Institute of Biostructure and Bioimaging, National Council of Research, Via De Amicis 95, Naples, Italy.
Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, Naples, Italy.
Eur Heart J Cardiovasc Imaging. 2019 Aug 1;20(8):949-958. doi: 10.1093/ehjci/jez025.
Impaired myocardial perfusion reserve (MPR) may occur earlier than coronary atherosclerosis and it may be an early manifestation of developing coronary artery disease (CAD) in patients with resistant hypertension (RH). We evaluated the relationship between RH and MPR in patients with systemic arterial hypertension after balancing for coronary risk factors.
We studied 360 subjects without overt CAD and normal myocardial perfusion at stress-rest 82Rb positron emission tomography/computed tomography. To account for differences in baseline characteristics between patients with resistant and controlled hypertension, we created a propensity score-matched cohort considering clinical variables and coronary risk factors. Before matching, patients with RH were significantly older, had higher prevalence of male gender and hypercholesterolaemia, and showed significantly lower global hyperaemic myocardial blood flow (MBF) and MPR compared with those with controlled hypertension, while baseline MBF and coronary artery calcium (CAC) content were similar in both groups. After matching, there were no significant differences in clinical variables and coronary risk factors between patients with resistant and controlled hypertension, but patients with RH still had lower hyperaemic MBF and MPR (both P < 0.001). At univariable and multivariable linear regression analyses, age, RH, and CAC resulted significant predictors of lower MPR values (all P < 0.05).
After balancing clinical characteristic by propensity score analysis, patients with RH had a blunted hyperaemic MBF and MPR compared with patients with controlled hypertension. The identification of impaired MPR could help to identify early structural alterations of the arterial walls in patients with RH.
心肌灌注储备（MPR）受损可能早于冠状动脉粥样硬化发生，并且可能是抵抗性高血压（RH）患者发生冠状动脉疾病（CAD）的早期表现。我们评估了在平衡冠状动脉危险因素后，全身高血压患者的 RH 与 MPR 之间的关系。
我们研究了 360 名无明显 CAD 且应激-静息 82Rb 正电子发射断层扫描/计算机断层扫描心肌灌注正常的患者。为了考虑抵抗性和控制性高血压患者之间基线特征的差异，我们创建了一个倾向评分匹配队列，考虑了临床变量和冠状动脉危险因素。在匹配之前，RH 患者年龄较大，男性和高胆固醇血症的患病率较高，与控制性高血压患者相比，整体充血性心肌血流（MBF）和 MPR 明显较低，而两组的基线 MBF 和冠状动脉钙（CAC）含量相似。匹配后，抵抗性和控制性高血压患者的临床变量和冠状动脉危险因素无显著差异，但 RH 患者的充血性 MBF 和 MPR 仍较低（均 P<0.001）。在单变量和多变量线性回归分析中，年龄、RH 和 CAC 是 MPR 值降低的显著预测因子（均 P<0.05）。
通过倾向评分分析平衡临床特征后，RH 患者的充血性 MBF 和 MPR 较控制性高血压患者降低。MPR 受损的识别有助于识别 RH 患者动脉壁的早期结构改变。
