Coronary vascular reserve is similarly reduced in hypertensive patients without any other coronary risk factors and in normotensive smokers and hypercholesterolemic patients with angiographically normal coronary arteries.
Hypertensive patients (HTP) with left ventricular hypertrophy have reduced coronary vascular reserve (CVR), but in HTP without left ventricular hypertrophy, CVR is within the normal range according to values determined in subjects without taking into account coronary risk factors such as cigarette smoking or hypercholesterolemia. To examine the influence of hypertension, cigarette smoking, and hypercholesterolemia on coronary flow and resistance reserve, coronary flow velocity was measured using a Doppler catheter before and after a maximally vasodilating dose of papaverine in 15 normotensive subjects without any coronary risk factors (Group 1), in 12 nonsmoker HTP with normal lipid profiles who had never been treated (Group 2), in 8 normotensive smoker patients (Group 3), in 9 normotensive nonsmoker patients with hypercholesterolemia (Group 4), and in 13 normotensive smoker patients with hypercholesterolemia (Group 5). All patients had normal coronary arteriography and left ventricular mass and function. Peak-to-resting coronary flow velocity ratio and mean aortic pressure were used to determine coronary flow reserve (CFR) and a minimal coronary vascular resistance index (MCVRI). Results show that in groups 2, 3, 4, and 5 comparatively to Group 1, CFR was similarly reduced (4.60 +/- 0.74 [P < .001], 4.59 +/- 0.35 [P < .001], 5.01 +/- 0.55 [P < .05], 5.03 +/- 0.78 [P < .05], groups 2 to 5, respectively, compared to group 1 5.66 +/- 0.68), and that MCVRI was similarly augmented (0.19 +/- 0.03 [P < .01], 0.20 +/- 0.0 [P < .001], 0.19 +/- 0.02 [P < .05], 0.19 +/- 0.03 [P < .05], groups 2 to 5, respectively, compared to group 1 0.16 +/- 0.02). In conclusion, HTP without left ventricular hypertrophy have a similar reduction of their CVR as smokers and hypercholesterolemic patients when compared to a group of subjects without any coronary risk factors. This should be taken into account when determining a group of control subjects for coronary reserve.
Antony
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I
Service d'Explorations Fonctionnelles, Hôpital Louis Mourier, Centre Hospitalier Universitaire Xavier-Bichat, Colombes, France.
Nitenberg
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A
D000328:Adult; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D006937:Hypercholesterolemia; D006973:Hypertension; D008875:Middle Aged; D015999:Multivariate Analysis; D012907:Smoking