Effect of Intensive Blood Pressure Treatment on Endothelial Damage and Vascular Endothelial Growth Factor, an Index of Angiogenesis in Hypertension Dirk Felmeden City Hospital, Birmingham, England, UK Hypertensive patients are at high risk for atherosclerosis and thrombosis, a risk that can be reduced by lowering blood pressure. The results of this study suggest that the beneficial effects of blood pressure reduction may be mediated through decreased endothelial damage and possibly decreased abnormal angiogenesis as well. This study evaluated the benefits of blood pressure reduction in 136 high-risk hypertensive individuals, defined as patients with three or more major cardiac risk factors such as smoking, age >55 years, presence of diabetes mellitus, etc. The patients were randomized to receive treatment with either atenolol plus bendroflumethiazide or amlodipine plus perinopril. (The patients were started on monotherapy, but most were put on combination therapy during the titration process.) The researchers assessed endothelial damage by measuring von Willebrand factor (vWF) and assessed angiogenesis by measuring vascular endothelial growth factor (VEGF); measurements were taken at baseline and after six months of therapy. The goal of the study was to determine whether "the complications of hypertension and the beneficial effects of blood pressure reduction may be related to endothelial damage and/or to abnormal angiogenesis." Dr. Felmeden explained that elevated VEGF in untreated chronic hypertensive patients may be a response to a deterioration of the capillary vasculature caused by elevated systemic pressures, although there is no hard evidence at this time to support this hypothesis. At this time, he explained, we know simply that VEGF is useful as a marker for elevated blood pressure. The study results demonstrated significant reductions in systolic and diastolic pressure at six months compared with baseline, as well as corresponding significant reductions in levels of vWF and VEGF. Therefore, "when compared to control subjects, high-risk hypertensives demonstrate evidence of endothelial damage and abnormal angiogenesis, both of which are reduced in these patients after six months of effective antihypertensive treatment. These findings may be related to the pathophysiology of hypertension and its complications, and to the well-documented beneficial effects of blood pressure lowering." Reporter: Andre Weinberger, MD Copyright 2000-2013 by HESCO International, Ltd. All rights reserved.