Abstract 5124: Renal Function and Cardiac Structure and Function in Hypertensives With Established Diastolic Dysfunction in the VALIDD and EXCEED Trials

Abstract

Background : Impaired in renal function is associated with increased risk of cardiac events. The relationship between mild impairments in renal function and degree of diastolic dysfunction (DD) has not been well established. Methods : Estimated glomerular filtration rate (eGFR), urine albumin-to-creatine ratio (ACR) and echocardiographic measures were assessed in 597 subjects with stage 1 or 2 hypertension, no heart failure, and DD by reduced mitral annular early relaxation velocity (E′) enrolled in the VALIDD (n=381) and EXCEED (n=216) trials. Both trials tested different BP reduction strategies for improvement in DD. Results : eGFR was ≤60 ml/min/1.73m 2 in 80 subjects (13%), 61–75 in 130 (22%), and >75 in 387 (65%). Decreasing eGFR was significantly associated with lower E′ (p=0.0033), higher E/E′ (p=0.0252), higher LA volume index (p=0.0117), smaller LV volume (p<0.0001), and higher NT-proBNP (p=0.0042). ACR was undetectable in 149 subjects (27%), 1– 4 in 130 (24%), 5–9 in 93 (17%), 10 –30 in 104 (19%), and >30 in 75 (14%). Increasing ACR was associated with lower E′, higher LV mass, increased LV wall thickness, and higher NT-proBNP even after adjustment for age, gender, race, and differences in 7 baseline characteristics (p<0.014 for all associations). In combined analysis, both eGFR (p=0.0166) and ACR (p=0.0019) were independent predictors of baseline E′, without evidence of significant interaction. Conclusions : Among hypertensive subjects with DD, mild impairments of eGFR and elevated levels of albuminuria are associated with greater degrees of DD. Both eGFR and albuminuria are additive and independently associated with worse DD.