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Endothelial dysfunction and mild renal insufficiency in essential hypertension.
Circulation. 2004 Aug 17; 110(7):821-5.Circ

Abstract

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.

METHODS AND 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.

Authors+Show Affiliations

Internal Medicine and Cardiovascular Diseases Unit, Department of Experimental and Clinical Medicine G. Salvatore, University Magna Graecia of Catanzaro, Catanzaro, Italy.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15289371

Citation

Perticone, Francesco, et al. "Endothelial Dysfunction and Mild Renal Insufficiency in Essential Hypertension." Circulation, vol. 110, no. 7, 2004, pp. 821-5.
Perticone F, Maio R, Tripepi G, et al. Endothelial dysfunction and mild renal insufficiency in essential hypertension. Circulation. 2004;110(7):821-5.
Perticone, F., Maio, R., Tripepi, G., & Zoccali, C. (2004). Endothelial dysfunction and mild renal insufficiency in essential hypertension. Circulation, 110(7), 821-5.
Perticone F, et al. Endothelial Dysfunction and Mild Renal Insufficiency in Essential Hypertension. Circulation. 2004 Aug 17;110(7):821-5. PubMed PMID: 15289371.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endothelial dysfunction and mild renal insufficiency in essential hypertension. AU - Perticone,Francesco, AU - Maio,Raffaele, AU - Tripepi,Giovanni, AU - Zoccali,Carmine, Y1 - 2004/08/02/ PY - 2004/8/4/pubmed PY - 2005/2/23/medline PY - 2004/8/4/entrez SP - 821 EP - 5 JF - Circulation JO - Circulation VL - 110 IS - 7 N2 - 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. METHODS AND 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. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/15289371/Endothelial_dysfunction_and_mild_renal_insufficiency_in_essential_hypertension_ L2 - https://www.ahajournals.org/doi/10.1161/01.CIR.0000138745.21879.27?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -