Renal resistance and long-term blood pressure in individuals genetically predisposed for essential hypertension

Buus, Niels Henrik; Mulvany, Michael J.; Eiskjær, Hans; Christensen, Kent Lodberg; Skov, Karin

doi:10.1097/hjh.0000000000000919

Cited by 5 publications

(3 citation statements)

References 37 publications

(53 reference statements)

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“…While R a did not change, TVR decreased significantly. This is noteworthy, since we would have expected a parallel auto regulatory decrease in R a to conserve RBF as has previously been described with for example angiotensin receptor blockers [39]. That R a did not decrease while RBF did suggests a SLGT2i-induced relative afferent vasoconstriction.…”

Section: Discussionsupporting

confidence: 59%

Renal and systemic hemodynamic effects of empagliflozin: Three randomized, double blind, placebo controlled cross-over trials

Nielsen,

Duus,

Buus

et al. 2024

Preprint

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Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve renal outcomes in type 2 diabetes mellitus (DM2) and chronic kidney disease (CKD). A decrease in renal blood flow (RBF) with attenuation of glomerular hyperfiltration may contribute to this. We examined renal and systemic hemodynamic effects of SGLT2i in relevant patient categories. Methods: Using a double-blind placebo controlled cross-over design we randomized patients with DM2 and estimated glomerular filtration rate (eGFR) >60 ml/min/1.73m2 (n=16), patients with DM2 and eGFR 20-60 ml/min/1.73m2 (n=17) and patients with non-diabetic CKD and eGFR 20-60 ml/min/1.73m2 (n=16) to empagliflozin 10 mg daily or placebo for four weeks and crossed over to the opposite treatment after two-week washout. RBF was measured with 82Rubidium positron emission tomography/computed tomography (82Rb-PET/CT), GFR as plasma clearance of 99mTechnetium- diethylene-triamine-pentaacetate, while 24-hour blood pressure (BP) and total peripheral vascular resistance (TVR) were recorded using the commercially available Mobil-O-graph. Results: Compared to placebo empagliflozin reduced RBF by 6% in the DM2-CKD group (p<0.001), while there were non-significant decreases of 4% in the DM2 group and 1% in the CKD group (p=0.29 and 0.72). Empagliflozin reduced GFR, BP and TVR in all groups. Although total renal vascular resistance (RVR) remained unchanged, calculations based on Gomez? equations revealed a reduction of post-glomerular resistance in the DM2 and CKD groups. Conclusion: Short-term empagliflozin treatment reduced RBF in patients with DM2 and CKD, whereas GFR, BP and TVR were reduced in all groups. The lack of reduction in total RVR together with a decrease in post-glomerular resistance and systemic BP suggest SGLT2i protect the glomerulus due to relative pre-glomerular vasoconstriction and post-glomerular vasodilation.

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Section: Discussionsupporting

confidence: 59%

Renal and systemic hemodynamic effects of empagliflozin: Three randomized, double blind, placebo controlled cross-over trials

Nielsen,

Duus,

Buus

et al. 2024

Preprint

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“…At the same time, due to the degradation of insulin receptors, insulin starts accumulating in the body. As a result, the more amount of insulin prevents degradation of fat materials, blood triglycerides, which further intensifies hypertension [24].…”

Section: Crmentioning

confidence: 99%

Determination and Analysis of Trace Elements in Five Kinds of Traditional Chinese Medicine in High Blood Pressure Medicinal Food by ICP-AES

Yang

Yan

Zhang

et al. 2020

Journal of Chemistry

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Objective. To establish a method for analysis of microelements in five kinds of traditional Chinese medicine in high blood pressure medicinal food, mainly including manganese, cobalt, selenium, iron, magnesium, and other 15 elements. Methods. The samples were digested using a microwave digestion instrument through NHO3-H2O2 solution, and then, the elements were synthesized by inductively coupled plasma atomic emission spectrometry (ICP-AES). Results. The content of cobalt, manganese, zinc, copper, and nickel in the high blood pressure diet foods is higher, the RSD is between 0.005% and 4.82%, and the recovery rate ranges from 93.40% to 106.5%. The precision and recovery of the detection method are higher. Conclusion. The experiment result is better. Medicinal foods curing high blood pressure contain a number of micronutrients that are beneficial to the human body. This experiment provides some meaningful basis for the prevention and treatment of cardiovascular diseases such as hypertension.

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“…The relationship between early abnormalities in renal haemodynamics and its clinical determinants, however, may be far from being completely elucidated as indicated by the elegant study by Buus and coworkers, appearing on the present issue of the Journal [10]. Building on previous findings that abnormally high renal resistance in off-spring of parents with hypertension may signal a long-term higher risk of hypertension development, the authors set out to assess whether 1-year treatment with a renin-angiotensinaldosterone inhibitor prevents long-term increase in blood pressure values over a 10-year follow-up period.…”

mentioning

confidence: 94%

Can we predict outcome by noninvasive assessment of renal haemodynamics in hypertension? The role of renal resistive index

Viazzi

Pontremoli

2016

Journal of Hypertension

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E arly abnormalities in renal haemodynamics, namely an increased afferent arteriolar resistance, have been traditionally regarded as a marker of more severe hypertension status and subclinical target organ damage. Although a large body of evidence has been accumulated over the years on this topic in the experimental animal setting, data in humans have been more difficult to be collected because of the relatively cumbersome and invasive techniques used to assess renal haemodynamics in clinical studies. More recently, the possibility to obtain functional and structural information on the renal vasculature by means of noninvasive ultrasonographic Doppler assessment has spurred a growing interest in this area. In particular, blood flow abnormalities detected by analysis of intraparenchymal arterial Doppler waveform, that is the socalled renal resistive index (RRI), have been associated with the occurrence of cardiovascular and renal events [1,2].The RRI can easily be calculated by the ratio of the difference between maximum and minimum (enddiastolic) flow velocity to maximum flow velocity: RRI ¼ (maximum velocity À minimum velocity)/maximum velocity and may theoretically range from 0 to 1. Three to five reproducible waveforms have to be obtained at interlobar or arcuate arteries in three different renal sites, and RRI values from these waveforms are averaged to compute the mean RRI for each kidney [1,2]. In healthy patients, RRI have been shown to vary from 0.58 AE 0.05 (mean AE SD) to 0.64 AE 0.04, and a value lower than 0.7 has been traditionally taken to indicate normal impedance to renal blood flow, although a considerable heterogeneity has been reported [3].As a matter of fact, the physiological mechanisms and clinical determinants of RRI are yet to be fully elucidated.Although RRI was initially proposed as an indicator of renal vascular resistance to blood flow, more recent studies suggest that vascular compliance plays a key role in shaping its values [1,2]. Using an electrical model simulating changes in vascular resistance, inductance, and compliance, a recent study helped us to clarify that intrarenal impedance to blood flow, and the RRI vary in response to changes in distal resistance with the same directionality. In contrast, impedance changed in the opposite direction to the RRI when the distal compliance, proximal compliance, or proximal resistance was modified. The stiffening of systemic vasculature triggers an increase in pulse pressure which, in turn, may lead to high RRI values. Additionally, heart rate can affect RRI because of changes in diastolic duration that affect end-diastolic velocity [2].Besides vascular and haemodynamic factors, other variables such as ureteral obstruction and interstitial renal parenchymal damage may lead to an increase in RRI. As a matter of fact, clinical-pathological correlation studies in patients with chronic kidney disease and renal transplants have reported somewhat contrasting results [1,2]. Arteriolosclerosis and tubulo-interstitial nephropathies seem to be corre...

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Renal resistance and long-term blood pressure in individuals genetically predisposed for essential hypertension

Abstract: RA is associated with 24-h BP levels, but temporary lowering of BP and RA by candesartan does not prevent BP from increasing further. Prevention of hypertension appears not feasible by short-term inhibition of the rennin-angiotensin system in young adults.

Cited by 5 publications

References 37 publications

Renal and systemic hemodynamic effects of empagliflozin: Three randomized, double blind, placebo controlled cross-over trials

Renal and systemic hemodynamic effects of empagliflozin: Three randomized, double blind, placebo controlled cross-over trials

Determination and Analysis of Trace Elements in Five Kinds of Traditional Chinese Medicine in High Blood Pressure Medicinal Food by ICP-AES

Can we predict outcome by noninvasive assessment of renal haemodynamics in hypertension? The role of renal resistive index

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