eft ventricular hypertrophy (LVH) represents an independent risk factor for cardiovascular mortality and morbidity in patients with hypertension (HT). 1,2 In particular, concentric LVH is associated with a higher risk of cardiac arrhythmias, and even sudden death, and predicts the development of heart failure. [3][4][5] Hemodynamic load is strongly involved in the development of LVH in HT, but blood pressure and the degree of LVH do not necessarily correlate. The development of LVH is influenced by various neurohumoral factors, and the reninangiotensin-aldosterone system is strongly involved. 6 Several reports have indicated the possibility that aldosterone directly promotes myocardial hypertrophy and interstitial fibrosis. [7][8][9][10][11] A correlation between left ventricular (LV) myocardial mass and plasma aldosterone concentration (PAC) has already been reported in patients with essential HT (EHT). Some investigations have detailed LVH and the LV geometry in EHT patients already receiving treatment, 12-15 but there are no studies of patients with untreated EHT.Accordingly, the role of aldosterone in LVH and the LV geometry in patients with untreated EHT remains unclear.In the present study we focused on the serum procollagen type III amino-termnal peptide (PIIINP), which is formed during the conversion of procollagen type III to collagen type III and released into the blood, then cleared from the blood via hepatobiliary elimination. The serum concentration of PIIINP is used as a marker of collagen type III synthesis in various organs, including the liver under conditions of preserved bile excretion. [16][17][18][19] High serum levels of PIIINP have recently gained attention as reflecting ongoing fibrosis in the heart. [20][21][22][23][24] The present study had the primary objective of elucidating the relationship between aldosterone and LVH and LV geometry in patients with untreated EHT. In addition, the degree of ongoing fibrosis associated with various geometrical patterns of LVH was examined by assaying the serum PIIINP concentrations. Finally, the contribution of myocardial fibrosis to the process of LVH is discussed. Methods PatientsWe enrolled 57 consecutive patients (27 men, 30 women; mean age, 56±2 years) with untreated EHT. The criteria for HT were: systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥90 mmHg. Patients with the following diseases were excluded from the study: secondary HT, coronary artery disease, valvular heart disease, atrial fib- Background The present study examined the role of aldosterone in left ventricular hypertrophy (LVH) and geometry in patients with untreated essential hypertension (EHT), and investigated the contribution of myocardial fibrosis to the process of LVH. Methods and ResultsThe relationship of the plasma aldosterone concentration (PAC) to LVH and left ventricular (LV) geometry was investigated in 57 consecutive patients with untreated EHT. PAC correlated with both LV mass index (LVMI: r=0.46, p=0.0004) and relative wall thickness (RWT: r=0.33, p=0...
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