Multimedialna platforma wiedzy medycznej Internetowa Księgarnia Medyczna Kalendarium Konferencji
Arterial Hypertension
MENU
Shortcuts Submit an article Author Guidelines Ahead Of Print Reviewers 2023

open access

Vol 27, No 1 (2023)
Review paper
Published online: 2023-01-31
View PDF Download PDF file View HTML
Get Citation

Methods for the assessment of microcirculation in patients with hypertension

Katarzyna Lewandowska1, Dorota Marzyńska1, Patrycja Rzesoś1, Alicja Partyka1, Franciszek Dydowicz1, Mikołaj Lewandowski1, Regina Pawlak-Chomicka1, Andrzej Tykarski1, Paweł Uruski1
DOI: 10.5603/AH.a2023.0004
·
Arterial Hypertension 2023;27(1):1-12.
Affiliations
  1. Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland

open access

Vol 27, No 1 (2023)
REVIEW
Published online: 2023-01-31

Abstract

Background: Skin microcirculation is considered an easily accessible vascular bed, which can potentially be representative and helpful in evaluating, understanding the mechanisms of microvascular function and detection of its dysfunction. Many studies claim that functional changes in cutaneous circulation precede the development of arterial hypertension (HT). Identifying them at an early stage can enhance patients’ prognosis. There are methods which can be applied for these purposes. We aimed to describe available methods of skin microcirculation assessment, in the context of HT.

Material and methods: The PubMed database was searched till March 2022. Research articles used in the systematic review were experimental articles, reviews and abstracts from conference materials that reported the methods of the microcirculation assessment. From 1131 records, 47 articles were included in the final review.

Results: This review identified that the microcirculation examined with various methods was dysfunctional in HT patients. Standard HT treatment usually helped to achieve a partial reversal of those changes. Even though some of the methods described are non-invasive and relatively affordable, still, none of them is the standard for HT diagnosis.

Conclusion: Each of the methods has its advantages and disadvantages. Photoplethysmography appears to be promising. The method is non-invasive, cheap, does not require experience, and might be synchronized with mobile devices. It is possible that the simplification of the device calibration process and the development of a method allowing for the correct interpretation of the result, regardless of e.g., the patient's skin color, could influence its wider use in the group of HT patients.

Abstract

Background: Skin microcirculation is considered an easily accessible vascular bed, which can potentially be representative and helpful in evaluating, understanding the mechanisms of microvascular function and detection of its dysfunction. Many studies claim that functional changes in cutaneous circulation precede the development of arterial hypertension (HT). Identifying them at an early stage can enhance patients’ prognosis. There are methods which can be applied for these purposes. We aimed to describe available methods of skin microcirculation assessment, in the context of HT.

Material and methods: The PubMed database was searched till March 2022. Research articles used in the systematic review were experimental articles, reviews and abstracts from conference materials that reported the methods of the microcirculation assessment. From 1131 records, 47 articles were included in the final review.

Results: This review identified that the microcirculation examined with various methods was dysfunctional in HT patients. Standard HT treatment usually helped to achieve a partial reversal of those changes. Even though some of the methods described are non-invasive and relatively affordable, still, none of them is the standard for HT diagnosis.

Conclusion: Each of the methods has its advantages and disadvantages. Photoplethysmography appears to be promising. The method is non-invasive, cheap, does not require experience, and might be synchronized with mobile devices. It is possible that the simplification of the device calibration process and the development of a method allowing for the correct interpretation of the result, regardless of e.g., the patient's skin color, could influence its wider use in the group of HT patients.

Full Text:

View PDF Download PDF file View HTML
Get Citation

Keywords

arterial hypertension; microcirculation; skin; microvascular rarefaction

About this article
Title

Methods for the assessment of microcirculation in patients with hypertension

Journal

Arterial Hypertension

Issue

Vol 27, No 1 (2023)

Article type

Review paper

Pages

1-12

Published online

2023-01-31

Page views

2372

Article views/downloads

501

DOI

10.5603/AH.a2023.0004

Bibliographic record

Arterial Hypertension 2023;27(1):1-12.

Keywords

arterial hypertension
microcirculation
skin
microvascular rarefaction

Authors

Katarzyna Lewandowska
Dorota Marzyńska
Patrycja Rzesoś
Alicja Partyka
Franciszek Dydowicz
Mikołaj Lewandowski
Regina Pawlak-Chomicka
Andrzej Tykarski
Paweł Uruski

References (66)
  1. Forouzanfar MH, Liu P, Roth GA, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015. JAMA. 2017; 317(2): 165–182.
    CrossRefPubMed
  2. Kearney P, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet. 2005; 365(9455): 217–223.
    CrossRefPubMed
  3. Niklas A, Flotyńska A, Puch-Walczak A, et al. WOBASZ II investigators. Prevalence, awareness, treatment and control of hypertension in the adult Polish population — Multi-center National Population Health Examination Surveys — WOBASZ studies. Arch Med Sci. 2018; 14(5): 951–961.
    CrossRefPubMed
  4. De Ciuceis C, Porteri E, Rizzoni D, et al. Structural alterations of subcutaneous small-resistance arteries may predict major cardiovascular events in patients with hypertension. Am J Hypertens. 2007; 20(8): 846–852.
    CrossRefPubMed
  5. Kumar V, Abbas AK, Aster JC. Robbins Basic Pathology. 10th ed . Elsevier 2018.
  6. Strain WD, Adingupu DD, Shore AC. Microcirculation on a large scale: techniques, tactics and relevance of studying the microcirculation in larger population samples. Microcirculation. 2012; 19(1): 37–46.
    CrossRefPubMed
  7. Jung F, Pindur G, Ohlmann P, et al. Microcirculation in hypertensive patients. Biorheology. 2013; 50(5-6): 241–255.
    CrossRefPubMed
  8. Davis MJ, Hill MA. Signaling mechanisms underlying the vascular myogenic response. Physiol Rev. 1999; 79(2): 387–423.
    CrossRefPubMed
  9. Davis MJ, Wu X, Nurkiewicz TR, et al. Integrins and mechanotransduction of the vascular myogenic response. Am J Physiol Heart Circ Physiol. 2001; 280(4): H1427–H1433.
    CrossRefPubMed
  10. Feihl F, Liaudet L, Waeber B, et al. Hypertension. Hypertension. 2006; 48(6): 1012–1017.
    CrossRef
  11. Renna NF, de Las Heras N, Miatello RM. Pathophysiology of vascular remodeling in hypertension. Int J Hypertens. 2013; 2013: 808353.
    CrossRefPubMed
  12. Heagerty AM, Aalkjaer C, Bund SJ, et al. Small artery structure in hypertension. Dual processes of remodeling and growth. Hypertension. 1993; 21(4): 391–397.
    CrossRefPubMed
  13. Folkow B, Folkow B, Folkow B, et al. Importance of adaptive changes in vascular design for establishment of primary hypertension, studied in man and in spontaneously hypertensive rats. Circ Res. 1973; 32(4): Suppl 1:2–Suppl 116.
    CrossRefPubMed
  14. Więcek A, Januszewicz A, Szczepańska-Sadowska E. Hipertensjologia : patogeneza, diagnostyka i leczenie nadciśnienia tętniczego. Medycyna Praktyczna, Kraków 2015.
  15. Levy BI, Ambrosio G, Pries AR, et al. Microcirculation in hypertension: a new target for treatment? Circulation. 2001; 104(6): 735–740.
    CrossRefPubMed
  16. Vicaut E. Microcirculation and arterial hypertension. Drugs. 1999; 59(Spec No): 1–10.
  17. Debbabi H, Bonnin P, Levy BI. Effects of blood pressure control with perindopril/indapamide on the microcirculation in hypertensive patients. Am J Hypertens. 2010; 23(10): 1136–1143.
    CrossRefPubMed
  18. Debbabi H, Uzan L, Mourad JJ, et al. Increased skin capillary density in treated essential hypertensive patients. Am J Hypertens. 2006; 19(5): 477–483.
    CrossRefPubMed
  19. Coca Payeras A, Williams B, Mancia G, et al. Authors/Task Force Members:, ESC Scientific Document Group . 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33): 3021–3104.
    CrossRefPubMed
  20. Turner J, Belch JJF, Khan F. Current concepts in assessment of microvascular endothelial function using laser Doppler imaging and iontophoresis. Trends Cardiovasc Med. 2008; 18(4): 109–116.
    CrossRefPubMed
  21. Takeshita A, Mark AL. Decreased vasodilator capacity of forearm resistance vessels in borderline hypertension. Hypertension. 1980; 2(5): 610–616.
    CrossRefPubMed
  22. Conway J. A vascular abnormality in hypertension. A study of blood flow in the forearm. Circulation. 1963; 27(4 Pt 1): 520–529.
    CrossRefPubMed
  23. Smith CJ, Santhanam L, Bruning RS, et al. Upregulation of inducible nitric oxide synthase contributes to attenuated cutaneous vasodilation in essential hypertensive humans. Hypertension. 2011; 58(5): 935–942.
    CrossRefPubMed
  24. Grodzicki T, Necki M, Cwynar M, et al. [Laser doppler flowmetry--repeatability of the method]. Przegl Lek. 2003; 60(2): 89–91.
    PubMed
  25. Cesarone MR, Laurora G, Belcaro GV. Microcirculation in systemic hypertension. Angiology. 1992; 43(11): 899–903.
    CrossRefPubMed
  26. Nahid MSEl, Ashmaui AEl. The skin microcirculatory changes in the normal and hypertensive elderly. Eur Geriatr Med. 2015; 6(1): 7–10.
    CrossRef
  27. Sieg-Dobrescu D, Burnier M, Hayoz D, et al. The return of increased blood pressure after discontinuation of antihypertensive treatment is associated with an impaired post-ischemic skin blood flow response. J Hypertens. 2001; 19(8): 1387–1392.
    CrossRefPubMed
  28. Aellen J, Dabiri A, Heim A, et al. Preserved capillary density of dorsal finger skin in treated hypertensive patients with or without type 2 diabetes. Microcirculation. 2012; 19(6): 554–562.
    CrossRefPubMed
  29. Mahé G, Humeau-Heurtier A, Durand S, et al. Assessment of skin microvascular function and dysfunction with laser speckle contrast imaging. Circ Cardiovasc Imaging. 2012; 5(1): 155–163.
    CrossRefPubMed
  30. Millet C, Roustit M, Blaise S, et al. Comparison between laser speckle contrast imaging and laser Doppler imaging to assess skin blood flow in humans. Microvasc Res. 2011; 82(2): 147–151.
    CrossRefPubMed
  31. Roustit M, Cracowski JL. Non-invasive assessment of skin microvascular function in humans: an insight into methods. Microcirculation. 2012; 19(1): 47–64.
    CrossRefPubMed
  32. Lazaridis A, Triantafyllou A, Dipla K, et al. Skin microvascular function, as assessed with laser speckle contrast imaging, is impaired in untreated essential and masked hypertension. Hypertens Res. 2022; 45(3): 445–454.
    CrossRefPubMed
  33. Wilkinson IB, Webb DJ. Venous occlusion plethysmography in cardiovascular research: methodology and clinical applications. Br J Clin Pharmacol. 2001; 52(6): 631–646.
    CrossRefPubMed
  34. Junqueira C, Magalhaes M, Brandao A, et al. [PP.36.15] Venous occlusion plethysmography and biomarkers as evaluation methods of endothelium function in patients with arterial hypertension. J Hypertens. 2016; 34(Suppl 2): e339–e340.
    CrossRef
  35. Allen J. Photoplethysmography and its application in clinical physiological measurement. Physiol Meas. 2007; 28(3): R1–39.
    CrossRefPubMed
  36. Zheleznykh EA, Danilogorskaya YA, Privalova EV, et al. Combination Antihypertensive Therapy with Perindopril and Indapamide in Patients with Essential Hypertension: Effect on Endothelial and Cognitive Markers of Vascular Improvement. Adv Ther. 2018; 35(10): 1698–1712.
    CrossRefPubMed
  37. Elgendi M, Fletcher R, Liang Y, et al. The use of photoplethysmography for assessing hypertension. NPJ Digit Med. 2019; 2: 60.
    CrossRefPubMed
  38. Liang Y, Chen Z, Ward R, et al. Hypertension Assessment Using Photoplethysmography: A Risk Stratification Approach. J Clin Med. 2018; 8(1).
    CrossRefPubMed
  39. Hosanee M, Chan G, Welykholowa K, et al. Cuffless Single-Site Photoplethysmography for Blood Pressure Monitoring. J Clin Med. 2020; 9(3).
    CrossRefPubMed
  40. Duarte-Gamas L, Pereira-Neves A, Sousa J, et al. The Diagnostic Accuracy of Intra-Operative Near Infrared Spectroscopy in Carotid Artery Endarterectomy Under Regional Anaesthesia: Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg. 2021; 62(4): 522–531.
    CrossRefPubMed
  41. Suneetha D, Murthy P. Blood Pressure Meter Using Near-Infrared Spectroscopy Sensors. Int J Adv Res. 2016; 4(12): 475–478.
    CrossRef
  42. Jones S, Park C, Chaturvedi N, et al. p77 Near infrared spectroscopy (NIRS) can detect differences in microvascular reactive hyperaemia in the presence of hypertension. Artery Research. 2017; 20(C): 74.
    CrossRef
  43. Cerný V, Turek Z, Pařízková R. Orthogonal polarization spectral imaging. Physiol Res. 2007; 56(2): 141–147.
    CrossRefPubMed
  44. Knotzer H, Hasibeder WR. Microcirculatory function monitoring at the bedside--a view from the intensive care. Physiol Meas. 2007; 28(9): R65–R86.
    CrossRefPubMed
  45. He FJ, Marciniak M, Markandu ND, et al. Effect of modest salt reduction on skin capillary rarefaction in white, black, and Asian individuals with mild hypertension. Hypertension. 2010; 56(2): 253–259.
    CrossRefPubMed
  46. Podoleanu AGh. Optical coherence tomography. J Microsc. 2012; 247(3): 209–219.
    CrossRefPubMed
  47. Donati S, Maresca AM, Cattaneo J, et al. Optical coherence tomography angiography and arterial hypertension: A role in identifying subclinical microvascular damage? Eur J Ophthalmol. 2021; 31(1): 158–165.
    CrossRefPubMed
  48. Tan W, Yao X, Le TT, et al. The Application of Optical Coherence Tomography Angiography in Systemic Hypertension: A Meta-Analysis. Front Med (Lausanne). 2021; 8: 778330.
    CrossRefPubMed
  49. Cutolo M, Sulli A, Secchi ME, et al. The contribution of capillaroscopy to the differential diagnosis of connective autoimmune diseases. Best Pract Res Clin Rheumatol. 2007; 21(6): 1093–1108.
    CrossRefPubMed
  50. Cutolo M, Smith V, Sulli A, et al. Atlas of capillaroscopy in rheumatic diseases: state of the art. Z Rheumatol. 2006; 65(4): 290–296.
  51. Mishra A, Grover C, Singal A, et al. Nailfold capillary changes in newly diagnosed hypertensive patients: An observational analytical study. Microvasc Res. 2021; 136: 104173.
    CrossRefPubMed
  52. Humbert P, Sainthillier JM, Mac-Mary S, et al. Capillaroscopy and videocapillaroscopy assessment of skin microcirculation: dermatologic and cosmetic approaches. J Cosmet Dermatol. 2005; 4(3): 153–162.
    CrossRefPubMed
  53. Gallucci F, Russo R, Buono R, et al. Indications and results of videocapillaroscopy in clinical practice. Adv Med Sci. 2008; 53(2): 149–157.
    CrossRefPubMed
  54. Antonios TFT, Nama V, Wang D, et al. Structural skin capillary rarefaction in essential hypertension. Hypertension. 1999; 33(4): 998–1001.
    CrossRefPubMed
  55. Neubauer-Geryk J, Hoffmann M, Wielicka M, et al. Current methods for the assessment of skin microcirculation: Part 1. Postepy Dermatol Alergol. 2019; 36(3): 247–254.
    CrossRefPubMed
  56. Ring EFJ, Ammer K. Infrared thermal imaging in medicine. Physiol Meas. 2012; 33(3): R33–R46.
    CrossRefPubMed
  57. Lahiri BB, Bagavathiappan S, Jayakumar T, et al. Medical applications of infrared thermography: A review. Infrared Phys Technol. 2012; 55(4): 221–235.
    CrossRefPubMed
  58. Kirubha SPA, Akash T, Roy B, et al. Infrared Thermography for Correlating Blood Pressure and Temperature. 2020 International Conference on Communication and Signal Processing (ICCSP). 2020.
    CrossRef
  59. Thiruvengadam J, Mariamichael A. A preliminary study for the assessment of hypertension using static and dynamic IR thermograms. Biomed Tech (Berl). 2018; 63(2): 197–206.
    CrossRefPubMed
  60. Southall DP, Bignall S, Stebbens VA, et al. Pulse oximeter and transcutaneous arterial oxygen measurements in neonatal and paediatric intensive care. Arch Dis Child. 1987; 62(9): 882–888.
    CrossRefPubMed
  61. Fife CE, Smart DR, Sheffield PJ, et al. Transcutaneous oximetry in clinical practice: consensus statements from an expert panel based on evidence. Undersea Hyperb Med. 2009; 36(1): 43–53.
  62. Grolman RE, Wilkerson DK, Taylor J, et al. Transcutaneous oxygen measurements predict a beneficial response to hyperbaric oxygen therapy in patients with nonhealing wounds and critical limb ischemia. Am Surg. 2001; 67(11): 1072–9; discussion 1080.
    PubMed
  63. Mayevsky A, Chance B. Oxidation-reduction states of NADH in vivo: from animals to clinical use. Mitochondrion. 2007; 7(5): 330–339.
    CrossRefPubMed
  64. Piotrowski L, Urbaniak M, Jedrzejczak B, et al. Note: Flow mediated skin fluorescence — A novel technique for evaluation of cutaneous microcirculation. Rev Sci Instrum. 2016; 87(3): 036111.
    CrossRefPubMed
  65. Nizinski J, Filberek P, Sibrecht G, et al. Non-invasive in vivo human model of post-ischaemic skin preconditioning by measurement of flow-mediated 460-nm autofluorescence. Br J Clin Pharmacol. 2021; 87(11): 4283–4292.
    CrossRefPubMed
  66. Pawlak-Chomicka R, Krauze T, Uruski P, et al. The Effect of Antihypertensive Drugs on NADH in Newly Diagnosed Primary Hypertension. Cardiol Res Pract. 2022; 2022: 6159883.
    CrossRefPubMed

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl