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      Hemodynamics in Borderline Hypertension: Acute Effect of Furosemide

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          In order to identify the hemodynamics of borderline essential hypertension, radionuclide angiography was performed before and after bolus injection of furosemide (40 mg i.v.) both at 3 min (i.e. before diuretic effect) and at 30 min (i.e. after diuretic effect) in 16 borderline (B) patients and in 14 age-matched WHO classification I-II essential hypertensives (H) patients. 14 age-matched normotensive (N) subjects were used as controls. B patients were further subdivided into two subgroups according to a cardiac index under or above 3 liter/min/m2 in basal conditions. Baseline hemodynamic characteristics showed higher values of mean arterial pressure (MAP) and systemic vascular resistance index (SVRI) in both H and B patients when compared with N subjects (p < 0.001). Furthermore, B and H patients exhibited lower values of left ventricular peak filling rate (PFR) than seen in N subjects (p < 0.01 and p < 0.05, respectively). H patients demonstrated higher peak systolic blood pressure/end-systolic volume ratio (PSP/ESV) than seen in N subjects (p < 0.05). PFR positively correlated with peak emptying rate (PER) only in N and B patients (p < 0.05). After furosemide administration, even though differences were observed in the absolute values, B and H patients showed similar hemodynamic patterns. Only the B subgroup with cardiac index (CI) > 3 liter (‘volume-dependent’ patients) showed a decrease in left ventricular end-diastolic volume index (LVEDVI) at 30 min associated with a lowering of stroke index (SI; p < 0.005 for both), when compared with pre-drug values. In B patients with CI < 3 liter (‘afterload-dependent’ patients) no differences were observed either at 3 min or at 30 min in comparison with values obtained prior to drug administration. Moreover, in this subgroup, like in H patients, there was a negative correlation (p < 0.01) between 3-min percent change of SVRI and 3-min percent change of SI. Our data suggest that in ‘borderline’ hypertension: (a) there may be an increase in peripheral resistance, as in established hypertension, especially when age-matched groups are considered; (b) the earliest sign of compromised left ventricular function is the reduction in dia-stolic PFR but, unlike established hypertension, this index is still correlated with systolic function; (c) cardiac output might be even somewhat reduced and also negatively correlated with vascular resistance (‘afterload-dependent’ hearts); (d) furosemide (acute administration) might contribute to a better definition of hemodynamic behavior.

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          Author and article information

          S. Karger AG
          11 November 2008
          : 71
          : 6
          : 331-340
          aInstitute of Internal Medicine IV, Department of Special Medical Pathology II, and bInstitute of Internal Medicine I, Department of Cardiovascular Disease, and cInstitute of Nuclear Medicine and Medical Physics, University of Florence, Italy
          173687 Cardiology 1984;71:331–340
          © 1984 S. Karger AG, Basel

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          Pages: 10
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