title: Synergic effects of renin and aldosterone on right ventricular function in hypertension: a tissue Doppler study.
abstract: BACKGROUND
  Right ventricular dysfunction (RVD) is associated with poor cardiovascular outcome. The renin-angiotensin-aldosterone system is involved in alterations of the left ventricular geometry and function. Detrimental effects of the renin-angiotensin-aldosterone system on the right ventricular function are being postulated, but data supporting this assumption are still lacking. The aim of the study was to assess the impact of hyperreninemia, hyperaldosteronism or their combination on right ventricular function in hypertensive individuals.
  
  
  METHODS
  Plasma renin activity (PRA) and plasma aldosterone concentrations (PACs) were measured in 116 hypertensive patients, divided as follows: normal PRA and PAC (n = 38); high PRA and normal PAC (hypereninemia) (n = 26); normal PRA and high PAC (hyperaldosternism) (n = 27); high PRA and PAC (HRA) (n = 25). Echocardiographic evaluation of the left and right ventricles (RV), including tissue Doppler imaging, was performed. RVD was identified by tissue Doppler Imaging-derived Myocardial Performance Index, calculated with a multisegmental approach.
  
  
  RESULTS
  Indices of the right ventricular structure and function, as well as the prevalence of RVD, were higher in hyperreninemia and hyperaldosternism groups as compared with the normal group, and a further increase was observed in the HRA patients. Regression models showed a similar risk of RVD in the hyperreninemia and hyperaldosternism patients, regardless of systemic and pulmonary pressure, as well as left ventricular dysfunction. Notably, patients with both hyperreninemia and hyperaldosternism exhibited the strongest association with RVD as compared with patients with only hyperreninemia or hyperaldosternism.
  
  
  CONCLUSIONS
  Isolated hyperreninemia or hyperaldosternism determines a similar impairment of the right ventricular function, whereas their combination is further detrimental. Renin and aldosterone may represent early biomarkers of right ventricular dysfunction in hypertension.
authors.affiliation: aCardiology, Department of Clinical and Molecular Medicine, University of Rome 'Sapienza' bIRCCS Neuromed, Pozzilli, Italy cCardiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
authors.forename: Mario
authors.initials: M
authors.lastname: Gregori
authors.forename: Benedetta
authors.initials: B
authors.lastname: Giammarioli
authors.forename: Giuliano
authors.initials: G
authors.lastname: Tocci
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 / Q000502:physiology*; D000886:Anthropometry / Q000379:methods; D015415:Biomarkers / Q000097:blood; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood / Q000502:physiology*; D012084:Renin-Angiotensin System / Q000502:physiology*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D016278:Ventricular Function, Right / Q000502:physiology*
chemical_list: D015415:Biomarkers; D000450:Aldosterone; D012083:Renin