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To assess whether increased shedding of adhesion molecules in plasma provides an index for endothelial damage in hypertension.Three groups of hypertensive patients with increasing severity of vascular damage were studied: 20 essential hypertensives, 21 atherosclerotic, renovascular hypertensives and four malignant hypertensives. Twenty healthy subjects were included as a control group. Levels of P-selectin, E-selectin, intracellular adhesion molecule 1, vascular cell adhesion molecule and von Willebrand factor in venous blood were measured, using sandwich-type enzyme-linked immunosorbent assay.For essential hypertensives a trend for increased P-selectin and E-selectin values compared with those in controls was observed (159 ± 44 versus 132 ± 40 ng/ml, P = 0.062 and 40 ± 13 versus 34 ± 17 ng/ml, P = 0.055, respectively). P-selectin (210 ± 84 ng/ml, P = 0.0021) and E-selectin (42 ± 12 ng/ml, P = 0.012) levels in renovascular hypertensives were significantly higher than those in healthy controls. There were no significant increases in circulating levels of intracellular adhesion molecule 1, vascular cell adhesion molecule and von Willebrand factor either in essential hypertensives or in renovascular hypertensives. Marked increases in circulating levels of adhesion molecules and von Willebrand factor relative to those in controls were observed in malignant hypertensives (P-selectin 634 ± 332 versus 132 ± 40 ng/ml, P = 0.0004; vascular cell adhesion molecule 968 ± 187 versus 493 ± 139 ng/ml, P = 0.0004; and von Willebrand factor 259 ± 75 versus 130 ± 72 U/dl, P = 0.016).Progression of vascular damage in essential, renovascular and malignant hypertension is associated with a rise in circulating levels of P-selectins and, to a lesser extent, E-selectins, whereas levels of intracellular adhesion molecule 1, vascular cell adhesion molecule and von Willebrand factor are elevated only in diseases associated with acute severe vascular damage, including malignant hypertension. Our data suggest that selectins may be useful as indicators of vascular damage in hypertension.