Tucker B, Fabbian F, Giles M, Thuraisingham RC, Raine AEG,
Left ventricular hypertrophy and ambulatory blood
pressure monitoring in chronic renal failure
Nephrol Dial Transplant
(Apr) 12:724-728 1997
This paper analyzes in detail the association between hypertension and LVH
patients with mild (CrCl>30ml/min) to moderate (CrCl<30 ml/min.) CRF.
Eighty-five clinically stable patients (64 on antihypertensive medications)
from 120 non-diabetic patients in an academic clinical center participated
study. Patients with known cardiovascular complications or poorly compliant
the antihypertensive treatment were excluded from the study.
Hypertension (24h Syst >140 mmHg, 24hDiastolic >90 mmHg) was present
26% of patients with mild CRF and in the 46% of those with severe CRF
(notwithstanding antihypertensive treatment). There was a high prevalence
non-dippers (40% in the first group and 52% in the second group).
loss of the nocturnal BP fall was confined to hypertensive patients. LVH and
dilatation increased with progression of chronic renal failure being more
in the group with severe CRF (LVH 38%, LV dilat. 17%) than in that with
(LVH 16%, LV dilat. 9%). Systolic function (FS<25%) was present only in
patient with severe CRF. In the combined analysis of the two groups, 24h
pressure was the stronger univariate predictor of LVMI (r=0.52). On
analysis of the two groups, daytime systolic pressure (group I) and night-
systolic pressure (group II) were the most important determinant of LVM.
multivariate analysis arterial pressure remained a significant independent
of LVM. The correlations between LVM and clinic BP were less strong than
between LVM and 24h BP.
Comment: This paper confirms the importance of echocardiography for
detection of LVH in patients with renal diseases. LVH (which identifies
risk of cardiac death and stroke) and LV dilatation increase with
Thus even in stable, compliant patients without clinical evidence of
disease, arterial hypertension contributes to LVH. This study extends
observations made in "normotensive" patients with chronic glomerulonephritis
normal GFR. Ambulatory BP in these patients is distinctly higher than in
normotensive controls and is associated with increased LVM [Gebert S.
1995(6):388 abstr.] Intervention studies will establish whether strict BP
can allow the reversion of LVH in patients with mild to moderate CRF.
(Carmine Zoccali, M.D., Reggio Calabria, Italy).
The abstract of this paper is available from Oxford Press