VASCULAR OR CARDIAC? DIFFERENT TARGET ORGAN DAMAGE IN HYPERTENSIVE PATIENTS WITH OR WITHOUT CHRONIC KIDNEY DISEASE

Abstract

The aim of our study was to evaluate different types of target organ damage (TOD) in hypertensive patients, with or without chronic kidney disease (CKD).90 hypertensive patients were enrolled from our Hypertension Center: 48 with normal renal function and 42 with CKD. We performed a complete echocardiographic study in all subjects in order to evaluate cardiac damage; non-mydriatic digital fundus oculi examination and carotid-femoral PWV to assess, respectively, small vessels and large arteries alterations.We considered Left Ventricular Mass index (LVMi) and h/r index to determine Left Ventricular Hypertrophy (LVH) or remodeling, Arteriolar-Venular Ratio (AVR) to evaluate retinal vessels and carotid-femoral PWV as a measure of arterial stiffness.Both groups showed abnormal values of PWV, but significantly higher in CKD group (13.72 ± 1.3 vs 9.78 ± 0.491, p = 0.0166). Mean AVR values were abnormal only in CKD hypertensive, with a significant difference compared to simply hypertensive patients (0.75 ± 0.006 vs 0.84 ± 0.020, p = 0.0001). In the echocardiographic examination, no statistically significant alterations were found between the two groups (LVMi 118.04 ± 4.870 vs 113.42 ± 3.440, p = 0.123; h/r 0.42 ± 0.119 vs 0.44 ± 0.010, p = 0.454).Our results confirm that TOD is different in hypertensive patients with CKD. In these patients the target is essentially vascular, affecting either big and small vessels. Hypertensive patients without CKD showed a more typical cardiac TOD with an increase of left ventricular remodeling and hypertrophy.The assessment of vascular damage pays an essential role in TOD detection, so the use of PWV and the evaluation of retinal vessels should be always performed.