title: Inadequate RAAS suppression is associated with excessive left ventricular mass and systo-diastolic dysfunction.
abstract: BACKGROUND
  Inadequate suppression of renin-angiotensin-aldosterone system (RAAS) following postural maneuvers may have detrimental effects on cardiac structure and function. In this study, we aimed to appraise the clinical significance of this phenomenon by assessing its relation with inappropriate ventricular mass (ILVM), an adverse phenotype of LV remodeling and dysfunction.
  
  
  METHODS
  Both supine and upright plasma renin activity (PRA) and aldosterone concentrations (PAC) were measured in 115 young newly diagnosed hypertensive subjects. 24-h ambulatory blood pressure monitoring and echocardiographic evaluation including tissue Doppler imaging (TDI) were also performed. Patients were divided as follows: (1) normal PRA and PAC (N) (n = 63); (2) suppressible RAAS (SR) in supine position (n = 27); (3) not suppressible RAAS (NSR) (n = 25). ILVM was expressed as the observed/predicted LV mass ratio ×100 (%PLVM), while LV dysfunction (LVD) was identified by TDI-derived myocardial performance index (MPI).
  
  
  RESULTS
  NSR showed a higher prevalence of ILVM than SR and N. As compared with N and SR, NSR patients had reduced indices of systolic and diastolic function. MPI of the LV as well as prevalence of LVD was also significantly higher in the NSR group. Regression models showed that lack of RAAS suppression was independently associated with ILVM and LVD.
  
  
  CONCLUSIONS
  Prevalence of ILVM and LVD is higher in patients without clinostatic RAAS suppression. Our findings encourage the assessment of RAAS deregulation to better estimate individual cardiovascular risk in patients with arterial hypertension.
authors.affiliation: Cardiology Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Via di Grottarossa, 1035-1039, Rome, Italy, gremao@libero.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Gregori
authors.forename: Giuliano
authors.initials: G
authors.lastname: Tocci
authors.forename: Andrea
authors.initials: A
authors.lastname: Marra
authors.forename: Giulia
authors.initials: G
authors.lastname: Pignatelli
authors.forename: Caterina
authors.initials: C
authors.lastname: Santolamazza
authors.forename: Alberto
authors.initials: A
authors.lastname: Befani
authors.forename: Giuseppino Massimo
authors.initials: GM
authors.lastname: Ciavarella
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferrucci
authors.forename: Francesco
authors.initials: F
authors.lastname: Paneni
mesh_terms: D000328:Adult; D000450:Aldosterone / Q000097:blood*; D018660:Blood Pressure Monitoring, Ambulatory; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011187:Posture; D015995:Prevalence; D012044:Regression Analysis; D012083:Renin / Q000097:blood*; D012084:Renin-Angiotensin System / Q000502:physiology*; D016683:Supine Position; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000503:physiopathology; D020257:Ventricular Remodeling
chemical_list: D000450:Aldosterone; D012083:Renin