Renal and cardiac abnormalities in primary hypertension.
ABSTRACT The relationship between mild reduction in renal function and cardiac structure and function have not yet been fully elucidated. We investigated cardiac and renal abnormalities in 400 untreated, nondiabetic patients (65% men, mean age 47 years) with primary hypertension and normal serum creatinine.
Renal abnormalities were defined as creatinine clearance less than 75 ml/min per 1.73 m2 (Cockcroft-Gault formula) and/or the presence of microalbuminuria (albumin-to-creatinine ratio). Left ventricular structure and function were assessed by echocardiography.
The prevalence of microalbuminuria and reduced creatinine clearance was 13 and 31%, respectively. Patients with renal abnormalities shared greater left ventricular mass index, higher prevalence of left ventricular hypertrophy, and unfavorable geometric patterns. Microalbuminuria was also associated with inappropriate left ventricular mass and depressed midwall fractional shortening, whereas reduced creatinine clearance was associated with lower stroke volume and higher central pulse pressure/stroke volume ratio and total peripheral resistance. Stepwise regression analysis showed that both albuminuria and creatinine clearance were independently related to left ventricular mass. Logistic regression analysis of the reciprocal interaction of microalbuminuria and reduced creatinine clearance on the occurrence of subclinical cardiac damage showed that reduced creatinine clearance entailed a greater risk of left ventricular hypertrophy in patients with normal albuminuria alone, whereas the presence of microalbuminuria was associated with a greater risk of left ventricular hypertrophy independently of creatinine clearance.
These findings provide further proof of the role of cardiorenal interaction in the development of hypertension-related cardiovascular disease, and may have clinical implications.
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ABSTRACT: Left ventricular hypertrophy (LVH) and microalbuminuria are common in hypertensive patients and are often associated with metabolic syndrome (MetS). However, it is not clear whether MetS could modify the association between cardiac and renal damage. The aim of this study was to assess if the relationship of albumin/creatinine ratio (ACR) and left ventricular mass (LVM) could be independent from MetS in hypertensive overweight/obese patients. 180 essential hypertensive and overweight/obese (body mass index [BMI] ≥25 kg/m(2)) patients referred to our Hypertension Centre from January 2006 to April 2009 because of blood pressure (BP) control-related problems were studied. Exclusion criteria were scarce adherence to antihypertensive drug therapy as investigated by the Morisky Medical Adherence Scale (MMAS), heart failure (New York Heart Association III or IV or left ventricular ejection fraction [LVEF] <50%), liver failure, cancer or other systemic severe diseases. MetS was defined according to the National Cholesterol Education Program (USA) Adult Treatment Panel III classification as modified by the American Heart Association. ACR was obtained from first morning urine specimens. Left ventricular dimensions, mass and ejection fraction, were measured by echocardiography following the American Society of Echocardiography recommendations. Patients with microalbuminuria had a 6-fold higher risk for LVH/h(2.7) and 2-fold higher risk for LVH/body surface area (BSA). Univariate linear regression analysis showed a positive relationship between ACR and LVM, expressed both as LVM/h(2.7) or LVM/BSA, as well as a direct correlation between logACR and interventricular diameters and ejection fraction. Regression models including logACR, estimated glomerular filtration rate, BMI, age, hypertension duration, smoking and MetS (as a single variable as well as each single component), showed that only logACR, BMI, hypertension duration and systolic blood pressure (SBP) were independently associated with LVM/h(2.7). Along with BP and BMI, albuminuria measured in a morning urine sample as ACR is a valuable low-cost index of cardiac organ damage and increased cardiovascular risk in hypertensive patients independently by MetS. On the other hand, MetS is not an independent risk factor for cardiac damage because it does not seem to add anything more than the sum of each of its components (especially SBP and adiposity indexed by BMI) to the relationship between cardiac and renal subclinical organ damage.High Blood Pressure & Cardiovascular Prevention 12/2011; 18(4):195-201.
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ABSTRACT: Introduction Chronic kidney disease (CKD) is associated with increased cardiovascular risk and mortality. We evaluated whether stage 3 (s3)-CKD is associated with abnormalities of the cardiovascular system.Methods Thirty-nine asymptomatic s3-CKD patients, free of prevalent cardiovascular disease, were compared with 44 control subjects with comparable prevalence of hypertension (66% vs 69% in s3-CKD). In addition to standard echocardiographic parameters, we computed non-invasive effective arterial elastance (EAE, in mmHg/mL/beat), systolic left ventricular elastance (LVe, in mmHg/mL) and myocardial mechanic efficiency (MME, in mL/sec), using previously reported formulas.Results s3-CKD and controls were comparable for age, sex, lipid profile and prevalence of diabetes mellitus and smoking habit. Left ventricular (LV) mass, geometry and stroke work were similar in the two groups, with both ejection fraction and midwall shortening (mS) significantly reduced in the CKD group (both p < 0.001). Within the s3-CKD group, 36% had clear-cut depressed mS. EAE and peripheral resistance were higher in s3-CKD than in controls (both p < 0.005), and MME was reduced in CKD (p < 0.005), an impairment even clearer after controlling for LV mass, and increasing with increasing values of LV mass (p < 0.001). In addition, at a given level of peripheral resistance, LV geometry was less concentric in s3-CKD than in controls (p < 0.05).Conclusions s3-CKD asymptomatic patients show a peculiar cardiovascular phenotype, characterized by impaired mechano-energetic efficiency and reduced midwall mechanics, in the presence of inadequately compensating LV concentric remodelling. Whether these characteristics might result in higher cardiovascular risk in s3-CKD should be investigated.Received for publication 17 May 2010; accepted for publication 5 June 2010.High Blood Pressure & Cardiovascular Prevention 05/2010; 17(2):59-64.
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ABSTRACT: Blood pressure (BP) control is poorly achieved in hypertensive patients, worldwide. We evaluated clinic BP levels and the rate of BP control in hypertensive patients included in observational studies and clinical surveys published between 2005 and 2011 in Italy. We reviewed the medical literature to identify observational studies and clinical surveys on hypertension between January 2005 and June 2011, which clearly reported information on clinic BP levels, rates of BP control, proportions of treated and untreated patients, who were followed in different clinical settings (mostly in general practice, and also in outpatient clinics and hypertension centres). The overall sample included 158 876 hypertensive patients (94 907 women, mean age 56.6 ± 9.6 years, BMI 27.2 ± 4.2 kg/m(2), known duration of hypertension 90.2 ± 12.4 months). In the selected studies, average SBP and DBP levels were 145.7 ± 15.9 and 87.5 ± 9.7 mmHg, respectively; BP levels were higher in patients followed in hypertension centres (n = 10 724, 6.7%; 146.5 ± 17.3/88.5 ± 10.3 mmHg) than in those followed by general practitioners (n = 148 152, 93.3%; 143.5 ± 13.9/84.8 ± 8.9 mmHg; P < 0.01). More than half of the patients were treated (n = 91 318, 57.5%); among treated hypertensive patients, only 31 727 (37.0%) had controlled BP levels. The present analysis confirmed inadequate control of BP in Italy, independently of the clinical setting. Although some improvement was noted compared with a similar analysis performed between 1995 and 2005, these findings highlight the need for a more effective clinical management of hypertension.Journal of Hypertension 06/2012; 30(6):1065-74. · 4.22 Impact Factor