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Glomerular hyperfiltration indicates early target organ damage in essential hypertension
R E Schmieder1, F H Messerli, G Garavaglia
1Department of Medicine, University of Bonn, Bonn-Venusberg, Federal Republic of Germany.
Insights
In essential hypertension, a high glomerular filtration rate (GFR) is linked to early left ventricular hypertrophy. This finding suggests GFR may indicate early target organ damage in hypertensive patients.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Essential hypertension is a leading cause of cardiovascular disease.
- Left ventricular hypertrophy (LVH) is an early sign of cardiac damage in hypertension.
- The relationship between renal hemodynamics and LVH in early-stage hypertension requires further elucidation.
Purpose of the Study:
- To investigate the association between renal hemodynamic parameters and left ventricular hypertrophy in patients with essential hypertension.
- To determine if glomerular filtration rate (GFR) or renal blood flow predicts early cardiac structural changes.
Main Methods:
- Echocardiography was used to assess left ventricular structure in 111 patients.
- Iodine I 131 aminohippuric acid clearance measured renal blood flow.
- Creatinine clearance determined glomerular filtration rate.
Main Results:
- GFR showed a positive correlation with left ventricular mass (r = .52) and cross-sectional area (r = .21).
- Hypertensive patients with LVH exhibited a higher GFR and filtration fraction compared to those without LVH, even at similar arterial pressure and body mass.
- Renal blood flow and renal vascular resistance did not differ significantly between groups.
Conclusions:
- Glomerular hyperfiltration is associated with early cardiac structural changes in essential hypertension.
- A high GFR may serve as an early indicator of target organ damage in hypertensive individuals with normal renal function.
Abstract:
In 111 patients with essential hypertension (World Health Organization stage I or II), we examined the relationship between renal hemodynamics and left ventricular hypertrophy. Left ventricular structure was determined by two-dimensional guided M-mode echocardiography, renal blood flow by iodine I 131 aminohippuric acid clearance, and glomerular filtration rate by creatinine clearance. The glomerular filtration rate correlated with left ventricular mass (r = .52) and left ventricular cross-sectional area (r = .21). Conversely, at a similar age, body mass index, body surface area, and arterial pressure, hypertensive patients with left ventricular hypertrophy disclosed a higher glomerular filtration rate and filtration fraction than those without left ventricular hypertrophy, whereas renal blood flow and renal vascular resistance measurements were not significantly different. Thus, at similar levels of arterial pressure and renal blood flow, glomerular hyperfiltration was linked to early cardiac structural changes in essential hypertension. We conclude that, in a hypertensive patient with normal renal function, a high glomerular filtration rate may be an indicator for early target organ damage in essential hypertension.