Nephrology Dialysis Transplantation, Vol 12, Issue 4 724-728, Copyright © 1997 by Oxford University Press
B Tucker, F Fabbian, M Giles, RC Thuraisingham, AE Raine and LR Baker
BACKGROUND: Left ventricular hypertrophy (LVH) is both common and an
important predictor of risk of death in end-stage renal failure (ESRF). In
mild to moderate chronic renal failure (CRF), the timing of onset of LVH
and the factors involved in its initial development have not been fully
elucidated. The present study was undertaken to examine the prevalence and
potential determinants of echocardiographically determined LVH in this
connection, and to compare 24-h ambulatory blood pressure (BP) recordings
with BP measured at a previous clinic visit. METHODS: From a cohort of 120
non-diabetic patients who had been attending a nephrology clinic, 118
agreed to participate in the study. Of these we selected for analysis 85
stable patients (37 male). Patients with known cardiovascular disease,
those with a history of poor compliance with antihypertensive medication,
and those in whom such medication had been changed in the previous 3 months
were excluded. Clinic BP, 24-h ambulatory BP, echocardiography, body mass
index (BMI), serum creatinine (SCr), creatinine clearance (CrCl),
haemoglobin (Hb), fasting cholesterol (CHOL), triglyceride TRIGL), plasma
glucose, calcium (Ca), phosphate (PO4), alkaline phosphatase (ALK PHOS),
parathyroid hormone (PTH) concentrations, and 24-h urinary protein were
assessed in all patients. Seventy-seven per cent were on antihypertensive
medication. RESULTS: LVH was detected in 16% of patients with CrCL > 30
ml/min, and 38% of patients with CrCl < 30 ml/min. By stepwise
regression analysis, ambulatory systolic BP (P < 0.0001), male gender (P
< 0.0001), BMI (P < 0.0002), and Hb concentration (P < 0.002) were
the only independent determinants of left ventricular (LV) mass. Nocturnal
systolic BP (P < 0.02) was the main determinant of LVH in the group of
patients with advanced CRF. The correlation between left ventricular mass
index (LVMI) and mean 24-h ambulatory systolic BP (r = 0.52, 95% confidence
interval 0.50-0.54) was statistically significantly stronger than with
outpatient systolic BP (r = 0.25, 95% confidence interval 0.23-0.27). The
same was true for the correlation between LVMI and mean 24-h ambulatory
diastolic BP (r = 0.42, 95% confidence interval 0.40-0.44), and outpatient
diastolic BP (r = 0.22, 95% confidence interval 0.20-0.24). CONCLUSIONS:
Twenty-four hour ambulatory BP recording and echocardiography are required
for accurate diagnosis of inadequate BP control and early LVH in patients
with chronic renal impairment, independent determinants of which are
hypertension, male sex, BMI, and anaemia.
ORIGINAL ARTICLES
Left ventricular hypertrophy and ambulatory blood pressure monitoring in chronic renal failure
Department of Nephrology, St Bartholomew's Hospital London, UK.
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