Left Ventricular Hypertrophy In Hypertensive Patients Research Articles

Association between plasma microRNA-29a and left ventricular hypertrophy in patients with hypertension

Objective: Previous studies have shown that plasma microRNA-29a (miRNA-29a) is associated with myocardial fibrosis and the degree of cardiac hypertrophy in patients with hypertrophic cardiomyopathy. However, the relationship between plasma miRNA-29a and hypertensive left ventricular hypertrophy (LVH) has not yet been reported. So the purpose of this study is to investigate the relationship between the plasma miRNA-29a and hypertensive LVH. Method: Enrolled 168 hypertensive patients and classified the patients into 2 groups: those with LVH (LVH group, n=41) and those without LVH (NLVH group, n=127). All patients underwent echocardiography examination. Left ventricular mass index (LVMI) was calculated by interventricular septal thickness (IVSd), left ventricular posterior wall thickness(LVPWTd), left ventricular end diastolic dimension (LVEDD) and left ventricular mass index (LVMI) were obtained. Plasma levels of miRNA-29a were assessed by quantitative real-time polymerase chain reaction (qRT-PCR). The relationship between plasma miRNA-29a levels and LVH was analyzed. Results: Plasma miRNA-29a was significantly higher in LVH group than in NLVH group (0.52±0.10 vs. 0.37±0.07, t=9.788, P<0.01) . Pearson correlation analysis evidenced a positive correlation between plasma miRNA-29a levels and IVSd(R=0.459, P<0.01), LVPWTd (R=0.398, P<0.01), and LVMI (R=0.745, P<0.01). After adjustment for gender, age, systolic blood pressure, diastolic blood pressure, body mass index, hypertension duration, antihypertensive drugs, multiple regression analysis showed that there were still positive correlations between plasma miRNA-29a level and IVSd (β=0.535, P<0.01), LVPWTd (β=0.085, P<0.01), and LVMI (β=0.806, P<0.01). Conclusion: Plasma miRNA-29a level is positively associated with LVH in hypertensive patients, and future studies are warranted to explore if miRNA-29a could be used as a potential biomarker for LVH assessment in hypertensive patients.

Hypertension and hypertensive left ventricular hypertrophy are associated with ACE2 genetic polymorphism

AimsRenin-angiotensin system modulates cardiac structure independent of blood pressure. The present study aimed at investigating whether single nucleotide polymorphism (SNP) and haplotype of angiotensin converting enzyme 2 (ACE2) could influence blood pressure and the susceptibility to hypertensive left ventricular hypertrophy (LVH). Subjects and methodsA total of 647 patients (347 females and 300 males) with newly diagnosed mild to moderate essential hypertension were enrolled in a blood pressure matched, case-control study. Four ACE2 tagSNPs (rs2074192, rs4646176, rs4646155 and rs2106809) were genotyped and major haplotypes consisting of these four SNPs were reconstructed for all subjects. Key findingsIn females, minor alleles of ACE2 rs2074192 and rs2106809 respectively conferred a 2.1 and 2.0 fold risk for LVH. ACE2 haplotype TCGT increased the risk for LVH while another haplotype CCGC decreased the risk in females. The covariates-adjusted mean left ventricular mass index was 11% greater in TCGT haplotype carriers than in noncarriers in women. In females, the covariates-adjusted mean systolic blood pressure was 3.4 mm Hg lower in CCGC haplotype carriers than in noncarriers. In males, the covariates-adjusted mean systolic blood pressure was 2.4 mm Hg lower in CCGC haplotype carriers than in noncarriers. SignificanceACE2 tagSNPs rs2074192 and rs2106809 as well as major haplotypes CCGC and TCGT may serve as novel risk markers for LVH in hypertensive patients.

Independent Effects of Hypertension and Obesity on Left Ventricular Mass and Geometry: Evidence from the Cardiovision 2030 Study.

Obesity and hypertension independently promote pathological left ventricular remodelling (LVR) and left ventricular hypertrophy (LVH), but to what extent they do so when they do not coexist is unclear. We used data from the Cardiovision Brno 2030 study to assess—for the first time in a region where no investigations have been previously carried out—the independent association of obesity and hypertension with LV geometry, and to evaluate the effects of hypertension in normal weight patients and the effects of obesity in normotensive patients. Overall, 433 individuals, aged 25–65 years, with no history of cardiovascular disease and/or antihypertensive treatment, were stratified into four groups according to BMI and hypertension: normal weight non-hypertensive (NWNH), normal weight hypertensive (NWH), overweight/obese non-hypertensive (ONH) and overweight/obese hypertensive (OH). LVR was classified as normal, concentric LVR (cLVR), concentric LVH (cLVH) or eccentric LVH (eLVH). Linear regression analysis demonstrated that body mass index (BMI) and systolic blood pressure (SBP) are the main predictors of LV mass and that they interact: SBP had a stronger effect in overweight/obese (β = 0.195; p = 0.033) compared to normal weight patients (β = 0.134; p = 0.048). Hypertension increased the odds of cLVR (OR = 1.78; 95%CI = 1.04–3.06; p = 0.037) and cLVH (OR = 8.20; 95% CI = 2.35–28.66; p = 0.001), independent of age, sex and BMI. Stratified analyses showed that NWH had a greater odd of cLVH (OR = 7.96; 95%CI = 1.70–37.08; p = 0.008) and cLVR (OR = 1.62; 95%CI = 1.02–3.34; p = 0.047) than NWNH. In the absence of hypertension, obesity was not associated with LVM and abnormal LV geometry, suggesting that it is not per se a determinant of LVR. Thus, antihypertensive therapy still remains the first-line approach against LVH in hypertensive patients, though weight loss interventions might be helpful in those who are obese.

A1630 Association between growth differentiation factor 15 and left ventricular hypertrophy in hypertensive patients and healthy adults

Objectives: Growth differentiation factor 15 (GDF-15) as an independent biomarker of cardiovascular diseases merits further evaluation. Methods: We studied the association between plasma GDF-15 levels and left ventricular hypertrophy (LVH) in hypertensive patients and healthy adults. Hypertensive LVH measurements were performed via echocardiography and analyzed using the cube formula, and human GDF-15 together with interleukin-6 (IL-6) and matrix metalloproteinase-9 (MMP-9) concentrations were determined via enzyme-linked immunosorbent assay (ELISA). Results: A total of 302 participants were recruited for this clinical study. Circulating GDF-15, IL-6 and MMP-9 levels were significantly higher in LVH patients (n = 67) than in non-LVH patients (n = 172) and healthy controls (n = 63) (p < 0.001). After adjustment for confounders via multivariate logistic regression, elevated plasma GDF-15 concentrations remained independently associated with LVH in hypertensive patients. In addition, GDF-15 was positively correlated with IL-6 and MMP-9 levels in human plasma, respectively, suggesting that a link exists between GDF-15 expression and inflammation. We also calculated an optimal GDF-15 cut-off point with which LVH severity can be predicted in the current study. Conclusion: GDF-15 is associated with hypertensive LVH and may be a powerful biomarker with which LVH risk can be predicted in patients with hypertension.

Left ventricular hypertrophy is associated with increased sirtuin level in newly diagnosed hypertensive patients

ABSTRACTBackground: Arterial hypertension is one of the leading causes of mortality and morbidity in general population. Sirtuin 1 (SIRT1) has diverse anti-inflammation, anti-oxidant, and anti-apopytosis effects on endothelium and is associated with endothelial aging and dysfunction. The objective of this study was to evaluate the relation of serum SIRT1 level with left ventricular hypertrophy (LVH) in newly diagnosed hypertensive patients.Methods: One hundered and twenty-five consecutive, newly diagnosed hypertensive patients were divided into two groups with regard to presence of LVH and compared to 40 healthy control subjects. LVH was determined by transthoracic echocardiography using the cube formula. Serum SIRT1 level was analyzed with enzyme-linked immunosorbent assay.Results: Serum SIRT1 level was significantly higher in patients with LVH compared to those without LVH (14.3 ± 3.9 ng/ml vs. 7.9 ± 3.6 ng/ml, ​P < 0.001) and healthy control subjects (14.3 ± 3.9 ng/ml vs 6.6 ± 2.0 ng/ml, P < 0.001). Multivariate logistic regression analysis revealed higher serum SIRT1 level independently predicted LVH in hypertensive patients (OR 1.50; 95% CI, 1.30–1.73; P < 0.001). Receiver-operating characteristic curve analysis demonstrated a cutoff value of 9.4 had a sensitivity of 90% and specificity of 74% for the prediction of LVH (AUC 0.885; 95% CI, 0.815–0.935; ​P < 0.0001).Conclusion: SIRT1 was a powerful biomarker for predicting LVH in hypertensive patients.

Impact of left ventricular hypertrophy on long-term clinical outcomes in hypertensive patients who underwent successful percutaneous coronary intervention with drug-eluting stents.

Left ventricular hypertrophy (LVH) is associated with increased risk for vascular events and mortality. This study investigated 8-year clinical outcomes of hypertensive patients with LVH who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES) compared with hypertensive patients without LVH.A total of 1704 consecutive hypertensive patients who underwent PCI from 2004 to 2014 were enrolled. We classified them into either the LVH group (n = 406) or the control group (without LVH, n = 1298). LVH was defined by LV mass index > 115 g/m2 in men and > 95 g/m2 in women. After propensity score matched (PSM) analysis, 2 PSM groups (366 pairs, n = 732, c-statistic = 0.629) were generated.For up to 8 years, the LVH group showed a higher incidence of cardiac death (4.4% vs 1.2%, log-rank P = .023, hazard ratio: 3.371, 95% confidence interval: 1.109–10.25; P = .032) compared with the control group. However, there were no significant differences between the 2 groups in the incidence of total death, myocardial infarction, revascularization, and major adverse cardiac events up to 8 years.LVH in hypertensive patients who underwent successful PCI with DES was associated with higher incidence of cardiac death up to 8 years of follow-up. More careful managements and clinical follow-up are needed and treatment strategies should specifically focus to target prevention and reversal of LVH in hypertensive patients.

OP-135 - Comparison of the Effect of Olmesartan and Atenolol on Left Ventricular Hypertrophy in Hypertensive Patients

Objective: Hypertension (HT) is an important public health problem both in our country and in the world. HT often causes left ventricular hypertrophy (LVH) in heart. We aimed to compare the effect of olmesartan and atenelol on LVH in hypertensive patients.

Use of Doppler Echocardiography as a Prognostic Marker in Evaluating Hypertensive Patients with and without left Ventricular Hypertrophy-A Hospital Based Study in Vellore

Background: The number of individuals with hypertension in India is increasing rapidly, however, the awareness, detection, treatment and control rates are very poor. The incidence of cardiomyopathies such as Left ventricular Hypertrophy (LVH) is seen to be quite high in patients with hypertension. In addition to this, metabolic diseases like diabetes mellitus, obesity and hyperlipidemia may increase the incidence of cardiovascular changes such as Left ventricular Hypertrophy. LVH plays a prognostic risk factor in hypertensive patients. Methods: M-mode echocardiography, Blood pressure measurements and biochemical analyses for all the patients- Hypertensive (n=25); Hypertensive with LVH (n=25); LVH (n=25) and Normotensive (n=25) were carried out. The statistical analyses were performed using MATLAB software. Results: The high prevalence of LVH in Hypertensive patients on echocardiography implies that these patients require detailed cardiovascular evaluation despite absence of symptoms. Conclusion: The Doppler echocardiography outcomes have shown to be useful substitute marker for prognosis and intervention studies. New Doppler echocardiographic techniques with much accuracy to investigate subclinical condition will benefit further for this group of patient at excessive cardiovascular risk.

Association between growth differentiation factor 15 and left ventricular hypertrophy in hypertensive patients and healthy adults

ABSTRACTGrowth differentiation factor 15 (GDF-15) as an independent biomarker of cardiovascular diseases merits further evaluation. We studied the association between plasma GDF-15 levels and left ventricular hypertrophy (LVH) in hypertensive patients and healthy adults. Hypertensive LVH measurements were performed via echocardiography and analyzed using the cube formula, and human GDF-15 together with interleukin-6 (IL-6) and matrix metalloproteinase-9 (MMP-9) concentrations were determined via enzyme-linked immunosorbent assay (ELISA). All data were analyzed using SPSS 13.0 software. A total of 302 participants were recruited for this clinical study. Circulating GDF-15, IL-6 and MMP-9 levels were significantly higher in LVH patients (n = 67) than in non-LVH patients (n = 172) and healthy controls (n = 63) (p < 0.001). After adjustment for confounders via multivariate logistic regression, elevated plasma GDF-15 concentrations remained independently associated with LVH in hypertensive patients. In addition, GDF-15 was positively correlated with IL-6 and MMP-9 levels in human plasma, respectively, suggesting that a link exists between GDF-15 expression and inflammation. We also calculated an optimal GDF-15 cut-off point with which LVH severity can be predicted in the current study. In conclusion, GDF-15 is associated with hypertensive LVH and may be a powerful biomarker with which LVH risk can be predicted in patients with hypertension.

Association of renin–angiotensin–aldosterone system gene polymorphisms with left ventricular hypertrophy in patients with heart failure with preserved ejection fraction: A case–control study

ABSTRACTBackground: Heart failure with preserved ejection fraction (HFpEF) has close ties with hypertension, though risk factors to the development of HFpEF in hypertensive patients are not fully understood. Left ventricular hypertrophy (LVH) signifies the susceptibility toward diastolic heart dysfunction, and genetic determinants of LVH as a result may serve as risk predictors for HFpEF in hypertension. We investigated the role of three renin–angiotensin–aldosterone system (RAAS) gene polymorphisms in the development of LVH in hypertensive patients with a diagnosis of HFpEF. Methods: A total of 176 hypertensive patients with a diagnosis of HFpEF were divided to cases with LVH and controls without. rs4343 and rs4291 of angiotensin-converting enzyme (ACE) and rs5186 of angiotensin receptor type 1 were genotyped using PCR-RFLP method. Results: Genotypes and allele frequencies were significantly different between the case and control groups for rs4343 and rs4291, whereas no difference was observed for rs5186.Conclusion: Increased ACE activity explains the significant association of rs4343 and rs4291 polymorphisms with LVH in the carriers. Furthermore, findings support the pathophysiologic links between RAAS and increased LV mass in hypertension and suggest a genetic susceptibility to HFpEF. Such polymorphisms may serve as risk predictors of HFpEF in hypertensive patients.

Angiotensin II as an Indicator of Left ventricular Hypertrophy in Uncontrolled Treated Hypertensive Patients

Background: left ventricular hypertrophy (LVH) in uncontrolled hypertension is a major risk factor and the mechanism is not fully understood weather it is due to increased afterload or due to an angiotensin II (Ag II) mediated action on the heart. Objectives: we studied the relationship between Ag II serum level and concentric LVH in patients with hypertension. Methods: a total of 91 patients were included, all had long standing (≥ 5 years) essential uncontrolled treated hypertension and were categorized into two groups according to presence of concentric LVH by echocardiographic criteria (LV mass index (LVMI)>115 g/ m2 for men, LVMI>95 g/m2 for women and relative wall thickness (RWT)>0.42). Group I had 47 patients with LVH and group II had 44 patients without LVH. Ag II serum level was measured in all of them. Results: Ag II serum level was higher than normal range in all patients in both groups (cutoff value was taken as 30pg/ml). It was significantly higher in patients with LVH (group I) with mean level 70 pg/ml compared to 43 pg/ml in patients without LVH (group II) (p=0.000). In patients with LVH, Ag II serum level had positive correlation with BMI (r=0.325, P=0.026) but it had no correlation to age, gender, diabetes, duration of hypertension and, surprisingly no correlation to severity of LVH. Conclusion: Patients with LVH have higher serum level of Ag II compared to patients without LVH but it cannot be considered as the only causative factor for LVH in hypertensive patients and other factors should be considered.

Abstract 12513: Comparison of Global Myocardial Function With 2 Types of Pressure-Overload Left Ventricular Hypertrophy Using Two-Dimentional Speckle-Tracking Echocardiography

Introduction: Left ventricular hypertrophy (LVH) secondary to hypertension and aortic stenosis (AS) are often considered together to be pressure overload hypertrophy. Comparisons of myocardial function by the 2 most common causes of LVH are limited. The global LV afterload that may be assessed by valvuloarterial impedance plays a detrimental effect on LV systolic function. Hypothesis: We hypothesized that important differences may exist in the myocardial function with these 2 origins of pressure-overload LVH. Methods: Global LV longitudinal strain (GLS) were measured using speckle-tracking echocardiography in 38 hypertensive LVH (H-LVH) patients and 36 patients with severe AS and preserved LV ejection fraction. To estimate the global LV afterload, we calculated the valvuloarterial impedance (Z va ) as the sum of the systolic arterial pressure and the mean transvalvular pressure gradient divided by the stroke volume index. Results: The patients were divided into two groups according to the level of Z va : low Z va (Z va &lt;3mmHg ml/m 2 , n=25) and high Z va (Z va ≥3mmHg ml/m 2 , n=49). GLS was reduced in the high Z va group (p&lt;0.05). The patients in the high Z va group were divided into two subgroups: AS group (n=28) and H-LVH group (n=21). Systolic blood pressure was higher in the H-LVH group than in the AS group (p&lt;0.0001). However, LV mass index and LV ejection fraction were not significantly differences. GLS was significantly reduced in the AS group (p&lt;0.0001). In the AS group, GLS was significantly correlated with Zva (r=0.44). However, there was no correlation between GLS and mean transaortic pressure gradient. Conclusions: Despite of similar global LV afterload and LV hypertrophy, myocardial LV longitudinal systolic function is impaired in patients with severe AS compared with H-LVH patients. However, there is no correlation between AS severity and LV longitudinal deformation. The magnitude of the global LV afterload as reflected by Z va is a powerful determinant of altered LV longitudinal deformation in severe AS patinets with preserved LV ejection fraction.

Association between long-term prescription of aldosterone antagonist and the progression of heart failure with preserved ejection fraction in hypertensive patients

BackgroundHypertension complicated with left ventricular hypertrophy (LVH) and diastolic dysfunction is independently related to increasing risk of subsequent incident heart failure with preserved ejection fraction (HFpEF). This study was designed to evaluate the influences of long-term aldosterone antagonist prescription in these patients. MethodsUsing a propensity score matching of 1:2 ratio, this retrospective claims database study compared spironolactone prescription (n=65) and non-spironolactone therapy (n=130) in hypertensive patients with LVH [left ventricular mass index (LVMI)>125g/m2 for men and >110g/m2 for women] and suspected diastolic dysfunction (E/E′ ratio between 8 and 15) and without clinical signs or symptoms of heart failure. ResultsWith a median follow-up of 7.4years, the new-onset symptomatic HFpEF occurred in 3 of 65 patients in the spironolactone group and 21 of 130 patients in the non-spironolactone group (P=0.021). Spironolactone also generated more prominent improvement in diastolic function and LVH. And multivariate logistic regression model revealed that spironolactone prescription (OR 0.177, 95% CI: 0.045–0.687, P=0.012) was associated with a reduced risk of new onset of symptomatic HFpEF, and the elevation of LVMI (OR 1.053, 95% CI: 1.011–1.097, P=0.012) or E/E′ (OR 1.280, 95% CI: 1.015–1.615, P=0.037) was associated with a high risk of new onset of symptomatic HFpEF. ConclusionsLong-term aldosterone antagonist exposure was associated with protective effects in terms of the incidence of new-onset symptomatic HFpEF, LV diastolic dysfunction and LVH in hypertensive patients, which might be beneficial for the delay of HFpEF progression.

What Is the Effect of Metabolic Syndrome without Hypertension on Left Ventricular Hypertrophy?

Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular events. There is a strong association between metabolic syndrome (MetS) and LVH in hypertensive patients. However, the relation between LVH and MetS in the absence of hypertension has not been studied. To study the impact of MetS on LV mass in patients without hypertension. Fifty MetS patients without hypertension and 50 healthy control subjects were enrolled. Twelve-lead electrocardiography, laboratory testing, and echocardiography were done with assessment of the left ventricular diastolic (LVEDD) and systolic dimensions (LVESD), fraction of shortening (FS), ejection fraction (EF), Doppler-derived mitral valve flow velocity waves (E-wave, A-wave, E/A ratio), left ventricular mass and mass index (LVMI). There was no significant difference between the two groups regarding LVEDD, LVESD, FS, EF, E-wave velocity, A-wave velocity, or E/A ratio. However, mean posterior wall thickness, IVST, LV mass, LVMI, and incidence of LVH were significantly higher in MetS patients. There was a significant positive correlation between LVMI and blood glucose level (r = 0.528, P < 0.00001), hemoglobin A1c (HbA1c) (r = 0.416, P < 0.0001), triglycerides level (r = 0.535, P < 0.00001), and obesity (r = 0.307, p = 0.0019). There was a significant negative correlation between LVMI and HDL-C level (r = -0.377, P < 0.0001). The same parameters were predictors for LVH in a logistic regression analysis. Even in the absence of hypertension, MetS patients had significantly higher LV wall thickness, LV mass and LVMI, and incidence of LVH than control subjects.

CRT-400.08 Impact of Left Ventricular Hypertrophy in Hypertensive Patients Underwent Successful Percutaneous Coronary Intervention With Drug Eluting Stents on Long-term Clinical Outcomes

Hypertension (HTN) and its organ damage such as left ventricular hypertrophy (LVH) can lead to worsening heart failure, cardiovascular morbidity and mortality. However, there are limited data regarding the impact of LVH in HTN patients (pts) who underwent successful percutaneous coronary

Serum soluble RAGE level inversely correlates with left ventricular hypertrophy in essential hypertension patients.

Soluble receptor for advanced glycation end-products (sRAGE) acts as a decoy to prevent interaction between RAGE and its pro-inflammatory ligands. sRAGE levels have been found to decrease in chronic inflammatory diseases, including hypertension. However, few data have been reported concerning the association between serum sRAGE levels and hypertensive left ventricular hypertrophy (LVH). Fasting blood samples were obtained from 209 essential hypertensive patients, and sRAGE levels were measured using a commercially available double-sandwich enzyme-linked immunosorbent assay kit. All patients underwent complete transthoracic echocardiographic examination. LVH was defined as a left ventricular mass index >115 g/m(2) for men and >95 g/m(2) for women. Eighty-one hypertensive patients (38.76%) were categorized in the LVH(+) group. Age (P = 0.009), hypertension duration (P = 0.013), triglyceride levels (P = 0.028), and systolic blood pressure (P = 0.026) were higher, and sRAGE and high-density lipoprotein cholesterol levels were lower in the LVH(+) group compared with the LVH(-) group. Multivariate logistic regression analysis showed that sRAGE level [odds ratio (OR) = 0.916; 95% confidence interval (CI) = 0.864-0.984; P = 0.003], hypertension duration (OR = 1.024; 95%CI = 1.003-1.052; P = 0.027), and triglyceride level (OR = 1.017; 95%CI = 1.005-1.039; P = 0.018) were independent predictors of LVH in hypertensive patients. In conclusion, serum sRAGE level was inversely associated with LVH in hypertensive patients.

0508: Brain natriuretic peptide in hypertensive patients on regular hemo-dialysis: does it have diagnostic implication?

Brain natriuretic peptide (BNP) quantification is a useful cardiovascular diagnostic and prognostic test. In renal failure its use may have constraints, as it depends on renal clearance and concomitant volume overload. The aim of this study was to evaluate the clinical usefulness of BNP in hypertensive patients on maintenance hemodialysis (HD). Design and Methods we measured BNP levels in 30 patients immediately before and after HD. All patients had preserved left ventricular ejection fraction (LVEF ≥50%) and underwent 48-hours ambulatory blood pressure measurement. Cardiac parameters were evaluated by echocardiography. The left ventricular mass index (LVMi) and BNP levels decreased significantly after HD (p<0.001). LVMi was significantly associated with the duration of hypertension (p=0.03). After HD, LVMi was significantly associated to the diurnal, nocturnal and 48-hours ambulatory blood pressure. BNP levels were associated to diastolic blood pressure and LVMi before and after HD. A BNP cut-off value of 68.91pg/mL after HD resulted in 81.8% specificity and 100% sensitivity for the presence of left ventricular hypertrophy (LVH), (AUC ROC: 0.864) in hypertensive patients. BNP had strong associations with prevalent LVH in hypertensive patients on hemodialysis.

Association of Endothelial and Mild Renal Dysfunction With the Severity of Left Ventricular Hypertrophy in Hypertensive Patients.

The association between impaired renal function and increase left ventricular mass was shown to be related to increase in arterial stiffness, which indicates that vascular homeostasis and remodeling may impact the left ventricular hypertrophy (LVH) in patients with renal dysfunction. We measured the peripheral arterial reactive hyperemia index (RHI) and estimated glomerular filtration rate (eGFR) in 317 hypertensive patients comprising 115 normal RHI (RHI > 1.67) and normal eGFR (eGFR ≥ 90ml/min per 1.73 m(2)), 136 low RHI (RHI ≤ 1.67), 27 low eGFR (60 ≤ eGFR < 90ml/min per 1.73 m(2)) and 39 low RHI combined with low eGFR. Multivariate logistic regression analysis identified lg RHI (odds ratio (OR): 0.001, 95% confidence interval (CI): 10(-6) to 0.426, P = 0.024) and lg eGFR (OR: 0.009, 95% CI: 10(-4) to 0.414, P = 0.016) as independent factors correlated with LVH respectively in hypertensive patients. Compared with normal RHI and eGFR patients, the extent of LVH in patients with either low RHI (OR: 1.224 95% CI: 0.451 to 3.327, P = 0.691) or low eGFR (OR: 0.593 95% CI: 0.070 to 5.037, P = 0.632) did not significantly increase, while it increased significantly in patients with low RHI combined with low eGFR (OR: 4.629 95% CI: 1.592 to 13.458, P = 0.005). The concurrence of endothelial and mild renal dysfunction was significantly associated with the severity of LVH in hypertensive patients.

PP.23.16

Objective: Brain natriuretic peptide (BNP) quantification is a useful cardiovascular diagnostic and prognostic test. In renal failure its use may have constraints, as it depends on renal clearance and concomitant volume overload. The aim of this study was to evaluate the clinical usefulness of BNP in hypertensive patients on maintenance hemodialysis (HD). Design and method: We measured BNP levels in 30 patients immediately before and after HD. All patients had preserved left ventricular ejection fraction (LVEF > 50%) and underwent 48-hours ambulatory blood pressure measurement. Cardiac parameters were evaluated by echocardiography. Results: The left ventricular mass index (LVMi) and BNP levels decreased significantly after HD (p < 0.001). LVMi was significantly associated with the duration of hypertension (p = 0.03). After HD, LVMi was significantly associated to the diurnal, nocturnal and 48-hours ambulatory blood pressure. BNP levels were associated to diastolic blood pressure and LVMi before and after HD. A BNP cut-off value of 68.91 pg/mL after HD resulted in 81.8% specificity and 100% sensitivity for the presence of left ventricular hypertrophy (LVH), (AUC ROC: 0.864) in hypertensive patients. Conclusions: BNP had strong associations with prevalent LVH in hypertensive patients on hemodialysis.

The association between BMP4 gene polymorphism and its serum level with the incidence of LVH in hypertensive patients.

BackgroundBone morphogenic proteins 4 (BMP4) is associated with cardiac remodeling under different conditions. However, the role of BMP4 and its gene polymorphism in the incidence of left ventricular hypertrophy (LVH) in hypertensive patients remains unknown.MethodsA total of 1265 patients diagnosed with essential hypertension (EH) were recruited. Patients were assigned to LVH+ (n = 420) and LVH- (n = 845) groups. serum BMP4 level was measured and two single nucleotide polymorphism (SNPs) polymorphisms, 6007C > T and -5826G > A of BMP4 gene were genotyped. We also inhibited the BMP4 by small interfering RNA (siRNA). The effect of BMP4 on the hypertrophic response in Human Cardiomyocytes AC16 cells was studied.ResultsWe found that the 6007C > T polymorphism of the BMP4 gene and the serum BMP4 level were significantly associated with the risk to develop LVH. With TT as reference, multivariate logistic regression analysis showed the 6007CC genotype carriers had a higher susceptibility to LVH incidence (adjusted OR = 2.65, 95% CI: 1.63-4.31, adjusted P < 0.001). Our in vitro study shows that the BMP4 inhibition in cardiomyocyte by si-RNA technique significantly decreased the Ang II induced cardiomyocyte size and protein content per cell, indicating the importance of BMP4 in the cardiomyocyte hypertrophy.ConclusionCollectively, our data suggest that both the 6007C > T of the BMP4 gene and the serum BMP4 level may be used as potential marker for LVH incidence among the EH patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-014-0368-x) contains supplementary material, which is available to authorized users.