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Left ventricular adaptation to hypertension and plasma renin activity
G du Cailar1, J L Pasquié, J Ribstein
1Service de Médecine Interne G, Hopital Lapeyronie, 34295 Montpelier Cedex 5, France.
Insights
In essential hypertension, left ventricular hypertrophy patterns are linked to distinct hemodynamic profiles and renin-angiotensin system activity. Eccentric hypertrophy correlates with higher cardiac index and lower plasma renin activity.
Area of Science:
- Cardiology
- Hypertension Research
- Renal Physiology
Background:
- Chronic pressure and volume overload cause distinct myocardial hypertrophy.
- The impact of these factors on left ventricular morphology in essential hypertension is not fully understood.
Purpose of the Study:
- To investigate the association between renin-angiotensin system activity and left ventricular adaptation in never-treated hypertensive patients.
- To explore how different left ventricular hypertrophy patterns relate to hemodynamic and functional profiles.
Main Methods:
- Echocardiography was used to categorize 333 never-treated hypertensive patients based on left ventricular mass and relative wall thickness.
- Plasma renin activity was measured to assess the renin-angiotensin system.
- Hemodynamic parameters and myocardial contractility were evaluated.
Main Results:
- Higher systolic and pulse arterial pressure were linked to concentric left ventricular hypertrophy.
- Eccentric left ventricular hypertrophy was associated with a higher cardiac index and lower basal plasma renin activity.
- Concentric left ventricular hypertrophy showed a tendency for depressed myocardial contractility.
Conclusions:
- In early essential hypertension without renal dysfunction, distinct anatomical patterns of cardiac adaptation correlate with specific hemodynamic, myocardial function, and renin-angiotensin system activity profiles.
- These findings highlight the heterogeneous nature of left ventricular remodeling in hypertension.
Abstract:
Chronic pressure and volume overload result in morphologically and functionally distinct forms of myocardial hypertrophy. In essential hypertension, the respective effect of these factors on the morphology of the left ventricle remains unknown. In the present study, we hypothesised that activity of the renin angiotensin system (assessed by plasma renin activity) may be associated to the variability of the left ventricular adaptation to essential hypertension. To assess this relation, we categorised by echocardiography 333 never-treated hypertensive patients, according to values of left ventricular mass and relative wall thickness. Higher systolic and pulse arterial pressure was strongly associated with concentric left ventricular hypertrophy (27% of hypertensives). When compared to the normal left ventricle group, patients with eccentric left ventricular hypertrophy (15% of hypertensives) had a high cardiac index (5 +/- 1 vs 4 +/- 0.8 L/min/m2; P = 0.0001), a lower basal plasma renin activity (0.81 +/- 0.63 vs 1.45 +/- 1.3 ng/ml/h; P = 0.02) and similar mean values of left ventricular performance and glomerular filtration rate. A tendency for depressed myocardial contractility assessed by the midwall shortening/end-systolic stress was associated with concentric left ventricular remodelling and hypertrophy when compared to hypertensive with a normal left ventricle. In conclusion, at the early phase of essential hypertension, in patients without renal dysfunction, each anatomic pattern of cardiac adaptation to hypertension was associated with a distinct profile of haemodynamics, myocardial function and activity of the renin-angiotensin system. Journal of Human Hypertension (2000) 14, 181-188.