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Cardiac Function In Renovascular Hypertensive Patients With and Without Renal Dysfunction

BACKGROUND Hypertension impairs left ventricular (LV) diastolic and systolic function, which might be aggravated by inflammation or neurohumoral activation. We hypothesized that LV diastolic dysfunction is more common in patients with renovascular hypertension (RVHT) compared with essential hyperten... Full description

Journal Title: American journal of hypertension 2014, Vol.27 (3), p.445-453
Main Author: Khangura, Kirandeep K
Other Authors: Eirin, Alfonso , Kane, Garvan C , Misra, Sanjay , Textor, Stephen C , Lerman, Amir , Lerman, Lilach O
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: US: Oxford University Press
ID: ISSN: 0895-7061
Link: https://www.ncbi.nlm.nih.gov/pubmed/24162729
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recordid: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3935004
title: Cardiac Function In Renovascular Hypertensive Patients With and Without Renal Dysfunction
format: Article
creator:
  • Khangura, Kirandeep K
  • Eirin, Alfonso
  • Kane, Garvan C
  • Misra, Sanjay
  • Textor, Stephen C
  • Lerman, Amir
  • Lerman, Lilach O
subjects:
  • Aged
  • Biomarkers - blood
  • Blood pressure
  • Chi-Square Distribution
  • Comparative analysis
  • Complications and side effects
  • Confidence intervals
  • Creatinine - blood
  • Diastole
  • diastolic function
  • Essential hypertension
  • Female
  • Glomerular Filtration Rate
  • Health aspects
  • Humans
  • Hypertension
  • Hypertension - complications
  • Hypertension - diagnosis
  • Hypertension - mortality
  • Hypertension - physiopathology
  • Hypertension, Renovascular - complications
  • Hypertension, Renovascular - diagnosis
  • Hypertension, Renovascular - mortality
  • Hypertension, Renovascular - physiopathology
  • Hypertrophy, Left Ventricular - diagnostic imaging
  • Hypertrophy, Left Ventricular - etiology
  • Hypertrophy, Left Ventricular - mortality
  • Hypertrophy, Left Ventricular - physiopathology
  • Hypertrophy, Right Ventricular - diagnostic imaging
  • Hypertrophy, Right Ventricular - etiology
  • Hypertrophy, Right Ventricular - mortality
  • Hypertrophy, Right Ventricular - physiopathology
  • Kaplan-Meier Estimate
  • Kidney - physiopathology
  • Kidney diseases
  • Left ventricular function
  • left ventricular hypertrophy
  • Male
  • Medical research
  • Middle Aged
  • Minnesota - epidemiology
  • Multivariate Analysis
  • Original
  • Original Article
  • Prevalence
  • Renal hypertension
  • renovascular hypertension
  • Retrospective Studies
  • Risk Factors
  • Stroke Volume
  • Systole
  • Time Factors
  • Ultrasonography
  • Ventricular Dysfunction, Left - diagnostic imaging
  • Ventricular Dysfunction, Left - etiology
  • Ventricular Dysfunction, Left - mortality
  • Ventricular Dysfunction, Left - physiopathology
  • Ventricular Function, Left
  • Ventricular Remodeling
ispartof: American journal of hypertension, 2014, Vol.27 (3), p.445-453
description: BACKGROUND Hypertension impairs left ventricular (LV) diastolic and systolic function, which might be aggravated by inflammation or neurohumoral activation. We hypothesized that LV diastolic dysfunction is more common in patients with renovascular hypertension (RVHT) compared with essential hypertension (EHT). METHODS Hypertensive patients who underwent both renal imaging to exclude RVHT and cardiac echocardiography within a 3-year period were identified retrospectively. Patients with significant renovascular disease were included in the RVHT group (n = 75); those without significant renovascular disease were included in the EHT group (n = 69). Cardiac function and structure were compared. RESULTS Baseline renal function was preserved (serum creatinine ≤ 2mg/dl) in EHT patients and impaired (serum creatinine > 2mg/dl) in only 9 RVHT patients. RVHT patients had higher systolic blood pressure, E/e' ratio, and greater prevalence of concentric hypertrophy but lower estimated glomerular-filtration-rate (eGFR) compared with EHT patients. Increased prevalence of LV diastolic dysfunction remained statistically significant in patients with RVHT after multivariable adjustment for age, sex, blood pressure, eGFR, diabetes, smoking, and statin use, with a relative risk (95% CI) for abnormal E/e' of 1.70 (95% confidence interval = 1.05-2.90; P = 0.03) compared with EHT. RVHT patients with severe renal dysfunction showed greater impairments in cardiac systolic and diastolic function compared with those in EHT patients or preserved renal function RVHT patients. CONCLUSIONS Among hypertensive patients undergoing echocardiography, cardiac structure and diastolic function are impaired in RVHT patients compared with EHT patients and remain different after adjustment for multiple significant covariables. When associated with significant renal dysfunction, RVHT aggravates LV hypertrophy and both systolic and diastolic dysfunction. Hence, identification of RVHT and renal dysfunction warrants development of targeted management strategies.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0895-7061
fulltext: fulltext
issn:
  • 0895-7061
  • 1879-1905
url: Link


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titleCardiac Function In Renovascular Hypertensive Patients With and Without Renal Dysfunction
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creatorcontribKhangura, Kirandeep K ; Eirin, Alfonso ; Kane, Garvan C ; Misra, Sanjay ; Textor, Stephen C ; Lerman, Amir ; Lerman, Lilach O
descriptionBACKGROUND Hypertension impairs left ventricular (LV) diastolic and systolic function, which might be aggravated by inflammation or neurohumoral activation. We hypothesized that LV diastolic dysfunction is more common in patients with renovascular hypertension (RVHT) compared with essential hypertension (EHT). METHODS Hypertensive patients who underwent both renal imaging to exclude RVHT and cardiac echocardiography within a 3-year period were identified retrospectively. Patients with significant renovascular disease were included in the RVHT group (n = 75); those without significant renovascular disease were included in the EHT group (n = 69). Cardiac function and structure were compared. RESULTS Baseline renal function was preserved (serum creatinine ≤ 2mg/dl) in EHT patients and impaired (serum creatinine > 2mg/dl) in only 9 RVHT patients. RVHT patients had higher systolic blood pressure, E/e' ratio, and greater prevalence of concentric hypertrophy but lower estimated glomerular-filtration-rate (eGFR) compared with EHT patients. Increased prevalence of LV diastolic dysfunction remained statistically significant in patients with RVHT after multivariable adjustment for age, sex, blood pressure, eGFR, diabetes, smoking, and statin use, with a relative risk (95% CI) for abnormal E/e' of 1.70 (95% confidence interval = 1.05-2.90; P = 0.03) compared with EHT. RVHT patients with severe renal dysfunction showed greater impairments in cardiac systolic and diastolic function compared with those in EHT patients or preserved renal function RVHT patients. CONCLUSIONS Among hypertensive patients undergoing echocardiography, cardiac structure and diastolic function are impaired in RVHT patients compared with EHT patients and remain different after adjustment for multiple significant covariables. When associated with significant renal dysfunction, RVHT aggravates LV hypertrophy and both systolic and diastolic dysfunction. Hence, identification of RVHT and renal dysfunction warrants development of targeted management strategies.
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subjectAged ; Biomarkers - blood ; Blood pressure ; Chi-Square Distribution ; Comparative analysis ; Complications and side effects ; Confidence intervals ; Creatinine - blood ; Diastole ; diastolic function ; Essential hypertension ; Female ; Glomerular Filtration Rate ; Health aspects ; Humans ; Hypertension ; Hypertension - complications ; Hypertension - diagnosis ; Hypertension - mortality ; Hypertension - physiopathology ; Hypertension, Renovascular - complications ; Hypertension, Renovascular - diagnosis ; Hypertension, Renovascular - mortality ; Hypertension, Renovascular - physiopathology ; Hypertrophy, Left Ventricular - diagnostic imaging ; Hypertrophy, Left Ventricular - etiology ; Hypertrophy, Left Ventricular - mortality ; Hypertrophy, Left Ventricular - physiopathology ; Hypertrophy, Right Ventricular - diagnostic imaging ; Hypertrophy, Right Ventricular - etiology ; Hypertrophy, Right Ventricular - mortality ; Hypertrophy, Right Ventricular - physiopathology ; Kaplan-Meier Estimate ; Kidney - physiopathology ; Kidney diseases ; Left ventricular function ; left ventricular hypertrophy ; Male ; Medical research ; Middle Aged ; Minnesota - epidemiology ; Multivariate Analysis ; Original ; Original Article ; Prevalence ; Renal hypertension ; renovascular hypertension ; Retrospective Studies ; Risk Factors ; Stroke Volume ; Systole ; Time Factors ; Ultrasonography ; Ventricular Dysfunction, Left - diagnostic imaging ; Ventricular Dysfunction, Left - etiology ; Ventricular Dysfunction, Left - mortality ; Ventricular Dysfunction, Left - physiopathology ; Ventricular Function, Left ; Ventricular Remodeling
ispartofAmerican journal of hypertension, 2014, Vol.27 (3), p.445-453
rights
0American Journal of Hypertension, Ltd 2013. All rights reserved. For Permissions, please email: journals.permissions@oup.com 2013
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descriptionBACKGROUND Hypertension impairs left ventricular (LV) diastolic and systolic function, which might be aggravated by inflammation or neurohumoral activation. We hypothesized that LV diastolic dysfunction is more common in patients with renovascular hypertension (RVHT) compared with essential hypertension (EHT). METHODS Hypertensive patients who underwent both renal imaging to exclude RVHT and cardiac echocardiography within a 3-year period were identified retrospectively. Patients with significant renovascular disease were included in the RVHT group (n = 75); those without significant renovascular disease were included in the EHT group (n = 69). Cardiac function and structure were compared. RESULTS Baseline renal function was preserved (serum creatinine ≤ 2mg/dl) in EHT patients and impaired (serum creatinine > 2mg/dl) in only 9 RVHT patients. RVHT patients had higher systolic blood pressure, E/e' ratio, and greater prevalence of concentric hypertrophy but lower estimated glomerular-filtration-rate (eGFR) compared with EHT patients. Increased prevalence of LV diastolic dysfunction remained statistically significant in patients with RVHT after multivariable adjustment for age, sex, blood pressure, eGFR, diabetes, smoking, and statin use, with a relative risk (95% CI) for abnormal E/e' of 1.70 (95% confidence interval = 1.05-2.90; P = 0.03) compared with EHT. RVHT patients with severe renal dysfunction showed greater impairments in cardiac systolic and diastolic function compared with those in EHT patients or preserved renal function RVHT patients. CONCLUSIONS Among hypertensive patients undergoing echocardiography, cardiac structure and diastolic function are impaired in RVHT patients compared with EHT patients and remain different after adjustment for multiple significant covariables. When associated with significant renal dysfunction, RVHT aggravates LV hypertrophy and both systolic and diastolic dysfunction. Hence, identification of RVHT and renal dysfunction warrants development of targeted management strategies.
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1Biomarkers - blood
2Blood pressure
3Chi-Square Distribution
4Comparative analysis
5Complications and side effects
6Confidence intervals
7Creatinine - blood
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9diastolic function
10Essential hypertension
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12Glomerular Filtration Rate
13Health aspects
14Humans
15Hypertension
16Hypertension - complications
17Hypertension - diagnosis
18Hypertension - mortality
19Hypertension - physiopathology
20Hypertension, Renovascular - complications
21Hypertension, Renovascular - diagnosis
22Hypertension, Renovascular - mortality
23Hypertension, Renovascular - physiopathology
24Hypertrophy, Left Ventricular - diagnostic imaging
25Hypertrophy, Left Ventricular - etiology
26Hypertrophy, Left Ventricular - mortality
27Hypertrophy, Left Ventricular - physiopathology
28Hypertrophy, Right Ventricular - diagnostic imaging
29Hypertrophy, Right Ventricular - etiology
30Hypertrophy, Right Ventricular - mortality
31Hypertrophy, Right Ventricular - physiopathology
32Kaplan-Meier Estimate
33Kidney - physiopathology
34Kidney diseases
35Left ventricular function
36left ventricular hypertrophy
37Male
38Medical research
39Middle Aged
40Minnesota - epidemiology
41Multivariate Analysis
42Original
43Original Article
44Prevalence
45Renal hypertension
46renovascular hypertension
47Retrospective Studies
48Risk Factors
49Stroke Volume
50Systole
51Time Factors
52Ultrasonography
53Ventricular Dysfunction, Left - diagnostic imaging
54Ventricular Dysfunction, Left - etiology
55Ventricular Dysfunction, Left - mortality
56Ventricular Dysfunction, Left - physiopathology
57Ventricular Function, Left
58Ventricular Remodeling
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titleCardiac Function In Renovascular Hypertensive Patients With and Without Renal Dysfunction
authorKhangura, Kirandeep K ; Eirin, Alfonso ; Kane, Garvan C ; Misra, Sanjay ; Textor, Stephen C ; Lerman, Amir ; Lerman, Lilach O
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7Creatinine - blood
8Diastole
9diastolic function
10Essential hypertension
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12Glomerular Filtration Rate
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16Hypertension - complications
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18Hypertension - mortality
19Hypertension - physiopathology
20Hypertension, Renovascular - complications
21Hypertension, Renovascular - diagnosis
22Hypertension, Renovascular - mortality
23Hypertension, Renovascular - physiopathology
24Hypertrophy, Left Ventricular - diagnostic imaging
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26Hypertrophy, Left Ventricular - mortality
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45Renal hypertension
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47Retrospective Studies
48Risk Factors
49Stroke Volume
50Systole
51Time Factors
52Ultrasonography
53Ventricular Dysfunction, Left - diagnostic imaging
54Ventricular Dysfunction, Left - etiology
55Ventricular Dysfunction, Left - mortality
56Ventricular Dysfunction, Left - physiopathology
57Ventricular Function, Left
58Ventricular Remodeling
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abstractBACKGROUND Hypertension impairs left ventricular (LV) diastolic and systolic function, which might be aggravated by inflammation or neurohumoral activation. We hypothesized that LV diastolic dysfunction is more common in patients with renovascular hypertension (RVHT) compared with essential hypertension (EHT). METHODS Hypertensive patients who underwent both renal imaging to exclude RVHT and cardiac echocardiography within a 3-year period were identified retrospectively. Patients with significant renovascular disease were included in the RVHT group (n = 75); those without significant renovascular disease were included in the EHT group (n = 69). Cardiac function and structure were compared. RESULTS Baseline renal function was preserved (serum creatinine ≤ 2mg/dl) in EHT patients and impaired (serum creatinine > 2mg/dl) in only 9 RVHT patients. RVHT patients had higher systolic blood pressure, E/e' ratio, and greater prevalence of concentric hypertrophy but lower estimated glomerular-filtration-rate (eGFR) compared with EHT patients. Increased prevalence of LV diastolic dysfunction remained statistically significant in patients with RVHT after multivariable adjustment for age, sex, blood pressure, eGFR, diabetes, smoking, and statin use, with a relative risk (95% CI) for abnormal E/e' of 1.70 (95% confidence interval = 1.05-2.90; P = 0.03) compared with EHT. RVHT patients with severe renal dysfunction showed greater impairments in cardiac systolic and diastolic function compared with those in EHT patients or preserved renal function RVHT patients. CONCLUSIONS Among hypertensive patients undergoing echocardiography, cardiac structure and diastolic function are impaired in RVHT patients compared with EHT patients and remain different after adjustment for multiple significant covariables. When associated with significant renal dysfunction, RVHT aggravates LV hypertrophy and both systolic and diastolic dysfunction. Hence, identification of RVHT and renal dysfunction warrants development of targeted management strategies.
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