Attenuated coronary flow reserve and vascular remodeling in patients with hypertension and left ventricular hypertrophy

OBJECTIVES The purpose of this study was to evaluate the association betwee n hypertension and left ventricular hypertrophy (LVH) with both coronary va scular remodeling and endothelial function. BACKGROUND The association between endothelial and nonendothelial coronary flow reserve with vascular remodeling in patients with hypertension and LVI -I is still unclear. METHODS One hundred and eleven patients with normal or mildly diseased coro nary arteries at angiography underwent intravascular ultrasound examination of the left anterior descending coronary artery. Patients were divided int o three groups: group I: n = 13, hypertensive patients with LVH; group 2: n 30, hypertensive patients without LVH; group 3: n 68, normotensive patient s. Vessel and lumen area and atherosclerotic plaque area were evaluated. Va scular reactivity was examined using intracoronary adenosine and acetylchol ine. RESULTS Vessel area in group 1 (with LVH) was significantly (p < 0.01) grea ter than that in group 2 (without LVH), whereas, vessel area in both groups 1 and 3 was similar (12.8 +/- 0.8 mm(2), 10.7 +/- 0.4 mm(2) and 11.5 +/- 0 .3 mm(2)). Coronary blood flow at baseline for patients in group 1 (with LV H) was significantly greater than it was for patients in groups 2 and 3 (81 .1 +/- 9.9 ml/min, 56.5 +/- 6.2 ml/min and 48.1 +/- 3.2 ml/min, both p < 0. 05). In comparison with groups 2 and 3, the response to both acetylcholine and adenosine was significantly impaired in patients with LVH. CONCLUSIONS The current study demonstrates that hypertension with LVH is as sociated with both coronary vascular remodeling and attenuated endothelial and nonendothelial coronary flow reserve. (C) 2000 by the American College of Cardiology.