Effect of early endothelial function improvement on subclinical target organ damage in hypertensives

Abstract Endothelial dysfunction is acknowledged as a marker for subclinical target organ damage (STOD) in hypertension, though its therapeutic potential has not yet been clarified. This study assessed whether early endothelial function improvement (EEFI) reduced STOD in patients with essential hypertension (EH). We conducted a retrospective cohort analysis of 503 EH patients initially free from STOD. Endothelial function was assessed using brachial artery flow-mediated dilation (FMD), with values ≤ 7.1% indicating dysfunction. Patients were initially categorized by endothelial status (dysfunction: n = 192, normal: n = 311), and further divided into improved or unimproved groups based on changes within three months post-enrollment. During a median follow-up of 25 months, 195 patients developed STOD. The incidence of STOD was significantly higher in patients initially dysfunctional compared to those with normal function. Kaplan-Meier analysis indicated that the improved group had a lower cumulative incidence of STOD compared to the unimproved group (p < 0.05). Multivariable Cox regression confirmed EEFI (HR = 0.56, 95%CI 0.36–0.87) as an independent protective factor against STOD in EH patients, particularly in males, overweight individuals, and non-diabetics. In conclusion, EEFI significantly reduces STOD incidence in EH patients initially exhibiting endothelial dysfunction, especially in specific subgroups, emphasizing the need for early intervention in endothelial function to prevent STOD.