Left ventricular mass in hypertensive patients with mild-to-moderate reduction of renal function.
OBJECTIVE
Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular (CV) morbidity and mortality. The aim of the present study was to evaluate the relationship between LV mass and mild-to-moderate renal dysfunction in a group of non-diabetic hypertensives, free of CV diseases, participating in the Renal Dysfunction in Hypertension (REDHY) study.


METHODS
Patients with diabetes, a body mass index (BMI) of more than 35 kg/m(2), secondary hypertension, CV diseases and a glomerular filtration rate (GFR) of less than 30 mL/min per 1.73 m(2) were excluded. The final sample included 455 patients, who underwent echocardiographic examination and ambulatory blood pressure monitoring.


RESULTS
There was a significant trend for a stepwise increase in LV mass, indexed by both body surface area (LVMI) and height elevated to 2.7 (LVMH(2.7)), with the declining renal function, that remained statistically significant after correction for potential confounders. The prevalence of LVH, defined either as LVMI of 125 g/m(2) or more or as LVMH(2.7) of 51 g/m(2.7) or more, was higher in subjects with lower values of GFR than in those with normal renal function (P < 0.001 in both cases). The multiple regression analysis confirmed that the inverse association between GFR and LVM was independent of confounding factors.


CONCLUSIONS
The present study confirms the high prevalence of LVH in patients with mild or moderate renal dysfunction. In the patients studied (all with a GFR of 30 mL/min per 1.73 m(2)), the association between LVM and GFR was independent of potential confounders, including 24 h blood pressure load. Taking into account the negative prognostic impact of LVH, further studies focusing on a deeper comprehension of the mechanisms underlying the development of LVH in chronic kidney disease patients are needed.
Cerasola
Giovanni
G
Chair of Internal Medicine, Department of Internal Medicine, Cardiovascular and Nephro-urological Diseases, European Society of Hypertension Excellence Centre, University of Palermo, Palermo, Italy. medint@unipa.it
Nardi
Emilio
E
Mulè
Giuseppe
G
Palermo
Alessandro
A
Cusimano
Paola
P
Guarneri
Marco
M
Arsena
Rosalia
R
Giammarresi
Gaia
G
Carola Foraci
Anna
A
Cottone
Santina
S
D000328:Adult; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D001827:Body Height; D001830:Body Surface Area; D016009:Chi-Square Distribution; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D007558:Italy; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index