From the Cattedra di Medicina Interna I (G.M.), Ospedale S. Gerardo,
Monza; Istituto Scientifico Ospedale S. Luca (G.P.), IRCCS, Istituto
Auxologico Italiano, Milano; and Divisione di Medicina d'Urgenza (G.B.,
P.M., R.C., G.T.) and Centro Fisiologia Clinica e Ipertensione (L.U., C.S.,
A.M.), Ospedale Maggiore, IRCCS, and University of Milano, Italy.
Correspondence to Prof Giuseppe Mancia, Cattedra di Medicina Interna, Università di Milano, Ospedale S. Gerardo dei Tintori, Via Donizetti 106–20052 Monza (MI), Italy.
Abstract—Limited information
is available for humans on whether blood viscosity affects total
peripheral resistance and, hence, blood pressure. Our study
was aimed at assessing the effects of acute changes in blood viscosity
on both clinic and 24-hour ambulatory blood pressure (BP) values. In 22
normotensive and hypertensive patients with polycythemia, clinic and
24-hour ambulatory BPs were measured before and 7 to 10 days after
isovolumic hemodilution; this was performed through the withdrawal of
400 to 700 mL of blood, with concomitant infusion of an equivalent
volume of saline-albumin solution. Hematocrit, plasma renin
activity, plasma endothelin-1, right atrial diameter
(echocardiography), and blood viscosity were
measured under both conditions. Plasma renin activity and right atrial
diameter were used as indirect markers of blood volume changes. Plasma
endothelin-1 was used to obtain information on a vasomotor substance
possibly stimulated by our intervention, which could counteract
vasomotor effects. Isovolumic hemodilution reduced hematocrit from
0.53±0.05 to 0.49±0.05 (P<.01). Plasma renin
activity, plasma endothelin-1 and right atrial diameter were unchanged.
Clinic blood pressure was reduced by hemodilution (systolic,
144.3±5.4 to 136.0±3.9 mm Hg[mean±SEM];
diastolic, 87.0±2.8 to 82.1±2.6 mm Hg,
P<.05 for both) and a reduction was observed also for
24-hour average ABP (systolic, 133.6±2.9 to 129.5±2.7
mm Hg; diastolic, 80.0±2.0 to 77.3±1.7 mm Hg,
P<.05 for both). The reduction was consistent
in hypertensive patients (n=12), whereas in normotensive patients
(n=10) it was small and not significant. Both clinic and 24-hour
average heart rates were unaffected by the hemodilution. Thus, in
polycythemia, reduction in blood viscosity without changing blood
volume causes a significant fall in both clinic and 24-hour ambulatory
BPs; this is particularly true when, as can often happen, blood
pressure is elevated. This emphasizes the importance this variable
may have in the determination of blood pressure and the potential
therapeutic value of its correction when altered.
© 1998 American Heart Association, Inc.
Scientific Contributions
Hemodilution Reduces Clinic and Ambulatory Blood Pressure in Polycythemic Patients
Key Words: blood viscosity • hemodilution • blood pressure monitoring, ambulatory • hemorheology
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