Relationships between coronary flow vasodilator capacity and small artery remodelling in hypertensive patients.

Rizzoni, Damiano; Palombo, Carlo; Porteri, Enzo; Muiesan, María Lorenza; Kozàkovà, M.; Canna, Giovanni La; Nardi, Matilde; Guelfi, Daniele; Salvetti, Massimo; Morizzo, C.; Vittone, F.; Rosei, Enrico Agabiti

doi:10.1097/00004872-200303000-00030

Cited by 174 publications

(113 citation statements)

References 47 publications

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“…49 A further increase in arterial stiffness can be more detrimental to individuals presenting with elevated BP, as many already show increases in arterial stiffness 51 and increased peripheral resistance, further increasing cardiac risk. 52 We found differential changes between arterial stiffness and BP in our pre-to stage-1 hypertensive population.…”

Section: Aementioning

confidence: 55%

Effect of 4 weeks of aerobic or resistance exercise training on arterial stiffness, blood flow and blood pressure in pre- and stage-1 hypertensives

et al. 2008

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The benefits of aerobic exercise (AE) training on blood pressure (BP) and arterial stiffness are well established, but the effects of resistance training are less well delineated. The purpose of this study was to determine the impact of resistance vs aerobic training on haemodynamics and arterial stiffness. Thirty pre-or stage-1 essential hypertensives (20 men and 10 women), not on any medications, were recruited (age: 48.2 ± 1.3 years) and randomly assigned to 4 weeks of either resistance (RE) or AE training. Before and after training, BP, arterial stiffness (pulse wave velocity (PWV)) and vasodilatory capacity (VC) were measured. Resting systolic BP (SBP) decreased following both training modes (SBP: RE, pre 136±2.9 vs post 132±3.4; AE, pre 141±3.8 vs post 136 ± 3.4 mm Hg, P ¼ 0.005; diastolic BP: RE, pre 78 ± 1.3 vs post 74 ± 1.6; AE, pre 80 ± 1.6 vs post 77 ± 1.7 mm Hg, P ¼ 0.001). Central PWV increased (P ¼ 0.0001) following RE (11 ± 0.9-12.7 ± 0.9 m s À1 ) but decreased after AE (12.1 ± 0.8-11.1 ± 0.8 m s À1 ). Peripheral PWV also increased (P ¼ 0.013) following RE (RE, pre 11.5±0.8 vs post 12.5 ± 0.7 m s À1 ) and decreased after AE (AE, pre 12.6 ± 0.8 vs post 11.6 ± 0.7 m s À1 ). The VC area under the curve (VC AUC ) increased more with RE than that with AE (RE, pre 76±8.0 vs post 131.1±11.6; AE, pre 82.7±8.0 vs post 110.1 ± 11.6 ml per min per s per 100 ml, P ¼ 0.001). Further, peak VC (VC peak ) increased more following resistance training compared to aerobic training (RE, pre 17±1.9 vs post 25.8±2.1; AE, pre 19.2±8.4 vs post 22.9 ± 8.4 ml per min per s per 100 ml, P ¼ 0.005). Although both RE and AE training decreased BP, the change in pressure may be due to different mechanisms.

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Section: Aementioning

confidence: 55%

Effect of 4 weeks of aerobic or resistance exercise training on arterial stiffness, blood flow and blood pressure in pre- and stage-1 hypertensives

et al. 2008

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“…Our study provides evidence that aliskiren might be at least as protective as ramipril in reducing subcutaneous structural alterations and particularly the media-to-lumen ratio, which is known to be inversely related to coronary flow reserve 34 and to predict future cardiovascular events.…”

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confidence: 70%

Effects of a Long-Term Treatment With Aliskiren or Ramipril on Structural Alterations of Subcutaneous Small-Resistance Arteries of Diabetic Hypertensive Patients

et al. 2014

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Abstract-Structural alterations of subcutaneous small-resistance arteries are associated with a worse clinical prognosis in hypertension and non-insulin-dependent diabetes mellitus. The effects of the direct renin inhibitor aliskiren on microvascular structure were never previously evaluated. Therefore, we investigated the effects of aliskiren in comparison with those of an extensively used angiotensin-converting enzyme inhibitor, ramipril, on peripheral subcutaneous small-resistance artery morphology, retinal arteriolar structure, and capillary density in a population of patients with non-insulin-dependent diabetes mellitus. Sixteen patients with mild essential hypertension and with a previous diagnosis of non-insulin-dependent diabetes mellitus were included in the study. Patients were then randomized to 1 of the 2 active treatments (aliskiren 150 mg once daily, n=9; or ramipril 5 mg once daily, n=7). Each patient underwent a biopsy of the subcutaneous fat from the gluteal region, an evaluation of retinal artery morphology (scanning laser Doppler flowmetry), and capillary density (capillaroscopy), at baseline and after 1 year of treatment. Subcutaneous small arteries were dissected and mounted on a pressurized micromyograph, and the media-to-lumen ratio was evaluated. A similar office blood pressure-lowering effect and a similar reduction of the wall-to-lumen ratio of retinal arterioles were observed with the 2 drugs. Aliskiren significantly reduced media-to-lumen ratio of subcutaneous small-resistance arteries, whereas ramipril-induced reduction of media to lumen ratio was not statistically significant. No relevant effect on capillary density was observed. In conclusion, treatment with aliskiren or ramipril was associated with a correction of microvascular structural alterations in patients with non-insulin-dependent diabetes mellitus. An increased media-to-lumen ratio of subcutaneous smallresistance arteries is a potent predictor of cardiovascular events in patients with increased blood pressure values, [10][11][12] part of them being also diabetics.10,11 Antihypertensive treatment is able to regress structural alterations in subcutaneous small-resistance arteries of essential hypertensive patients 13 ; however, despite similar blood pressure-lowering effects, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptors blockers, and calcium channel blockers proved to be more effective than diuretics and β-blockers in terms of reduction in the media-to-lumen ratio. 13 The extent of the reduction in the media-to-lumen ratio of subcutaneous small-resistance arteries was recently demonstrated to be an independent predictor of cardiovascular events in essential hypertension. 14 However, in patients with diabetes mellitus, it seems more difficult to obtain a complete regression of small-resistance artery structural alterations, despite prolonged treatment. 15-18A possible explanation is related to the presence, in patients with diabetes mellitus, of hypertrophic remodeling of small arteries, which repre...

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“…In fact, a significant correlation between coronary flow reserve and subcutaneous small resistance artery remodeling was detected in hypertensive patients, suggesting that structural alterations in small resistance arteries may be present simultaneously in different vascular districts, and changes in morphology of the subcutaneous vasculature may reflect concomitant clinically important alterations in the coronary vessels. 23 The extent of structural alterations in small resistance vessels is more pronounced in hypertensive patients with diabetes mellitus compared with those observed in nondiabetic hypertensives or with normotensive diabetics, suggesting that clustering of risk factors may have synergistic deleterious effects on the vasculature. 24 Recent data suggest that in humans as well, alterations in small resistance artery morphology may represent the most prevalent and perhaps the earliest form of target organ damage in essential hypertension.…”

Section: Rizzoni Et Al Prognostic Role Of Small-artery Structurementioning

confidence: 96%

Prognostic Significance of Small-Artery Structure in Hypertension

et al. 2003

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Background-The presence of structural alterations in the microcirculation may be considered an important mechanism of organ damage; however, it is not currently known whether structural alterations of small arteries may predict fatal and nonfatal cardiovascular events. Methods and Results-One hundred twenty-eight patients were included in the present study. There were 59 patients with essential hypertension, 17 with pheochromocytoma, 20 with primary aldosteronism, 12 with renovascular hypertension, and 20 normotensive patients with non-insulin-dependent diabetes mellitus. All subjects were submitted to a biopsy of subcutaneous fat. Small resistance arteries were dissected and mounted on an isometric myograph, and the tunica media-to-internal lumen ratio (M/L) was measured. The subjects were reevaluated after an average follow-up time of 5.4 years. Thirty-seven subjects had a documented fatal or nonfatal cardiovascular event (5.32 events/100 patients per year). In the subcutaneous small arteries of subjects with cardiovascular events, a smaller internal diameter and a clearly greater M/L was observed. Our subjects were subdivided according to the presence of an M/L greater or smaller than the mean and median values observed in the whole population (0.098) or mean value ϩ2 SD of our normal subjects (0.11). Life-

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Relationships between coronary flow vasodilator capacity and small artery remodelling in hypertensive patients.

Cited by 174 publications

References 47 publications

Effect of 4 weeks of aerobic or resistance exercise training on arterial stiffness, blood flow and blood pressure in pre- and stage-1 hypertensives

Effect of 4 weeks of aerobic or resistance exercise training on arterial stiffness, blood flow and blood pressure in pre- and stage-1 hypertensives

Effects of a Long-Term Treatment With Aliskiren or Ramipril on Structural Alterations of Subcutaneous Small-Resistance Arteries of Diabetic Hypertensive Patients

Prognostic Significance of Small-Artery Structure in Hypertension

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