Blood pressure: 18 papers
Peer-reviewed work on the endothelial glycocalyx, microvascular health and the ingredients in our formulas, newest first. Abstracts are indexed here and every paper links to the journal.
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Published paper
Association of COVID-19 with impaired endothelial glycocalyx, vascular function and myocardial deformation four months after infection
This case-control study compared 70 people four months after COVID-19 infection with 70 age- and sex-matched untreated hypertensive patients and 70 healthy controls, measuring glycocalyx thickness (sublingual perfused boundary region), endothelial and coronary function, arterial stiffness, cardiac strain, and blood markers. Post-COVID patients showed impaired glycocalyx, reduced flow-mediated dilatation and coronary flow reserve, and stiffer arteries — similar to hypertensive patients and worse than healthy controls — plus markedly higher oxidative stress and thrombomodulin. Right ventricular function was worse in the COVID group than in either comparison group, and residual cardiovascular symptoms tracked with these abnormalities.
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Published paper
Six-month supplementation with high dose coenzyme Q10 improves liver steatosis, endothelial, vascular and myocardial function in patients with metabolic-dysfunction associated steatotic liver disease: A Randomized Double-blind, Placebo Controlled Trial
In this single-center, double-blind randomized trial, 60 non-diabetic patients with MASLD received either a supplement containing 240 mg/day coenzyme Q10 (plus choline, milk thistle, cynara, selenium, vitamin C and B vitamins) or placebo for 6 months, alongside Mediterranean diet and exercise advice. The CoQ10 group showed reductions in liver fat (CAP), sublingual perfused boundary region (a marker of thicker endothelial glycocalyx), arterial stiffness and blood pressure, plus improved brachial flow-mediated dilation, coronary flow reserve and left ventricular global longitudinal strain, while the placebo group showed no significant change. Reductions in liver steatosis correlated with the vascular and myocardial improvements.
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Published paper
Glycocalyx-targeted therapy ameliorates age-related arterial dysfunction
In mice, researchers reduced glycocalyx thickness by knocking down hyaluronan synthase 2 (Has2) and found this reproduced hallmarks of arterial aging: impaired endothelium-dependent dilation and increased aortic stiffness. Conversely, feeding old mice for 10 weeks with a glycocalyx-component supplement (Endocalyx, containing high-molecular-weight hyaluronan, glucosamine sulfate, fucoidan and superoxide dismutase) or with high-molecular-weight hyaluronan alone restored glycocalyx thickness and barrier function and improved endothelial function, aortic stiffness and blood pressure. Aortic wall composition (collagen, elastin) in supplemented old mice also resembled that of young mice.
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Published paper
Perfused boundary region as biomarker for endothelial integrity in former preterms in adolescence
In the Belgian PREMATCH cohort, researchers measured sublingual perfused boundary region (PBR, an inverse index of glycocalyx thickness) by sidestream dark-field imaging in 93 adolescents born at extremely low birth weight (ELBW) and 87 healthy controls, alongside blood pressure, cystatin-C-based eGFR, and retinal vessel imaging. PBR did not differ between the groups even though ELBW survivors had higher blood pressure, lower eGFR, and altered retinal vessel width and tortuosity. The authors provide reference PBR values for adolescents but conclude that PBR correlates too weakly with other microvascular markers to serve as a stand-alone marker of endothelial integrity in this group.
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Published paper
The microvascular endothelial glycocalyx: An additional piece of the puzzle in veterinary medicine
This narrative review summarizes the structure, functions, and disease relevance of the endothelial glycocalyx (eGlx), with a focus on the near-absence of research in cats and dogs. It compares direct visualization methods (perfusion/immersion fixation electron microscopy, lectin staining) with clinically applicable indirect methods (ELISAs for shed hyaluronan, syndecan-1, heparan sulfate; sidestream dark-field imaging of the perfused boundary region). It also reviews evidence for glycocalyx damage in sepsis, kidney disease, hypervolemia and hypertension, and outlines candidate protective or restorative strategies.
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Published paper
May We Use Non-Invasive Indices of Aortic Stiffness and Endothelial Glycocalyx as Biomarkers for Idiopathic Pulmonary Artery Hypertension Follow-Up?
This single-patient case report tracks three annual evaluations (2018-2020) of a woman with idiopathic pulmonary arterial hypertension, comparing invasive hemodynamics and exercise capacity with two non-invasive systemic vascular measures: carotid-femoral pulse wave velocity (aortic stiffness) and sublingual perfused boundary region (endothelial glycocalyx, GlycoCheck). When her pulmonary vascular resistance worsened, glycocalyx measures worsened (higher PBR, lower red blood cell filling), and both improved after treatment was changed. The authors suggest these indices deserve further study as non-invasive follow-up markers, but a single case cannot establish this.
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Published paper
Sex-related associations of high-density lipoprotein cholesterol with aortic stiffness and endothelial glycocalyx integrity in treated hypertensive patients
This cross-sectional study of 193 treated hypertensive patients examined whether HDL cholesterol levels relate to aortic stiffness (carotid-femoral pulse wave velocity) and endothelial glycocalyx integrity (sublingual perfused boundary region measured by sidestream dark-field imaging/GlycoCheck). Higher HDL-C was weakly and inversely associated with aortic stiffness in the whole group, and with PBR5-9 (a marker where higher values indicate a thinner glycocalyx) specifically in men, regardless of smoking status. No such glycocalyx association was seen in women, despite their higher HDL-C levels.
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Published paper
Effects of Glucagon Like Peptide 1 Receptor Agonists, Sodium Glucose Cotransporter 2 Inhibitors, and Their Combination on Endothelial Glycocalyx, Arterial Function, and Myocardial Work Index in Patients With Type 2 Diabetes Mellitus After 12 Month Treatme
In this 12-month randomized trial, 160 patients with type 2 diabetes were assigned to add-on insulin, liraglutide (GLP-1RA), empagliflozin (SGLT-2i), or the GLP-1RA/SGLT-2i combination. Despite similar HbA1c reductions across groups, the newer agents and especially the combination produced greater improvements in sublingual glycocalyx thickness (perfused boundary region), arterial stiffness, central blood pressure, and echocardiographic myocardial strain and work indices than insulin.
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Published paper
Uncoupling of Microvascular Blood Flow and Capillary Density in Vascular Cognitive Impairment
Researchers used sublingual video microscopy (GlycoCheck system) to compare how the smallest blood vessels respond to spontaneous changes in blood flow in 15 men with vascular cognitive impairment from cerebral small vessel disease and 15 male controls. In healthy controls, the number of red-cell-perfused capillaries rose as feed vessel flow rose, whereas in patients with cognitive impairment it did not. The authors interpret this as an uncoupling of microvascular flow from perfused capillary density, which could limit oxygen and nutrient exchange when metabolic demand increases.
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Published paper
Early Onset Preeclampsia Is Associated With Glycocalyx Degradation and Reduced Microvascular Perfusion
This exploratory cross-sectional study used sublingual sidestream dark field imaging (GlycoCheck) plus blood markers to compare endothelial glycocalyx status in 137 third-trimester pregnant women. Women with early-onset preeclampsia (<34 weeks) showed greater glycocalyx degradation (higher perfused boundary region) and fewer capillaries filled with red blood cells than normotensive women, women with gestational diabetes, or those with late-onset preeclampsia. Circulating heparan sulfate proteoglycans and hyaluronic acid were also elevated in early-onset preeclampsia.
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Published paper
Increase in perfused boundary region of endothelial glycocalyx is associated with higher prevalence of ischemic heart disease and lesions of microcirculation and vascular wall.
This cross-sectional study measured the perfused boundary region (PBR), an index of red blood cell penetration into the endothelial glycocalyx, using sidestream dark-field capillaroscopy in 208 middle-aged patients. Higher PBR values (above about 2 micrometers) were associated with a greater prevalence of ischemic heart disease and cerebral atherosclerosis, as well as structural and functional abnormalities of the arterial wall and skin microcirculation. The authors propose PBR as a reproducible, non-invasive candidate marker of cardiovascular disease.
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Published paper
Induced Trf2 deletion leads to aging vascular phenotype in mice associated with arterial telomere uncapping, senescence signaling, and oxidative stress
Researchers deleted the telomere-protecting protein Trf2 in adult mice to force telomere 'uncapping' without shortening telomeres, then measured artery and microvessel function. Trf2 deletion produced senescence signaling, oxidative stress, impaired nitric-oxide-dependent vasodilation, thinner endothelial glycocalyx, reduced microvascular perfusion, and modestly higher systolic blood pressure — a pattern resembling normal vascular aging.
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Published paper
HDL cholesterol levels and endothelial glycocalyx integrity in treated hypertensive patients
This cross-sectional study measured sublingual perfused boundary region (PBR 5-9 µm) with GlycoCheck sidestream dark-field imaging in 120 treated hypertensive patients over 50 and compared results across HDL-cholesterol tertiles. Patients in the highest HDL-C tertile (71-101 mg/dL) had a modestly lower PBR (thicker glycocalyx) than those with lower HDL-C. However, in multivariable analysis only BMI, not HDL-C, independently predicted PBR.
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Published paper
Association of impaired endothelial glycocalyx with arterial stiffness, coronary microcirculatory dysfunction, and abnormal myocardial deformation in untreated hypertensives
This cross-sectional case-control study compared sublingual glycocalyx thickness (measured as perfused boundary region, PBR, by sidestream dark-field imaging/GlycoCheck) in 320 untreated hypertensive patients and 160 normotensive controls. Hypertensives had thicker PBR (indicating thinner, more damaged glycocalyx), stiffer arteries, lower coronary flow reserve, and reduced left ventricular longitudinal strain. Higher PBR remained independently associated with arterial stiffness, coronary microcirculatory dysfunction, and impaired myocardial deformation after adjustment for standard risk factors.
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Published paper
Improvement of arterial stiffness and myocardial deformation in patients with poorly controlled diabetes mellitus type 2 after optimization of antidiabetic medication
This study compared arterial stiffness, heart muscle deformation, endothelial function, and sublingual microvascular glycocalyx thickness in 50 patients with poorly controlled type 2 diabetes versus 25 healthy controls, then reassessed the diabetic patients 6 months after their antidiabetic medication was optimized. At baseline, diabetic patients had stiffer arteries, worse left ventricular strain and diastolic indices, and a higher perfusion boundary region (indicating a thinner endothelial glycocalyx). After achieving glycemic control, carotid-femoral pulse wave velocity fell and untwisting velocity and flow-mediated dilatation improved.
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Published paper
P673 Improvement of arterial stiffness and myocardial deformation in patients with poorly controlled diabetes mellitus type 2 after optimization of antidiabetic medication
This conference abstract compared 50 adults with poorly controlled type 2 diabetes with 25 healthy controls using arterial stiffness measures, speckle-tracking echocardiography, sublingual microvascular imaging (GlycoCheck perfused boundary region), and brachial flow-mediated dilation. Diabetic patients had stiffer arteries, worse left ventricular deformation, and a higher PBR (indicating a thinner endothelial glycocalyx). After six months of optimized antidiabetic medication and achieved glycemic control, carotid-femoral pulse wave velocity fell and untwisting velocity and endothelial function improved.
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Published paper
Effect of an acute and chronic slat load on microvascular permeability in healthy subjects.
In a randomized crossover study, 12 healthy men followed 8 days of a low-sodium diet and 8 days of a high-sodium diet, and also received an acute intravenous hypertonic saline load. Microvascular permeability (transcapillary escape rate of radiolabeled albumin) rose after the acute salt infusion but not after chronic dietary salt loading, while sublingual glycocalyx measures (perfused boundary region) and microvascular perfusion were unchanged in all conditions.
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Published paper
Characteristics and determinants of the sublingual microcirculation in populations of different ethnicity
This population-based study used sidestream/oblique epi-illumination sublingual capillaroscopy with GlycoCheck software to measure capillary density and the perfused boundary region (PBR, an inverse proxy for glycocalyx thickness) in 252 Han Chinese, 220 She Chinese and 254 Flemish adults. Higher cardiovascular risk (age, BMI, cholesterol, Framingham score) was associated with greater functional capillary recruitment, and in perfused capillaries a higher BMI and higher blood pressure were associated with lower PBR (i.e. apparently thicker glycocalyx). Associations were consistent across the three ethnic groups, although absolute PBR and capillary density differed between Chinese and Flemish participants.
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