Abstract-Assessment of appropriateness of left ventricular mass (LVM) for a given workload may better stratify hypertensive patients. Inappropriate LVM may reflect the interaction of genetic and neurohumoral factors other than blood pressure playing a significant role in myocardial growth. Primary aldosteronism (PA) represents a clinical model useful in assessing the effect of aldosterone increase on LVM. The aim of this study was to evaluate the inappropriateness of LVM in patients with PA. In 125 patients with PA (54 females; adrenal hyperplasia in 73 and adenoma in 52 patients) and in 125 age-, sex-, and blood pressure-matched, essential hypertensive patients, echocardiography was performed. The appropriateness of LVM was calculated by the ratio of observed LVM to the predicted value using a reference equation. In all of the subjects plasma renin activity and aldosterone, as well as clinic and 24-hour blood pressure, were measured. The prevalence of inappropriate LVM was greater in patients with traditionally defined left ventricular hypertrophy (70% and 44%, respectively; Pϭ0.02) but also in patients without left ventricular hypertrophy (17% and 9%, respectively; Pϭ0.085). In PA patients, a correlation was observed between the ratio of observed:predicted LVM and the ratio of aldosterone:plasma renin activity levels (rϭ0.29; Pϭ0.003) or the postinfusion aldosterone concentration (rϭ0.44; Pϭ0.004; nϭ42). In conclusion, in patients with PA, the prevalence of inappropriate LVM is increased, even in the absence of traditionally defined left ventricular hypertrophy. The increase in aldosterone levels could contribute to the increase of LV mass exceeding the amount needed to compensate hemodynamic load. (Hypertension. 2008;52:529-534.)

Cardiovascular (CV) complications such as myocardial infarction, heart failure, stroke and renal failure are related to both the degree and the duration of blood pressure (BP) increase. Resistant hypertension (RH) is associated with a higher risk of CV complications and a higher prevalence of target organ damage (TOD). The relationship between CV disease and TOD can be bidirectional. Elevated BP in RH may cause CV structural and functional alterations, and the development or persistence of left ventricular hypertrophy, aortic stiffness, atherosclerotic plaques, microvascular disease and renal dysfunction, may render hypertension more difficult to control. Specifically, RH is related to several conditions, including obesity, sleep apnea, diabetes, metabolic syndrome and hyperaldosteronism, characterized by an overexpression of humoral and hormonal factors that are involved in the development and maintenance of TOD. Optimal therapeutic strategies, including pharmacological treatment and innovative invasive methodologies, have been shown to achieve adequate BP control and induce the regression of TOD, thereby potentially improving patient prognosis.

S ystemic arterial hypertension is associated with vascular changes in the retina that may occur in acute stages or develop chronically.1 Retinal microcirculation represents, perhaps, the only microvascular district that may be directly observed and evaluated by a relatively simple funduscopic examination. Clinical fundoscopic assessment of retinal microcirculation is still based on a classic approach used to detect structural alterations of retinal arterioles associated with chronic blood pressure (BP) elevations, as well as long-lasting abnormalities in insulin sensitivity and blood glucose profile. However, several studies have proved a weak clinical usefulness of Keith-Wegener classification, because of poor reproducibility and association with other indices of target organ damage.2,3 Fundoscopic examination has gained new popularity, thanks to the availability of standardized procedures based on computer-assisted evaluation of digitized retinal photographs. [4][5][6] The arteriovenous ratio of retinal arterioles and venules, proposed with these techniques, was shown to predict the incidence of stroke and cardiovascular morbidity, although the methodology with digitized photographs and the need of a core reading center prohibited its widespread clinical use.7 Wall-to-lumen ratio (WLR) of retinal arterioles, measured using scanning laser Doppler flowmetry (SDLF), has been proposed as an in vivo parameter of vascular damage for large-scale evaluation. [8][9][10] This index seems to be a robust indicator of the severity of hypertension 9 and of the presence of early renal damage.10 WLR of the retinal arterioles was found to be increased in patients with cerebrovascular events 9 and related to the extent of intima-media thickness in the carotid artery.11 In addition, it was demonstrated that WLR of retinal arterioles assessed with SLDF provides information similar to that obtained with the micromyographic measurement of media-to-lumen ratio of subcutaneous small arteries, generally considered the gold standard approach to the evaluation of microvascular structure. 12Central BP, indicative of changes in large conduit arteries, was found to be an independent determinant of vascular remodeling in retinal arterioles, 13 supporting the concept that changes in macrovasculature and microvasculature are strongly interrelated and confirming previous results obtained with invasive assessment of small artery remodeling by micromyography. 14 Because the possible interrelationship between alterations in retinal arterioles and 24-hour BP has not been extensively evaluated and because the influence of ambulatory BP monitoring in respect to peripheral and central hemodynamics on retinal structure deserves further investigation, we considered worthwhile assessing the relationship of WLR of retinal arterioles with clinic brachial and 24-hour ambulatory BP and with central BP in normotensive subjects and in patients with primary hypertension.Abstract-Wall-to-lumen ratio of retinal arterioles might serve as an in vivo parameter of ...

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