The Relationship Between Aortic Root Size and Hypertension: An Unsolved Conundrum.

Area of Science:

• Cardiovascular Medicine
• Nephrology
• Vascular Biology

Background:

• Thoracic aortic aneurysms and dissection are life-threatening vascular diseases with high mortality rates.
• Increased aortic root diameter (ARD) is a primary risk factor for aortic dissection, rupture, and aortic valve regurgitation.
• The relationship between arterial hypertension and aortic root enlargement is debated, with inconsistent findings possibly due to varied ARD measurement and indexing methods.

Purpose of the Study:

• To investigate the association between aortic root diameter (ARD) and chronic kidney disease (CKD) in hypertensive individuals.
• To explore the correlation between estimated glomerular filtration rate (eGFR) and ARD, both indexed and unindexed.
• To determine a potential eGFR threshold for identifying hypertensive patients with a dilated aortic root.

Main Methods:

• Retrospective analysis of hypertensive patients comparing ARD measurements (absolute, BSA-indexed, height-indexed) between CKD and non-CKD groups.
• Univariate and multiple regression analyses to assess the correlation between eGFR and ARD, controlling for confounding factors.
• Receiver-operating characteristic (ROC) curve analysis to identify the optimal eGFR threshold for distinguishing dilated ARD.

Main Results:

• Hypertensive patients with CKD exhibited significantly greater ARD (absolute, ARD/BSA, ARD/H) compared to those with normal renal function.
• Univariate analysis revealed significant inverse correlations between eGFR and ARD (absolute, ARD/BSA, ARD/H).
• Multiple regression analysis confirmed that eGFR remained significantly associated with ARD/H and ARD/BSA after adjusting for covariates.
• ROC analysis identified an eGFR of approximately 50 mL/min/1.73 m² as the optimal threshold for differentiating dilated ARD in hypertensive patients.

Conclusions:

• Reduced kidney function, indicated by lower eGFR, is significantly associated with aortic root enlargement in hypertensive individuals.
• A dilated aortic root, even without aneurysm formation, may represent a marker of hypertensive organ damage.
• Further research is warranted to explore the prognostic implications of aortic root dilatation and the potential benefits of antihypertensive therapy on ARD.