Abbreviations: BP, blood pressure; UACR, urinary albumin-creatinine ratio. Data are shown as median value (25% value–75% value). The overall P value was calculated using analysis of variance. aP<.001 vs normotension. bP<.05 vs white-coat hypertension.
Letter to the Editor
Relationship Between Endothelial Dysfunction and Kidney Disease
Version of Record online: 12 DEC 2013
©2013 Wiley Periodicals, Inc.
The Journal of Clinical Hypertension
Volume 16, Issue 2, page 156, February 2014
How to Cite
Kabutoya, T., Hoshide, S., Ogata, Y., Eguchi, K. and Kario, K. (2014), Relationship Between Endothelial Dysfunction and Kidney Disease. The Journal of Clinical Hypertension, 16: 156. doi: 10.1111/jch.12236
- Issue online: 13 FEB 2014
- Version of Record online: 12 DEC 2013
To the Editor:
We thank Dr Balta and colleagues for their interest in our work, and would like to respond to their recent article. We agree concerning the importance of investigating the pathological status in patients with masked hypertension (MHT), including inflammation markers. We reanalyzed the association between endothelial dysfunction (ie, the flow-mediated vasodilation [FMD] magnitude [ΔFMD] and the integrated FMD response [FMD-AUC120]) and other pathological status.
We also measured the urinary albumin-creatinine ratio (UACR) in our studies, (Table1). The UACR in the patients with sustained hypertensive (office blood pressure [BP] ≥140/90 mm Hg and home BP ≥135/85 mm Hg) was significantly higher than that among both the patients with white-coat hypertension (office BP ≥140/90 mm Hg and home BP <135/85 mm Hg) and the patients with normotension (office BP <140/90 mm Hg and home BP < 135/85 mm Hg). The differences in UACR in the MHT group and those in the normotensive patients were not statistically significant, but the underlying reason might be a type II error. This finding was similar to that obtained in our previous study.
|Normotension (n=90)||White-Coat Hypertension (n=41)||Masked Hypertension (n=41)||Sustained Hypertension (n=85)||P Values|
|UACR||9.2 (6.3–24.4)||12.7 (6.1–27.6)||14.1 (7.6–45.7)||14.6 (7.5–81.6)a,b||<.001|
FMD-AUC120 was significantly inversely associated with log UACR (r=−0.18, P=.008), but ΔFMD was not associated with log UACR (r=−0.06, P=.35). FMD-AUC120 reflected kidney disease, but ΔFMD did not.
The UACR was significantly higher in the patients in the lowest tertile for FMD-AUC120 (FMD-AUC120 <5.0 mmxs, n=86) than in the patients in the highest tertile for FMD-AUC120 (FMD-AUC120 ≥11.0 mmxs, n=86 [P<.001]; Figure1, panel A), but the UACR was similar in the patients in the lowest and highest tertiles for ΔFMD (P=1.0; Figure1, panel B).
We did not evaluate sedentary habits or liver function. We measured the high-sensitivity CRP (hsCRP) level, but log-hsCRP was not associated with ΔFMD or with FMD-AUC120.
As Dr Balba commented, endothelial dysfunction, which was measured as FMD (not ΔFMD, but FMD-AUC120), might be associated with kidney disease. However, in our patient population, there was no association between FMD and inflammation. We previously demonstrated that FMD-AUC120 was associated with the Framingham risk score, and further studies including more patients are needed to clarify the associations among FMD-AUC120, inflammation, and other pathological status factors.
- 1Masked hypertension as an unrecognized destructive condition. J Clin Hypertens (Greenwich). 2013; doi: 10.1111/jch.12240., , , , .
- 2Inflammatory markers should be assessed together with cardiovascular risk factors by clinicians in masked hypertension. J Clin Hypertens (Greenwich). 2013;15:443–444., , , , , .
- 3The time course of flow-mediated vasodilation and endothelial dysfunction in patients with a cardiovascular risk factor. J Am Soc Hypertens. 2012;6:109–116., , , , , .
- 4Masked hypertension defined by home blood pressure monitoring is associated with impaired flow-mediated vasodilatation in patients with cardiovascular risk factors. J Clin Hypertens (Greenwich). 2013;15:630–636., , , , .
- 5Masked hypertension defined by ambulatory blood pressure monitoring is associated with an increased serum glucose level and urinary albumin-creatinine ratio. J Clin Hypertens (Greenwich). 2010;12:578–587., , , et al.