title: The relationship between renal impairment and left ventricular structure, function, and ventricular-arterial interaction in hypertension.
abstract: OBJECTIVE
  Our objective was to define the relationship between renal dysfunction--both albuminuria and reduced estimated glomerular filtration rate (eGFR)--and cardiac structure and diastolic dysfunction among patients with chronic hypertension.
  
  
  METHODS
  Both albuminuria and eGFR were measured in 540 asymptomatic patients with hypertension and diastolic dysfunction assessed by reduced early mitral annular relaxation velocity (E'). The majority of patients were white, mean age was 60 ± 10 years, mean SBP was 149 ± 18 mmHg, and there was a low prevalence comorbid conditions. Albuminuria was undetectable in 148 (27%), within the normal to low range [urine albumin-to-creatinine ratio (UACR) 1-25 mg/g for men, 1-17 mg/g for women] in 292 (54%), and high or very high (UACR >25 mg/g for men, >17 mg/g for women) in 100 (19%). Estimated GFR was 60 ml/min per 1.73 m² or less in 75 (14%), 61-90 ml/min per 1.73 m² in 244 (45%), and more than 90 ml/min per 1.73 m² in 221 (41%).
  
  
  RESULTS
  Albuminuria, even within the normal range, was associated with greater left ventricular wall thickness (P = 0.01), higher relative wall thickness (P = 0.004), worse diastolic function reflected in lower E' (P = 0.01), greater arterial and left ventricular end-systolic stiffness (P < 0.0001 and P = 0.003, respectively), and higher N-terminal pro-brain natriuretic peptide (NT-proBNP) level (P = 0.0025), even after adjustment for differences in baseline characteristics. In contrast, no independent relationship was observed between eGFR and parameters of cardiac structure or function.
  
  
  CONCLUSIONS
  Among asymptomatic hypertensive patients with evidence of diastolic dysfunction, the presence of albuminuria, even within the normal range, is associated with greater concentric remodeling, greater left ventricular end-systolic stiffness, and worse diastolic function.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02445, USA. ashah11@rics.bwh.harvard.edu
authors.forename: Amil M
authors.initials: AM
authors.lastname: Shah
authors.forename: Carolyn S P
authors.initials: CS
authors.lastname: Lam
authors.forename: Susan
authors.initials: S
authors.lastname: Cheng
authors.forename: Anil
authors.initials: A
authors.lastname: Verma
authors.forename: Akshay S
authors.initials: AS
authors.lastname: Desai
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Rocha
authors.forename: Robert
authors.initials: R
authors.lastname: Hilkert
authors.forename: Joseph
authors.initials: J
authors.lastname: Izzo
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zile
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Aurigemma
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000503:physiopathology*; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged