An open discussion about endothelial dysfunction: is it timely to propose a classification?

This text proposes a classification for endothelial dysfunction including etiological, functional and evolutionary aspects: (I) Etiological classification: (a) primary or ‘genotypic’ (homozygote children hemocystinuria carriers, normotensive patients with familial antecedents of essential arterial hypertension); (b) secondary or ‘phenotypic’ (atherosclerosis, coronary artery disease, hypertension, diabetes and others). (II) Functional classification: (a) ‘vasotonic’ (cardiovascular diseases, vasospasm and thrombosis); (b) ‘vasoplegic’ (distributive shock: sepsis, anaphylaxis, anaphylactoid reactions and vasoplegias related to cardiopulmonary bypass). (III) Evolutionary or prognostic classification: (a) ‘reversible endothelial dysfunction’ (more probable of happening in the initial phases of the ‘vasoplegic’ dysfunctions); (b) ‘partially reversible endothelium dysfunction’ (to include the idea of improvement or modification without complete reversion as in ‘vasotonic’ dysfunctions associated with the cardiovascular diseases); (c) ‘irreversible endothelial dysfunction’ (advanced evolution of the cardiovascular diseases and sepsis).