Determinants Of Left Ventricular Hypertrophy Research Articles

Central blood pressure obtained by cuff-based oscillometry as a determinant of left ventricular hypertrophy in hypertensive patients.

Limited and conflicting data have been reported on the prognostic relevance of central blood pressure (CBP) compared with brachial blood pressure (BP) in the anticipation of hypertension-mediated organ damage and the majority of data derived using applanation tonometry with its known complexities. The objective of the present study was to investigate the diagnostic factors of left ventricular hypertrophy (LVH) with a special highlight on the utility of non-invasive oscillometric CBP measurement and derived hemodynamic indices compared to brachial BP as indicators of LVH. This cross-sectional study included 300 hypertensive patients (mean age 55.3 years, 61.3% female, 51.7% obese) with a mean duration of hypertension was 5.8 years. They underwent measurement of brachial BP, using a mercury sphygmomanometer, and CBP, using a Mobil-O-Graph, alongside the determination of left ventricular (LV) mass by two-dimensional transthoracic echocardiography. LVH and LV geometric patterns were defined by LV mass index/height 2.7 and relative wall thickness. Bivariate then multivariate analysis showed that age, BMI, central systolic BP (SBP), and pulse wave velocity (PWV) were significant determinants of LVH and optimally controlled brachial BP was a significant negative determinant for LVH. Central SBP had an acceptable diagnostic performance to determine LVH in patients with hypertension (AUC = 0.722, 95% confidence interval: 0.618-0.824, SE = 0.21, P -value <0.001). Using one-way ANOVA, a comparison of means among age groups showed that the steady increase in central SBP and PWV with aging was greater among LVH patients than non-LVH patients. Estimated central SBP using Mobil-O-Graph showed a significantly higher correlation to LVH than brachial SBP values. The consistent increase in central SBP and PWV with aging was greater among LVH patients than non-LVH patients.

Prevalence and determinants of left ventricular hypertrophy among elderly hypertensive patients attending tertiary health care center in West Bengal, India

: Hypertension (HTN) is one of the most prevalent, modifiable and treatable causes of cardiovascular diseases in the elderly. Damage to cardiovascular system due to chronic hypertension causes hypertensive heart disease including left ventricular hypertrophy (LVH). It is a physiological adaptation to chronic blood pressure (BP) indicating grave prognosis and should be diagnosed early.Present study therefore aimed to assess LVH and other Cardio-vascular (CV) changes and to ascertain correlation between the electrocardiographic (ECG) and radiographic / chest x-ray (CXR) evidences and find out their determinants among elderly hypertensive patients.100 elderly hypertensive subjects were included in study. Cardio-vascular changes and LVH was assessed by using chest x-ray and ECG. Other bio-chemical investigations were done also.: 29% and 32% subjects had LVH detected by Chest x-ray and ECG respectively. Female, increasing age, family history and duration of HTN, smoking, alcohol consumption were found independent determinants of LVH. Subjects with LVH had higher mean blood pressures, mean pulse pressure and higher blood urea nitrogen than those without LVH. Micro-albuminuria was significantly more frequent in patients with LVH as detected by CXR. Fasting Blood sugar and dyslipidaemia was associated with greater odds of developing LVH.In low resource settings, where standard diagnostic tests are unavailable- chest x-ray and ECG are the useful tools for detection of cardio vascular changes / LVH among chronic hypertensive.

Blood group and its correlation with cardiovascular risk factors: A community survey

Cardiovascular disease is a leading cause of morbidity and mortality globally. Non-O blood groups have been shown to confer a high risk of coronary heart disease. There is paucity of data on the relationship between blood group and left ventricular hypertrophy, among other cardiovascular risk factors. A community-based study was done to evaluate the blood groups and their associations with conventional cardiovascular risk factors in Ejigbo. Anthropometry, blood pressure and other clinical variables were measured. Blood samples were taken for biochemical analysis for blood group typing, serum cholesterol and triglyceride assay. A 12- lead electrocardiogram was performed. The analysis was done using SPSS version 20 to determine possible relationships between the variables. Two hundred and six cases were recruited and analyzed. The prevalence of the various groups was as follows: A - 23%; B-31.4%; AB-4.4%; O-41.2%; rhesus-positive-92.7% and rhesus-negative-7.3%. Blood group B had similar systolic blood pressure (136.0±23.9 vs 137.3±22.3; p=0.726), higher Sokolow- Lyon voltage sum (3.3±1.1 vs 2.9±0.9; p=0.025) and serum triglycerides [14(21.9%) vs7(8.4%), p=0.021] than those with blood group O. Those with Rhesus Positive status had longer PR interval (169.3±25.4 vs 154.2±19.1; p value=0.055) and QRS duration (83.8±12.8 vs 78.4±7.6; p value=0.043) than those with Rhesus negative blood groups. Binary logistic regression revealed blood group B as an independent determinant of left ventricular hypertrophy( LVH) (OR: 3.028; p=0.012; 95% CI:1.275-7.192). Blood group B is a determinant of LVH. Rhesus positive status is associated with delayed electrical conduction through the myocardium.

Determinants of left ventricular hypertrophy and dysfunction in adults with coarctation of aorta

Abstract Background Several coarctation of aorta (COA) severity indices are used for timing of COA intervention, and to define severity of residual coarctation post-intervention. However, it is unclear how many of these COA indices are required in order to recommend intervention, and what degree of residual coarctation results in suboptimal recovery of the left ventricle (LV). Our aim was to assess the correlation between different COA indices and effects of chronic LV pressure overload (LV hypertrophy, diastolic and systolic dysfunction), and to determine the effect of residual coarctation on LV reverse remodeling after COA intervention. Methods COA severity indices were defined as Doppler COA gradient, systolic blood pressure, upper-to-lower-extremity systolic blood pressure gradient, aortic isthmus ratio. LV remodeling indices were defined as LV mass index (LVMI), LV global longitudinal strain (LVGLS), e' and E/e'. LV reverse remodeling was defined as the difference between indices obtained pre-intervention and 5-years post-intervention (delta LVMI, e', E/e', LVGLS). Results Of the COA indices analyzed in 546 adult COA patients, aortic isthmus ratio had the strongest correlation with LVMI (β±standard error −28.3±14.1, p&amp;lt;0.001), LVGLS (1.51±0.42, p=0.005), e' (3.11±1.10, p=0.014), and E/e' (−13.4±6.67, p=0.008). Residual aortic isthmus ratio also had the strongest correlation with LV reverse remodeling, and residual aortic isthmus ratio &amp;lt;0.7 was predictive of suboptimal LV reverse remodeling post-intervention. Conclusion Considering the known prognostic implications of LV remodeling and reverse remodeling in response to pressure overload, these results support the use of aortic isthmus ratio for timing of COA intervention, and for prognostication post-intervention. Funding Acknowledgement Type of funding source: None

Sodium toxicity in peritoneal dialysis: mechanisms and "solutions".

The major trials in peritoneal dialysis (PD) have demonstrated that increasing peritoneal clearance of small solutes is not associated with any advantage on survival, whereas sodium and fluid overload heralds higher risk of death and technique failure. On the other hand, higher sodium and fluid overload due to loss of residual kidney function (RKF) and higher transport membrane is associated with poor patient and technique survival. Recent experimental studies also show that, independently from fluid overload, sodium accumulation in the peritoneal interstitium exerts direct inflammatory and angiogenetic stimuli, with consequent structural and functional changes of peritoneum, while in patients with Chronic Kidney Disease sodium stored in interstitial skin acts as independent determinant of left ventricular hypertrophy. Noteworthy, this tissue pool of sodium is modifiable being removed by dialysis. Therefore, novel PD strategies to optimize sodium removal, including the use of bimodal and/or low-sodium solutions, are actively tested. Nonetheless, a holistic approach aimed at preserving peritoneal function and the kidney may represent the key of therapy success in the hard task of preserving adequate sodium balance in PD patients. In this review, we describe the available evidence on sodium toxicity in PD, either related or unrelated to fluid overload, and we also discuss about possible "solutions" to preserve or restore sodium balance in PD patients.

Nondipping pattern on 24-h ambulatory blood pressure monitoring is associated with left ventricular hypertrophy in chronic kidney disease.

Few studies have assessed the role of 24-h ambulatory blood pressure monitoring (ABPM) in adults with nondialysis chronic kidney disease (CKD). We examined the potential determinants of left ventricular hypertrophy (LVH) and mass index (LVMI) in this population. We carried out a cross-sectional study on 69 stage 3b-5 CKD adults who had ABPM and transthoracic echocardiography performed simultaneously. Hypertension (HT) was defined as 24 h blood pressure (BP) of at least 130/80 mmHg. ABPM parameters considered were BP dipping status, BP load, and the BP night-time/daytime ratio. We performed stepwise backward multivariate linear and logistic regression to assess the determinants of LVH and LVMI. ABPM parameters were considered the main independent variables, whereas HT, angiotensin-converting enzyme inhibitor/angiotensin II receptor antagonist use, glomerular filtration rate of less than 30 ml/min/1.72 m, diabetes, smoking, age, sex, hemoglobin, and parathyroid hormone levels were considered covariates. LVH was present in 22 (31.8%) patients. In linear regression analysis, systolic [β=-13.8, 95% confidence interval (CI)=-26.3 to -1.3, P=0.031] and mean (β=-13.5, 95% CI=-25.7 to -1.2, P=0.031) nondipping status was associated with increased LVMI. BP load and night-time/daytime ABPM ratio were not associated with LVMI. In logistic regression analysis, systolic nondipping status (odds ratio=0.27, 95% CI=0.08-0.91, P=0.036) was associated with LVH. Among covariates, estimated glomerular filtration rate of less than 30 ml/min/1.72 m and HT were associated with LVH and increased LVMI. At 1-year follow-up, mean nondipping status on the initial ABPM remained associated significantly with increased LVMI (β=-19.8, 95% CI=-36.6 to -3.0, P=0.022). These data confirm the high incidence of LVH among nonrenal replacement therapy CKD patients and suggest that the nondipping phenomenon on ABPM is associated independently with LVH and increased LVMI in this population.

Determinants of Left Ventricular Hypertrophy and Diastolic Dysfunction in an HIV Clinical Cohort

The aim of this work was to investigate determinants of structural myocardial abnormalities in persons living with human immunodeficiency virus (PLWH). We reviewed archived transthoracic echocardiograms (TTEs) performed on PLWH at Duke University Medical Center from 2001 to 2012. The primary outcomes were presence of left ventricular hypertrophy (LVH) or diastolic dysfunction (DD). TTEs for 498 human immunodeficiency virus-infected persons were reviewed (median age 44 years, 38% female, 72% black, 34% with hypertension, 15% with diabetes). Among those with usable images, LVH was detected in 174 of 473 persons (37%) according to LV mass criteria and in 99 of 322 persons (31%) according to American Society of Echocardiography LV mass index criteria. Definite DD was detected in 18 of 224 persons (8%). LVH was more common in PLWH with a CD4 count ≤ 200 cells/mm3 proximal to TTE (adjusted OR 1.68, 95% CI 1.08-2.62), CD4 nadir ≤ 200 cells/mm3 (adjusted OR 1.63, 95% CI 1.04-2.54) and less common in persons with viral suppression (OR 0.46, 95% CI 0.27-0.80). Lower CD4 nadirs (P = .002) and proximal CD4 counts (P = .002) were also associated with DD. Persons with a history of advanced human immunodeficiency virus-associated immune suppression are at higher risk of LVH and DD than infected persons with preserved immune function.

NON-DIPPING PHENOMENON MEASURED BY 24H-AMBULATORY BLOOD PRESSURE MONITORING IS A STRONG PREDICTOR OF LEFT VENTRICULAR HYPERTROPHY IN CHRONIC KIDNEY DISEASE

Objective: Few studies have assessed the role of 24 h ambulatory blood pressure monitoring (ABPM) in adults suffering from non-dialysis chronic kidney disease (CKD). We examined potential determinants of left ventricular hypertrophy (LVH) and mass index (LVMI) in this population. Design and method: We conducted a cross-sectional study on 69 stage 3b-5 CKD adults who had ABPM and transthoracic echocardiography performed simultaneously. Hypertension (HT) was defined as 24 h blood pressure (BP) > or = 130/80 mmHg. ABPM parameters considered were BP dipping status, BP load and BP nighttime/daytime ratio. We conducted stepwise backward multivariate linear and logistic regression to assess determinants of LVH and LVMI. ABPM parameters were considered main predictors whereas HT, ACEI/ARAII use, GFR < 30 ml/min/1.72m2, diabetes, smoking, age, gender, Hb and PTH levels were considered covariates. Results: LVH was present in 22 (31.8%) patients. In linear regression analysis, systolic (β=−13.8, 95% CI = −26.3; −1.3, p = 0.031) and mean (β=−13.5, 95% CI = −25.7; −1.2, p = 0.031) dipping statuses were negatively associated with LVMI. BP load and nighttime/daytime ABPM ratio were not associated with LVMI. In logistic regression analysis, systolic dipping status (OR = 0.27, 95% CI = 0.08; 0.91, p = 0.036) was negatively associated with LVH. Amongst covariates, eGFR < 30 ml/min/1.72m2 and HT were positively associated with LVH and LVMI. At one-year follow-up, mean dipping status on the initial ABPM remained significantly associated with LVMI (β=−19.8, 95% CI = −36.6; −3.0, p = 0.022). Conclusions: These data confirm the high incidence of LVH amongst non-RRT CKD patients and suggest that non-dipping phenomenon on ABPM is an independent and strong predictor of LVH and LVMI in this population.

Lifestyle Changes for Abdominal Obesity Prevention and Encouraging Fruit Consumption May Be Beneficial in Preventing Left Ventricular Hypertrophy in Sub-Saharan African and Maghreb

There is a growing body of evidence showing a close correlation between left ventricular mass with cardiovascular morbidity and overall mortality. Therefore, identifying the determinants of left ventricular hypertrophy can be of great importance for cardiovascular prevention, for prognosis and therapeutic intervention. Objective: To assess the prevalence and identify the independent determinants of echocardiographic left ventricular hypertrophy in The MA-Ghreb and Sub-Saharan Africa Left-Ventricul ArGEometry Study (MAG-SALVAGES) participants. Methods: The MAG-SALVAGES is a community based study in which 100 asymptomatic Black Sub-Saharan African (BSSA) and 189 white skin Maghreb within the age of 18 to 55 years underwent a resting echocardiography. Multivariate logistic regression analysis was utilized to identify the independent determinants of LVH left ventricular hypertrophy. Results: Men represented the majority of the enrolled participants: 173 (59.9%). Echocardiographic left ventricular hypertrophy was seen in 10 (3.5%) participants. Age ≥40 years, female gender, overall obesity, abdominal obesity, hypertension status and less fruit consumption were significantly associated with echocardiography left ventricular hypertrophy. After adjusting for confounding factors, age ≥40 years, female gender, abdominal obesity and less fruit consumption were independently and significantly associated with echocardiographic left ventricular hypertrophy, as illustrated in the following equation: Y = 0.36 + 0.162 age >40 years + 2.69 female gender + 2.52 abdominal obesity + 1.31 less fruit consumption. Conclusion: Lifestyle changes for the prevention of abdominal obesity and encouraging fruit consumption may be beneficial in preventing left ventricular hypertrophy.

Determinants of Left Ventricular Hypertrophy in Hypertensive Patients seen in a Teaching Hospital in Ghana

Hypertensive heart disease presenting as left ventricular hypertrophy (LVH) is a common and potentially modifiable cardiovascular risk factor often overlooked in most sub-Saharan African countries including Ghana. This cardiac marker occurring in hypertension is very important because it affects the overall cardiovascular disease risk assessment and management. We sought to assess the prevalence and determinants of electrocardiographic left ventricular hypertrophy in patients with hypertension seen at the outpatient clinic of a Teaching Hospital in Ghana. A cross-sectional and prospective study was conducted on three hundred and fifty hypertensive patient at Komfo Anokye Teaching Hospital in Kumasi, Ghana. Following informed consent, a questionnaire was used to gather demographic, anthropometric and clinical details of patients. A standard resting 12-lead resting ECG was performed on all the study participants and Scott's criteria was used to determine LVH. Fischer's exact test for statistical significance at 95% confidence interval was used to evaluate associations between categorical variables. Various independent associations with LVH were also assessed using logistic regression analysis. P value of 0.05 was considered as statistically significant. The mean (± standard deviation) age of the patients was 59.65 ± 13.52 years. The mean systolic and diastolic blood pressures were 141.76 ± 20.26 mmHg, 84.28 ± 10.49 mmHg respectively; and the body mass index was 27.5 ± 6.09 kg/m2. The prevalence of electrocardiographic left ventricular hypertrophy (ECG-LVH) among the hypertensive patients was 46.6%. When multiple logistic regression analysis was done, male gender (adjusted OR: 2.40, 95% CI 1.53-3.78, P=0.000), cigarette smoking (adjusted OR: 0.34, 95% CI 0.12-0.95, P=0.040) elevated SBP (adjusted OR: 1.79, 95% CI 1.09-2.93, P=0.200) and uncontrolled BP (adjusted OR: 1.86, 95% CI 1.15- 3.01, P=0.011) emerged as independent determinants of left ventricular hypertrophy. In conclusion, LVH is a common pre-clinical cardiac complication in Ghanaian individuals with hypertension. Male gender, cigarette smoking, elevated systolic blood pressure and uncontrolled BP appear to be the main determinants of this important pre-clinical cardiac damage.

Echocardiographic Characteristic Of Left Ventricular Geometry Of 12-17 Years Athletes

Aim. To compare the type of left ventricular geometry associated with training among 12-17 years athletes currently competing in cycling, rowing and basketball playing and to determine the factors influencing left ventricular geometry. Methods. A total 167 male athletes 12-17 year-old, involved in basketball (n = 62), academic rowing (n =51) and cycling (n = 54) and 168 sedentary non-athletes, matched for age and sex were involved in this study. All participants underwent twodimensional, M-mode and Doppler echocardiography. To estimate left ventricular geometry relative wall thickness and left ventricular mass index were calculated. Left ventricular geometry was assessed as normal, eccentric ventricular hypertrophy, concentric left ventricular hypertrophy, concentric left ventricular remodeling. Results. Left ventricular hypertrophy was present in 48 % of all athletes, predominantly (34 %) eccentric hypertrophy. 16% of athletes had concentric hypertrophy. Only 7% of athletes manifested concentric remodeling. The prevalence of eccentric hypertrophy was more common in cyclists (54%), concentric hypertrophy was more frequent in rowers (38%), and normal left ventricular geometry was more common in basketball players (53%). Multivariate regression analysis showed that age was the important determinant of eccentric and concentric left ventricular hypertrophy. Eccentric left ventricular hypertrophy also was independently associated to training volume (hour per week) and cycling sporting discipline. Conclusion. Almost half of athletes (48%) had left ventricular hypertrophy, predominantly eccentric hypertrophy, and the age was the important determinant of left ventricular hypertrophy (eccentric and concentric). Training volume and cycling sporting discipline were significantly associated with eccentric left ventricular hypertrophy.

New-onset diabetes and glucose regulation are significant determinants of left ventricular hypertrophy in renal transplant recipients.

Background. New-onset diabetes after transplantation (NODAT) is associated with decreased graft survival and an increased risk for cardiovascular disease. The objective of this study was to evaluate the risk factors for development of NODAT and its' relationship with arterial stiffness and left ventricular mass index (LVMI) in kidney transplant recipients. Methods. 159 kidney transplant recipients were selected from our transplantation center who underwent renal transplantation between years 2007 and 2010. Results. Among 159 patients, 57 (32.2%) patients were with NODAT who were significantly older than patients without diabetes (P: 0.0001). Patients with NODAT had significantly higher pulse wave velocity (PWv) (P: 0.033) and left ventricular mass index LVMI (P: 0.001) compared to patients without NODAT. Further analysis was done according to LVMI as follows: LVMI > 130 g/m2 (n: 57) and LVMI ≤ 130 g/m2 (n: 102). We observed higher office systolic and diastolic BP, serum trygliceride, glucose, creatinine, age, and HbA1c (P: 0.0001) levels in patients with LVMI > 130 g/m2. Linear regression analysis revealed that HbA1c was the major determinant of LVMI (P: 0.026, β: 0.361). Conclusions. HbA1c is the major determinant of LVMI, so strict control of serum glucose levels is essential for preventing cardiovascular disease in patients with NODAT.

Left Ventricular Hypertrophy and Insulin Resistance in Adults from an Urban Community in the Gambia: Cross-Sectional Study

ObjectiveTo determine the association between left ventricular hypertrophy and insulin resistance in Gambians.DesignCross-sectional study.SettingOutpatient clinics of Royal Victoria Teaching Hospital and Medical Research Council Laboratories in Banjul.ParticipantsThree hundred and sixteen consecutive patients were enrolled from outpatient clinics. The data of 275 participants (89 males) were included in the analysis with a mean (± standard deviation) age of 53.7 (±11.9) years.InterventionsA questionnaire was filled and anthropometric measurements were taken. 2-D guided M-mode echocardiography, standard 12-1ead electrocardiogram, fasting insulin and the oral glucose tolerance test were performed.Main Outcome MeasuresThe Penn formula was used to determine the left ventricular mass index, 125 g/m2 in males and 110 g/m2 in females as the cut-off for left ventricular hypertrophy. Using the fasting insulin and fasting glucose levels, the insulin resistance was estimated by the homeostatic model assessment formula. Logistic regression analysis was used to determine the association between left ventricular hypertrophy and insulin resistance.ResultsThe mean Penn left ventricular mass index was 119.5 (±54.3) and the prevalence of Penn left ventricular mass index left ventricular hypertrophy was 41%. The mean fasting glucose was 5.6 (±2.5) mmol/l, fasting insulin was 6.39 (±5.49) μU/ml and insulin resistance was 1.58 (±1.45). There was no association between Penn left ventricular mass index left ventricular hypertrophy and log of insulin resistance in univariate (OR = 0.98, 95% CI = 0.80 – 1.19, p = 0.819) and multivariate logistic regression (OR = 0.93, 95% CI = 0.76–1.15, p = 0.516) analysis.ConclusionNo association was found in this study between left ventricular hypertrophy and insulin resistance in Gambians and this does not support the suggestion that insulin is an independent determinant of left ventricular hypertrophy in hypertensives.

Determinants of left ventricular hypertrophy in patients with recent diagnosis of essential hypertension

Development of left ventricular hypertrophy (LVH) is a multifactorial phenomenon. We retrospectively assessed the risk factors for LVH in patients with recent diagnosis of essential hypertension. We analysed 1518 participants with recent diagnosis of essential hypertension (≤2 years). The duration of hypertension was established after cross-checking the patients' history and the records of the general practitioners'. The following cardiovascular (CV) risk factors were considered: age (men >55 years, women >65 years), SBP >140 mmHg, DBP >90 mmHg, obesity, diabetes, hypercholesterolemia, low or high-density lipoprotein (HDL)-cholesterol (men <40 m/dl, women <50 mg/dl), and chronic kidney disease (CKD). Age, prevalence of metabolic diseases, CKD, and the severity of hypertension were higher in patients with LVH. One hundred twenty-two (8%) patients did not have CV risk factors, whereas 288 (19%), 472 (31.1%), 351 (23.1%) and 285 (18.8%) patients had one, two, three and more than three CV risk factors, respectively. At univariate analysis, CV risk factors for LVH where found to be sex, age, SBP, low HDL-cholesterol, obesity, diabetes, CKD, and metabolic syndrome. In the multivariate analysis, the independent predictors of LVH were found to be sex, age, SBP, obesity and diabetes. A significant correlation was found between indexed left ventricular mass and body mass index (r(2) = 0.167), age (r(2) = 0.077) and SBP (r (2)= 0.055). This study reveals that, in patients with recent diagnosis of essential hypertension obesity represents the most important modifiable CV risk factor for LVH.

Determinants of left ventricular hypertrophy in patients with recent diagnosis of essential hypertension

Determinants of left ventricular hypertrophy in patients with recent diagnosis of essential hypertension

Determinants of Left Ventricular Hypertrophy in Hypertensive Patients: Identification of High-Risk Patients by Metabolic, Vascular, and Inflammatory Risk Factors

Left ventricular hypertrophy (LVH) is recognized as an independent predictor of cardiovascular morbidity and mortality in hypertensive patients. Thus, it is critical to understand the mechanisms underlying the development of LVH for formulation screening and treatment strategies. This study was designed to determine the association between echographically determined LVH measures and markers of inflammation, neurohormonal activity, glomerular function, oxidative stress, insulin resistance, and vascular endothelial function. In this study, 129 hypertensive subjects were evaluated for lipids, glucose, HbA1C, insulin, homeostasis model assessment-insulin resistance, C-reactive protein (CRP), urinary microalbumin, homocysteine, aldosterone, renin, and endothelin. LVH parameters including interventricular septum thickness, posterior wall thickness (PWT), and left ventricular mass index (LVMI) were assessed echographically. Serum aldosterone levels were significantly positively associated with left ventricular mass (LVM) and marginally positively associated with LVMI and PWT. Both LVM and LVMI were significantly elevated in subjects with high versus normal serum aldosterone levels (p = 0.018 for LVM and p = 0.050 for LVMI). Serum endothelin was positively associated with LVM and LVMI. In multiple linear regression analysis, aldosterone remained a significant predictor of LVM (standardized β = 0.229, p = 0.024), and endothelin a marginally significant predictor of LVM (standardized β = 0.178, p = 0.077). Among serum lipids, high-density lipoprotein cholesterol only had a significant inverse association with LVM and PWT. Homocysteine as well as CRP were significantly positively associated with LVM and LVMI in females. This study found that aldosterone and endothelin levels are the most important independent determinants of LVH in hypertensive subjects. These markers may be useful to identify asymptomatic hypertensive subjects at risk for heart failure.

The Relationship Between Measures Of Obesity And Echocardiographic Determinants Of Left Ventricular Hypertrophy In Nigerian Adults

Background Obesity is becoming a global epidemic and the prevalence is increasing not only in the developed countries but also in developing countries like Nigeria. The main adverse consequences are cardiovascular diseases, type 2 diabetes and several cancers. Left ventricular hypertrophy (LVH) is a cardiovascular consequence of obesity and it is an independent risk factor for stroke, myocardial infarction and sudden death. It is therefore necessary to know to what extent obesity is responsible for the development of LVH and what measures of obesity are implicated. Method: A total number of two hundred and thirty (230) subjects were recruited for the study. One hundred and fifty (150) were obese while eighty (80) were non obese controls. Body mass index (BMI), waist circumference (WC) and waist- hip ratio (WHR) were measured and calculated as the case may be. Based on their BMI, the subjects were classified as obese and non obese. Blood pressure measurements on at least two occasions and fasting plasma glucose estimates were done to identify normotensive, normoglycemic subjects who were included in the study. Echocardiography was done on all subjects after physical examination. The Left Ventricular Mass was calculated using Devereux modified ASE cube formula and this was indexed to height 2 and to body surface area.Results BMI and WC were strongly correlated with all echocardiographic parameters with BMI having the strongest correlation with LVM/H 2 (r=0.708, p<0.001) in males and (r=0.799,p<0.001) in females. This was followed by WC (r=0.678, p<0.001) in males and (r=0.646,p<0.001) in females. WHR was weakly correlated with LVM/H 2 (r=0.213, P=0.040) in males and (r=0.218, p=0.011) in females.Conclusion and RecommendationBody mass index (BMI) and waist circumference (WC) had stronger correlations with echocardiographic determinants of left ventricular hypertrophy compared to Waist hip ratio (WHR) in this study. BMI and WC should therefore be the preferred measures of obesity for the assessment of the impact of obesity on left ventricular mass and hypertrophy.

Relative Plasma Volume Monitoring and Blood Pressure Control

Establishing dry weight in hemodialysis patients is an inexact science.1 Monitoring changes in blood pressure with volume removal is crude but can be effective in establishing dry weight. Unfortunately, probing for dry weight (eg, reduction of volume on dialysis sufficient to reduce blood pressure to <140/90 mm Hg) can lead to intradialytic hypotension, and this is more common in patients with large intradialytic weight gain. Often clinicians use medication-directed blood pressure control strategies in the hemodialysis patient.2 This paradoxically may interfere with the opportunity to achieve dry weight, because if the patient is on increased amounts of antihypertensive medication, more sizeable reductions in blood pressure with ultrafiltration may occur during dialysis.3 This would limit the opportunity for volume removal. As a consequence, the patient would then be chronically volume overloaded. If antihypertensive medication escalation results from inadequate achievement of goal blood pressure during dialysis, a vicious cycle would ensue. The net result is more risk of adverse events from medications and increased ventricular volume and pressure. Recurrent ventricular volume overload may be one of the most important factors leading to heart failure and increased risk of arrhythmia. Thus, …

Relationship between increased arterial stiffness and other markers of target organ damage

The purpose of the present study was to assess the relationship of arterial stiffness with other markers of target organ damage, and the clinical factors related to it. Cross-sectional study that included 208 (115 men) never treated hypertensive, non-diabetic patients (mean age, 49+/-12 years). In addition to a full clinical study, 24h ambulatory blood pressure (BP), and determination of left ventricular hypertrophy (LVH) and microalbuminuria were performed. Clinical arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWV) obtained with applanation tonometry (SphygmoCor-System). PWV was 8.3 (7.3-9.9)m/s (median, interquartile range). Stepwise regression analysis revealed that age (beta=0.086, p<0.001), 24-h pulse pressure (beta=0.058, p<0.001), and low-density lipoprotein (LDL) cholesterol (beta=0.009, p<0.013) were independent determinants of PWV. PWV>12m/s (indicating target organ lesion) was present in only 16 (7.7%) patients, less frequent than LVH (28% of the patients) and microalbuminuria (16%). However, of the 16 patients with elevated PWV, 10 (62%) had neither LVH or microalbuminuria. In a logistic multivariate regression analysis the factors related to elevated PWV were age > or =45 in man and > or =55 in women (OR: 23.8, 95% CI: 2.7-195.5; p=0.004), LDL cholesterol > or =160mg/dl (OR: 10.6, 95% CI: 2.6-42.7; p=0.001) and increased 24-h pulse pressure > or =55mmHg (OR: 3.9, 95% CI: 1.2-12.9; p=0.03). In untreated middle age hypertensives arterial stiffness assessed by PWV is less frequent than LVH or microalbuminuria. PWV is mainly related to age, LDL cholesterol, and pulse pressure values.

Do Restless Legs Syndrome (RLS) and Periodic Limb Movements of Sleep (PLMS) Play a Role in Nocturnal Hypertension and Increased Cardiovascular Risk of Renally Impaired Patients?

Hypertension can cause or promote renal failure and is related to cardiovascular mortality, the major cause of death in patients with renal impairment. Changes in the circadian BP pattern, particularly the blunting or reversal of the nocturnal decline in BP, are common in chronic renal failure. These changes in turn are among the major determinants of left ventricular hypertrophy. Using a chronobiological approach, it is possible to obtain better insight into the reciprocal relationship between hypertension, renal disease, and increased cardiovascular risk of renal patients. Disruption of the normal circadian rhythm of rest/activity may be hypothesized to underlie the high cardiovascular morbidity and mortality of such patients. Epidemiological studies reveal that hemodialysis patients experience poor subjective sleep quality and insomnia and, in comparison to healthy persons, are more likely to show shorter sleep duration and lower sleep efficiency. Sleep apnea may be present and is usually investigated in these patients; however, the prevalence of restless legs syndrome (RLS), which is high in dialysis patients and which has been associated with increased risk for cardiovascular disease in the general population, could also play a role in the pathogenesis of sleep-time hypertension in renal patients. Careful assessment of sleep quality, in particular, diagnostic screening for RLS and periodic limb movements (PLM) in renal patients, is highly recommended. In renal failure, attention to sleep quality and related perturbations of the sleep/wake cycle may help prevent the occurrence and progression of cardiovascular disease. (Author correspondence: prf@unife.it)