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Reduced systemic microvascular function in patients with resistant hypertension and microalbuminuria: an observational study

Journal of Human Hypertension volume 38, pages 806–813 (2024)Cite this article

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Abstract

Resistant hypertension (RH) may be associated with microalbuminuria (MAU), a marker of cardiovascular risk and target organ damage, and both may be related to microvascular damage. Laser speckle contrast imaging (LSCI) is an innovative approach for noninvasively evaluating systemic microvascular endothelial function useful in the context of RH with or without MAU. Microalbuminuria was defined as a urine albumin-to-creatinine ratio between 30 and 300 mg/g. Microvascular reactivity was evaluated using LSCI to perform noninvasive measurements of cutaneous microvascular perfusion changes. Pharmacological (acetylcholine [ACh], or sodium nitroprusside [SNP]) and physiological (postocclusive reactive hyperemia [PORH]) stimuli were used to evaluate vasodilatory responses. Thirty-two patients with RH and a normal urine albumin-to-creatinine ratio (RH group) and 32 patients with RH and microalbuminuria (RH + MAU) were evaluated. Compared with patients without MAU, patients with RH + MAU showed reduced endothelial-dependent systemic microvascular reactivity, as demonstrated by an attenuation of microvascular vasodilation induced by PORH. On the other hand, ACh-induced vasodilation did not differ between groups. The results also revealed reduced endothelial-independent (SNP-induced) microvascular reactivity in hypertensive patients with MAU compared with patients without MAU. In this study, there was evidence of endothelial dysfunction associated with impaired microvascular smooth muscle function in patients with RH + MAU. This may suggest that patients with RH need more intensive therapeutic strategies for the control of blood pressure to avoid further vascular damage and the resulting consequences.

The study was registered at ClinicalTrials.gov (https://register.clinicaltrials.gov) under protocol # NCT05464849, initial release 12/07/2022.

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Fig. 1: Systemic endothelial-dependent microvascular effects of postocclusive reactive hyperemia.
Fig. 2: Systemic endothelial-dependent microvascular effects induced by acetylcholine.
Fig. 3: Systemic endothelial-independent microvascular effects induced by sodium nitroprusside.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank Marcio Marinho Gonzalez for his excellent technical assistance.

Funding

This investigation was supported by grants from CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico, E.T. grant #311680/2021-6) and FAPERJ (Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro), E.T. grant #E-26/200.976/2022.

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  1. National Institute of Cardiology, Rio de Janeiro, Brazil

    Vinicius Crahim, Valéria Verri, Andrea De Lorenzo & Eduardo Tibirica

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  1. Vinicius Crahim
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  2. Valéria Verri
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  3. Andrea De Lorenzo
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  4. Eduardo Tibirica
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Contributions

ET, VC, ADL, and VV contributed to the conception and design of the study, and to the analysis and interpretation of data; ET, VC, ADL, and VV were also involved in the drafting of the manuscript, and literature review. All authors have given final approval of the version to be published and are publicly responsible for its content.

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Correspondence to Eduardo Tibirica.

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The authors declare no competing interest.

Ethical approval

The present study was performed in accordance with the Helsinki Declaration of 1975, revised in 2000, and was approved by the Institutional Review Board (IRB) of the National Institute of Cardiology, Rio de Janeiro, Brazil, under protocol # CAAE 53946021.8.0000.5272. Once deemed eligible to participate in this study, all subjects read and signed an informed consent document approved by the IRB. The study was registered at ClinicalTrials.gov (https://register.clinicaltrials.gov) under protocol # NCT05464849, initial release 12/07/2022.

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Crahim, V., Verri, V., De Lorenzo, A. et al. Reduced systemic microvascular function in patients with resistant hypertension and microalbuminuria: an observational study. J Hum Hypertens 38, 806–813 (2024). https://doi.org/10.1038/s41371-024-00958-7

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