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Other Techniques for the Assessment of Small Artery Damage in Hypertension

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Assessment of Preclinical Organ Damage in Hypertension

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Abstract

The evaluation of minimum vascular resistance in the forearm with a plethysmographic technique is one of the earliest methods employed for the assessment of the microcirculation. Maximum post-ischemic flow is indeed correlated with the ratio between wall thickness and internal lumen in resistance arterioles. For such an evaluation, it is therefore mandatory that the vascular district investigated is at a real maximum vasodilatation. In humans, this may be obtained by a combination of ischemia, muscular effort and, possibly, heat. From the maximum post-ischemic blood flow it is possible to calculate minimum vascular resistance, which represents an indirect index of microvascular structural alterations, with the additional advantage of an in vivo evaluation. Recently a further, interesting and promising approach was proposed. The method is based on the association between a confocal measurement of th e external diameter of retinal arteriole, and an evaluation of the internal diameter with a laser Doppler technique. The comparison between the two images, defined as “reflection image” and “perfusion image” is made by a dedicated software. From these two measurements, it is relatively easy to calculate the ratio between wall thickness and internal lumen. In summary, new, non invasive techniques for the evaluation of microvascular morphology and for for cardiovascular risk stratification in hypertensive patients are presently under development. They may represent a promising and interesting future perspective.

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References

  1. Agabiti-Rosei E, Rizzoni D, Castellano M, Porteri E, Zulli R, Muiesan ML, Bettoni G, Salvetti M, Muiesan P, Giulini SM. Media: lumen ratio in human small resistance arteries is related to forearm minimal vascular resistance. J Hypertens. 1995;13:341–7.

    Article  Google Scholar 

  2. Pedrinelli R, Taddei S, Spessot M, Salvetti A. Maximal postischemic forearm vasodilation in human hypertension: a reassessment of the method. J Hypertens. 1987;5 Suppl 5:S431–3.

    Google Scholar 

  3. Pedrinelli R, Spessot M, Salvetti A. Reactive hyperemia during short-term blood flow and pressure changes in the hypertensive forearm. J Hypertens. 1990;8:467–71.

    Article  CAS  PubMed  Google Scholar 

  4. Rizzoni D, Porteri E, Boari GEM, De Ciuceis C, Sleiman I, Muiesan ML, Castellano M, Miclini M, Agabiti-Rosei E. Prognostic significance of small artery structure in hypertension. Circulation. 2003;108:2230–5.

    Article  PubMed  Google Scholar 

  5. De Ciuceis C, Porteri E, Rizzoni D, Rizzardi N, Paiardi S, Boari GEM, Miclini M, Zani F, Muiesan ML, Donato F, Salvetti M, Castellano M, Tiberio GAM, Giulini SM, Agabiti RE. Structural alterations of subcutaneous small arteries may predict major cardiovascular events in hypertensive patients. Am J Hypertens. 2007;20:846–52.

    Article  PubMed  Google Scholar 

  6. Mathiassen ON, Buus NH, Sihm I, Thybo NK, Mørn B, Schroeder AP, Thygesen K, Aalkjaer C, Lederballe O, Mulvany MJ, Christensen KL. Small artery structure is an independent predictor of cardiovascular events in essential hypertension. J Hypertens. 2007;25:1021–6.

    Article  CAS  PubMed  Google Scholar 

  7. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Task Force Members. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281–357.

    Article  CAS  PubMed  Google Scholar 

  8. Flammer J, Konieczka K, Bruno RM, Virdis A, Flammer AJ, Taddei S. The eye and the heart. Eur Heart J. 2013;34:1270–8.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Wong TY, Mitchell P. Hypertensive retinopathy. N Engl J Med. 2004;351:2310–7.

    Article  CAS  PubMed  Google Scholar 

  10. Rizzoni D, De Ciuceis C, Porteri E, Paiardi S, Boari GE, Mortini P, Cornali C, Cenzato M, Rodella LF, Borsani E, Rizzardi N, Platto C, Rezzani R, Agabiti RE. Altered structure of small cerebral arteries in patients with essential hypertension. J Hypertens. 2009;27:838–45.

    Article  CAS  PubMed  Google Scholar 

  11. Wong TY, Klein R, Sharrett AR, Duncan BB, Couper DJ, Tielsch JM, Klein BE, Hubbard LD. Retinal arteriolar narrowing and risk of coronary heart disease in men and women. The Atherosclerosis Risk in Communities Study. JAMA. 2002;287:1153–9.

    PubMed  Google Scholar 

  12. Masaidi M, Cuspidi C, Giudici V, Negri F, Sala C, Zanchetti A, Grassi G, Mancia G. Is retinal arteriolar-venular ratio associated with cardiac and extracardiac organ damage in essential hypertension ? J Hypertens. 2009;27:1277–83.

    Article  CAS  PubMed  Google Scholar 

  13. Rizzoni D, Muiesan ML. Retinal vascular caliber and the development of hypertension: a meta-analysis of individual participant data. J Hypertens. 2014;32:225–7.

    Article  CAS  PubMed  Google Scholar 

  14. Hughes AD, Martinez-Perez E, Jabbar AS, Hassan A, Witt NW, Mistry PD, Chapman N, Stanton AV, Beevers G, Pedrinelli R, Parker KH, Thom SA. Quantification of topological changes in retinal vascular architecture in essential and malignant hypertension. J Hypertens. 2006;24:889–94.

    Article  CAS  PubMed  Google Scholar 

  15. Hughes AD, Stanton AV, Jabbar AS, Chapman N, Martinez-Perez ME, McG Thom SA. Effect of antihypertensive treatment on retinal microvascular changes in hypertension. J Hypertens. 2008;26:1703–7.

    Article  CAS  PubMed  Google Scholar 

  16. Harazny JM, Ritt M, Baleanu D, Ott C, Heckmann J, Schlaich MP, Michelson G, Schmieder RE. Increased wall:lumen ratio of retinal arterioles in male patients with a history of a cerebrovascular event. Hypertension. 2007;50(4):623–829.

    Article  CAS  PubMed  Google Scholar 

  17. Ritt M, Harazny JM, Ott C, Schlaich MP, Schneider MP, Michelson G, Schmieder RE. Analysis of retinal arteriolar structure in never-treated patients with essential hypertension. J Hypertens. 2008;26(7):1427–34.

    Article  CAS  PubMed  Google Scholar 

  18. Ritt M, Harazny JM, Ott C, Schneider MP, Schlaich MP, Michelson G, Schmieder RE. Wall-to-lumen ratio of retinal arterioles is related with urinary albumin excretion and altered vascular reactivity to infusion of the nitric oxide synthase inhibitor N-monomethyl-L-arginine. J Hypertens. 2009;27:2201–18.

    Article  CAS  PubMed  Google Scholar 

  19. Baleanu D, Ritt M, Harazny J, Heckmann J, Schmieder RE, Michelson G. Wall-to-lumen ratio of retinal arterioles and arteriole-to-venule ratio of retinal vessels in patients with cerebrovascular damage. Invest Ophthalmol Vis Sci. 2009;50:4351–9.

    Article  PubMed  Google Scholar 

  20. Harazny JM, Raff U, Welzenbach J, Ott C, Ritt M, Lehmann M, Michelson G, Schmieder RE. New software analyses increase the reliability of measurements of retinal arterioles morphology by scanning laser Doppler flowmetry in humans. J Hypertens. 2011;29:777–82.

    Article  CAS  PubMed  Google Scholar 

  21. Rizzoni D, Porteri E, Duse S, De Ciuceis C, Agabiti Rosei C, La Boria E, Semeraro F, Costagliola C, Sebastiani A, Danzi P, Tiberio GAM, Giulini SM, Docchio F, Sansoni G, Sarkar A, Agabiti RE. Relationship between media to lumen ratio of subcutaneous small arteries and wall to lumen ratio of retinal arterioles evaluated non-invasively by scanning laser Doppler flowmetry. J Hypertens. 2012;30:1169–75.

    Article  CAS  PubMed  Google Scholar 

  22. Muiesan ML, Salvetti M, Rizzoni D, Paini A, Agabiti-Rosei C, Aggiusti C, Bertacchini F, Stassaldi D, Gavazzi A, Porteri E, De Ciuceis C, Agabiti-Rosei E. Pulsatile hemodynamics and microcirculation: evidence for a close relationship in hypertensive patients. Hypertension. 2013;61:130–6.

    Article  CAS  PubMed  Google Scholar 

  23. Ott C, Raff U, Harazny JM, Michelson G, Schmieder RE. Central pulse pressure is an independent determinant of vascular remodeling in the retinal circulation. Hypertension. 2013;61:1340–5.

    Article  CAS  PubMed  Google Scholar 

  24. Salvetti M, Agabiti Rosei C, Paini A, Aggiusti C, Cancarini A, Duse S, Semeraro F, Rizzoni D, Agabiti Rosei E, Muiesan ML. Relationship of wall-to-lumen ratio of retinal arterioles with clinic and 24-hour blood pressure. Hypertension. 2014;63:1110–5.

    Article  CAS  PubMed  Google Scholar 

  25. Rizzoni D, Palombo C, Porteri E, Muiesan ML, Kozàkovà M, La Canna G, Nardi M, Guelfi D, Salvetti M, Morizzo C, Vittone F, Agabiti RE. Relationships between coronary vasodilator capacity and small artery remodeling in hypertensive patients. J Hypertens. 2003;21:625–32.

    Article  CAS  PubMed  Google Scholar 

  26. Izzard AS, Rizzoni D, Agabiti-Rosei E, Heagerty AM. Small artery structure and hypertension: adaptive changes and target organ damage. J Hypertens. 2005;23:247–50.

    Article  CAS  PubMed  Google Scholar 

  27. Heagerty AM. Predicting hypertension complications from small artery structure. J Hypertens. 2007;25:939–40.

    Article  CAS  PubMed  Google Scholar 

  28. Schiffrin EL, Touyz RM. From bedside to bench to bedside: role of renin-angiotensin-aldosterone system in remodeling of resistance arteries in hypertension. Am J Physiol Heart Circ Physiol. 2004;287:H435–46.

    Article  CAS  PubMed  Google Scholar 

  29. Mulvany MJ. Small artery structure: time to take note? Am J Hypertens. 2007;20:853–4.

    Article  PubMed  Google Scholar 

  30. Rizzoni D, Aalkjaer C, De Ciuceis C, Porteri E, Rossini C, Rosei CA, Sarkar A, Agabiti RE. How to assess microvascular structure in humans. High Blood Press Cardiovasc Prev. 2011;18:169–77.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Clinical and Experimental Sciences, Clinica Medica, University of Brescia, Piazzale Spedali Civili 1, Brescia, 25121, Italy

    Damiano Rizzoni & Claudia Agabiti Rosei

Authors
  1. Damiano Rizzoni
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  2. Claudia Agabiti Rosei
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Correspondence to Damiano Rizzoni .

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Editors and Affiliations

  1. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

    Enrico Agabiti Rosei

  2. IRCCS Istituto Auxologico Italiano, University of Milano-Bicocca, Milano, Italy

    Giuseppe Mancia

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Rizzoni, D., Rosei, C.A. (2015). Other Techniques for the Assessment of Small Artery Damage in Hypertension. In: Agabiti Rosei, E., Mancia, G. (eds) Assessment of Preclinical Organ Damage in Hypertension. Springer, Cham. https://doi.org/10.1007/978-3-319-15603-3_13

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  • DOI: https://doi.org/10.1007/978-3-319-15603-3_13

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-15602-6

  • Online ISBN: 978-3-319-15603-3

  • eBook Packages: MedicineMedicine (R0)

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