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(Hypertension. 2001;38:907.)
© 2001 American Heart Association, Inc.

Scientific Contributions

Impairment of Renal Vasodilation With L-Arginine Is Related to More Severe Disease in Untreated Hypertensive Patients

Elena Bello; Carlos Caramelo; Nieves Martell; José María Alcázar; Javier González; María Dolores López; Luis Miguel Ruilope; Francisco Román González; Adela María Rovira; Rosa Gazapo; María José Soldevilla; Santos Casado

From the Instituto de Investigaciones Médicas, Fundación Jiménez Díaz (E.B., C.C., J.G., M.D.L., F.R.G., R.M.G., M.J.S., S.C.), Hypertension Units, Hospital Clínico de San Carlos (N.M.), and Hospital Doce de Octubre (J.M.A., L.M.R.), Universidad Autónoma and Universidad Complutense; and Instituto Reina Sofía de Investigación Nefrológica (C.C., F.R.G., S.C.), Madrid, Spain.

Correspondence to Carlos Caramelo, MD, Laboratorio de Nefrología-Hipertensión, Fundación Jiménez Díaz, Universidad Autónoma, Av Reyes Católicos 2, 28040 Madrid, Spain. E-mail ccaramelo{at}fjd.es

Abstract—— Data remain insufficient to place the decreased response to L-arginine in hypertensive patients within a consistent pathophysiological sequence. The aim of the present study in patients with essential hypertension was to assess the relationships between the response to L-arginine and a set of relevant clinical and laboratory parameters. In this prospective, interventional study, we administered L-arginine to untreated hypertensive individuals and healthy control subjects and measured the clearance of inulin and of para-aminohippurate and a set of biochemical and clinical variables. L-Arginine infusion revealed major differences between control subjects and 1 subgroup (group B) of hypertensive individuals. Group B hypertensives (n=18) had no increase in inulin clearance and no decrease in renal vascular resistance with L-arginine; however, in another subset of hypertensive patients (group A, n=27), the insulin clearance increased and renal vascular resistance decreased similar to the control group (group C, n=11). The ambulatory blood pressure monitoring in group B showed both an increased mean diastolic pressure and a "nondipper" pattern in the nocturnal regulation of arterial pressure. These findings in group B were accompanied by significant alterations in optic fundus and left ventricle hypertrophy and increased microalbuminuria (all, P<0.05). Furthermore, group B individuals had significantly lower values of HDL cholesterol and a higher baseline atherogenic index, plasma insulin level, and glucose/insulin index. We disclose a previously undescribed relationship between end organ repercussion and decreased renal hemodynamic response to L-arginine. Our results may help to understand the mechanisms that lead to target organ damage in hypertension.

Key Words: L-arginine • hypertension, essential • endothelium • blood pressure monitoring, ambulatory

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