Reduction of left ventricular mass index with blood pressure reduction in chronic renal failure

Aim: We have reported previously in a study of 85 non-diabetic patients wit h chronic renal failure (CRF) that 24-h ambulatory blood pressure (ABP) rec ording and echocardiography are required for accurate diagnosis of inadequa te blood pressure (BP) control and early left ventricular hypertrophy (LVH) . In this study we found that the only independent determinants of left ven tricular (LV) mass were hypertension, male sex, body mass index (BMI) and a nemia. Little is known about the progression of LVH in patients as they pro gress from moderate to end-stage renal failure. Patients and methods: We un dertook a follow-up observational study in a cohort of 65 (26 male, 12 blac k Afro-Caribbean and 7 Asian) of those patients originally investigated. Pa tients who had reached end-stage renal failure (ESRF) were not studied. Res ults: A statistically significant correlation was found between change in l eft ventricular mass index (LVMI) and change in mean ABP parameters (r = 0. 27 (p < 0.03) for 24-h systolic, r = 0.21 (p < 0.05) for 24-h diastolic. r = 0.29 (p < 0.02) for mean arterial pressure (MAP), r = 0.24 (p < 0.05) for daytime systolic, r = 0.30 (p < 0.02) for nocturnal systolic and r = 0.26 (p < 0.05) for nocturnal diastolic BP). Hemoglobin concentration and BMI ch anged little between the two studies and no other statistically significant correlations were found in respect of any other parameters studied, which has allowed us to isolate the effect of one determinant - adequacy of BP co ntrol - upon LVH. Conclusion: In patients with moderade chronic renal impai rment, reduction in BP is associated with reduction of LVMI over time. Amon g the antihypertensive agents ACE inhibitors appeared to have the greatest ability to reduce LV mass in the subjects with LVH at baseline. Larger inte rventional studies are needed to determine whether ACE inhibitors are super ior to other anti-hypertensive agents in LVH regression in chronic renal fa ilure patients.