| Lowering of blood pressure and coronary blood flow in isolated systolic hypertension. | |
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MedLine Citation:
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PMID: 11428534 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: In essential hypertension, the lower limit of autoregulation of coronary flow shifts to higher perfusion and the hypertensive ventricle is at a higher than normal risk of ischemia, and less able to tolerate acute reduction of coronary perfusion pressure. Little is known about pattern of coronary flow in isolated systolic hypertension, a pathologic condition in which the elevated systolic blood pressure is associated with a lower than normal vascular compliance and normal or slightly greater than normal mean arterial pressure and vascular resistance. OBJECTIVE: To evaluate the effects of rapid normalization of blood pressure on coronary blood flow in isolated systolic hypertension. METHODS: We subjected 20 patients with isolated systolic hypertension to intraoperative hemodynamic and transesophageal echocardiographic monitoring during peripheral vascular surgery. Coronary flow velocity integrals and diameters in the left anterior descending coronary artery were evaluated under baseline conditions and after normalization of blood pressure, which occurred spontaneously during anesthesia (10 cases; group 1A) or was induced by infusion of nitrate (10 cases, group 1B). RESULTS: After normalization of systolic blood pressure integrals decreased significantly only for patients in group 1A; percentage changes of diameter were significantly greater for patients in group 1B. Therefore, coronary blood flow after normalization of systolic blood pressure increased for patients in group 1B (by 28+/-25%) and decreased for patients in group 1A (by 30+/-21%). Changes in integrals were inversely related to those in diameter (r= -0.72, P < 0.001); for patients in group 1A changes in coronary perfusion pressure and diameter were related to those of integrals (r= 0.94; P < 0.0005). CONCLUSIONS: In isolated systolic hypertension, despite there being similar changes of the systolic blood pressure, administration of nitrates caused a marked increase of coronary flow through direct effects on coronary circulation, whereas spontaneous normotension was associated with a significant reduction of coronary flow. |
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Authors:
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G Tamborini; A Maltagliati; L Trupiano; G Berna; E Sisillo; L Salvi; M Pepi |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Coronary artery disease Volume: 12 ISSN: 0954-6928 ISO Abbreviation: Coron. Artery Dis. Publication Date: 2001 Jun |
Date Detail:
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Created Date: 2001-06-28 Completed Date: 2001-12-04 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 9011445 Medline TA: Coron Artery Dis Country: England |
Other Details:
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Languages: eng Pagination: 259-65 Citation Subset: IM |
Affiliation:
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Centro Cardiologico, Fondazione Monzino, IRCCS, Centro di Studio per le Ricerche Cardiovascolari del CNR, Milan, Italy. gtamborini@cardiologicomonzino.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Anesthetics, Intravenous Blood Pressure / drug effects* Coronary Circulation / drug effects* Diazepam Echocardiography Echocardiography, Transesophageal Female Humans Hypertension / drug therapy*, physiopathology Male Middle Aged Nitroglycerin / therapeutic use Systole / drug effects Vasodilator Agents / therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Anesthetics, Intravenous; 0/Vasodilator Agents; 439-14-5/Diazepam; 55-63-0/Nitroglycerin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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