Left ventricular hypertrophy and geometry in hypertensive patients with chronic kidney disease.
OBJECTIVE
To evaluate the prevalence of left ventricular hypertrophy (LVH) and left ventricular geometry in a group of 293 hypertensive patients with stage 2-5 chronic kidney disease (CKD), compared with 289 essential hypertensive patients with normal renal function.


METHODS
All patients underwent echocardiographic examination. Patients on stage 1 CKD, dialysis treatment, or with cardiovascular diseases were excluded.


RESULTS
LVH was observed in 47.1% of patients with CKD and in 31.14% of essential hypertensive patients (P < 0.0001). We found increasingly higher left ventricular diameters, thicknesses, and mass from stage 2 to 5 CKD. Distribution of concentric and eccentric LVH was not different between the two groups. However, after introducing mixed hypertrophy, the difference between the two groups group was disclosed (P = 0.027). The prevalence of inappropriate left ventricular mass was 52.6% in patients with CKD vs. 30.5% in essential hypertensive patients (P < 0.0001). Multiple regression analysis confirmed that the association between renal function and left ventricular mass (beta -0.287; P < 0.0001) was independent by potential confounders. From stage 4 to 5, the significant increase of left ventricular mass was due to growth in posterior wall thickness rather than end-diastolic diameter. Diastolic function was significantly worse in patients with CKD, especially in more advanced stages.


CONCLUSIONS
Our study confirms that LVH is highly prevalent in patients with CKD; in this population, LVH is often inappropriate and characterized by the simultaneous increase of wall thicknesses and diameters.
Nardi
Emilio
E
Dipartimento di Medicina Interna, Cattedra di Medicina Interna and Hypertension Excellence Centre of the European Society of Hypertension, Università degli Studi di Palermo, Palermo, Italy. emilionardi@virgilio.it
Palermo
Alessandro
A
Mulè
Giuseppe
G
Cusimano
Paola
P
Cottone
Santina
S
Cerasola
Giovanni
G
D000368:Aged; D000450:Aldosterone / Q000378:metabolism; D001795:Blood Pressure Determination / Q000379:methods; D016022:Case-Control Studies; D002395:Catecholamines / Q000097:blood; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D015150:Echocardiography, Doppler; D004573:Electrolytes / Q000097:blood / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D017408:Guidelines as Topic; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D007558:Italy; D007674:Kidney Diseases / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012044:Regression Analysis; D012083:Renin / Q000378:metabolism
D002395:Catecholamines; D004573:Electrolytes; D000450:Aldosterone; D003404:Creatinine; D012083:Renin