Ismaeel H, Berberi A, Shamseddeen W, et al.
Mild Reductions in GFR Predict Left Ventricular Pathology in Young
Newly Diagnosed Never Treated Mildly Hypertensive Lebanese Patients.
ASN Annual Meeting -- San Francisco
J Am Soc Nephrol
(Nov) 18:631A 2007

We reported previously (JASN 17: 428A, 2006), that in untreated young mildly
hypertensive individuals without evidence of underlying renal disease, the
presence of even modest reductions in GFR predicts significant large and
small arterial and arteriolar disease.
To determine whether GFR may
also predict left ventricular (LV) remodeling, 541
young
(mean age = 53
13 years; males = 65%) newly diagnosed never
treated mildly hypertensive (mean SBP142
21mmHg) Lebanese individuals underwent echocardiographic evaluation for
determination of LV geometry. GFR (MDRD) was more than 60 ml/min in all
patients (mean serum Creatinine 1.1
0.5
mg/dl). Presence and patterns of LV hypertrophy (LVH) were defined according
to the 2006 Guidleines of the ACC/ESC for LV mass index (LVMI) and relative
wall thickness (RWT): LVH: LV mass/height2.7 > 51
g/m2.7 for both men and women; concentric if RWT >0.43.
Accordingly, patients were classified as having normal LV, concentric
remodeling (CR), concentric hypertrophy (CH), or eccentric hypertrophy
(EH).
Results: Only 12% of patients had normal LV indeces. 47.3% had
CH, 32.7% had EH, and 7.9% had CR. Multivariate multinomial logistic
regression analysis revealed that the only variables which independently
predicted the presence of LVH were higher values for SBP (p<0.01) and
lower values for GFR (p=0.02).
Conclusions: Significant LV pathology
was already present in 88% of newly diagnosed young Lebanesehypertensive
patients. This prevalence was considerably higher than that reported in other
studies in similarly hypertensive cohorts (LIFE 76%; Jackson Cohort 76%;
Framingham 24%-28%; HyperGen 30%; Cardiovascular Health Study 15%).
Furthermore, the sole predictor for the presence of LVH other than SBP, was
the value of estimated GFR. These data support the concept that mildly
reduced filtration capacity may not only contribute to the pathogenesis of
progressive systemic arteriopathy, but also to the development of LV
pathology.
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