Renal dysfunction and diastolic impairment among British ethnic minorities with hypertension: the Ethnic-Echocardiographic Heart of England Screening Study.
Renal dysfunction is frequently associated with left ventricular (LV) hypertrophy and diastolic dysfunction in hypertensive patients. Limited data exist on renal dysfunction and diastolic impairment among British ethnic minorities with hypertension. We studied associations between renal impairment and diastolic dysfunction in hypertensive subjects of African-Caribbean and South Asian origin. Five hundred and ten hypertensive subjects with ejection fraction ⩾55% and with no history of ischaemic heart disease/valve pathology were included from the original population of the Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES). Diastolic function and cardiac remodelling were measured by echocardiography. LV hypertrophy was common and present in 62% of patients with normal estimated glomerular filtration rate (eGFR, >90 ml min-1per 1.73 m2), 73% in those with eGFR 60-89 ml min-1per 1.73 m2and 87% with eGFR <60 ml min-1per 1.73 m2. On both univariate and multivariable linear regression, reduced eGFR was associated with higher LV mass index (LVMI, P=0.01 and P=0.039, respectively). On multivariable analyses, increased LVMI (but not eGFR) was an independent predictor of echocardiographic parameters of diastolic dysfunction. Higher LVMI was an independent predictor of all-cause or cardiovascular death on multivariable analyses (both P=0.002), but not eGFR. LV hypertrophy is common in minority ethnic groups with hypertension, especially in the presence of renal dysfunction. Increased LVMI rather than renal impairment per se is a major determinant of diastolic dysfunction and increased risk of cardiovascular or all-cause death among hypertensive patients without end-stage renal failure.
University of Birmingham, Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK.
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Shantsila
University of Birmingham, Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK.
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Shantsila
Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
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Gill
University of Birmingham, Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK.
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D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D017691:Caribbean Region / Q000208:ethnology; D003430:Cross-Sectional Studies; D003971:Diastole; D004452:Echocardiography; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000401:mortality / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*