Determinants of Left Ventricular Hypertrophy in Hypertensive Patients: Identification of High-Risk Patients by Metabolic, Vascular, and Inflammatory Risk Factors

Maya Peer; Mona Boaz; Matas Zipora; Marina Shargorodsky

doi:10.1055/s-0033-1348880

International Journal of Angiology, Table of Contents

Int J Angiol 2013; 22(04): 223-228
DOI: 10.1055/s-0033-1348880

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Determinants of Left Ventricular Hypertrophy in Hypertensive Patients: Identification of High-Risk Patients by Metabolic, Vascular, and Inflammatory Risk Factors

Authors

Maya Peer

¹Department of Internal Medicine, Woltson Medical Center, Holon, Israel
Mona Boaz

²Department of Epidemiology and Statistics, Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Matas Zipora

³Department of Biochemistry, Wolfson Medical Center, Holon, Israel
Marina Shargorodsky

⁴Department of Endocrinology, Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Abstract

Left ventricular hypertrophy (LVH) is recognized as an independent predictor of cardiovascular morbidity and mortality in hypertensive patients. Thus, it is critical to understand the mechanisms underlying the development of LVH for formulation screening and treatment strategies. This study was designed to determine the association between echographically determined LVH measures and markers of inflammation, neurohormonal activity, glomerular function, oxidative stress, insulin resistance, and vascular endothelial function. In this study, 129 hypertensive subjects were evaluated for lipids, glucose, HbA1C, insulin, homeostasis model assessment-insulin resistance, C-reactive protein (CRP), urinary microalbumin, homocysteine, aldosterone, renin, and endothelin. LVH parameters including interventricular septum thickness, posterior wall thickness (PWT), and left ventricular mass index (LVMI) were assessed echographically. Serum aldosterone levels were significantly positively associated with left ventricular mass (LVM) and marginally positively associated with LVMI and PWT. Both LVM and LVMI were significantly elevated in subjects with high versus normal serum aldosterone levels (p = 0.018 for LVM and p = 0.050 for LVMI). Serum endothelin was positively associated with LVM and LVMI. In multiple linear regression analysis, aldosterone remained a significant predictor of LVM (standardized β = 0.229, p = 0.024), and endothelin a marginally significant predictor of LVM (standardized β = 0.178, p = 0.077). Among serum lipids, high-density lipoprotein cholesterol only had a significant inverse association with LVM and PWT. Homocysteine as well as CRP were significantly positively associated with LVM and LVMI in females. This study found that aldosterone and endothelin levels are the most important independent determinants of LVH in hypertensive subjects. These markers may be useful to identify asymptomatic hypertensive subjects at risk for heart failure.

Keywords

cardiovascular disease - cardiovascular risk factors - hypertension - hypercholesterolemia - creatinine - high-sensitivity C-reactive protein

Full Text

References

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