The relationship between renal impairment and left ventricular structure, function, and ventricular-arterial interaction in hypertension

Amil M. Shah*, Carolyn S P Lam, Susan Cheng, Anil Verma, Akshay S. Desai, Ricardo A. Rocha, Robert Hilkert, Joseph Izzo, Suzanne Oparil, Bertram Pitt, James D. Thomas, Michael R. Zile, Gerard P. Aurigemma, Scott D. Solomon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Objectives: Our objective was to define the relationship between renal dysfunction-both albuminuria and reduced estimated glomerular filtration rate (eGFR)-and cardiac structure and diastolic dysfunction among patients with chronic hypertension. Methods: Both albuminuria and eGFR were measured in 540 asymptomatic patients with hypertension and diastolic dysfunction assessed by reduced early mitral annular relaxation velocity (E′). The majority of patients were white, mean age was 60±10 years, mean SBP was 149±18 mmHg, and there was a low prevalence comorbid conditions. Albuminuria was undetectable in 148 (27%), within the normal to low range [urine albumin-to-creatinine ratio (UACR) 1-25mg/g for men, 1-17mg/g for women] in 292 (54%), and high or very high (UACR >25mg/g for men, >17mg/g for women) in 100 (19%). Estimated GFR was 60ml/min per 1.73m or less in 75 (14%), 61-90ml/min per 1.73m in 244 (45%), and more than 90ml/min per 1.73m in 221 (41%). Results: Albuminuria, even within the normal range, was associated with greater left ventricular wall thickness (P=0.01), higher relative wall thickness (P=0.004), worse diastolic function reflected in lower E′ (P=0.01), greater arterial and left ventricular end-systolic stiffness (P<0.0001 and P=0.003, respectively), and higher N-terminal pro-brain natriuretic peptide (NT-proBNP) level (P=0.0025), even after adjustment for differences in baseline characteristics. In contrast, no independent relationship was observed between eGFR and parameters of cardiac structure or function. Conclusion:: Among asymptomatic hypertensive patients with evidence of diastolic dysfunction, the presence of albuminuria, even within the normal range, is associated with greater concentric remodeling, greater left ventricular end-systolic stiffness, and worse diastolic function.

Original languageEnglish (US)
Pages (from-to)1829-1836
Number of pages8
JournalJournal of hypertension
Issue number9
StatePublished - Sep 2011


  • albuminuria
  • echocardiography
  • glomerular filtration rate
  • hypertension

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine


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