Is obesity predictive of cardiovascular dysfunction independent of cardiovascular risk factors?

INTRODUCTION: Obesity is thought to exert detrimental effects on the cardiovascular (CV) system. However, this relationship is impacted by the co-occurrence of CV risk factors, type 2 diabetes (T2DM) and overt disease. We examined the relationships between obesity, assessed by body mass index (BMI) and waist circumference (WC), and CV function in 102 subjects without overt CV disease. We hypothesized that obesity would be independently predictive of CV remodeling and functional differences, especially at peak exercise. METHODS: Brachial (bSBP) and central (cSBP) systolic pressure, carotid-to-femoral pulse wave velocity (PWVcf) augmentation index (AGI; by SphygmoCor), and carotid remodeling (B-mode ultrasound) were examined at rest. Further, peak exercise cardiac imaging (Doppler ultrasound) was performed to measure the coupling between the heart and arterial system. RESULTS: In backward elimination regression models, accounting for CV risk factors, neither BMI nor WC were predictors of carotid thickness or PWVcf; rather age, triglycerides and hypertension were the main determinants. However, BMI and WC predicted carotid cross-sectional area and lumen diameter. When examining the relationship between body size and SBP, BMI (ß=0.32) and WC (ß=0.25) were predictors of bSBP (P<0.05), whereas, BMI was the only predictor of cSBP (ß=0.22, P<0.05) indicating a differential relationship between cSBP, bSBP and body size. Further, BMI (ß=-0.26) and WC (ß=-0.27) were independent predictors of AGI (P<0.05). As for resting cardiac diastolic function, WC seemed to be a better predictor than BMI. However, both BMI and WC were inversely and independently related to arterial-elastance (net arterial load) and end-systolic elastance (cardiac contractility) at rest and peak exercise. CONCLUSION: These findings illustrate that obesity, without T2DM and overt CV disease, and after accounting for CV risk factors, is susceptible to pathophysiological adaptations that may predispose individuals to an increased risk of CV events.

Role of prostanoids and 20-HETE in mediating oxygen-induced constriction of skeletal muscle resistance arteries.

This study determined the contribution of cytochrome P450 (CP450) 4A enzyme metabolites of arachidonic acid in mediating the constriction of isolated rat skeletal muscle resistance arteries in response to elevated PO2. Gracilis arteries (GA) were viewed via television microscopy and constrictor responses to elevated PO2 were measured with a video micrometer. Endothelium removal and treatment of GA with 17-octadecynoic acid (17-ODYA; suicide substrate inhibitor of CP450 4A enzymes) impaired oxygen-induced constriction of the vessels; treatment of endothelium-denuded GA with 17-ODYA eliminated responses to elevated PO2. NOS inhibition and inhibition of EET production had no effect on oxygen-induced constriction of the vessels, although cyclooxygenase inhibition with indomethacin impaired GA responses to elevated PO2. Treatment of GA with dibromododecenyl methylsulfimide (DDMS; inhibitor of 20-hydroxyeicosatetraenoic acid (20-HETE) production) or 6(Z),15(Z)-20-HEDE (antagonist for 20-HETE receptors) mimicked the effects of 17-ODYA on GA responses to elevated PO2. Treatment of vessels with iberiotoxin or glibenclamide reduced the constriction of the vessels in response to elevated PO2 while treatment with both K+ channel blockers eliminated oxygen-induced constriction of the vessels. Following treatment of GA with indomethacin and 20-HETE, the vessels failed to respond to elevated PO2. These results suggest that oxygen-induced constriction of skeletal muscle resistance arteries represents the combined effects of reduced prostanoid release from the vascular endothelium and enhanced 20-HETE production in vascular smooth muscle cells.

Impaired dilation of skeletal muscle microvessels to reduced oxygen tension in diabetic obese Zucker rats.

This study determined alterations to hypoxic dilation of isolated skeletal muscle resistance arteries (gracilis arteries; viewed via television microscopy) from obese Zucker rats (OZR) compared with lean Zucker rats (LZR). Hypoxic dilation was reduced in OZR compared with LZR. Endothelium removal and cyclooxygenase inhibition (indomethacin) severely reduced this response in both groups, although nitric oxide synthase inhibition (N(omega)-nitro-L-arginine methyl ester) reduced dilation in LZR only. Treatment of vessels with a PGH(2)-thromboxane A(2) receptor antagonist had no effect on hypoxic dilation in either group. Arterial dilation to arachidonic acid, iloprost, acetylcholine, and sodium nitroprusside was reduced in OZR versus LZR, although dilation to forskolin and aprikalim was unaltered. Treatment of arteries from OZR with oxidative radical scavengers increased dilation to hypoxia and agonists, with no effect on responses in LZR. The restored hypoxic dilation in OZR was abolished by indomethacin. These results suggest that hypoxic dilation of skeletal muscle microvessels from LZR represents the summated effects of prostanoid and nitric oxide release, whereas the impaired response of vessels in OZR may reflect scavenging of PGI(2) by superoxide anion.

High-salt diet impairs hypoxia-induced cAMP production and hyperpolarization in rat skeletal muscle arteries.

This study determined the effects of hypoxia on diameter, vascular smooth muscle (VSM) transmembrane potential (E(m)), and vascular cAMP levels for in vitro cannulated skeletal muscle resistance arteries (gracilis arteries) from Sprague-Dawley rats fed a low-salt (LS) or a high-salt (HS) diet. Arterial diameter and VSM E(m) were measured in response to hypoxia, iloprost, cholera toxin, forskolin, and aprikalim. In HS rats, arterial dilation and VSM hyperpolarization after hypoxia, iloprost, and cholera toxin were impaired versus responses in LS rats, whereas responses to forskolin and aprikalim were unaltered. Blockade of prostaglandin H(2) and thromboxane A(2) receptors had no effect on responses to hypoxia or iloprost in vessels from both rat groups, suggesting that inappropriate activation of these receptors does not contribute to the impaired hypoxic dilation with HS. Hypoxia, cholera toxin, and iloprost increased vascular cAMP levels in vessels of LS rats only, whereas forskolin increased cAMP levels in all vessels. These data suggest that reduced hypoxic dilation of skeletal muscle microvessels in rats on a HS diet may reflect an impaired ability of VSM to produce cAMP after exposure to prostacyclin.

Impaired NO-dependent dilation of skeletal muscle arterioles in hypertensive diabetic obese Zucker rats.

This study determined alterations to nitric oxide (NO)-dependent dilation of skeletal muscle arterioles from obese (OZR) versus lean Zucker rats (LZR). In situ cremaster muscle arterioles from both groups were viewed via television microscopy, and vessel dilation was measured with a video micrometer. Arteriolar dilation to acetylcholine and sodium nitroprusside was reduced in OZR versus LZR, although dilation to aprikalim was unaltered. NO-dependent flow-induced arteriolar dilation (via parallel microvessel occlusion) was attenuated in OZR, impairing arteriolar ability to regulate wall shear rate. Vascular superoxide levels, as assessed by dihydroethidine fluorescence, were elevated in OZR versus LZR. Treatment of cremaster muscles of OZR with the superoxide scavengers polyethylene glycol-superoxide dismutase and catalase improved arteriolar dilation to acetylcholine and sodium nitroprusside and restored flow-induced dilation and microvascular ability to regulate wall shear rate. These results suggest that NO-dependent dilation of skeletal muscle microvessels in OZR is impaired due to increased levels of superoxide. Taken together, these data suggest that the development of diabetes and hypertension in OZR may be associated with an impaired skeletal muscle perfusion via an elevated vascular oxidant stress.

Relative contributions of cyclooxygenase- and cytochrome P450 omega-hydroxylase-dependent pathways to hypoxic dilation of skeletal muscle resistance arteries.

This study determined the contribution of prostanoids, cytochrome P450 (CP450) 4A enzyme metabolites of arachidonic acid, and other potential mediators of hypoxic dilation of isolated rat skeletal muscle resistance arteries. Gracilis arteries (GA) were viewed via television microscopy and dilator responses to hypoxia (reduction in superfusate and perfusate PO2 from approximately 145 to approximately 40 mm Hg) were measured with a video micrometer. Hypoxic dilation of gracilis arteries was severely impaired by either endothelium removal or cyclooxygenase inhibition with indomethacin, but not by nitric oxide synthase inhibition with L-NAME. Treatment of GA with 17-octadecynoic acid (17-ODYA) alone to inhibit CP450 4A enzymes significantly reduced hypoxic dilation from control levels. Treatment of vessels with N-methylsulfonyl-6-(2-proparglyoxyphenyl)hexanoic acid (MS-PPOH) to inhibit the production of epoxyeicosatrienoic acids (EETs) did not alter hypoxic dilation, although treatment with dibromo-dodecenyl-methylsulfimide (DDMS) to inhibit 20-hydroxyeicosatetraenoic acid (20-HETE) production had similar effects as 17-ODYA. Treatment of GA with 6(Z),15(Z)-20-HEDE, a competitive antagonist of the actions of 20-HETE, mimicked the effects of 17-ODYA and DDMS treatment on hypoxic dilation. These results suggest that hypoxic dilation of skeletal muscle resistance arteries primarily represents the effects of enhanced prostanoid release from vascular endothelium, although a contribution of reduced 20-HETE production via CP450 omega-hydroxylase enzymes also regulates hypoxic dilation of these vessels.

Altered mechanisms underlying hypoxic dilation of skeletal muscle resistance arteries of hypertensive versus normotensive Dahl rats.

OBJECTIVE: To determine mechanisms underlying hypoxic dilation of skeletal muscle resistance arteries from normotensive (NT) and hypertensive (HT) Dahl salt-sensitive (SS) rats. METHODS: Isolated gracilis arteries (GA) from both rat groups were viewed via television microscopy and vascular responses to a reduction in PO2 from 145 mm Hg to 40 mm Hg were measured with a video micrometer. Responses were determined following endothelium removal and following inhibition of specific biochemical pathways regulating vascular tone. RESULTS: Hypoxic dilation was impaired in HT rats versus NT controls. Endothelium removal abolished hypoxic dilation in NT rats, although a significant dilation to hypoxia remained in vessels from HT animals. Inhibition of cytochrome P450 (CP450) 4A enzymes blunted hypoxic dilation in both groups, while inhibition of epoxyeicosatrienoic acid (EET) production impaired responses in NT rats only. Inhibition of 20-hydroxyeicosatetraenoic acid (20-HETE) production or blockade of membrane receptors for 20-HETE reduced hypoxic dilation in HT rats, with minimal effects in NT animals. Nitric oxide synthase inhibition had no effect on hypoxic dilation in either group, while cyclooxygenase inhibition significantly reduced this response in both groups. CONCLUSIONS: These results suggest that the mechanisms of hypoxic dilation in GA from NT Dahl-SS rats are altered with HT, impairing the response to reduced PO2. While hypoxia induces substantial prostanoid release in both groups, the role of CP450 4A enzymes is shifted from EET production in NT rats toward inhibition of 20-HETE production in HT rats.

20-HETE contributes to myogenic activation of skeletal muscle resistance arteries in Brown Norway and Sprague-Dawley rats.

OBJECTIVE: To evaluate the role of 20-hydroxyeicosatetraenoic acid (20-HETE), a product of arachidonic acid omega-hydroxylation via cytochrome P450 (CP450) 4A enzymes, in regulating myogenic activation of skeletal muscle resistance arteries from normotensive Brown Norway (BN) and Sprague-Dawley (SD) rats. METHODS: Gracilis arteries (GA) were isolated from each animal, viewed via television microscopy, and vessel diameter responses to elevated transmural pressure were measured with a video micrometer under control conditions and following pharmacological inhibition of the CP450 4A enzyme system. RESULTS: Under control conditions, GA from both rat groups exhibited strong, endothelium-independent myogenic activation, which was impaired following treatment with either 17-octadecynoic acid (17-ODYA) or dibromo-dodecenylmethylsulfimide (DDMS), two mechanistically different inhibitors of 20-HETE production. The addition of tetraethylammonium (KCa channel inhibitor) to 17-ODYA-treated GA restored myogenic reactivity to levels comparable to those under control conditions. Treatment of GA from BN and SD rats with 6(Z),15(Z)-20-HEDE, a selective antagonist for 20-HETE receptors, mimicked the effects of 17-ODYA and DDMS treatment on myogenic reactivity. CONCLUSIONS: These results suggest that the production of 20-HETE via CP450 4A enzymes contributes to the myogenic activation of skeletal muscle resistance arteries from normotensive BN and SD rats. 20-HETE may act through a receptor-mediated process to block vascular smooth muscle KCa channels in response to the elevated transmural pressure.

20-HETE modulates myogenic response of skeletal muscle resistance arteries from hypertensive Dahl-SS rats.

The present study determined the role of 20-hydroxyeicosatetraenoic acid [20-HETE; produced by omega-hydroxylation of arachidonic acid via cytochrome P-450 (CP450) 4A enzymes] in regulating myogenic activation of skeletal muscle resistance arteries from normotensive (NT) and hypertensive (HT) Dahl salt-sensitive (SS) rats. Gracilis arteries (GA) were isolated from each rat and viewed via television microscopy, and changes in vessel diameter with altered transmural pressure were measured with a video micrometer. Under control conditions, GA from both groups exhibited strong, endothelium-independent myogenic activation. Treatment of GA with 17-octadecynoic acid (17-ODYA; inhibitor of CP450 4A enzymes) did not alter myogenic activation in NT rats, but impaired this response in HT animals. Treatment of GA from HT rats with dibromo-dodecynyl-methylsulfimide (DDMS; inhibitor of 20-HETE production) impaired myogenic activation, as did application of 20-hydroxyeicosa-6(Z),15(Z)-dienoic acid, an antagonist for 20-HETE receptors. Application of iberiotoxin, a Ca(2+)-activated potassium (K(Ca)) channel inhibitor, restored myogenic activation from HT rats treated with DDMS. These results suggest that myogenic activation of skeletal muscle resistance arteries from NT Dahl-SS rats does not depend on CP450, whereas myogenic activation of these vessels in HT Dahl-SS rats is partly a function of 20-HETE production, inhibiting K(Ca) channels through a receptor-mediated process.

Microvascular flow and tissue PO(2) in skeletal muscle of chronic reduced renal mass hypertensive rats.

This study determined whether arteriolar blood flow, capillary red blood cell (RBC) velocity, capillary hematocrit (Hct(cap)), and tissue PO(2) are altered in cremaster muscles of rats with chronic reduced renal mass hypertension (RRM-HT) relative to normotensive rats on high- or low-salt (NT-HS vs. NT-LS) diet. The blood flow in first- through third-order arterioles was not different between NT and HT rats, either at rest or during maximal relaxation of the vessels with 10(-4) M adenosine. Capillary RBC velocity was similar between the groups at rest but was elevated in RRM-HT and NT-HS rats during adenosine superfusion. Hct(cap) was reduced at rest in RRM-HT and NT-HS rats compared with NT-LS and was reduced in RRM-HT rats during adenosine-induced dilation. Tissue PO(2) was reduced in RRM-HT and NT-HS rats compared with NT-LS rats during control conditions and was lower in RRM-HT than in NT-LS rats during adenosine-induced dilation. These results indicate that both RRM-HT and chronic exposure of normotensive rats to a high-salt diet lead to reduced tissue oxygenation, despite the maintenance of normal arteriolar blood flow.

Contribution of extrinsic factors and intrinsic vascular alterations to reduced arteriolar reactivity with high-salt diet and hypertension.

OBJECTIVE: To determine whether the impaired relaxation of skeletal muscle arterioles of rats on high-salt diet or with reduced renal mass hypertension (RRM-HT) represents intrinsic alterations to microvessels alone, or whether extravascular influences also contribute to reduced dilator responses. METHODS: Normotensive (NT) Sprague-Dawley rats were fed low-salt (LS) or high-salt (HS) diets, and RRM-HT rats were fed HS diet for 4-6 weeks. In situ and isolated cremaster muscle first-order arterioles (1A) were examined using television microscopy, and a video micrometer was used to measure diameter changes in response to acetylcholine (ACH), cholera toxin (CT), and sodium nitroprusside (SNP). RESULTS: Compared to normotensive low-salt (NT-LS) rats, responses of 1A to the agonists were reduced in normotensive high-salt (NT-HS) and RRM-HT rats. Arteriolar reactivity to the agonists in NT-LS rats aid in NT-HS rats was not different between in situ and in vitro environments. However, in RRM-HT rats, the reactivity of 1A to each agonist was greater in isolated arterioles than in in situ arterioles. CONCLUSIONS: These results suggest that the impaired response of skeletal muscle arterioles to vasodilator stimuli in normotensive rats on high-salt diet primarily reflects alterations to microvessels alone, while reduced dilator responses in RRM-HT rats represent a combination of extravascular influences and intrinsic alterations to arterioles themselves.

Longitudinal differences in vascular control mechanisms in isolated resistance arteries of the rat cremaster muscle.

The purpose of this study was to determine if there are intrinsic differences in resting tone, vascular reactivity, myogenic responses, and neurogenic vasoconstriction between the large and small feeder arteries and first order arterioles (1A) of the rat cremaster muscle. The pudic-epigastric artery (PEA), external spermatic artery (ESA), and 1A were isolated and changes in vessel diameter were recorded in response to: (1) increases in intralumenal pressure, (2) inhibition of nitric oxide synthase (NOS), (3) norepinephrine (NE), (4) acetylcholine (ACh), and (5) perivascular nerve stimulation. Vessel responses to Ca(2+)-free physiological salt solution were measured to assess resting tone, which was significantly greater in the ESA and 1A compared to the PEA. NE caused a significant constriction of all vessels, with 1A exhibiting the greatest sensitivity. NOS inhibition did not alter vascular sensitivity to NE, but enhanced resting tone in ESA and 1A. ACh induced significant dilation in ESA and 1A, with minimal effect on PEA. The myogenic response was not different between ESA and 1A, but was minimal in PEA. Perivascular nerve stimulation induced a significant vasoconstriction in all vessels tested. These results suggest that the relative importance of different vascular control mechanisms varies substantially at different levels of the cremasteric arterial network and that the ESA and 1A may be the major site of active vascular regulation upstream from the cremaster muscle microcirculation.

Impairment of flow-induced dilation of skeletal muscle arterioles with elevated oxygen in normotensive and hypertensive rats.

The effects of elevated PO(2) on flow-induced dilation of in situ skeletal muscle arterioles was assessed in cremaster muscle preparations from spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto (WKY) rats. Blood flow increases in selected arterioles were initiated by occlusion of a parallel daughter branch from a parent arteriole. Changes in the diameter of the perfused arteriole were measured with a video micrometer and erythrocyte velocity was measured using optical Doppler velocimetry. Superfusate PO(2) was controlled by changing the O(2) concentration (0% O(2) or 21% O(2)) of the equilibration gas mixture. The increase in arteriolar diameter during occlusion was reduced in SHR compared to WKY rats, resulting in an elevated wall shear rate in SHR. Elevated PO(2) decreased flow-induced dilation in both groups and increased wall shear rate during parallel occlusion. An inhibitor of the formation of 20-HETE via cytochrome P450-4A enzymes (P450), dibromododecenyl methylsulfimide, minimized O(2)-induced constriction of arterioles and prevented the O(2)-induced decrease in flow-induced dilation and the increase in wall shear rate in both SHR and WKY rats. These results suggest that: (1) flow-induced dilation of in situ skeletal muscle arterioles is impaired in SHR compared to WKY, (2) elevated O(2) compromises flow-induced dilation in both groups, (3) 20-HETE contributes to both the O(2)-induced increases in resting tone and the reduced flow-induced dilation of cremasteric arterioles with elevated PO(2).

Short-term angiotensin converting enzyme inhibition reduces basal tone and dilator reactivity in skeletal muscle arterioles.

Alterations in resting tone, maximum diameter, and dilator reactivity to acetylcholine (ACH) and sodium nitroprusside (SNP) were assessed in cremaster muscle microvessels of Sprague-Dawley rats receiving angiotensin converting enzyme (ACE) inhibition with captopril for 4 days and in untreated time-control rats. The transilluminated in situ cremaster muscle was superfused with physiologic salt solution (PSS) and viewed via television microscopy; arteriolar diameter was measured using a videomicrometer. Before agonist challenge, resting arteriolar diameter was significantly increased in captopril-treated rats. Although maximum arteriolar diameter (determined during superfusion of the cremaster muscle with Ca2+-free PSS containing 10(-4) mol/L adenosine) was not altered with ACE inhibition, the maximum possible arteriolar dilation was reduced in captopril-treated rats. Captopril administration reduced both ACH- and SNP-induced dilation of cremasteric arterioles compared with responses in control rats, although this was partially a function of the reduced capacity for dilation, primarily to SNP. These observations indicate that short-term ACE inhibition reduces both resting tone and agonist-induced dilator responses of skeletal muscle arterioles.

Contribution of cytochrome P-450 omega-hydroxylase to altered arteriolar reactivity with high-salt diet and hypertension.

The present study evaluated the contribution of cytochrome P-450 omega-hydroxylase in modulating the reactivity of cremaster muscle arterioles in normotensive rats on high-salt (HS) and low-salt (LS) diet and in rats with reduced renal mass hypertension (RRM-HT). Changes in arteriolar diameter in response to ACh, sodium nitroprusside (SNP), ANG II, and elevated O(2) were measured via television microscopy under control conditions and following cytochrome P-450 omega-hydroxylase inhibition with 17-octadecynoic acid (17-ODYA) or N-methylsulfonyl-12,12-dibromododec-11-enamide (DDMS). In normotensive rats on either LS or HS diet, resting tone was unaffected and arteriolar reactivity to ACh or SNP was minimally affected by cytochrome P-450 omega-hydroxylase inhibition. In RRM-HT rats, cytochrome P-450 omega-hydroxylase inhibition reduced resting tone and significantly enhanced arteriolar dilation to ACh and SNP. Treatment with 17-ODYA or DDMS inhibited arteriolar constriction to ANG II and O(2) in all the groups, although the degree of inhibition was greater in RRM-HT than in normotensive animals. These results suggest that metabolites of cytochrome P-450 omega-hydroxylase contribute to the altered reactivity of skeletal muscle arterioles to vasoconstrictor and vasodilator stimuli in RRM-HT.

Reduced renal mass hypertension, but not high salt diet, alters skeletal muscle arteriolar distensibility and myogenic responses.

The effects of high salt diet and reduced renal mass hypertension (RRM-HT) on skeletal muscle arteriolar distensibility and myogenic responses were investigated in male Sprague-Dawley rats. Rats were enclosed in an air-tight box with the in situ cremaster muscle exteriorized and viewed via television microscopy. Normotensive rats were fed low salt (0.4% NaCl) or high salt (4.0% NaCl) diet and RRM-HT rats were fed high salt diet for 4-6 weeks. With the cremaster muscle superfused with either physiological salt solution (for myogenic responses) or Ca(2+)-free physiological salt solution (for arteriolar distensibility), box pressure (and therefore, intravascular pressure) was increased in 5 mm Hg increments to a maximum of +30 mm Hg. The myogenic responses of arterioles were not altered by high salt diet, but were enhanced with RRM-HT. Arteriolar distensibility was not affected by high salt diet, but was reduced in RRM-HT rats compared to either normotensive rat group. These data suggest that high salt diet does not significantly alter either myogenic responses or the distensibility of rat cremasteric arterioles. However, RRM-HT enhances myogenic responses of these vessels while reducing arteriolar distensibility. The impact of these effects must be taken into account when interpreting data describing alterations in skeletal muscle microvessel reactivity for animals on high salt diet or with RRM hypertension.

Development and reversibility of altered skeletal muscle arteriolar structure and reactivity with high salt diet and reduced renal mass hypertension.

OBJECTIVE: To determine the development and reversibility of the altered vasodilator reactivity of cremasteric arterioles in rats on high-salt diet and with reduced renal mass hypertension (RRMHT). METHODS: Sprague Dawley rats were fed high-salt (HS) or low-salt (LS) diet and RRMHT rats were fed HS diet (HSRRM) over 4 weeks, after which a group of HS and HSRRM rats were fed LS diet for 4 additional weeks (HS/LS and HS/LSRRM), while all others remained on their original diet. Changes in arteriolar diameter to dilator agonists (acetylcholine, iloprost, cholera toxin, forskolin, and sodium nitroprusside) and to Ca2+ free solution plus adenosine (to determine maximum diameter) were measured with a videomicrometer. RESULTS: Reduced vasodilator reactivity developed over 4 weeks with HS diet and RRMHT, although more rapidly and to a greater extent with RRMHT. In HS rats, the reduced reactivity was completely reversible with restoration of LS diet. Complete recovery of dilator reactivity to control levels did not occur with restoration of LS diet and normotension in HS/LSRRM rats, although the slope of the recovery over the final 4 weeks was comparable to that in normotensive HS/LS animals. CONCLUSIONS: Impaired vasodilator reactivity, occurring with high-salt diet, appears to be fully reversible. Impaired vascular reactivity may recover after restoration of normal blood pressure in RRMHT, although over a longer period than with high-salt diet alone.