20 / 76
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 1, January/February 2017
18
AFRICA
The most important limitations of our study were its
retrospective design and the small sample size, as well as the lack
of testing for other biochemical and echocardiographic markers
that have shown a relationship with coronary slow flow. Studies
with a prospective design integrating a larger number of patients
and coronary slow-flow markers would provide more valuable
data. In our study, the proximal coronary artery diameters were
not compared. Due to the fact that vasoconstriction, which may
develop secondarily due to an increase in sympathetic tone, may
have had an effect on the TIMI frame count. Measurement of
proximal artery diameters and comparing them between the two
groups would produce more valuable information.
In our study, we found higher TIMI frame counts in all
three coronary arteries and a higher mean TIMI frame count in
the non-dipper hypertensive patients than in the dipper group.
Microvascular bed changes and endothelial dysfunction in
non-dipper hypertensive patients can be confirmed with TIMI
frame count, which is a predictor of coronary slow flow rate.
Conclusion
In this study, the TIMI frame count, which is a simple,
productive, objective and reproducible method for indirect
determination of microvascular changes, was found to be
higher in non-dipper hypertensive patients than in dipper
hypertensives.
References
1.
Millar-Craig MW, Bishop CN, Raftery EB. Circadian variation of
blood-pressure.
Lancet
1978;
1
: 795–797.
2.
Pickering TG. The clinical significance of diurnal blood pressure varia-
tions: dippers and nondippers.
Circulation
1990;
81
: 700–702.
3.
Seo WS, Oh HS. The circadian rhythms of blood pressure and heart
rate in the hypertensive subjects: dippers and non-dippers.
Yonsei Med
J
2002;
43
: 320–328.
4.
Fujii T, Uzu T, Nishimura M,
et al
. Circadian rhythm of natriuresis is
disturbed in nondipper type of essential hypertension.
Am J Kidney Dis
1999;
33
: 29–35.
5.
Kurpesa M, Trzos E, Drozdz J,
et al
. Myocardial ischemia and auto-
nomic activity in dippers and non-dippers with coronary artery disease:
assessment of normotensive and hypertensive patients.
Int J Cardiol
2002;
83
: 133–142.
6.
Kobrin I, Oigman W, Kumar A,
et al
. Diurnal variation of blood pres-
sure in elderly patients with essential hypertension.
J Am Geriatr Soc
1984;
2
: 896–899.
7.
Shimada K, Kawamoto A, Matsubayashi K,
et al
. Diurnal blood pres-
sure variations and silent cerebrovasculer damage in elderly patients
with hypertension.
J Hypertens
1992;
10
: 875–878.
8.
Gibson CM, Cannon CP, Daley WL
, et al
. TIMI frame count: a quan-
titative method of assessing coronary artery flow.
Circulation
1996;
93
:
879–878.
9.
Roman MJ, Pickering TG, Schwartz JE,
et al
. Is the absence of a normal
nocturnal fall in blood pressure (nondipping) associated with cardiovas-
cular target organ damage?
J Hypertens
1997;
15
: 969–978.
10. O’Brien E, Sheridan J, O’Malley K. Dippers and non-dippers.
Lancet
1988;
2
: 397–400.
11. Ohkubo T, Hozawa A, Yamaguchi J,
et al
. Prognostic significance of
the nocturnal decline in blood pressure in individuals with and without
high 24-h blood pressure: The Ohasoma study.
J Hypertens
2002;
20
:
2183–2189.
12. Verdecchia P, Schilacci G, Borgioni C. Altered circadian blood pressure
profile and prognosis
. Blood Pressure Monitor
1997;
2
: 347–352.
13. Cushman WC, Ford CE, Einhorn PT,
et al
. Blood pressure control by
drug group in the Antihypertensive and Lipid-Lowering Treatment to
Prevent Heart Attack Trial (ALLHAT).
J Clin Hypertens (Greenwich)
2008;
10
: 751–760.
14. Yazıcı M, Demircan S, Durna K,
et al
. The incidence of nondipping
state in normotensive patients with coronary slow flow and its relation-
ship with prognosis.
Arch Turk Soc Cardiol
2005;
33
: 319–325.
15. Evola S, Cuttitta F, Evola G,
et al
. Early detection of coronary artery
flow and myocardial perfusion impairment in hypertensive patients
evidenced by Myocardial Blush Grade (MBG) and Thrombolysis in
Myocardial Infarction (TIMI) Frame Count (TFC).
Intern Med
2012;
51
: 1653–1660.
16. Pekdemir H, Cin VG, Cicek D,
et al
. Slow coronary flow may be a sign
of diffuse atherosclerosis. Contribution of FFR and IVUS.
Acta Cardiol
2004;
59
: 127–133.
17. Xia S, Deng SB, Wang Y,
et al
. Clinical analysis of the risk factors of
slow coronary flow.
Heart Vessels
2010;
10
: 81–85.
18. Niskanen LK, Laaksonen DE, Nyyssonen K,
et al
. Uric acid level as
a risk factor for cardiovascular and all-cause mortality in middle-aged
men: a prospective cohort study.
Arch Intern Med
2004;
164
: 1546–1551.
19. Ioachimescu AG, Brennan DM, Hoar BM,
et al
. Serum uric acid is
an independent predictor of all-cause mortality in patients at high risk
of cardiovascular disease: a preventive cardiology information system
(PreCIS) database cohort study.
Arthritis Rheum
2008;
58
: 623–630.
20. Turhan H, Erbay AR, Yasar AS,
et al
. Impaired coronary blood flow
in patients with metabolic syndrome: Documented by Thrombolysis In
Myocardial Infarction (TIMI) frame count method.
Am Heart J
2004;
148
: 789–794.
21. Taddei S, Virdis A, Ghiadoni L,
et al
. Vitamin C improves endothelium-
dependent vasodilation by restoring nitric oxide activity in essential
hypertension
. Circulation
1998;
97
: 2222–2229.
22. Panza JA, Quyyumi AA, Brush JE Jr, Epstein SE. Abnormal endothe-
lium-dependent vascular relaxation in patients with essential hyperten-
sion.
N Engl J Med
1990;
323
: 22–27.
23. Higashi Y, Sasaki S, Kurisu S. Regular aerobic exercise augments
endothelium-dependent vascular relaxation in normotensive as well
as hypertensive subjects role of endothelium-derived nitric oxide.
Circulation
1999;
100
: 1194–1202.
24. Treasure CB, Klein JL, Vita JA,
et al
. Hypertension and left ventricular
hypertrophy are associated with impaired endothelium-mediated relaxa-
tion in human coronary resistance vessels.
Circulation
1993;
87
: 86–93.
25. Higashi Y, Oshima T, Ozono R,
et al
. Effects of L-arginine infusion
on renal hemodynamics in patients with mild essential hypertension.
Hypertension
1995;
25
: 898–902.
26. SchiffrinEL, Deng LY. Comparison of effects of angiotensin I-converting
enzyme inhibition and
β
-blockade for 2 years on function of small arter-
ies from hypertensive patients.
Hypertension
1995;
25
: 699–703.
27. Higashi Y, Nakagawa K, Kimura M,
et al
. Circadian variation of blood
pressure and endothelial function in patients with essential hyperten-
sion: a comparison of dippers and non-dippers.
J Am Coll Cardiol
2002;
40
: 2039–2043.