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

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.