Endothelial function in patients with arterial hypertension and initial clinical symptoms of shronic serebral insufficiency

Prevention of chronic cerebral blood supply insufficiency is the leading aspect in prevention of cerebrovascular diseases. Initial stages of these changes are of special interest, with endothelial dysfunction playing the major role. The aim of the study is to assess the function of endothelium in patients with initial stages of chronic cerebral blood supply insufficiency and noncomplicated hypertension. We included 48 men and 61 women (mean age 57.4±5.8 years) to perform complex standardized assessment. Patients with history of stroke or acute coronary syndrome, head trauma or other severe disease, or stenosis of cervical arteries ≥ 30% were excluded. We performed clinical evaluation with assessment of neurological deficit and duplex ultrasound of cervical arteries, echocardiography, 24-hour blood pressure monitoring, brain MRI or CT and complex neuropsychological testing. Endothelial function was assessed with functional tests (hemoreological and vasoactive cuff test, test of cerebrovascular reactivity with nitroglycerine). We tested the level of Von Willebrand factor and homocystein as biomarkers of endothelial function. The rate of endothelial dysfunction in patients with non-complicated hypertension was 64%, and high agreement rate of both cuff tests was revealed. The hemoreological cuff test was difficult to perform, and its results were highly dependent on the initial values. Prospective studies are needed to estimate the prognostic value of endothelial dysfunction for the progression of the chronic cerebral blood supply insufficiency.