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High prevalence of myocardial ischemia and vasoconstrictive hormonal release in hypertension during chronic renal
C Napoli1, F Di Gregorio, P Sorice
1Department of Medicine, Regional Hospital of Pellegrini, Naples, Italy.
Insights
Hypertensive patients with chronic kidney disease show more myocardial ischemia and higher levels of norepinephrine and endothelin-1 (ET-1) compared to those with essential hypertension. This suggests an increased cardiovascular risk in uremic hypertensive individuals.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Arterial hypertension causes cardiovascular alterations and increases risk.
- Chronic renal failure influences neuroendocrine responses, impacting hypertension mechanisms.
- Elevated endothelin-1 (ET-1) and catecholamines are implicated in hypertension and myocardial ischemia.
Purpose of the Study:
- To investigate differences in myocardial ischemia and hormonal release between essential hypertension and hypertension in chronic renal failure.
- To evaluate the role of norepinephrine and ET-1 in hypertensive patients with and without chronic renal failure.
Main Methods:
- Echocardiography for wall motion and thickening analysis in 20 hypertensive uremic and 20 essential hypertensive patients.
- 99mTc-MIBI-SPECT for myocardial perfusion evaluation.
- Plasma norepinephrine and ET-1 measurements at baseline and peak exercise.
Main Results:
- Hypertensive uremic patients exhibited greater myocardial ischemia degree and impaired left ventricular function post-exercise.
- Higher basal and exercise-induced plasma norepinephrine and ET-1 levels were observed in hypertensive uremic patients.
- Correlations found between norepinephrine/ET-1 levels and perfusion defects/kinetic alterations.
Conclusions:
- Hypertensive uremic patients demonstrate a higher degree of myocardial ischemia.
- Enhanced plasma release of norepinephrine and ET-1 in these patients may increase cardiovascular risk.
- This study provides novel insights into the pathophysiology of hypertension in chronic renal failure.
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.