A blood pressure independent association between glomerular albumin leakage and electrocardiographic left ventricular hypertrophy. The LIFE Study

Abstract

In the Losartan Intervention For Endpoint reduction (LIFE) study left ventricular (LV) hypertrophy was associated with increased urine albumin/creatinine ratio (UACR) at baseline. To evaluate whether this association was due only to parallel blood pressure (BP)-induced changes we re-examined the patients after 1 year of antihypertensive treatment to investigate whether changes in LV hypertrophy and UACR were related independently of changes in BP. In 7142 hypertensive patients included in the LIFE study, we measured UACR, LV hypertrophy by electrocardiography, plasma glucose and BP after 2 weeks of placebo treatment and again after 1 year of antihypertensive treatment with either an atenolol or a losartan based regime. At baseline and still after 1 year of treatment logUACR (R = 0.28, P Ͻ 0.001) was still correlated to LV hypertrophy (␤ = 0.05) assessed by ECG independently of systolic BP (␤ = 0.16), plasma glucose (␤ = 0.19) and age (␤

Effects of Eplerenone, Enalapril, and Eplerenone/Enalapril in Patients With Essential Hypertension and Left Ventricular Hypertrophy

“…11 In the present study, there was a relatively poor correlation between the effect of eplerenone (alone or in combination with enalapril) on the change in BP and its effect on reducing LV mass. A similar poor correlation has been reported in previous studies, including LIFE, 12 suggesting that other factors may be as important or more important for reducing LV mass than BP reduction per se. However, one must exercise caution in concluding that reduction in BP is not of critical importance in reducing target-organ damage.…”

Reductions in albuminuria and in electrocardiographic left ventricular hypertrophy independently improve prognosis in hypertension: the LIFE Study

“…All ECGs were interpreted at a central ECG laboratory at Sahlgrenska University Hospital/Ö stra in Gö teborg, Sweden by experienced investigators who were blinded to clinical information. The degree of LVH was assessed by the product of QRS duration times the Cornell voltage combination (R aVL þ S V3 þ 6 mm in women) or Sokolow-Lyon voltage summation (S V1 þ R V5/6 ) [8]. QRS duration was measured to the nearest 4 ms, and the R-and S-wave amplitudes were measured to the nearest 0.05 mV.…”

Role of Microalbuminuria in the Assessment of Cardiovascular Risk in Essential Hypertension

“…It is interesting that recent data from the Losartan Intervention For Endpoint study indicate that the relationship between urinary albumin excretion and cardiovascular risk holds true, well below the levels currently used to define microalbuminuria (11). Furthermore, there is evidence that the regression of left ventricular hypertrophy parallels the reduction of albuminuria and is related to it, to some degree regardless of BP changes (12). This opens the way to a broader use of microalbuminuria assessment not only for its prognostic value but also for monitoring the efficacy of treatment.…”