Prevalence and Correlates of Left Ventricular Hypertrophy in the African American Study of Kidney Disease Cohort Study

Peterson, Gail; Backer, Tine De; Gabriel, Avril; Ilić, Vladimir; Vagaonescu, Tudor; Appel, Lawrence J.; Contreras, Gabriel; Kendrick, Cindy; Rostand, Stephen G.; Phillips, Robert A.

doi:10.1161/hypertensionaha.107.090613

Cited by 46 publications

(34 citation statements)

References 59 publications

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“…The limit of statistical significance was set at Po0.05 by two-tailed tests. 16,17,23,29,40 3 interventional prospective trials 13,30,34 and the remaining 2 were performed in specialist out-patient centers. 19,42 In approximately half of the studies, the effective observation period, including the echocardiographic examination, was before the year 2000.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies

et al. 2011

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on behalf of the Italian Society of Hypertension Left-ventricular hypertrophy (LVH) is a cardinal manifestation of hypertensive organ damage associated with an increased cardiovascular (CV) risk. We reviewed recent literature on the prevalence of LVH, as assessed by echocardiography, in order to offer an updated information on the magnitude of subclinical alterations in LV structure in contemporary human hypertension. A MEDLINE search using key words 'left ventricular hypertrophy', 'hypertension', 'echocardiography' and 'cardiac organ damage' was performed in order to identify relevant papers. Full articles published in English language in the last decade, (1 January 2000 --1 December 2010), reporting studies in adult or elderly individuals, were considered. A total of 30 studies, including 37 700 untreated and treated patients (80.3% Caucasian, 52.4% men, 9.6% diabetics, 2.6% with CV disease) were considered. LVH was defined by 23 criteria; its prevalence ranged from 36% (conservative criteria) to 41% (less conservative criteria) in the pooled population. LVH prevalence was not different between women and men (range 37.9 --46.2 versus 36.0 --43.5%, respectively). Eccentric LVH was more frequent than concentric hypertrophy (range 20.3 --23.0 versus 14.8 --15.8, respectively, Po0.05); concentric phenotype was found in a consistent fraction (20%) of both genders. Despite the improved management of hypertension in the last two decades, LVH remains a highly frequent biomarker of cardiac damage in the hypertensive population. Our analysis calls for a more aggressive treatment of hypertension and related CV risk factors leading to LVH. INTRODUCTIONLeft ventricular hypertrophy (LVH) secondary to arterial hypertension is a complex cardiac phenotype resulting from the response of myocyte and non-myocyte components to mechanical and neuro-humoral stimuli. 1 Although the mechanisms underlying this process remain incompletely understood, available evidence from the last two decades indicates that chronic haemodynamic overload has a driving role in activating LV myocardial growth; in turn, non-haemodynamic variables (that is, genetic, ethnic, environmental and hormonal factors) modulate the extent (and type) of the hypertrophic response. 2 --4 LVH in hypertensive patients may be regarded as a powerful, independent biomarker reflecting the impact of pressure overload as well as of several risk factors 5 on the heart.Routinely assessed LVH by electrocardiography or more accurately by echocardiography, is a strong determinant of cardiovascular (CV) prognosis over and beyond conventional risk factors in both population-based studies and in selected hypertensive cohorts. 6 --8 Initial levels of LV mass and mass reduction during antihypertensive treatment define CV risk related to subclinical cardiac damage 9 and influence therapeutic strategies. 10 In recent years, observational and interventional studies addressing hypertensive LVH performed worldwide 5 --9,11,12 offered us the opportunity to update available information o...

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Section: Discussionmentioning

confidence: 99%

Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies

et al. 2011

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“…A 2D, M-mode pulsed Doppler and pulsed tissue Doppler echocardiogram were obtained and processed by the Cardiovascular Research Foundation and then read centrally by trained echocardiographers. 8 …”

Section: Methodsmentioning

confidence: 99%

Disparate Estimates of Hypertension Control From Ambulatory and Clinic Blood Pressure Measurements in Hypertensive Kidney Disease

et al. 2009

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Abstract-Ambulatory blood pressure (ABP) monitoring provides unique information about day-night patterns of blood pressure (BP). The objectives of this article were to describe ABP patterns in African Americans with hypertensive kidney disease, to examine the joint distribution of clinic BP and ABP, and to determine associations of hypertensive target organ damage with clinic BP and ABP. This study is a cross-sectional analysis of baseline data from the African American Study of Kidney Disease Cohort Study. Masked hypertension was defined by elevated daytime (Ն135/ 85 mm Hg) or elevated nighttime (Ն120/70 mm Hg) ABP in those with controlled clinic BP (Ͻ140/90 mm Hg); nondipping was defined by a Յ10% decrease in mean nighttime systolic BP; reverse dipping was defined by a higher nighttime than daytime systolic BP. Of the 617 participants (mean age: 60.2 years; 62% male; mean estimated glomerular filtration rate: 43.8 mL/min per 1.73 m 2 ) with both clinic BP and ABP, 498 participants (80%) had a nondipping or reverse dipping profile. Of the 377 participants with controlled clinic BP (61%), 70% had masked hypertension. Compared with those with controlled clinic BP or white-coat hypertension, target organ damage (proteinuria and left ventricular hypertrophy) was more common in those with elevated nighttime BP, masked hypertension, or sustained hypertension. In conclusion, clinic BP provides an incomplete and potentially misleading assessment of the severity of hypertension in African Americans with hypertensive kidney disease, in large part because of increased nighttime BP. Whether lowering nighttime BP improves clinical outcomes is unknown but should be tested given the substantial burden of BP-related morbidity in this population.

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“…According to the different guidelines published by the major kidney societies, systolic BP should be lowered to values of Ͻ130 mmHg. One has to be aware, however, that as a predictor of adverse CKD or cardiovascular events, clinic BP measurement may be inferior to ambulatory BP measurement (11). This issue is particularly relevant in CKD because of the tendency for nighttime BP to be elevated (little or no nocturnal decrease in BP) and the fact that central (aortic) BP tends to be higher than peripheral (brachial) BP (11,12).…”

Section: Which Bp Component Systolic or Diastolic Is Most Relevant mentioning

confidence: 99%

“…One has to be aware, however, that as a predictor of adverse CKD or cardiovascular events, clinic BP measurement may be inferior to ambulatory BP measurement (11). This issue is particularly relevant in CKD because of the tendency for nighttime BP to be elevated (little or no nocturnal decrease in BP) and the fact that central (aortic) BP tends to be higher than peripheral (brachial) BP (11,12). In patients with diabetes, guidelines recommend that lower BP targets may provide further benefit, but prospective trials have thus far failed to confirm this epidemiologic observation.…”

Section: Which Bp Component Systolic or Diastolic Is Most Relevant mentioning

confidence: 99%

The Message for World Kidney Day 2009

Bakris¹,

Ritz²

2009

Clinical Journal of the American Society of Nephrology

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Prevalence and Correlates of Left Ventricular Hypertrophy in the African American Study of Kidney Disease Cohort Study

Cited by 46 publications

References 59 publications

Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies

Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies

Disparate Estimates of Hypertension Control From Ambulatory and Clinic Blood Pressure Measurements in Hypertensive Kidney Disease

The Message for World Kidney Day 2009

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