort), RRU2.34 [95% confidence interval

(CI) 1.11-4.95], and with M: L>-0.098 (mean level of a

normotensive control groupR2SD), RRU2.49 (95%

CI 1.21-5.11). Both results remained significant (RRU2.19,

95% CI 1.04-4.64, and RRU2.20, 95% CI 1.06-4.56,

respectively) when adjusted for Heart Score level

(10-year mortality risk-estimate, integrating age, gender,

systolic blood pressure, cholesterol and smoking).

Conclusion Abnormal resistance artery structure

independently predicts cardiovascular events in essential

hypertensive patients at moderate risk. J Hypertens

25:1021-1026 Q 2007 Lippincott Williams & Wilkins.

Journal of Hypertension 2007, 25:1021-1026