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Updated: May 6, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Cardiac function in renovascular hypertensive patients with and without renal dysfunction
Kirandeep K Khangura1, Alfonso Eirin, Garvan C Kane
1Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.
Insights
Renovascular hypertension (RVHT) patients show more impaired heart function than essential hypertension (EHT) patients. RVHT, especially with kidney dysfunction, significantly worsens cardiac structure and function.
Area of Science:
- Cardiology
- Nephrology
- Hypertension Research
Background:
- Hypertension negatively impacts left ventricular (LV) diastolic and systolic function.
- Inflammation and neurohumoral activation may exacerbate these effects.
- Renovascular hypertension (RVHT) may be associated with a higher prevalence of LV diastolic dysfunction compared to essential hypertension (EHT).
Purpose of the Study:
- To investigate the hypothesis that LV diastolic dysfunction is more prevalent in patients with RVHT compared to EHT.
- To compare cardiac function and structure between RVHT and EHT patients.
Main Methods:
- Retrospective analysis of hypertensive patients who underwent renal imaging and cardiac echocardiography.
- Patients were categorized into RVHT (n=75) and EHT (n=69) groups based on the presence of significant renovascular disease.
- Cardiac function, structure, and renal function (serum creatinine, eGFR) were compared between groups.
Main Results:
- RVHT patients exhibited higher systolic blood pressure, E/e' ratio, and concentric hypertrophy, with lower eGFR compared to EHT patients.
- LV diastolic dysfunction was significantly more prevalent in RVHT patients, even after multivariable adjustment (RR 1.70, 95% CI 1.05-2.90).
- Severe renal dysfunction in RVHT patients was associated with greater impairments in both systolic and diastolic cardiac function.
Conclusions:
- Cardiac structure and diastolic function are impaired in RVHT patients compared to EHT patients, independent of several covariables.
- RVHT associated with significant renal dysfunction exacerbates LV hypertrophy and cardiac systolic and diastolic dysfunction.
- Identifying RVHT and renal dysfunction is crucial for developing targeted management strategies.
Background:
Hypertension impairs left ventricular (LV) diastolic and systolic function, which might be aggravated by inflammation or neurohumoral activation. We hypothesized that LV diastolic dysfunction is more common in patients with renovascular hypertension (RVHT) compared with essential hypertension (EHT).
Methods:
Hypertensive patients who underwent both renal imaging to exclude RVHT and cardiac echocardiography within a 3-year period were identified retrospectively. Patients with significant renovascular disease were included in the RVHT group (n = 75); those without significant renovascular disease were included in the EHT group (n = 69). Cardiac function and structure were compared.
Results:
Baseline renal function was preserved (serum creatinine ≤ 2mg/dl) in EHT patients and impaired (serum creatinine > 2mg/dl) in only 9 RVHT patients. RVHT patients had higher systolic blood pressure, E/e' ratio, and greater prevalence of concentric hypertrophy but lower estimated glomerular-filtration-rate (eGFR) compared with EHT patients. Increased prevalence of LV diastolic dysfunction remained statistically significant in patients with RVHT after multivariable adjustment for age, sex, blood pressure, eGFR, diabetes, smoking, and statin use, with a relative risk (95% CI) for abnormal E/e' of 1.70 (95% confidence interval = 1.05-2.90; P = 0.03) compared with EHT. RVHT patients with severe renal dysfunction showed greater impairments in cardiac systolic and diastolic function compared with those in EHT patients or preserved renal function RVHT patients.
Conclusions:
Among hypertensive patients undergoing echocardiography, cardiac structure and diastolic function are impaired in RVHT patients compared with EHT patients and remain different after adjustment for multiple significant covariables. When associated with significant renal dysfunction, RVHT aggravates LV hypertrophy and both systolic and diastolic dysfunction. Hence, identification of RVHT and renal dysfunction warrants development of targeted management strategies.
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