Endothelial dysfunction and mild renal insufficiency in essential hypertension.
BACKGROUND
Mild to moderate renal insufficiency in individuals with essential hypertension is currently considered the expression of a renal microvasculopathy characterized by preglomerular arteriolar involvement and tubulo-interstitial changes. Whether endothelial dysfunction plays a role in this alteration is still undefined.


RESULTS
We investigated the relationship between endothelial function (hemodynamic response to acetylcholine [ACh] in the forearm) and renal function in 500 patients with uncomplicated, never-treated, essential hypertension and serum creatinine within the normal range (ie, < or =1.5 mg/dL). Serum creatinine, creatinine clearance, and estimated glomerular filtration rate (GFR, by the Modification of Diet in Renal Disease formula) were related to the forearm blood flow response to ACh (all P< or =0.003), and these relationships held true in multiple regression analyses that included age, gender, systolic pressure, serum cholesterol and glucose, smoking, and body mass index. Accordingly, on multiple logistic regression analysis, the risk of moderate renal dysfunction (ie, an estimated GFR <60 mL x min(-1) x 1.73 m(-2)) was 64% lower (OR 0.36, 95% CI 0.18 to 0.70) in patients in the third ACh tertile (ie, those showing the higher vasodilatory response) than in those in the first tertile (ie, showing the lower response). C-reactive protein was related directly to serum creatinine and inversely to GFR and vasodilatory response to ACh, which suggests that endothelial dysfunction is a possible mechanism linking inflammation and impaired renal function in essential hypertension.


CONCLUSIONS
An impaired vasodilatory response to ACh appears to be associated with renal function loss in patients with essential hypertension. This association suggests that systemic endothelial dysfunction is involved in mild to moderate renal insufficiency in patients with uncomplicated essential hypertension.
Internal Medicine and Cardiovascular Diseases Unit, Department of Experimental and Clinical Medicine G. Salvatore, University Magna Graecia of Catanzaro, Catanzaro, Italy.
Francesco
F
Perticone
Raffaele
R
Maio
Giovanni
G
Tripepi
Carmine
C
Zoccali
D000109:Acetylcholine / Q000494:pharmacology; D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000209:etiology; D001161:Arteriosclerosis / Q000453:epidemiology; D001786:Blood Glucose / Q000032:analysis; D001916:Brachial Artery / Q000503:physiopathology; D002097:C-Reactive Protein / Q000032:analysis; D003404:Creatinine / Q000097:blood; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000209:etiology*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014664:Vasodilation / Q000187:drug effects*; D014665:Vasodilator Agents / Q000494:pharmacology
D001786:Blood Glucose; D008055:Lipids; D014665:Vasodilator Agents; D002097:C-Reactive Protein; D003404:Creatinine; D000109:Acetylcholine