Parallel Deterioration of Albuminuria, Arterial Stiffness and Left Ventricular Mass in Essential Hypertension: Integrating Target Organ Damage

Abstract

Background: Albuminuria, arterial stiffening and left ventricular hypertrophy (LVH) constitute target organ damage. We estimated whether increased urinary albumin excretion, assessed by albumin-to-creatine ratio (ACR), and carotid to femoral pulse wave velocity (c-f PWV) were accompanied by augmented left ventricular (LV) mass index (LVMI) in hypertension. Methods: In 428 non-diabetic untreated hypertensives (257 men, mean age = 52 years, office blood pressure (BP) = 146/93 mm Hg) the distributions of ACR and c-f PWV were split by the median (8 mg/g and 7.8 m/s, respectively). Results: Age, male sex, 24 h systolic BP, ACR and c-f PWV were the independent predictors of LVMI (R² = 0.478, p < 0.0001). Among patients with low ACR (n = 198), those with high c-f PWV (n = 84) compared to those with low c-f PWV (n = 114) were characterized by increased LVMI (by 8.9 g/m², p = 0.012) and prevalence of LVH (30 vs. 14%, p = 0.015). Similarly among patients with high ACR (n = 230), those with high c-f PWV (n = 123) compared to those with low c-f PWV (n = 107) exhibited heightened LVMI (by 13.6 g/m², p = 0.001). Conclusions: Increased ACR in conjunction with pronounced arterial stiffness is accompanied by augmented LV mass and higher LVH rates. Furthermore, the interrelationships between albuminuria, c-f PWV and LVMI suggest parallel target organ damage progression.

Urinary Protein Excretion Is Associated with Left Ventricular Hypertrophy in Treatment-Naïve Hypertensive Patients in an African Hospital Setting

“…This is in agreement with previous studies [9,18] that reported LVH to be more frequently observed in males. Our findings of a correlation in women differs from those of Redon et al [7] who found a correlation between microalbuminuria and LVH in men, but not in women, with mild hypertension in Spain.…”

“…However, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) VII advocates more aggressive treatment of hypertension in patients with proteinuria and LVH [5]. The association between proteinuria and left ventricular (LV) mass has been inconsistent [6,7,8,9,10,11]. Moreover, studies carried out in Africa have used the semi-quantitative dipstick to measure proteinuria and electrocardiography (ECG) to assess the LV mass [12,13].…”

Aging Male Spontaneously Hypertensive Rat as an Animal Model for the Evaluation of the Interplay between Contrast-Induced Acute Kidney Injury and Cardiorenal Syndrome in Humans

“…LVH is considered a predictor of adverse renal outcome in patients with high cardiovascular risk [24] . Augmented LV mass index and higher LVH rates are correlated with an increase in urinary albumin excretion [25] . Further, LVH is accompanied by a reduction of renal function in hypertensive patients [26] .…”

“…In this review, we discuss how the aging male SHR can be a suitable animal model for the evaluation of the interaction between CI-AKI and CRS type 1 and 3. Table 1 and figure 1 show similar risk factors for CI-AKI, including hypertension, obesity, and age, shared by the SHR [17][18][19][20][21][22][23] and humans with preclinical CRS [10,18,[23][24][25][26][27][28][29] . In humans with preclinical CRS, essential hypertension acts as a risk factor for subclinical cardiac and renal damage.…”

Preclinical Cardiorenal Interrelationships in Essential Hypertension

“…In a cohort of 428 untreated essential hypertensives, an increased albumin-to-creatinine ratio (ACR) irrespective of the level of microalbuminuria (MA), in conjunction with pronounced arterial stiffness, is accompanied by augmented left ventricular mass and higher LVH rates [12]. An independent association between GFR estimated either through the MDRD formula or creatinine clearance and left ventricular mass, indexed either for body surface area or for height 2.7 , was also exhibited in a group of nondiabetic hypertensives free of cardiovascular diseases [13].…”