Objectives: Previous research has shown that submaximal mouth opening by mandibular extension (ME) is followed by a prolonged reduction in blood pressure. This effect was observed in young and adult normotensive and hypertensive rats and in young normotensive human subjects. Methods: We assessed the effects of a ME for 10 minutes obtained with a fixed mouth opener in both hypertensive adult humans (aged 55 years or older) and elderly (6-7 months) anaesthetized, hypertensive rats (SHR). Blood pressure and heart rate were measured every 10 minutes by non-invasive automatic recorders for 30 minutes before and 120 minutes after the procedure. Nine human hypertensive subjects (7 experimental and 2 controls) and seven spontaneously hypertensive rats (5 experimental and 2 controls) were tested. Results: A statistically significant reduction in systolic blood pressure (SBP), mean arterial blood pressure (MABP) and heart rate (HR) was observed after ME in the seven hypertensive human subjects, in whom an average decrease of 15 mmHg for SBP, 10 mmHg for MABP and 7 bpm for HR, was observed. A similar hypotensive effect was recorded in spontaneously hypertensive rats that displayed a statistically significant decrease of SBP, DBP and MABP, amounting to about 40-50 mmHg. Conclusion: This study provides the first evidence that ME has an important and prolonged hypotensive effect when applied to subjects with high blood pressure, making their arterial blood pressure decrease toward normal values for at least two hours.

Previous studies in anesthetized normotensive rats demonstrated that a single mouth opening for 10 min obtained by an ad hoc dilator (mandibular extension [ME]) produced a blood pressure reduction by about 20 mmHg lasting for about 2 h and that once‐repeated ME prolonged this effect. We here describe these effects in hypertensive rats. Mean (intra) arterial blood pressure (MABP) and heart rate (HR) was followed for up to a maximum of 470 min after single or repeated 10 min‐lasting ME in two groups of anesthetized, male, 6–9 months old hypertensive rats. In one group, hypertension was induced by dexamethasone (20 μg/kg/day, subcutaneously for 7 days; Dex‐HT); the other group was spontaneously hypertensive rats (SHR). Studies were done, in Dex‐HT rats, after only surgical procedures (no ME, sham‐operated rats), single ME, early repeated (after 10 min) ME (ER‐ME) and late repeated (after 160 min) ME (LR‐ME) and, in SHR, after only surgical procedures and ER‐ME. One‐way ANOVA for repeated measures revealed no significant effect on MABP and HR in sham‐operated groups. In Dex‐HT rats, single ME was followed by a significant MABP decline by 25 mmHg, lasting for 100 min; ER‐ME and LR‐ME were followed by an even greater significant MABP decline by 40 mmHg, which outlasted the experimental observation period. In SHR, ER‐ME gave similar results as in Dex‐HT rats. HR significantly declined in all, except sham‐operated groups. In conclusions, ME is followed by a prolonged MABP decline also in hypertensive rats. This effect is even more pronounced, in length and magnitude, after repeated ME.

Objective: The activation of the renin-angiotensin-aldosterone system (RAAS) is an established factor worsening insulin sensitivity and global cardiovascular risk in metabolic syndrome, obesity and diabetes. However little attention has been given in recent years to the response of RAAS to physiological oral sugar intake, despite early studies documented an increase of plasma renin activity after oral glucose load (Trovati,1989). Aim of this study was to assess RAAS changes after an oral glucose load in a population with cardiometabolic risk. Design and method: We studied preliminarly 31 overweight/obese non diabetic patients (24F/7 M, mean age 45yrs, 11 with mild hypertension, 21 obese) who consecutively underwent a standard oral glucose tolerance test (OGTT) in their diagnostic workup. After informed consent, blood pressure (BP) was measured and plasma samples were taken at baseline and 120 min during OGTT for the additional evaluation of insulin, renin, aldosterone, potassium and sodium levels. Student paired t test and regression analysis were used for statistical evaluation Results: Results. At 120 min (i.e. the peak of insulin concentration), mean BP, sodium and potassium levels decreased significantly (mean ± SD: from 97 ± 8 to 92 ± 10 mmHg, 140 ± 3 to 139 ± 2 mEq/L, 4.0 ± 0.4 to 3.7 ± 0.3 mEq/L, respectively, p < .001), with an increase in renin (from 21 ± 20 to 35 ± 46 microUI/ml, p < .02) and a decrease in aldosterone (from 95 ± 53 to 74 ± 38 pg/ml, p < .05) levels. In the subgroup of hypertensive patients, similar trends were observed. Multiple regression analysis showed independent correlations of aldosterone, insulin and renin with potassium levels (p = 0.02). The decrease in BP levels was related to the peak insulin levels (p < .01). Conclusions: In overweight/obese subjects we observed during OGTT an acute increase in renin (and, conversely, a decrease in aldosterone) levels, confirming early observations in normal subjects after insulin-induced hypokalemia. We hypothesize that subjects who frequently eat high-sugar meals in their daily life may undergo repeated episodes of reactive renin stimulation with lowered potassium levels, both known to be adverse factors for cardiovascular and metabolic risk. Future studies are deserved to confirm the results in larger populations and assess their pathophysiological significance.

We have recently shown that in humans submaximal mouth opening associated with partial masticatory movements for 10 min is followed by a small but significant and prolonged reduction of blood pressure and heart rate. We here report the effects of a fixed mouth opener.

Previous data have shown both in the rat and in the human that a single mandibular extension lasting 10 min induces a significant important and prolonged reduction in blood pressure and heart rate, affecting also rat pial microcirculation by the release of endothelial factors. In the present work, we assessed whether repeated mandibular extension could further prolong these effects. We performed two mandibular extensions, the second mandibular extension being applied 10 min after the first one. The second mandibular extension produced a reduction in blood pressure and heart rate for at least 240 min. As in the case of a single mandibular extension, pial arterioles dilated persisting up to 140 min after the second extension. Spectral analysis on 30 min recordings under baseline conditions and after repetitive mandibular extensions showed that the pial arterioles dilation was associated with rhythmic diameter changes sustained by an increase in the frequency components related to endothelial, neurogenic, and myogenic activity while a single mandibular extension caused, conversely, an increase only in the endothelial activity. In conclusion, repetitive mandibular extension prolonged the effects of a single mandibular extension on blood pressure, heart rate and vasodilation and induced a modulation of different frequency components responsible of the pial arteriolar tone, in particular increasing the endothelial activity.

OBJECTIVE:To compare zofenopril + hydrochlorothiazide (Z + H) vs. irbesartan + hydrochlorothiazide (I + H) efficacy on daytime SBP in elderly (>65 years) patients with isolated systolic hypertension (ISH), untreated or uncontrolled by a previous monotherapy.METHODS:After a 1-week run-in, 230 ISH patients (office SBP ≥ 140  mmHg and DBP < 90  mmHg + daytime SBP ≥ 135  mmHg and daytime DBP < 85  mmHg) were randomized double-blind to 18-week treatment with Z + H (30 + 12.5  mg) or I + H (150 + 12.5  mg) once daily, in an international, multicenter study. Z and I doses could be doubled after 6 and 12 weeks, and nitrendipine 20  mg added at 12 weeks in nonnormalized patients.RESULTS:In the full analysis set (n = 216) baseline-adjusted average (95% confidence interval) daytime SBP reductions after 6 weeks (primary study end point) were similar (P = 0.888) with Z + H [7.7 (10.7, 4.6)  mmHg, n = 107] and I + H [7.9 (10.7, 5.0)  mmHg, n = 109]. Daytime SBP reductions were sustained during the study, and larger (P = 0.028) with low-dose Z + H at study end [16.2 (20.0, 12.5)  mmHg vs. 11.2 (14.4, 7.9)  mmHg I + H]. Daytime SBP normalization (<135 mmHg) rate was similar under Z + H and I + H at 6 and 12 weeks, but more common under Z + H at 18 weeks (68.2 vs. 56.0%, P = 0.031). Both drugs equally reduced SBP in the last 6 h of the dosing interval and homogeneously reduced SBP throughout the 24 h. The proportion of patients reporting drug-related adverse events was low (Z + H: 4.4% vs. I + H: 6.0%; P = 0.574).CONCLUSION:Elderly patients with ISH respond well to both low and high-dose Z or I combined with H.

The availability of robust nomograms is essential for the correct evaluation of blood pressure (BP) values in children. A literature search was conducted by accessing the National Library of Medicine by using the keywords BP, pediatric and reference values/nomograms. A total of 43 studies that evaluated pediatric BP nomograms were included in this review. Despite the accuracy of the latest studies, many numerical and methodological limitations still remain. The numerical limitations include the paucity of data for neonates/infants and for some geographic areas (Africa/South America/East Europe/Asia) and ethnicities. Furthermore, the data on ambulatory BP and response to exercise are extremely limited, and the criteria for stress-test interruption are lacking. There was heterogeneity in the methodologies employed to perform the measurements, in the inclusion/exclusion criteria (often not reported), in the data normalization and the data expression (Z-scores/percentiles/mean values). Although most studies adjusted the measurements for age and/or height, the classification by specific age/height subgroups varied. Gender differences were generally considered, whereas other confounders (that is, ethnicity/geographic area/environment) were seldom evaluated. As a result, nomograms were heterogeneous, and when comparable, at times showed widely different confidence intervals. These differences are most likely because of both methodological limitations and differences among the populations studied. Some robust nomograms exist (particularly those from the USA); however, it has been demonstrated that if adopted in other countries/continents, they may generate an unpredictable bias in the evaluation of BP values in children. Actual pediatric BP nomograms present consistent limitations that affect the evaluation of BP in children. Comprehensive nomograms, which are based on a large population of healthy children (including neonates/infants) and use standardized methodology, are warranted for every country/region.

Renal denervation (RD) is an emerging treatment for resistant arterial hypertension (RAH). RAH is characterized by hyperactivity of catecholaminergic and renin–angiotensin–aldosterone systems (RAAS), with elevated arterial blood pressure and a higher prevalence of cardiovascular overload and remodeling. As renal innervation is involved in sympathetic and RAAS overactivation, RD has the potential to reduce blood pressure by influencing this pathophysiological network [ [1] James P.A. Oparil S. Carter B.L. et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311: 507-520 Crossref PubMed Scopus (5772) Google Scholar ]. Indeed, RD has been shown to reduce renal norepinephrine spillover [ [2] Cohen-Mazor M. Mathur P. Stanley J.R. et al. Evaluation of renal nerve morphological changes and norepinephrine levels following treatment with novel bipolar radiofrequency delivery systems in a porcine model. Hypertens. 2014; 32: 1678-1692 Crossref Scopus (32) Google Scholar ] and it seems to exert beneficial effects also on cardiac remodeling by reduction of cardiac hypertrophy [ [3] Brandt M.C. Mahfoud F. Reda S. et al. Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension. J. Am. Coll. Cardiol. 2012; 59: 901-909 Crossref PubMed Scopus (436) Google Scholar ].

In the present study we have extended our previous findings about the effects of 10 minutes of passive mandibular extension in anesthetized Wistar rats. By prolonging the observation time to 3 hours, we showed that 10 minutes mandibular extension caused a significant reduction of the mean arterial blood pressure and heart rate respect to baseline values, which persisted up to 160 minutes after mandibular extension. These effects were accompanied by a characteristic biphasic response of pial arterioles: during mandibular extension, pial arterioles constricted and after mandibular extension dilated for the whole observation period. Interestingly, the administration of the opioid receptor antagonist naloxone abolished the vasoconstriction observed during mandibular extension, while the administration of Nω-Nitro-L-arginine methyl ester, a nitric oxide synthase inhibitor, abolished the vasodilation observed after mandibular extension. Either drug did not affect the reduction of mean arterial blood pressure and heart rate induced by mandibular extension. By qRT-PCR, we also showed that neuronal nitric oxide synthase gene expression was significantly increased compared with baseline conditions during and after mandibular extension and endothelial nitric oxide synthase gene expression markedly increased at 2 hours after mandibular extension. Finally, western blotting detected a significant increase in neuronal and endothelial nitric oxide synthase protein expression. In conclusion mandibular extension caused complex effects on pial microcirculation involving opioid receptor activation and nitric oxide release by both neurons and endothelial vascular cells at different times.

This study developed and then tested the feasibility, acceptability and initial efficacy of a 3-session, culturally adapted, intervention combining motivational enhancement therapy (MET) and strengths-based case management (SBCM) delivered by promotoras in Spanish to reduce heavy drinking among male, Latino day laborers. A pilot two-group randomized trial (N = 29) was conducted to evaluate the initial efficacy of MET/SBCM compared to brief feedback (BF). Alcohol-related measures were assessed at 6, 12 and 18 weeks after baseline. Most intervention group participants (12/14) attended all counseling sessions and most participants (25/29) remained in the study at 18 weeks. Alcohol related measures improved in both groups over time with no statistically significant differences observed at any of the time points. However the comparative effect size of MET/SBCM on weekly drinking was in the large range at 6-weeks and in the moderate range at 12-weeks. Post hoc analyses identified a statistically significant reduction in number of drinks over time for participants in the intervention group but not for control group participants. Despite the extreme vulnerability of the population, most participants completed all sessions of MET/SBCM and reported high satisfaction with the intervention. We feel our community partnership facilitated these successes. Additional studies of community-partnered and culturally adapted interventions are needed to reduce heavy drinking among the growing population of Latinos in the U.S.

Various procedures involving stimulations of facial regions are known to induce so-called trigemino-cardiac reflexes that entail a decrease of heart rate and blood pressure. We here report the effects of a specific stimulation that consists in a submaximal passive mandibular extension obtained by means of a dilatator applied for 10 minutes between the upper and lower incisor teeth, associated with partial active masticatory movements. Blood pressure and heart rate were determined in 18 young normal volunteers by Omron M4, before (20 minutes), during (10 minutes) and after mandibular extension (80 minutes) and under control conditions (same overall duration without stimulation). While control values remained stable, mandibular extension was followed by a progressive decline of both blood pressure (up to about 12/11 mmHg) and heart rate (up to about 13 bpm), statistically confirmed by ANOVA both on absolute values and on changes from basal values. The decline of systolic blood pressure and heart rate significantly correlated with basal values. The present findings indicate that submaximal opening of the mouth, associated to partial masticatory movements, induces a prolonged reduction of blood pressure and heart rate in normotensive volunteers.

Several studies have shown that exposure to altered magnetic fields affects nociception by suppressing stress-induced hypoalgesia, and that this effect is reduced or abolished if the treatment is performed in the absence of light. This raises the question as to whether other sources of sensory stimuli may also modulate these magnetic effects. We investigated the possible role of olfaction in the magnetically induced effects on sensitivity to nociceptive stimuli and heart rate (HR) in restraint-stressed homing pigeons exposed to an Earth-strength, irregularly varying (<1 Hz) magnetic field. The magnetic treatment decreased the nociceptive threshold in normally smelling birds and an opposite effect was observed in birds made anosmic by nostril plugging. Conversely, no differential effect of olfactory deprivation was observed on HR, which was reduced by the magnetic treatment both in smelling and anosmic pigeons. The findings highlight an important role of olfactory environmental information in the mediation of magnetic effects on nociception, although the data cannot be interpreted unambiguously because of the lack of an additional control group of olfactory-deprived, non-magnetically exposed pigeons. The differential effects on a pigeon's sensitivity to nociceptive stimulus and HR additionally indicate that the magnetic stimuli affect nociception and the cardiovascular system in different ways.

Background Consistent evidence shows an impact of systemic haemodynamic overload on the right ventricle, but its functional and structural consequences have received scarce attention for several reasons including the difficult application of conventional imaging techniques due to the complex shape and orientation of that cardiac chamber. Aims To evaluate whether mild to moderate, uncomplicated hypertension associates with abnormal right ventricular structure and function and how those changes relate to homologous changes in the left ventricle. Data were acquired by steady-state free-precession cardiac MRI, the state of the art tool for the morphological and functional evaluation of the right ventricle. Materials and methods Twenty-five (12 women) uncomplicated, untreated, essential hypertensive patients were compared with 24 (13 women) sedentary normotensive controls of comparable age. Wall thickness, indexed ventricular mass, end-diastolic volumes, early peak filling rate, a correlate of diastolic relaxation, and ejection fraction were measured at both ventricles. Remodelling index, the ratio of ventricular mass to end-diastolic volume, was used as an index of concentricity. Results Right ventricular mass index, ventricular wall thickness and remodelling index were greater in hypertensive subjects and associated with reduced peak filling rate, a pattern consistent with concentric right ventricular remodelling. In the hypertensive group, positive, highly significant biventricular correlations existed between indexed mass, early peak filling rate and ejection fraction. Conclusions Systemic hypertension associates with concentric right ventricular remodelling and impaired diastolic function, confirming that the unstressed ventricle is not immune to the effects of systemic hypertension. Structural and functional right ventricular adaptation to systemic hypertension tends to parallel the homologous modifications induced by systemic haemodynamic overload on the left ventricle.

Objectives Patients and animal models of arterial hypertension are characterized by structural and functional abnormalities of the coronary microcirculation. Using a translational approach, we ascertained whether antihypertensive treatment can reverse microvascular remodelling and improve myocardial perfusion.Methods In 20 hypertensive patients with left ventricular hypertrophy, blood pressure, left ventricular mass index and myocardial blood flow were measured at baseline and after 6 months of treatment with perindopril + indapamide. In spontaneously hypertensive rats, blood pressure, coronary flow and histomorphometry of intramural coronary arterioles were measured after 8 weeks of treatment with placebo or perindopril + indapamide.Results In patients, treatment decreased blood pressure (161 +/- 10/96 +/- 5 to 136 +/- 12/81 +/- 6 mmHg; P<0.0001) and left ventricular mass index (93 +/- 16 to 85 +/- 17 g/m(2); P<0.01) while increasing baseline (0.69 +/- 0.13 to 0.88 +/- 0.36 ml/min per g; P<0.05) and hyperaemic myocardial blood flow (1.42 +/- 0.32 to 1.94 +/- 0.99 ml/min per g; P<0.05). In rats treated with perindopril + indapamide (n=11), blood pressure was 93 +/- 18/55 +/- 18 mmHg compared to 215 +/- 18/161 +/- 17 mmHg in placebo (n=6; P<0.001), baseline flow was unchanged whilst hyperaemic coronary flow was 19.89 +/- 3.50 vs. 12.15 +/- 0.99 ml/min per g, respectively (P<0.01). The medial area of intramural arterioles was 1613 +/- 409 with perindopril + indapamide and 8118 +/- 901 mu m(2) with placebo (P<0.001).Conclusion In patients with arterial hypertension and left ventricular hypertrophy, perindopril + indapamide reduced blood pressure and left ventricular mass index and improved resting and hyperaemic myocardial blood flow. Data in rats provide evidence that the improvement in coronary flow observed after treatment is due to reverse remodelling of intramural coronary arterioles and improved microvascular function. J Hypertens 29:364-372 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

Renal function is known to be a strong predictor of cardiovascular prognosis, and cardiorenal disease is increasingly investigated in medical research. In this study, we tested the hypothesis that a single combined cardiorenal scintigraphy examination with the perfusion tracer Tc-99m-tetrofosmin is feasible and may allow the simultaneous investigation of cardiac and renal pathology in cardiovascular patients. Methods: Thirty patients scheduled for dual-day gated SPECT also gave their informed consent for a renal acquisition after a single injection of 370 MBq of Tc-99m-tetrofosmin, at rest (30 patients) or with adenosine (21 patients), and to undergo an additional standard renal study with the glomerular tracer Tc-99m-diethylenetriamine-pentaacetic acid (DTPA) (74 MBq) after 1wk (24 patients). Kidney images and renograms were obtained. Renal uptake index, expressed as the percentage ratio of kidney counts cumulated over the second minute after injection to the administered dose, was calculated as a functional renal parameter. Time to peak activity and separate kidney percentage uptake (as the percentage contribution of each kidney to total renal uptake) were also calculated. Results: Compared with Tc-99m-DTPA, Tc-99m-tetrofosmin provided better-quality kidney images, with a higher uptake index (13.17% +/- 4.76% vs. 8.33% +/- 2.45%, P < 0.001) and with comparable separate kidney percentage uptake and times to peak activity. Tc-99m-tetrofosmin uptake index was significantly lower in the patients who were more compromised according to renal and cardiovascular functional parameters, and correlated with Tc-99m-DTPA uptake index (r = 0.77, P < 0.001), serum creatinine (r = 0.59, P < 0.005), log brain natriuretic peptide N-terminal levels (r = -0.65, P < 0.005), myocardial and carotid intima-media wall thickness (for both, r = -0.61, P < 0.005), and the Doppler index of renal vascular resistance (r = -0.60, P < 0.005). In the 21 patients who underwent the provocative test, adenosine induced a significant decrease in renal Tc-99m-tetrofosmin uptake index (from 14.12% +/- 4.50% to 11.81% +/- 3.33%, P < 0.005) suggesting a decrement in renal perfusion or function. Conclusion: Tc-99m-tetrofosmin cardiorenal scintigraphy is feasible at low cost as a single-shot study and may allow both the evaluation of renal morphology and renograms during a cardiac study and the calculation of renal functional parameters.

We have previously reported that the exposure to an abnormal magnetic field simulating the one encountered by the International Space Station (ISS) orbiting around the Earth may enhance autonomic response to emotional stimuli. Here we report the results of the second part of that study which tested whether this field also affects cognitive functions. Twenty‐four volunteers participated in the study, 12 exposed to the natural geomagnetic field and 12 to the magnetic field encountered by ISS. The test protocol consisted of a set of eight tests chosen from a computerized test battery for the assessment of attentional performance. The duration of exposure was 90 min. No effect of exposure to ISS magnetic field was observed on attentional performance. Bioelectromagnetics 30:45–51, 2009. © 2008 Wiley‐Liss, Inc.

Primary aldosteronism is increasingly investigated in hypertension being associated with an elevated cardiovascular risk. Aldosterone has been reported to increase in the luteal phase in normal women but to our knowledge the influence of the ovarian cycle on the first screening for primary aldosteronism (that is, on the levels of plasma aldosterone and its relationship to PRA levels) was never investigated. We measured hormonal levels during one cycle in 26 low-renin mild hypertensive outpatients. LH, FSH, 17 β-estradiol, progesterone, aldosterone and PRA were assayed at the seventh, fourteenth, twenty-first and twenty-eighth days of the cycle after 30 min of recumbency. Aldosterone and PRA increased from the seventh (follicular phase) to twenty-first day (luteal phase) from 11.2 to 17.8 ng 100 ml −1 and from 0.23 to 0.35 ng ml −1 h −1 , respectively (both P =0.004) The proportion of patients with aldosterone >15 ng 100 ml −1 significantly increased from the follicular to the luteal phase, (8/26 vs 19/25, P =0.018); a similar increase was found for Aldosterone-PRA Ratio >30 combined with either a minimum PRA value of 0.5 ng ml −1 h −1 or aldosterone >15 ng 100 ml −1 (7/26 vs 16/25 and 7/26 vs 17/25 respectively, P <0.05). Aldosterone was positively related to PRA and progesterone. Higher aldosterone levels may be frequently encountered in the second part of the ovarian cycle in low-renin hypertensive women. This variability appears to be an important factor to be taken into account in the first-step laboratory screening for primary aldosteronism and should be considered in the process of standardization of the diagnostic work-up for this disease.

Renal function is known to be a strong predictor of cardiovas- cular prognosis, and cardiorenal disease is increasingly in- vestigated in medical research. In this study, we tested the hypothesis that a single combined cardiorenal scintigraphy ex- amination with the perfusion tracer 99m Tc-tetrofosmin is feasible and may allow the simultaneous investigation of cardiac and re- nal pathology in cardiovascular patients. Methods: Thirty pa- tients scheduled for dual-day gated SPECT also gave their informed consent for a renal acquisition after a single injection of 370 MBq of 99mTc-tetrofosmin, at rest (30 patients) or with adenosine (21 patients), and to undergo an additional standard renal study with the glomerular tracer 99mTc-diethylenetriamine- pentaaceticacid(DTPA)(74MBq)after1wk(24patients).Kidney images and renograms were obtained. Renal uptake index, expressed as the percentage ratio of kidney counts cumulated over the second minute after injection to the administered dose, was calculated as a functional renal parameter. Time to peakactivityandseparatekidneypercentage uptake(astheper- centage contribution of each kidney to total renal uptake) were also calculated. Results: Compared with 99m Tc-DTPA, 99m Tc- tetrofosmin provided better-quality kidney images, with a higher uptake index (13.17% 6 4.76% vs. 8.33% 6 2.45%, P , 0.001) and with comparable separate kidney percentage uptake and times to peak activity. 99m Tc-tetrofosmin uptake index was sig- nificantly lower in the patients who were more compromised according to renal and cardiovascular functional parameters, and correlated with 99m Tc-DTPA uptake index (r 5 0.77, P , 0.001), serum creatinine (r 5 0.59, P , 0.005), log brain natriu- reticpeptideN-terminallevels(r 52 0.65,P ,0.005),myocardial and carotid intima-media wall thickness (for both,r 52 0.61,P , 0.005), and the Doppler index of renal vascular resistance (r 5 20.60, P , 0.005). In the 21 patients who underwent the provoc- ative test, adenosine induced a significant decrease in renal 99mTc-tetrofosmin uptake index (from 14.12% 6 4.50% to 11.81% 6 3.33%, P , 0.005) suggesting a decrement in renal perfusion or function. Conclusion: 99mTc-tetrofosmin cardiore- nal scintigraphy is feasible at low cost as a single-shot study andmayallow boththeevaluation ofrenal morphology andreno- grams during a cardiac study and the calculation of renal func- tional parameters.