Relation of Impaired Coronary Microcirculation to Increased Urine Albumin Excretion in Patients With Systemic Hypertension and No Epicardial Coronary Arterial Narrowing

doi:10.1016/j.amjcard.2011.11.035

The American Journal of Cardiology

Volume 109, Issue 7, 1 April 2012, Pages 1026-1030

https://doi.org/10.1016/j.amjcard.2011.11.035 Get rights and content

Coronary flow reserve (CFR) is impaired and urinary albumin excretion is increased in patients with essential hypertension. Our aim was to investigate the associations between CFR and cardiac and renal damage in hypertensives. For this purpose we studied 37 never-treated hypertensives (57.9 years old, 16 men) without chest pain but with a positive ischemia stress test result and normal coronary arteries on coronary angiogram. CFR was calculated by a 0.014-inch Doppler guidewire (Flowire, Volcano, San Diego) in the left anterior descending artery in response to bolus intracoronary administration of adenosine (60 μg) as the ratio of hyperemic to basal average peak velocity of the distal vessel. All participants underwent complete echocardiographic study including left ventricular diastolic function evaluation by tissue Doppler imaging (peak early diastolic velocity/peak atrial systolic velocity) and determination of the albumin-to-creatinine ratio (ACR). Hypertensives with low CFR (<2.5, n = 22) compared to those with high CFR (n = 15) exhibited a larger left ventricular mass index by 10.9 g/m² (p = 0.045) and ACR values by 10 mg/g (p <0.001). CFR was negatively correlated with logACR (r = −0.511, p = 0.001). LogACR (beta −0.792, p <0.001), male gender (beta 0.313, p = 0.005), left ventricular mass index (beta −0.329, p = 0.007), and peak early diastolic velocity/peak atrial systolic velocity (beta 0.443, p <0.001) were the only independent predictors of CFR in linear regression analysis (adjusted R² = 0.672). In conclusion, never-treated asymptomatic hypertensives who exhibit impaired CFR and angiographically normal epicardial arteries are characterized by intrarenal vascular damage as reflected by increased ACR. These findings suggest a plausible role of ACR estimation in the identification of hypertensive subjects with early coronary microvascular dysfunction.

Section snippets

Methods

From the pool of patients who were referred or self-referred for evaluation of high blood pressure (BP) to the outpatient hypertension unit of our institute, we identified 37 consecutive never-treated essential hypertensives (57.9 years old, 16 men, Caucasian, daytime systolic BP >135 mm Hg) with positive ischemia treadmill exercise test results confirmed with thallium scintigraphy or dobutamine stress echocardiography who had no angiographically significant (<30%) stenoses in their coronary

Results

Hypertensive patients with low CFR compared to those with normal CFR did not differ in age, gender, body mass index, waist circumference, and metabolic profile (p = NS for all comparisons). Moreover, the difference in 24-hour systolic and diastolic BP values between study groups was not statistical significant (p = NS for the 2 comparisons). No change in CFR was detected in the 5 subjects who received the infusion of the normal saline solution.

Hypertensives with low CFR compared to those with

Discussion

The present study demonstrated an independent association of ACR with CFR assessed during cardiac catheterization in never-treated hypertensive patients asymptomatic for chest pain. According to our results hypertensives with impaired CFR and angiographically normal coronary arteries are characterized by increased ACR values, supporting the existence of a diffuse cardiorenal microcirculatory dysfunction.

Currently, no technique allows the direct in vivo visualization of coronary microcirculation

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Systemic hypertensionRelation of Impaired Coronary Microcirculation to Increased Urine Albumin Excretion in Patients With Systemic Hypertension and No Epicardial Coronary Arterial Narrowing

Section snippets

Methods

Results

Discussion

Am J Cardiol

Am J Hypertens

Am J Cardiol

J Am Soc Echocardiogr

Am J Cardiol

J Am Soc Hypertens

Am Heart J

Kidney Int

Am J Med

Am J Hypertens

Am J Cardiol

Coronary microvascular dysfunction

N Engl J Med

Evaluation of the microcirculation in hypertension and cardiovascular disease

Eur Heart J

Left ventricular remodeling impairs coronary flow reserve in hypertensive patients

J Hypertens

Coronary flow reserve in hypertensive patients with appropriate or inappropriate left ventricular mass

J Hypertens

Systemic hypertension
Relation of Impaired Coronary Microcirculation to Increased Urine Albumin Excretion in Patients With Systemic Hypertension and No Epicardial Coronary Arterial Narrowing