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Cardiac Sympathetic Nervous System in Early Essential Hypertension Assessed by ¹²³I-MIBG

Department of Cardiology, Shizuoka General Hospital, Shizuoka
Third Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan

Correspondence: For correspondence or reprints contact: Kazuyuki Sakata, MD, Department of Cardiology, Shizuoka General Hospital, 4-27-1 Kita-andou, Shizuoka, Japan.

ABSTRACT

Sympathetic overactivity has been noted in various clinical stages of essential hypertension. The purpose of this study is to investigate ¹²³I-metaiodobenzylguanidine (MIBG) uptake and washout in patients with borderline and mild hypertension. Methods: To assess cardiac sympathetic function in essential hypertension, we performed ¹²³I-MIBG cardiac imaging and echocardiography in 25 normotensive, 25 borderline hypertensive and 24 mildly hypertensive men. Age and body mass index were similar in the three groups. Results: Regarding the echocardiographic variables, the left ventricular mass index (LVMI) was significantly higher in the mildly hypertensive group (125.6 ± 28.6 g/m²) than in the normotensive (99.9 ± 20.7 g/m²) and the borderline hypertensive (110.0 ± 24.4 g/m²) groups (P < 0.001 and P < 0.05, respectively). Regarding the scintigraphic variables, the heart-to-mediastinum (H/M) ratio was significantly lower in the mildly hypertensive group (1.8 ± 0.3) than in the normotensive (2.1 ± 0.3) and the borderline hypertensive (2.1 ± 0.2) groups. In contrast, the washout rate was significantly higher in the mildly hypertensive group (17.6% ± 10.8%) than in the normotensive (7.0% ± 4.9%) and the borderline (11.9% ± 8.9%) hypertensive groups (P < 0.001 and P < 0.02, respectively). In addition, the borderline hypertensive group had a significantly higher washout rate than the normotensive group (P < 0.05). MIBG washout rate had a strong positive correlation with LVMI (r = 0.77, P < 0.0001). In contrast, the H/M ratio had a weak negative correlation with LVMI (r = –0.40, P < 0.0006). Conclusion: During the course of establishment of essential hypertension, the washout rate becomes higher with the advance of hypertension and with the development of left ventricular hypertrophy. Thus, we suggest a strong relationship between cardiac sympathetic activity and the advance of hypertension at its early stages.

Key Words: ¹²³I-metaiodobenzylguanidine imaging • essential hypertension • left ventricular mass

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