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High blood pressure is inversely related with the presence and extent of coronary collaterals

Journal of Human Hypertension volume 19, pages 809–817 (2005)Cite this article

Abstract

Patients with hypertension have an increased case fatality during acute myocardial infarction (MI). Coronary collateral (CC) circulation has been proposed to reduce the risk of death during acute ischaemia. We determined whether and to which degree high blood pressure (BP) affects the presence and extent of CC circulation. A cross-sectional study in 237 patients (84% males), admitted for elective coronary angioplasty between January 1998 and July 2002, was conducted. Collaterals were graded with Rentrop's classification (grade 0–3). CC presence was defined as Rentrop-grade ⩾1. BP was measured twice with an inflatable cuff manometer in seated position. Pulse pressure was calculated by systolic blood pressure (SBP)−diastolic blood pressure (DBP). Mean arterial pressure was calculated by DBP+1/3 × (SBP−DBP). Systolic hypertension was defined by a reading ⩾140 mmHg. We used logistic regression with adjustment for putative confounders. SBP (odds ratio (OR) 0.86 per 10 mmHg; 95% confidence interval (CI) 0.73–1.00), DBP (OR 0.67 per 10 mmHg; 95% CI 0.49–0.93), mean arterial pressure (OR 0.73 per 10 mmHg; 95% CI 0.56–0.94), systolic hypertension (OR 0.49; 95% CI 0.26–0.94), and antihypertensive treatment (OR 0.53; 95% CI 0.27–1.02), each were inversely associated with the presence of CCs. Also, among patients with CCs, there was a graded, significant inverse relation between levels of SBP, levels of pulse pressure, and collateral extent. There is an inverse relationship between BP and the presence and extent of CC circulation in patients with ischaemic heart disease.

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References

  1. Njolstad I, Arnesen E . Preinfarction blood pressure and smoking are determinants for a fatal outcome of myocardial infarction: a prospective analysis from the Finnmark Study. Arch Intern Med 1998; 158: 1326–1332.

    Article  CAS  Google Scholar 

  2. Koerselman J, van der Graaf Y, de Jaegere PP, Grobbee DE . Coronary collaterals: an important and underexposed aspect of coronary artery disease. Circulation 2003; 107: 2507–2511.

    Article  Google Scholar 

  3. Seiler C . The human coronary collateral circulation. Heart 2003; 89: 1352–1357.

    Article  Google Scholar 

  4. Popma JJ, Bittl J . Coronary angiography and intravascular ultrasonography. In: Braunwald E, Zipes DP, Libby P (eds). Heart Disease: A Textbook of Cardiovascular Medicine. WB Saunders Company: Philadelphia, 2001, pp 387–418.

    Google Scholar 

  5. Fukai M et al. Angiographically demonstrated coronary collaterals predict residual viable myocardium in patients with chronic myocardial infarction: a regional metabolic study. J Cardiol 2000; 35: 103–111.

    CAS  PubMed  Google Scholar 

  6. Kornowski R . Collateral formation and clinical variables in obstructive coronary artery disease: the influence of hypercholesterolemia and diabetes mellitus. Coron Artery Dis 2003; 14: 61–64.

    Article  Google Scholar 

  7. Kilian JG, Keech A, Adams MR, Celermajer DS . Coronary collateralization: determinants of adequate distal vessel filling after arterial occlusion. Coron Artery Dis 2002; 13: 155–159.

    Article  Google Scholar 

  8. Fujita M et al. Determinants of collateral development in patients with acute myocardial infarction. Clin Cardiol 1999; 22: 595–599.

    Article  CAS  Google Scholar 

  9. Kyriakides ZS et al. Coronary collateral circulation in coronary artery disease and systemic hypertension. Am J Cardiol 1991; 67: 687–690.

    Article  CAS  Google Scholar 

  10. Karpanou EA et al. Significance of arterial hypertension on coronary collateral circulation development and left ventricular function in coronary artery disease. J Hypertens 1988; (Suppl 6): S151–S153.

  11. Heinle RA, Levy RI, Gorlin R . Effects of factors predisposing to atherosclerosis on formation of coronary collateral vessels. Am J Cardiol 1974; 33: 12–16.

    Article  CAS  Google Scholar 

  12. Simons PC et al. Second manifestations of ARTerial disease (SMART) study: rationale and design. Eur J Epidemiol 1999; 15: 773–781.

    Article  CAS  Google Scholar 

  13. Rentrop KP, Cohen M, Blanke H, Phillips RA . Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol 1985; 5: 587–592.

    Article  CAS  Google Scholar 

  14. van Liebergen RA et al. Quantification of collateral flow in humans: a comparison of angiographic, electrocardiographic and hemodynamic variables. J Am Coll Cardiol 1999; 33: 670–677.

    Article  CAS  Google Scholar 

  15. Rogers G, Oosthuyse T . A comparison of the indirect estimate of mean arterial pressure calculated by the conventional equation and calculated to compensate for a change in heart rate. Int J Sports Med 2000; 21: 90–95.

    Article  CAS  Google Scholar 

  16. Kurotobi T et al. Reduced collateral circulation to the infarct-related artery in elderly patients with acute myocardial infarction. J Am Coll Cardiol 2004; 44: 28–34.

    Article  Google Scholar 

  17. Habib GB et al. Influence of coronary collateral vessels on myocardial infarct size in humans. Results of phase I thrombolysis in myocardial infarction (TIMI) trial. The TIMI Investigators. Circulation 1991; 83: 739–746.

    Article  CAS  Google Scholar 

  18. Rentrop KP, Thornton JC, Feit F, Van Buskirk M . Determinants and protective potential of coronary arterial collaterals as assessed by an angioplasty model. Am J Cardiol 1988; 61: 677–684.

    Article  CAS  Google Scholar 

  19. Sabia PJ et al. An association between collateral blood flow and myocardial viability in patients with recent myocardial infarction. N Engl J Med 1992; 327: 1825–1831.

    Article  CAS  Google Scholar 

  20. Seiler C, Fleisch M, Garachemani A, Meier B . Coronary collateral quantitation in patients with coronary artery disease using intravascular flow velocity or pressure measurements. J Am Coll Cardiol 1998; 32: 1272–1279.

    Article  CAS  Google Scholar 

  21. Kyriakidis MK et al. Relation between changes in blood flow of the contralateral coronary artery and the angiographic extent and function of recruitable collateral vessels arising from this artery during balloon coronary occlusion. J Am Coll Cardiol 1994; 23: 869–878.

    Article  CAS  Google Scholar 

  22. Meier B et al. Coronary wedge pressure in relation to spontaneously visible and recruitable collaterals. Circulation 1987; 75: 906–913.

    Article  CAS  Google Scholar 

  23. Werner GS et al. Angiographic assessment of collateral connections in comparison with invasively determined collateral function in chronic coronary occlusions. Circulation 2003; 107: 1972–1977.

    Article  Google Scholar 

  24. Buschmann I, Schaper W . The pathophysiology of the collateral circulation (arteriogenesis). J Pathol 2000; 190: 338–342.

    Article  CAS  Google Scholar 

  25. Yilmaz MB et al. Obesity is associated with impaired coronary collateral vessel development. Int J Obes Relat Metab Disord 2003; 27: 1541–1545.

    Article  CAS  Google Scholar 

  26. Lee CW et al. Temporal patterns of gene expression after acute hindlimb ischemia in mice: insights into the genomic program for collateral vessel development. J Am Coll Cardiol 2004; 43: 474–482.

    Article  CAS  Google Scholar 

  27. Fujita M, Tambara K . Recent insights into human coronary collateral development. Heart 2004; 90: 246–250.

    Article  CAS  Google Scholar 

  28. Miura S et al. Angiotensin-converting enzyme inhibitor promotes coronary collateral circulation in patients with coronary artery disease. Circ J 2003; 67: 535–538.

    Article  CAS  Google Scholar 

  29. Heeschen C, Weis M, Cooke JP . Nicotine promotes arteriogenesis. J Am Coll Cardiol 2003; 41: 489–496.

    Article  CAS  Google Scholar 

  30. Hochberg I et al. Haptoglobin phenotype and coronary artery collaterals in diabetic patients. Atherosclerosis 2002; 161: 441–446.

    Article  CAS  Google Scholar 

  31. Nishikawa H et al. Pravastatin promotes coronary collateral circulation in patients with coronary artery disease. Coron Artery Dis 2002; 13: 377–381.

    Article  Google Scholar 

  32. Nagai Y et al. Plasma level of homocysteine is inversely-associated with the development of collateral circulation in patients with single-vessel coronary artery disease. Circ J 2002; 66: 158–162.

    Article  CAS  Google Scholar 

  33. Duan J et al. Hyperhomocysteinemia impairs angiogenesis in response to hindlimb ischemia. Arterioscler Thromb Vasc Biol 2000; 20: 2579–2585.

    Article  CAS  Google Scholar 

  34. Piek JJ et al. Clinical, angiographic and hemodynamic predictors of recruitable collateral flow assessed during balloon angioplasty coronary occlusion. J Am Coll Cardiol 1997; 29: 275–282.

    Article  CAS  Google Scholar 

  35. Newman PE . The coronary collateral circulation: determinants and functional significance in ischemic heart disease. Am Heart J 1981; 102: 431–445.

    Article  CAS  Google Scholar 

  36. Sasayama S, Fujita M . Recent insights into coronary collateral circulation. Circulation 1992; 85: 1197–1204.

    Article  CAS  Google Scholar 

  37. Henderson RD et al. Angiographically defined collateral circulation and risk of stroke in patients with severe carotid artery stenosis. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Stroke 2000; 31: 128–132.

    Article  CAS  Google Scholar 

  38. Boudier HA . Hypertension and microcirculation. Arch Mal Coeur Vaiss 2002; 95 (Spec No 6): 17–22.

    PubMed  Google Scholar 

  39. Boudier HA . Arteriolar and capillary remodelling in hypertension. Drugs 1999; 58 (Spec No 1): 37–40.

    PubMed  Google Scholar 

  40. Vicaut E . Microcirculation and arterial hypertension. Drugs 1999; 58 (Spec No 1): 1–10.

    Article  Google Scholar 

  41. Wong TY et al. Prospective cohort study of retinal vessel diameters and risk of hypertension. BMJ 2004; 329: 79.

    Article  Google Scholar 

Download references

Acknowledgements

These data were presented previously in part as a poster, entitled ‘High blood pressure is inversely related with presence and extent of coronary collaterals’, at the 14th European Meeting on Hypertension of the European Society of Hypertension 2004 (Paris, France). We gratefully acknowledge Koos (J) Plomp, Cardiologist, Department of Cardiology, Heart Lung Center Utrecht, UMC Utrecht, Utrecht, The Netherlands, for scoring the 100 coronary angiograms to assess interobserver variability of the collateral grading. We thank Michael Edlinger for his accurate handling of the SMART-data. We thank Prof Harry AJ Struijker Boudier, PhD, for critical revision of the manuscript. We thank Christine AE Broeders for her excellent secretarial assistance. The work presented in this paper is part of a program grant from the Netherlands Organisation for Health Research and Development (ZonMw, project number 904-65-095). This funding source had no involvement in the writing of this paper or its submission. MCV is supported by the Netherlands Organisation for Scientific Research (NWO, Grant number 016-036-041).

Author information

Author notes

  1. P P Th de Jaegere

    Present address: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands

  2. J Koerselman, P P Th de Jaegere, M C Verhaar, Y van der Graaf and D E Grobbee: Members listed in the Appendix.

Authors and Affiliations

  1. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    J Koerselman, Y van der Graaf & D E Grobbee

  2. Department of Cardiology, Heart Lung Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands

    P P Th de Jaegere

  3. Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands

    M C Verhaar

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  1. J Koerselman
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  2. P P Th de Jaegere
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  3. M C Verhaar
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  4. Y van der Graaf
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  5. D E Grobbee
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for the SMART Study Group

Corresponding author

Correspondence to D E Grobbee.

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Conflict of interest statement: None.

Appendix

Appendix

The SMART Study Group consists of A Algra, MD, PhD, Y van der Graaf, MD, PhD, DE Grobbee, MD, PhD, GEHM Rutten, MD, PhD, Julius Center for Health Sciences and Primary Care, JD Banga, MD, PhD, FLJ Visseren, MD, PhD, Department of Internal Medicine, BC Eikelboom, MD, PhD, FL Moll, MD, PhD, Department of Vascular Surgery, LJ Kappelle, MD, PhD, Department of Neurology, HA Koomans, MD, PhD, Department of Nephrology, WPThM Mali, MD, PhD, Department of Radiology, PAFM Doevendans, MD, PhD, and PPTh de Jaegere, MD, PhD, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.

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Koerselman, J., de Jaegere, P., Verhaar, M. et al. High blood pressure is inversely related with the presence and extent of coronary collaterals. J Hum Hypertens 19, 809–817 (2005). https://doi.org/10.1038/sj.jhh.1001917

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