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CLINICAL STUDIES

Relations between cardiac and vascular structure in patients with primary and secondary hypertension

Damiano Rizzoni, MD^a, Maria Lorenza Muiesan, MD^a, Enzo Porteri, MD^a, Massimo Salvetti, MD^a, Maurizio Castellano, MD^a, Giorgio Bettoni, MD^a, Guido Tiberio, MD^*, Stefano Maria Giulini, MD^*, Cristina Monteduro, MD^a, Guido Garavelli, MD and Enrico Agabiti-Rosei, MD^a

^a Chair of Semeiotica and Metodologia Medica, University of Brescia, Brescia, Italy
^* Chair of Chirurgia Generale, University of Brescia, Brescia, Italy
Divisione di Medicina, Ospedale di Cremona, Brescia, Italy

Manuscript received January 12, 1998; revised manuscript received May 26, 1998, accepted June 4, 1998.

Address for correspondence: Dr. Damiano Rizzoni, U.O.P. Scienze Mediche, University of Brescia, c/o 1^a Medicina, Spedali Civili, 25100 Brescia, Italy
Damiano.Rizzoni{at}schering-plough.it

Background. Data on cardiac and vascular structure in secondary hypertension are generally scarce, and no data on the interrelations between cardiac mass and structural characteristics of the vessel wall, both in large and in small resistance arteries, are presently available.

Objectives. The aim of this study was to investigate the relation between structural changes in subcutaneous small arteries, left ventricular mass and wall thickness of the common carotid artery in patients with primary and secondary hypertension.

Methods. Seventy-four subjects were included in the study: 11 patients with pheochromocytoma, 14 with primary aldosteronism (PA), 19 with renovascular hypertension (RVH), 18 with essential hypertension (EH) and 12 normotensive (NT) control subjects. All subjects were submitted to a biopsy of subcutaneous fat. Morphologic characteristics of subcutaneous small resistance arteries (relaxed diameter <300 µm) were directly evaluated using a micromyographic technique. All subjects were submitted to calculation of left ventricular mass index (LVMI) and common carotid artery intima-media thickness (CCIMT), using ultrasound technique.

Results. The correlation coefficients between the media to lumen ratio in subcutaneous small arteries (M/L) and LVMI or between M/L and CCIMT were closer in RVH than in pheochromocytoma, EH or NT; in PA the correlation coefficients were slightly less close than those in RVH. An excess prevalence of carotid plaques in RVH was observed.

Conclusions. A close relation between small resistance artery morphology and cardiac or carotid artery structure may be observed in those hypertensive patients in whom the renin-angiotensin-aldosterone system is activated. In constrast, in NT, EH and pheochromocytoma no significant correlation between M/L and LVMI or CCIMT was observed.

Abbreviations and Acronyms   CCIMT = common carotid artery intima-media thickness   EH = essential hypertension   LVH = left ventricular hypertrophy   LVMI = left ventricular mass index   M/L = media to lumen ratio in subcutaneous small arteries   NT = normotensive or normotension   PA = primary aldosteronism   RVH = renovascular hypertension

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