Structural alterations in subcutaneous small resistance arteries predict changes in the renal function of hypertensive patients.
BACKGROUND
We have previously demonstrated that structural alterations in subcutaneous small resistance arteries of hypertensive patients, as indicated by an increased media to lumen ratio (M/L), are a potent predictor of cardiovascular events, and that a close correlation exists between serum creatinine and M/L. The aim of the present study was to assess whether M/L of subcutaneous small resistance arteries may predict subsequent changes in renal function in hypertensive patients.


METHODS
Sixty participants (13 normotensive participants and 47 hypertensive patients) underwent a biopsy of subcutaneous fat. Resistance-sized arteries were dissected and mounted on a wire myograph, and M/L was measured. Patients were re-evaluated after a mean follow-up period of 8.6 years. Serum creatinine, blood urea nitrogen, and uric acid were measured; glomerular filtration rate (eGFR) was estimated according to Modification of Diet in Renal Disease formula.


RESULTS
At baseline, we observed significant correlations between M/L and serum creatinine, eGFR, blood urea nitrogen, systolic, diastolic, mean, and pulse pressure. In addition, we observed significant correlations between M/L and serum creatinine at follow-up (r = 0.57; P < 0.001), percentage changes in serum creatinine (r = 0.46; P < 0.001), eGFR at follow-up (r = -0.43; P < 0.001); percentage changes in eGFR, yearly changes in eGFR, blood urea nitrogen at follow-up, and uric acid at follow-up. A multivariate analysis in which all common cardiovascular risk factors were included showed that M/L ratio is the most potent predictor of changes in renal function.


CONCLUSIONS
Our data suggest that structural alterations in subcutaneous small arteries may predict the time course of changes in renal function during a follow-up period of about 9 years.
Boari
Gianluca E M
GE
Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy.
Rizzoni
Damiano
D
De Ciuceis
Carolina
C
Porteri
Enzo
E
Avanzi
Daniele
D
Platto
Caterina
C
Mazza
Monica
M
Brignani
Alida
A
Rosei
Claudia Agabiti
CA
Ricotta
Doris
D
Caimi
Luigi
L
Rosei
Enrico Agabiti
EA
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001158:Arteries / Q000473:pathology* / Q000503:physiopathology*; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology*; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D050151:Subcutaneous Fat / Q000098:blood supply*; D017540:Tunica Media / Q000473:pathology; D014655:Vascular Resistance
D000959:Antihypertensive Agents; D003404:Creatinine