Renal Resistive Index After Captopril Test by Echo-Doppler in Essential Hypertension

Veglio, Franco; Provera, Edoardo; Pinna, Giuliano; Frascisco, Mauro F.; Rabbia, Franco; Melchio, Remo; Panarelli, Maurizio; Chiandussi, L

doi:10.1093/ajh/5.7.431

Cited by 40 publications

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“…In a Veglio et al [25] study including a relatively small group of 45 patients with essential HT it was shown that RRI was higher in subjects with a long-standing HT as compared to normotensive subjects and correlated with the severity and duration of the disease. The authors reported that baseline RRI was significantly higher in moderate and severe HT when compared to normal subjects and patients with mild HT [2,10,21,25].…”

Section: Discussionmentioning

confidence: 96%

Renal resistive index in patients with true resistant hypertension: results from the RESIST-POL study

et al. 2016

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A b s t r a c tBackground: Increased ultrasound Doppler renal resistive index (RRI) is a marker of atherosclerotic and hypertensive organ damage both at renal and systemic level. Aim:To evaluate RRI in patients with true resistant hypertension (TRHT) in the RESIST-POL study. Methods:From 204 patients diagnosed with TRHT in the RESIST-POL study, 151 patients (90 male, 61 female, mean age: 47.7 ± 10.4, range: 19-65 years) without secondary hypertension were included into the analysis. All patients were characterised by estimated glomerular filtration rate > 60 mL/min/1.73 m 2 and no history of diabetes prior to the study. As a control group we included 50 age-and gender-matched patients (35 male, 15 female, mean age: 46.8 ± 10.4, range: 19-65 years) with primary well-controlled hypertension. The groups also did not differ in respect to the number of years of known history of hypertension. The RRIs were evaluated on the basis of the Doppler ultrasound examination. Increased RRI was defined as ≥ 0.7. Results:Both groups did not differ in terms of renal function. Patients with TRHT were characterised by higher RRI as compared with the group with well-controlled hypertension (0.62 ± 0.05 vs. 0.60 ± 0.05, p < 0.05). In the TRHT group RRI correlated significantly with age, clinic and ambulatory blood pressure measurement, diastolic blood pressure (DBP) levels, as well as with clinic pulse pressure (PP) (r = 0.297; p = 0.001), with daytime (r = 0.355; p < 0.001) and nighttime (r = 0.313; p < 0.001) PP, and with fasting glucose concentration (r = 0.215; p = 0.008) and E/E' ratio (r = 0.289; p = 0.001) on echocardiography. RRI values were significantly higher in TRHT patients with newly diagnosed diabetes as compared with TRHT patients without diabetes (0.65 ± 0.05 vs. 0.62 ± 0.05, p = 0.022). Age, daytime DBP, daytime PP, and E/E' ratio but not fasting glucose concentration correlated independently with RRI in the model. Among patients with TRHT, patients with increased RRI were characterised by older age (52.2 ± 4.9 vs. 47.3 ± 10.6 years, p = 0.012), higher body mass index (32.8 ± 6.0 vs. 29.7 ± 4.5 kg/m 2 , p = 0.034), as well as lower daytime and nighttime DBP values and lower daytime and nighttime heart rate, as compared to patients with RRI < 0.7. The TRHT patients with increased RRI as compared to patients with RRI < 0.7 were characterised also by higher daytime and nighttime PP. Both groups did not differ in respect of renal function. Conclusions:Our study showed that the patients with TRHT were characterised by significantly higher RRI values as compared to the subjects with well-controlled hypertension. It may also be suggested that in the subjects with TRHT renal vascular resistance is related to blood pressure values, selected echocardiographic abnormalities, and some surrogate markers for metabolic and cardiovascular events, including fasting glucose plasma concentration and PP, respectively. www.kardiologiapolska.plRenal resistive index in patients with true resistant hypertension: results from the RESIST-POL...

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Section: Discussionmentioning

confidence: 96%

Renal resistive index in patients with true resistant hypertension: results from the RESIST-POL study

et al. 2016

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“…Poor control of blood glucose, as represented by increased HbA 1c , and basal PRA affected the magnitude of decrease in RI in patients with type 2 diabetes. Veglio et al (15) reported that in healthy subjects and patients with mild hypertension, RI values of interlobar arteries after the captopril (50 mg) test were significantly higher than those before the captopril test. In the present study, RI values in the control subjects were significantly increased after the captopril test, being consistent with the results of Veglio et al, despite the difference between studies in the dose of captopril used.…”

Section: Factors Associated With ⌬Ri In Diabetic Patientsmentioning

confidence: 99%

Intrarenal Hemodynamic Changes After Captopril Test in Patients With Type 2 Diabetes

et al. 2003

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OBJECTIVE -ACE inhibitors are known to be effective in preventing the progression of diabetic nephropathy. Activation of the renin-angiotensin system (RAS) is reported to contribute to intrarenal hemodynamic abnormality in diabetic patients. We examined whether RAS blockade by captopril induces intrarenal hemodynamic changes in normotensive patients with type 2 diabetes.RESEARCH DESIGN AND METHODS -The patients ranged in age from 40 to 65 years (20 men and 20 women). A total of 15 age-and sex-matched healthy individuals served as control subjects. Resistive index (RI) of interlobar arteries was examined by duplex Doppler sonography before and after the oral captopril (25 mg) test.RESULTS -At baseline, no significant differences in RI values or plasma renin activity (PRA) were seen between the patients and healthy subjects. In healthy subjects, the RI values after the captopril test were significantly higher than baseline values (P Ͻ 0.01). However, in patients with type 2 diabetes, both with normoalbuminuria and microalbuminuria, RI values after the test were significantly lower than baseline values (P Ͻ 0.001). There were significant negative correlations between ⌬RI value and HbA 1c (r ϭ -0.458, P Ͻ 0.005) and between ⌬RI value and baseline PRA in diabetic patients (r ϭ -0.339, P Ͻ 0.05). Multiple regression analysis showed that HbA 1c and baseline PRA significantly and independently affected the magnitude of decrease in RI values after captopril administration in diabetic patients (R 2 ϭ 0.391, P Ͻ 0.0001).CONCLUSIONS -These results indicate that the intrarenal RAS may be activated in diabetic patients, that such activation may be affected by poor glycemic control, and that blockade of RAS activation by ACE inhibitor reduces intrarenal vascular resistance in diabetic patients. The results emphasize the beneficial effects of ACE inhibition in improving intrarenal hemodynamics in diabetic patients. Diabetes Care 26:132-137, 2003S everal studies ranging from pharmacology to genetics have indicated that the renin-angiotensin system (RAS) plays a role in the pathogenesis of diabetic nephropathy (1,2). Recently, hyperglycemia has been reported to induce intrarenal RAS activation in patients with type 1 diabetes (3). In type 2 diabetic patients with advanced nephropathy, intrarenal RAS activation is reported to be one of the mechanisms of renal hemodynamic changes and one of the important factors contributing to progression of diabetic nephropathy (4). In patients with both type 1 and type 2 diabetes, RAS inhibition by either ACE inhibitors or angiotensin receptor antagonists has emerged as a clear choice for prevention and treatment of diabetic nephropathy (5-7). Although a renoprotective effect of ACE inhibitors and angiotensin receptor antagonists has been demonstrated in diabetic nephropathy, little is known concerning the control of the renal circulation by RAS inhibition in diabetic patients.Duplex Doppler sonography is useful for detecting intrarenal hemodynamic abnormalities such as those seen in obstructive...

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“…Thus currently, RRI is accepted as a well-known marker of renal vascular and interstitial damage, corresponding to an increased total cardiovascular risk (10). To this regard we can cite a study where RRI, measured at interlobar arteries, shown to be associated with the severity and duration of essential hypertension (11) while in 426 patients with essential hypertension was also demonstrated that impairment of renal hemodynamics, as assessed by an increased RRI, was associated with an increased risk of cardiovascular and renal outcomes (12). Moreover it is also known that RRI decreases with use of renin angiotensin system (RAS) inhibitors, due to the hemodynamic changes induced by these antihypertensive agents.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal prospective observational type study about determinants of renal resistive index variations in chronic renal failure patients treated with conventional medical and dietetic therapy

Brardi

Cevenini

Giovannelli

et al. 2017

Arch Ital Urol Androl

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Objective: This longitudinal prospective observational type study was conceived with the aim to examine the impact on renal resistive index (RRI) of the variables that we can manipulate with therapeutic and or dietetic interventions in a chronic kidney disease population in order to known which of these variables was statistically related to changes in RRI and therefore could become the object of the greatest therapeutic effort. Material and methods: This study was undertaken between May 2016 to May 2017 in the outpatient nephrology and urology clinic of San Donato Hospital in Arezzo. The study population (84 patients: 47 males and 37 females) was randomly selected among the chronic kidney patients (with various degrees of renal impairment) affected by hypertension and or diabetes mellitus. After a comprehensive medical examination these patients were submitted to determination of serum creatinine, glycated hemoglobin, 24-hour urinary albumin excretion and finally renal Doppler ultrasonography. Then the patients were submitted to a full therapeutic and dietetic intervention to ameliorate the renal impairment by a wide range of actions and after on average a one-year interval were submitted again to a new medical examination and a second determination of serum creatinine, glycated hemoglobin, 24-hour urinary albumin excretion and a new renal Doppler ultrasonography too. Results: The comparison between basal and final data revealed a slight reduction in the mean of bilateral renal resistance indices (Delta RRI: -0.0182 ± 0.08), associated to a slight increase in the mean glomerular filtration rate (Delta GFR: 0.8738 ± 10.95 ml/min/1.73 m 2 ), a reduction in mean body weight (Delta weight: -1.9548 ± 5.26 Kg) and mean BMI (Delta BMI: -0.7643 ± 2.10 Kg/m 2 ) as well as a reduction in the mean systolic blood pressure (Delta systolic blood pressure: -8.8333 ± 25.19 mmHg). Statistical analysis showed statistically significant correlations (p < 0.05) between Delta RRI and Delta weight (p < 0.03), Delta BMI (p < 0.02) and Delta systolic blood pressure (p < 0.05). Conclusion: Despite the many limitations the our study clearly identifies the targets (yet widely known) to act on to prevent kidney alterations related to RRI and provides further evidence, if any, of the utility of RRI as a key parameter in monitoring patients with chronic renal failure and as a valuable tool to drive the clinical efforts to contrast the kidney disease.KEY WORDS: Longitudinal prospective observational type study; Renal ultrasonography; Renal resistive index; Chronic kidney patients; Conventional medical and dietetic therapy. SummaryNo conflict of interest declared.

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Renal Resistive Index After Captopril Test by Echo-Doppler in Essential Hypertension

Cited by 40 publications

References 0 publications

Renal resistive index in patients with true resistant hypertension: results from the RESIST-POL study

Renal resistive index in patients with true resistant hypertension: results from the RESIST-POL study

Intrarenal Hemodynamic Changes After Captopril Test in Patients With Type 2 Diabetes

Longitudinal prospective observational type study about determinants of renal resistive index variations in chronic renal failure patients treated with conventional medical and dietetic therapy

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