Observations on peripheral microcirculation in young hypertensive patients.

The increase of the peripheral blood flow resistance level is the major hemodynamic parameter in pathophysiology of essential hypertension (HT). The functional and morphological abnormalities of the microcirculation in the early stage, sometimes before the increase of the blood pressure, are intensely explored. Their identification is a proof for the genetical component of the hypertensive disease theory (studies on young male patients). Our purpose is to examine the capillary peripheral bed at the terminal phalanx level using in vivo capillary microscopy on a group of patients that have the risk of developing HT or that already have HT stage I (according to the JNC 7 Report). The nailfold area and the dorsal surface of the phalanx of fingers 3 and 4 were observed, having as a first objective the search for the areas with rare capillaries. Contrary to the data of the existing studies we have not found any case of significant capillary density decrease or of diffuse capillary rarefaction. Seven patients out of the total number of fifteen with HT stage I were identified to have a low vasomotility score. Considering the association of these cases with glucose intolerance (3 cases) and dyslipidemia (4 cases) the capillary functional anomaly could be related to precapillary arteriole modifications (endothelial dysfunction? metabolic status?).