40 research outputs found
Relationship between Diabetes Mellitus and Degree of Coronary Artery Disease in Uraemic Patients Investigated with Coronary Angiography
Differing Effects of Calcium Antagonists on Recovery from Ischaemia in Working Rat Heart
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