Circulation, Vol 83, 845-853, Copyright © 1991 by American Heart Association
A Polese, N De Cesare, P Montorsi, F Fabbiocchi, M Guazzi, A Loaldi and MD Guazzi
BACKGROUND. At any given perfusion pressure, coronary reserve is expressed
by the difference between autoregulated and maximally vasodilated flow. In
hypertension the raised coronary resistance reduces the steepness of the
pressure-flow relationship at maximal vasodilatation. In the presence of
cardiac hypertrophy the line of autoregulated flow becomes higher. For
these reasons coronary reserve is reduced and the point at which baseline
flow approaches the maximal achievable flow might be shifted to a higher
perfusion pressure. Thus, any reduction below this elevated and critical
value of pressure would lower the coronary flow. METHODS AND RESULTS. The
investigated patients were normotensive (controls, nine) and hypertensive
with normal (group I, seven) or augmented LV mass index because of
concentric LV hypertrophy (group II, eight). All had effort-induced angina
and angiographically normal left epicardial branches. Flow in the great
cardiac vein was measured by thermodilution in the baseline and during
stepwise (5 mm Hg every 5 minutes) decrease of the coronary perfusion
pressure with a titrated nitroprusside i.v. infusion; perfusion pressures
of 60 mm Hg in the controls and 70 mm Hg in the hypertensives were taken as
end points. Baseline flow averaged 102 ml/min in normotensives, 104 ml/min
in hypertensive group I and 148 ml/min in hypertensive group II. At the end
points flow was similar to baseline in the controls and group I. In group
II coronary flow started to decline and myocardial O2 extraction started to
slightly but significantly rise at perfusion pressures of 90-80 mm Hg; at
the end point flow was reduced by 26% (p less than 0.01 from baseline). The
perfusion patterns did not seem to be related to the changes in tension-
time index and heart rate. CONCLUSIONS. The association of high blood
pressure (reduced ability of the coronary arterioles to dilate) and
hypertrophy of the myocardium (augmented baseline coronary flow) may shift
the point of exhaustion of coronary reserve to a higher perfusion pressure
and make the myocardium vulnerable to treatment-induced relative
hypertension.
ARTICLES
Upward shift of the lower range of coronary flow autoregulation in hypertensive patients with hypertrophy of the left ventricle
Istituto di Cardiologia dell' Universita degli Studi Milano, Italy.
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