Relations between cardiac and vascular structure in patients with primary and secondary hypertension

• Published in: Journal of the American College of Cardiology Vol. 32; no. 4; pp. 985 - 992
• Main Authors: Rizzoni, Damiano, Muiesan, Maria Lorenza, Porteri, Enzo, Salvetti, Massimo, Castellano, Maurizio, Bettoni, Giorgio, Tiberio, Guido, Giulini, Stefano Maria, Monteduro, Cristina, Garavelli, Guido, Agabiti-Rosei, Enrico
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-10-1998; Elsevier Science
• Subjects: Arterial hypertension. Arterial hypotension; Arterioles - pathology; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Carotid Artery, Common - diagnostic imaging; Carotid Artery, Common - pathology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Echocardiography; Female; Heart Ventricles - diagnostic imaging; Heart Ventricles - pathology; Humans; Hyperaldosteronism - complications; Hypertension - diagnostic imaging; Hypertension - etiology; Hypertension - pathology; Hypertension, Renovascular - diagnostic imaging; Hypertension, Renovascular - pathology; Hypertrophy, Left Ventricular - complications; Hypertrophy, Left Ventricular - diagnostic imaging; Male; Medical sciences; Middle Aged; Pheochromocytoma - complications; Skin - blood supply; PA; EH; LVMI; RVH; NT; M/L; CCIMT; LVH; Sonography; Heart; Human; Hypertension; Secondary; Echocardiography; Pathophysiology; Cardiovascular disease; Artery; Carotid; Morphology; Primary; Comparative study
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(98)00322-2

Background. Data on cardiac and vascular structure in secondary hypertension are generally scarce, and no data on the interrelations between cardiac mass and structural characteristics of the vessel wall, both in large and in small resistance arteries, are presently available.
Objectives. The aim of this study was to investigate the relation between structural changes in subcutaneous small arteries, left ventricular mass and wall thickness of the common carotid artery in patients with primary and secondary hypertension.
Methods. Seventy-four subjects were included in the study: 11 patients with pheochromocytoma, 14 with primary aldosteronism (PA), 19 with renovascular hypertension (RVH), 18 with essential hypertension (EH) and 12 normotensive (NT) control subjects. All subjects were submitted to a biopsy of subcutaneous fat. Morphologic characteristics of subcutaneous small resistance arteries (relaxed diameter <300 μm) were directly evaluated using a micromyographic technique. All subjects were submitted to calculation of left ventricular mass index (LVMI) and common carotid artery intima-media thickness (CCIMT), using ultrasound technique.
Results. The correlation coefficients between the media to lumen ratio in subcutaneous small arteries (M/L) and LVMI or between M/L and CCIMT were closer in RVH than in pheochromocytoma, EH or NT; in PA the correlation coefficients were slightly less close than those in RVH. An excess prevalence of carotid plaques in RVH was observed.
Conclusions. A close relation between small resistance artery morphology and cardiac or carotid artery structure may be observed in those hypertensive patients in whom the renin-angiotensin-aldosterone system is activated. In constrast, in NT, EH and pheochromocytoma no significant correlation between M/L and LVMI or CCIMT was observed.