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High prevalence of myocardial ischemia and vasoconstrictive hormonal release in hypertension during chronic renal failure
- Source :
- Europe PubMed Central
- Publication Year :
- 1997
-
Abstract
- OBJECTIVE: Indexes of myocardial ischemia and vasoconstrictive hormonal release were evaluated in order to investigate the difference between essential hypertension and hypertension during chronic renal failure. BACKGROUND: Arterial hypertension induces several cardiovascular alterations that reflect themselves either on the heart and/or on the coronary blood flow enhancing the cardiovascular risk. Since chronic renal failure can influence the neuroendocrine response, various mechanisms involved in hypertension during chronic renal failure are still unclear. High endothelin 1 (ET-1) levels have been found both in arterial hypertension and during chronic renal failure. Interestingly, either ET-1 or catecholamines seem also to be implied in the pathogenesis of myocardial ischemia. METHODS: 20 hypertensive uremic and 20 essentially hypertensive patients underwent echocardiographic wall motion and wall thickening analysis performed at baseline and immediately after the end of exercise. Simultaneously, myocardial perfusion was evaluated by 99mTc-MIBI-SPECT. In addition, plasma norepinephrine and ET-1 concentrations were measured at baseline and at peak exercise. RESULTS: The segmental radionuclide analysis showed a greater ischemic degree in hypertensive uremic patients. Yet, we were able to identify one or more regions of the left ventricle in which both systolic thickening measurements and wall motion after exercise were impaired. After exercise, wall thickening impairment was correlated with both wall motion abnormalities (r = 0.72, p < 0.01) and MIBI ischemic grade (r = 0.82, p < 0.001). Basal and after-exercise plasmatic norepinephrine and endothelin levels were higher in hypertensive uremic than in essentially hypertensive patients. Moreover, there was a significant correlation between increments in norepinephrine concentration and MIBI perfusion defects, and between the increment in ET-1 concentration and both MIBI perfusion defects, or kinetic alterations assessed by wall motion as well as by wall thickening. CONCLUSIONS: This is the first cross-sectional study in which a higher degree of myocardial ischemia has been observed in hypertensive uremic patients combined with an enhanced plasma release of both norepinephrine and ET-1. This phenomenon may contribute to enhance the cardiovascular risk of these patients.
- Subjects :
- Male
medicine.medical_specialty
Middle Aged
Endothelin-1
Female
Echocardiography
Exercise Test
Norepinephrine
Kidney Failure, Chronic
Humans
Hypertension, Renal
Image Interpretation, Computer-Assisted
Tomography, Emission-Computed, Single-Photon
Hemodynamics
Cross-Sectional Studies
Aged
Hypertension
Myocardial Ischemia
Ischemia
Essential hypertension
Left ventricular hypertrophy
Kidney Failure
Norepinephrine (medication)
Computer-Assisted
Internal medicine
Medicine
Chronic
Renal
Image Interpretation
Tomography
business.industry
Vascular disease
Settore BIO/13
General Medicine
medicine.disease
Endothelin 1
Endocrinology
Nephrology
Cardiology
Emission-Computed
business
Perfusion
Single-Photon
Kidney disease
medicine.drug
Subjects
Details
- ISSN :
- 16608151
- Volume :
- 76
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Nephron
- Accession number :
- edsair.doi.dedup.....799c69fe40ab40eba19eb3673e0f4e05