Post-occlusive Reactive Hyperemia in Individuals with Arterial Hypertension According to Portable Dual-Channel Laser Blood Microcirculation Analyzer

Purpose – to conduct a comparative analysis of the parameters of post-occlusion reactive hyperemia development in apparently healthy individuals and patients with arterial hypertension, using a portable dual-channel laser blood microcirculation analyzer. Materials and methods. Two observation groups were formed: patients with arterial hypertension (AH group, n=39) and healthy individuals (control group, n=32). Microcirculation parameters were determined during the occlusion test using laser Doppler flowmetry. The fluorescence amplitude of the coenzyme – reduced nicotinamide adenine dinucleotide (NADH) – was determined using laser fluorescence spectroscopy. The content of nitrates and nitrites (NOx) in the subjects’ blood serum was determined and the deformability of erythrocytes after their incubation with the NO donor – sodium nitroprusside – was assessed. Results. The initial indicator of microvascular perfusion in the observation groups did not differ statistically significantly. In the AH group, the maximum perfusion value (MPmax) achieved during the development of reactive post-occlusive hyperemia was 20% lower (p<0.01), the time to reach MPmax was increased by 46% (p<0.01), and the perfusion half-recovery time was reduced by 42% (p<0.01), compared with the control group. The amplitude of myogenic and neurogenic factors modulating blood flow in the AH group was reduced by 39% and 41%, respectively (p<0.05). The increase in erythrocyte deformability in response to the NO donor was 37% lower (p<0.01), and the NOx content in the blood serum was increased by 32% (p<0.01). The amplitude of NADH fluorescence was 49% (p<0.01) higher in the AG group than in the control group. Conclusion. The obtained results demonstrate a slowdown in flow-dependent vasodilation and a reduction in the post-occlusion hyperemic period in individuals with hypertension compared to healthy subjects. These changes were linked to a decrease in the activity of local mechanisms modulating microcirculation, impaired NO-dependent regulatory processes, and a slowdown in oxidative metabolism in individuals with hypertension.

1. Chazova IY, Martynyuk TV. Pulmonary hypertension. Hand book. Moscow: Practice, 2015. 928 p. (In Russ.).

2. Santoro L, Falsetti L, Zaccone V, et al. On behalf of gemelli against COVID-post-acute care study group. Impaired endothelial function in convalescent phase of COVID-19: a 3 month follow up observational prospective study. J Clin Med. 2022;11(7):1774. https://doi.org/10.3390/jcm11071774.

3. Thijssen DHJ, Bruno RM, van Mil ACCM, et al. Expert consensus and evidence-based recommendations for the assessment of flow-mediated dilation in humans. Eur. Heart J. 2019;40:2534-2547. https://doi.org/10.1093/eurheartj/ehz350.

4. Higashi Y. Assessment of endothelial function. International heart journal. 2015;56(2):125-134. https://doi.org/10.1536/ihj.14-385.

5. Barsukov AV, Shcherbakova KA, Maltsev DS, et al. The relationship between the indicators of the retina condition and other target organ changes in uncomplicated essential hypertension. Arterial Hypertension. 2020;26(4):410-420. (In Russ.). https://doi.org/10.18705/1607-419X-2020-26-4-410-420.

6. Seitz A, Ong P. Endothelial dysfunction in COVID-19: A potential predictor of long-COVID? Int. J. Cardiol. 2022;349:155-156. https://doi.org/10.1016/j.ijcard.2021.11.051.

7. Fedorovich AA. The functional state of regulatory mechanisms of the microcirculatory blood flow in normal conditions and in arterial hypertension according to laser Doppler flowmetry. Reg. Circ. Microcirc. 2010;9(1):49-60. (In Russ.). https://doi.org/10.24884/1682-6655-2010-9-1-49-60.

8. Jekell A, Kalani M, Kahan T. The interrelation of endothelial function and microvascular reactivity in different vascular beds, and risk assessment in hypertension: results from the Doxazosin-ramipril study. Heart Vessels. 2019;34(3):484-495. https://doi.org/10.1007/s00380-018-1265-7.

9. Sagaydachny AA. Occlusion test: methods of analysis, reaction mechanisms, application prospects. Reg. Circ. Microcirc. 2018;17(3):5-22. https://doi.org/10.24884/1682-6655-2018-17-3-5-22. (In Russ.).

10. Joannides R, Haefeli WE, Linder L., et al. Nitric oxide is responsible for flow-dependent dilatation of human peripheral conduit arteries in vivo. Circulation. 1995;91(5):1314-1319. https://doi.org/10.1161/01.CIR.91.5.1314.

11. Georgakoudi I, Quinn KP. Optical imaging using endogenous contrast to assess metabolic state. Annu Rev Biomed Eng. 2012;14:351-367. https://doi.org/10.1146/annurev-bioeng-071811-150108.

12. Sidorov VV, Rybakov YuL, Gukasov VM. A device for comprehensive noninvasive diagnostics of the tissue microcirculation system of human skin. Biomedical Engineering. 2021;55(4):232-235. https://doi.org/10.1007/s10527-021-10108-9.

13. Laser Doppler flowmetry of blood microcirculation / еd. by AI Krupatkin, VV Sidorov: A guide for doctors. Moscow: JSC “Publishing House “Medicine”, 2005. 256 р. (In Russ.).

14. Vasiliev AP, Streltsova NN. Skin microcirculation in patients with arterial hypertension and in patients with a combination of arterial hypertension and type II diabetes mellitus. Regional blood circulation and microcirculation. 2020;19(4):44-52. (In Russ.). https://doi.org/10.24884/1682-6655-2020-19-4-44-52.

15. Mikhailov PV, Muravyov AV, Osetrov IA, et al. Age-related changes in microcirculation: the role of regular physical activity. Research Results in Biomedicine. 2019;5(3):82-91. (In Russ.). https://doi.org/10.18413/2658-6533-2019-5-3-0-9.

16. Vlasov TD, Petrischev NN, Lazovskaya OA. Endothelial dysfunction. Do we understand this term properly? Messenger of anesthesiology and resuscitation. 2020;17(2):76-84. (In Russ.). https://doi.org/10.21292/2078-5658-2020-17-2-76-84.

17. Vasina EYu, Malakhova ZL, Anosov IA, et al. Assessment of endothelium-dependent vasodilation in the clinic: what endothelial factor are we studying? Arterial hypertension. 2020;26(2):211-218. (In Russ.). https://doi.org/10.18705/1607-419X-2020-26-2-211-218.

18. Félétou M, Vanhoutte PM. EDHF: new therapeutic targets? // Pharmacological Research. 2004;49(6):565–580. https://doi.org/10.1016/j.phrs.2003.10.017.

19. Cooke JP, Tsao PS. Go with the flow // Circulation. 2001;103(23):2773-2775. https://doi.org/10.1161/01.CIR.103.23.2773.

20. Korolev AI, Fedorovich AA, Gorshkov AYu, Drapkina OM. Microcirculation of the skin with essential arterial hypertension. Reg. Circ. Microcirc. 2020;19(2):4-10. (In Russ.). https://doi.org/10.24884/1682-6655-2020-19-2-4-10.

21. Salazar Vázquez BY, Cabrales P, Tsai AG, Intaglietta M. Nonlinear cardiovascular regulation consequent to changes in blood viscosity. Clin Hemorheol Microcirc. 2011;49(1-4):29-36. https://doi.org/10.3233/CH-2011-1454.

22. Muravyov AV, Tikhomirova IA, Mikhaylov PV, Akhapkina AA, Ostroumov RS. Interrelations of hemorheological parameters and microcirculation in subjects with an increased blood pressure. Human Physiology. 2018; 44(5):541-548. (In Russ.). https://doi.org/10.1134/S0131164618050107.

23. Volkova E., Zamyshliaev A., Mikhailov P., et al. The relationship between the non-newtonian properties of blood, its fluidity and transport potential in patients with arterial hypertension. Series on Biomechanics. 2023;37(3): 11-18. https://doi.org/10.7546/SB.02.03.2023.

24. Sriram K, Salazar Vázquez BY, Tsai AG, et al. Autoregulation and mechanotransduction control the arteriolar response to small changes in hematocrit. Am J Physiol Heart Circ Physiol. 2012 Nov 1;303(9):H1096-106. https://doi.org/10.1152/ajpheart.00438.2012.

25. Zhloba AA, Subbotina TF, Alekseevskaya ES. The content of nitric oxide in blood plasma of health persons depending on age. Klin Lab Diagn. 2016;61(11):760-765. (In Russ.) https://doi.org/10.18821/0869-2084-2016-61-11-760-765.

26. Chebotareva AA, Komarevtseva IA, Yusuf RMS, et al. Nitric oxide metabolites in tissues, blood serum, mononuclear and mesenchymal stem cells / Kursk Scientific and Practical Bulletin Man and his health. 2016:2;90-95. (In Russ.). https://doi.org/10.21626/vestnik/2016-2/17.

27. Muravyov AV, Tikhomirova IA, Avdonin PV, et al. Comparative efficiency of three gasotransmitters (nitric Oxide, Hydrogen Sulfide and Carbon Monoxide): Analysis on the model of red blood cell microrheological responses. Journal of Cellular Biotechnology. 2021;7(1):1-9. https://doi.org/10.3233/JCB-200023.

28. Antonova N, Volkova E, Zamyshlyaev A, et al. Сontribution of red blood cell microrheological characteristics to impaired blood fluidity in peripheral arterial occlusive disease (PAOD) and their correction with gasotransmitters. Series on Biomechanics. 2024;38(2):3-10. https://doi.org/10.7546/SB.01.02.2024.

29. Luo Х, Li R, Yan L-Jun. Roles of Pyruvate, NADH, and Mitochondrial Complex I in Redox Balance and Imbalance in β Cell Function and Dysfunction. J Diabetes Res. 2015;2015:512618. https://doi.org/10.1155/2015/512618.

30. Salmin VV, Salmina AB, Fursov AA, et al. Application of fluorescence spectroscopy for assesment of myocardial ischemic injury. Journal of Siberian Federal University. Biology 2. 2011;4:142-157. (In Russ.).