[Left ventricular hypertrophy among hypertensive patients with diminished glomerular filtration rate].Pol Merkur Lekarski. 2008 Oct; 25(148):309-14.PM
Current guidelines of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) for the management of arterial hypertension (AH) have recognized the importance of subclinical organ damages such as renal function impairment and left ventricular hypertrophy (LVH) on cardiovascular prognosis in patients with this condition.
To assess the prevalence of LVH among hypertensive patients with diminished renal function. We evaluated the relationship between reduced estimated glomerular filtration rate (eGFR) and LVH diagnosed with echocardiography (ECHO) (odds ratio, OR).
MATERIAL AND METHODS
The study was performed in 749 consecutive hospitalized patients with diagnosed and treated essential AH. Chronic kidney disease (CKD) was defined as eGFR < 60 ml/min/1.73 m2. LVH was definied by the presence of the voltage criteria of Sokolow-Lyon (sum of the Sv1 i Rv5/6 > 38 mm) in electrocardiography (ECG) and by echocardiographically assessed left ventricle mass (LVM) and left ventricle mass index (LVMI) (LVMI > or = 125 g/m2 among men and > or = 110 g/m2 among women).
Mean value of eGFR in the studied group was 65.2 +/- 17.9 ml/min/1.73 m2. CKD diagnosed according to eGFR was found in 314 patients (42%). An ECG LVH was present in 68 patients (9.1%). Mean value of LVM in the studied group was 65.2 +/- 17.9 ml/min/1.73m2 and LVMI 118.78 +/- 28.1 g/m2, respectively. LVH diagnosed according to LVMI value occurred in 226 patients (48.8% of patients who underwent ECHO examination). There was no difference in the prevalence of ECG LVH between patients with CKD and without these condition (about 9%). Mean value of LVMI was statistically higher in CKD group (p<0.05). The risk of abnormal LVMI values in echocardiogram increased in age over 65 (OR 3.64), in the presence of atherogenic dyslipidaemia (OR 1.73), diabetes (OR 1.68), clinical signs of atherosclerosis (OR 4.36), eGFR < 60 ml/min/1.73 m2 (OR 1.90) and ECG LVH (OR 1.53).
CKD was present in about one-half of AH patients. CKD patients had worse global cardiovascular profile as compared with those with normal renal function. The prevalence of LVH diagnosed with ECHO is more common in this group, eGFR < 60 ml/ min/1.73 m2 increases the odds for LVH diagnosis based upon ECHO. This simple parameter can be helpful for more accurate qualification for ECHO examinations in AH patients.