Endothelial function and risk of hypertension and blood pressure progression: the prospective investigation of the vasculature in Uppsala seniors.

OBJECTIVES: Impaired endothelial function is associated with risk of cardiovascular events, possibly via increased blood pressure. We aimed to investigate if impaired endothelial function is associated with risk of hypertension and blood pressure progression in a large community-based sample.
METHODS: In the population-based Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, endothelium-dependent vasodilation (EDV) was measured in resistance arteries using the invasive forearm technique and in conduit arteries using the flow-mediated vasodilation technique (FMD) at age 70, and participants were re-examined after 5 years. We investigated risk of developing hypertension or blood pressure progression in multivariable-adjusted logistic regression models.
RESULTS: In 201 out of 506 untreated persons, blood pressure progressed to a higher stage, and among 197 normotensive persons, 87 developed hypertension. Endothelial function, measured with the invasive forearm technique and the brachial ultrasound technique, did not predict either the development of hypertension [EDV: odds ratio (OR) per SD 1.16, 95% confidence interval (CI) 0.84-1.59; FMD: OR per SD 1.00, 95% CI 0.76-1.33) or blood pressure progression (EDV: OR per SD 0.90, 95% CI 0.73-1.11; FMD: OR per SD 1.01, 95% CI 0.84-1.21).
CONCLUSION: In this large community-based sample of elderly, impaired endothelial function measured with the invasive forearm technique did not play a major role in the development of hypertension or blood pressure progression. Observed associations between endothelial dysfunction and risk of cardiovascular events are likely mediated through other pathways than hypertension.