LEFT-VENTRICULAR HYPERTROPHY AND AMBULATORY BLOOD-PRESSURE MONITORINGIN CHRONIC-RENAL-FAILURE

Background, Left ventricular hypertrophy (LVH) is both common and an i mportant predictor of risk of death in end-stage renal failure (ESRF). In mild to moderate chronic renal failure (CRF), the timing of onset of LVH and the factors involved in its initial development have not be en fully elucidated. The present study was undertaken to er;amine the prevalence and potential determinants of echocardiographically determi ned LVH in this connection, and to compare 24-h ambulatory blood press ure (BP) recordings with BP measured at a previous clinic visit. Metho ds. From a cohort of 120 non-diabetic patients who had been attending a nephrology clinic, 118 agreed to participate in the study. Of these we selected for analysis 85 stable patients (37 male). Patients with. known cardiovascular disease, those with a history of poor compliance with antihypertensive medication, and those in whom such medication ha d been changed in the previous 3 months were excluded. Clinic BP, 24-h ambulatory BP, echocardiography, body mass index (BMI), serum creatin ine (SCr), creatinine clearance (CrCl), haemoglobin (Hb), fasting chol esterol (CHOL), triglyceride TRIGL), plasma glucose, calcium (Ca), pho sphate (PO4), alkaline phosphatase (ALK PHOS), parathyroid hormone (PT H) concentrations, and 24-h urinary protein were assessed in all patie nts. Seventy-seven per cent were on antihypertensive medication. Resul ts. LVH was detected in 16% of patients with CrCL >30 ml/min, and 35% of patients with CrCl <30 ml/min. By stepwise regression analysis, amb ulatory systolic BP (P < 0.0001), male gender (P < 0.0001), BMI (P < 0 .0002), and Hb concentration (P < 0.002) were the only independent det erminants of left ventricular (LV) mass. Nocturnal systolic BP (P < 0. 02) was the main determinant of LVH in the group of patients with adva nced CRF. The correlation between left ventricular mass index (LVMI) a nd mean 24-h ambulatory systolic BP (r = 0.52, 95% confidence interval 0.50-0.54) mras statistically significantly stronger. than with outpa tient systolic BP (r = 0.25, 95% confidence interval 0.23-0.27). The s ame was true for the correlation between LVMI and mean 24-h ambulatory diastolic BP (r = 0.42, 95% confidence interval 0.40-0.44), and outpa tient diastolic BP (r = 0.22, 95% confidence interval 0.20-0.24). Conc lusions. Twenty-four hour ambulatory BP recording and echocardiography are required for accurate diagnosis of inadequate BP control and earl y LVH in patients with chronic renal impairment, independent determina nts of which are hypertension, male sex, BMI, and anaemia.