title: High prevalence of myocardial ischemia and vasoconstrictive hormonal release in hypertension during chronic renal failure.
abstract: 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.
authors.affiliation: Department of Medicine, Regional Hospital of Pellegrini, Naples, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Napoli
authors.forename: F
authors.initials: F
authors.lastname: Di Gregorio
authors.forename: P
authors.initials: P
authors.lastname: Sorice
authors.forename: A
authors.initials: A
authors.lastname: Di Benedetto
authors.forename: S
authors.initials: S
authors.lastname: Ciafre
authors.forename: T
authors.initials: T
authors.lastname: Posca
authors.forename: A
authors.initials: A
authors.lastname: Ferrara
authors.forename: E
authors.initials: E
authors.lastname: Di Paolo
authors.forename: G
authors.initials: G
authors.lastname: Bruzzese
authors.forename: F P
authors.initials: FP
authors.lastname: D'Armiento
authors.forename: L
authors.initials: L
authors.lastname: Mansi
authors.forename: A
authors.initials: A
authors.lastname: Liguori
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D004452:Echocardiography; D019332:Endothelin-1 / Q000097:blood*; D005080:Exercise Test; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000378:metabolism*; D006977:Hypertension, Renal / Q000150:complications / Q000378:metabolism*; D007090:Image Interpretation, Computer-Assisted; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000000981:diagnostic imaging; D009638:Norepinephrine / Q000097:blood*; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019332:Endothelin-1; D009638:Norepinephrine