Left Ventricular Hypertrophy and Geometry in Untreated Essential Hypertension is Associated With Blood Levels of Aldosterone and Procollagen Type III Amino-Terminal Peptide

Nakahara, Takao; Takata, Yasuyuki; Hirayama, Yoji; Asano, Katsuaki; Adachi, Hidemitsu; Shiokawa, Genzo; Sumi, Teijin; Ogawa, Takashi; Yamashina, Akira

doi:10.1253/circj.71.716

Cited by 39 publications

(21 citation statements)

References 44 publications

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“…Elevated aldosterone is associated with fibrotic and inflammatory changes in the heart and both animal and clinical studies have documented that these changes are associated with LV hypertrophy. 20 Evidence of a relationship between circulating aldosterone levels and LV mass has been obtained in population studies, 21,22 in cross-sectional 23,24 and longitudinal studies of patients with primary hypertension, 25 and in normotensive patients with familial hyperaldosteronism type I. 26 However, most of the clinical evidence in support of an independent contribution of aldosterone to the development and progression of LV hypertrophy comes from studies conducted in patients with primary aldosteronism.…”

Section: Discussionmentioning

confidence: 99%

Dietary Salt Intake Is a Determinant of Cardiac Changes After Treatment of Primary Aldosteronism

et al. 2016

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Primary aldosteronism is associated with increased left ventricular (LV) mass independently of blood pressure. Previous studies suggest that elevated aldosterone causes cardiac damage only in the presence of an inappropriate salt status. We examined the relevance of dietary salt intake on cardiac changes in patients with primary aldosteronism before and after treatment. Sixty-five patients with tumoral or idiopathic primary aldosteronism were recruited at a University medical center and followed after either surgical (n=30) or medical (n=35) treatment. At baseline and 1 year after treatment, cardiac morphology and functional variables were measured by echocardiography together with duplicate 24-hour urinary sodium collections. At baseline, LV mass index was associated with urinary sodium excretion and plasma aldosterone levels. During follow-up, blood pressure (from 167/102–135/83 mm Hg; P <0.001) and LV mass index (from 50.5±13.0–44.4±8.9 g/m 2.7 ; P <0.001) decreased significantly with nonsignificant changes in LV geometry and functional properties. At the end of follow-up, percentage decrease in LV mass index was significantly greater in patients who had >10% reduction in urinary sodium excretion (15.0±12.5%) than in the remaining patients (5.5±9.3%; P <0.001). Changes in LV mass index induced by both surgical and medical treatment were directly and independently correlated with changes in blood pressure (β=0.419; P =0.009) and urinary sodium excretion (β=0.334; P =0.012) observed at follow-up. These findings strongly support the hypothesis that dietary salt intake has a crucial role in aldosterone-related LV changes and could contribute to cardiac damage in patients with primary aldosteronism.

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Section: Discussionmentioning

confidence: 99%

Dietary Salt Intake Is a Determinant of Cardiac Changes After Treatment of Primary Aldosteronism

et al. 2016

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“…UA is also capable of activating the rennin-angiotensin system, which is thought to mediate the development of LVH through many mechanisms (Agabiti-Rosei et al, 2006;Nakahara et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

Hyperuricemia and its association with carotid intima-media thickness in hypertensive and non hypertensive patients

Elsayed

Mostafa

Abdel-Khalik

et al. 2010

Journal of End-to-End-testing

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Carotid intima-media thickness (C-IMT) measured noninvasively by ultrasonography is widely used as a marker for increased risk of cardiovascular disease. Also hyperuricemia (HU) is a well recognized risk factor for cardiovascular diseases. The study was designed to assess the relation between hyperuricemia and carotid intima-media thickness C-IMT in patients with and without hypertension (HTN).This study included 126 patients divided into four groups: (1) Group A, included 59 hypertensive patients with hyperuricemia. (2) Group B, included 29 hypertensive patients without hyperuricemia. (3) Group C, included 17 patients with hyperuricemia and normal blood pressure without history of hypertension. (4) Group D, included 21 control subjects.We measured carotid intima-media thickness by B-mode ultrasound in the common carotid and internal carotid artery. Routine echocardiography and uric acid level was assessed for all patients.We found that C-IMT was significantly higher in group A, B and C than group D; and it was significantly higher in group A than B. This means that C-IMT is significantly higher in all hypertensive groups than control group but it was significantly higher in hypertensive hyperuricemia (group A) than those hypertensives without hyperuricemia. We also observed a higher C-IMT in hyperuricemic non hypertensive patients than control group this means that hyperuricemia per se could be a risk factor for atherosclerosis. Uric acid levels among the whole number of patients included in the study and among the groups with hyperuricemia (group A and group C) were positively correlated with the intimal-media thickness (IMT) while there were no correlations in the other two groups without hyperuricemia.We found that left ventricular hypertrophy (LVH) was significantly higher in hypertensive patients (group A&B) than normotensives (group C&D) either with or without hyperuricemia and this was evident in the hypertensive hyperuricemic patients (group A); but unexpectedly we observed the presence of LVH in the hyperuricemic non hypertensive patients (group C) which was significantly higher than the control group (group D). This means that hyperuricemia is a risk factor for development of LVH hypertrophy independently of hypertension.Therefore, higher serum uric acid levels are associated with increased C-IMT and left ventricular hypertrophy in hypertensive and even non hypertensive patients. So, early screening for hyperuricemia and lowering serum uric acid levels might be beneficial in slowing progression of atherogenesis.

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“…3) UA induces infl ammatory and proliferative cytokines like tumor necrosis factor-α and mitogen-activated protein kinases, [4][5][6] which promote cardiac hypertrophy. UA also activates the renin-angiotensin-aldosterone system, [7][8][9][10] which is a well-known system for hypertrophy and hyperplasia of myocytes and fi brosis of the heart. Thus, it may be interesting to study in humans whether UA is associated with LVH.…”

Section: Eft Ventricular Hypertrophy (Lvh) Is An Independentmentioning

confidence: 99%

Serum Uric Acid Is Associated With the Left Ventricular Mass Index in Males of a General Population

et al. 2014

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SummaryThe association of serum uric acid (UA) with left ventricular hypertrophy (LVH) remains controversial. We investigated this issue in a general population. Participants consisted of 1,943 subjects (774 males and 1,169 females) aged over 40 years, living in Tanushimaru (a Japanese cohort of the Seven Countries Study). Serum UA and other biochemistry parameters were determined by a standard analytical technique. All individuals underwent anthropometric measurements and 2-dimensional echocardiography. Because serum UA levels are much higher in males than in females, they were analyzed separately. When LV mass index (LVMI) levels were stratifi ed according to tertile as low (≤ 80 cm : n = 252) in males, there were signifi cant relationships between LVMI and UA, in addition to age, body mass index, systolic blood pressure, medication for hypertension, triglycerides, and alcohol intake. Multiple stepwise regression analysis revealed LVMI was signifi cantly associated with systolic BP (P < 0.0001), medication for hypertension (P < 0.0001), UA (P = 0.003), BMI (P = 0.019), and alcohol intake (P = 0.038) in males. In females, LVMI was not associated with UA. In a multiple logistic regression analysis, a signifi cantly higher odds ratio of LVH (odds ratio: 1.77, 95%CI: 1.01-3.09, P < 0.05) was observed for males in the highest UA tertile versus the lowest UA tertile after adjustments for confounding factors, but not for females. In this cross-sectional study, there was a clear difference in the relation of UA and LVH between males and females. High serum UA was signifi cantly and independently associated with LVH evaluated by echocardiography in only males of a general population. (Int Heart J 2014; 55: 65-70) Key words: Epidemiology, Echocardiography L eft ventricular hypertrophy (LVH) is an independent and powerful risk factor for cardiovascular events and death. 1,2) Uric acid (UA) may induce LVH and the following mechanisms have been proposed.3) UA induces infl ammatory and proliferative cytokines like tumor necrosis factor-α and mitogen-activated protein kinases, [4][5][6] which promote cardiac hypertrophy. UA also activates the renin-angiotensin-aldosterone system, 7-10) which is a well-known system for hypertrophy and hyperplasia of myocytes and fi brosis of the heart. Thus, it may be interesting to study in humans whether UA is associated with LVH. Several such studies have been performed.11-15) However, the results have not been consistent. Some studies reported a positive association only in males 14,15) and others reported such an association only in females.13) In some studies, 11,13,15) the enrolled subjects were only hypertensive while in others, 12,14) they were apparently healthy subjects. Nowadays, many subjects are taking antihypertensive medications. Thus, data must be analyzed after adjustment for confounders like gender, hypertension, and others. Furthermore, in many studies, 14,16) LVH was measured by electrocardiography (ECG), and in a few studies, 12,13) it was measured by echocardiograph...

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Left Ventricular Hypertrophy and Geometry in Untreated Essential Hypertension is Associated With Blood Levels of Aldosterone and Procollagen Type III Amino-Terminal Peptide

Cited by 39 publications

References 44 publications

Dietary Salt Intake Is a Determinant of Cardiac Changes After Treatment of Primary Aldosteronism

Dietary Salt Intake Is a Determinant of Cardiac Changes After Treatment of Primary Aldosteronism

Hyperuricemia and its association with carotid intima-media thickness in hypertensive and non hypertensive patients

Serum Uric Acid Is Associated With the Left Ventricular Mass Index in Males of a General Population

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