Reduction of left ventricular mass index with blood pressure reduction in chronic renal failure

Aim: We have reported previously in a study of 85 non-diabetic patients with chronic renal failure (CRF) that 24-h ambulatory blood pressure (ABP) recording and echocardiography are required for accurate diagnosis of inadequate blood pressure (BP) control and early left ventricular hypertrophy (LVH). In this study we found that the only independent determinants of left ventricular (LV) mass were hypertension, male sex, body mass index (BMI) and anemia. Little is known about the progression of LVH in patients as they progress from moderate to end-stage renal failure. Patients and methods: We undertook a follow-up observational study in a cohort of 65 (26 male, 12 black Afro-Caribbean and 7 Asian) of those patients originally investigated. Patients who had reached end-stage renal failure (ESRF) were not studied. Results: A statistically significant correlation was found between change in left ventricular mass index (LVMI) and change in mean ABP parameters (r = 0.27 (p < 0.03) for 24-h systolic, r = 0.21 (p < 0.05) for 24-h diastolic, r = 0.29 (p < 0.02) for mean arterial pressure (MAP), r = 0.24 (p < 0.05) for day-time systolic, r = 0.30 (p < 0.02) for nocturnal systolic and r = 0.26 (p < 0.05) for nocturnal diastolic BP). Hemoglobin concentration and BMI changed little between the two studies and no other statistically significant correlations were found in respect of any other parameters studied, which has allowed us to isolate the effect of one determinant - adequacy of BP control - upon LVH. Conclusion: In patients with moderate chronic renal impairment, reduction in BP is associated with reduction of LVMI over time. Among the antihypertensive agents ACE inhibitors appeared to have the greatest ability to reduce LV mass in the subjects with LVH at baseline. Larger interventional studies are needed to determine whether ACE inhibitors are superior to other anti-hypertensive agents in LVH regression in chronic renal failure patients

Left ventricular hypertrophy and ambulatory blood pressure monitoring in chronic renal failure

Background: Left ventricular hypertrophy (LVH) is both common and an important predictor of risk of death in end-stage renal failure (ESRF). In mild to moderate chronic renal failure (CRF), the timing of onset of LVH and the factors involved in its initial development have not been fully elucidated. The present study was undertaken to examine the prevalence and potential determinants of echocardiographically determined LVH in this connection, and to compare 24-h ambulatory blood pressure (BP) recordings with BP measured at a previous clinic visit. Methods: From a cohort of 120 non-diabetic patients who had been attending a nephrology clinic, 118 agreed to participate in the study. Of these we selected for analysis 85 stable patients (37 male). Patients with known cardiovascular disease, those with a history of poor compliance with antihypertensive medication, and those in whom such medication had been changed in the previous 3 months were excluded. Clinic BP, 24-h ambulatory BP, echocardiography, body mass index (BMI), serum creatinine (SCr), creatinine clearance (CrCl), haemoglobin (Hb), fasting cholesterol (CHOL), triglyceride TRIGL), plasma glucose, calcium (Ca), phosphate (PO(4)), alkaline phosphatase (ALK PHOS), parathyroid hormone (PTH) concentrations, and 24-h urinary protein were assessed in all patients. Seventy-seven per cent were on antihypertensive medication. Results: LVH was detected in 16% of patients with CrCL > 30 ml/min, and 38% of patients with CrCl < 30 ml/min. By stepwise regression analysis, ambulatory systolic BP (P < 0.0001), male gender (P < 0.0001), BMI (P < 0.0002), and Hb concentration (P < 0.002) were the only independent determinants of left ventricular (LV) mass. Nocturnal systolic BP (P < 0.02) was the main determinant of LVH in the group of patients with advanced CRF. The correlation between left ventricular mass index (LVMI) and mean 24-h ambulatory systolic BP (r = 0.52, 95% confidence interval 0.50-0.54) was statistically significantly stronger than with outpatient systolic BP (r = 0.25, 95% confidence interval 0.23-0.27). The same was true for the correlation between LVMI and mean 24-h ambulatory diastolic BP (r = 0.42, 95% confidence interval 0.40-0.44), and outpatient diastolic BP (r = 0.22, 95% confidence interval 0.20-0.24). Conclusions: Twenty-four hour ambulatory BP recording and echocardiography are required for accurate diagnosis of inadequate BP control and early LVH in patients with chronic renal impairment, independent determinants of which are hypertension, male sex, BMI, and anaemia

Relation between left ventricular hypertrophy and blood pressure in chronic renal failure

Left ventricular hypertrophy (LVH) is both common and an important predictor of morbidity and mortality in end stage renal failure (ESRF). The aim of our study was to examine the prevalence of LVH in different stages of chronic renal failure (CRF) and which risk factors are involved in its development. We carefully selected 85 stable patients (37 M, 48 F), age 49 (plus or minus) 14 years, creatinine clearance (CrCl) 39 (plus or minus) 30 ml/min with no history of diabetes, ischaemic or valvular heart disease, cerebrovascular or peripheral vascular disease. They underwent 24 hr ambulatory blood pressure (BP) monitoring and echocardiography for left ventricular mass index (LVMI). Clinic BP, body mass index (BMI), serum creatinine (SCr), CrCl, haemoglobin (Hb), calcium (Ca), phosphate (P0(4)), parathyroid hormone (PTH) and 24 hr urinary protein exception were measured. Patients with CrCl < 30 ml/min (group 2) had higher proteinuria, P0(4), PTH, systolic BP (sBP) and LVMI, whilst HB was lower than in patients with CrCl > 30 ml/min (group 1), LVH was detected in 16% of patients in group 1 and 38% in group 2. By stepwise regression analysis, BMI, male gender, 24 hr sBP, and Hb were independent determinants of LVMI. We conclude that LVH is a common finding in pre- dialysis CRF. Decreasing sBP and correcting anaemia might reduce LVH, thus decreasing morbidity and mortality in ESRF