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Coronary Flow Reserve and Small Artery Remodelling in Hypertensive Patients

Re-Analysis of Data and Review of the Literature

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Abstract

Objective: To evaluate the relationship between subcutaneous small arteries structure and coronary flow reserve in patients with essential hypertension.

Methods: Eighteen patients with mild to moderate essential hypertension and normal epicardial coronary arteries were included in the study and underwent a biopsy of the subcutaneous fat from the gluteal region. Subcutaneous small arteries were dissected and mounted on a micromyograph. The media thickness, the normalized internal diameter and the media: lumen ratio were then calculated. Measurement of coronary flow velocity in the left anterior descending artery before and during maximal pharmacological vasodilatation was performed by transesophageal Doppler echocardiography.

Results: Mean and peak coronary flow reserve (CFR) as well as minimum coronary resistance were significantly correlated to both media: lumen ratio and normalized internal diameter of subcutaneous small arteries. Those patients with a mean CFR (mCFR) of <2.69 (i.e. 1 SD below the mean of values in our normal reference subjects) had a greater media: lumen ratio and a smaller internal diameter compared with those with a mCFR of ≥2.69. Similarly, patients with a media: lumen ratio of ≥0.109 had a smaller mCFR compared with those with a media: lumen ratio of <0.109.

Conclusions: These results are in keeping with the hypothesis of a generalized remodelling of small arteries, that may also be responsible for a reduced coronary vasodilator capacity even in patients with mild to moderate essential hypertension.

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References

  1. Folkow B. Physiological aspects of primary hypertension. Physiol Rev 1982; 63: 347–504

    Article  Google Scholar 

  2. Mulvany MJ, Aalkjaer C. Structure and function of small arteries. Physiol Rev 1990; 70: 921–71

    Article  CAS  Google Scholar 

  3. Heagerty AM, Aalkjaaer C, Bund SJ. Small artery structure in hypertension: dual process of remodeling and growth. Hypertension 1993; 21: 391–7

    Article  CAS  Google Scholar 

  4. Agabiti-Rosei E, Rizzoni D, Castellano M, et al. Media:lumen ratio in human small resistance arteries is related to forearm minimal vascular resistance. J Hypertens 1995; 13: 341–7

    Article  Google Scholar 

  5. Aalkjaer C, Haegerty AM, Petersen KK, et al. Evidence for increased media thickness, increased neural amine uptake, and depressed excitation-contraction cou-pling in isolated resistance vessels from essential hypertensives. Circ Res 1987; 61(2): 181–6

    Article  CAS  Google Scholar 

  6. Rizzoni D, Porteri E, Castellano M, et al. Vascular hypertrophy and remodeling in secondary hypertension. Hypertension 1996; 28: 785–90

    Article  CAS  Google Scholar 

  7. Rizzoni D, Porteri E, Guelfi D, et al. Cellular hypertrophy in subcutaneous small arteries of patients with renovascular hypertension. Hypertension 2000; 35: 931–5

    Article  CAS  Google Scholar 

  8. Lever AF. Slow pressor mechanisms in hypertension: a role for hyper-trophy of resistance vessels? J Hypertens 1986; 4: 515–24

    Article  CAS  Google Scholar 

  9. Schiffrin EL. Reactivity of small blood vessels in hypertension: relationship with structural changes. Hypertension 1992; 19Suppl. II: II1–9

    PubMed  CAS  Google Scholar 

  10. Folkow B, Grimby G, Thulesius O. Adaptive structural changes in the vascular wall in hypertension and their relation to the control of peripheral resistance. Acta Physiol Scand 1958; 44: 255–72

    Article  CAS  Google Scholar 

  11. Conway J. A vascular abnormality in hypertension: a study of blood flow in the forearm. Circulation 1963; 27: 520–9

    Article  CAS  Google Scholar 

  12. Pedrinelli R, Dell’Omo G, Gimelli A, et al. Myocardial and forearm blood flow reserve in mild-moderate essential hypertensive patients. J Hypertens 1997; 115: 667–73

    Article  Google Scholar 

  13. Vogt M, Motz W, Strauer BE. Coronary hemodynamics in hypertensive heart disease. Eur Heart J 1992; 13Suppl. D: 44–9

    Article  Google Scholar 

  14. Kaski JC. Myocardial ischemia in the hypertensive patient: the role of coronary microcirculation abnormalities. Eur Heart J 1993; 14Suppl. J: 32–7

    PubMed  Google Scholar 

  15. Kozàkovà M, Palombo C, Pratali L, et al. Mechanisms of coronary flow reserve impairment in human hypertension: an integrated approach by transthoracic and transesophageal echocardiography. Hypertension 1997; 29: 551–9

    Article  Google Scholar 

  16. Rizzoni D, Palombo C, Porteri E, et al. Relationship between coronary vasodilator capacity and small artery remodeling in hypertensive patients. J Hypertens 2003; 21: 615–21

    Article  Google Scholar 

  17. European Society of Hypertension/European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003 21: 1011–53

  18. Kozàkovà M, Palombo C, Pratali L, et al. Assesssment of coronary reserve by transoesophageal Doppler echocardiography. Eur Heart J 1997; 18: 514–23

    Article  Google Scholar 

  19. Sahn DJ, De Maria A, Kisslo J, et al. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978; 58: 1072–83

    Article  CAS  Google Scholar 

  20. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation 1977; 55: 613–8

    Article  CAS  Google Scholar 

  21. Dubois D, Dubois EF. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 1916; 17: 863–71

    Article  CAS  Google Scholar 

  22. Savage DD, Garrison RJ, Kannel WB, et al. The spectrum of left ventricular hypertrophy in a general population sample: the Framingham study. Circulation 1987; 75Suppl. I: I-26–I-30

    CAS  Google Scholar 

  23. Devereux RB, Lutas EM, Casale PN, et al. Standardization of M-mode echocardiographic left ventricular anatomic measurements. J Am Coll Cardiol 1984; 4: 1222–30

    Article  CAS  Google Scholar 

  24. Muiesan ML, Pasini GF, Salvetti M, et al. Cardiac and vascular structural changes. Prevalence and relation to ambulatory blood pressure in a middle-aged general population in northern Italy: the Vobarno Study. Hypertension 1996; 27: 1046–52

    Article  CAS  Google Scholar 

  25. Rizzoni D, Muiesan ML, Porteri E, et al. Relations between cardiac and vascular structure in patients with primary and secondary hypertension. J Am Coll Cardiol 1998; 32: 985–92

    Article  CAS  Google Scholar 

  26. Aalkjaer C, Eiskjaer H, Mulvany MJ, et al. Abnormal structure and function of isolated subcutaneous resistance vessels from essential hypertensive patients despite antihypertensive treatment. J Hypertens 1989; 7: 305–10

    PubMed  CAS  Google Scholar 

  27. Mulvany MJ, Halpern W. Contractile properties of small resistance vessels in spontaneously hypertensive and normotensive rats. Circ Res 1977; 41(1): 19–26

    Article  CAS  Google Scholar 

  28. Mulvany MJ, Hansen PK, Aalkjaer C. Direct evidence that the greater contractility of resistance vessels in sponta-neously hypertensive rats is associated with a narrowed lumen, a thickened media, and an increased number of smooth muscle cell layers. Circ Res 1978; 43(6): 854–64

    Article  CAS  Google Scholar 

  29. Rizzoni D, Porteri E, Boari G, et al. Prognostic significance of small-artery structure in hypertension. Circulation 2003; 108: 2230–5

    Article  Google Scholar 

  30. Rizzoni D, Porteri E, Guelfi D, et al. Structural alterations in subcutaneous small arteries of normotensive and hypertensive patients with non insulin dependent diabetes mellitus. Circulation 2001; 103: 1238–44

    Article  CAS  Google Scholar 

  31. Mulvany MJ. Biophysical aspects of resistance vessels studied in spontaneous and renal hypertensive rats. Acta Physiol Scand 1988; 133Suppl. 571: 129–38

    Google Scholar 

  32. Olsen MH, Wachtell K, Meyer C, et al. Association between vascular dysfunction and reduced myocardial flow reserve in patients with hypertension: a LIFE substudy. J Human Hypertens 2004; 18: 445–52

    Article  CAS  Google Scholar 

  33. Buus NH, Bottcher M, Bottker HE, et al. Reduced vasodilator capacity in syndrome X related to structure and function of resistance arteries. Am J Cardiol 1999; 83(2): 149–54

    Article  CAS  Google Scholar 

  34. Muiesan ML, Rizzoni D, Salvetti A, et al. Structural changes in small resistance arteries and left ventricular geometry in patients with primary and secondary hypertension. J Hypertens 2002; 20: 1439–46

    Article  CAS  Google Scholar 

  35. Schafer S, Kelm M, Mingers S, et al. Left ventricular remodelling impairs coronary flow reserve in hypertensive patients. J Hypertens 2002; 20: 1431–7

    Article  CAS  Google Scholar 

  36. Vatner SF, Hittinger L. Coronary vascular mechanisms involved in decompensation from hypertrophy to heart failure. J Am Coll Cardiol 1993; 22Suppl. A: 34A–40A

    Article  CAS  Google Scholar 

  37. Kozàkovà M, de Simone G, Morizzo C, et al. Coronary vasodilator capacity and hypertension-induced increase in left ventricular mass. Hypertension 2003; 41: 224–9

    Article  CAS  Google Scholar 

  38. Thybo NK, Mulvany MJ, Jastrup B, et al. Some pharmacological and elastic characteristics of isolated subcutaneous small arteries from patients with essential hypertension. J Hypertens 1996; 14: 993–8

    Article  CAS  Google Scholar 

  39. Intengan HD, Deng LY, Li JS, et al. Mechanics and composition of human subcutaneous resistance arteries in essential hypertension. Hypertension 1999; 33(Pt II): 569–74

    Article  CAS  Google Scholar 

  40. Schiffrin EL. Remodeling of resistance arteries in essential hypertension and effects of antihypertensive treatment. Am J Hypertens 2004: 1192–1200

    Google Scholar 

  41. Thybo NK, Stephens N, Cooper A, et al. Effect of antihypertensive treatment on small arteries of patients with previously untreated essential hypertension. Hypertension 1995; 25(Pt 1): 474–81

    Article  CAS  Google Scholar 

  42. Rizzoni D, Porteri E, De Ciuceis C, et al. Effects of treatment with candesartan or enalapril on subcutaneous small resistance artery structure in hypertensive patients with NIDDM. Hypertension 2005; 45(Pt 2): 659–65

    Article  CAS  Google Scholar 

  43. Buus NH, Bottcher M, Jorgesen CG, et al. Myocardial perfusion during long-term angiotensin-converting enzyme inhibition or beta-blockade in patients with essential hypertension. Hypertension 2004; 44: 465–70

    Article  CAS  Google Scholar 

  44. Mathiassen ON, Buus NH, Sihm I, et al. Small artery structure is an independent predictor of cardiovascular events in essential hypertension. J Hypertens 2007; 25: 1021–6

    Article  CAS  Google Scholar 

  45. De Ciuceis C, Porteri E, Rizzoni D, et al. Structural alterations of subcutaneous small arteries may predict major cardiovascular events in hypertensive patients. Am J Hypertens 2007; 20: 846–52

    Article  Google Scholar 

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, Chair of Internal Medicine, II Medicina, Spedali Civili, Brescia, 25100, Italy

    Damiano Rizzoni, Enzo Porteri, Maria Lorenza Muiesan, Massimo Salvetti, Carolina De Ciuceis, Eugenia Belotti & Enrico Agabiti Rosei

  2. Department of Internal Medicine, University of Pisa, Pisa, Italy

    Carlo Palombo, Michaela Kozàkovà & Carmela Morizzo

Authors
  1. Damiano Rizzoni
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  2. Carlo Palombo
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  3. Enzo Porteri
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  4. Maria Lorenza Muiesan
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  5. Michaela Kozàkovà
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  6. Massimo Salvetti
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  7. Carmela Morizzo
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  8. Carolina De Ciuceis
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  9. Eugenia Belotti
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  10. Enrico Agabiti Rosei
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Correspondence to Damiano Rizzoni.

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Rizzoni, D., Palombo, C., Porteri, E. et al. Coronary Flow Reserve and Small Artery Remodelling in Hypertensive Patients. High Blood Press Cardiovasc Prev 15, 127–134 (2008). https://doi.org/10.2165/0151642-200815030-00006

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  • DOI: https://doi.org/10.2165/0151642-200815030-00006

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