P22 The Role of Renal Dysfunction on Target Organ Damage and Cardiovascular Risk in Hypertensives

Abstract

Purpose/Background/Objective

Hypertension is associated with increased left ventricular (LV) hypertrophy, aortic stiffness and renal dysfunction, which are all predictors of cardiovascular risk. We investigated the effect of renal dysfunction on LV mass and aortic stiffness in hypertensives.

Methods

We enrolled 1223 consecutive hypertensives (mean age 53.0 ± 11.6 years, 726 males). We estimated the glomerular filtration ratio (GFR) using the MDRD formula. We classified our population as hypertensives with moderate to severe renal dysfunction (GFR ≥ 60 ml/min/1.73 m², n = 1091). LV mass index (LVMI) was assessed echocardiographically and calculated using the Devereux formula. Aortic stiffness and wave reflections were assessed with pulse wave velocity (PWV) and augmentation index (AIx), respectively. Ten-year cardiovascular risk was estimated with Framingham Risk score.

Results

After adjustment for age, gender, mean blood pressure, body-mass index, diabetes mellitus, low-density lipoprotein and C-reactive protein hypertensives with GFR < 60 ml/min/1.73 m² compared to hypertensives with GFR ≥ 60 ml/min/1.73 m² had higher PWV levels (8.86 m/s vs. 7.92 m/s, p = 0.014), higher LVMI (119.5 g/m² vs. 114.9 g/m², p = 0.012) and higher AIx (31.1% vs. 27.4%, p = 0.05). On the contrary, hypertensives with GFR ≥ 60 ml/min/1.73 m² had similar 10-year cardiovascular risk compared to hypertensives with GFR ≥ 60 ml/min/1.73 m² (17.3% vs. 13.0%, p = 0.323).

Conclusions

Renal dysfunction is associated with LVMI and aortic stiffness. Hypertensives with moderate to severe renal dysfunction despite having similar 10-year cardiovascular risk with hypertensives with normal renal function or mild renal dysfunction, demonstrate higher aortic stiffness and LV mass, implying a possible underestimation of risk by Framingham.