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(Arteriosclerosis, Thrombosis, and Vascular Biology. 1996;16:455-461.)
© 1996 American Heart Association, Inc.

Articles

Factor VII Hyperactivity and Endothelial Cell Damage Are Found in Elderly Hypertensives Only When Concomitant With Microalbuminuria

Kazuomi Kario; Takefumi Matsuo; Hiroko Kobayashi; Miyako Matsuo; Toshiyuki Sakata; Toshiyuki Miyata; Kazuyuki Shimada

From the Department of Internal Medicine (K.K.), Awaji-Hokudan Public Clinic, Hokudan, Hyogo; the Department of Internal Medicine (K.K., T. Matsuo) and Central Laboratory (H.K., M.M.), Hyogo Prefectural Awaji Hospital, Sumoto; Clinical Laboratory (T.S.) and Research Institute (T. Miyata), National Cardiovascular Center, Suita, Osaka; and the Department of Cardiology (K.S.), Jichi Medical School, Tochigi, Japan.

Correspondence to Kazuomi Kario, MD, 480-2, Ikuha, Hokudan, Tsuna, Hyogo, 656-16, Japan.

Abstract We studied the relationships among albuminuria, factor VII (FVII) hyperactivity, and endothelial cell damage in 61 elderly hypertensive subjects. The plasma levels of activated FVII (FVIIa), FVII coagulant activity, FVII antigen (FVIIag), von Willebrand factor (vWF), and thrombomodulin were measured to assess FVII hyperactivity and endothelial cell damage, and urinary albumin excretion rate (UAE) was calculated using 12-hour nighttime (7 PM to 7 AM) urine collection (mean for 2 consecutive nights). We performed 24-hour ambulatory blood pressure monitoring in all 61 hypertensive patients and classified them into a white-coat hypertension group (n=12) and a sustained hypertension group (n=49). For the levels of FVII, vWF, and thrombomodulin, there were no differences between the white-coat hypertension group and normotensive control subjects (n=25). In the sustained hypertensive group, only the microalbuminuric subgroup (UAE, 15 to 300 µg/min: n=30) showed significant elevation compared with the normotensive group for the level of FVIIa (mean [95% confidence interval]: 4.0 [3.6 to 4.4] versus 3.0 [2.6 to 3.3] ng/mL, P<.001), the FVIIa/FVIIag ratio (an indicator of activation of FVII zymogen to FVIIa) (1.33 [1.19 to 1.50] versus 1.04 [0.92 to 1.19], P<.01), the level of vWF (188 [165 to 214] % versus 144 [129 to 160] %, P<.01), and thrombomodulin (11.7 [10.3 to 13.3] versus 9.3 [8.5 to 10.3] ng/mL, P<.01). In contrast, none of these levels in the normoalbuminuric hypertensive group (UAE <15 µg/min, n=19) differed from that in the normotensive control group. These results suggest that among elderly hypertensives, only those with microalbuminuria show enhancement of FVII activation and endothelial cell damage, while patients with white-coat hypertension and normoalbuminuric hypertensives do not show these accompanying abnormalities. Thus, increased levels of FVII activity and markers of endothelial cell damage might account for the higher risk of cardiovascular events in essential hypertension with microalbuminuria.

Key Words: factor VII • endothelial cell damage • hypertension • microalbuminuria • elderly

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