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