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Factors determining cardiac hypertrophy in hypertensive patients with or without peripheral vascular disease
M Brahimi1, B I Levy, M E Safar
1Hôpital Broussais, Service de Médecine Interne 1, 96 Rue Didot, 75014 Paris, France.
Insights
Patients with peripheral vascular disease exhibit greater cardiac hypertrophy compared to controls. Increased natriuresis, indicating higher sodium intake, appears to be the primary driver of this cardiac remodeling.
Area of Science:
- Cardiology
- Vascular Medicine
- Nephrology
Background:
- Peripheral vascular disease (PVD) significantly increases mortality risk, primarily due to coronary ischemic disease and congestive heart failure.
- Cardiac hypertrophy is a known complication of hypertension, but its prevalence and severity in PVD patients remain unexplored.
Purpose of the Study:
- To investigate cardiac mass and hypertrophy in hypertensive patients with and without peripheral vascular disease.
- To identify factors associated with cardiac hypertrophy in this patient population.
Main Methods:
- Echocardiography was used to determine cardiac mass in 25 hypertensive patients (11 without PVD, 14 with PVD).
- Measurements included systemic blood pressure, ankle-brachial systolic pressure ratio (ASP/BSP), and 24-hour natriuresis.
- Patients were matched for age, sex, mean arterial pressure, and antihypertensive treatment.
Main Results:
- Patients with PVD showed significantly higher cardiac mass (157 vs. 116 g/m2), pulse pressure (81 vs. 55 mmHg), and natriuresis (180 vs. 144 mmol/24h) compared to controls, despite similar mean arterial pressure.
- Cardiac mass correlated positively with pulse pressure, mean arterial pressure, and natriuresis, and negatively with the ASP/BSP ratio.
- Multivariate analysis identified natriuresis as the sole significant correlate of cardiac mass.
Conclusions:
- Hypertensive patients with PVD develop more pronounced cardiac hypertrophy than those without PVD, even at equivalent mean arterial pressures.
- Elevated natriuresis, suggesting higher sodium intake, appears to be a key factor influencing cardiac hypertrophy in PVD, rather than mechanical factors.
Abstract:
1. Coronary ischaemic disease and congestive heart failure are the principal causes of mortality in patients with peripheral vascular disease. Whether cardiac hypertrophy is present and even more pronounced in peripheral vascular disease than in other populations has never been explored.2.Twenty-five hypertensive patients were investigated, 11 without and 14 with peripheral vascular disease, matched for age, sex, mean arterial pressure and antihypertensive drug treatment. Cardiac mass was determined using echocardiography together with measurement of systemic blood pressure, ratio between ankle systolic pressure (ASP) and brachial systolic pressure (BSP), and standard biochemical parameters including natriuresis per 24 h.3. At the same mean arterial pressure, patients with peripheral vascular disease had a significantly higher cardiac mass (157+/-12 versus 116+/-6 g/m2; P<0.01), pulse pressure (81+/-5 versus 55+/-4 mmHg; P<0.01) and natriuresis (180+/-17 versus 144+/-6 mmol/24h; P<0. 01) than controls. Using univariate correlations, cardiac mass was positively associated with pulse pressure, mean arterial pressure and natriuresis, and negatively with the ASP/BSP ratio. On the basis of multivariate regression analysis, only natriuresis was positively correlated to cardiac mass.4. Patients with peripheral vascular disease develop a higher degree of cardiac hypertrophy in comparison with hypertensive subjects with the same level of mean arterial pressure. Sodium intake rather than mechanical factors seems to be the major modulating factor which influences the degree of cardiac hypertrophy.