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Left ventricular hypertrophy and geometry in hypertensive patients with chronic kidney disease

Nardi, Emilio; Palermo, Alessandro; Mulè, Giuseppe; Cusimano, Paola; Cottone, Santina; Cerasola, Giovanni

doi: 10.1097/HJH.0b013e3283220ecd
Original papers: Heart

Objective To evaluate the prevalence of left ventricular hypertrophy (LVH) and left ventricular geometry in a group of 293 hypertensive patients with stage 2–5 chronic kidney disease (CKD), compared with 289 essential hypertensive patients with normal renal function.

Methods All patients underwent echocardiographic examination. Patients on stage 1 CKD, dialysis treatment, or with cardiovascular diseases were excluded.

Results LVH was observed in 47.1% of patients with CKD and in 31.14% of essential hypertensive patients (P < 0.0001). We found increasingly higher left ventricular diameters, thicknesses, and mass from stage 2 to 5 CKD. Distribution of concentric and eccentric LVH was not different between the two groups. However, after introducing mixed hypertrophy, the difference between the two groups group was disclosed (P = 0.027). The prevalence of inappropriate left ventricular mass was 52.6% in patients with CKD vs. 30.5% in essential hypertensive patients (P < 0.0001). Multiple regression analysis confirmed that the association between renal function and left ventricular mass (β −0.287; P < 0.0001) was independent by potential confounders. From stage 4 to 5, the significant increase of left ventricular mass was due to growth in posterior wall thickness rather than end-diastolic diameter. Diastolic function was significantly worse in patients with CKD, especially in more advanced stages.

Conclusion Our study confirms that LVH is highly prevalent in patients with CKD; in this population, LVH is often inappropriate and characterized by the simultaneous increase of wall thicknesses and diameters.

Dipartimento di Medicina Interna, Malattie Cardiovascolari e NefroUrologiche, Cattedra di Medicina Interna and Hypertension Excellence Centre of the European Society of Hypertension, Università degli Studi di Palermo, Palermo, Italy

Received 30 July, 2008

Revised 31 October, 2008

Accepted 13 November, 2008

Correspondence to Dr Emilio Nardi, MD, Via Alcide De Gasperi 30, 90146 Palermo, Italy Tel: +39 0916554345; fax: +39 0916554331; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.