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Left ventricular remodeling and renal function in never-treated essential hypertension
Pierre Fesler1, Guilhem Du Cailar, Jean Ribstein
1Department of Internal Medicine, CHU Montpellier, France.
Journal of the American Society of Nephrology : JASN
|March 28, 2003
Summary
Hypertension accelerates age-related kidney function decline, particularly with concentric left ventricular hypertrophy. This specific heart change, not blood pressure, significantly impacts glomerular filtration rate decline over time.
Area of Science:
- Nephrology
- Cardiology
- Gerontology
Background:
- Renal function naturally declines with age, a process potentially accelerated by hypertension.
- Left ventricular (LV) hypertrophy, particularly concentric patterns, is a marker of hypertension severity.
- The interplay between aging, hypertension, LV geometry, and renal function decline requires further elucidation.
Purpose of the Study:
- To investigate the influence of left ventricular (LV) geometry on the age-associated decline in renal function in hypertensive patients.
- To differentiate the impact of LV hypertrophy patterns versus blood pressure levels on renal function.
- To assess the relationship between LV remodeling and urinary albumin excretion in essential hypertension.
Main Methods:
- Cross-sectional study involving 195 normotensive subjects and 645 never-treated essential hypertensive patients.
- Classification of hypertensive patients into normal LV, concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH) groups based on LV mass and relative wall thickness.
- Estimation of glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) using isotopic clearance techniques.
Main Results:
- GFR and ERPF declined with age in both normotensive and hypertensive groups, irrespective of blood pressure or LV hypertrophy presence.
- The age-associated decline in GFR was significantly steeper in hypertensive patients with concentric hypertrophy (CH) or concentric remodeling (CR) compared to those with eccentric hypertrophy (EH) or normal LV.
- Urinary albumin excretion was elevated in patients with concentric or eccentric LV hypertrophy compared to those with CR or normal LV.
Conclusions:
- The concentric pattern of left ventricular (LV) response to hypertension, rather than blood pressure level or presence of LV hypertrophy alone, significantly influences the age-associated decline in glomerular filtration rate (GFR).
- Concentric left ventricular remodeling and hypertrophy represent a critical factor in accelerated renal function decline in hypertensive individuals.
- These findings highlight the importance of assessing cardiac structure in managing hypertensive patients to predict and potentially mitigate renal function loss.