Objective To explore the function of endothelial progenitor cells (EPCs) and influencing factors in patients with hypertension combined with coronary microvascular disease (CMVD).

Methods A total of 212 patients with hypertension who were treated with conventional oral antihypertensive drugs at the Central Hospital of Jiaozuo Coal Industry (Group) Co., Ltd. from January 2022 to December 2024 were selected and divided into two groups: the hypertension with CMVD group (n = 112) and the simple hypertension group (n = 100). The clinical data of all the research subjects were collected. Peripheral blood samples of all patients were collected, and mononuclear cells were isolated and cultured using density gradient centrifugation. Double fluorescence staining was performed for identification, and cells that were double positive were regarded as EPCs in differentiation. The average cell area of EPCs was calculated using Image J software. The cell proliferation ability of EPCs was observed using the tetrazolium salt colorimetric method (MTT), and the concentrations of vascular endothelial growth factor (VEGF), granulocyte-macrophage colony-stimulating factor (GM-CSF), and interleukin-6 (IL-6) were determined using the enzyme-linked immunosorbent assay method. Spearman rank correlation analysis and multivariate logistic regression analysis were used to analyze the influencing factors of EPCs in patients with hypertension combined with CMVD.

Results Compared with the group with simple hypertension, the proportion of double-fluorescence staining positive cells in the peripheral blood of the hypertension combined with CMVD group decreased ( 51.27±13.80% vs 75.34±12.66%, t = 13.180, P＜ 0.001). Compared with the group with simple hypertension, the levels of GM-CSF ( 6.30±2.11 vs 12.72±3.27 ng/L, t = 17.160, P＜ 0.001), endothelial cell area ( 18.60±3.59 vs 35.48±5.06 μm², t = 28.230, P＜0.001) were lower in the hypertension combined with CMVD group, while IL-6 ( 17.82±5.42 vs 5.34±1.74 pg/L, t = 22.030, P＜ 0.001) and VEGF ( 155.93±34.59 vs 68.91±14.90 ng/L, t = 23.300, P＜ 0.001) were higher. The results of EPCs proliferation detection showed that there was no significant difference in the proliferation ability of EPCs between the two groups from the 1st to 4th day of culture. Starting from the 5th day of self-culture, the proliferation activity of EPCs in the hypertension combined with CMVD group was significantly lower than that in the group with simple hypertension, and this difference persisted until the 7th day of culture. Repeated measurement variance analysis indicated that time, group, and their interaction all had statistical significance (P＜0.05). Spearman rank correlation analysis showed that in patients with hypertension combined with CMVD, the proportion of double-fluorescence staining positive cells was negatively correlated with heart rate, total cholesterol, low-density lipoprotein cholesterol (LDL-C), IL-6, and VEGF (r = –0.269, –0.245, –0.264, –0.549, –0.590, P＜0.01), and positively correlated with high-density lipoprotein cholesterol (HDL-C), GM-CSF, and endothelial cell area (r = 0.182, 0.501, 0.607, P＜0.01). Logistic regression analysis showed that in patients with hypertension combined with CMVD, heart rate, total cholesterol, LDL-C, HDL-C, IL-6, VEGF, GM-CSF, and endothelial cell area were all independent influencing factors affecting the proportion of double-fluorescence staining positive cells in peripheral blood EPCs.

Conclusion Patients with hypertension and CMVD exhibit functional disorders of EPCs characterized by reduced quantity, shrunken morphology, impaired proliferation and secretion functions. Their occurrence is closely related to increased heart rate, abnormal blood lipids, inflammation and dysregulation of angiogenic factors, collectively forming an important pathological basis for impaired microvascular endothelial repair ability.