OPPOSITE ASSOCIATIONS OF CIRCULATING ALDOSTERONE AND ATRIAL-NATRIURETIC-PEPTIDE WITH LEFT-VENTRICULAR DIASTOLIC FUNCTION IN ESSENTIAL-HYPERTENSION

It has been shown in animal experiments that angiotensin II and aldost erone have mitogenic effects on the cardiovascular system, whereas atr ial natriuretic peptide has antimitogenic properties. The aim of the p resent study was to relate plasma renin activity, angiotensin II, aldo sterone and atrial natriuretic peptide to left ventricular structure a nd function, assessed by use of imaging echocardiography and transmitr al Doppler velocimetry in 73 patients with essential hypertension, Wor ld Health Organization stages I-II, aged 43 +/- 10(s.d.) years. Left v entricular mass, wall thickness and internal diameter were not indepen dently related to the biochemical variables, except for a weak and pos itive association of wall thickness with plasma aldosterone (P = 0.06) . However, left ventricular early inflow peak velocity and deceleratio n were independently and inversely related to age (P < 0.001) and to p lasma aldosterone (P < 0.01), and positively to plasma atrial natriure tic peptide (P < 0.05). Peak flow velocity during atrial contraction w as positively related to plasma atrial natriuretic peptide both before (P < 0.001) and after (P < 0.05) controlling for significant covariat es (age, sex and blood pressure). We conclude that circulating renin, angiotensin II, aldosterone and atrial natriuretic peptide are not ind ependently related to left ventricular mass in essential hypertension. The inverse association of plasma aldosterone with indices of diastol ic function is compatible with a stimulating effect of aldosterone on myocardial fibrosis, which is opposed by atrial natriuretic peptide. T he apparently conflicting positive association of this peptide with at rial peak velocity is most likely due to stimulation of its secretion by atrial involvement.