HDCN Abstract:  ASN Annual Meeting -- San Francisco  

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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